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Cardiopulmonary > Final > Flashcards

Final Flashcards

1
Q

Describe internal respiration

A

Gas exchange that occurs at between the tissues and system capillaries

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2
Q

Describe the path of air entering the nose beginning with the nasal cavity and ending with the main stem bronchi

A

Nasal cavity
Nasopharynx
Oropharynx
Hypopharynx/laryngopharynx
Larynx
Trachea
Main stem bronchi

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2
Q

Describe external respiration

A

Gas exchange that occurs in the lungs between the pulmonary capillaries and the alveoli

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3
Q

What are the functions of the nose?

A

Warm air
Humidify air
Filter air
Smell
Resonance in speech

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4
Q

What structure in the nose facilitates the warming and humidification of incoming air? how?

A

Nasal conchae
They increase the surface area of the nasal cavities

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5
Q

How many pairs of tonsils are there? What are their names?

A

4 pairs
Lingual
Palatine
Tubal
Adenoid

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6
Q

Describe the paranasal sinuses

A

Air filled cavities
4 pairs
Light head
Provide vocal resonance

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7
Q

What is the function of the tonsils?

A

Assist immune system with production of antibodies

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8
Q

The adenoid tonsils can also be called what?

A

Pharyngeal tonsils

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8
Q

what anatomical landmark divides the upper and lower airways

A

Vocal cords

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9
Q

What is the cartilage structure below the thyroid cartilage?

A

The cricoid cartilage=

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9
Q

What is the structure that connects the thyroid cartilage and the cricoid cartilage?

A

The cricothyroid ligament

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10
Q

Where do the lower airways begin?

A

With the true vocal cords

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11
Q

What is the difference between conducting airways and respiratory airways?

A

Conducting airways facilitate ventilation
Respiratory airways support external respiration

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12
Q

List the conducting airways

A

larynx
Trachea
Main stem bronchi
Lobar bronchi
Segmental bronchi
Subsegemental bronchi
Small bronchi
Bronchioles
Terminal bronchioles

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12
Q

List the respiratory airways

A

Respiratory bronchioles
Alveolar ducts
Alveolar sacts
Alveolus

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13
Q

What happens to the airways as they branch?

A

Airways become progressively shorter, narrower and more numerous
Cross sectional area enlarges

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14
Q

What is the difference between the right and left main stem bronchus?

A

The RMS is shorter, wider and more vertical
The LMS is narrower, longer, and more horizontal

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15
Q

The RMS divides into what?

A

Upper lobar bronchus
Middle lobar bronchus
Lower lobar bronchus

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16
Q

The LMS divides into what?

A

Upper lobar bronchus
Lower lobar bronchus

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17
Q

Describe cartilaginous airways in regards to their function and which airways have cartilage

A

Are strictly conducting airways, no gas exchange
Consist of trachea, main stem bronchi, lobar bronchi, segmental bronchi, and subsegmental bronchi
Small bronchi are the last generation of airways that contain cartilage

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18
Q

Describe noncartilaginous airways in regards to their function and which airways do not have cartilage

A

Can be conducting airways and respiratory airways
Small bronchi are the first to not have cartilage

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19
Q

What is the main function of cartilage in the airways?

A

Structural integrity
Prevent airway collapse

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19
Q

With no cartilage, how do smaller airways stay open?

A

Pressure gradients
Alveoli have surfactant

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20
Q

What is the first generation of airways where cartilage is absent?

A

Bronchioles

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21
Q

Describe the cartilage found in small bronchi compared to the cartilage found in larger airways

A

Smaller airways have cartilage plates whereas larger airways have cartilage rings

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22
Q

At what point do cilia and mucous glands such as goblet cells no longer appear?

A

Terminal bronchioles

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23
Q

Where is smooth muscle found in the airways?

A

From the trachea to the terminal bronchioles

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23
Q

What airway marks the beginning of the respiratory zone?

A

Respiratory bronchioles

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23
Q

What airway marks the end of the conducting zone?

A

Terminal bronchioles

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24
Q

Define an acinus

A

An acinus is the term for the group of structures that arise from a single terminal bronchiole

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24
Q

Describe the atrium in terms of the lungs

A

The space at the entrance from the alveolar duct to an alveolar sac

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25
Q

Beginning with the terminal bronchiole, list the subsequent structures ending with the alveoli

A

Terminal bronchiole
Respiratory bronchiole
Alveolar duct
Alveolar sac
Alveous

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26
Q

ow often do cilia strike the gel layer?

A

About 15 times a second

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26
Q

What are the two distinct layers of the mucus blanket?

A

Sol layer
Gel layer

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27
Q

How fast can the mucociliary escalator move the mucus blanket

A

About 2 cm per minute

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28
Q

Describe the sol layer

A

Low viscosity mucus that allows the cilia to move through it quickly
From submucosal bronchial glands

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29
Q

Describe the gel layer

A

High viscosity mucous on top of the sol layer
Catches particulates for transport and expectoration
From goblet cells

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30
Q

Which airways do goblet cells disappear in?

A

At the end of the terminal bronchioles

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31
Q

What environmental factors can inhibit the mucociliary escalator?

A

Cigarette smoke
Dehydration
Pollutants

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32
Q

What iatrogentic effects can inhibit the mucociliary escalator

A

Hypoxia
General anesthesia
Parasymptholytic drugs
Positive pressure ventilation
Endotracheal suctioning
High FiO2

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33
Q

escribe pseudostratified epithelium

A

Appear to have several layers while being one layer
Each cell touches basement membrane

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34
Q

Describe the lamina propria

A

A thin layer of connective tissue that lies beneath the epithelium

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34
Q

Where is pseudostratified columnar epithelia found?

A

From the trachea until the until the terminal bronchioles
Cilia are absent in the respiratory bronchioles

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35
Q

What cells and tissue make up the mucosa?

A

Epithelium
Cilia
Pseudostratified columnar epithelium
Goblet cells
Basement membrane
Lamina propria

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36
Q

Describe the adventitia

A

A sheath of connective tissue that surrounds the airways
Interspersed with bronchial arteries, bronchial veins, nerves, lymphatic vessels and adipose tissue

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37
Q

Describe type 1 pneumocytes

A

Large flat (squamous) cells that make up the majority of the alveolar wall
Major site of gas exchange

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38
Q

Describe type 2 cells

A

Cuboidal cells that secrete surfactant
Have microvilli
surfactant made by lamellar bodies

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39
Q

Describe type 3 pneumocytes

A

Alveolar macrophages
Remove bacteria and foreign particles
Migrate as monocytes through the blood and into the alveoli

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40
Q

List the layers that an oxygen molecule would go through as it traveled from the alveolus to the pulmonary capillary

A

Surfactant layer
Liquid layer
Type 1 pneumocyte
Epithelial basement membrane
Interstitium
Endothelial basement membrane
Endothelial cell
Plasma
RBC

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41
Q

Describe collateral ventilation

A

Collateral ventilation is the ventilation of alveolar structures through passages or channels that bypass the normal airways when airways are restricted or obstructed

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42
Q

What are the three types of collateral ventilation?

A

Pores of kohn
Canals of lambert
Channels of martin

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43
Q

escribe the pores of kohn

A

Small holes between adjacent alveoli
Alveoli to alveoli ventilation

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44
Q

Describe canals of lambert

A

Collateral airways between respiratory bronchioles and adjacent alveoli
Provide ventilation between various airways within the acinus and between adjacent acini

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45
Q

Describe the channels of martin

A

Found between respiratory bronchioles within the acinus
Found between respiratory bronchioles and terminal bronchioles of adjacent segments
Bronchiole to bronchiole

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46
Q

What part of the type 2 cells secrete surfactant

A

Lamellar bodies

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47
Q

Describe the AC membrane

A

A thin tissue barrier through which gases are exchanged between the alveolar air and the blood in the pulmonary capillaries

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48
Q

hat is the role of surfactant in the alveoli?

