CH2 RESPIRATORY PHYSIOLOGY AND CRITICAL CARE

Question 1

Nitroprusside can cause

Answer 1

inc methemoglobin&raquo_space; SaO2 of 85 percent

cyanide toxicity&raquo_space; metabolic acidosis

thiocyanate toxicity&raquo_space; renal failure

Question 2

FRC

Answer 2

ERV+RV

maximizing FRC REDUCED ATELECTASIS AND Lessend incidence of pulmonary complication

Question 3

HOW TO INCREASE FRC post op

Answer 3

Early ambulatiin
incentive spirometry
deep breathing
intermittent positive pressure breathing

FRC should be greater than CC

Question 4

Normal PVR

Answer 4

50 -150 dyne-sec/cm5

Question 5

pt who sustained MI and underwent surgery most likely have another infarction when?

Answer 5

Third postoperative day

Question 6

BMI

Answer 6

kg/m2

18-24.9 normal
25.29.9 overweight
30-34.5 obesity
35-39.9 obesity 2 
superine bmi 50

Question 7

OBESITY:
CO ?
FRC?

Answer 7

0.1L/min / kg adipose
htn> cardiomegaky
Left sided heart failure

FRc decrease

Question 8

total volume of air that can be exhaled in the first second

Answer 8

FEV1
For expiratory volume in 1 min

normal:
75-85 % FVC / second
94% - 2 seconds
97% - e seconds

FEV1/FVC-= 0.75
< 70 - mild obstruction
< 60 - moderate
< 50 severe

Question 9

MAT is a nonreentrant ectopic atrial rhythm and seen in pt with!??

Answer 9

COPD

NOT amend ale for cardioverasio

Question 10

during the first minutes of apnea, PaCO2 will increase by

Answer 10

6mmHg/min

then 3-4mmHg

Question 11

complication of TPN

Answer 11

hypergly
hypoglycemia
hypophosphatemia
hyperchloremi metabolic acidosis

Question 12

O2 requirement in
adult?
newborn?

Answer 12

adult: 3-4ml/kg/min

newborn :7-9ml/kg/min

Question 13

CO2 production is increased in neonates Va maintains the PaCO2 near __mmHg

Answer 13

38-40

Question 14

LUNG VOLUMES AND CAPACITY

Answer 14

TV 500ml ( 6-8ml/kg) 
FRC 2400ml 
VC 4500 (60-70ml/kg) 
TLC 5900ml
FEV1 80%

Question 15

volume gas in the conducting airways is called

Answer 15

anatomic dead space

no gas exchange

Question 16

Volume of gas in the ventilated alveoli that are unperfused

Answer 16

functional dead space

no exchange

Question 17

physiologic dead space is

Answer 17

anatomic dead space + functional dead space

Question 18

How to calculate for the oxygen.m content in the blood

Answer 18

1.39 x hgb x arterial saturation + (0.003 x PaO2)

Question 19

inhalation of CO2 increased MV by

Answer 19

3-5ml/min /mmHg increas in PaCO2

Question 20

blood /gas solubiloty coefficient of O2

Answer 20

0.003

Question 21

one gram of hgb can bind ____ml of O2

Answer 21

1.39

Question 22

one kPa = cmH20

Answer 22

10cmH20

Question 23

is the Pa02 requiired to produce 50% saturation of hemoglobin

Answer 23

P50

Question 24

P50 of adult is

Answer 24

25mmHg

Question 25

transpulmonary pressure x VT

Answer 25

work of breathing work required to overcome the elastic forces and to overckme airflow or frictinal resistances in the airway

Question 26

normal mixed venous 02 saturation is?

