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Guyton Chapters > Ch43 Respiratory Insufficiency > Flashcards

Ch43 Respiratory Insufficiency Flashcards

1
Q

What is the primary factor that affects the diagnosis and treatment of respiratory disorders?

A

Understanding the basic physiological principles of respiration and gas exchange.

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2
Q

What are the two main causes of respiratory diseases?

A
  • Inadequate ventilation
  • Abnormalities of diffusion through the pulmonary membrane
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3
Q

What is the Henderson-Hasselbalch equation used for?

A

To determine the relationship between pH, CO2, and bicarbonate ion concentrations.

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4
Q

How is blood pH measured?

A

Using a glass pH electrode that generates a voltage directly proportional to pH.

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5
Q

What technique is used to determine blood CO2 levels?

A

A glass electrode pH meter that measures CO2 by diffusion into a bicarbonate solution.

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6
Q

What method is used to measure the concentration of O2 in blood?

A

Polarography, which measures electric current flow related to O2 concentration.

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7
Q

What is maximum expiratory flow?

A

The maximum air flow rate achieved during forceful expiration beyond which no increase occurs.

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8
Q

What happens to maximum expiratory flow as lung volume decreases?

A

Maximum expiratory flow rate decreases.

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9
Q

What are the two types of lung diseases illustrated in the maximum expiratory flow-volume curve?

A
  • Constricted lungs
  • Partial airway obstruction
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10
Q

What is the classic disease that causes severe airway obstruction?

A

Asthma.

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11
Q

What does forced expiratory vital capacity (FVC) measure?

A

The total volume of air exhaled with maximum effort after a deep inhalation.

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12
Q

In a normal person, what percentage of FVC is typically expired in the first second?

A

80%.

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13
Q

What is the FEV1/FVC percentage in individuals with serious airway obstruction?

A

Less than 20%.

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14
Q

What is chronic pulmonary emphysema characterized by?

A

Excess air in the lungs due to obstructive and destructive processes.

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15
Q

What are the major pathophysiological changes in chronic pulmonary emphysema?

A
  • Chronic infection
  • Excess mucus secretion
  • Inflammatory edema of bronchiolar epithelium
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16
Q

What is the physiological effect of bronchiolar obstruction in emphysema?

A

Increased airway resistance and greatly increased work of breathing.

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17
Q

True or False: In emphysema, the obstruction of airways makes expiration easier.

A

False.

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18
Q

Fill in the blank: The volume of air that can be forcibly exhaled in one second is called _______.

A

FEV1.

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19
Q

What is the relationship between lung volume and maximum expiratory flow?

A

As lung volume decreases, maximum expiratory flow also decreases.

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20
Q

What is the role of alveolar macrophages in the lungs?

A

To combat infection.

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21
Q

What happens to alveoli during chronic emphysema?

A

They become overstretched and marked destruction of alveolar walls occurs.

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22
Q

What are the physiological effects of chronic emphysema?

A

Variable effects depending on severity, including:
* Increased airway resistance
* Decreased diffusing capacity
* Abnormal ventilation-perfusion ratios
* Increased pulmonary vascular resistance
* Development of hypoxia and hypercapnia

Hypoxia and hypercapnia result from hypoventilation and loss of alveolar walls.

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23
Q

What causes increased work of breathing in chronic emphysema?

A

Bronchiolar obstruction increases airway resistance, making expiration difficult

The compressive force on the outside of the lung compresses both alveoli and bronchioles.

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24
Q

How does chronic emphysema affect the diffusion capacity of the lung?

A

Marked loss of alveolar walls greatly decreases the diffusing capacity

This results in poor oxygenation of blood and inadequate CO2 removal.