A

To reduce surface tension and prevent alveolar collapse

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49
Q

What kind of things are located in the interstitial space?

A

Connective tissue
Collagen fibers
Fibroblasts
Interstitial fluid
Macrophages
Lymphatic vessels

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50
Q

What are the structures that form the thoracic cavity?

A

Ribcage
Intercostal muscles
vertebra l column
Sternum
Diaphragm

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51
Q

In basic terms, what does the thoracic cavity contain?

A

The organs of ventilation, respiration and circulation

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52
Q

What are the 3 sections that make up the sternum?

A

Manubrium
Body
Xiphoid process

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53
Q

How many true ribs are there?

A

Ribs 1-7 are true ribs

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54
Q

How many ribs are considered false ribs

A

8,9,10 are false ribs

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55
Q

Which ribs are considered floating ribs?

A

11 and 12

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56
Q

What is the function of the costal groove?

A

The costal groove serves as a protective channel for nerves, arteries and veins on the underside of the rib

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57
Q

When inserting needles into the chest wall, where should they be aimed?

A

Aimed above the rib to prevent damage to nerves and vessels

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58
Q

What is a potential downside of collateral ventilation?

A

Potentially allows disease to spread quickly through the lung tissue

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59
Q

When performing CPR, what are the risks of compressing too low on the sternum?

A

The xiphoid process projects downward between the ribs. Placing the hands over it during CPR could result in contusions or puncturing of the underlying organs

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60
Q

What bones form the sternal angle or angle of louis?

A

The angle of louis is formed by the articulation of the manubrium with the body of the sternum

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61
Q

Where is the angle of louis in relation to costal cartilage?

A

Lies at the level of the second costal cartilage

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62
Q

What is the angle of louis used for?

A

It is the point from which all costal cartilages and ribs are counted because the first rib is under the clavicle and cannot be felt

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63
Q

What is the relative position of the angle of louis to the vertebrae?

A

Lies opposite of the vertebral disc between T4 and T5

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64
Q

What anatomical landmark serves as a reference point for the approximate location of where an ETT should be placed?

A

Sternal angle or angle of louis

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65
Q

Describe pump handle movement of the ribs

A

Viewing the ribs from the side, the movement of the ribs and the sternum during inspiration is up and out, which mimics the movement of a pump handle

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66
Q

Describe bucket handle movement

A

Viewing from the front, during inspiration the ribs move up and out similar to how a bucket handle would move

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66
Q

What do the pump handle and bucket handle movements facilitate?

A

They facilitate a change in the volume of the thoracic cavity which aids in inspiration and expiration

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67
Q

What do you call the opening at the top of the rib cage?

A

Superior thoracic outlet
Thoracic inlet/outlet

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68
Q

What do you call the opening at the bottom of the rib cage?

A

Inferior thoracic aperture

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69
Q

What is the function of the fluid in the pleural space?

A

To allow frictionless sliding between the pleura during ventilation

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69
Q

How is the fluid in the pleural space regulated?

A

Involves a balance between leakage from systemic and pulmonary capillaries and drainage by lymphatic vessels

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70
Q

Define a pneumothorax

A

An abnormal collection of air in the pleural space between the lung and the chest wall

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71
Q

What are the signs of a pneumothorax?

A

Absent or decreased breath sounds
Tracheal deviation away from affected side
Hyperresonance
Tachycardia
Hypotension
Increased PIP/MAP if on MV

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72
Q

What are the symptoms of a pneumothorax?

A

Acute onset chest pain
Acute onset SOB

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73
Q

What is the difference between a tension and a simple pneumothorax

A

A matter of degree
A tension pneumothorax will have more air infiltrating the pleural space and will be putting pressure on the heart decreasing venous return

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74
Q

If you were to look at an xray of a patient with a pneumothorax, the what would it look like?

A

The side with the pneumo would be black

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75
Q

What is a pleural effusion?

A

A build up of fluid in the pleural space

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76
Q

What kinds of fluid can be in the pleural space?

A

Plasma
Blood
Pus

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77
Q

What is transudate a result of?

A

An imbalance between oncontic and hydrostatic pressure resulting in fluid build up
Can result from congestive heart failure, renal failure or cirrhosis

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78
Q

What is exudate a result of?

A

Typically inflammatory conditions such as infections or pneumonia

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79
Q

What is the difference in the content of transudative and exudative fluid

A

Trasudative = low in protein and LDH
Exudative = high in protein and LDH

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79
Q

How do you treat a pleural effusion?

A

Thoracentesis to drain the fluid

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80
Q

List the structures found within the mediastinum

A

Trachea
Main stem bronchi
Heart
Pericardium
Great vessels leading into and out of the lungs
Esophagus
Vagus and phrenic nerves
thymus , lymph nodes, fat and connective tissue
Azygos and hemiazygos veins

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81
Q

What is located in the anterior portion of the mediastinum?

A

Lymph Nodes, fat, connective tissue, remnants of thymus

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82
Q

What is in the middle section of the mediastinum?

A

Pericardium, heart, bronchi, roots of great vessels

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83
Q

What is in the posterior section of the mediastinum?

A

Esophagus, thoracic aorta, azygos and hemiazygos veins, vagus nerve

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84
Q

Describe the hilum

A

The only place where the lungs are truly attached to the body
Area where main stem bronchi and great vessels enter lungs

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85
Q

What is the primary muscle of ventilation?

A

The diaphragm

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86
Q

What bones does the diaphragm attach to?

A

Vertebrae, ribs, xyphoid process

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87
Q

What is the name of the fibers within the diaphragm that form a broad connective sheet?

A

The central tendon

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88
Q

What does the diaphragm do during inspiration? Expiration?

A

Flatten
Returns to dome shape

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88
Q

T/F: The diaphragm is slightly elevated on the right side of the body because of the stomach

A

False. The diaphragm is slightly elevated on the right side because of the right lobe of the liver

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89
Q

What nerve controls the diaphragm?

A

The phrenic nerve

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90
Q

Where does the phrenic nerve exit the spinal column? Why is this relevant?

A

The phrenic nerve exits at C3-C5
Fractures between C1-C5 are likely to disrupt the phrenic nerve and compromise the ability to breathe

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91
Q

The phrenic nerve controls what?

A

The diaphragm

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92
Q

What are the accessory muscles of inspiration?

A

The external intercostals
Scales
Sternocleidomastoids
Pec major
Traps

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93
Q

What are the accessory muscles of exhalation

A

Internal intercostals
Abdominals (rectus abdominus, ext oblique, int oblique, transverse abdominus)

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94
Q

Describe the external intercostals role in inspiration

A

Lift rib cage causing pump handle and bucket handle movements which increase the volume of the thoracic cavity

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95
Q

Where do the scalene muscles attach?

A

The cervical spine and the first and second rib

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96
Q

Where do the sternocleidomastoid muscles attach?

A

The mastoid process, clavicle and manubrium

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97
Q

What are the 4 volumes that make up total lung capacity?

