RESPIRATORY PHYSIOLOGY

PHYSIOLOGY LABORATORY
CSU MEDICINE I-A
Group 5

Members:
Bacud, Emily Joy

Baguingan, Sieren

Del Rosario, Marielle

Gonzales, Errol John

Javier, Lloyd Aldrin

 Manzano, Jayson

Pacamalan, Maria Thalia Barbara

I. INTRODUCTION
Pulmonary ventilation is the act of breathing, which can be described as the movement of air into and out of the
lungs. The major mechanisms that drive pulmonary ventilation are atmospheric pressure (Patm); the air pressure
within the alveoli, called alveolar pressure (Palv); and the pressure within the pleural cavity, called intrapleural
pressure (Pip).

The alveolar and intrapleural pressures are dependent on certain physical features of the lung. However, the ability
to breathe—to have air enter the lungs during inspiration and air leave the lungs during expiration—is dependent
on the air pressure of the atmosphere and the air pressure within the lungs. Inspiration (or inhalation) and
expiration (or exhalation) are dependent on the differences in pressure between the atmosphere and the lungs.

Pulmonary ventilation is dependent on three types of pressure: atmospheric, intra-alveolar, and

interpleural. Atmospheric pressure is the amount of force that is exerted by gases in the air surrounding any
given surface, such as the body. Atmospheric pressure can be expressed in terms of the unit atmosphere,
abbreviated atm, or in millimeters of mercury (mm Hg). One atm is equal to 760 mm Hg, which is the atmospheric
pressure at sea level. Typically, for respiration, other pressure values are discussed in relation to atmospheric
pressure. Therefore, negative pressure is pressure lower than the atmospheric pressure, whereas positive pressure
is pressure that it is greater than the atmospheric pressure. A pressure that is equal to the atmospheric pressure is
expressed as zero.

Intra-alveolar pressure is the pressure of the air within the alveoli, which changes during the different phases
of breathing / Because the alveoli are connected to the atmosphere via the tubing of the airways (similar to the
two- and one-liter containers in the example above), the interpulmonary pressure of the alveoli always equalizes
with the atmospheric pressure.

Intrapleural pressure is the pressure of the air within the pleural cavity, between the visceral and parietal
pleurae. Similar to intra-alveolar pressure, intrapleural pressure also changes during the different phases of
breathing. However, due to certain characteristics of the lungs, the intrapleural pressure is always lower than, or
negative to, the intra-alveolar pressure (and therefore also to atmospheric pressure). Although it fluctuates during
inspiration and expiration, intrapleural pressure remains approximately –4 mm Hg throughout the breathing cycle.

Thoracic wall compliance is the ability of the thoracic wall to stretch while under pressure. This can also affect
the effort expended in the process of breathing. In order for inspiration to occur, the thoracic cavity must expand.
The expansion of the thoracic cavity directly influences the capacity of the lungs to expand. If the tissues of the
thoracic wall are not very compliant, it will be difficult to expand the thorax to increase the size of the lungs.

Pulmonary ventilation comprises two major steps: inspiration and expiration. Inspiration is the process that
causes air to enter the lungs, and expiration is the process that causes air to leave the lungs. A respiratory
cycle is one sequence of inspiration and expiration. In general, two muscle groups are used during normal
inspiration: the diaphragm and the external intercostal muscles.
Quiet breathing, also known as eupnea, is a mode of breathing that occurs at rest and does not require the
cognitive thought of the individual. During quiet breathing, the diaphragm and external intercostals must contract.

A deep breath, called diaphragmatic breathing, requires the diaphragm to contract. As the diaphragm relaxes, air
passively leaves the lungs.

In contrast, forced breathing, also known as hyperpnea, is a mode of breathing that can occur during exercise or
actions that require the active manipulation of breathing, such as singing.

