Unit 5 Pulmonology Flashcards
(135 cards)
1
Q
Organs of the Respiratory System
A
Nose Pharynx Larynx Trachea Bronchi Lungs
2
Q
Functions of the Nose
A
Warm, clean, and humidify air
detect odor
resonating chamber for voice amplification
3
Q
Superior Half of the Nose
A
Bony and cartilaginous supports
nasal bones medially and maxillae laterally
4
Q
Inferior Half of the Nose
A
Bony and cartilaginous supports
lateral and alar cartilages
5
Q
Ala Nasi
A
flared portion of the nose shaped by dense CT, forms lateral wall of each nostril
6
Q
Function of cilia of respiratory epithelium
A
sweep debris-laden mucus into pharynx to be swallowed
7
Q
Erectile tissue of inferior concha (Nose)
A
venous plexus that rhythmically engorges with blood and shifts flow of air from one side of fossa to the other once or twice an hour to prevent drying
8
Q
Spontaneous epistaxis
A
Nosebleed
most common site is inferior concha
9
Q
Lower Respiratory Tract Structures
A
Larynx Trachea Primary Bronchi Secondary Bronchi Tertiary Bronchi
10
Q
Visceral pleura is located
A
On the Lungs
11
Q
Parietal pleura is located
A
Lines Rib Cage
12
Q
Functions of the Pleural cavity
A
Reduce Friction Create Pressure Gradient *Lower Pressure assists lung inflation Compartmentalization *Prevents the spread of infection
13
Q
Breathing
A
Pulmonary Ventilation
one cycle of inspiration and expiration
14
Q
Quiet Respiration
A
At Rest
15
Q
Forced Respiration
A
Occurs during exercise
16
Q
Flow of Air in and out of lungs requires
A
a pressure difference between air pressure within lungs and outside body
17
Q
Respiratory Muscles
A
Diaphragm Scalenes External and Internal Intercostals Pectoralis Minor Sternocleidomastoid Erector Spinae Abdominals Latissumus Dorsi
18
Q
Diaphragm
A
Dome-Shaped
separates Thoracic and Abdominal Cavity
Contraction Flattens the Diaphragm
19
Q
Scalenes Function
A
Hold the first pair of ribs stationary
20
Q
External and Internal Intercostals function
A
stiffen thoracic cage; increases diameter
21
Q
What muscles are used in forced Inspiration
A
Pectoralis minor
sternocleidomastoid
erector spinae muscles
22
Q
What muscles are used in forced Expiration (Sing, Cough, Sneeze)
A
Abdominals and Latissimus Dorsi
23
Q
Neural control of breathing requires
A
Repetitive stimuli from the brain
24
Q
What controls unconscious breathing?
A
Neurons in the medulla Oblongata and Pons
25
Voluntary control of breathing is controlled by
Motor Cortex
26
Which neurons fire during Inspiration
Inspiratory Neurons
27
Which neurons fire during forced expiration
Expiratory neurons
28
Fibers of the Phrenic nerve go to which organ/structure
Diaphragm
29
Fibers of the Intercostal nerves go to which structures
Intercostal muscles
30
Respiratory effects of pain and emotion are innervated/ controlled by
The Limbic System and hypothalamus
31
Function of irritant receptors in the respiratory mucosa
stimulate vagal afferents to medulla, results in bronchoconstriction or coughing
32
Function of stretch receptors in airways
inflation reflex
excessive inflation triggers reflex
stops inspiration
33
Function of Chemoreceptors in Pulmonology
monitor blood pH, CO2 and O2 levels
34
Peripheral Chemoreceptors
Found in major blood vessels
Aortic Bodies
Carotid Bodies
35
Peripheral Chemoreceptors in the Aortic bodies
Signal the medulla via vagus nerves
36
Peripheral chemoreceptors in the Carotid bodies
Signals the medulla via Glossopharyngeal nerves
37
Central Chemoreceptors
Located in the medulla
| Primarily monitor pH of Cerebrospinal Fluid (CSF)
38
Voluntary Control neural Pathways
motor cortex of frontal lobe of cerebrum sends impulses down corticospinal tracts to respiratory neurons in spinal cord, bypassing brainstem
39
Limitation of Voluntary Controls
blood CO2 and O2 limits cause automatic respiration
40
Atmospheric Pressure drives
Respiration
41
1 Atmosphere
760 mmHg
42
Intrapulmonary pressure
pressure is inversely proportional to volume for a given amount of gas, as volume , pressure and as volume , pressure
43
Pressure Gradients
difference between atmospheric and intrapulmonary pressure created by changes in volume thoracic cavity
44
As the Volume of the thoracic cavity increases,
the Visceral pleura cling to the Parietal pleura
45
Intrapulmonary Pressure
Lungs expand with Visceral pleura
46
Transpulmonary pressure
Intrapleural-Intrapulmonary pressure
| not all pressure change in the pleural cavity is transferred to the lungs
47
Inflation is aided by
Warming of inhaled Air
48
How much air flows with a quiet breath
500 mL
49
During quiet breathing, expiration is achieved by
elasticity of lungs and thoracic cage
50
As the Volume of the Thoracic cavity decreases, what happens to the Intrapulmonary pressure?
