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Block 13 - The Development of Cardiorespiratory Disease > ALS Lecture 6 - Physiological Consequences of Restrictive Lung Disease DONE > Flashcards

ALS Lecture 6 - Physiological Consequences of Restrictive Lung Disease DONE Flashcards

1
Q

breathing control flow chart

A

medulla -> spinal cord -> spinal nerves C3, C4, C5 -> respiratory muscles

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2
Q

respiratory drive

A

occurs from brain, conscious and unconscious

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3
Q

ventilation depends on (3)

A

chest wall, airway resistance, lung compliance

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4
Q

diffusion (gas exchange)

A

gas crosses alveolar walls

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5
Q

perfusion (2)

A

blood’s oxygen carrying capacity (Hb), pulmonary circulation

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6
Q

inspiration muscles (3)

A

diaphragm, intercostals, sometimes accessory

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7
Q

expiration muscles (3)

A

diaphragm, intercostals, sometimes accessory

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8
Q

expiration muscles if breathing with increased drive (2)

A

internal intercostals, abdominal muscles

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9
Q

compliance is the measure of the lung’s abilitiy to

A

stretch and expand (distensibility of elastic tissue)

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10
Q

ventilation is the exchange of air between

A

lungs, atmosphere

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11
Q

minute ventilation =

A

tidal volume x respiratory rate

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12
Q

minute ventilation is the amount of air

A

in and out of the lungs in a minute

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13
Q

normal RR

A

12-16 breaths per min

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14
Q

alveolar ventilation =

A

(tidal volume - dead space) x respiratory rate

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15
Q

alveolar ventilation is the amount of air

A

exchanged within alveoli

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16
Q

which is more important, minute or alveolar ventilation?

A

alveolar ventilation

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17
Q

only the ___ _____ of the lung is where you get _____, the rest is ____ ____

A

very bottom, perfusion, dead space

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18
Q

label the ventilation diagram

A

done

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19
Q

ventilation homeostasis is a balance between

A

ventilatory capacity, ventilatory demand

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20
Q

ventilatory capacity is the maximum spontaneous ventilation that can be maintained

A

without development of respiratory muscle fatigue

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21
Q

ventilatory capacity put simply is how much you can

A

breathe in and out without respiratory muscle fatigue

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22
Q

ventilatory demand is the amount of

A

breathing needed to maintain normal PaCO2

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23
Q

Fick’s law of diffusion: rate of transfer of gas through a sheet of tissue is proportional to

A

tissue area, difference in gas partial pressure

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24
Q

rate of transfer of gas through a sheet of tissue is inversely proportional to

A

tissue thickness

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25
Q

diffusion is greater with (3)

A

larger SA, larger pressure gradient, smaller distance to diffuse across

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26
Q

label the diagram of diffusion

A

done

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27
Q

CO2 diffuses across the membrane ___ more rapidly than O2

A

20x

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28
Q

capillary transit time

A

how long blood is in capillaries

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29
Q

perfusion is the blood that

A

reaches alveoli via capillaries

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30
Q

maximal perfusion occurs at the lung bases when upright because of

A

gravity

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31
Q

hypoxic pulmonary vasoconstriction is a physiological mechanism to match

A

perfusion and ventilation

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32
Q

hypoxic pulmonary vasoconstriction - if we get a hypoxic area within lungs, blood vessels

A

restrict to send blood to better supplied areas, so blood still gets oxygenated

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33
Q

idiopathic pulmonary fibrosis involves (3)

A

small lungs, reduced compliance, thickened alveolar membrane

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34
Q

in idiopathic pulmonary fibrosis, FEV1/FVC ratio is

A

preserved (>70%)

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35
Q

look at the graphs and tables of idiopathic pulmonary fibrosis and the details with it

A

done

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36
Q

in idiopathic pulmonary fibrosis CXR shows

A

more prominent shadows in lower lung

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37
Q

in idiopathic pulmonary fibrosis CT scan shows

A

honeycomb cysts

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38
Q

look at the examples of arterial blood gases in idiopathic pulmonary fibrosis

A

done

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39
Q

hypoxaemia (low PaO2) and normal PaCO2 indicates

A

type 1 respiratory failure

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40
Q

mean age of idiopathic pulmonary fibrosis presentation

A

71

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41
Q

idiopathic pulmonary fibrosis male:female ratio is approx

A

2:1

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42
Q

idiopathic pulmonary fibrosis mean survival is

A

3.9 years

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43
Q

label the diagram of the different prognoses of idiopathic pulmonary fibrosis

A

done

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44
Q

3 common prognoses of idiopathic pulmonary fibrosis

A

rapid progression to death, slow progression with acute attacks which are usually fatal, stable with acute attacks

