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RESPIRATORY SYSTEM
CONTENTS
DEVELOPMENT OF RESPIRATORY SYSTEM ................................................................................................................... 5
ANATOMY OF RESPIRATORY SYSTEM ........................................................................................................................... 5
PHYSIOLOGY OF RESPIRATORY SYSTEM ........................................................................................................................ 6
GENERAL FEATURES OF RESPIRATORY PHYSIOLOGY ................................................................................................ 6
INSPIRATION AND EXPIRATION................................................................................................................................. 7
SURFACTANT ............................................................................................................................................................. 8
GASEOUS EXCHANGE ................................................................................................................................................ 8
VENTILATION PERFUSION RATIO AND COMPLIANCE ............................................................................................... 9
HYPERCARBIA AND ALVEOLAR HYPOVENTILATION ................................................................................................ 10
HYPERVENTILATION ................................................................................................................................................ 10
HIGH OXYGEN TENSION .......................................................................................................................................... 10
HYPOXIA .................................................................................................................................................................. 11
FEATURES OF HEMOGLOBIN ................................................................................................................................... 11
OXYHEMOGLOBIN DISSOCIATION CURVE ............................................................................................................... 12
REGULATION OF RESPIRATION ............................................................................................................................... 13
LUNG VOLUMES, CAPACITIES AND ALVEOLAR VENTILATION ................................................................................. 14
ACCLIMATISATION .................................................................................................................................................. 16
MOUNTAIN SICKNESS ............................................................................................................................................. 16
CAISSONS DISEASE ................................................................................................................................................. 16
SIGNS AND SYMPTOMS OF RESPIRATORY SYSTEM .................................................................................................... 17
GENERAL SIGNS AND SYMPTOMS OF RESPIRATORY SYSTEM ................................................................................ 17
HEMOPTYSIS ........................................................................................................................................................... 18
CYANOSIS ................................................................................................................................................................ 18
CLUBBING................................................................................................................................................................ 19
PANCOAST TUMOR ................................................................................................................................................. 19
CAPLAN SYNDROME................................................................................................................................................ 19
PULMONARY EDEMA .............................................................................................................................................. 20
ARDS............................................................................................................................................................................ 20
PULMONARY EMBOLISM ............................................................................................................................................ 21
PULMONARY HYPERTENSION ..................................................................................................................................... 23
PULMONARY VENOUS HYPERTENSION ...................................................................................................................... 24
COR PULMONALE ........................................................................................................................................................ 24
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RESPIRATORY SYSTEM
RESPIRATORY SYSTEM
RESPIRATORY SYSTEM
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RESPIRATORY SYSTEM
12 weeks
Pseudoglandular stage of lung
development
Pulmonary hypoplasia, Foregut cysts, Pulmonary
sequestration
Prematurity, Barotrauma, Oxygen therapy
Small airway disease, decreased FRC,
interstitial lung disease
Bronchopulmonary dysplasia
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RESPIRATORY SYSTEM
Pulmonary plexus
Normal diameter of Trachea
Lining cells of alveoli
NOT lining alveoli
MC cells in bronchoalveolar lavage
Clara cells are found in
Clara cells in bronchoalveolar lavage seen in
Lepidic pattern
Variants of bronchoalveolar carcinoma
Canals of Lembert in alveolar spaces in lung
Pleural reflection on left mid axillary line is in
Pleural extends up to which rib in mid axillary line
Pectus carinatum
Pectus excavatum
Pectus excavatum
Pectus excavatum
NOT true about pectus excavatum
Lung elasticity
More negative
Breath sounds more than 6 seconds
At the end of normal expiration of air in lungs is ERV
Mid stem bronchi
Increased compression of airway
Forced expiration, Dense air, Low lung volume
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RESPIRATORY SYSTEM
Respiration stops in last stage of expiration, in forced
expiration because of
Neutral position of Chest
Plateau pressure
Measurement of intravascular pressure by a pulmonary
catheter should be done
Water fall effect in
Blood flow to apex of lung during
Flow volume curve in RS
Childs respiratory physiology differs from adult
because of
WRONG statement about Compliance
Pulmonary circulation
Pulmonary circulation differ from systemic circulation
Lung circulation
Pulmonary vascular resistance is
decreased by
Bronchial circulation
Recruitment is seen in
During heavy exercise, cardiac output increases up to
five fold while pulmonary arterial pressure is very little.