Intrapulmonary Pressure increases and air is expelled
51
After inspiration, phrenic nerves continue to stimulate the diaphragm to produce
a braking action to elastic recoil
52
In forced Expiration, the internal intercostal muscles
Depress the ribs
53
In forced expiration, the abdominal muscles
Contract
54
In forced expiration, the abdominal muscles contract, resulting in
Increased abdominal pressure, which forces the diaphragm upward
Increased pressure on the Thoracic Cavity
55
Pneumothorax
Presence of Air in the pleural cavity
loss of negative intrapleural pressure allows lungs to recoil and collapse
56
Atelectasis
Collapse of lung (or part of lung)
57
Distensibility of Lungs
change in lung volume relative to a change in transpulmonary pressure
58
What is the primary control over resistance to airflow?
Bronchiolar Diameter
59
Bronchioconstriction is triggered by
airborne irritants, cold air, parasympathetic stimulation, histamine
60
Bronchodilation
is stimulated by sympathetic nerves, epinephrine
61
Alveolar Surface Tension
A Thin film of water is needed for gas exchange
62
The thin film of water on the Alveolar surface
creates surface tension that acts to collapse alveoli and distal bronchioles
63
Pulmonary Surfactant (great Alveolar Cells)
decreases surface tension
64
Premature infants that lack surfactant suffer from
respiratory distress syndrome
65
Dead Air
fills conducting division of airway, cannot exchange gases
66
Anatomic dead space
Conducting Division of Airway
67
Physiologic dead space
sum of anatomic dead space and any pathological alveolar dead space
68
Alveolar ventilation rate
air that ventilates alveoli X respiratory rate
directly relevant to ability to exchange gases
69
Spirometer
Measures Ventilation
70
tidal volume
volume of air in one quiet breath
71
inspiratory reserve volume
air in excess of tidal inspiration that can be inhaled with maximum effort
72
expiratory reserve volume
air in excess of tidal expiration that can be exhaled with maximum effort
73
residual volume
(keeps alveoli inflated)
air remaining in lungs after maximum expiration
74
Vital Capacity
total amount of air that can be exhaled with effort after maximum inspiration
75
What does Vital Capacity assess
strength of thoracic muscles and pulmonary function
76
Inspiratory Capacity
maximum amount of air that can be inhaled after a normal tidal expiration
77
Functional residual capacity
amount of air in lungs after a normal tidal expiration
78
Total lung capacity
maximum amount of air lungs can hold
79
Forced expiratory volume (FEV)
% of vital capacity exhaled/ time
| healthy adult - 75 to 85% in 1 sec
80
Peak flow
maximum speed of exhalation
81
Minute respiratory volume (MRV)
TV x respiratory rate, at rest 500 x 12 = 6 L/min
| maximum: 125 to 170 L/min
82
As age decreases What happens to lung compliance
Lung compliance decreases, respiratory muscles weaken
83
Exercise
maintains strength of respiratory muscles
84
Body size in regards to lung volume and capacity
proportional, big body/large lungs
85
Restrictive disorders
Decrease compliance and Vital Capacity
86
Obstructive disorders
interfere with airflow, expiration requires more effort or less complete
87
Air-Water Interface
Important for gas exchange between air in lungs and blood in capillaries
88
Gasses Diffuse
Down their concentration Gradient
89
Henry’s law
amount of gas that dissolves in water is determined by its solubility in water and its partial pressure in air
90
Factors affecting Gas exchange
Membrane Thickness
Membrane Surface Area
Ventilation-Perfusion Coupling
91
Ventilation-Perfusion Coupling
areas of good ventilation need good perfusion (vasodilation)
92
Membrane surface area
100 ml blood in alveolar capillaries, spread over 70 m2
93
Oxygen concentration in arterial blood
20 ml/dl
98. 5% bound to hemoglobin
1. 5% dissolved
94
Oxygen Binding to hemoglobin
each heme group of 4 globin chains may bind O2
oxyhemoglobin (HbO2 )
deoxyhemoglobin (HHb)
95
Oxyhemoglobin dissociation curve
relationship between hemoglobin saturation and PO2 is not a simple linear one
after binding with O2, hemoglobin changes shape to facilitate further uptake (positive feedback cycle)
96
Carbon dioxide transported as Carbonic Acid
carbonic acid - 90%
| CO2 + H2O →H2CO3 → HCO3- + H+
97
Carbon Dioxide Transported as carbaminohemoglobin
carbaminohemoglobin (HbCO2)
5% binds to amino groups of Hb (and plasma proteins)
98
Carbon Dioxide Transported as a Gas
As dissolved gas - 5%
99
What are the 3 ways carbon dioxide is transported?