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45
Q

examples of pharmacological management of idiopathic pulmonary fibrosis

A
  • pirfenidione, antifibrotic

- nintedanib, tyrosine kinase inhibitor

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46
Q

supportive management for idiopathic pulmonary fibrosis (4)

A

oxygen, pulmonary rehab, breathlessness management, transplant

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47
Q

obstructive lung disease

A

obstructed flow of air, affects ventilation

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48
Q

restrictive lung disease

A

chest volume restricted, increased work of breathing

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49
Q

examples of obstructive lung disease (4)

A

asthma, COPD, bronchiectasis, other airway disease

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50
Q

examples of restrictive lung disease (4)

A

pulmonary fibrosis, obesity, chest wall deformities, neuromuscular deformities

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51
Q

label the spirometry graph showing, normal, obstructive and restrictive patterns

A

done

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52
Q

normal FEV1/FVC

A

> 70%

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53
Q

obstruction spirometry pattern (3)

A

normal FVC, reduced FEV1, reduced FEV1/FVC ratio (<70%)

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54
Q

restriction spirometry pattern (3)

A

reduced FEV1, FEV1/FVC ratio almost normal (>70%)

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55
Q

during inspiration diaphragm

A

contracts, flattens, moves down

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56
Q

during inspiration ribcage

A

pulled up and out

57
Q

during inspiration external intercostal muscles

A

contract

58
Q

during inspiration internal intercostal muscles

A

relax

59
Q

during inspiration airways are

A

pulled open

60
Q

during inspiration pressure on outside is

A

greater than inside, air moves in

61
Q

label the diagram of inspiration and expiration

A

done

62
Q

during expiration diaphragm

A

relaxes, moves up

63
Q

during expiration ribcage

A

moves down and in

64
Q

during expiration external intercostal muscles

A

relax

65
Q

during expiration internal intercostal muscles

A

contract

66
Q

during expiration, airways are

A

compressed

67
Q

during expiration, pressure on inside is

A

greater than outside, air moves out

68
Q

if airways are narrowed already, they get even more

A

compressed, takes a long time to breathe out, decreased FEV1

69
Q

in obstructive lung disease, FEV1 is

A

reduced

70
Q

in obstructive lung disease, FVC is

A

preserved

71
Q

in obstructive lung disease, FEV1/FVC ratio is

A

reduced, <70%

72
Q

gas trapping happens in

A

obstructive lung disease

73
Q

gas trapping

A

airways close on expiration, parts of lungs get gas trapped

74
Q

in obstructive lung disease, diffusion is

A

normal (except in emphysema)

75
Q

in obstructive lung disease, perfusion is

A

normal (end stage can lead to cor pulmonale)