A

Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume

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98
Q

Describe tidal volume

A

Normal resting quiet breathing
The volume of air that is inhaled or exhaled in a single breath (usually about 500 mL)

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99
Q

Describe inspiratory reserve volume

A

The maximum amount of additional air that can be drawn into the lungs with best effort after normal inspiration

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100
Q

Describe expiratory reserve volume

A

The additional amount of air that can forcibly be exhaled from the lungs by determined effort after normal expiration

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101
Q

Describe reserve volume

A

The amount of air left in the lungs after a forced exhalation
Note, this volume cannot be directly measured, only calculated

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102
Q

What are the 4 lung capacities?

A

Total lung capacity
Inspiratory capacity
Vital capacity
Functional residual capacity

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103
Q

Describe total lung capacity

A

The volume of air contained in the lungs at the end of maximal inspiration

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104
Q

The volume of air contained in the lungs at the end of maximal inspiration is called what?

A

Total lung capacity

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105
Q

What volumes make up total lung capacity?

A

VT+IRV+ERV+RV

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106
Q

Describe inspiratory reserve capacity

A

The maximum volume of air that can be inspired after reaching the end of a normal quiet expiration

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107
Q

The maximum volume of air that can be inspired after reaching the end of normal quiet expiration is called what?

A

Inspiratory reserve capacity

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108
Q

What volumes make up inspiratory reserve capacity

A

IRC = VT+IRV

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109
Q

Describe vital capacity

A

The great volume of air that can be expelled from the lungs after taking the deepest possible breath

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110
Q

What volumes make up vital capacity?

A

VC = IRV + VT + ERV

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110
Q

The greatest volume of air that can be expelled from the lungs after taking the deepest possible breath is called what?

A

Vital capacity

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111
Q

Describe Functional Residual capacity

A

The volume of air present in the lungs at the end of passive expiration

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112
Q

What volumes make up FRC?

A

FRC = ERV + RV

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113
Q

The results of a pulmonary function test are dependent upin what?

A

The quality of instruction and coaching on the part of the clinician doing the testing
The ability to obtain and document multiple reproducible results
The patient giving their best effort during testing

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114
Q

T/F: Exhalation is a passive process in healthy individuals

A

True

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115
Q

Bronchospasms and increased secretions in the airways result in what?

A

Increased resistance to airflow
Increased work of breathing

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116
Q

What disease processes decrease the compliance of the lung tissue?

A

Interstitial lung diseases
Atelectasis
Fluid build up - pneumonia, pleural effusions

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117
Q

Increased resistance to airflow can be caused by what?

A

Bronchoconstriction
Bronchospasms
Secretions

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118
Q

Interstitial lung diseases such as pulmonary fibrosis and pneumonia do what to lung tissue?

A

Decrease compliance

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119
Q

Post op patients who have had major abdominal surgery tend to guard against deep breathing and painful abdominal movements. What can this potentially result in?

A

Secretion retention
Mucus plugging
Atelectasis
Pulmonary infection

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120
Q

The tendency of an object to return to its original shape after being deformed is referred to as what?

A

Elasticity or elastance

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121
Q

Define elasticity

A

The tendency of an object to return to its original shape after being deformed

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122
Q

Why do healthy lungs recoil inward?

A

Surface tension forces
Elastin in the walls of alveoli and within interstitium

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122
Q

Surface tension forces within the alveoli along with elastin in the walls of the alveoli and interstitium result in what?

A

Elastic recoil of the lungs away from the chest wall

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123
Q

At the same time the lungs are recoiling away from the chest wall, what is the chest wall doing?

A

The chest wall is recoiling away from the lungs

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124
Q

What is the point at which the lungs and chest wall balance each other?

A

End exhalation-

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125
Q

What determines FRC?

A

The balance point between inward lung recoil and outward chest wall recoil

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125
Q

The balance point between inward lung recoil and outward chest wall recoil determines what?

A

The FRC

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126
Q

What comprises the FRC?

A

ERV and RV
Expiratory reserve volume and Residual volume

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127
Q

What capacities are affected by a decrease in lung recoil force?

A

FRC (functional reserve capacity) is decrease
IC (inspiratory capacity) is decreased

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128
Q

An increase in FRC and a decrease in IC could be a result of what?

A

A decrease in lung recoil force

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129
Q

What capacities are affected by an increase in lung recoil force?

A

FRC is decreased
TLC is decreased
VC is decreased

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130
Q

Why does decreased FRC translate into and increased WOB?

A

Low FRC means that the lung volume at the of of normal exhalation is abnormally low implying that some alveoli are airless and collapsed
Collapsed alveoli strongly oppose inflation because of high surface tension
To open alveoli, patients have to breath harder to generate more pressure to expand the alveoli which increases the WOB

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131
Q

Why are collapsed alveoli difficult to inflate?

A

Surface tension is difficult to overcome

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132
Q

A decrease in the FRC could mean what?

A

Collapsed alveoli (atelectasis)

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133
Q

Collapsed alveoli do what to compliance?

A

Decrease compliance

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133
Q

Describe ventilation

A

Ventilation is the movement of gas into and out of the lungs which allows oxygen to enter the body and carbon dioxide to be removed

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134
Q

This process involves the movement of gas into and out of the lungs which allows oxygen to enter the body and carbon dioxide to be removed.

A

Ventilation

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135
Q

Describe tidal volume

A

The normal amount of air moving into and out of the lungs with each breath
Air dis[placed between normal inhalation and exhalation when extra effort is not applied
Healthy adult tidal volume is about 500 mL

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136
Q

What is the average tidal volume for a healthy adult?

A

About 500 mL

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137
Q

Describe minute ventilation

A

Defined as the total amount of air that moves into and out of the lungs in a minutes time

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138
Q

How is minute ventilation measured?

A

Typically measured via exhaled gas
Function of tidal volume x frequency

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139
Q

The region of the upper airway and the conducting zone is called what?

A

Anatomic dead space

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140
Q

Anatomic dead space is defined as what?

A

The region of the upper airway and conducting zone that does not participate in gas exchange

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141
Q

How can anatomical dead space be calculated?

A

Determined by calculating the ideal body weight in pounds

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142
Q

The IBW in pounds relates to what?

A

Anatomical dead space

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143
Q

Dead space ventilation is defined as what?

A

Movement in and out of the upper airways and conducting zone

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144
Q

Why are the areas that comprise the upper airways and conducting zone characterized as dead space?

A

They do not participate in gas exchange

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144
Q

What is the formula for IBW?

A

Males = 110+(5 x height in inches over 5 feet)
Females = 100 + (5 x height in inches over 5 feet)

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145
Q

Describe alveolar ventilation

A

Occurs in the respiratory zone
Movement of gas into and out of the region of the airways that includes the respiratory bronchioles alveolar ducts and alveoli

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146
Q

What is the formula for finding alveolar ventilation?

A

Alveolar ventilation = tidal volume - anatomical dead space

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147
Q

Describe the relationship between minute ventilation and carbon dioxide

A

Increased minute ventilation = decreased carbon dioxide
Decreased minute ventilation = increased carbon dioxide

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148
Q

Describe alveolar dead space

A

Occurs when the blood flow to the pulmonary capillary is compromised and gas exchange cannot take place
The volume of air in the lungs that is ventilated but not perfused

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149
Q

In its simplest form, dead space is…

A

Ventilation without perfusion

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150
Q

Obstructions to pulmonary capillaries result in what?

A

Alveolar dead space

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151
Q

Will gas exchange take place if blood flow to a pulmonary capillary is compromised?

A

No.
This results in alveolar dead space ventilation

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152
Q

What could a pulmonary embolus cause?

A

Obstruction of the pulmonary capillary and the creation of alveolar dead space and alveolar dead space ventilation

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153
Q

Alveolar dead space could be caused by what?