Respiratory volume is the term used for various volumes of air moved by or associated with the lungs at a given
point in the respiratory cycle. There are four major types of respiratory volumes: tidal, residual, inspiratory
reserve, and expiratory reserve. Tidal volume (TV) is the amount of air that normally enters the lungs during
quiet breathing, which is about 500 milliliters. Expiratory reserve volume (ERV) is the amount of air you can
forcefully exhale past a normal tidal expiration, up to 1200 milliliters for men. Inspiratory reserve volume
(IRV) is produced by a deep inhalation, past a tidal inspiration. This is the extra volume that can be brought into
the lungs during a forced inspiration. Residual volume (RV) is the air left in the lungs if you exhale as much air
as possible. The residual volume makes breathing easier by preventing the alveoli from collapsing.

II. MATERIALS AND PROCEDURE

A. Respiratory Rate
Determine the respiratory rate while the subject is engrossed in reading a textbook. The subject must
not be aware that you are taking his respiratory rate. Note whether the breathing is abdominal or
thoracic

B. Vital Capacity

Materials:
Water sealed Spirometer
Subject: All members of the class

Procedure:
1. Pre-experimental preparation
 See to it that the spirometer body is filled with water to within 1 ½ inches to the top
 Gently push the spirometer bell to its lower position
 Rotate the pulley until the right-hand edge of the stop is aligned with the zero mark
 With the spirometer bell in the lowest position and the stop aligned with the zero position,
rotate the pointer clockwise with your finger until it comes in contact with the stop and aligns
with zero
 Fit a mouthpiece to the breathing tube
2. Experimental Procedure
During the experiment on Vital Capacity or forced vital capacity, the subject nose must be filled
with a nose clip to prevent for leakage.

VITAL CAPACITY DETERMINATION

1. Perform maximum inspiration
 2. Hold Breath
3. Place the mouthpiece firmly in the mouth
4. Expire maximally
5. Remove the mouthpiece
6. Take one reading
7. Flush the spirometer by raising and lowering the bell four to five times
8. Repeat the procedure 2 or 3 times and record the longest value obtained for vital capacity.
(Note: always reset the pointer to the zero marker after each determination/reading)

C. Breath Holding Time

Materials:
1. Polygraph
2. Pneumography
Procedure:
 Pre-experimental preparation
1. Set up the polygraph.
2. Wrap the pneumograph around the chest where maximal excursions of the writing point can
be obtained and connect it to the polygraph.
 Experimental procedure
1. With the subject seated, have the subject do normal breathing for 4 or 5 respiratory cycles.
2. Hold breath at the end of a normal expiration for as long as you can. Note the time how long
the subject can hold his breath.
a. TIME: 16.71 seconds
3. Repeat no. 1.
4. Hold breath at the end of a normal inspiration for as long as you can. Note the time how long
the subject can hold his breath.
a. TIME: 32.12 seconds
5. Repeat no. 1.
6. Hyperventilate or overbreath for one minute. Hold breath at the end. Note the time how long
the subject can hold his breath.
PRECAUTION: Subject hyperventilating should stop the process the moment he feels dizzy.
a. TIME: 39.53 seconds

D. Hyperventilation

Material/s:
 Paper bag
Procedure:
1. Count subject’s normal respiration rate for 1 minutes (breaths per minute) and note depth as the
subject sits quietly. Record your observations.
2. Have the subject hyperventilate by breathing deeply and rapidly for 2 minutes. Immediately
following hyper ventilation, count respiratory rate and note their depth for one minute.
3. Have the subject rest to reach control level obtained in the procedure above.
 4. Next, have subject hyperventilate into a closed system such as a spirometer or a paper bag held
tightly over mouth and nose for 2 minutes, then remove the paper bag and note for rate and depth
of respiration. Explain result.

E. Auscultation

Materials:
 Stethoscope
Procedure:
1. Place a stethoscope low over the larynx or the trachea.
2. Pronounce “h” or “ch”, “f” and “1,2,3”.
3. Describe the character of the breath sounds- whether vesicular or bronchial and the
character of vocal resonance.

