1
Q
Route of Ventilation
A
Conducting
Respiratory
2
Q
Pulmonary artery delivers … to …
A
deoxygenated blood to lungs
and
oxygenated blood returns via pulmonary veins
3
Q
Each lung has a volume of
A
4 to 6 liters
4
Q
Gas exchange takes place in ..
A
the alveoli
5
Q
Gas exchange in alveoli moves via
A
diffusion
from high concentration to low
6
Q
at rest how much mL of oxygen enter the blood via alveoli each minute
A
250 mL
7
Q
during max exercise, how much mL of oxygen is exchanged
A
6000mL
8
Q
Lungs are surrounded by … which allows …
A
pleura
air flow to be isolated to trachea and the bronchiole tree
9
Q
break in the pleura
A
pneumothorax
10
Q
what happens in a pneumothorax
A
air enters by route outside bronchiole tree
11
Q
what is the most important muscle for inspiration
A
thoracic diaphragm
12
Q
as chest cavity enlarges …
A
negative pressure pulls air into lungs
13
Q
expiration at rest is accomplished by ..
A
the elastic nature of the lungs
14
Q
forceful expiration is accomplished by
A
rectus abdominous
abdominal obliques
internal intercostals
15
Q
during forced expiration …
A
the thoracic cavity decreased in size and positive pressure forces air out of lungs
16
Q
forces expiration with a closed glottis is called
A
valsalva maneuver
17
Q
during valsalva maneuver …
A
spine is moved into stiff position and venous return is decreased or completely blocked
18
Q
tidal volume
A
amount of air inspired or expired per breath during rest or exercise
19
Q
inspiratory reserve volume
A
max inspiration at the end of tidal inspiration
20
Q
expiratory reserve volume
A
max expiration at the end of tidal expiration
21
Q
residual lung capacity
A
volume in lungs after max expiration
22
Q
functional residual capacity
A
volume of air in lungs following tidal expiration
23
Q
total lung capacity
A
volume in lungs after max inspiration
24
Q
forced expiratory volume + its symbol
A
percentage of vital capacity that can be expired in 1 second
FEV1.0/FVC
25
what percent is considered the bottom of normal for forces expiratory volume
70%
26
maximum voluntary ventilation + what amount is normal
ventilatory capacity over a 15 second period
140-180 liter per minute
27
does training increase total lung capacity, forces vital capacity, forced expiratory volume, or tidal volume
no
28
does training increase ventilatory endurance
yes
29
breaths per minute + during exercise
10-12, exercise may be 35-45
30
tidal volumes max out at ...
60% of the vital capacity
31
with intense exercise what is increased
both rate and depth of ventilation
32
during mild to moderate exercise what is increased and met
increased ventilatory demand is met in trained individuals by increasing tidal volume with little increase in rate
33
people with asthma may have ...
exercise induced bronchospasm
34
bronchospasm may be worse or better in what conditions
worse: cold air, very dry air
better: hot humid air
35
what is in the air we breathe
20.9% oxygen
0.03% carbon dioxide
79% nitrogen + other gases
36
partial pressure of PO2 at sea level
PO2 = 0.209 * 760 = 159 mmHg
37
partial pressure of PCO2 at sea level
PCO2 = 0.0003 * 760 = 0.23 mmHg
38
partial pressure of PN2 at sea level
PN2 = 0.793 * 760 = 601 mmHg
39
partial pressure of water
about 47 mmHg
40
partial pressure of water decreased partial pressure of O2 by ...
10 mmHg
(air entering lungs is saturated with water by the nose/mouth pharynx and trachea)
41
alveoli air PO2
PO2 = 0.145 * (760 - 47) = 103 mmHg
42
alveoli air PCO2
PCO2 = 0.055 * (760 - 47) = 39 mmHg
43
alveoli air PN2
PN2 = 0.80 * (760 - 47) = 570 mmHg
44
alveolar air values are due to
oxygen moving in and carbon dioxide moving out of the blood
45
rate of diffusion is proportional to ...
pressure differential and the solubility of gas
46
pressure differential for oxygen is ... compared to deoxygenated blood
60 mmHg
47
Ficks Law
the rate of gas exchange through semi-permeable membrane is proportional to:
- surface area
- diffusion constant of gas
- concentration gradient on either side of the membrane
- inversely proportional to thickness of membrane
48
the a-v O2 difference
the difference between the O2 content of arterial blood + venous blood
49
normally .. mLs of O2 is carried by 100mLs of ...
