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Cardiopulmonary > Exam II > Flashcards

Exam II Flashcards

1
Q

what two components make up VO2?

A

(1) Q (cardiac output)

2) a-vO2 difference (amount of O2 utilized

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2
Q

how many lobes does the right lung have?

A

3

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3
Q

how many lobes does the left lung have?

A

2

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4
Q

what is anatomical dead space?

A

any space in the respiratory system that doesn’t reach the alveoli

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5
Q

what is physiologic dead space?

A

portion of the alveolar volume with poor ventilation/perfusion ratio

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6
Q

what direction is it often the easiest to access the lungs for tubes and other things?

A

lateral sides of the lungs

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7
Q

what is ventilation?

A

air flow in and out due to a pressure gradient (flows from high pressure to low pressure)

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8
Q

what is Boyle’s Law?

A

pressure is inversely proportional to volume

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9
Q

what are the inspiratory muscles involved with ventilation?

A

(1) diaphragm
(2) external intercostals
(3) scalenes (as breathing becomes labored scalenes will elevate the ribs)

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10
Q

what are the muscles involved with expiration at rest?

A

passively

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11
Q

what are the muscles involved with expiration at during exercise?

A

(1) abdominals (push diaphragm up)

2) internal intercostals (pull ribs down

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12
Q

why is being slumped over a more difficult position to expand the lungs and breathe?

A

(1) decreases space in the thoracic area

2) increases the pressure (more difficult to get air in

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13
Q

what is a pneuomothorax? what effect does it have on the lungs?

A

(1) presence of air / gas in the pleural cavity

(2) effects the volume pressure gradient of the lungs and can cause a collapsed lung

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14
Q

what MOI may cause a pneumothorax?

A

(1) MVA (can cause broken ribs which puncture the lungs)
(2) CPR
(3) test tubes placement

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15
Q

what are some s/s of a pneuomothroax?

A

(1) SOB / difficulty breathing

(2) tracheal deviation

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16
Q

what areas of the brain control depth and rate of breathing?

A

Pons and Medulla

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17
Q

what are the 3 components of the respiratory center in the brain?

A

(1) medullary rhythmicity area
(2) pneumotaxic area
(3) apneustic area

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18
Q

what is the medullary rhythmicity area responsible for?

A

maintains the rhythm of inspiration and expiration (autonomous like the SA node)

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19
Q

what is the pneumotaxic area area responsible for?

A

(1) continuous inhibitory impulses to the inspiratory neurons
(2) stimulates expiration (prevents lungs from filling too much)

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20
Q

what is the apneustic area responsible for?

A

(1) sends impulses to the inspiratory area

(2) stimulates inspiration

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21
Q

which system always overrides the other, the pneumotaxic or apneustic system? why?

A

(1) pneumotaxic always overrides the apneustic

(2) this is so you don’t over inflate and explode your lungs

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22
Q

chemically, how does the body sense a need to increase inspiration or expiration?

A

(1) CO2 levels

(2) pH levels

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23
Q

what is the bicarbonate equation?

A

H20 (+) CO2 >< H2CO3 >< H+ (+) HCO3

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24
Q

what occurs when there is a build up of CO2 in the body?

A

respiratory acidosis

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25
Q

what occurs when there is a build up of H+ and bicarbonate in the body?

A

metabolic acidosis

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26
Q

what is an increased level of CO2 within the blood called?

A

hypercapnia

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27
Q

what is a decreased level of CO2 within the blood called?

A

hypocapnia

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28
Q

what is stimulated when hypercapnia occurs within the body?

A

(1) apneustic stimulation (causing increased breathing)

(2) example: holding breath causes buildup of CO2, and when you breathe again CO2 is equalized

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29
Q

what is stimulated when hypocapnia occurs within the body?

A

(1) inspiration is not stimulated

(2) example: hyperventilation causes decreased CO2; response is to take more time between breaths

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30
Q

what is the Hering Breuer Reflex? how does it occur?

A

(1) prevents over inflation of the lungs due to stretch receptors in the lungs
(2) stretch of the lungs causes vagus nerve stimulation, which inhibits apneustic area allowing pneumotaxic area to dominate causing expiration

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31
Q

why does an increased temperature increase respiration rate?