III. RESULTS AND DISCUSSION

A. Respiratory Rate and Vital Capacity

MEMBERS RESPIRATORY TIDAL VOLUME VITAL CAPACITY

RATE (ml) (ml)
Bacud, Emily Joy 12 500 6336
Baguingan, Sieren 14 500 3960
Del Rosario, 15 300 3600
Marielle
Gonzales, Errol 18 300 6996
Javier, Lloyd 16 500 7548
Manzano, Jayson 17 500 6000
Pacamalan, Ma. 12 500 3396
Thalia

On the table above, it shows that all the members were within the normal range of Respiratory rate which
is 12-20 breaths per min. Bacud and Pacamalan got the lowest Respiratory rate, while Gonzales got the
highest. As to tidal volume, theoretically, the normal value is 500 ml, as seen on the table, most of the
members are in that value except Del Rosario and Gonzales which is 300 ml. In vital capacity, the normal
value is 4800 ml, however, in the result presented all the members are not in the normal value, it can be
seen that Javier got the highest (7548 ml), followed by Gonzales (6996) and Manzano, (600), most of the
female members are below the said value.

Conclusion: It can therefore be concluded that all the members have a normal respiratory rate and all the
male got the highest compared to all the female. In tidal volume, most of the members have a normal Tidal
Volume while two of them were below (Del Rosario and Gonzales). In vital Capacity, it can be concluded
that male have a higher Vital capacity as presented in the table while female have a lower vital capacity.
Other factors that may affect the variation including person’s habitual activities, body built, and take up of
oxygen
B. Breath Holding Time

When can you hold your breath longer? At the end of inspiration or at the end of expiration? Why?
After hyperventilation. Why?
Ms. Emily Baccud can hold her breath for as 16.71 seconds at the end of a normal expiration,
32.12 seconds after normal inspiration and 39.53 seconds after hyperventilation. Based on the
results we have gathered, end-inspiratory breath hold exhibits an intermediate duration compared
to the other two activities. After expiration, oxygen is released in the air and carbon dioxide
accumulates. Carbon dioxide is known to be the primary stimulus for expiration which shorten the
breath holding time. It was also noted that breath-holding time after hyperventilation is prolonged
since increased ventilation reduces the carbon dioxide pressure in the blood. Thus, the carbon
dioxide that accumulates while holding the breath takes longer to reach the threshold for which
Ms. Baccud will be forced to take another breath.

C. .Hyperventilation

Observation: Open System

BASELINE AFTER
HYPERVENTILATION
Respiratory Rate 18 15

Observation: Closed System

BASELINE AFTER
HYPERVENTILATION
Respiratory Rate 18 26

Hyperventilation affects the body’s pH level by altering its CO2 content. During hyperventilation via open
system, the body can excrete significant amount of CO2 thereby increasing the body’s pH. This excess
CO2 excretion can be overridden by slowing or regulating the respiratory rate. As seen in the experiment,
after 2 minutes of hyperventilating via open system, the body compensated for excess CO2 loss by slowing
the respiratory rate. In that manner, the body was given enough time to regain normal CO2 level.
Meanwhile, during hyperventilation via closed system, high amount of CO2 expelled is being brought back
to the body due to the closed system. This way, the CO2 level of the body increases significantly thus
causing acidosis. The body will compensate by increasing the respiratory rate to expel excess CO 2 in the
body. In the experiment conducted, it can be seen that the respiratory rate has increased. In this way, the
body was able to release high CO2 level to balance the body’s pH.
D. Auscultation

NAME RESPIRATORY SOUNDS (AUSCULTATION)