20 mLs of O2 is carried by 100 mLs of plasma
50
at rest the difference of plasma
with vigorous exercise the difference of plasma
at rest: 4-5 mLs/100mL of plasma
exercise: 15mLs/100 mLs of plasma or greater
51
oxygen in muscle at rest the PO2 is around ...
during heavy exercise ...
40 mmHg
may be zero
52
true or false : the alveoli tend to maintain the same PO2 + PCO2 even with exercise
true
53
how long does it take for blood to travel through lung capillaries
0.75 seconds
54
how long does it take for transfer of gases
0.25 seconds
55
with exercise, the travel time of blood through capillaries takes ..
0.35 seconds
56
at sea level alveolar oxygen is ...
100mL mmHg blood hemoglobin will be 100% saturated
57
at 6500 feet above sea level, blood hemoglobin saturation is about
90%
58
at 28000 (everest) the oxygen saturation is about
58%
59
acclimatization to living at high altitudes is an increase in total number of
RBC
60
what is the carrier for oxygen
hemoglobin
61
hemoglobin
iron containing protein that is contained in the red blood cell
62
hemoglobin allows blood to carry ... more oxygen than is normally found in plasma
70x more
63
each liter of blood carries ...
197 mL of oxygen captured as oxyhemoglobin
64
men have .. hemoglobin per 100mL of plasma
15-16 gm
65
women have .. hemoglobin per 100mL of plasma
13-14 gm
66
hematocrit
percentage of red blood cells in whole blood
67
hematocrit for men and women
men: 42-54
women: 37-47
68
each gram of hemoglobin can carry ... of oxygen
1.34 mL oxygen
69
true or false: decreases in hemoglobin will decrease the oxygen carrying capacity of the blood
true
70
anemia
decreased oxygen carry capacity of the blood
71
bohr effect
resultant shift of the dissociation curve due to increased temp, decreased pH, or increased CO2
72
bohr effect and exercise
temp + acidity of the blood may increase
73
myoglobin
iron containing protein found in skeletal + cardiac muscle
74
red muscles have ....
high myoglobin
75
do white muscles have high myoglobin
no
76
each myoglobin can hold ...
each hemoglobin can hold ...
1 O2
4 O2
77
myoglobin does not give up O2 until ...
tissue PO2 drops below 5 mmHg
78
CO2 is carried to the lungs by ...
1. blood as dissolved CO2 (5%)
2. combined to hemoglobin (20%)
3. combined with water as carbonic acid (H2CO3)
79
Carbonic acid is carried in the blood as ...
H+ and bicarbonate (HCO3)
80
Carbonic anhydrase
catalyses the combination of H2O + CO2 to carbonic acid
this facilitates transport of CO2 back to lungs
81
at rest, what activates the diaphragm and intercostal muscles
what does this cause to happen
reticular formation neurons in medulla
causes lungs to inflate
82
expiration is probably controlled by
stretch receptors in lung tissue + inhibition of inspiration by other neurons located in medulla
83
what detects decrease in PO2
peripheral chemoreceptors
84
where are peripheral chemoreceptors located + what are they called
located in arch of the aorta + at bifurcation of the common carotid
called: carotid bodies
85
a decrease in arterial PO2 would send info to and via
to the brain stem via vagus nerve
86
inspired PCO2 increases
ventilation rate by increasing plasma H+ ions
87
hyperventilation decreases
alveolar CO2 from 40 mmHg to 15 mmHg
88
how does body increase ventilation during exercise
- cortical influence from motor cortex to ventilatory centers in brain stem
- afferent input from joint receptors, muscle receptors, and tendon receptors (activate ventilatory centers in brain stem)
- increase temp which effects ventilation centers in brain stem
89
early in exercise bout, increased O2 are met by ...
