Lecture 12 (Exam II)

Question 1

What 3 lung volumes and capacities can we find from advanced spirometry that we cannot from basic spirometry?

Answer 1

• RV
• FRC
• TLC

Question 2

What is used as the indicator gas in advanced spirometry?

Answer 2

Helium

Question 3

What specifically does advanced spirometry measure?

Answer 3

It specifically measures FRC, and then you can use the FRC to find RV and TLC

Question 4

What 4 things do you need to perform advanced spirometry?

Answer 4

• An inert gas such as helium
• a helium meter
• a source of oxygen
• a CO2 absorber

Question 5

Why do we use an inert gas for advanced spirometry?

Answer 5

Because the inert gas won’t skew or affect the other gases of the lungs.

Question 5

Describe how advanced spirometry works

Answer 5

• Start off with a known concentration of the helium indicator gas
• Hook the patient up to the advanced spirometry circuit
• Have the patient breathe normally for a few minutes so the helium can make its way into the lungs.
• Then measure the amount of helium coming out of the lungs. It should be reduced from the original volume since it has been diluted with lung air.
• The amount of helium coming out of the lungs correlates with how much was in the lungs at the start.

Question 5

Which column on the period table represents the noble/inert gases?

Answer 5

The far right column

Question 6

What other inert gases can be used for lung diagnostic testing?

Answer 6

• Neon (expensive)
• Argon (rare and expensive)
• Xenon
• Radon

Question 7

Where is the random place that Schmidt said radon can be found?

Answer 7

In people’s basements in houses up north

Question 8

Why are all noble gases inert gases?

Answer 8

because they are chemically stable with full valence electron outer shells

Question 8

What is the second leading cause of lung cancer behind smoking?

Answer 8

radon

Question 9

• On the pulmonary compliance curve, do obstructive diseases have a steep or shallow curve?
• What does this mean?
• What is an example of an obstructive lung disease?

Answer 9

• Steep
• The lungs are more compliant
• emphysema

Question 10

• On the pulmonary compliance curve, do restrictive diseases have a steep or shallow curve?
• What does this mean?
• What is an example of a resrictive lung disease?

Answer 10

• Shallow
• The lung is less compliant
• Pulmonary fibrosis

Question 11

In emphysema, there is a ___ resistance to fill the alveoli up with air because the alveoli are more ___.

Answer 11

• low resistance
• more stretchy

Question 12

What happens when we have fibrosis of the lungs?

Answer 12

Scar tissue is laid down on the inside of the alveoli and small airways, making it much harder to get air into the lungs.
The more scar tissue that is laid down in the lungs, the harder it is to expand them and fill them with air.

Question 13

True or false:
Restrictive lung diseases reduce all volumes and capacities

Answer 13

true

Question 14

Is the lung more compliant on a large inspiratory or large expiratory maneuver?

Answer 14

A large expiratory maneuver

Question 15

What is the air-water interface

Answer 15

a place on the inside of all our alveoli where a very thin layer of water meets gas/air.

Question 16

What is surface tension?

Answer 16

The tendency of water to want to stick together

Question 17

What is a large contributor to the overall compliance of our lungs?

Answer 17

Surface tension

Question 18

Airflow is turbulent in ___ airways and ___ in small airways

Answer 18

• Turbulent
• Laminar

Question 19

What does having a low amount of surface tension do in our lungs?

Answer 19

* Makes the lungs more compliant * Makes the lungs easier to fill with air

Question 20

How does the body control how much surface tension we have in the lungs?

Answer 20

With surfactant

Question 21

What does surfactant do in the lungs?

Answer 21

It breaks surface tension by getting in between water molecules and prevents them from sticking together.

Question 22

Having a high amount of surfactant means we have ___ surface tension, and ___ compliant lungs.

Answer 22

* less surface tension * more compliant

Question 23

Having a low amount of surfactant means we have ___ surface tension and ___compliant lungs

Answer 23

* More surface tension * Less compliant

Question 24

What are the 2 main components of surfactant?

Answer 24

* Lipids (90%) * Proteins (10%)

Question 25

What is the purpose of lipids in surfactant?

Answer 25

* Creates lower surface tension * Changes the proliferation and cytotoxicity of lymphocytes

Question 26

* What are the 2 largest surfactant lipids? * What are their characteristics?

Answer 26

* Dipalmitoylphosphatidylcholine * Unsaturated phosphatidylcholine * These phospholipids have a long fatty acid tail with a charge head. * The are amphipathic which means they have portions that are water soluble and portions that are lipid soluble.

Question 27

What is the purpose of proteins in surfactant?

Answer 27

* They enhance chemotacis and phagocytosis * They inhibit the growth of pathogens

Question 28

What are the 4 surfactant proteins?

Answer 28

* SP-A and SP-D are hydropfilic * SP-B and SP-C are hydrophobic

Question 29

What happens to the surfactant if we have an area of the lung that collapses?

Answer 29

* Since no ventilation is coming to this area, and the alveoli aren't filling up with air, there is nothing to knock the alveoli off the tubular myelin so it becomes active. * Eventually the surfactant in this area of un-ventilated lung will run out and we will have an increase in surface tension.

Question 30

What are examples of restrictive lung diseases?

Answer 30

* Fibrosis * interstital lung disease * ARDS * tubercolosis

Question 31

What are examples of obstructive lung diseases?

Answer 31

* COPD * Emphysema * Asthma * Chronic bronchitis

Question 32

At higher lung volumes, airway resistance will be ___

Answer 32

low

Question 33

At lower lung volumes, airway resistance will be ___

Answer 33

high

Question 34

What are things that increase airway resistance? (long list)

Answer 34

* Parasympathetic nerve stimulation * Bronchoconstriction * Low lung volumes * forced expirations * breathing through your nose versus your mouth * increased mucous production * Airway inflammation * loss of lung elasticity * asthma * Smoking * cystic fibrosis * pulmonary edema * airway obstruction * airway collapse * ETT * cold, dry air * Allergens and irritants

Question 35

With increased airway resistance, you will have ___ airflow and ___ RR

Answer 35

* turbulent * increased RR

Question 36

What are things that decrease airway resistance? (long list)

Answer 36

* Stimulation of sympathetic nervous system * Bronchodilation * reduced airway mucous production * decreased airway inflammation * increased lung elasticity * bronchodilators (beta-2agonists) * anticholinergics * corticosteroids * warm humidified air

Question 37

An increase in the parasympathetic nervous system will ___ airway resistance and ___ PVR

Answer 37

* increase airway resistance by constricting airways * decreases PVR by relaxing vessels

Question 38

An increase in sympathetic stimulation will ___ airway resistance and ___ PVR

Answer 38

* Decrease airway resistance by relaxing airways * Increase PVR by constricting vessels.

Question 39

What are the main changes in the lungs we see with aging due to loss of elastic recoil?

Answer 39

* A slight increase in chest wall recoil * Increased RV * Increased FRC