A

attempting to lose body heat (ex. a dog panting when they’re hot)

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32
Q

why does decreased temperature decrease respiration rate?

A

in an attempt to conserve body heat

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33
Q

how does sympathetic stimulation affect respiration?

A

increases respiratory rate

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34
Q

how does blood pressure affect respiration rate?

A

(1) increased BP = decreased respiration

(2) decreased BP = increased respiration

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35
Q

what is tidal volume?

A

amount of air moved in / out with each breath

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36
Q

what is inspiratory reserve?

A

amount of air inspired above tidal volume

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37
Q

what is expiratory reserve?

A

amount of air expired below tidal volume

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38
Q

what is residual volume?

A

remaining air in the lungs once you’ve blown all the air out

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39
Q

what is vital capacity?

A

max amount of air expired after max inhalation (inspiratory reserve volume + tidal volume + expiratory reserve volume)

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40
Q

what is total lung capacity?

A

total volume the lungs can hold (vital capacity + residual volume)

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41
Q

what is functional residual capacity?

A

expiratory reserve volume + residual volume

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42
Q

what is inspiratory capacity?

A

tidal volume + inspiratory reserve volume

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43
Q

what is FEV1?

A

(1) forced expiratory volume (1 second)

(2) the amount of air you can expire in one second

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44
Q

what is restrictive lung disease?

A

can’t get air in their lung

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45
Q

what is obstructive lung disease?

A

can’t exhale air

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46
Q

what is a normal FEV1?

A

80-85% of air

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47
Q

what is the GOLD classification scale for COPD?

A 
All are FEV1 Scores
Gold 1 (Mild): >= 80% predicted
Gold 2 (Moderate): 50-80%
Gold 3 (Severe): <50%
Gold 4 (Very Severe): <30%
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48
Q

with obstructive lung diseases, how is residual volume affected?

A

very large residual volumes (can’t exhale so the RV increases)

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49
Q

physiologically what happens with obstructive diseases such as COPD and emphysema?

A

(1) alveoli lose their ability to recoil

(2) mucus in bronchial trees cause inflammation, decreasing diameter and increasing resistance

50
Q

how does height affect vital capacity?

A

(1) the taller you are the greater vital capacity (increased thoracic cavity size)

51
Q

how does body position affect vital capacity?

A

sitting while flexed decreases vital capacity because it limits the ability of the chest to expand

52
Q

what is minute ventilation? what factors affect minute ventilation?

A

(1) amount of air moved in and out in 1 minute

2) respiratory rate and tidal volume (how deep your breath is

53
Q

what is alveolar ventilation? how can it be optimized?

A

(1) air that reaches the alveolar chamber

(2) deep breathing

54
Q

how is alveolar air calculated?

A

tidal volume minus dead air

55
Q

how is ventilation affected by exercise?

A

(1) total ventilation can be increased up to 30x

2) RR and depth increase (depth being the more important factor so more O2 can reach the alveoli

56
Q

what is V/Q?

A

ratio of alveolar ventilation to pulmonary blood flow

57
Q

physiologically, what happens with restrictive lung disorders?

A

(1) lung expansion is restricted; difficult to get air in the lungs
(2) decreased lung or chest wall compliance or ventilatory muscle dysfunction

58
Q

what are some signs and symptoms of restrictive lung disorders?

A

(1) dyspnea
(2) tachypena
(3) coughing
(4) fatigue

59
Q

what are some pulmonary conditions that cause restrictive lung disorders? (9)

A

(1) interstitial pulmonary fibrosis
(2) pneumonia
(3) tuberculosis
(4) atelectasis
(5) pleural effusion
(6) pneumothorax
(7) pulmonary edema
(8) pulmonary embolism
(9) acute respiratory distress syndrome

60
Q

what are some extrapulmonary conditions that cause restrictive lung disorders? (7)

A

(1) chest wall trauma and surgery
(2) neuromuscular disorders
(3) pectus carinatum
(4) scoliosis
(5) ankylosing spondylitis
(6) diaphragm paralysis
(7) obesity

61
Q

how are the lung volumes and capacities affected with restrictive lung disorders?