Physiological ability of pulmonary circulation is best
explained by
Pulmonary circulation in hypoxia
Vascularity of lung
NOT true about lung circulation
Physiological dead space in lung
Physiological dead space
Normal ratio of physiological and anatomical dead
space
Anatomical dead space by
Best known metabolic function of lung
Important non respiratory function of lung
Vasoconstriction
Distended pulmonary veins in lower lobe
Decreased vital capacity in supine position, Most blood
in pulmonary capillary
Zone 1
150 ml
1:1
Single breath nitrogen curve
Conversion of angiotensin I to angiotensin II
Sodium balance
Forced EXPIRATION
Diaphragm, external intercostal
Serratus anterior, Serratus posterior, Scalene
External intercostalis
Inspiratory neuron
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RESPIRATORY SYSTEM
SURFACTANT
Surfactant is produced by
Size and number of inclusions in type II
alveolar epithelial cells producing
surfactant is increased by
Accelerates maturation of surfactant in
lung
Surfactant production in lungs start at
Surfactant is made up of
Major constituent of Surfactant
Action of surfactant in human body is done by
Hyaline membrane contains
Functions of surfactant
Type II pneumocytes
Thyroxine
Glucocorticoid
28 weeks
Phospholipid
Dipalmityl Phosphotidyl Choline
Lipid and protein
Fibrin
Increases compliance of lung, reduces
surface tension of alveolar fluid, prevents
collapse of alveoli
Break the structure of water in alveoli
Maintains alveolar integrity
Increase in alveolar surface area by surfactant
Reduced surface tension by surfactant
Type II pneumocytes
GASEOUS EXCHANGE
Oxygen cascade
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RESPIRATORY SYSTEM
Po2 in atmospheric air
Partial pressure of O2 at atmospheric pressure of 760
mm Hg
Atmospheric pressure 760mm Hg. O2 = 21%, partial
pressure of 02?
Po2 In Alveoli
Normal value of PO2 in healthy man is
At attitude of 6500 m, atmospheric pressure is 347 mm
Hg. inspired pO2
pO2 in pulmonary capillary
pO2 of aorta
Partial pressure of oxygen in venous blood
Concentration of O2 in blood 0.0025 ml, atm 760 mm
Hg, approximate oxygen tension
Normal level of Oxygen in blood when hemoglobin is
saturated with O2
Arterial blood O2 in ml of O2 per dL
Amount of dissolved oxygen transported in 100 ml of
plasma in a subject breathing 100% oxygen at 4 ATA
Additional amount of oxygen transported in 100 ml of
blood in a subject breathing 100 % oxygen under
hyperbaric conditions of 4 ATA compared to
normobaric conditions (1 ATA)
If hemoglobin is completely absent,
amount of plasma for basal oxygen
requirement
Gas used to measure diffusion in lung
Fraction of inspired air in mouth to mouth respiration
Respiratory quotient
Respiratory quotient of carbohydrate
Non Protein Respiratory Quotient
Rupture of mucosal blood vessels of trachea
Venous admixture by
160 mm Hg
159 mm Hg
104 mm Hg
80 mm Hg
73 mm Hg
97 mm Hg
95 mm Hg (because of physiological shunt)
4o mm Hg
80 mm Hg
20 ml/dl
19.8
9 ml
6 ml
83 L
CO
0.16 (16%)
VCO2/VO2
1
0.75
40 mm Hg
Thebesian veins, high V/Q areas of lung,
bronchial vein
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RESPIRATORY SYSTEM
Normal
Diffusion effect, Right to left shunt, Ventilation
perfusion abnormality
Bulbar poliomyelitis, COPD, Kyphoscoliosis
Excess of plasma bicarbonate in absence of volume
depletion
Lobar pneumonia
NIPPV
Hypertension, Tachycardia, Mydriasis due to
sympathetic stimulation
Respiratory failure, Ventilator failure, Pulmonary
edema, Drowning
Cessation of respiration
10 seconds
HYPERVENTILATION
Hyperventilation caused by
Voluntary hyperventilation at rest is
associated with
NOT a cause of hyperventilation
Initial change after Hyperventilation
In hyperventilation
Reduction in arterial oxygen tension caused by
Arterial blood gas determination in hyperventilation
shows
After hyperventilation for some time
holding breath is dangerous, due to
Alveolar O2 tension is
Solubility of CO2 is
Is toxic to tissues
Pulmonary edema, Retinal damage, CNS excitation and
confusion
Hyperthermia
Protective effect
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RESPIRATORY SYSTEM
