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MHD VI: Pulm > 11.19: Pulm Review > Flashcards

11.19: Pulm Review Flashcards

1
Q

What occurs to venous CO2 during exercise?

A
  • Increase

- There is no change in arterial gases during exercise

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2
Q

What is normal O2 consumption at rest?

A

250ml/min

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3
Q

What is RQ

A

“Respiratory quotient”

- RQ = VCo2 / VO2, normally = .8

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4
Q

Normal Tidal volume and respiratory rate?

A

RR = 10
TV = 500ml
**5 liters per minute

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5
Q

What happens to arteriole gas levels during exercise?

A
  • They always equilibrate in alveoli regardless of how hard you exercise or how short of breath you feel
  • Alveoli is always fully oxygenating blood
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6
Q

What happens to O2 in exercise?

A
  • VO2 increases until O2 delivery cannot meet oxidative phosphorylation requirement
  • Metabolic acidosis occurs after this to make more ATP
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7
Q

What is the anaerobic threshold?

A
  • HR at which lactate levels jump up greatly during exercise
  • ATP demands cannot be met oxidatively, so now some must be done anaerobically
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8
Q

What happens to tidal volume during exercise?

A

Increases

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9
Q

Equation for max heart rate?

A

220 - age

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10
Q

Does exercise cause hypoxemia?

A
  • NO, unless you have lung disease
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11
Q

What occurs in pulmonary fibrosis?

A
  • Lung volume cannot increase with pressure increase

- Lungs have lost their compliance

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12
Q

What is increased compliance?

A
  • Small pressure change giving bigger than normal volume

- Loss of recoil seen in emphysema

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13
Q

What occurs in emphysema?

A
  • Loss of lung recoil / increased compliance
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14
Q

How does asthma change compliance?

A

It doesnt

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15
Q

What is responsible for difference between minute ventilation and alveolar ventilation?

A

Dead space

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16
Q

What is dead space?

A
  • Volume of inspired gas that does not partake in gas exchange: “Ventilated but not perfused”
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17
Q

What is anatomic dead space?

A
  • Portion of each breath that does not make it far enough into lungs
  • Makes it into trachea but not lungs
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18
Q

What is physiologic dead space?

A
  • Gas that makes it to alveoli but is not exchanging gas as the alveoli it is in is not being perfused
  • Occurs in zone 1 of lung: upper alveoli
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19
Q

What is VD/Vt?

A
  • Portion of each tidal volume that is wasted
  • Dead space over tidal volume
  • Normally is about 30%
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20
Q

What happens to dead space in exercise

A
  • Dead space decreases with increased flow to apex of lung
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21
Q

What are diseases that can increase dead space?

A
  • Volume depletion
  • Pulmonary embolism
  • Increased alveolar pressure from mechanical ventilation
  • *Anything that will decrease perfusion to lung
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22
Q

What are the consequences of increased dead space?

A
  • Reduced CO2 elimination

- Increased work of breathing: dyspnea

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23
Q

What happens to PaCO2 in panic attack?

A
  • Decreases

- Your breathing rate increases to blow more off but you are not making more than normal

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24
Q

What does increased dead space normally do to minute ventilation?

A
  • Increases it to maintain normal Co2

- If CNS is not working Co2 will increase

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25
Q

What happens to CO2 in pulmonary embolism?

A
  • PaCo2 decreases because body does so many things to compensate
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26
Q

What is hypercapnia?

A

Excessive Co2 in bloodstream, typically caused by inadequate respiration

27
Q

What is WOB?

A

Work of breathing, person appears to be doing lots of work to get breath

28
Q

What could lead to Normal PaO2, O2 saturation but decreased O2 content?

A

Colon cancer leading to anemia

29
Q

What determines Hgb saturation?

A
  • Driving pressure of O2 in the blood

- How much Hgb is available for binding

30
Q

What is O2 content?

A
  • Total oxygen in blood including that bound to Hgb
31
Q

At which Po2 is 50% saturation achieved?

A
  • 27

- Usually will be dead

32
Q

What is normal venous PO2?

A
  • 50% leading to saturation of 75%
33
Q

What does arterial Po2 of 60 lead to?

A
  • 90% saturation

- Above PO2 60 minimal increase in saturation but decrease is drastic below 60

34
Q

What is normal PaO2?