A

ALL of the following are reduced:

(1) IRV
(2) TV
(3) ERV
(4) VC
(5) TLC

62
Q

how are FEV1 and FVC affected with restrictive lung disorders?

A

(1) FEV1 and FVC absolute values are reduced
(2) FEV1 / FVC Ratio is NORMAL to HIGH
(can’t get air in, but has no trouble expelling air, so ratio is preserved)

63
Q

what is the general pathophysiology of interstitial pulmonary fibrosis?

A

(1) chronic inflammation injures normal tissue, causing the tissue to be replaced by fibrous tissue
(2) fibrous tissue reduced compliance, leading to decreased ventilation and increases work of breathing
(3) causes impaired gas exchange (hypoxemia)

64
Q

what is atelectasis? what are typical causes?

A

(1) when segments of the lungs have collapsed

a) airway obstruction (bronchoconstriction, secretions / mucus plugging
(b) restrictive conditions (hypoventilation)

65
Q

what is pneumonia? what are typical causes?

A

(1) acute inflammation of lung parenchyma

(2) caused by bacterial, viral, or fungal infection; also by aspiration of food, fluid, or vomit into the lungs

66
Q

what is a pneumothorax? what are typical causes?

A

(1) accumulation of air or gas in the pleural space, causing the lung to collapse on the affected side
(2) caused by a defect in the visceral or parietal pleura

67
Q

what are the ways that a primary spontaneous, secondary spontaneous, and a traumatic pneumothorax can occur?

A

(1) primary: young, tall thing men (idiopathic)
(2) secondary: COPD, blebs, bullae
(3) traumatic: central line, gun shot, knife wound, rib fracture

68
Q

what occurs with a tension pneumothorax? why is it considered a medical emergency?

A

(1) occurs with a pneumothorax and air enters the pleural space, but can’t escape
(2) increasing pressure causes progressive lung collapse and may compromise venous return and CO

69
Q

what is pulmonary edema? what are the most common causes?

A

(1) pulmonary congestion
(2) develops with left sided heart failure; also due to ARDS, altitude sickness, and reperfusion injury following surgery

70
Q

what is a pulmonary embolus? what are the most common causes?

A

(1) floating clot of thrombus that lodges in pulmonary artery
(2) usually due to a DVT

71
Q

what is acute respiratory distress syndrome (ARDS)? how is someone classified as having ARDS?

A

(1) acute / rapid onset of respiratory failure
(2) PaO2 <60 mm Hg
PaCO2 >55 mm Hg

72
Q

what population does acute respiratory distress syndrome (ARDS) occur in?

A

critically ill; usually results from acute extensive lung inflammation

73
Q

physiologically, what happens with obstructive lung disorders?

A

(1) weakening, narrowing, and obstruction of airways (difficulty getting air out of the lungs)
(2) this obstruction of the airways causes air trapping, causing hyper inflation and an impaired gas exchange

74
Q

what are the two disorders that make up COPD?

A

(1) emphysema

(2) bronchitis

75
Q

what are other chronic obstrutive diseases but the dysfunction is variable? (3)

A

(1) asthma
(2) bronchiectasis
(3) cystic fibrosis

76
Q

how are the lung volumes and capacities affected with obstructive lung disorders?

A

(1) ERV decreases
(2) RV increases
(3) VC decreases
(4) FRC and TLC increases

77
Q

how are FEV1 and FVC affected with obstructive lung disorders?

A

(1) FEV1 and FVC absolute values are reduced

(2) FEV1 / FVC Ratio is significantly reduced

78
Q

what are the most common causes of chronic bronchitis? what is the general pathophysiology of the disease?

A

(1) smoking, pollutants, infections
(2) inflammtion causes hyper-secretion of mucus, causing ciliary dysfunction (mucus isn’t moving) and hyperactive bronchi (constriction)
(3) the above cascade causes scarring and thickening of bronchi and bacterial infections due to stagnant mucus

79
Q

what is required for a person to be diagnosed with chronic bronchitis?

A

(1) chronic cough and sputum

(2) most days for at least 3 months of the year for at least 2 years

80
Q

what are signs and symptoms of chronic bronchitis?