76
Q

in early asthma, Type 1 respiratory failure PaO2 is

A

low

77
Q

in early asthma, Type 1 respiratory failure PaCO2 is

A

low

78
Q

in early asthma, Type 1 respiratory failure HCO3+ is

A

normal

79
Q

in early asthma, Type 1 respiratory failure pH is

A

low

80
Q

in late severe asthma, Type 2 respiratory failure PaO2 is

A

low

81
Q

in late severe asthma, Type 2 respiratory failure PaCO2 is

A

high

82
Q

in late severe asthma, Type 2 respiratory failure HCO3 is

A

normal

83
Q

in late severe asthma, Type 2 respiratory failure pH is

A

low

84
Q

in COPD, Type 1 respiratory failure PaO2 is

A

low

85
Q

in COPD, Type 1 respiratory failure PaCO2 is

A

normal

86
Q

in COPD, Type 1 respiratory failure HCO3+ is

A

normal

87
Q

in COPD, Type 1 respiratory failure pH is

A

normal

88
Q

in COPD, Type 2 decompensated respiratory failure PaO2 is

A

low

89
Q

in COPD, Type 2 decompensated respiratory failure PaCO2 is

A

high

90
Q

in COPD, Type 2 decompensated respiratory failure HCO3+ is

A

normal

91
Q

in COPD, Type 2 decompensated respiratory failure pH is

A

low

92
Q

in COPD, Type 2 compensated respiratory failure PaO2 is

A

low

93
Q

in COPD, Type 2 compensated respiratory failure PaCO2 is

A

high

94
Q

in COPD, Type 2 compensated respiratory failure HCO3+ is

A

high

95
Q

in COPD, Type 2 compensated respiratory failure pH is

A

normal

96
Q

label the diagram of the spirometry graph

A

done

97
Q

label the diagram of the spirometer

A

done

98
Q

FVC

A

forced vital capacity, where volume plateaus, can’t blow any more

99
Q

FEV1

A

forced expiratory volume in 1 second

100
Q

in spirometry the patient

A

blow out hard and fast, trying to empty lungs

101
Q

FEV1/FVC should be

A

> 70%

102
Q

label the diagram of the helium dilution method

A

done

103
Q

helium dilution method (3 steps)

A
  1. known conc of helium in tank
  2. pt breathes in then out
  3. calculate change in conc to find lung volume
104
Q

flow rate

A

how quickly we can breath in and out

105
Q

flow rate tells us about

A

airway resistance

106
Q

Poiseuille’s law (for laminar flow)

A

resistance = inversely proportional to radius4

107
Q

peak flow steps (3 steps)

A
  1. pt blows hard and fast into tube 3 times

2. smallest reading taken

108
Q

flow volume loop shows us

A

rate of flow, dependent on volume

109
Q

label the flow volume loop table

A

done

110
Q

as we start to breathe out hard and fast, the flow volume loop curve

A

rises steeply

111
Q

DLCO stands for

A

diffusion capacity of the lung for carbon monoxide

112
Q

how do we measure DLCO? (4 steps)

A
  1. pt inspires air mix with CO
  2. 10 second breath-hold
  3. conc change is proportional to thickness of alveolar membrane
113
Q

why do we use CO in DLCO?

A

CO taken up by Hb

114
Q

respiratory rate

A

count breaths for 30secs, times by 2

115
Q

normal PaO2 (10-12kPa), Hb is saturated by oxygen to what percentage?

A

95%

116
Q

at PaO2 of about 8kPa, Hb is saturated by oxygen to what percentage?

A

90%

117
Q

below 90% oxygen saturation, oxygen delivery is

A

markedly compromised

118
Q

if O2 sats are below 90-92%, what is indicated?

A

blood gas measurement by arterial puncture

119
Q

label the oxygen dissociation curve

A

done

120
Q

when O2 saturations are above ~96% it doesn’t matter

A

how much you raise PaO2

121
Q

a small decrease in PaO2 will cause a

A

massive fall in O2 saturation

122
Q

2 types of restrictive lung disease

A

interstitial lung disease, chest wall deformities/neuromuscular disorders

123
Q

interstitial lung disease increases the

A

distance gas has to diffuse across to get between air and blood

124
Q

FEV1 in restrictive lung disease

A

reduced

125
Q

FVC in restrictive lung disease

A

reduced

126
Q

FEV1/FVC ratio in restrictive lung disease

A

normal or raised

127
Q

PaO2

A

partial pressure of O2 in arterial blood

128
Q

PaCO2

A

partial pressure of CO2 in arterial blood

129
Q

raised PaCO2 indicates

A

type 2 respiratory failure

130
Q

type 1 respiratory failure is

A

hypoxaemic, low paO2, low/normal PaCO2

131
Q

type 2 respiratory failure is

A

hypercapnic, low PaO2, high PaCO2

132
Q

label the acid-base balance diagram and the details below

A

done

133
Q

hypoxia can be caused by (3)

A

impaired diffusion, hypoventilation, V/Q mismatch

134
Q

2 types of V/Q mismatch

A
  • normal ventilation, decreased perfusion

- normal perfusion, decreased ventilation

135
Q

possible causes of decreased perfusion

A

right to left cardiac shunt, pulmonary emboli, not usually restrictive or obstructive

136
Q

label the diagram of decreased perfusion

A

done

137
Q

possible causes of decreased ventilation

A

pneumonia, pneumothorax, obstructive lung diseases (e.g. asthma)

138
Q

label the diagram of decreased ventilation

A

done

Block 13 - The Development of Cardiorespiratory Disease (14 decks)

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