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Pulmonary
Mechanics
PUL 1. Diagram how pleural
pressure, alveolar pressure, airflow, and lung volume change during a normal
quiet breathing cycle. Identify on the figure the onset of inspiration,
cessation of inspiration, and cessation of expiration. Describe how
differences in pressure between the atmosphere and alveoli cause air to move
in and out of the lungs.
PUL 2. Draw a normal
pulmonary pressure-volume (compliance) curve (starting from residual volume
to total lung capacity and back to residual volume), labeling the inflation
and deflation limbs. Explain the cause and significance of the hysteresis in
the curves.
PUL 3. Define
compliance and identify two common clinical conditions in which lung
compliance is higher or lower than normal.
PUL 4. Draw the
pressure-volume (compliance) curves for the lungs, chest wall, and
respiratory system on the same set of axes. Show and explain the
significance of the resting positions for each of these three structures.
PUL 5. Identify the
forces that generate the negative intrapleural pressure when the lung is at
functional residual capacity, and predict the direction that the lung and
chest wall will move if air is introduced into the pleural cavity (pneumothorax).
PUL 6. Draw a normal
spirogram, labeling the four lung volumes and four capacities. List the
volumes that comprise each of the four capacities. Identify which volume and
capacities cannot be measured by spirometry.
PUL 7. Define the
factors that determine total lung capacity, functional residual capacity,
and residual volume. Describe the mechanisms responsible for the changes in
those volumes that occur in patients with emphysema and pulmonary fibrosis.
PUL 8. Define surface
tension and describe how it applies to lung mechanics, including the effects
of alveolar size and the role of surfactants. Define atalectasis and the
role of surfactants in preventing it.
PUL 9. Describe the
principal components of pulmonary surfactant and explain the roles of each.
PUL 10. Describe the
effects of airway diameter and turbulent flow on airway resistance.
PUL 11. Describe how
airway resistance alters dynamic lung compliance.
PUL 12. Draw a
spirogram resulting from a maximal expiratory effort. Label the forced vital
capacity (FVC), timed forced expiratory volumes (FEVs), and the maximal
expiratory flow rate between 25-75% of FVC (FEF25-75%).
PUL 13. Draw a normal
maximal effort flow-volume curve, labeling the effort-dependent and
-independent regions. Use the concept of dynamic compression of airways to
explain why each point in the effort-independent region of the curve
represents a maximal flow rate that is uniquely dependent on lung volume.
Describe how and why the shape of the flow-volume curve is shifted in
chronic obstructive lung disease (COPD).
PUL 14. Differentiate
between the two broad categories of restrictive and obstructive lung
disease, including the spirometric abnormalities associated with each
category.
PUL 15. Describe the
regional differences in alveolar ventilation in healthy and diseased lungs
and explain the basis for these differences.
Alveolar
ventilation
PUL 16. Define partial pressure and fractional concentration as they apply
to gases in air. List the normal fractional concentrations and sea level
partial pressures for O2, CO2, and N2.
PUL 17. List the normal airway, alveolar, arterial, and mixed venous PO2
and PCO2 values. List the normal arterial and mixed venous values
for O2 saturation, [HCO3-], and pH.
PUL 18. Define and contrast the following terms: anatomic dead space,
physiologic dead space, wasted (dead space) ventilation, total minute
ventilation and alveolar minute ventilation.
PUL 19. Describe the concept by which physiological dead space can be
measured.
PUL 20. Define and contrast the relationships between alveolar ventilation
and the arterial PCO2 and PO2.
PUL 21. Describe in quantitative terms the effect of ventilation on PCO2
according to the alveolar ventilation equation.
PUL 22. Be able to estimate the alveolar oxygen partial pressure (PAO2)
using the simplified form of the alveolar gas equation. Be able to use the
equation to calculate the amount of supplemental O2 required to
overcome a reduction in PAO2 caused by hypoventilation or high
altitude.
PUL 23. Define the following terms: hypoventilation, hyperventilation,
hypercapnea, eupnea, hypopnea, and hyperpnea.
Pulmonary
Circulation
PUL 24. Contrast the systemic and pulmonary circulations with respect to
pressures, resistance to blood flow, and response to hypoxia.
PUL 25. Describe the regional differences in pulmonary blood flow in an
upright person. Define zones I, II, and III in the lung, with respect to
pulmonary vascular pressure and alveolar pressure.
PUL 26. Describe how pulmonary vascular resistance changes with alterations
in cardiac output or pulmonary arterial pressure. Explain in terms of
distention and recruitment of pulmonary vessels. Identify the zones in which
these two mechanisms apply.
PUL 27. Describe how pulmonary vascular resistance changes with lung volume.
Explain in terms of alterations in alveolar and extra-alveolar blood
vessels.
PUL 28. Describe the consequence of hypoxic pulmonary vasoconstriction on
the distribution of pulmonary blood flow.
PUL 29. Describe the effects of inspired nitric oxide on pulmonary vascular
resistance and hypoxic vasoconstriction.
PUL 30. Explain the development of pulmonary edema by a) increased
hydrostatic pressure, b) increased permeability, c) impaired lymphatic
outflow or increased central venous pressure, and d) hemodilution (e.g.,
with saline volume resuscitation).
PUL 31. Describe the major functions of the bronchial circulation.
Pulmonary
Gas Exchange
PUL 32. Name the factors that affect diffusive transport of a gas between
alveolar gas and pulmonary capillary blood.