Answer 26

75%

Question 27

mixed venous O2 saturation can be affected by:

Answer 27

``` Dec : hgb conc arterial PaCO2 CO O2 consumption ``` Increase: sepsis

Question 28

carbon monoxide affinity to hgb is

Answer 28

200 times greater then O2 PaO2 is normal o no inc in MV until tissue hypoxia>>lactic acidosis

Question 29

Respo acidosis is present when the PaCO2 exceeda

Answer 29

44mmHg

Question 30

an acute increase in PaCO2 of 10 mmHG will result in a decrease inph of

Answer 30

0.08 ph unit

Question 31

maximum decrease of HCO3 approx per change in PaCO2

Answer 31

5meq/L for ever 10mmHg dec in PaCO2 less the 40

Question 32

P50 < 26mmHg

Answer 32

leftward shift hemoglobin has a higher affinity ``` inc ph dec temp fetal hemoglobin abnormal hgb carboxyhemoglobin methemoglobin sulfhemoglobin dec 2,3 DPG ```

Question 33

P50>26

Answer 33

right ward shift hemoglobin has a lower affinity to O2 ``` respi acidosis inc temp inc 23 DPG preg sickle cell thalassemia ```

Question 34

IN ELDERLY : | respiratory changes

Answer 34

INCREASE: FRC RV CV ``` DECREASE VC MBC FEV1 ventilatory response to hypoxemia ``` NO CHANGE TLC

Question 35

the ventilation/perfusion ratio is greater at the apex or base?

Answer 35

greater at the apex than the base base= hypoxic and hypercarbic

Question 36

least well compensated acid-base disturbance

Answer 36

METABOLIC ALKALOSIS

Question 37

when arterial sampling is not possible. where to get "arterialized "venous blood

Answer 37

back of the hand estimate abg

Question 38

what test used to asses ventilatory capacity ?

Answer 38

FEV1/FVC MVV Flow volume curve FED 25%-75% ( not patients effort dependent)

Question 39

fraction of CO that transverses the pulmonary circulation without participating in gas exchange is called

Answer 39

TRANSPULMONARY SHUNT

Question 40

TRANSPULMONARY SHUNt: for every increase of alveolar arterial o2 oh 20mmHg there is increase in shunt fraction by how much

Answer 40

1%

Question 41

anatomic dead space ?

Answer 41

2ml/kg trachea right and left mainstem bronchi lobar and segmental bronchi

Question 42

in the resting adult , what percentage of total body O2 consumption is due to the work of breathing?

Answer 42

only 1-3% of total O2 consumption is used at rest 50% for pulmonary disease

Question 43

3 main mechanisms that body has to prevent changes in PH

Answer 43

buffer system - immediate ventilatory response- takes minutes renal response- hours to day

Question 44

HCO3

Answer 44

represents greater than 50% of the total buffering capacity of the body

Question 45

35% of buffering capacity of the

Answer 45

capacity of blood phosphates plasma proteins and bone

Question 46

plasma K increases approx ___ for each 0.1decrease in Ph

Answer 46

0.6 dysrhythmias is related partly to the effects of PH on myocardial K homeostasis

Question 47

Acid base disturbance

Answer 47

10meq HCO3 = 0.15ph 1mmHg PaCO2 = 0.08 ph 1mmHg PaCo2 dec-= 1meq HCO3

Question 48

volatile anesthetics inc P50 by

Answer 48

2-3.5mmHg right shift dec transfer of oxygen alveoli to hgb and improve the release O2 from hgb to peripheral tissues

Question 49

Carbon monoxide toxicity treatment

Answer 49

half life : 4-6 hrs at room air 100 percent o2 half life is 1hr

Question 50

PRIS

Answer 50

>4mg/kg/hr x >48hrs ``` cardiomyopathy cardiac failure metab acidosis skeletal muscle myopathy hepatomegaly hyperkalemia ```

Question 51

normal anion gap

Answer 51

10-12

Question 52

high anion gap :

Answer 52

``` metabolic acidosis lactic acidosis ketoacidosis acute and chronic renal failure toxins ```

Question 53

non anion gap

Answer 53

``` renal tubular acidosis expansion acidosis gastrointestinal bicarbonate loss drug induced hyperkalemia acid loads ```

Question 54

adverse physiologic effect od respi or metabolic acidosis

Answer 54

``` CNS DEPRESSION inc icp CVS depression cardiac dysrrhythmias vasodilation hypovolemia pulmo htn hyperkakemia ```

Question 55

TRALI | KEY FEATURES

Answer 55

Rise A-a gradient noncardiogenic pulmonary edema leukopenia

Question 56

Physiologic shunt? | CO?

Answer 56

2-5% CO