Pulmonary Anatomy and Physiology Review

Question 1

Ventilation: What is it

Answer 1

breathing, mechanical process that moves air into and out of lungs

Question 2

Gas Exchange: What is it?

Answer 2

exchange b/w blood and alveoli
exchange b/w blood and tissues

Question 3

Gas delivery to tissue is simply called __ flow.

Answer 3

blood

Question 4

____use oxygen to make ATP (cellular respiration).

Answer 4

tissues

Question 5

Gases return from ___ to the ___. Then exhalation occurs.

Answer 5

tissues to lungs

Question 6

External Respiration?

Answer 6

ventilation and gas exchange in lungs

Question 7

Internal Respiration?

Answer 7

oxygen utilization and gas exchange in tissues

Question 8

What can limit diaphragm displacement (4)?
SOAP pneumonic

Answer 8

Size of various GI organs, (esp. liver that lays inf. to diaphragm)
Obesity
Ascites
Pregnancy

Question 9

T/F: Pts will have a greater excursion in the upright position than lying in supine due to the level of the diaphragm is rising.

Answer 9

False, we’re talking supine here.

Question 10

The resting position of the diaphragm is determined by what?

Answer 10

body position

Question 11

Upper resp. tract consist of … (4)

Answer 11

Frontal Sinus
Nasal Conchae
Nose
Larynx

Question 12

Nose functions to conduct, __, & __ air. Then air goes into ___ which extends from base of skull to esophagus.

Answer 12

1&2) filtrate & humidify
3) pharynx

Question 13

1) What part of the pharynx serves as a passageway for food to the esophagus AND for air moving to/from the nasal cavity?
2) What about from the epiglottis to the esophagus at the level of C6?

Answer 13

1) Oropharynx
2) Laryngopharynx

Question 14

The central tendon/insertion of the diaphragm is a thin but strong __, located near the __ of the diaphragm but more anterior than posterior.

Answer 14

1) aponeurosis
2) center
also know your diaphragm is separated into R/L hemidiaphragms

Question 15

The diaphragm __ when we inhale and __ when we exhale. Displacement of the diaphragm during quiet breathing is __ of an in. and max excursion is __ inch(es).

Answer 15

1) contracts/flatten
2) relaxes/makes dome shape
3) 2/3s of an in.
4) 2.5-4 inches

Question 16

In supine the lung volumes are __ b/c abd. organs are elevated. Whereas lung volumes are __ in the upright position b/c of gravity.

Answer 16

1) low + greater excursion during breathing
2) high + less excursion during breathing

Question 17

In SL, hemidiaphragms are unequal. The uppermost side drops to a lower position leading to __ lung volume & __ excursion than in sitting position. The lower side rises higher than the thorax leading to __ lung volume & __ excursion than in sitting position.

Answer 17

1&2) higher lung volume & less excursion
3&4) lower lung volume & more excursion

Question 18

The external intercoastal is a muscle of __. Muscle fibers go in a ___ direction and contraction makes the lower rib __.

Answer 18

1) inspiration
2) inferomedial
3) elevate
during inspiration, lungs go EXTERNAL/outward, ribs go up (rib elevation)

Question 19

The internal intercoastal is a muscle of __. Muscle fibers go in a ___ direction and contraction pulls the ribs __. The __ muscles are also muscles of __.

Answer 19

1&5) expiration
2) posterior, inferomedial
3) downward/depression
4) abdominal
during expiration, lungs go INTERNAL/recoil, ribs go down (rib depression)

Question 20

___ is an active process at rest & during exercise. __ at rest of a passive process achieved through elastic recoil of the lung. Elastic recoil is the ___ of the lungs after inhalation d/t elastin in lung conn. tissue & __ __ of fluid that lines alveoli.

Answer 20

1) Inspiration
2) Expiration
3) rebound
4&5) surface tension
FORCED EXPIRATION IS ACTIVE

Question 21

The __ handle refers anterior portion of ribs moving fwd when they are elevated d/t ant. end being lower than the posterior end of the rib.
The __ handle refer to costovertebral joints 2-6 moving on a side-to-side axis resulting in raising & lowering of the sternal end of the rib.

Answer 21

1) Bucket handle
2) Pump handle

Question 22

The RIGHT lung has __ lobes, separated by _ fissures. What are the names of the lobes & fissures? How does ea. fissure separate the lobes?