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25
What is the consequence of unequal ventilation in the lungs due to emphysema?
Some lung portions are well ventilated while others are poorly ventilated, leading to abnormal ventilation-perfusion ratios ## Footnote This results in physiological shunting and dead space.
26
What is the impact of emphysema on pulmonary capillaries?
Loss of alveolar walls decreases the number of pulmonary capillaries, increasing pulmonary vascular resistance ## Footnote This can lead to pulmonary hypertension and right-sided heart failure.
27
What is pneumonia?
An inflammatory condition of the lung where alveoli are filled with fluid and blood cells ## Footnote Commonly caused by bacterial infection, especially pneumococci.
28
What happens to the pulmonary membrane during pneumonia?
The membrane becomes inflamed and highly porous, allowing fluid and blood cells to leak into the alveoli ## Footnote This leads to alveoli filling with fluid and cellular debris.
29
What are the major pulmonary abnormalities caused by pneumonia?
1. Reduction in surface area of the respiratory membrane 2. Decreased ventilation-perfusion ratio ## Footnote Both lead to hypoxemia and hypercapnia.
30
What is atelectasis?
Collapse of the alveoli in localized areas or an entire lung ## Footnote Can result from total airway obstruction or lack of surfactant.
31
What causes atelectasis due to airway obstruction?
Blockage of small bronchi with mucus or obstruction of a major bronchus by a large mucous plug or solid object ## Footnote This leads to absorption of trapped air and alveolar collapse.
32
What is the role of surfactant in the alveoli?
Surfactant decreases surface tension in the alveoli, preventing collapse ## Footnote A deficiency can lead to conditions like respiratory distress syndrome in newborns.
33
What characterizes asthma?
Spasmodic contraction of smooth muscles in bronchioles, causing partial obstruction and difficulty in breathing ## Footnote Affects 7-8% of people in the U.S. and can lead to increased functional residual capacity.
34
What is the typical cause of asthma in younger patients?
Allergic hypersensitivity, especially to plant pollens ## Footnote In older individuals, it is often due to nonallergenic irritants.
35
What substances are released by mast cells in response to allergens in asthma?
1. Histamine 2. Slow-reacting substance of anaphylaxis 3. Eosinophilic chemotactic factor 4. Bradykinin ## Footnote These substances contribute to airway resistance and bronchoconstriction.
36
What is the effect of tuberculosis on lung tissue?
Infection leads to macrophage invasion and fibrous walling off of lesions, causing lung tissue destruction ## Footnote Late stages result in fibrosis and reduced functional lung tissue.
37
What are the consequences of hypoxia?
Serious cellular hypoxia can lead to various physiological issues and may require oxygen therapy ## Footnote The effectiveness of therapy varies based on the cause of hypoxia.
38
What are the types of hypoxia?
1. Inadequate oxygenation due to extrinsic reasons 2. Pulmonary disease-related hypoxia ## Footnote Includes causes like atmospheric O2 deficiency, hypoventilation, and abnormal ventilation-perfusion ratios.
39
What is the term for the oxygenation of the blood in the lungs?
Oxygenation of the blood in the lungs
40
What are extrinsic reasons for oxygen deficiency in the atmosphere?
* Deficiency of O2 in the atmosphere * Hypoventilation (neuromuscular disorders)
41
What are the pulmonary diseases that can cause hypoventilation?
* Increased airway resistance * Decreased pulmonary compliance * Abnormal alveolar ventilation-perfusion ratio * Diminished respiratory membrane diffusion
42
What are the causes of inadequate oxygen transport to tissues?
* Anemia or abnormal hemoglobin * General circulatory deficiency * Localized circulatory deficiency (peripheral, cerebral, coronary vessels) * Tissue edema
43
What are the causes of inadequate tissue capability of using oxygen?
* Poisoning of cellular oxidation enzymes * Diminished cellular metabolic capacity due to toxicity, vitamin deficiency, or other factors
44
What is the classic cause of inability of tissues to use O2?
Cyanide poisoning
45
What are the effects of hypoxia on the body?
* Depressed mental activity * Reduced work capacity of muscles
46
What are the methods of administering oxygen therapy?
* Patient's head in a tent with O2 * Breathing pure O2 or high concentrations from a mask * Administering O2 through an intranasal tube
47
True or False: O2 therapy is completely effective in atmospheric hypoxia.
True
48
In hypoventilation hypoxia, how much more O2 can a person breathing 100% O2 move into the alveoli?
Five times
49
How does O2 therapy affect impaired alveolar membrane diffusion?
Increases PO2 in the lung alveoli from about 100 mm Hg to as high as 600 mm Hg
50
In what type of hypoxia is O2 therapy of much less value?
Hypoxia caused by anemia, abnormal hemoglobin transport, circulatory deficiency, or physiological shunt
51
What does cyanosis mean?
Blueness of the skin due to excessive amounts of deoxygenated hemoglobin
52
What is the minimum amount of deoxygenated hemoglobin in arterial blood that causes cyanosis?
More than 5 grams in each 100 ml of blood
53
What three factors often contribute to the sensation of dyspnea?
* Abnormality of respiratory gases (hypercapnia, hypoxia) * Amount of work performed by respiratory muscles * State of mind
54
What is hypercapnia?
Excess carbon dioxide in the body fluids
55
True or False: Hypercapnia occurs with all types of hypoxia.
False
56
What happens when alveolar PCO2 rises above 60 to 75 mm Hg?
Severe dyspnea occurs
57
What is the term for the mental anguish associated with an inability to ventilate enough air?
Dyspnea
58
What is a resuscitator?
A device that applies intermittent positive pressure to assist breathing
59
What is the function of a tank respirator?
Creates positive and negative pressure to facilitate breathing
60
What can excessive positive pressure in a resuscitator cause?
Damage to the lungs and reduced cardiac output
61
What is the typical positive pressure limit set for normal lungs in resuscitators?
12 to 15 cm H2O
62
What is the primary function of mechanical ventilators compared to tank respirators?
Push air into the airways with positive pressure
63
What is the positive pressure range in cm H2O during ventilation?
0 to +5 cm H2O
64
What has largely replaced the tank respirator in modern medicine?
Superior mechanical ventilators
65
What happens to the pressure inside the lungs when air is forced in by a resuscitator?
It becomes greater than pressure everywhere else in the body
66
How does positive pressure affect venous return?
It decreases blood flow into the chest and heart from peripheral veins
67
What type of mediators are involved in immune responses in airway diseases?
Specialized proresolving mediators
68
What year was the article on specialized proresolving mediators published in Physiol Rev?
2018
69
Who discussed evolving concepts for safer ventilation in Crit Care?
Marini JJ
70
What is the focus of the paper by Martinez FD in N Engl J Med?
Early-life origins of chronic obstructive pulmonary disease
71
What is the main topic of the Lancet article by Papi et al.?
Asthma
72
What physiological aspect did Quinton et al. review in Physiol Rev?
Integrative physiology of pneumonia
73
What did Pavord et al. redefine in their Lancet article?
Airways diseases after asthma
74
What condition is discussed in Rabe and Watz's article in Lancet?
Chronic obstructive pulmonary disease
75
What type of review did Raju et al. publish regarding chest CT signs?
Pictorial review
76
What environmental issue was reviewed by Schraufnagel et al. in Chest?
Air pollution and non-communicable diseases
77
What do Sheel and Romer focus on in their work in Compr Physiol?
Ventilation and respiratory mechanics
78
What concept is addressed by Suki et al. in their article on emphysema?
Mechanical stress-induced lung remodeling
79
What condition is analyzed by Veasey and Rosen in N Engl J Med?
Obstructive sleep apnea in adults
80
What disease is the focus of the article by Zumla et al. in N Engl J Med?
Tuberculosis

Guyton Chapters (9 decks)

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