Chap 11, 18, 19, and 20 Flashcards
(131 cards)
1
Q
The growth and development of the lungs is essentially complete by about what age
A
20 years of age
2
Q
Most of the pulmonary function indices reach their maximum levels between
A
20 and 25 years of age and then progressively decline
3
Q
Functional residual capacity
A
is the volume remaining in the lungs when the elastic recoil of the lungs exactly balances the natural tendency of the chest wall to expand
4
Q
What decreases with aging causing what to increase
A
The elastic recoil of the lungs, causing the compliance to increase. Illustrated as a shift to the left of the volume pressure curve
5
Q
The decrease in lung elasticity develops because what
A
the alveoli progressively deteriorate and enlarge
6
Q
What age do the alveoli progressively deterioate and enlarge at
A
after age 30
7
Q
Senile emphysema or senile hyperinflation of the lungs
A
Structurally, the alveolar changes resemple the air sav changes associated with emphysema
8
Q
What happens to the costal cartilages with aging
A
progressively calcify, causing the ribs to slant downward, and this structural change causes the thorax to become less compliant, causing the transpulmonary pressure difference
9
Q
Transpulmonary pressure difference is responsible for
A
holding the airway open- diminished with age
10
Q
which is greater the reduction in chest wall compliance or the increase in lung compliance
A
Reduction in chest wall compliance is slightly greater than the increase inlung compliance, resulting in an overall moderate decline in total compliance of the respiratory system
11
Q
Work expendicture of a 60 yr old to overcome static mechanical forces during normal breathing is how much greater than in a 20 year old
A
20 percent greater
12
Q
What essentially remains the same throughout the life retaining to the lungs
A
Total lung capacity (TLC), if it shall decrease it is prob due to the decreased height that typically occurs with age
13
Q
Residual volume with age
A
increases, due to age related alveolar enlargement and to small airway closure
14
Q
as the RV increases, what also increases
A
RV/ TLC ratio
15
Q
RV/TLC ratio increases from approx what at age 20 to what at age 60
A
20 percent at age 20, to 35% at age 60, increase occurs predominantly at after age 40
16
Q
What decreases as the RV increases
A
Expiratory reserve volume (ERV). FRC increases with age as well, just not as much as RV and RV/TLC
17
Q
Because the FRC typically increases with age, the what decreases
A
Inspiratory capacity (IC)
18
Q
Vital capacity is equal to what
A
TLC minus the RV
19
Q
VC inevitably decreases as the what increases
A
RV
20
Q
In men the VC decreases how much per year
A
25mL, and 20mL/year in women.
21
Q
In general, the VC decreases about what percent by age 70
A
40-50 percent
22
Q
one of the most prominent physiologic changes associated with age is
A
the reduced efficiency in forced air expulsion
23
Q
Estimated that these dynamic lung functions decrease approx
A
20-30 percent throughout the average adults life
24
Q
FEV in men/ women and age
A
decreases about 30 mL/ year in men, and about 20mL/ year in women after about age 20. Debatable why
25
Pulmonary Diffusion Capacity
Progressively decreases after about 20 years of age. About 20% over the course of an adult life. (2ml/min/mm Hg in men and 1.5mL/min/mm Hg in women)
26
Decline results from pulmonary diffusion capacity
from decreased alveolar surface area caused by alveolar destruction, increased alveolar wall thickness, and decreased pulmonary capillary blood flow, all of which are known to occur with aging
27
Alveolar Dead Space Ventilation
increases with advancing age. due to decreased cardiac index associated with aging and the structural alterations of the pulmonary capilaries that occur as a result of normal alveolar deterioration
28
Natural loss of lung elasticity results in
an increase in lung compliance, which in turn leads to an increase in dead space ventilation. Estimated that the alveolar dead space vent increases about 1mL/ year throughout adult life
29
Pulmonary Gas Exchange
The alveolar arterial oxygen tension difference P(A-a)O2 prog increases with age. Factors include Physiologic shunt, the mismatching of ventilation and perfusion, and a decreased diffusion capacity
30
In normal adult,the PaO2
should be greater than 90 torr up to 45 years of age
31
after 45 years of age the PaO2
generally declines between age 45 and 75, then often increases slightly and levels off
32
Minimum low PaO2 should be
greater than 75 torr- regardless of age
33
PaCO2
remains constant throughout life- greater diffusion ability of CO2 through the alveolar-capillary barrier. Then the pH and HCO3 remains constant as well
34
Maximum arterial venous oxygen content difference C(a-V)O2 / factors
tends to decrease with age. Contributory factors include 1. Decline in physical fitness 2. less efficient peripheral blood distribution and 3. reduction in tissue enzyme activity
35
Anemia
common finding in the elderly. red bone marrow has a tendency to be replaced by fatty marrow, especially in the long bones.