HYPOXIA
O2 content of arterial blood
Decrease in respiration causes
Hypoxia
Hypoxia is characterized by
Tachycardia in hypoxia is due to
Hypoxia causes
MC physiological cause of hypoxemia
Most prone for hypoxic injury
Neurons may get irreversibly damaged if exposed to
significant hypoxia for
No stimulation of ventilation by hypoxia
until pO2 falls below
Hypoxia does NOT cause vasodilatation in
Hypoxemia does NOT depend on
Variant of hypoxia NOT stimulating peripheral
chemoreceptors
Anemic hypoxia is due to
Best test for anemic hypoxia
Hypoxia seen in general anesthesia
Best parameter for analysis of hypoxic hypoxia
Condition leading to tissue hypoxic without alteration of
blood oxygen content
Stagnant hypoxia is due to
Best test for stagnant hypoxia
Histotoxic hypoxia
Best test for histotoxic hypoxia
Oxygen therapy is NOT effective in
Does NOT used to prevent hypoxia
Stimulus for pulmonary vasoconstriction
Pulmonary Vasoconstrictor
Primary pulmonary hypoventilation
19.4 ml/100 ml
Decreased pH + Increased PCO2
When it is severe, it causes stimulation of sympathetic
nervous system, It leads to accumulation of hydrogen
and lactate ions, If it is chronic, causes rightward shift of
oxygen Hb curve.
Intense chemoreceptor response, Low arterial
PO2,favourable response to 100 % CO2
Diffuse vasodilatation
Decrease in cerebral blood flow
Hypoventilation
Hippocampus
8 minutes
60 mm Hg
Lung
Hb
Anemic hypoxia
Decreased O2 content in arterial blood
Oxygen content or Hb%
Hypoxic hypoxia
Arterial pO2
Cyanide poisoning
Reduced blood flow
AV difference
CO and cyanide
AV difference of PO2 of venous blood
Histotoxic anoxia
Pin Index
Hypoxemia, Hypercapnia, Thromboxane
Low PaO2
Does not respond to chemical stimuli
FEATURES OF HEMOGLOBIN
Hemoproteins
Hemoprosthetic group is found in
Heme synthesis require
Initially important for hemoglobin synthesis
First step of heme synthesis
Key enzyme in heme biosynthesis
Hemoglobin is a buffer because of
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RESPIRATORY SYSTEM
Buffer NOT involved in non rapid achievement of Renal
pH
Allosteric protein
Quarternary Structure
Hemoglobin is present in
Hemoglobin structure
Hemoglobin
Hemoglobin
Hemoglobin
Hydrophobic pockets
Hb has 4 polypeptide, Iron is present in ferrous state,
Hb is structurally similar to myoglobin, Ferrous ions are
in porphyrin rings
Histidine
His E7
Hindered environment, protects CO
poisoning
Histidine F8 of globin chain
Histidine F8 to tyrosine
Histidine 21 to serine
Glutamate for valine
Valine for alanine
Oxygenation (breaks salt bridge)
2,3 DPG
Decreased production of 2,3 bisphosphoglycerate
Zeta epsilon
HbF
HbF
Strong affinity for 2,3 DPG
Sigmoid curve of oxygen dissociation, Positive co
operativity
Heme at hydrophobic pockets
1.39 ml of O2
Carbaminocompounds, dissolved gas,
bicarbonate
250 ml
S shaped
Binding of one oxygen molecule increases the affinity of
binding other O2 molecules
Shifting affinity for Oxygen
Hyperbolic
8 alpha helix
Because p50 is low
Binding of O2 cause release of H+
3.6 pKa
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RESPIRATORY SYSTEM
curve in an adult
During exercise, increase in O2 delivery to muscle
increase because of
Role of 2,3-DPG
Major role of 2,3-DPG
Feature of 2,3-DPG
Increase in 2,3-DPG seen in
In anemia concentration of 2,3-DPG
Fetal hemoglobin has higher affinity for oxygen due to
Shift of Oxygen dissociation curve to right is by
Oxygen curve shift to right
Compound shifting curve to right
Shift to right in
Acidosis shift curve to
Right shift in oxygen dissociation curve does NOT occur
in
Oxygen dissociation curve does NOT shift to right in
Does NOT shift ODC to right
Curve shift of left by
Increased pH causes O2 dissociation curve to
What causes O2 curve to left
Oxygen dissociation in peripheral tissues is NOT altered
by
Does NOT influence dissociation curve
Oxygen affinity is increased by
Oxygen affinity is NOT increased by
Oxygen affinity is NOT increased in
O2 delivery to tissue does NOT depend on
Decrease in affinity of hemoglobin when pH of blood
falls
O2 delivery to tissue is decreased by