A

Obstruction in the pulmonary capillary-pulmonary embolus

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154
Q

Describe physiologic dead space

A

Anatomical dead space + alveolar dead space

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155
Q

The combination of anatomical dead space and alveolar dead space creates what?

A

Physiologic dead space
Physiologic dead space = anatomical dead space + alveolar dead space

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156
Q

The volume of air in the conducting zone that is ventilated but not perfused is called what?

A

Alveolar dead space

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157
Q

How do you calculate anatomical dead space?

A

By calculating the ideal body weight in pounds

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158
Q

How do you calculate tidal volume?

A

Ideal body weight in kg x 6-8 mL/kg (dependent on patient)

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159
Q

What does the alveolar air equation tell us?

A

The partial pressure of a oxygen in the alveoli

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160
Q

Give the formula for the alveolar air equation

A

PAO2 = FIO2 (PB-PH2O) - PaCO2/RQ
PAO2 = partial pressure of oxygen in alveoli
FiO2 = fraction of inspired oxygen
PB = barometric pressure (usually 760 mmHg)
PH2O = barometric pressure of water (usually 47 mmHg)
PaCO2 = partial pressure of CO2 in arterial blood
RQ = respiratory quotient (0.8)

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161
Q

Where the actual fuck does the pulmonary circuit begin and end?

A

Begins where main pulmonary artery leaves RV
Ends where the 4 pulmonary veins dump blood into the left atrium

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162
Q

Where the fuck does the systemic circuit begin and end?

A

Starts with blood exiting the left atrium and entering the aortic artery
Ends with the superior and inferior vena cava dumping blood into the right atrium

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163
Q

What is valve stenosis?

A

A pathological narrowing or constriction of a valve outlet causing increase pressure in the proximal chamber and vessels leading into the proximal chambers

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164
Q

What does mitral valve stenosis cause?

A

High pressures in the left atrium back up into the pulmonary circulation which can lead to pulmonary edema

165
Q

What does aortic valve stenosis cause?

A

High pressures in the left ventricle causes thickening of the wall of the left ventricle and eventually heart failure resulting in pulmonary edema

166
Q

What causes rheumatic feve

A

Certain strains of streptococcal bacteria
Strep throat that isnt properly treated can trigger rheumatic fever

167
Q

What is the risk associated with rheumatic fever?

A

Rheumatic fever can damage heart muscle and heart valves

167
Q

How does rheumatic fever damage the heart valves? What is this called?

A

Bacterial growth on the heart valves and myocardium causing damage
Also known as subacute bacterial endocarditis

168
Q

Subacute bacterial endocarditis is being seen in increasing numbers in what populations?

A

IV substance users

169
Q

What is the term for the first heart sound and what does it indicate?

A

S1 = lub
Closure of the tricuspid and mitral valves

170
Q

What is the term for the second heart sound and what does it indicate?

A

S2 = dub
Closure of the semilunar valves

171
Q

Myocardial infarction, compromised electrical conduction in the heart and congestive heart failure could all be generally categorized as what?

A

Heart attack

172
Q

Heart attack is a colloquial term that could refer to:

A

Myocardial infarction (most likely)
Compromised electrical conduction in the heart
Congestive heart failure

173
Q

Describe the physiological conditions that lead to coronary artery disease

A

Occurs when the lumen of one or more coronary arteries narrows limiting the flow of oxygen rich blood to surrounding heart muscle tissue
Can lead to myocardial infarction

174
Q

Narrowing of the lumen in the coronary arteries will reduce the flow of oxygen rich blood to the heart. What is this disease process called and what can it lead to?

A

Coronary artery disease
Myocardial infarction

175
Q

Describe cholesterol

A

A waxy substance produced and released into the bloodstream by cells in the liver

176
Q

A waxy substance produced and released into the bloodstream by cells in the liver

A

Cholesterol

177
Q

Describe plague

A

Build up of LDL cholesterol and other substances in the walls of the coronary arteries

178
Q

A build up of LDL cholesterol on the walls of the coronary arteries is called what?

A

Plaque

179
Q

Describe atherosclerosis

A

Condition that leads to walls of the coronary arteries becoming thick and stiff as a result of the build up of plaque on the artery walls which can lead to the blockage of the artery and myocardial infarction
Can also be called CAD

180
Q

A condition that leads to the walls of the coronary arteries becoming thick and stiff as a result of the build up of plaque on the artery walls

A

Atherosclerosis

181
Q

Define arteriosclerosis

A

Loss of elasticity of coronary arteries caused by atherosclerosis

181
Q

The loss of elasticity in the coronary arteries is called what? What is it caused by?

A

Arteriosclerosis
Atherosclerosis

182
Q

What is a stationary blood clot called?

A

A thrombus

183
Q

What is a thrombus?

A

A stationary blood clot

184
Q

What is an embolus?

A

A mobile blood clot

185
Q

A mobile blood clot is called what?

A

An embolus

186
Q

Describe myocardial ischemia

A

Reduced blood and oxygen delivery to the tissue

187
Q

The reduction of blood flow and oxygen delivery to tissues

A

Myocardial ischemia

188
Q

Describe a myocardial infarction

A

Blood supply to the heart muscle is totally blocked or severely reduced resulting in the death of heart tissue

189
Q

The death of heart tissue as a result of decreased or blocked blood flow is called what?

A

A myocardial infarction

190
Q

What is angina?

A

Chest pain resulting from myocardial ischemia

191
Q

What is a coronary artery bypass CABG?

A

A surgical intervention which attempts to bypass obstructions caused by CAD

192
Q

A surgical intervention which attempts to bypass obstructions caused by CAD

A

CABG

193
Q

Pain felt beneath the sternum and radiating the left or right arm, neck or jaw is referred to as what? What is the cause?

A

Angina pectoris
Results from decrease flow of oxygen to myocardial tissue aka myocardial ischemia

194
Q

When does angina occur?

A

When the myocardium doesnt get the required blood and oxygen supply necessary to meet its demand, may occur during periods of physical exertion and go away after rest = stable angina

195
Q

What is reversible or stable angina?

A

Occurs when heart works harder and needs more oxygen and goes away when oxygen demand is decreased

196
Q

What is progressive or unstable angina?

A

Occurs when a plague in one or more coronary arteries ruptures

197
Q

Describe the initial stages of atherosclerosis

A

LDL deposits in the artery wall
Macrophages engulf the invading cholesterol
Macrophages become full of cholesterol and as more macrophages collect in the area, they form a fatty streak between the tunica media and tunica intima which can develop into a plaque which pushes the intima into the lumen reducing blood flow

198
Q

What does the plaque develop over time?

A

A fibrous coating on its outer edge

199
Q

What can happen if cholesterol continues to collect in foam cells?

A

If cholesterol continues to collect in foam cells, the fibrous outer coating can weaken and eventually rupture resulting in smaller downstream arteries becoming blocked

200
Q

What can happen at the rupture site if the problem is not addressed?

A

The rough surface of the rupture can cause RBCs to adhere to it and form a clot which could completely block the artery

201
Q

Describe Low density Lipoproteins

A

LDL cholesterol joins with fats and other substances to build up in the inner walls of your arteries. These are necessary for carrying cholesterol throughout the body, but too many of them can lead to CAD

202
Q

Describe high density lipoproteins

A

HDL remove cholesterol from the blood stream and the artery walls. A high HDL count is desirable because it reduces you chances of strokes and CAD

203
Q

What is considered a good HDL level?

A

Ideal is 60 or higher
Men = 40 or higher is acceptable
Women = 50 or higher is acceptable

204
Q

What is considered a good LDL level?