36
Gastrointestinal atrophy
commonly associated with advancing age may slow the absorption of iron or vitamin B. bleeding is also more prevelant in the elderly
37
Control of ventilation with age
Ventilatory rate and heart rate responses to hypoxia and hypercapnia diminish with age. Due to a reduced sensitivity and responsivenessof the peripheral and central chemoreceptors and the slowing of central nervous system pathways with age
38
Neural output
slowed with age to respiratory muscles and the lower chest wall and reduces lung mechanical efficiency
39
Ventilatory response to hypoxia is decreased
more than 50% in the healthy male over 65 years of age
40
The ventilatory response to hypercapnia
is decreased by more than 40%
41
Defense mechanisms
Rate of Mucocilliary transport system declines with age.. decreased cough reflex is more than 70 % of the elderly population
42
Example of defense mechanisms disease
Dysphagia (impaired esophageal motility) increases the risk for aspiration and pneumonia
43
What limits exercise in elderly
Oxygen transport system is critically dependent on the cardiovascular system than on respiratory function
44
The maximum O2 uptake peaks at
age 20 and progressively and linearly decreases with age
45
Major causes of death in the aging population are
diseases of the cardiovascular system
46
between 30 and 80 years of age, the thickness of the left ventricular wall increases by about what
25 percent
47
Heart with age
Fibrosis, CT increases, less elastic, compliance of heart is reduced, pumps less efficiency, heart valves thicken
48
Maximum heart rate equation
Max heart rate= 220 - age
49
Stroke volume
diminishes with age
50
Cardiac Output
As stroke volume diminishes, the cardiac output inevitable declines (CO= SV x HR)
51
As the cardiac output declines what also decreases
Cardiac index
52
As an individual ages the
a. Residual volume decreases
b. Exp Reserve volume increases
c. fuctional residual capacity decreases
d. vital capacity decreases
D. Vital Capacity Decreases
53
Most of the lung fuction indices reach their maximum levels between
20-25 years of age
54
With advancing age, the
1. Lung Compliance decreases
2. chest wall compliance increases
3. lung compliance increases
4. Chest wall compliance decreases
3. lung compliance increases and 4. chest wall compliance decreases
55
As an individual ages the
1. forced vital capacity increases
2. peak expiratory flow rate decreases
3. forced expiratory volume in 1 sec increases
4. maximum voluntary ventilation increases
2. Peak expiratory flow rate decreases
56
With advancing age, the
PaO2 decreases, C(a-V)O2 decreases
57
Maximum HR of a 45 year old is
175 beats/min
58
Over the course of life, the diffusion capacity decreases by about
20 percent
59
Between 30 and 80 years of age, the cardiac output decreases by about
40 percent
60
With advancing age the
1. BP increases
2. SV decreases
3. CO increases
4. Heart work decreases
BP increases, SV decreases, Heart work decreases
61
Between 20 and 60 years of age, the RV/TLC
increases from 20 to 35 percent
62
During Exercise
Ventilation may increase as much as 20-fold, oxygen diffusion capacity as much as 3- fold, CO as much as 6-fold, muscle blood flow as much as 25- fold, O2 consumption as much as 20 fold and heat prod as much as 20 fold
63
Muscle training can increase muscle size and stregnth
30-60 %
64
Athletes heart chambers and mass
increased by 40%
65
Anaerobic threshold
point at which anaerobic metabolism develops
66
During normal quiet breathing, an adult exchanges about how many L of gas per minute
6
67
During strenuous exercise adult exchanges about how much gas per minute
Can increase to 120 L/min
68
Why must alveolar ventilation increase
1. supply sufficient O2 to the blood 2. eliminate the excess CO2 prod by the skeletal muscles
69
During very heavy exercise Vt and RR
Vt 60% of the vital capacity, and RR may be as high as 30 bpm
70
Three distinct consecutive breathing patters are seen during mild and moderate exercise.
First stage, second stage, and third stage
71
first stage
characterized by an increase in alveolar ventilation within seconds after the onset of exercise
72
Second stage
slow, gradual further increase in alveolar vent developing during approx the first 3 min of exercise
73
Third stage
final stage, alveolar ventilation stabilizes
74
Normal Oxygen consumption at rest ml
250 mL/min, the skeletal muscles account for approx 35-40 %
75
Oxygen consumption during exercise ml
3500 ml/min
76
Mean alveolar - arterial oxygen tension difference of about 10 torr because of
1. mismatching of ventilation and perfusion and 2. right to left pulmonary shunting of blood
77
During exercise three essential physiologic responses must occur in order for the circulatory system to supply the working muscles with good amount of blood
1. sympathetic discharge 2. increase in CO 3. increase in arterial blood pressure
78
Increase O2 demands during exercise are met almost entirely by what
an increased CO
79
The increased CO during exercise results from
1. increased SV 2. increased HR 3. combination of both
80
Greater the vasodilation in the working muscles
the greater the stroke volume and cardiac output (sympathetic discharge)
81
Increased sympathetic stimulation causes
1. increased HR 2. increased strength of contraction
82
There is an increase in arterial blood pressure during exercise because of
1. Sympathetic discharge 2. increased CO 3. Vasoconstriction of the blood vessels in the nonworking muscle areas
83
at rest how much of the muscle capillaries are dilated
approx 20-25 %
84
Heat stroke
As much as 5 to 10 pounds of body fluid lost in 1 hour.