Answer 22

1) 3 lobes: RUL, RML, RLL
2) 2 fissures:
the oblique MAJOR fissure separates RLL from RML & RUL
the horizontal MINOR fissure separates RML from RUL

Question 23

The R lung lobes are separated into 10 segments total. How many segments belong to ea. lobe? What are these segment names?

Answer 23

RUL has 3 = superior (apical/apex), anterior, posterior
RML has 2 = medial, lateral
RLL has 5 = superior, medial/middle, lateral, anterior basal, posterior basal

Question 24

Left lung is __ than R lung in size. L lung has __ lobes (also name them) with the __ fissure separating them. How many segments does the lung have total and w/in. ea. lobe? What are the segments names?

Answer 24

1) smaller
2) 2
3) Oblique
4) 9 total, LUL = 5, LLL = 4
5) -LUL segments = anterior, apico-posterior (some consider this 2 diff segments), superior lingular, inferior lingular
-LLL segments = superior (apical), anterior, posterior, lateral

Question 25

Our lungs have R and L main bronchi. Then they become __ bronchi when passing through a lobe of the lung and __ bronchi when passing through a segment of ea. lobe. The __ are the smallest segments of your bronchi.

Answer 25

1) lobar 2) segmental 3) bronchioles

Question 26

The __ zone is where gas-exchange occurs. It's made up of __ __, alveolar __, and the __.

Answer 26

1) respiratory 2) respiratory bronchioles 3) alveolar ducts 4) alveoli

Question 27

During inspiration there is a __ in lung/thoracic cavity volume and a __ in intrapulmonary pressure (w/in the lung/alveoli). This brings about a _(positive/negative)_ (subatmospheric) intrapulmonary pressure leading to air flow __ lungs.

Answer 27

1) increase 2) decrease 3) negative 4) into

Question 28

At rest (no inspiration or expiration), intrapulmonary pressure is __ to atmospheric pressure.

Answer 28

equal to *no airflow*

Question 29

T/F: If intrapleural pressure was ever more positive than intrapulmonary pressure or transpulmonary pressure, our lungs would collapse.

Answer 29

TRUE AF

Question 30

For expiration, intrapulmonary pressure becomes more __ than atmospheric pressure. Intrapleural pressure remains __.

Answer 30

1) positive 2) negative

Question 31

Resting TV is __ to __ mLs. __ ventilation is the total volume of air inhaled OR exhaled in __. It also assesses the ___ of ventilation. To calculate it, multiply __ by __. At rest = 5 L/min Max ex = 70-125 L/min

Answer 31

1&2) 350-500 3&4) Minute ventilation; one minute 5) effectiveness 6&7) TV x RR

Question 32

Loss of __ reduces recoiling capacity in diseases like Emphysema. The lungs can easily inflate with increased/excessive __ but reduced __

Answer 32

1) elastin 2) compliance 3) elasticity

Question 33

The capacity/ease of the lungs to expand and stretch is lung __. The ability of the lungs to recoil after being stretched is __.

Answer 33

1) compliance 2) elasticity

Question 34

Lung compliance is defined as change in lung __ over change in transpulmonary __. Compliance can be affected by factors that produce __ to distention like infiltration of conn. tissue into lung __ causing fibrosis. Fibrosis can be correlated with __ compliance of a lung.

Answer 34

1) volume 2) pressure 3) resistance 4) parenchyma 5) low

Question 35

Elasticity/recoil of thoracic wall is created by the elasticity of tissue in the __ wall. Recoiling of this favors __ of the thoracic cavity.

Answer 35

1) chest wall 2) expansion

Question 36

Created by the fluid secreted on the lining of alveoli, __ __ is the tendency of liquids to acquire the least surface area possible & favoring the __ of lungs inward/resisting lung expansion. This helps to determine lung compliance.

Answer 36

1) Surface tension 2) Recoiling

Question 37

__ reduces surface tension. Without it, recoil __ and compliance __, like in the lung of a pre-term baby.

Answer 37

1) Surfactant 2) increases 3) decreases

Question 38

Our lungs don't collapse when we are not actively breathing due to recoiling of chest wall outwardly causing _(expansion/compression)_. Our lungs tend to recoil _(outward/inward)_, but because they are __ to the thoracic wall they are always under a balance of elastic tension.

