Physiology I - Respiratory Unit Exam II Review

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Terminology / Description

• Hypoxia
• Anoxia
• Ischemia
• Hypoxemia
• Anatomic Dead Space
• Alveolar Dead Space
• Physiological Shunt
• Physiologic Dead Space
• V/Q mismatches
• Atelectasis
• Collateral ventilation of the lung - pore of Kohn
• Inspiratory stridor on the Air Flow-lung Volume loop curve
• acute respiratory distress

• Be familiar with the following physics laws (lung volume & Pressure)

Boyle's Law- describes how the pressure of a gas tends to increase as the volume of the
container decreases.
Laplace's law: Describes the factors that determine left ventricular wall stress, which is a major
determinant of myocardial oxygen demand.
Poiseuille's law: Turbulent flow of air is present at large airways and airways branching sites
Lavoisier’s law: The law of conservation of mass or principle of mass conservation states that for
any system closed to all transfers of matter and energy, the mass of the system must remain
constant over time, as the system's mass cannot change, so quantity can neither be added nor
be removed
Fick's Law describes the relationship between the rate of diffusion and the three factors that
affect diffusion. It states that 'the rate of diffusion is proportional to both the (1) surface area
and (2) concentration difference (partial pressure) and is inversely proportional to the (3)
thickness of the membrane'.
Charles Gas law
Reynold’s Number (Air way turbulence)
Describe “normal” Inspiration and expiration mechanism of action
• Inspiration active contraction of muscles – such as the diaphragm
• expiration passive
• Forced expiration
• What forces facilitate inspiration and what factors facilitates expiration

In a lung dissection slide: determine which anatomical structures involved in conducting air and
which ones participate in gas exchange (understand particle size variations for each structure)

• (bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveoli sacs)

Determine which muscle(s) are mainly (primarily) involved in inspiration, expiration, and coughing

• Rectus Abdominis
• Sternocleidomastoids
• External intercostals
• Internal intercostal
• Diaphragm

Be familiar with the effect of zero gravity on respiratory muscles Be familiar with Lung Volumes

& Capacities and how these are affected by common disease states.

• Expiratory reserve volume

• Residual volume (cannot be calculated using spirometers)
• Inspiratory reserve volume
• Tidal volume
• Vital Capacity
• Total Lung Capacity
• Functional Residual Capacity (the balance between the inward pull of the lung and the outward
spring of the chest wall)
Obstructive lung disease
• diminished expiratory
flows and increased lung
volumes
• relatively smaller changes
during inspiration

Upper airway obstruction

• blunting of peak
expiratory and
inspiratory flow
• curves will be flatter
rather than proceeding
to peaks
total tidal volumes may
remain the same

Restrictive lung disease

• smaller lung volumes during

each respiratory cycle
• curve will not reach as large
volumes as normal
Know the anatomical layers oxygen has to transverse (move) through the blood gas barrier from the
alveoli to RBC.

Body response adaptation to

• Low circulatory CO2

o Receptors involved
o breathings rate (increases or decreases)
• low circulatory O2
o Receptors involved
o breathings rate (increases or decreases)

Lung compliance
• Definition
• Factors that determine(s) Lung Compliance:
Surface Tension of the lungs (Alveoli).
o The higher the surface tension, the lower the compliance
o Surfactant reduces the surface tension thus increasing compliance
Elasticity (Elastic recoil of the Lungs (alveoli)
o Compliance is inversely related to the elastic recoil of the lungs
o Thickening of lung tissue (pulmonary fibrosis) will decrease lung compliance
Compliance relationship to lung volume and pressure
• Compliance is highest at moderate lung volumes, and much lower at volumes which
are very low or very high. The compliance of the lungs demonstrates lung hysteresis; that is,
the compliance is different on inspiration and expiration for identical volumes.

• Saline-filled lungs are more compliant (i. e, ΔV/ΔP is greater) than air-filled and show no critical
opening pressure or hysteresis

• Lung is less compliant at the highest volumes (peaks) and lowest ones

• More pressure to inflate the lungs than to deflate and that is why there is none identical
Pressure Volume curve during inflation and deflation, and it is not a linear relationship on the
Volume/pressure curve

• Compliance is increased in obstructive lung disease like pulmonary emphysema, less

in asthma and at a minor degree in chronic bronchitis. In emphysema, the elastic recoil is
 decreased, and the P-V curve is shifted up and left. This is due to the loss of elastic tissue as a
result of alveolar wall destruction.