85
During strenuous exercise, an adults alveolar ventilation can increase
20 fold
86
The maximum alveolar ventilation generated during heavy exercise under normal conditions is about what percent of the max voluntary ventilation
50-65 %
87
During heavy exercise, the total cardiac output may increase as much as
8 fold
88
At the onset of exercise sympathetic discharge causes the
Peripheral vascular system to constrict, heart to increase its stregnth of contraction, blood vessels of the working muscles to dilate
89
During exercise, the SV reaches its peak when the CO is at about what percent of its maximum
50%
90
During exercise, heat production may increase as much as
20 fold
91
During exercise the oxygen consumption of the skeletal muscles may account for more than
95% of the total VO2
92
During very heavy exercise, the
PaCO2 decreases, PaO2 remains constant, and pH decreases
93
during maximum exercise, the O2 diffusion capacity may increase as much as
3 fold
94
During exercise the P(A-a)O2 begins to increase when the oxygen consumption reaches about what percent of its max
40 %
95
Peripheral chemoreceptors
when PaO2 falls low enough (to about 60torr) to stimulate the carotid and aortic bodies, kown as peripheral chemoreceptors. Which transmit signals to the medulla to increase ventilation
96
Hypoxic Ventilator response
when the medulla is signaled to increase ventilation
97
The barometric pressure is about half the sea level value of 760 torr at an altitude of
18,000 -19,000 ft
98
The O2 diffusion capacity of high altitude natives is about
20-25 percent greater than predicted
99
Acute mountain sickness is characterized by
sleep disorders, headache, dizziness, palpitation, loss of appetite
100
The symptoms of acute mountain sickness are generally most severe on the
second or third day after ascent
101
When an individual is subjected to a high altitude for a prolonged period of time which of the following is seen
An increased RBC production, A decreased PaCO2, an Increased P(A-a)O2
102
At high altitude the overal ventilation perfusion ratio improves T/F
true
103
In individuals who have acclimatized to a high altitude, an increased CO is seen T/F
false
104
Theres a linear relationship between the degree of ascent and the degree of pulmonary vasoconstriction and hypertension T/F
True
105
Natives who have been at high altitudes for generations commonly demonstrate a mild resp alk
True
106
The concentration of myoglobin in skeletal muscles is decreased in high altitude natives
False
107
At what depth below the water surface does the pressure increase to 3.0 atm
99 ft
108
If an indiv fully inhales to a TLC of 4.5 L at sea level (760 mmHg) and dives to a depth of 66 feet, the lungs will be compressed to about
1.5 L
109
Diving reflex consists of
Decreased CO, bradycardia, peripheral vasoconstriction
110
The half life of Carboxyhemoglobin when a victim is breathing RA at 1atm is approx
5 hours
111
Hyperventilation prior to a breath hold dive can be dangerous T/F
true
112
the fall in PAO2 as a diver returns to the surface is known as the hypoxia of ascent T/F
true
113
chest pain and coughing caused by decompression sickness is known as the bends T/F
false
114
the so called PCO2 resp drive breaking poing during a dive is about 55 torr T/F
true
115
approx 0.3 mL of O2 is physically dissolved in each 100 ml of blood for every PaO2 increase of 100 torr T/F
truee
116
Circulation during exercise
blood flow to the muscles increase, length and intensity of exercsie is limited , at the onset of exercise there is a sympathetic discharge, increase HR and strength of contraction, peripheral blood vessels contrict except for the muscles that are working which dilate
117
Increase in CO demands met entirely by
Blood pressure
118
Pulmonary vascular resistance goes down
dilates vascular bed and improves blood flow
119
Systemic vascular resistance goes down
peripheral constriction is less than the dilation of the muscles so the net is a decrease in SVR
120
Pulmonary rehab
works with patients to improve cardovascular exercise tolerance (phase 1: info gather, 2: Educate and exercise 3: output pt)
121
Chronic oxygen deprivation from high altitude is similar to
chronic hypoxemia from lung disease
122
barometric pressure goes which way as you go up
goes down as you go up
123
if you go from one level to another you
acclimate
124
acute mnt sickness starts after
6-12 hours, lasts 2-3 days, usually acclimated by 4th day
125
Example of high altitude pulmonary edema
CHF
126
Increase altitude=
Polycythemia, larger lung volumes or capacities
127
low oxygen=
hypoxic environment
128
if you hit anaerobic threshold
the minute ventilation climes more due to lactic acid which can be counteracted by a decrease in PaCO2
129
Lactic acid causes an increase in
pH and PaCO2
130
high altitude pulmonary edema
tachypnea, tachycardia, crackles in lung base (fluid). Pink frothy sputum, from increased PVR due to hypoxia and or increased permeability of membranes
131
Increased CO due to low oxygen
Increased PVR due to low oxygen causing vasocontriction of pulmonary vessels