A

(1) dyspnea
(2) use of accessory muscles
(3) pursed lipped breathing
(4) digital clubbing
(5) adventitious or decreased breath sounds
(6) hypoxemia

81
Q

what is emphysema? what are the most common causes?

A

(1) enlargement and destruction of alveoli
(2) 95% of cases develop gradually (caused by chronic bronchitis, smoking, and pollutants)
5% is genetic (trypsin enzyme digests lung tissue)

82
Q

what is the general pathophysiology of emphysema?

A

(1) loss of elastic properties and ability to gas exchange in the acini
(2) these non functional acini form bullaer or blebs
(3) the above causes alveoli to collapse during expiration causing air to become trapped leading to hyperinflation of the lungs

83
Q

what happens to the O2 and CO2 in the blood in patients with emphysema?

A

hypoxemia and hypercapnia

84
Q

what are signs and symptoms of emphysema?

A

(1) dyspnea and cough
(2) use of accessory muscles
(3) pursed lipped breathing
(4) digital clubbing
(5) adventitious or decreased breath sounds
(6) hypoxemia

85
Q

what is the normal pulmonary arterial pressure (PAP)?

A

(1) 8-18 mmHg
(2) SBP: 15-30 mmHg
(3) DBP: 4-12 mmHg

86
Q

what is considered elevated mean pulmonary arterial pressure (PAP)?

A

(1) Rest: >25 mmHg

(2) Exercise: >30 mmHg

87
Q

what can elevated mean PAP cause?

A

(1) right sided heart failure
(2) right ventricular hypertrophy
(3) increased peripheral vascular resistance (PVR)

88
Q

what is cor pulmonale? what can this condition lead to?

A

(1) pulmonary hypertension SECONDARY to a pulmonary disease

2) right ventricular hypertrophy, right sided heart failure, and increased peripheral vascular resistance (PVR

89
Q

what medications are used to manage COPD?

A

(1) oxygen
(2) bronchodilators (vasodilation of bronchioles)
(3) glucocorticosteroids (reduce inflammation)

90
Q

when is mechanical respiration indicated for a patient with COPD?

A

when either condition occurs:

(1) PaO2 <60 mmHg
(2) PaCO2 >55 mmHg

91
Q

what is asthma? what are the most common causes?

A

(1) chronic airway inflammation leading to reversible episodes of airway obstruction (episodes can resolve spontaneously or with medications)
(2) airways are hypersensitive to various stimuli (pollen, mold, food, smoke, cold air, exercise, stress)

92
Q

what is the general pathophysiology of asthma?

A

(1) inflammation causes smooth muscle spasms in the lungs, causing bronchoconstriction and excessive mucous production
(2) leads to decreased expiratory flow, air trapping, hyperventilation and eventually an impaired gas exchange

93
Q

what are signs and symptoms of asthma?

A

(1) dyspnea
(2) wheezing
(3) chest tightening
(4) cough
(5) decreased FEV1, FVC, FEV1/FVC ratio

94
Q

what is bronchiectasis? what are the most common causes?

A

(1) permanent dilation and distortion of bronchi caused by destruction of elastic and muscular components of bronchial wall
(2) usually SECONDARY to other lung conditions such as (CF, recurrent pulmonary infections, and emphysema)

95
Q

what is cystic fibrosis and the pathophysiology? what causes this disorder?

A

(1) genetic defect that causes very thick mucous production that can’t be cleared by the cilia; this leads to bacterial growth, lung infections and eventually destruction of lung tissues
(2) it’s an inherited disorder (both parents must carry the gene)

96
Q

what is the partial pressure of O2 and CO2 at the alveolus, in arterial blood, and in venous blood?

A 
(1) Alveolus and (2) Arterial Blood:
PO2: 100 mmHg
PCO2: 40 mmHg
(3) Venous Blood
PO2: 40 mmHg
PCO2: 46 mmHg
97
Q

is CO2 or O2 more soluble?

A

CO2 25x more soluble than O2

98
Q

how is oxygen transported in blood? (2)

A

(1) 1-2% dissolved in blood plasma

(2) 98-99% bound to hemoglobin

99
Q

what function does myoglobin play? where is myoglobin found in the body?