A

Less than 100, preferably below 70 if coronary artery disease is present

205
Q

What is considered to be a high LDL level?

A

160 or higher
190 considered to be very high

206
Q

What is a good triglyceride level?

A

Less than 149, ideal is less than 100

207
Q

What is considered a high triglyceride level?

A

200 or higher with 500 considered to be very high

208
Q

Where do atherosclerotic plaques form?

A

Between the tunica media and the tunica intima

209
Q

What comprises a total cholesterol score?

A

HDL + LDL + Triglycerides

210
Q

What class of drugs are used to lower cholesterol?

A

Statins

210
Q

How do statins treat high cholesterol?

A

Statins disrupt the production of cholesterol by blocking an enzyme in the liver cells which decreases the amount of cholesterol being released into the bloodstream
Some statins reduce the inflammatory response process in the vessel wall resulting in fewer macrophages going to phagocytose the invading cholesterol resulting in fewer foam cells and plaque which results in the plaques growth slowing or stopping and preventing the rupture and subsequent formation of a clot

211
Q

When can collateral circulation reduce the risk of myocardial infarction?

A

If the narrowing or coronary arteries progresses gradually over a long period of time, collateral circulation develops to supply ischemic areas and reduce the risk of MI
Does not have a major effect in cases where narrowing occurs rapidly either due to plaque rupture or clot formation

212
Q

What are non modifiable/internal risk factors for CAD by atherosclerosis?

A

Age
Gender (women pre menopause have a hormonal advantage)
Family history of coronary artery disease (relative with MI before 40)
Male pattern baldness

213
Q

What are some of the tests that can be performed in order to diagnose CAD?

A

Electrocardiogram
Echocardiogram
Exercise stress test
Nuclear stress test
Cardiac catheterization and angiogram
Cardiac CT scan

214
Q

Describe an angiogram

A

A catheter is placed in the coronary arteries via the femoral or brachial artery
One placed, a radio opaque dye is injected via the catheter into the blood stream
Pictures are taken via a specialized xray machine in a process called fluoroscopy which will show areas of narrowing in the arteries

215
Q

What are some modifiable risk factors for CAD caused by atherosclerosis?

A

Smoking or tobacco use
High cholesterol levels
Diabetes
Hypertension
Obesity
Psychosocial stress
Sedentary lifestyle
Reduced consumption of fruit and vegetables
Poor oral hygeine
Type A personality
Presence of peripheral vascular disease

216
Q

What non-atherosclerotic factors could cause an MI?

A

Coronary artery occlusion secondary to vasculitis
Cardiomyopathy
Coronary trauma
Primary coronary vasospasm (can be linked to stimulant use)
Coronary anomalies including aneurysms of coronary arteries
Factors that increase oxygen requirement or decrease oxygen deliver
Aortic dissection

217
Q

Describe stenosis

A

Valve tights and slows blood flow beyond the valve making it harder for the heart to pump blood
Caused by calcium build up or scarring of the valve tissue

218
Q

What is the most common cause of cardiac regurgitation?

A

Valve prolapse
The leaflets of the mitral valve bulge = prolapse into the left atrium

219
Q

What is regurgitation?

A

Valve doesnt close tightly enough or is prolapsed allowing blood to leak backward leading to a fluid build up

220
Q

Describe rheumatic heart disease

A

A condition where the heart valves have been permanently damaged by rheumatic fever
Damage may occur shortly after an untreated streptococcal infection occurs resulting in an inflammatory response by the body which can cause ongoing damage

221
Q

What part of the heart is most commonly rheumatic heart disease?

A

The mitral valve is most commonly affected valve in 50-60% of cases
Aortic and mitral valves only make up 20% of cases

222
Q

Rheumatic fever can be the cause of what valve pathologies?

A

Stenosis
Regurgitation

223
Q

A life threatening condition which results in inflammation in the inner lining (endocardium) chambers and valves

A

Endocarditis

224
Q

Describe endocarditis

A

A life threatening inflammation of the endocardium chambers and valves

225
Q

What causes endocarditis?

A

Bacterial infections that enter the bloodstream, travel to the heart and lodge on heart valves or heart tissue
Bacteria form growths called vegetations on the valves that cause leaking and damage

226
Q

What are the risk factors for endocarditis?

A

IV drug use, poor dentation, in-dwelling catheter, artificial heart valves

227
Q

How does a cardiac catheterization work?

A

Examines the inside of coronary arteries via angiogram
Catheter is inserted through the femoral or brachial artery and into the coronary arteries via the aorta
One catheter is in place, a radiopaque contrast dye is injected via catheter into the bloodstream
Specialized x ray machine takes a series of images in a process called fluoroscopy which shows areas of narrowing in the arteries

228
Q

Describe what an angioplasty does

A

Opens blocked arteries and restores normal blood flow to the myocardium
Opens clogged artery by inflating a tiny balloon in it
Often combined with implantation of a stent to help prop open the artery and decrease the chance of another blockage

229
Q

Describe the process of CABG

A

Creates new pathways for blood and oxygen to be delivered to the myocardium
Done by harvesting arteries or veins (usually mammary or saphenous veins) and using them to reroute blood around blocked coronary arteries

230
Q

What is a coronary artery stent?

A

A tiny wire mesh tube used to prop open an artery during angioplasty
Stays in permanently
Frequently contain drugs that have a slow release time and are meant to prevent clot formation

231
Q

What are lifestyle changes that reduces the risk of CAD?

A

Healthy diet
Regular exercise
No smoking
Reduce stress
Lose weight

232
Q

What are medications that treat CAD?

A

Cholesterol modifiers
Aspirin
Beta blockers
Calcium channel blockers
Angiotensin converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Nitroglycerin
Ranolazine
Clot busters

233
Q

What are procedures that can restore and improve blood flow in the coronary arteries?

A

Cardiac catheterization
Angiogram
Angioplasty
Stent placement

234
Q

What surgical intervention is used to treat CAD?

A

CABG or angioplasty with stent placement

235
Q

Define total lung capacity

A

The volume of air in the lungs upon the maximum effort of inspiration

236
Q

What is the TLC in the average health adult?

A

6 L

236
Q

What volumes make up TLC

A

Inspiratory reserve volume
Resting tidal volume
Expiratory reserve volume
Residual volume

237
Q

Describe tidal volume

A

The lung volume representing the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied

238
Q

What is the average tidal volume in a healthy young adult?

A

About 500 mL

239
Q

Describe inspiratory reserve volume

A

The maximal amount of additional air that can be drawn into the lungs with best effort after normal inspiration

240
Q

The maximal amount of additional air that can be drawn into the lungs with best effort after normal inspiration

A

Inspiratory reserve volume

241
Q

Describe expiratory reserve volume

A

The additional amount of air that can be forcibly exhaled from the lungs by determined effort after a normal expiration

242
Q

The additional amount of air that can be forcibly exhaled from the lungs by determined effort after normal expiration

A

Expiratory reserve volume

243
Q

Describe residual volume

A

The amount of air left in the lungs after a forced exhalation
Note: this volume cant be measured, only calculated

244
Q

What is the amount of air left in the lungs after a forced exhalation?

A

Residual volume

245
Q

What are the four lung volumes that make up total lung capacity?