BRONCHIAL VESICULAR SOUND VOCAL
SOUND (F) RESONANCE
(h/ch) (1,2,3)
Baguingan, Sieren Loud/high-pitched Soft/low-pitched Loud, clear
Bacud, Emily Loud/high-pitched Soft/low-pitched Loud, clear
Gonzales, Errol Loud/high-pitched Soft/low-pitched Loud, clear
Javier, Llloyd Loud/high-pitched Soft/low-pitched Loud, clear
Del Rosario, Marielle Loud/high-pitched Soft/low-pitched Loud, clear
Manzano, Jayson Loud/high-pitched Soft/low-pitched Loud, clear
Pacamalan, Thalia Loud/high-pitched Soft/low-pitched Loud, clear
Auscultation was done all over the lungs- front, axillary, regions and back. Quiet breathing was first
examined to the students then they were asked to breathe while pronouncing h/ch and f. Bronchial breath
sounds was examined corresponding with the sounds produced by breathing while pronouncing “h” or
“ch”. There were loud, rough, harsh sounds or breathing heard and of high frequency. In normal bronchial
breathing, as heard over the trachea, there is a pause between the inspiratory and expiratory sounds, which
are of nearly equal duration and of about the same intensity throughout. These sounds are also heard
between the scapulae, at the level of the fourth dorsal vertebra (bifurcation of trachea), and they occur also
during expiration, being slightly louder on the right side, owing to the slightly greater caliber of the right
bronchus.

Vesicular breath sounds were examined by placing the stethoscope over the right 5th intercostal space, we
heard a sound over the entire area, the so called “normal vesicular sound” which is audible during
inspiration. The students were asked to pronounce “f” while listening on his chest wall. It was a fine
sighing or breezy sound which gradually increases in intensity until it reaches a maximum and falls away
before expiration begins. The sound has at one time, a soft, at another a sharper character. In the expiratory
sound, it is feeble sighing sound, of an indistinct, soft character. This is caused by the air passing out of
the air vesicles, this is shorter than the inspiratory, loudest at first and soon disappears and give an
inaudible sound. This absence is not a sign of disease. Normally, breathing over most areas of the chest is
vesicular.
Vocal resonance was also examined while listening to the breath sounds. Vocal resonance is the resonance
within the chest of sounds made by the voice. It is the detection of vibrations transmitted to the chest from
vocal cords as a person repeats a phrase like “1, 2, 3”. As the student whispers a phrase like “1, 2, 3”, the
sounds heard were loud and clear. Conditions that increase or reduce conduction of breath sounds to the
stethoscope have similar effects on vocal resonance. Consolidated lung conducts sound better than air-
containing lung, so in consolidation the vocal resonance is increased and sounds are louder and clearer. In
such circumstances like in the experiment that the student whispers and produce a clear and loud sound,
this condition is called whispering pectoriloquy.
IV. ANSWERS TO QUESTION