A

(1) myoglobin is essentially an oxygen reservoir that can transfer O2 to mitochondria when needed
(2) it’s found in slow twitch muscle fibers of skeletal and cardiac muscle

100
Q

how is carbon dioxide transported in blood? (3)

A

(1) 10% dissolved in blood plasma
(2) 20% bound to hemoglobin
(3) 70% as plasma bicarbonate ion

101
Q

what is the equation for the formation of the bicarbonate ion?

A

CO2 + H20&raquo_space; H2CO3&raquo_space; H + HCO3

H2CO3 is carbonic acid; HCO3 is biocarbonate ion

102
Q

what are normal pH values for blood?

A

7.35 - 7.45 (mean: 7.4)

103
Q

what are normal bicarbonate (HCO3) ion values for blood?

A

22 - 26 mmol/l (mean: 24)

104
Q

what are normal PaCO2 values for arterial blood?

A

35-45 mmHg (mean: 40)

105
Q

what causes respiratory acidosis?

A

(1) hypoventilation

(2) hypercapnia

106
Q

what causes respiratory alkalosis?

A

(1) hyperventilation

(2) hypocapnia

107
Q

what are some common causes of respiratory acidosis?

A

(1) COPD
(2) neuromuscular diseases (ex. SCI, ALS, GBS, MS)
(3) pneumonia
(4) trauma
(5) anesthesia
(6) drug OD

108
Q

what are some signs and symptoms of respiratory acidosis?

A

(1) dyspnea
(2) anxiety / restlessness
(3) disorientation
(4) stupor / coma
(5) irritability
(6) HA
(7) hyperkalemia (causes cardiac arrhythmias)

109
Q

how does the body compensate for respiratory acidosis? how can we as PTs help?

A

(1) kidneys produce more HCO3 or excrete more H+ to raise levels of HCO3
(2) increase and assist with ventilation

110
Q

what are some common causes of respiratory alkalosis?

A

(1) anxiety, anger, hysteria (panic attack)
(2) pain
(3) Hypoxia (leads to hyperventilation) due to CHF, pulmonary emboli / fibrosis, brain trauma, fever, mechanical ventilation

111
Q

what are some signs and symptoms of respiratory alkalosis?

A

(1) numbness / tingling
(2) muscular twitching
(3) tetany
(4) convulsions
(5) hypokalemia (causes cardiac arrhythmias)

112
Q

how does the body compensate for respiratory alkalosis? how can we as PTs help?

A

(1) kidneys excrete more HCO3 (urination) to decrease the pH towards normal
(2) decrease or stop hyperventilation

113
Q

what are some common causes of metabolic acidosis?

A

(1) DM
(2) renal failure
(3) lactic acidosis
(4) diarrhea
(5) hyperkalemia

114
Q

what are some signs and symptoms of metabolic acidosis?

A

(1) nausea
(2) vomiting
(3) diarrhea
(4) HA
(5) stupor / coma
(6) hyperkalemia (causes cardiac arrhythmias)

115
Q

what are some common causes of metabolic alkalosis?

A

(1) vomiting
(2) NG suctioning
(3) diuretics
(4) antacids
(5) hypokalemia
(6) hyperaldosteronism
(7) hypochloremia

116
Q

what are some signs and symptoms of metabolic alkalosis?

A

(1) nausea
(2) vomiting
(3) diarrhea
(4) NG drainage
(5) numbness / tingling
(6) muscle twitching / tetany
(7) convulsions
(8) hypokalemia (causes cardiac arrhythmias)

117
Q

what are the primary regulators of acid-base balance in the body?

A

(1) lungs (fast)

2) kidneys (slow

118
Q

what should the O2 flow rate be for a nasal cannula?

119
Q

what should the O2 flow rate be for a simple mask?

A

5-10 L/min

120
Q

what should the O2 flow rate be for a aerosol mask?

A

10-12 L/min

121
Q

what should the O2 flow rate be for a Venturi mask?

A

4-10 L/min

Cardiopulmonary (2 decks)

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