A

Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume

246
Q

Describe inspiratory capacity

A

The maximum volume of air that can be inspired after reaching the end of a normal quiet expiration
IC = VT + IRV

247
Q

The maximum volume of air that can be inspired after reaching the end of normal quiet expiration

A

Inspiratory capacity

247
Q

Describe vital capacity

A

The greatest volume of air that can be expelled from the lungs after taking the deepest possible breath
VC = IRV + VT + ERV

248
Q

The greatest volume of air that can be expelled from the lungs after taking the deepest possible breath

A

Vital capacity

249
Q

Describe functional residual capacity

A

The volume of air present in the lungs at the end of passive expiration
At FRC the opposing elastic recoil forces of the lungs and chest wall are in equilibrium and there is no exertion by the diaphragm or other respiratory muscles
FRC = ERV + RV

250
Q

What volumes make up inspiratory capacity?

A

IRC = VT + IRV

251
Q

What are the volumes that make up vital capacity?

A

VC = IRV + VT + ERV

251
Q

What are the volumes that make up Functional residual capacity?

A

FRC = ERV + RV

252
Q

What effect can obesity have on breathing?

A

A very large abdomen can impede downward diaphragmatic movement during inspiration, decreasing inspired volume and possible causing chronic underventilation

253
Q

What can shallow breathing in post op patients result in?

A

Secretion retention
Mucus plugging
Atelectasis
Pulmonary infection/pneumonia

254
Q

What is hemodynamics?

A

Pressure, flow, and volumes of blood traveling through the vascular system

254
Q

Where does the systemic circuit begin and end?

A

The systemic circuit begins where aorta leaves the left ventricle
The systemic circuit ends with the superior and inferior vena cava and coronary sinus dump into the right atrium

255
Q

Where does the pulmonary circuit begin

A

The pulmonary circuit begins as blood leaves the right ventricle and enters the pulmonary arteries
The pulmonary circuit ends where the pulmonary veins dump the blood into the left atrium

256
Q

Define blood pressure

A

The amount of pressure exerted against the inside walls of the blood vessels as blood travels throughout the systemic and pulmonary circuits

257
Q

Define systolic blood pressure

A

The amount of pressure exerted against the inside walls of the arteries when the heart contracts

258
Q

What factors control blood pressure?

A

Heart
Blood
Vessels

258
Q

If there is an increase in heart rate, how will blood pressure be affected?

A

It will increase

259
Q

If there is a decrease in heart rate, how will blood pressure be affected?

A

It will decrease

260
Q

How does contractility affect blood pressure?

A

Increase contractility = increased blood pressure
Decreased contractility = decreased blood pressure

261
Q

How does the blood influence blood pressure?

A

Amount of blood influences the blood pressure
Can be altered by altering fluid level (IV, diuretics)

262
Q

How do the vessels influence blood pressure?

A

Vessel diameter influence blood pressure
Vasoconstriction = increased BP
Vasodilation = decreased BP

263
Q

Define diastolic blood pressure

A

The amount of pressure exerted against the inside walls of the arteries when the heart is at rest

264
Q

What is the formula for mean systemic arterial pressure?

A

SAP = systolic pressure + 2(diastolic pressure) / 3

265
Q

What is the normal range for mean system arterial pressure?

A

Normal is about 92 mmHg

266
Q

How do you measure systemic blood pressure?

A

Blood pressure cuff
Indwelling arterial line

267
Q

What is the normal range for blood pressure?

A

<120/<80

268
Q

What is the prehypertension range for blood pressure?

A

120-139 / 80-89

269
Q

What is the Stage 1 hypertension range for blood pressure?

A

140-159 / 90-99

270
Q

What is the stage 2 hypertension range for blood pressure?

A

> 160 / >100

271
Q

What is the normal range for pulmonary arterial pressure?

A

30-15 / 15-5

272
Q

What is the normal range for mean PAP?

A

8 -20 mmHg

272
Q

How can you measure PAP?

A

Pulmonary artery catheter
Echocardiogram
Transesophageal echocardiogram

273
Q

Describe the ejection fraction?

A

The percent of the LVEDV that is ejected during systole

274
Q

What is LVEDV?

A

Left ventricle end diastolic volume

275
Q

What is LVEDP?

A

Left ventricle end diastolic pressure

276
Q

What is the normal range for the ejection fraction?

A

50-65%

277
Q

Describe stroke volume

A

Volume of blood ejected from left ventricle during systole in mL

278
Q

Describe Cardiac output

A

The amount of blood the heart pumps out per minute

279
Q

What is the normal range for cardiac output?

A

4-8 L/m

280
Q

Why might we reduce the cardiac output in post op patients?

A

We want to decrease the amount of pressure being applied to the newly grafted arteries after a CABG surgery

281
Q

What is the cardiac index?

A

A method that factors in cardiac output and body size to narrow down the acceptable range for a patient

282
Q

What is the formula for cardiac index

A

CI = Cardiac output / body surface area

283
Q

How do you calculate stroke index?

A

cardiac index/heart rate

284
Q

How do you calculate stroke volume index?

A

SV/BSA

285
Q

Describe the path of the action potential as it travels through the heart

A

Sinoatrial node
Atrioventricular node
Bundle of His
Common bundle branches
Right and left bundle branches
Purkinje Fibers into myocardium

286
Q

What is the “pacemaker” of the heart?

A

The sinoatrial node
Sets intrinsic rate of contraction of 60-100 BPM

287
Q

If the SA node is compromised, what takes over as the pacemaker?

A

The atrioventricular node
Sets intrinsic rate of 40-60 BPM

288
Q

What are the SA node and AV node made o

A

Specialized nodal tissues that can generate impulses and set HR

289
Q

Under normal conditions, the AV node is suppressed by what?

A

The SA node
Overdrive suppression

290
Q

The AV node slows the intrinsic rate set by the SA node. Why?

A

Allows time for ventricular filling

291
Q

Sometimes impulses are generated from abnormal regions of the heart. What are these referred to as?

A

Ectopic foci

292
Q

What is automaticity?

A

The unique ability of the cardiac muscle to intrinsically initiate a spontaneous electrical impulse
These spontaneously triggered impulses are conducted through the myocardium which triggers the heart muscle to contract

293
Q

What are the four defining features of the heart?

A

Automaticity
Conductivity
Excitability
Contractility

293
Q

Describe excitability

A

The ability of cells to respond to electrical, chemical or mechanical stimulation

294
Q

Imbalances in electrolytes as well as certain drugs can increase excitability in myocytes. What can this lead to?

A

Dysrythmias

295
Q

Why cant cardiac contractions be sustained?

A

Because they would kill you. Wishful thinking at this point’
Cardiac contractions cannot be sustained because myocardial tissues is characterized by a prolonged period of inexcitability after contraction

296
Q

What is the period during which the myocardial tissue is inexcitable called?

A

The refractory period

297
Q

What is contractility?

A

The ability to shorten muscle fibers

298
Q

Define afterload

A

The amount of resistance offered by the vasculature to the outflow of blood as it tries to leave the the ventricles

299
Q

Define preload

A

The stretch placed on the myocardium after diastole

300
Q

How do we measure preload in the right heart?

A

By measuring central venous pressure

301
Q

How do we measure preload in the left heart

A

By measuring pulmonary capillary wedge pressure

302
Q

How do we determine afterload in the right heart?

A

Pulmonary vascular resistance

303
Q

How do we determine afterload in the left heart

A

By calculating vascular systemic resistance

304
Q

How can we influence preload?

A

By influencing input and output

305
Q

How can we increase preload?

A

Administer IV fluid
Crystaloids, colloids, blood products

306
Q

How can we decrease preload?

A

Increase output

307
Q

How can we manipulate afterload?

A

Give drugs that cause vasodilation/constriction
Introduce or eliminate fluids

308
Q

Define hypoventilation

A

PaCO2 > 45 mmHg

309
Q

Define Hyperventilation

A

PaCO2 < 35 mmHg

309
Q

What does the S1 lub sound indicate?