1. What is the sequence of techniques in examining the thorax?

With abdominal assessment, you inspect first, then auscultate, percuss, and palpate. This order is
different from the rest of the body systems, for which you inspect, then percuss, palpate, and
auscultate. The difference is based on the fact that physical handling of peritoneal contents may alter
the frequency of bowel sounds.
 INSPECTION: First, take a look at the abdomen. You do most of the exam standing to the right of
your supine patient. Inspect for symmetry while standing at the side of your patient, then move to a
position behind his head. Note the contour of the abdomen: Is it flat, scaphoid (concave), or
protuberant (convex)? A flat contour is expected in well-muscled, athletic adults; thin adults may have
a scaphoid abdomen. A rounded abdomen is commonly seen in young children, but in adults it's the
result of poor muscle tone from inadequate exercise or being overweight. A localized enlargement
may indicate a hernia, tumor, cysts, bowel obstruction, or enlargement of abdominal organs. Ask your
patient to take a deep breath and hold it because this lowers the diaphragm and compresses the organs
of the abdominal cavity, which may make previously unseen bulges or masses appear.
 AUSCULTATION: Normal gut sounds are gurgling sounds (usually occurring 5 to 35 per minute)
that can be heard with the diaphragm of a stethoscope. Decreased sounds, such as no sounds for 1
minute, are a sign of decreased gut activity. Gut sounds may be markedly decreased after abdominal
surgery, abdominal infection, or injury. Absent sounds (no sounds for 5 minutes) are an ominous sign.
 PERCUSSION: Percussing the body gives one of three results: Tympany is usually present in most
of the abdomen caused by air in the gut (a higher pitch than the lungs). Resonance is a lower-pitched
and hollow sound (found in normal lungs). Dullness is a flat sound without echoes; the liver, spleen,
and fluid in the peritoneum (ascites) give a dull note, but an unusual dullness may be a clue to an
underlying abdominal mass.
 PALPATION: With your patient in the supine position, begin light palpation by depressing the
abdominal wall no more than 1 cm. At this point, you're mostly looking for areas of tenderness. The
most sensitive indicators of tenderness are your patient's facial expression. Also note any abdominal
guarding that's present. Next, proceed to deep palpation, depressing 3.8 to 5 cm in an effort to identify
abdominal masses or areas of deep tenderness. If your patient is ticklish, place your hand over his hand
while palpating.

2. What is the normal breath holding time in adults?

 Most untrained people can comfortably hold their breath for 30 seconds before gasping. That
threshold has little to do with oxygen—your body has plenty of that in reserve. The more dangerous
problem is the buildup of carbon dioxide, which acidifies the blood.

3. What are the muscles of respiration?

 Muscles that raise the rib cage are muscles of inspiration.
Contraction of the external intercostals causes the ribs to move upward and forward in a “bucket
handle” motion. Accessory muscles include the sternocleidomastoid muscles, the anterior serrati,
and the scaleni.
 Muscles that depress the rib cage are muscles of expiration:
internal intercostals, abdominal recti and diaphragm
 Heavy breathing requires the additional use of the secondary respiratory muscles, including the upper
trapezius, scalenes, sternocliedomastoid, levator scapulae and pectoralis minor
4. What are the different pressures of the lungs?
 Pleural Pressure Is the Pressure of the Fluid in the Space Between the Lung Pleura and Chest Wall
Pleura. The normal pleural pressure at the beginning of inspiration is about −5 centimeters of water.
During inspiration, averaging about −7.5 centimeters of water.
 Alveolar Pressure Is the Air Pressure Inside the Lung Alveoli. When the glottis is open and there is no
movement of air, the pressures in all parts of the respiratory tree are equal to the atmospheric pressure,
which is considered to be 0 centimeters of water. During inspiration, the pressure in the alveoli
decreases to about −1 centimeter of water. During expiration, the alveolar pressure rises to about +1
centimeter of water.
 Atmospheric Pressure: pressure outside the body.

5. What are the elastic forces of the lungs?

 Elastic forces of the lung tissues are determined mainly by the elastin and collagen fibers. Elastic
forces caused by surface tension in the alveoli account for about two thirds of the total elastic forces
in normal lungs.

6. The work of inspiration is divided into 3 fractions? Define each.

The work of inspiration can be divided into three fractions:

 compliance work or elastic work:
 the lung's ability to stretch and expand (distensibility of elastic tissue) the lungs against the
lung and chest elastic forces.
 tissue resistance work
 that work required to overcome the viscosity of the lung and chest wall structures.
 airway resistance work
 The work required to overcome airway resistance to movement of air into the lungs.
7. What are the different lung volumes and capacities? Define each.

