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I.ObstructiveandRestrictiveDiseases.......................................................................................2
II.RespiratoryParameters...........................................................................................................2
III.StructuresoftheThoracicWall................................................................................................2
IV.RespiratoryHistology...............................................................................................................3
V.PressureChangesDuringRespiration......................................................................................4
VI.ControlofRespiration..............................................................................................................4
VII.BreathingPatterns...................................................................................................................4
Notleavingtowntheweekendbeforeanexamwouldbeagood
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IwishthelibrarywereopensoIcouldprintthesestupidthings.
Page2 CardiopulmonaryExamITables
TableI ObstructiveandRestrictiveDiseases
Type Examples RV FEV1 FVC FEV1/FVC FEF2575 TLC Compliance Image
COPD,asthma,
emphysema,chronic
Obstructive bronchitis,cysticfibrosis,
upperairwayobstruction
cantgetairout
Interstitiallungdisease,
fibrosis,pulmonary
edema,pneumonia,
Restrictive pleuritis,neuromuscular
disease,obesitycantget
airin
TableII RespiratoryParameters
Parameter Equation Explanation Normalvalue
TV=tidalvolume(500mL),ADS=anatomicaldead (500mL150mL)x12/min=
AlveolarVentilation(VA) VA=(TVADS)xRR space(150mL),RR=respiratoryrate 4200mL/min
KVCO L/
ArterialCO2(PaCO2) PaCO2= VCO2=ventilatedCO2perminute(200mL/min) =40mmHg
VA L/
PIO2 =inhaled=(Patm PHO)xPpO2
P CO
AlveolarO2(PAO2) PAO2=PIO2 Patm=760mmHg,PHO=47mmHg,PpO2=21% 150 =100mmHg
R VCO L/ .
R= = =0.8
VO L/
AlveolarArterialO2Gradient
[P(Aa)O2,Aagradient]
(Aa)=PAO2PaO2 A=alveolar,a=arterial <1215mmHg
VCO =ventilatedCOperminute,PaCO =arterialCO
VCO
CODiffusionCapacity(DLCO) DLCO= Usedtoassessalveolarcapillarymembranediffusion, 25mL/min/mmHg
PaCO reducedinbothobstructiveandrestrictivediseases
Elastance(E) E=2T/r T=surfacetensionofalveolus,r=radiusofalveolus (sameaspressure)
VL VL=volumeoflung,PPL=pleuralpressure
Compliance(CL) CL= Inverselyrelatedtoelastance(CL=1/E)
0.2L/cmH2O
PPL
O2Content CO=CapHbx[Hb] CapHb=Hemoglobinbindingcapacity(1.34mL/g) 1.34mL/gx15g/dL=20mLO2/dL
TableIII StructuresoftheThoracicWall
Structure Description Significance Images
Looseconn.tissueseparatingparietal Formscleavageplane,canslicethroughit
Endothoracicfascia
pleura&fibrouspericardiumfromwall withoutdisruptingtheintrathoracicpressure
st
Superiorthoracic T1vertebra,1 pairofribs,andsuperior Passageoftrachea,esophagus,vessels,and
aperture(inlet) borderofmanubrium nervessiteofthoracicoutletsyndrome
th th
Inferiorthoracic T12vertebra,11 and12 pairsofribs, Allowspassageofinferiorvenacava,
aperture(outlet) costalcartilages710,xiphisternaljoint esophagus,andaorta
Jugularnotch Superiormarginofmanubrium AnteriorlocationofT2vertebra
nd
Sternalangle(Louis) Angleofmanubriumandsternum AnteriorlocationofT4T5,2 costalcartilage
Xiphisternaljoint Betweenxiphoidprocessandsternum AnteriorlocationofT8T9
th
Subcostalangle Sternalattachmentof7 costalcart. HandlocationforCPR
Costalmargin Formedbycartilageofribs710 Lowerborderofthorax
Trueribs Ribs17 Attachdirectlytosternumviacostalcartilage
Falseribs Ribs810 Attachtosternumviacostalmargin
Floatingribs Ribs1112 Nosternalattachment
Externalintercostalmm. Extendfromtubercletoanteriortips Mostexterior,runinferiorandmedial
Internalintercostalmm. Lateralborderofsternumtoangleofribs Middlelayer,runinferiorandlateral
Innermostintercostalm. Lateralthoracicwall Mostinterior,vestigial
Transversusthoracism. Fanshapedmuscleonanteriorwall Vestigial
Subcostalmm. Posteriorthoracicwall Vestigial
12:superiorintercostal/subclaviana.
Posteriorintercostalaa. Supplyposteriorportionsofintercostalmm.
311:branchesfromdescendingaorta
16:internalthoracica.
Anteriorintercostalaa. Supplyanteriorportionsofintercostalmm.
711:musculophrenica.(term.Branch)
Drainintoazygous,hemiazygous,or
Posteriorintercostalvv. Drainposteriorportionsofintercostalmm.
superiorintercostalvv.