Answer 38

1) expansion 2) inward 3) stuck

Question 39

T/F: Pulmonary ventilation and perfusion are distributed equally throughout the lung.

Answer 39

FALSE Ventilation (V) = 50%> at the base than the apex (more at the apex) Perfusion (Q) = dependent on body position in response to gravity (more at the base)

Question 40

At to APEX of the lung: the alveoli are _(larger/smaller)_ and _(more/less)_ compliant, the intrapleural pressure is more _(negative/positive)_, leading to _(more/less)_ ventilation.

Answer 40

1) larger 2) less 3) negative 4) less **If intrapleural pressure is more negative, this usually means the lung is INSPIRING air in b/c the pressure MUST be subatmospheric**

Question 41

At to BASE of the lung: there _(more/less)_ vascular pressure, more recruitment/distention, and _(more/less)_ resistance to blood flow, leading to _(greater/less)_ blood flow/perfusion.

Answer 41

1) more 2) less 3) greater **remember Q is gravity dependent though**

Question 42

A normal V/Q ratio is __. If perfusion occurs with very limited ventilation, this results in a __, where blood leaves the lung deoxygenated. If ventilation occurs with very limited perfusion, this results in physiologic __ __. where a portion of the lung is NOT perfused.

Answer 42

1) 0.8 2) shunt 3) dead space

Question 43

What is one condition that can cause a shunt? What about a dead space?

Answer 43

Shunt: mucus, COVID, pulmonary obstruction Dead Space: PE

Question 44

To compensate for a shunt, the pulmonary arterioles __ causing reduced ventilation and perfusion. To compensate for a dead space, the pulmonary arterioles __ causing enhanced ventilation and perfusion.

Answer 44

1) constrict 2) dilate

Question 45

__ __ __ is a test that measures V/Q in your lungs. It most often used to dx or rule out a __ ___. Radioactive albumin is injected into blood and xenon or technetium (radionuclides) are inhaled in by the pt.

Answer 45

1) Ventilation Perfusion Scan 2) PE

Question 46

Dalton's law is the total pressure of a gas mix is ___ the sum of pressure of each gas in it. __ pressure is the pressure of an individual gas that can be measured by multiplying the gas % by the total pressure.

Answer 46

1) equal to 2) Partial **REMEMBER: O2 makes up 21% of the atmosphere, so partial pressure of O2 = 760 X 21% = 159 mmHg.**

Question 47

Describe the amount of PaO2 & PaCO2 the following parts of the path air takes through the body: 1) Atmosphere 2) Alveolar air after external respiration 3) Oxygenated blood to L atrium of the heart 4) Systemic tissue cells after internal respiration 5) Deoxy blood to R atrium 6) *For this step, just know blood goes from R atrium to lungs for exhalation*

Answer 47

1) PaO2 > PaCO2 2) PaO2 > PaCO2 3) PaO2 > PaCO2 4) PaO2 slightly < PaCO2 5) PaO2 slightly < PaCO2

Question 48

Oxygen Dissociation Curve: As _(more/less)_ oxygen becomes available in the blood (PaO2), Hb binding affinity for O2 increases leading to a _(incr/decr)_ in oxy saturation (SaO2). As PaO2 _(incr/decr)_ in environments like the veins so does SaO2, d/t Hb binding affinity for O2 _(incr/decr)_ as well.

Answer 48

1) more 2) increase 3) decreases 4) decreasing

Question 49

As CO2 increases in the blood, blood pH levels __(incr/decr)_ and become more _(acidic/alkalitic)_. This is caused by __ventilation (decr. RR) and reduced _(inhalation/exhalation)_ volumes.

Answer 49

1) decrease 2) acidic 3) hypoventilation 4) exhalation

Question 50

As CO2 decreases in the blood, blood pH levels __(incr/decr)_ and become more _(acidic/alkalitic)_. This is caused by __ventilation (incr. RR) and reduced _(inhalation/exhalation)_ volumes.

Answer 50

1) increase 2) alkalitic 3) hyperventilation 4) exhalation

Question 51

FIO2 is the fraction of _(inhaled/exhaled)_ air that is oxygen. Normal values is __%. For every liter of supplemental oxygen via a nasal cannula, the FIO2 increases by _%.

Answer 51

1) inhaled 2) 21% 3) 4%