Pulmonary Volumes
 The tidal volume is the volume of air inspired or expired with each normal breath; it amounts to about
500 milliliters in the average adult male.
 The inspiratory reserve volume is the extra volume of air that can be inspired over and above the
normal tidal volume when the person inspires with full force; it is usually equal to about 3000
milliliters.
 The expiratory reserve volume is the maximum extra volume of air that can be expired by forceful
expiration after the end of a normal tidal expiration; this volume normally amounts to about 1100
milliliters.
 The residual volume is the volume of air remaining in the lungs after the most forceful expiration; this
volume averages about 1200 milliliters.
 Pulmonary Capacities
 The inspiratory capacity equals the tidal volume plus the inspiratory reserve volume. This capacity is
the amount of air (about 3500 milliliters) a person can breathe in, beginning at the normal expiratory
level and distending the lungs to the maximum amount.
 The functional residual capacity equals the expiratory reserve volume plus the residual volume. This
capacity is the amount of air that remains in the lungs at the end of normal expiration (about 2300
milliliters).
 The vital capacity equals the inspiratory reserve volume plus the tidal volume plus the expiratory
reserve volume. This capacity is the maximum amount of air a person can expel from the lungs after
first filling the lungs to their maximum extent and then expiring to the maximum extent (about 4600
milliliters).
 The total lung capacity is the maximum volume to which the lungs can be expanded with the greatest
possible effort (about 5800 milliliters); it is equal to the vital capacity plus the residual volume. All
pulmonary volumes and capacities are usually about 20 to 25 percent less in women than in men, and
they are greater in large and athletic people than in small and asthenic people.

8. What are the areas of gas exchange?

Gas exchange is the delivery of oxygen from the lungs to the bloodstream, and the elimination of
carbon dioxide from the bloodstream to the lungs. It occurs in the lungs between the alveoli and a
network of tiny blood vessels called capillaries, which are located in the walls of the alveoli.

The walls of the alveoli actually share a membrane with the capillaries in which oxygen and carbon
dioxide move freely between the respiratory system and the bloodstream. Oxygen molecules attach to
red blood cells, which travel back to the heart. At the same time, the carbon dioxide molecules in the
alveoli are blown out of the body with the next exhalation.

9. Define and explain each dead space.

 Anatomic Dead space

Airway regions that, because of inherent structure, are not capable of 02 and C02 exchange with
the blood. Anatomic dead space includes the conducting zone, which ends at the level of the
terminal bronchioles. Significant gas exchange (02 uptake and C02 removal) with the blood occurs
only in the alveoli.
 Alveolar Dead space
 Alveolar dead space (alvV0) refers to alveoli containing air but without blood flow in the
surrounding capillaries. An example is a pulmonary embolus.
 Physiologic Dead space
Physiologic dead space refers to the total dead space in the lung system (anatomic dead space +
alveolar dead space). When the physiologic dead space is greater than the anatomic dead space, it
implies the presence of alveolar dead space, somewhere in the lung, alveoli are being ventilated
but not perfused.
10. What are the normal respiratory functions of the nose?

As air passes through the nose, three distinct normal respiratory functions are performed by the nasal
cavities: (1) the air is warmed by the extensive surfaces of the conchae and septum, a total area of about
160 square centimeters
(2) the air is almost completely humidified even before it passes beyond the nose

(3) the air is partially filtered. These functions together are called the air conditioning function of the
upper respiratory passageways.
Filtration Function of the Nose:

The hairs at the entrance to the nostrils are important for filtering out large particles. Much more important,
though, is the removal of particles by turbulent precipitation. That is, the air passing through the nasal
passageways hits many obstructing vanes: the conchae (also called turbinates, because they cause
turbulence of the air); the septum; and the pharyngeal wall. Each time air hits one of these obstructions, it
must change its direction of movement. The particles suspended in the air, having far more mass and
momentum than air, cannot change their direction of travel as rapidly as the air can. Therefore, they
continue forward, striking the surfaces of the obstructions, and are entrapped in the mucous coating and
transported by the cilia to the pharynx to be swallowed.