A

Atrioventricular valves closings = systole

310
Q

What does the S2 dub sound indicate?

A

Semilunar valve closure = diastole

311
Q

What connects the right and left atrium in the fetal heart?

A

Fossa olvalis

312
Q

Where does the coronary circuit begin? End?

A

The coronary os (ostia = plural)
Ends in coronary sinus

313
Q

An abnormal build up of fluid in the pericardial cavity is called what?

A

Pericardial effusion

314
Q

Between what layers of heart tissue does a pericardial effusion occur?

A

Parietal pericardium and visceral pericardium

315
Q

The parietal pericardium, the visceral pericardium and the pericardial space make up what?

A

The serous pericardium

316
Q

If you were to get stabbed in the heart, in what order would the knife penetrate the cardiac tissues starting with the fibrous pericardium

A

Fibrous pericardium
Parietal pericardium
Pericardial space
Visceral pericardium / epicardium
Myocardium
Endocardium

316
Q

The visceral pericardium is also known as what?

A

Epicardium

317
Q

A heart murmur could be caused by what?

A

Defects in the interventricular septum

318
Q

On average, how much CO2 is produced per minute?

A

200 ml

319
Q

On average, how much O2 is consumed per minute?

A

250 ml

319
Q

How do we get the respiratory quotient?

A

CO2 produced/Oxygen consumed
Generally around .8

320
Q

What is the correct term for slow, shallow breathing?

A

Hypopnea

321
Q

What is the correct term for fast, deep breathing?

A

Hyperpnea

321
Q

If a change in breathing pattern is said to have a physiologic cause, what does that mean?

A

Physiologic causes are factors that change respiratory patterns in order to meet metabolic demands of body tissues
Exercise, high altitude….anemia?

322
Q

If a change in breathing pattern is said to have a pathologic cause, what does that mean?

A

Pathologic causes are factors that change respiratory pattern due to illness
Infection or sepsis

323
Q

How do we determine if ventilation is effective?

A

Measuring PaCO2 and its effects on pH

324
Q

What is the correlation between a change in pH and a change in PaCO2?

A

12 mmHg change in PaCO2 is results in a 0.1 change in pH

325
Q

What does the VT/VD ratio tell us?

A

The VD/VT ratio provides an index of wasted ventilation per breath

326
Q

What is the formula for calculating the VD/VT ratio?

A

(PaC02 - PECO2)/PaCO2

326
Q

What is a normal VD/VT ratio?

A

0.2-0.4

327
Q

What does a VD/VT ratio of 0.4-0.6 mean?

A

Indicates lung compromise

328
Q

What does a VD/VT ratio of greater than 0.6 mean?

A

Indicates serious lung compromise

328
Q

What is a normal PECO2?

A

28 mmHg

329
Q

What is bronchial circulation a subset of?

A

Systemic circulation

330
Q

Where does the bronchial circuit begin?

A

The descending thoracic aorta

331
Q

What does bronchial circulation supply oxygenated blood to?

A

Walls of airways from mainstem bronchi down to the respiratory bronchioles
Visceral pleura
Pulmonary nerves
Mediastinal lymph nodes
Walls of pulmonary arteries and veins

332
Q

Describe how 2/3rd of poorly oxygenated bronchial capillary blood returns to the heart

A

Blood drains in bronchial venules which anastomoses to pulmonary venules that eventually empty into pulmonary veins leading back to the left heart

333
Q

Describe how 1/3rd of poorly oxygenated bronchial capillary blood returns to the heart

A

Bronchial submucosal and adventitial venules drain into bronchial veins which drain into the azygos and homozygous veins eventually returning to the right atrium

334
Q

What is the significance behind the return route of 2/3rds of bronchial blood?

A

The poorly oxygenated blood from the bronchial circuit mixes with the well oxygenated blood of the pulmonary circuit which is then sent to the left circuit and then put into systemic circulation
This decreases the oxygen content of the pulmonary venous blood creating an anatomical shunt

335
Q

What is an anatomical shunt?

A

Blood that does not have the opportunity to participate in gas exchange at the AC membrane

336
Q

What is considered a normal anatomical shunt?

A

3-5%

337
Q

What is the consequence of anatomical shunting?

A

Systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas which gives rise to the normal alveolar to arterial oxygen difference

338
Q

What are some examples of abnormal anatomical shunts?

A

Tetralogy of fallot
Pulmonary atresia
Transposition of the great arteries
Truncus arteriosus

339
Q

What is the connection between bronchial vein depth and blood drainage?

A

Deep veins drain into the pulmonary veins
Superficial veins drain into the azygos and hemiazygos veins

340
Q

What are thebesian veins?

A

Small cardiac veins that exist in the muscular walls of the heart and drain directly into the heart cavities

340
Q

What is the impact of thebesian veins?

A

Thebesian veins drain directly into the heart cavities including the left atrium which means that they constitute an anatomical shunt by diluting the oxygenated blood with poorly oxygenated blood

340
Q

The bronchial circulation begins where the bronchial arteries branch off of/arise from:

A

The thoracic descending aorta

340
Q

The bronchial circulation is

A

A subset of the systemic circulation

341
Q

The bronchial arterial circuit contains

A

Oxygen rich blood

341
Q

When blood passes through the capillary beds of the walls of the bronchi and bronchioles, oxygen diffuses out of the blood and into the tissues of the wall of the airways. The source of this blood is the:

A

The bronchial arterial circuit

341
Q

Bronchopulmonary-arterial anastomoses are

A

vascular connections between bronchial venules and pulmonary venules

342
Q

After gas exchange occurs at the tissue level, blood from the bronchial circulation level is directed back to the right atrium via the

A

Azygos and hemiazygos veins

343
Q

The bronchial arteries deliver blood to all of the following locations EXCEPT

A

The pulmonary capillaries

344
Q

Where does the bronchial circuit end?

A

In 2 different locations. The pulmonary venules taking blood back to the left atrium and the azygos or hemiazygos veins taking blood back to the right atrium

344
Q

What are the two normal sources of the normal anatomical shunt?

A

Bronchial circulation
Thebesian veins

345
Q

An example of alveolar dead space is

A

An alveolus that is ventilated but not perfused
Remember, for it to be dead space the alveolus cannot be collapsed

346
Q

Describe a pulmonary shunt

A

When an alveoli is perfused but not ventilated

347
Q

Describe physiologic shunts

A

Anatomic shunt + pulmonary shunt

348
Q

What is the symbol for physiologic shunt?

A

QS/QT
Perfusion shunted/perfusion total

349
Q

What is another term for the QS/QT ratio?

A

Venous admixture

349
Q

How do we calculate physiologic shunt?

A

QS/QT = CcO2 - CaO2 / CcO2 -CvO2

349
Q

How do you determine a patient’s minute alveolar ventilation

A

Calculate a patient’s dead space based on ideal body weight in pounds, then calculate a patient’s tidal volume based on their ideal body weight in kilograms multiplied by 6-8 ml/kg. Then dead space from tidal volume and multiply by respiratory rate

350
Q

The percentage of blood being ejected during systole is called what?

A

The ejection fraction

351
Q

The volume of blood being ejected during systole is called what?

A

The stroke volume

352
Q

The information obtained from the arterial blood gas also allowed the clinician to calculate an a/A ratio. This value represents:

A

the percentage of oxygen that has moved from the alveoli into the pulmonary capillaries during gas exchange at the alveolar capillary membrane

352
Q

If a patients PaCO2 goes from 40 mmhg to 52 mmHg, what happens to their pH?