A

100

35
Q

What would carbon monoxide poisoning lead to?

A
  • Normal arterial PO2
  • Decreased saturation since Carbon monoxide has higher affinity for Hgb
  • Pulse Oximeter on finger cannot pick up this change
36
Q

Can exercise decrease arterial oxygen saturation?

A

No

37
Q

What is the alveolar arterial Oxygen gradient?

A
  • What the O2 gradient between ideal alveolus and pulmonary capillaries should be
38
Q

Equation for alveolar arterial oxygen gradient?

A

150 - (PaCo2/RQ) - PaO2

  • PaCo2 / O2 is measured from blood gas
  • RQ = .8
39
Q

What is the normal Alveolar / arterial gradient?

A
  • (Age / 4) + 4

- As you age, gradient increases

40
Q

When does A-a gradient increase?

A
  • Most lung diseases
41
Q

When is there hypoxemia with normal Aa gradient?

A
  • High altitude
  • Hypercapnia
  • Decreases FIO2
42
Q

What happens to vascular resistance with increased oxygen content in the lungs?

A
  • Decreases

- Vasoconstriction occurs on hypoxia

43
Q

Why does arterioles constrict with low O2 content in alveoli?

A
  • If there won’t be much oxygen for blood to pick up, body does not want to send blood through that region so vasoconstriction occurs to prevent this
  • **This is opposite to what happens in the rest of the body
44
Q

What can hypoxia lead to in lungs?

A
  • Pulmonary htn. as vasoconstriction increases

- Cor pulmonale can occur

45
Q

What happens at high altitude?

A
  • PO2 decreases
  • Begin to breathe more dropping CO2 leading to alkalosis
  • Bicarb will also drop to compensate as kidneys will waste bicarb
46
Q

What are we short of breath at altitude?

A
  • Lower barometric pressure leading to less oxygen in the air
47
Q

What will prolonged altitude exposure lead to?

A
  • Increased EPO increasing hematocrit
  • Increased 2/3 dpg leading to more O2 release at tissue
  • Increased mitochondrial
  • *Can lead to pulmonary hypertension
48
Q

How to calculate acute change in PH from change in CO2

A
  • For each 10 decrease in Co2, PH should increase .08

- If change does not occur as expected something else is happening or kidney is responding

49
Q

What can move hemoglobin curve right?

A

“Reduced affinity”

  • Increased temp
  • Increased 2/3 DPG
  • Acidosis
  • Altitude
50
Q

What can move hemoglobin curve left?

A

“Increased affinity”

  • Alkalosis
  • Decreased temp
  • Decreased 2/3 DPG
51
Q

Does BP in arteries have any effect on pulmonary hypertension?

A

No

52
Q

What can lead to pulmonary htn.?

A
  1. Destruction of lung parenchyma: Emphysema
  2. Decreased vasculature: PE
  3. Left to right shunt
  4. Hypoxic vasoconstriction
53
Q

What is normal pressure in lungs?

A

25 mmhg

54
Q

What can lead to hypoxemia with normal Aa gradient?

A
  1. Hypoventilation

2. Altitude

55
Q

What can lead to hypoxia with increased Aa gradient?

A
  1. Shunt
  2. VQ mismatch
  3. Diffusion / perfusion mismatch
56
Q

What occurs in VQ mismatch?

A
  • Not ventilating alveoli but still perfusing them
57
Q

Upper or lower lungs ventilated more?

A
  • Lower

- More perfusion in lower lungs too

58
Q

What does VQ mismatch lead to?

A
  • Mild hypoxia that responds to supplemental O2
59
Q

What can cause VQ mismatch?

A
  1. Asthma
  2. COPD
  3. Pulmonary Emboli
  4. ILD
60
Q

What is a shunt?

A

Movement of blood from venous to arterial without being oxygenated

61
Q

What does shunt lead to?

A
  • Severe hypoxia that does not respond to supplemental oxygen
62
Q

What can lead to shunt?

A
  1. Alveoli that are full of blood, pus, or water
  2. Malformation of alveoli
  3. Cardiac shunts
63
Q

Two most common causes of hypoxia?

A
  1. VQ mismatch

2. Shunt

64
Q

Why is diffusion impairment not common?

A
  • Blood is fully oxygenated in 25% of the time it spends in capillary
  • Lots of margin for error

MHD VI: Pulm (20 decks)

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