BMSN2202Tutorial#1

RevisiononPulmonaryPhysiologyand
Disorders

Dr. YeungManNga,Mandy
Rm423,SchoolofNursing
Tel:39176684
Email:mandyymn@hku.hk 1
Whatiselasticrecoil?
Tendencyofanelasticobjecttoreturntoitsoriginalshapeafteritis
deformedbyanexternalforce.

Atequilibrium,recoilpressurehasthesamemagnitudeastheforceapplied,
buttheyareofoppositedirection.

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Elasticrecoiloftherespiratorysystem
Ifyouwanttoinflatethelungs,youhavetoovercometheelasticrecoilofthe
respiratorysystem

1. Elasticrecoilofthelung
a. Whatisthenaturalpositionofthelungs? Collapsed(thelungsarealways
expandedinsidechestcavity)
b. Whatcontributestotherecoilpressureofthelungs?
i. Elasticityoflungtissue
ii. Surfacetensioninalveoli

2. Elasticrecoilofthechestwall
a. Whatisthenaturalpositionofthechestwall?
b. Whatcontributestotherecoilpressureofthechestwall?

3
 Surfacetensionoftheairliquidinterface

Capillary

TypeIalveolarcells
(respiratorysurface) TypeIIalveolarcells
(secretessurfactant)

https://beyondthedish.wordpress.com/2011/11/21/ 4
Elasticrecoiloftherespiratorysystem
Ifyouwanttoinflatethelungs,youhavetoovercometheelasticrecoilofthe
respiratorysystem

1. Elasticrecoilofthelung
a. Whatisthenaturalpositionofthelungs? Collapsed(thelungsarealways
expandedinsidechestcavity)
b. Whatcontributestotherecoilpressureofthelungs?
i. Elasticityoflungtissue
ii. Surfacetensioninalveoli

2. Elasticrecoilofthechestwall
a. Whatisthenaturalpositionofthechestwall? 60%Vitalcapacity
b. Whatcontributestotherecoilpressureofthechestwall?
i. Elasticityofthechestwalltissue
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 Lungvolumesandcapacities
Lungvol.(L) Maximalinspiration
Chestwall
expanded

6.0

60%VC

3.0
compressed
Chestwall

2.5

1.5
Maximalexpiration

6
Q3.Lungvolumeat______________isconsideredthenaturalposition
oftherespiratorysystem. Noenergyexpenditureis
requiredtomaintainthis
A. tidalvolume position(i.e.nomuscle
B. residualvolume contractionneeded)
C. totallungcapacity
D. functionalresidualcapacity(Endexpiratorypositionatrest)

Outwardrecoilofchestwall= inwardrecoiloflungs
Intrapleuralpressure(Pip)= 4mmHg

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Q4.Whenlungvolumeisatresidualvolume,

A. thelungsarerecoilingoutward.
B. thechestwallisrecoilingoutward.
C. inspiratorymusclesareactively
contractingtomaintainthisposition.
Chestwallrecoil> lungrecoil
D. transpulmonary pressureatthis Energy neededtoovercome
positionislargerthanwhenlung therecoilpressuredifference
volumeisattotallungcapacity.
Pressuredifference
betweeninside&
outsideofthelungs 60%VC
= Palv Pip
= forcethatexpands
thelungs NP
RV

8
Q5.Lungcompliance

A. isconstantatanylungvolume.
B. increaseswithincreasinglungvolume.
C. ishigherinsupineposition.lungvol.,pulmonarybloodow
D. ishigherinpatientwithemphysema.lungtissuedestruction
E. ishigherinpatientwithpulmonaryfibrosis scarringoflungtissue
F. decreaseswithage. lung ssue

Lungtissueisverystretched
highrecoilpressure

Compliance = vol / pressure

=slopeofpressurevol.curve
Smallairwayclosed needmoreenergy toopen theairways

9
Q6.Airwayresistance(Raw) 1/r4
A. isthelowestinthetracheaasithasthe Lowesttotalcross
largestradius. sectionalarea

B. isthehighestinthesmallbronchiolesas Highesttotalcross
theyhavethesmallestradii. sectionalarea

C. isconstantthroughoutarespiratorycycle.lungvol. Raw
lungvol. Raw
D. isdecreasedincaseofpulmonaryfibrosis.
lungcompliance
elas crecoil Radialtraction
radialtraction

Air
way

10
Lungfunctiontests
Q1.Whichofthefollowingstatementsabout
vitalcapacityis/arecorrect?

A. Itcanbemeasuredbyusinga
simplespirometer.
Measuresall lungvol.andcapacities
B. Itcanbemeasuredbyusing bymeasuringtheamountofN inthe
2
nitrogenwashouttechnique. lungsatthebeginningoftest.
C. Increaseinvitalcapacitymay Expansionoflungsisrestricted
indicaterestrictivelungdiseases. (e.g.pulmonaryfibrosis)
D. Patientwithemphysemawillshow
increasedforcedvitalcapacity.