increasing tidal volume
(as exercise proceeds ventilation rate increases)
90
lactic acid
by product of anaerobic metabolism
91
as lactate builds up in blood, ventilation rate
increases rapidly
92
at rest energy requirement for breathing is
1.9 - 3.1 mL of O2 per liter of air breathed or 4%
(exercise may climb to 11%)
93
training does what to energy cost, tidal volume, and breathing rate
energy cost: decreases
tidal volume: increases
breathing rate: decreases
94
ventilatory equivalent
ratio of amount of air ventilated over the amount of O2 taken up
- healthy people VE is 25 to 1
95
are VE higher for arm or lower extremity exercise
arm
96
pH of blood
around 7.4
97
increases in CO2 in the blood causes
acidosis
98
acidosis can cause pH to
decrease to 7.0 or lower
99
COPD - chronic obstructive pulm disease
1. asthma
2. emphysema
3. chronic bronchitis
100
asthma definition
obstruction to flow of air, but usally reversible
101
emphysema definition
loss of elasticity of lung tissue, from destruction of connective tissue supporting alveoli
destruction of alveoli blood supply
102
chronic bronchitis definition
inflammation of bronchial tubes
- thick mucus covering which obstructs air flow
103
asthma symptoms
- wheezing
- coughing
- trouble breathing
- chest tightness
- symptoms worse at night
104
diagnosis of asthma
spirometry testing FEV1/FVC
105
causes of asthma attack
- allergens (dust, animal fur, etc)
- irritants (smoke, air pollution, etc)
- certain medications (aspirin, anti inflamm, etc)
- sulfites in food + drink
- viral upper respiratory infections (colds)
- exercise
106
long-term drugs for asthma
- inhaled long acting beta2 agonist
- leukotriene inhibitors
- cromolyn + nedocromil
- theophylline
107
emphysema symptoms
- difficulty breathing
- coughing
- wheezing (early in expiration !!)
- excess mucus production
- bluish tint to skin
108
causes of emphysema
- cigarette smoking
- deficiency of alpha-1 antitrypsin (AAT)
109
diagnosis of emphysema
- increased air in chest + destruction of lung tissue
- spirometry
110
chronic bronchitis definition
smokers disease
111
chronic bronchitis symptoms
- smokers cough
- yellowish mucus
- wheeze + shortness of breath
- can lead to emphysema
112
diagnosing chronic bronchitis
- present for at least 3 months in 1 year and occur for at least 2 years in a row
- tests : sputum analysis
- chest x-ray
- test of pulm function
- arterial blood gas (ABG)
- pulse oximetry
113
reduced lung volume causes
1. due to changes in lung tissue
2. diseases of pleura
3. disease chest wall
4. problems w/ neuromuscular aspect of filling the lung
114
restrictive lung disease
- starts out as inflammatory process
- lesions (fibrotic tissue) occues which distort the alveoli
- alveolar capillaries may be changed or destroyed
- decreased oxygenation is end result
115
restrictive lung disease reduces
- reduced total lung capacity
- reduced forces vital capacity
116
classification of restrictive diseases
1st: interstitial lung disease
2nd: extrinsic disorders or extraparenchymal diseases
117
interstitial lung disease
diseases cause inflammation or scarring of lung tissue
ex: idiopathic fibrotic disease, connective tissue disease, drug-induced disease
118
extrinsic disorders
disease of chest wall, pleura, respiratory muscles
- result in lung restriction, impaired ventilatory function, respiratory failure
- neuromuscular disorder, ALS, parkinson
119
idiopathic pulmonary fibrosis
- fibrotic tissue forms in parenchyma of lung
- increased risk associated w/ exposure to dust, metals, solvents
120
sarcoidosis
disease that can affect almost any organ in the body but most often the lungs
- immune system overreacts, resulting in damage to bodys own tissues
- classic feature : formation pf granulomas which are microscopic clumps of inflammatory cells
- restricts lung volume
121
kyphoscoliosis
deformity of spine
- restricts lung capacity
122
causes of parenchymal lung disease
inhaled dust such as silica, asbestos, metals
123
symptoms of fibrotic disease
- exertion dyspnea
- dry unproductive cough
- hemoptysis
