Problem Solving Session (PSS) Respiratory Physiology I MBBS Phase I (2011/2012), 4th January 2012 Prepared by Assoc Prof

Rosnah Ismail
1. The tracing below shows spirometry recording from Matt, a healthy first-year medical student.

a. What is the value for Matts (i) minute ventilation, (ii) inspiratory reserve volume, (iii) expiratory reserve volume and (iv) vital capacity. (v) If his anatomical dead space is 150 ml, calculate his alveolar ventilation at rest. b. At point B on the spirometer tracing, Matt was asked to breathe through a wide bore, cylindrical tube 50 cm in length. (i) What effect does this have on the dead space? (ii) Why does this lead to an increase in TV? . (iii) Assuming VA remains constant when he breathes through the tube, calculate the volume of the tube. . (iv) Do you think the VA could be maintained by increasing the respiratory rate alone? Explain your answer. 2. A patient comes to UMMC for a pulmonary function test. a. His FEV1 was found to be 2 L and FVC was 3.5 L. Explain whether his pulmonary function is normal. b. He also underwent measurement of FRC using the helium dilution technique. The data obtained are as follows: [correction factor of the equipment can be neglected] He conc at beginning of expt (C1) He conc at end of expt (C2) Volume of He introduced 12.5% 6.5% 600 ml

i. Calculate his FRC. ii. Calculate his RV if his ERV is 1.4 L. iii. Are his FRC and RV normal? Explain. 3. Respiratory system a. Define compliance. b. Explain the function of surfactant. c. Draw graphs showing the change in lung volume, intrapleural and alveolar pressures in one respiratory cycle. d. i. Where would you find the greatest resistance towards airflow in lungs? Explain your answer. ii. An individual has fibrosis with thickening of alveolar-capillary membrane. At rest the patients O2 level is normal. What would you expect to happen to the blood O 2 level during exercise? iii. A patient has a reduced inspiratory capacity and TLC. FRC, RV and ERV remain unchanged. Is the problem caused by a disorder of the chestwall, the lungs or the diaphragm? Explain your answer. iv. During quiet breathing, state whether the ventilation is greater at the base or the apex? Explain. v. An exercising subject breathes a low conc of CO in a steady state. If his P ACO is 0.5 mmHg and his CO uptake is 30 ml/min, calculate his diffusing capacity of his lungs for CO. What is his estimated DLO2? vi. What is the PO2 in the tank with a pressure at 3,000 mmHg and contains 80% O2. What will be the PIO2 in the airways of a man breathing this air? vii. Explain the dyspnea seen in someone suffering from congestive heart failure. What pattern of breathing would be adopted by this patient? 4. The following data was obtained from Leong who is 75 kg. Parameter Respiratory rate Tidal vol PaCO2 PECO2 PIO2 (airway) PICO2 VCO2 VO2 a. i. What is dead space? ii. Define physiological dead space. c. The Bohr equation can be used to calculate the physiological dead space; . VD=TV (PaCO2 PECO2). Calculate Leongs physiological dead space PaCO2

12 per min 500 ml 40 mmHg 25 mmHg 150 mmHg 0 200 ml/min 250 ml/min

d. Estimate Leongs anatomical dead space and calculate his alveolar dead space. e. Explain why alveolar dead space if present, is usually found in the apex of the lungs. f. Calculate the PaO2 of Leong. (Hint: Use alveolar air equation and assume PACO2 = PaCO2) MCQ 1. Regarding pulmonary pressures: A. Intrapleural pressure is always negative B. Alveolar pressure is zero at the end of inspiration C. Intrapleural pressure is more negative at the base of an upright lungs D. Intrapleural pressure is -6 mmHg at the end of expiration E. The lungs may collapse when intrapleural pressure is zero The following factors may decrease airway resistance: A. increase in parasympathetic activity B. an intrapleural pressure that is more negative C. smoke D. increase in lung volume E. beta agonist The following statements are true: A. VC is the sum of IC + FRC B. FEV1.0 /FVC is <60% in a person suffering from fibrosis C. RV is increased in a person suffering from chronic bronchitis D. Inspiratory capacity is the volume of air that can be maximally inspired after a normal inspiration E. Expired air has PO2 that is higher than that of alveolar air Alveolar ventilation A. that is greater than normal will cause PaCO2 to increase B. will always increase when frequency of breathing is increased C. may be low in a person suffering from myasthenia gravis D. of a normal person is about 4 L/min E. is never equal to minute ventilation Gas diffusion: A. The surface area for diffusion is increased during exercise B. If gas X is twice as soluble as gas Y, X will diffuse faster than gas Y C. Mild polycythaemia will decrease O2 diffusing capacity D. An increase in PIO2 will decrease PaCO2 E. The thickening of the alveolar-capillary membrane may cause transfer of O2 across the membrane to be diffusion-limited Respiratory system: A. Alveolar oedema will increase the pulmonary compliance B. When a pneumothorax is induced, the chest wall expands C. When a the radius of an airway is reduced to 1/3, the resistance increases 3-fold D. The resistance in the extra-alveolar vessel decreases at the end of maximal inspiration E. The resistance of the pulmonary vessel is 1/20 of that of systemic circulation

2.

3.

4.

5.

6.