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 Normallungs Characteristics:
1. lungcompliance
2. alllungvolumes&
capaci es

IC

Pulmonaryfibrosis ERV

ERV
RV

http://en.wikipedia.org/wiki/Idiopathic_pulmonary_fibrosis#mediaviewer/File:Ipf_NIH.jpg 12
Lungfunctiontests
Q1.Whichofthefollowingstatementsaboutvitalcapacity
is/arecorrect?

A. Itcanbemeasuredbyusinga
simplespirometer.
Abletomeasurealllungvol.
B. Itcanbemeasuredbyusing andcapacities.Principleof
nitrogenwashouttechnique. testistomeasuretheamount
ofN2 inthelungs.
C. Increaseinvitalcapacitymay Expansionoflungsisrestricted
indicaterestrictivelungdiseases. (e.g.pulmonaryfibrosis)
D. Patientswithemphysemahave
increasedforcedvitalcapacity. Obstructivedisease
(airwayobstruction)

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 Normal Emphysema

IC

ERV
IC
RV

Characteristics:
1. ___________ofalveolarwall
destruction
enlarged lungcompliance TLC
2. ________alveolidueto________________
narrowing radialtraction ERV,RV
3. __________ofsmallairwaysduetoreduced_____________

http://www.acbrown.com/lung/Lectures/RsVntl/RsVntlPthpEmph.htm 14
Lungfunctiontests
Q1.Whichofthefollowingstatementsaboutvitalcapacity
is/arecorrect?

A. Itcanbemeasuredbyusinga
simplespirometer.
Abletomeasurealllungvol.
B. Itcanbemeasuredbyusing andcapacities.Principleof
nitrogenwashouttechnique. testistomeasuretheamount
ofN2 inthelungs.
C. Increaseinvitalcapacitymay Expansionoflungsisrestricted
indicaterestrictivelungdiseases. (e.g.pulmonaryfibrosis)
D. Patientswithemphysemahave Obstructivedisease
increasedforcedvitalcapacity. (airwayobstruction)
decreased Standardtestforassessing
airwayobstruction:
=FEV1/FVCratio(<0.8)

15
Matchingalveolarventilationwithperfusion
MostefficientwaytoloadO2 andremoveCO2
1. everyalveolushasfreshairsupply(ventilation)
2. capillarybloodflowisavailableforeachalveolus(perfusion)
Matchedventilationandperfusion(@normalrestingstate)
. .
alveolarventilation/perfusionratio(VA/Q)~ 0.8
PartlyregulatedbyalveolarPO2

Ifthereisanymismatch inventilationandperfusion
changeinalveolarventilation/perfusionratio
ventilationperfusioninequality(chiefcauseofhypoxemiainvariousdisease)
inefficientgasexchange
affectarterialpartialpressures

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Ventilationperfusioninequality
1. Alveolusisnotventilatedandthereissufficientbloodsupply
. .
VA/Q=0(shunt)
a. WhathappenstoalveolarPO2 andPCO2?

PO2 ________;PCO
2_________
b. WhathappenstoPO2 andPCO2ofeffluentblood?
eventuallythesameasthatofthemixedvenousblood
c. WhathappenstoarterialPO2 andPCO2?

PaO2 _______;PaCO
2________

NormalalveolarPO2 =100 AtmosphericPO2 =160

NormalalveolarPCO2 =40 AtmosphericPCO2 =0.3
alveolus

NormalmixedvenousPO2 =40
NormalmixedvenousPCO2 =45

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Ventilationperfusioninequality
2. Alveolusiswellventilated,butnobloodsupply
. .
VA/Q=
a. WhathappenstoalveolarPO2 andPCO2?

PO2 ________;PCO
2_________
b. WhathappenstoPO2 andPCO2ofeffluentblood?
eventuallythesameasthatoftheinspiredair(ifthereisanyblood)

NormalalveolarPO2 =100
NormalalveolarPCO2 =40
AtmosphericPO2 =160
alveolus AtmosphericPCO2 =0.3

NormalmixedvenousPO2 =40
NormalmixedvenousPCO2 =45
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Howdoesventilationperfusioninequality
affectarterialPO2?
Littlebloodflow
1. PO2 inbothalveoliand
Littleventilation blood
1. PO2 inbothalveoli 2. little intotalO2 carried
andblood permlblood(HbO2 curve)
2. totalO2 carried
permlblood

PaO2 isdetermined
bytherelative
amountofblood
thatcomefromthe3
typesofalveoli

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Howdoesventilationperfusioninequality
affectarterialPCO2?
Littlebloodflow
PCO2 inbothalveoli
Littleventilation andblood
PCO2 inbothalveoli
andblood