Be familiar of the following areas on the graph

o Total lung work of breathing

o Resistive Inspiratory work
o Resistive Expiratory work
• Understand the respiratory physiology of a pneumothorax as far lung parenchyma movement, the
chest wall movement and pulmonary pressures (Intra-pleural pressure, Plural pressure, Chest wall
Pressure

Contraction and relaxation of the diaphragm.

o Effect on the thoracic cavity / intrapleural pressure (+/-)/ lung volume

Describe the Function of

• Pulmonary Receptors
o Stretch receptors
o Irritant receptors (blockage of receptors prevents reflex to initiate cough)
o J receptors (sensation of difficulty breathing)
o C Fibers – cough stimulation
o Gamma System
o Joint receptors (increases respiration at the start of exertion abruptly)
• Central Chemoreceptors
• Peripheral Chemoreceptors

Effect of smoke on the mucociliary escalator (Movement)

Cough stimulation for new smokers

Be familiar with Respiratory Control Center

• The brain stem controls automatic functions such as breathing, digestion, heart rate and blood
pressure.
• The cerebral cortex of the brain controls voluntary respiration
• Medulla – regulates involuntary respiration

Medullary Respiratory Center:

o Dorsal Group controls Inspiration

o Ventral Group controls Expiration (forced expiration)

• Apneustic Center (Function?)

• Pneumotaxic Center (Function?)
• Nerves branches (C3, C4, C5) associated with muscles of the respiratory structures

Acid base disorders: Be able to diagnose the disorder based on the values of pH, HCO3-, CO2

• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Alkalosis
• Metabolic Acidosis

Oxygen transport in blood

• 1.5 % carried in the plasma as a dissolved gas.
• 98.5 % bound to the protein hemoglobin in red blood cells.
Alveoli Surfactant
• production by which Alveolar cells?
• Function?
• Mechanism of action
• Relationship between surfactant, radius of the alveoli, surface tension, intra-alveolar pressure,
and compliance.

Know the different types of cells in Alveoli walls & function.

• Alveolar Macrophages
• Non-ciliated bronchiolar secretory cells
• Pneumocytes type I
• Pneumocyte type II
• Goblet cells

Pulmonary deposition of inhaled particles (size) and lung diseases

• Allergic Rhinitis
• Bronchial Asthma
• Alveolitis
• Tracheitis
• Laryngitis
Air flow – Lung volume loop changes with respect to FEV1, FVC %, TLC for the following
• Restrictive disorders (Interstitial Pulmonary Fibrosis)
• Upper Obstructive disorders (Bronchial or Tracheal Obstruction)
• Lower Obstructive orders (Asthma, Emphysema, COPD)

Describe and understand the respiratory physiological for

• Neonatal Respiratory Distress Syndrome (NRDS)
• Pneumothorax - A collapsed lung as far lung parenchyma movement, the chest wall movement
and pulmonary pressures (Intra-pleural pressure, plural pressure, chest wall pressure)
• Decompression Sickness – Bends? Treatment?
• Nitrogen narcosis
Elastic recoiling of the chest wall (VS) Elastic recoiling of the lung

As the lungs recoils elastically pulling force in the plural cavity decreases pressure inside it

Describe

• Bohr effect
• Haldane effect
• Carbonic anhydrae catalyzed reaction
Know the effects of the following factors on oxyhemoglobin dissociation curve with respect to (right or
left shift) – (Unloading /loading) – (higher affinity/lower affinity)

o pH
o CO2
o Temperature
o DPG
o Carbon monoxide Poisoning

Compare and contrast between Fetal Hb (Vs) Maternal Hb Oxyhemoglobin dissociate curve

Calculating Physiological Dead Volume (Space) using Bohr’s equation

Be familiar with the effects of Opioids on Reparation Centers

• PaO2?
The role of albumin in maintaining lung homeostasis (Lung fluid balance)

Be familiar with

• The body physiological response during exercise

• The body physiological response at high altitude

Be familiar with High Altitude Pulmonary Edema (HAPE)

• Constriction of pulmonary vessels

• fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs.
• Beside the symptoms of high altitude, HAPE individual suffer from Chest tightness, persistent
cough, frothy sputum and suffocation during sleep
• Treatment: oxygen is the usually the first treatment.
Blood flow distribution in the lungs in relation to alveolar and arterial pressures

• Apex of the lung

• Base of the lung

Alveolar Ventilation Equation

• Effects of (increased/decreased) Alveolar Ventilation on

o Alveolar PO2
o Alveolar PCO2
• CO2 transport assumes a variety of forms / locations
o Bound to hemoglobin
o Carbonic acid
o HCO3 -
o Dissolved in plasma
The oxygen concentration (oxygen content) of systemic arterial blood depends on
• Partial pressure of inspired oxygen
• The adequacy of ventilation and gas exchange
• The concentration of hemoglobin
• Affinity of the hemoglobin molecule for oxygen.
• Know how to calculate Alveolar PO2 in the blood gas

o [PAO2 = FiO2(P –47) –PaCO2/R]

Identify the causes of Hypoxemia when there is

• Alveolar-arterial Gradient (A-a) – Normal Values

• A-a Gradient – High Values
• Which ones respond best and poorly to O2 administration?
[PAO2 = FiO2(P –47) –PaCO2/R]