Carbonic Acid
carbaminohemoglobin
Dissolved Gas
100
Alveolar exchange of CO2
carbonic acid - 70%
carbaminohemoglobin - 23%
dissolved gas - 7%
101
Chloride Shift
Keeps reaction proceeding, exchanges HCO3- for Cl- (H+ Binds to Hemoglobin)
102
CO2 Loading
Carbonic Anhydrase in RBC Catalyzes
| CO2 + H2O →H2CO3 → HCO3- + H+
103
O2 Unloading
H+ binding to HbO2 lowers its affinity for O2
Hb arrives 97% saturated, leaves 75% saturated - venous reserve
utilization coefficient
amount of oxygen Hb has released 22%
104
Alveolar Gas Exchange reactions are the opposite of
Systemic Gas Exchange
105
CO2 Unloading
As Hemoglobin loads O2, its affinity for H+ Decreases, H+ Dissociates from Hb and Bind with HCO3-
CO2+ H2O
106
Reverse Chloride Shift
HCO3- diffuses back into RBC in exchange for Cl- ; Free CO2 Generated diffuses into alveolus to be exhaled
107
Factors that affect O2 Unloading
Ambient PO2
Temperature
Bohr Effect
Biphosphoglycerate
108
Ambient PO2 Affect on O2 Unloading
Active tissue has decreased PO2, and O2 is released
109
Temperature affect on O2 Unloading
Active tissue has an increased temp and O2 is released
110
Bohr effect
| affect on O2 Unloading
Active tissue has an increase in CO2, which lowers Ph, (Muscle burn), and O2 Is released
111
Biphosphoglycerate (BPG) affect on O2 Unloading
RBCs produce BPG which binds to Hemoglobin; O2 is released
112
What would be the effect of an increased Body Temp (Fever), TH, GH, Testosterone, or Epinephrine?
All Raise BPG and cause O2 Unloading (an increased metabolic rate will require Oxygen)
113
Factors that affec CO2 Loading
Haldane Effect
114
Haldane Effect
Low Level of HbO2(as in active tissue) enables blood to transport more CO2)
HbO2 does not bind CO2 as well as Deoxyhemoglobin (HHb)
HHb binds more H+ than HbO2
115
Haldane effect reaction
as H+ is removed this shifts the
CO2 + H2O -----> HCO3- + H+
reaction to the right
116
Blood Chemistry and Respiration Rhythm
Rate and Depth of breathing is adjusted to maintain levels of pH, PCO2, and PO2
117
Effects of Hydrogen Ions
```
pH of CSF
Respiratory Acidosis
Hypercapnia
Respiratory Alkalosis
ph Imbalances
```
118
What is the most powerful Respiratory Stimulus (in regards to Hydrogen Ions)
pH of CSF (Cerebrospinal Fluid)
119
Cerebrospinal Fluid
CSF
120
Respiratory Acidosis
acidosis (pH < 7.35) caused by failure of pulmonary ventilation
121
HyperCapnia
PCO2 > 43 mmHg
CO2 easily crosses blood-brain barrier
in CSF the CO2 reacts with water and releases H+
central chemoreceptors strongly stimulate inspiratory center
122
Blowing Off CO2
pushes reaction to the left CO2 (expired) + H2O
123
Respiratory Alkalosis
(pH > 7.45)
hypocapnia: PCO2 < 37 mmHg
Hypoventilation (Increased CO2), pushes reaction to the right Increased CO2 + H2O ----->H2CO3------>HCO3- + H+
H+ (increases acid), lowers pH to normal
124
Effects of pH Imbalances
Metabolic Causes
Uncontrolled Diabetes Mellitus
-Fat Oxidation causes ketoacidosis; May be compensated for by Kussmaul Respiration (Deep Rapid Breathing)
125
Effects of Carbond Dioxide
Indirect affects on Respiration (Ph)
Direct Effects: increased CO2 may directly stimulate peripheral chemoreceptors and trigger increased ventilation more quickly than central chemoreceptors
126
Effects of Oxygen
Usually Little Effect
Chronic Hypoxemia; PO2<60 mmHg, can significantly stimulate ventilation
-emphysema
-High Altitudes for several days
127
Causes of Hypoxemic Hypoxia
due to inadequate pulmonary gas exchange
| high altitudes, drowning, aspiration, respiratory arrest, degenerative lung diseases, CO poisoning
128
Causes of Ischemic Hypoxia
Inadequate Circulation
129
Causes of Anemic Hypoxia
Anemia
130
Causes of Histotoxic Hypoxia
Metabolic Poison (Cyanide)
131
Signs of Hypoxia
Blueness of Skin
132
Primary Effects of Hypoxia
tissue necrosis, organs with high metabolic demands affected first
133
Oxygen Toxicity
pure O2 breathed at 2.5 atm or greater
134
Effects of Oxygen Toxicity
generates free radicals and H2O2
destroys enzymes
damages nervous tissue
leads to seizures, coma, death
135
Hyperbaric Oxygen
formerly used to treat premature infants, caused retinal damage, discontinued