11. What are the 3 zones of the lungs?

Zone 1: Alveolar pressure > arterial pressure > venous pressure. It the zone where blood flow is lowest.
Zone 2: arterial pressure > alveolar pressure > venous pressure. the blood flow in this zone is driven by
the difference between arterial pressure and alveolar pressure.
Zone 3: Alveolar pressure > venous pressure > arterial pressure. blood flow here is the highest and is
driven by the difference between arterial and venous pressures.
12. How does the pulmonary circulation accommodate the increase cardiac output in exercise without large
increase in pulmonary arterial pressure?
The pulmonary circulation is a low pressure, high flow circuit. Low pressure prevents fluid moving out
of fluid from the pulmonary vessels into the interstitial space, and allows the right ventricle to operate at
minimal energy cost. Exercise increases oxygen uptake (VO2) and carbon dioxide output (VCO2) up to
some twenty-fold above resting values, and this increase in gas exchange is matched by an increase in
cardiac output up to some 6-fold. The 6-fold increase in cardiac output is needed for the increased
convective transport demands of these gases to and from exercising muscles. Thus, exercise is a
considerable stress on the pulmonary circulation, taking the entire cardiac output while keeping the lungs
dry and the right ventricle compensated.

Two main adjustments take place:

 a three-fold increase in capillary blood volume, allowing to compensate for the decreased red blood
cell transit time
 and an increase in mean VA/Q relationship by a factor of three to increase alveolar PO2 (PAO2)
and decrease alveolar PCO2 (PACO2).

These adaptations explain why pulmonary gas exchange is generally well preserved up to high levels of
exercise, as assessed by maintained arterial PO2 (PaO2) and PaCO2, and by chemoreflex decrease in
PaCO2 above the ventilatory threshold.
13. What is pleural effusion and it’s causes?

Pleural effusion is the build-up of excess fluid between the layers of the pleura outside the lungs.
The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to
lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura.

Pleural effusions are very common. Depending on the cause, the excess fluid may be either protein-
poor (transudative) or protein-rich (exudative).

The most common causes of transudative (watery fluid) pleural effusions include:
 Heart failure
 Pulmonary embolism
 Cirrhosis
 Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly caused by:
 Pneumonia
 Cancer
 Pulmonary embolism
 Kidney disease
 Inflammatory disease
Other less common causes of pleural effusion include:
 Tuberculosis
 Autoimmune disease
 Bleeding (due to chest trauma)
 Chylothorax (due to trauma)
 Rare chest and abdominal infections
  Asbestos pleural effusion (due to exposure to asbestos)
 Meig’s syndrome (due to a benign ovarian tumor)
 Ovarian hyperstimulation syndrome
Certain medications, abdominal surgery and radiation therapy may also cause pleural effusions.
Pleural effusion may occur with several types of cancer including lung cancer, breast cancer and
lymphoma. In some cases, the fluid itself may be malignant (cancerous), or may be a direct result
of chemotherapy.
14. Differentiate Pneumothorax, Hemothorax, Chylothorax, and Pyothorax?

All of these conditions are caused by accumulation in the pleural space and they differ only in what
accumulates between the layers of the pleura.

 Pneumothorax: occurs when air enters the pleural space, which causes the lung to collapse.
 Hemothorax: occurs when blood accumulates in the pleural space.
 Chylothorax: occurs when lymphatic fluid accumulates in the pleural space, this could be due to
trauma.
 Pyothorax: is the presence of inflammatory fluid or pus in the pleural space.

15. What are the factors that affect the rate of gas diffusion through the respiratory membrane?

Factors:
 The thickness of the respiratory membrane
 The surface of the respiratory membrane
 The diffusion coefficient of the gas in the substance of the respiratory membrane.
 The partial pressure difference of the gas between the two sides of the membrane