Drainintointernalthoracicor
Anteriorintercostalvv.
musculophrenicvv.
Termbranches:musculophrenic,superior
Internalthoracica. Suppliesanteriorintercostals
epigastric
Drainsparasternal,post.mediastinal,
Thoracicduct intercostal,paratracheal,andsup. EmptiesintoLsubclavianv.
phrenicnodes
CardiopulmonaryExamITables Page3
TableIV RespiratoryHistology
Tissue Images Description Components Function
PCCE(ciliatedcolumnar) Epitheliallining,sweepoutparticles
Linerespiratorytract Gobletcells Containmucusdroplets&granules
Respiratory fromnasopharynx
Brushcells Numerousmicrovilli,sensoryreceptors
epithelium toterminal
bronchioles Basalcells Lieonbasallamina,mitotic
Smallgranulecells Neuroendocrine
PCCE(ciliatedcolumnar) Epitheliallining,sweepoutparticles
Upperpair,linedbyrespiratoryepithelium(L
Falsevocalfolds(VF)
Connectspharynxto image)
Larynx trachea
Hyalinecartilage Lowerpair,linedbysquamousepithelium,
Truevocalfolds(VoF)
containvocalism.(VM,Rimage)
Cartilagerings 1620,hyalinecartilage
10cmlong
Splitsintobronchiat
Trachea carina(levelof
Fibroelasticligament Preventsoverdistensionoftracheallumen
sternalangle)
Trachealism. Allowsforregulationoflumen
PCCE Moregobletcells
Rbronchusis
shorter,wider,
Bronchi moreverticalthanL
Smoothmuscle Becomesmoreprominentinsmallerbronchi
Secondary:3R,2L
Cartilage Becomeirregularplatesinsecondarybronchi
Simplecuboidalepithelium Ciliated,fewtonogobletcells
Terminal Lackglandsand
Claracells Secreteglycosaminoglycansfordetoxification
bronchioles cartilage
Smoothmuscle TargetofANSstimulation
Ciliated,fewtonogobletcells,transitionsto
Transitionbetween Simplecuboidalepithelium
simplesquamousatalveolaropenings
Respiratory conductingand
bronchioles respiratoryportions
Alveoliinwalls Claracells Secrateglycosaminoglycansfordetoxification
Simplesquamousepithelium Nociliaorgobletcells
Aroundrespiratory
Alveolar bronchiolewhere Alveolarsac Communicatebtw.ductandalveoliviaatrium
Page4 CardiopulmonaryExamITables
TableV PressureChangesDuringRespiration
Parameter Graph Changes Significance
Mustbereducedinordertoallowlung
expansionduringinspirationandviceversa
Highestatrest(FRC) duringexpiration
PleuralPressure Lowersduringinspirationinordertoallowairin
Lowestatendofinspiration(TLC) Levelswithatmosphericpressureduring
pneumothorax,resultingintheinabilityto
expand,causingcollapse
Zeroatrest(FRC),endofinspiration(TLC)
Decreasesinordertoallowairintoalveolus
AlveolarPressure Lowestatmiddleofinspiration(maxairflow)
Increasesinordertoexpelair
Highestatmiddleofexpiration(maxairflow)
TidalVolume Amountofairexchangedinonerespiratorycycle
TableVI ControlofRespiration
ControlComponent Location Sensitivity Action
Reticularactivatingsystem(RAS) Medulla Controlsawakevs.asleepstate
Membraneproperties,
Respiratorypatterngenerator RAS,dorsalandventralnucleiofmedulla Generatesrhytmicpattern(Botzingercomplex)
chemoreceptor/vagal/CNSinput
Pneumotaxiccenter Ponsrostraldorsolateral Affectsinspiratoryduration
Centralchemoreceptors Surfaceofventrolateralmedulla PaCO2,pH SendsoutputtoRPG
Peripheralchemoreceptors Carotidandaorticbodies PaO2,PaCO2,pH Innervatedbycarotidsinusn.ofCNIX
Irritantreceptors Respiratoryepithelium Irritants Provokescoughorsneeze
Pulmonaryvascular(J)receptors Vessles,possiblycapillaries Vascularcongestion Causestachypnea
TableVII BreathingPatterns
Pattern Cause Effect
HeringBreuerreflex Inflationofalveoli Modulatestidalvolumeviavagalafferents,importantininfants
CheyneStokesrespirations Poorcirculationtime Crescendodecrescendopatternoftenwithapnea
Centralsleepapnea(5%) Lackofinspiratorystimulation(EMG) Periodiclossofairflow,concomitantlossofCNSdrive
Obstructivesleepapnea(95%) Obstructionofairways Nolossofcentraldrive,inspiratorystimulationofdiaphragmpresentonEMG
Forallotherareas,refertothemyriadofquestionsthatDr.Smithsenttous.