PUL 33. Describe the kinetics of oxygen transfer from alveolus to capillary
and the concept of capillary reserve time (i.e., the portion of the
erythrocyte transit time in which no further diffusion of oxygen occurs).
PUL 34. Define oxygen diffusing capacity, and describe the rationale and
technique for the use of carbon monoxide to determine diffusing capacity.
PUL 35. Describe how the ventilation/perfusion (V/Q) ratio of an
alveolar-capillary lung unit determines the PO2 and PCO2
of the blood emerging from that lung unit.
PUL 36. Identify the average V/Q ratio in a normal lung. Explain how V/Q is
affected by the vertical distribution of ventilation and perfusion in the
healthy lung.
PUL 37. Describe the normal relative differences from the apex to the base
of the lung in alveolar and arterial PO2, PCO2, pH,
and oxygen and carbon dioxide exchange.
PUL 38. Predict how the presence of abnormally low and high V/Q ratios in a
person's lungs will affect arterial PO2 and PCO2.
PUL 39. Describe two causes of abnormal V/Q distribution.
PUL 40. Define right-to-left shunts, anatomic and physiological shunts, and
physiologic dead space (wasted ventilation). Describe the consequences of
each for pulmonary gas exchange.
PUL 41. Describe the airway and vascular control mechanisms that help
maintain a normal ventilation/perfusion ratio. Name two compensatory
reflexes for V/Q inequality.
PUL 42. Be able to calculate the alveolar to arterial PO2
difference, (A-a)DO2. Describe the normal value for (A-a) DO2
and the significance of an elevated (A-a) DO2.
PUL 43. Name five causes of hypoxemia.
Oxygen
and Carbon Dioxide Transport
PUL 44. Define oxygen partial pressure (tension), oxygen content, and
percent hemoglobin saturation as they pertain to blood.
PUL 45. Draw an oxyhemoglobin dissociation curve (hemoglobin oxygen
equilibrium curve) showing the relationships between oxygen partial
pressure, hemoglobin saturation, and blood oxygen content. On the same axes,
draw the relationship between PO2 and dissolved plasma O2
content (Henry’s Law). Compare the relative amounts of O2 carried
bound to hemoglobin with that carried in the dissolved form.
PUL 46. Describe how the shape of the oxyhemoglobin dissociation curve
influences the uptake and delivery of oxygen.
PUL 47. Define P50.
PUL 48. Show how the oxyhemoglobin dissociation curve is affected by changes
in blood temperature, pH, PCO2, and 2,3-DPG, and describe a
situation where such changes have important physiological consequences.
PUL 49. Describe how anemia and carbon monoxide poisoning affect the shape
of the oxyhemoglobin dissociation curve, PaO2, and SaO2.
PUL 50. List the forms in which carbon dioxide is carried in the blood.
Identify the percentage of total CO2 transported as each form.
PUL 51. Describe the importance of the chloride shift in the transport of CO2
by the blood.
PUL 52. Identify the enzyme that is essential to normal carbon dioxide
transport by the blood and its location.
PUL 53. Draw the carbon dioxide dissociation curves for oxy- and
deoxyhemoglobin. Describe the interplay between CO2 and O2
binding on hemoglobin that causes the Haldane effect.
PUL 54. Explain why the total gas pressure of the venous blood is
subatmospheric and why this situation is accentuated when breathing 100% O2.
Explain how breathing 100% O2 can result in further arterial O2
desaturation in hypoxemic patients who develop mucous plugging of their
airways (absorption atelectasis).
PUL 55. Define respiratory acidosis and alkalosis and give clinical examples
of each.
PUL 56. Describe the mechanism and function of respiratory acid base
compensations.
Respiratory
Control
PUL 57. Identify the regions in the central nervous system that play
important roles in the generation and control of cyclic breathing.
PUL 58. Give three examples of reflexes involving pulmonary receptors that
influence breathing frequency and tidal volume. Describe the receptors and
neural pathways involved.
PUL 59. List the anatomical locations of chemoreceptors sensitive to changes
in arterial PO2, PCO2, and pH that participate in the
control of ventilation. Identify the relative importance of each in sensing
alterations in blood gases.
PUL 60. Describe how changes in arterial PO2 and PCO2
alter alveolar ventilation, including the synergistic effects when PO2
and PCO2 both change.
PUL 61. Describe the respiratory drive in a COPD patient, and predict the
change in respiratory drive when oxygen is given to a COPD patient.
PUL 62. Describe the mechanisms for the shift in alveolar ventilation that
occur immediately upon ascent to high altitude, after remaining at altitude
for two weeks, and immediately upon return to sea level.
PUL 63. Describe the physiological basis of shallow water blackout during a
breath-hold dive.
PUL 64. Describe the significance of the feedforward control of ventilation
(central command) during exercise, and the effects of exercise on arterial
and mixed venous PCO2, PO2, and pH.
Age Effects
and Nonrespiratory Lung Functions
PUL 65. Describe the effect of aging on lung volumes, lung and chest wall
compliance, blood gases, and respiratory control.
PUL 66. Identify the mechanism by which particles are cleared from the
airways.
PUL 67. Describe mechanisms for clearance of vasoactive substances from the
blood during passage through the lung. Identify a substance that is almost
completely cleared and one that is not cleared to any significant extent.
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© 2006, The American Physiological Society/Association of Chairs of
Departments of Physiology, Bethesda, MD
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