16. What is the normal ventilation perfusion ratio? Ventilation perfusion mismatch? Give pathologic
examples of mismatch?
The normal V/Q ratio is 0.8
Ventilation- perfusion or V/Q mismatch occurs when there is an obstruction in the airway, such as when
your choking, or an obstruction in the blood vessel or blood clot in the lung. When V/Q ratio is high, there
is high PO2 and low PCO2. Conversely, when the ration is low, the PO2 is low and the PCO2 is high.
Moreover, when V/Q ratio is 0, this means that there is a shunt (i.e Right to left shunt) or there is airway
obstruction. When the V/Q is infinite, there is perfusion but no ventilation, as seen in pulmonary
embolism.
Some pathologic conditions with V/Q mismatch are:
 COPD
 Asthma
 Pneumonia
 Pulmonary edema
 Airway obstruction
 Pulmonary embolism
17. What is the composition of the respiratory center and their function?
Respiratory center- composed of several groups of neurons located bilaterally in the medulla oblongata
and pons of the brain stem.
Function:
a. Dorsal respiratory group – control of respiration and respiratory control
b. Ventral respiratory group- both inspiration and expiration
c. Pneumotaxic center- limits the duration of inspiration and increase the respiratory rate

18. What is Hering- Breuer inflation reflex?

Hering-Breuer inflation reflex
 when lungs become overly inflated, the stretch receptor activate and appropriate feedback
response that “switch off” the inspiratory ramp and thus stops further inspiration. This
reflex also increases the rate of respiration, as in true signals from the pneumotaxic center.
19. What is the primary stimulus in the excitation of the chemosensitive neurons? Explain.
Hydrogen Ions. The sensory neurons in the chemosensitive area are especially excited by
hydrogen ions, in fact, it is believed that hydrogen ions may be the only important direct stimulus for these
neurons. Although increase in CO2 concentration in the blood does not directly stimulate the
chemosensitive neurons, it has a very potent indirect effect. Hydrogen ion can’t cross the blood brain
barrier but CO2 can easily pass through. CO2 travels in the blood and can combine with H2O to form
carbonic acid which can dissociate to become H+ and HCO3-. Thus, a rise in PCO2 in the blood,
subsequently increases the H+ concentration which will stimulate chemosenstive neurons.
Central chemoreceptors in the medulla oblongata, are sensitive to the changes in pH in the blood
20. What is the importance of vocal resonance? Give pathologic conditions that would increase or decrease
the intensity of the sound heard?
Vocal resonance is the result the transfer of sound produced by the vocal folds through the vocal
tract. The vocal tract filters the sound, selectively enhancing harmonics basing on size/shape of the vocal
tract. The perceived resonance is the result of the filtered tone.The resonators include the mouth, the nose
and associated nasal sinuses, the pharynx, and even the chest cavity. The function of the nasal resonators
is demonstrated by the change in voice quality when a person has a severe cold that blocks the air passages
to these resonators.
Resonance Disorders could result from too much or too little and/or oral sound energy in the speech signal.
This includes:
 Hypernasality: when too much sound resonates in the nasal cavity during speech. In severe
cases, abnormal speech characteristics can occur such as nasal emission. This is due to an
abnormal opening between the nose and the mouth during speech.
 Hyponasality: when there is not enough sound resonating in the nasal cavity during speech.
This could be due to congestion of blockage in the throat or nose.
 Cul-de-sac: occurs when sounf resonates in the throat or nose and is trapped in that area
with no outlet.
21. What are adventitious breath sounds and their associated conditions?
Adventitious breath sounds are abnormal sounds that are heard over patient’s lung or airways. These
sounds include crackles which are discontinuous popping sounds as can be observe in patients with
pneumonia, pulmonary edema interstitial lung disease and heart failure. Wheezes which are continuous
sounds that are high or low pitch and is usually more pronounced in expiration, this can be heard in patients
with asthma and COPD. Pleural rubs which are creaking sounds. This is due to inflamed pleural surfaces
rubbing on each other during breathing. Stridor, loud, high-pitched sound heard during inspiration. This
is can be observed in patients with upper respiratory tract obstruction when heard on inspiration and if
heard during expiration it is associated with intrathoracic tracheobronchial lesions.