124
symptoms of extrinsic restrictive disorders
- chest wall disorders (scoliosis) asymptomatic in younger individuals but symptomatic in elderly
- decreased exercise tolerance + respiratory infections
- neuromuscular diseases have the same symptoms (ALS, parkinsons)
125
pulmonary fibrosis treatment
- corticosteroids may slow progression
- immunosuppressive agents may be used for those who do not respond to cortiosteriods
- supplemental oxygen
126
pneumonia
- inflammation of lung
- may be viral or bacterial
- restricts lung volume
- restricts oxygenation of blood bc of fluid in aveoli
127
lung cancer
- uncontrolled cell growth
- cancerous tissue may invade other areas (metastasis)
128
Stage 0 Lung Cancer
cancer limited to lining of air passages + hasnt invaded lung tissue
129
Stage 1 Lung Cancer
cancer has spread to layers of lung tissue but has not reached lymph nodes or beyond
- 60-80% chance of surviving 5 years
130
Stage 2 Lung Cancer
cancer has invaded neighboring lymph nodes or spread to chest wall
- 40-50% chance of surviving 5 years
131
Stage 3 Lung Cancer
stage 3a
- cancer has spread from lung to lymph nodes beyond the lung area
- not treated surgically
- 15-30% chance of surviving 5 years
stage 3b
- cancer has spread to areas such as heart, blood vessels, trachea, esophagus (all within chest)
- not treated surgically
- 10-15% chance of surviving 5 years
132
Stage 4 Lung Cancer
cancer has spread to other parts of body; liver, bones, brain
- less than 2% change of surviving 5 years
133
lung cancer types
- small cell (16%)
- non-small cell (80%)
134
non-small cell subtypes
- squamous : 25% of all lung cancers, grows more slowly than other types
- adenocarcinoma : 40% of all lung cancers
135
squamous cell
- arises from mucosa of bronchi
- associated with smoking
- obstructive + restrictive as they block bronchioles and grow into surrounding tissue
- metastasize late to liver and brain
136
adenocarcinoma
- may arise from bronchial epithelial cells
- most common form of lung cancer
- metastasize to CNS
137
small cell (oat cell)
- less common than non small cell
- grows more rapidly
- associated with smoking
- usually has metastasized by time of diagnosis
138
small cell (oat cell) arises
from neuroendocrine cells in the bronchi
- may produce hormones such as ADH
139
what metastasizes very early mainly due to CNS, but also the liver, pancreas, bone, spleen, etc
small cell (oat cell)
140
many cancers metastasize to
the lungs
141
lung cancers metastasize to the
adrenal glands, liver, brain, and bone
142
long term tobacco smoke causes what % of lung cancer
85%
143
non-smokers account for what percent and include what for lung cancer
15%
- genetics
- radon gas
- asbestos
- air pollution
- second hand smoke
144
signs and symptoms of lung cancer
- dyspnea
- hemoptysis
- chronic cough
- wheezing
- chest or abdominal pain
- dysphonia (hoarse voice)
- dysphagia
- cachexia (weight loss)
- fatigue
- loss of appetite
145
life time risk for cancer
smoker : 17% males , 12% females
non smoker: 1.3% males + females
146
all of carcinomas as they progress will become ...
both restrictive + obstructive
147
conducting
anatomical dead space
- nose
- mouth
- pharynx
- trachea
- primary bronchi
- secondary bronchi
- tertiary bronchi
- bronchioles
148
respiratory
- alveolar ducts
- alveoli
149
connects with bronchopulmonary segment
tertiary bronchi
150
connects with each lung
primary bronchi
151
connects with lobes
secondary bronchi
152
physiological dead space
air that makes it to alveoli but does not participate in exchange of gases
153
tube with cartilage on front and sides, not back
trachea
154
aerobic training will
decrease energy cost of breathing
155
cigarette smoking causes
decrease lung function
156
pH of blood is basic acidic or neutral
basic
157
unconscious breathing is controlled by
brainstem
158
least common form of non small cell lung cancer
squamous cell carcinoma
159
normal value of FEV1/FVC in healthy 20 year old
80-95%
UTHSC Applied Exercise Phys
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