A

It goes down by 0.1

353
Q

Describe how we get the respiratory quotient

A

Healthy individuals consume 250 ml of oxygen per minute while producing 200 ml of carbon dioxide. Dividing the carbon dioxide produced by the oxygen consumed gives us the respiratory quotient, 0.8

353
Q

RBCs have a unique, bi-concave design that increases their surface area and facilitates their major function(s), which is to:

A

to carry oxygen bound with hemoglobin to the tissues

354
Q

The major difference between plasma and serum is

A

the absence of fibrinogen and other clotting factors in serum

355
Q

A term that can be used interchangeably with “white blood cells” is:

A

Leukocytes

356
Q

Red blood cells comprise approximately what percentage of total circulating blood volume?

A

45%

357
Q

Thrombocytes are also known as

A

Platelets

358
Q

Which component of the blood is the heaviest, occupying the bottom of a test

A

tube vial that has been centrifuged?

358
Q

Approximately how many hemoglobin protein molecules are contained within a single red blood cell?

A

Hundreds of millions

359
Q

Someone who has a hematocrit or hemoglobin that is below the normal range is referred to as

A

Anemic

360
Q

Hemoglobin is expressed in units of “g%” which represents

A

the weight (in grams) of hemoglobin contained within a sample of 100 mL of blood

361
Q

Deoxyhemoglobin refers to hemoglobin that

A

is not carrying any oxygen in its heme groups

362
Q

Every hemoglobin protein molecule contains four “hemes” that are capable of binding with one molecule of

A

Oxygen

363
Q

Given the information that your patient has a hematocrit (Hct) of 18%, you are able to determine that their hemoglobin level is approximately

A

6%

364
Q

Hematocrit is approximately 3x ________

A

Hemoglobin

365
Q

A hematocrit test measures what?

A

Percentage of red blood cells in blood

366
Q

If a person has a hemoglobin count of 15%, what is their hematocrit?

A

45%

366
Q

What is a normal hematocrit range in men?

A

40-54%

367
Q

What is a normal hematocrit range in women?

A

36-48%

368
Q

In reference to the physiology of oxygen transport, the value”1.34” is best described as:

A

The amount of oxygen in milliliters that is capable of combining with one gram of Hgb

369
Q

In reference to the physiology of oxygen transport, the units of “vol %” describes:

A

The amount of oxygen in milliliters contained within a 100 ml of blood

370
Q

The “V” in V/Q ratio or V/Q mismatch represents:

A

minute alveolar ventilation, which can be calculated if you know a person’s tidal volume, anatomical dead space and respiratory rate

371
Q

The number 0.0031 represents

A

the amount of oxygen in mL that dissolves in plasma for each mm Hg of partial pressure of oxygen (PO2)

372
Q

The difference between CaO2 and CvO2 is represented by

A

C(a-v)O2

373
Q

Which of the following values for CcO2 would be considered typical in a normal, healthy person with a normal Hgb who is breathing room air?

A

20 vol%

374
Q

How many heme groups are in a single hemoglobin?

A

4

375
Q

What is at the center of every heme group?

A

An iron molecule

376
Q

How many oxygen molecules can be carried by a single heme?

A

4

377
Q

Describe cooperative binding

A

When an oxygen molecule binds to iron in one heme group, it changes the shape of the molecule in such a way that it makes other subsequent bindings more likely

377
Q

What units are hemoglobin measured in?

A

Grams percent/ g%

378
Q

What is the normal hemoglobin range for men?

A

12-17%

379
Q

What is the normal hemoglobin range for women?

A

12-15%

379
Q

What is it called if someones hemoglobin is too high?

A

Polycythemia

380
Q

What is CaO2?

A

The oxygen content in arterial blood
When calculating, take out 2 decimals

381
Q

What is CvO2?

A

The oxygen content in mixed venous blood
When calculating, take out 2 decimals

382
Q

What is CcO2?

A

The oxygen content in end capillary blood
When calculating, take out 2 decimals

382
Q

How do you calculate CaO2?

A

(Hgb x 1.34 x SaO2) + (PaO2 x 0.0031)
Calculate the amount of oxygen bound to hemoglobin and the amount of oxygen dissolved in the plasma and add the two values together

383
Q

What are the units that describe oxygen content in the blood?

A

Volume percent
mL of oxygen / 100 mL of blood

384
Q

How do you calculate CvO2?

A

(HgB x 1.34 x SvO2) + (PvO2 x 0.0031)
Calculate oxygen bound to HgB and amount of oxygen dissolved in the plasma

385
Q

What does C(a-v)O2 tell us?

A

The difference between the amount of oxygen delivered from the left heart to the tissues and the amount of oxygen that is delivered from the tissues back to the right heart

386
Q

How do you calculate CcO2?

A

(Hgb x 1.34 x SAO2) + (PAO2 x 0.0031)
Note, when calculating CcO2, SAO2 will always be 1

387
Q

What does DO2 stand for?

A

Oxygen transport

388
Q

How do you calculate oxygen transport? (DO2)

A

CaO2 x CO x 10
Multiply by 10 because CaO2 is for how much oxygen is in 100 ml of blood

388
Q

What is the P/F ratio?

A

PaO2/FiO2
A means of determining the amount of oxygen in the blood compared to the FiO2 required to maintain that level

389
Q

What is a normal range for the P/F ratio?

A

350-500

390
Q

What would a P/F ratio of 200-300 indicate?

A

Mild respiratory distress syndrome

390
Q

What would a P/F ratio of 100-200 indicate?

A

Moderate respiratory distress syndrome

391
Q

What would a P/F ratio of <100 indicate?

A

Severe respiratory distress syndrome

392
Q

What is the formula for calculating the V/Q ratio?

A

Minute alveolar ventilation / cardiac output

392
Q

What is a normal V/Q ratio?

A

0.8 - 1

393
Q

What happens if ventilation is greater than perfusion?

A

Dead space

393
Q

What happens if perfusion is greater than ventilation?

A

Pulmonary shunting

394
Q

A V/Q ratio of less than 0.8 indicates…

A

Shunting

395
Q

A V/Q ratio of greater than 1 indicates

A

The presence of dead space or increase dead space

396
Q

How do we calculate oxygen consumption (VO2)

A

Not directly measurable
Determined by calculating the difference in DO2 from left heart to tissues and DO2 from the tissues to the right heart

397
Q

How is CO2 carried by the blood for elimination?

A

As bicarbonate
Dissolved in plasma
Attached to heme protein chains
Attached to plasma proteins

398
Q

Explain the role of bicarbonate in CO2 transport

A

CO2 enters an RBC which contains water. CO2 combines with water to form carbonic acid. Carbonic acid is unstable and breaks down into bicarbonate and a hydrogen ion. Bicarbonate then moves out of the RBC as part of the chloride shift and is transported in the plasma

399
Q

What happens to the hydrogen ion created by the break down of carbonic acid?

A

It binds to a heme

400
Q

What is the technical term for a CO2 molecule bound to a protein?

A

A carbamino compound

401
Q

What is the term for a hydrogen bound to a heme?

A

Deoxyhemoglobin

402
Q

What allows for the rapid reaction between water and carbon dioxide?

A

A hydrolysis reaction performed by carbonic anhydrase

403
Q

What happens when venous blood returns to the AC membrane?

A

Oxygen diffuses into the RBC, kicks the hydrogen ion off of the heme, bicarbonate moves back into the RBC and a reaction takes the now free hydrogen ion and the bicarbonate and creates CO2 and water allowing the CO2 to diffuse out of the blood and into the alveoli

Cardiopulmonary (6 decks)

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