REGULATION OF RESPIRATION
Pacemaker of respiration
Spontaneous rhythmic respiration is initiated in
Rhythmic control of respiration lies at
Rhythm of Respiration is maintained by
Most important stimulus of respiratory centre
Respiratory centre is stimulated by
Respiratory centre
Respiratory centre depression NOT caused by
Complete transaction of brain stem above
the pons
Section above pons inhibit
Pneumotaxic centre
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RESPIRATORY SYSTEM
Inhibition of Pneumotaxic centre causes
Lesion of pneumotaxic centre
In cat apneustic centre is destroyed along with cutting
of vagi
Lesion of prebotzinger complex
Transection at mid pons level result in
Transaction at mid pons level with intact
vagii
Apneusis is caused by
What will be effect of respiration if transaction made
between pons and medulla
Lesion below medulla
NOT a stimulus for pulmonary vasoconstriction
Central chemoreceptors are most sensitive to
Chemoreceptor reflex primarily causes
Primary direct stimulus for excitation of central
chemoreceptors
Central and peripheral chemoreceptors respond to
Peripheral chemoreceptors stimulated by
Administration of pure O2 to hypoxic patients is
dangerous because
Does NOT stimulate peripheral chemoreceptors
Does NOT stimulate peripheral chemoreceptors
Tidal volume excessive load is prevented by activation
of
Inflation of lung induce further inflation
Herring Breuer inflation reflex
Affect resting ventilation
Does NOT affect resting ventilation
J receptors are present in
Stimulation of J receptors cause
J receptor stimulation causes
J receptor reflex
J receptor reflex
Lung reflexes are mediated by
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RESPIRATORY SYSTEM
respiration
Tidal volume calculated by
Tidal Volume in both Men and women
Resting tidal ventilation
Minimal tidal volume for adult resuscitation
Maintenance of tidal volume
Expiratory reserve volume
Inspiratory reserve volume
Residual volume
Inspiratory capacity (TV + IRV)
Normal vital capacity (TV + IRV + ERV)
Functional residual capacity (ERV + RV)
Total lung capacity
Amount of air in lungs at the end of tidal breath
Volume of air in Lungs when respiratory muscles are at
rest
Functional residual capacity is
Functional residual capacity
Normal functional residual capacity
Functional residual capacity is measured following
At functional residual capacity, trans respiratory pressure
system
Nitrogen washout method for
During quiet inspiration, alveolar
pressure
Alveolar ventilation
Total alveolar volume in litre per minute
Alveolar Ventilation if an adult shows tidal volume 600
ml, dead space of 150 ml and respiratory rate of 15/min
Alveolar PaO2
FEV1
FEV1 is
Instrument used for measuring vital capacity and FEV
Vital Capacity
Critical Closing volume is
Closing Capacity depends of
Breathing reserve
Hyaline membrane disease
Decreased maximum mid expiratory flow rate indicates
obstruction in
Used to measure resistance to smaller airways
Total lung capacity depends on
Normal Vd/Vt ratio in adult
Better vision in video assisted thoracoscopic surgery
created by
Spirometry used in diagnosis of
Volume that can NOT be measured by spirometer
Spirometry does NOT measure
Routine spirometry can NOT measure
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RESPIRATORY SYSTEM
In body plethysmography, a person is asked to expire
against closed glottis. change in pressure in the lung
and the box
Man connected to body plethysmograph for estimation
of FRC
ACCLIMATISATION
During acclimatization
Features of acclimatization
MOUNTAIN SICKNESS
Acute mountain sickness is associated with
Treatment of acute mountain sickness
Monges disease
Sleep desaturation
Acetazolamide
Chronic mountain sickness
CAISSONS DISEASE
For every 20 meter depth
Decompression sickness
Decompression sickness seen in
Caisson disease
Feature of Caisson disease
Pathological changes in Caisson disease is due to
Main danger in deep sea divers is due to
Nitrogen narcosis is due to
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RESPIRATORY SYSTEM
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