PaCO2 isdetermined
bytherelativeamount
ofbloodthatcome
fromthe3typesof
alveoli

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OveralleffectofV/Qmismatch
DecreasedPaO2 (hypoxemia)andincreasedPaCO2(hypercapnia)
AnincreaseinPaCO2 triggerschemoreceptorreflex
increasesventilation(respiratorycompensation)
PaCO2 returnstonormal
butPaO2 cannotreturntonormalvalue
(duetohighO2 saturationatPO2 >60mmHg)

97.5%

21
 cerebrum
Regulationofbreathing
Limbicsystem
Q1.Respiratorycontrolcentres Hypothalamus

arelocatedinthe
A. midbrainandpons. Central
B. ponsandmedulla. Pneumotaxic chemoreceptors
centre
C. midbrainandmedulla. Apneustic
D. hypothalamusand centre
medulla. CNIXandX
Peripheral
chemoreceptors
Baroreceptors CNX Inspiratory
Q2.Apneusticcentre Stretch
centre
receptors Expiratory
centre
A. stimulatesinspir.centre
B. inhibitsinspir.centre
C. stimulatesexpir.centre
D. inhibitsexpir.centre

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Q3.Whichofthefollowingreceptorsisinvolvedinregulationof
breathinginresponsetochangesinpH?
A. TypeJreceptors Pathologicalconditions(e.g.pulmonaryoedema)
B. Stretchreceptor HeringBreuerreflexforfeedback
C. Irritantreceptors regulationofbreathingrhythm
D. Chemoreceptors
1. central(medullaoblongata)
2. peripheral(aorticandcarotidbodies)

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Q4.Whichofthefollowingstatementsiscorrectaboutthechangesin
respiratorysysteminresponsetodiabeticketoacidosis?
high H+ in blood

A. Centralchemoreceptorsareactivatedleadingtoa
largeincreaseinventilation. NotactivatedasH+ ionscannotcross
bloodbrainbarrierreadily
B. Bothcentralandperipheralchemoreceptorsare
activatedleadingtoalargeincreaseinventilation.
C. Centralchemoreceptorsareinhibitedwhile DuetoPCO2 as
peripheralchemoreceptorsareactivated ventilationincreases
resultinginaslightincreaseinventilation.
D. Centralchemoreceptorsareactivatedwhile
peripheralchemoreceptorsareinhibited
resultinginaslightincreaseinventilation.

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Q5.Concerningtheperipheralchemoreceptors:

A. TheyrespondtochangesinarterialPO2
butnotpH.
B. Theyarethemostimportantreceptors
thatcauseincreaseinventilationin Central chemoreceptorasCSF
havelittlebufferingcapacityso
responsetoariseinPCO2. thatslightchangesinPCO2
resultsinalargerchangeinpH.
C. TheirresponsetochangesinPCO2 is
slowerthanthatofthecentral Fasterastheyareinclose
chemoreceptors. proximitywitharterialblood

D. Undernormalcondition,theirresponse
tochangesinPO2 isverysmall.

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WhenPCO2 iskeptconstant@40mmHg
PO2 willcausealargeincreasein
ventilationesp.whenPO2 <60mmHg

Inrealsitua on,ven la onwill

leadtoPCO2 whichinturninhibits
ventilation

Therefore,theoveralleffectofPO2
=aslightincreaseinventilation

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Q6.Themostpowerfulstimulusforbreathinginaheathypersonis

A. lossofO2 intissues.
B. increaseinCO2.
C. pH(acidosis).
D. pH(alkalosis).
Respiratoryfailure
Definition:
Respiratoryfailureoccurswhenthelungsfailtooxygenatethearterial
bloodadequatelyand/orfailstopreventCO2 retention

Generalindicationforrespiratoryfailure:
1. PaO2 lowerthan60mmHg(hypoxemia)and/or
2. PaCO2 greaterthan50mmHg(hypercapnia)

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TypeIandTypeIIRespiratoryFailure
TypeIfailure
Causes Gas exchangefailure
1. Impairedgasdiffusion
2. V/Qmismatch
Mostlungdiseases(e.g.fibrosis, apparatus(e.g.complianceis
COPD,pulmonaryoedema)
TypesIIfailure
Ventilationfailure
1. Hypoventilation
Problemwithbreathing
toolow,neurodepression,
weaknessinrespiratory
muscles)

Presence ofrespiratory
compensation Yes No orinsufficient
(chemoreceptorreflex)
AlterationinPO2 Low,< 60mmHg Low,<60mmHg
1. normal
AlterationinPCO2 High,>50mmHg
2. normal 50mmHg

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 Impaired diffusion V/Qmismatch Ventilation failure

AlterationinPO2

Normal(asCO2
AlterationinPCO2 diffusion is20Xfaster
thanO2)
Presence of
Yesdueto
respiratory YesduetolowPO2 No orinsufficient
PCO2
compensation
PO2 Towards normal Towardsnormal

PCO2 Normal

Causes Hypoxia Hypercapnia

Hypoventilation

Impaireddiffusion X(fastCO2 diffusion rate)

Shunt X(lowered inseriousshunt)

V/Qmismatch (maybecompensated)