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Exam 2 Keystone > L18 - Intro to Pulmonary Physiology > Flashcards

L18 - Intro to Pulmonary Physiology Flashcards

1
Q

Part of the lung where there is:

  • Bulk air movement
  • Anatomic dead space (no alveoli)
  • No gas exchange
A

Conducting Zone

Includes: trachea, bronchi, bronchioles, terminal bronchioles

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2
Q

Part of the lung where there is:

  • Increasing number of alveoli
  • Air distribution by diffusion
  • Alveolar-capillary unit; Gas exchange takes place
A

Transitional / Respiratory Zone

Includes: respiratory bronchioles, alveolar ducts, alveolar sacs

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3
Q

Describe normal lung histology

A

Large spaces between alveoli and thin alveolar walls

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4
Q

A. What are the 2 sources of blood to the lungs and what are their primary roles?

B.How does this impact lung infarctions?

A

A.

  1. Pulmonary artery - responsible for gas exchange (pulm aa –> alveoli –> alveolar ducts –> RBC picks up and drops off CO2 –> pulm vv)
  2. Bronchial artery - gives nutrition to lungs

B. Lung rarely infarcts since it has 2 sources of blood

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5
Q

Tidal Breathing: Inspiration Which is false?

A. Brain initiates inspiratory signal

B. Inspiratory muscles contract

C. Thoracic volume increases - diaphragm flattens

D. Intrapleural pressure increases

E. Alveoli expand

F. Alveolar pressure less than atmospheric

G. Air gradient so air flows into airways until Alveolar = atmospheric pressure

A

D. decreases

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6
Q

Tidal Breathing: Expiration Which is false?

A. Brain ceases inspiratory signal

B. Inspiratory muscles relax - diaphragm returns to normal shape

C. Alveoli recoil (elastic)

D. Thoracic volume decreases

E. Alveolar pressure much less than atmospheric

F. Air flows out of airways until Alveolar = atmospheric pressure

A

E. Alveolar pressure much greater than atomospheric

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7
Q

T/F Restrictive lung diseases or rib cage abnormalities will impair normal tidal breathing?

A

T

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8
Q

Which is not a common pulmonary symptoms?

  1. Dyspnea
  2. Syncope
  3. Hemoptysis
  4. Cough
  5. Nausea
A
  1. Nausea is not a common symptom Chest pain is the other pulmonary symptom
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9
Q

On physical exam: Whistle noise made during exhalation due to narrow tubes

A

Wheezing

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10
Q

On inspection what do you look for in someone with impaired pulmonary function?

A
  1. ability to finish a sentence
  2. cyanosis
  3. use of accessory muscles
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11
Q

On physical exam: Static-like sound due to alveoli filled with fluid.

A

Rales (crackles)

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12
Q

On physical exam: Sound made on inspiration as if one was breathing through a straw. This is due to upper airway obstruction causing turbulent flow

A

Stridor

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13
Q

What physical exam sign may indicate chronic lung disease?

A

Clubbing

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14
Q

On percussion a pleural effusion will sound _____?

A

Dull (due to fluid around lungs)

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15
Q

On percussion a pneumothorax will sound _____?

A

Hyperresonant around the pleural space

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16
Q

Spirometry is a test used to:

A. Exam lung function

B. Differentiate obstructive from restrictive lung diseases

C. Evaluate symptoms such as dyspnea, cough and wheezing

D. monitor response to therapy

E. Stage the severity of lung disease

F. Detect bronchial hyporesponsiveness

A

F. Hyperresponsiveness

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17
Q

Describe the technique of how patients must breathe during spirometry.

A

Inhale to TLC, then forcibly exhale to RV. (e.g. VC)

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18
Q

Volume of air exhaled in first second by forced expiratory effort

A

FEV1 (Forced Expiratory Volume at the first second)

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19
Q

Total volume of air exhaled by forced expiratory effort

A

FVC (Forced Vital Capacity)

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20
Q
  • Expressed as a percentage
  • Above 70% to be normal
A

FEV1/FVC (ratio of FEV1 to FVC)

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21
Q

Reference (normal) values of spirometry tests are NOT based on:

A. Weight

B. Height

C. Sex

D. Age

E. Ethnicity

A

A. Weight is not used

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22
Q

Breathing volume at rest (includes normal inhalation and exhalation)

A

Tidal volume

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23
Q

Additional air that can be forcibly inhaled after the inspiration of a normal tidal volume

A

Inspiratory reserve volume

24
Q

Max volume of air that can be expelled from the lungs after normal expiration

A

Expiratory reserve volume

25
Q

Maximum amount of air a person can expel from the lungs after a maximum inhalation

A

Vital capacity

26
Q

Normal range for FEV1 & FVC

A

80-120% predicted

27
Q

What does a FEV1/FVC less than 70% indicate?

A

Airflow obstruction

28
Q

Post-bronchodilator response is used to determine reversibility of airflow obstruction after given albuterol.

  1. Which is reversible (aka will give a positive response), asthma or COPD?
  2. What % and volume increase is considered a positive response?
A
  1. Asthma
  2. 12% and 200ml increase from pre (FEV1 or FVC)
29
Q
  1. FEV1/FVC in healthy nonsmokers (increases/decreases) with age in M and F.
  2. This results in (over/underdiagnosis) of COPD in the elderly
  3. This results in (over/underdiagnosis) of asthma in the young
A
  1. decreases
  2. overdiagnosis (false positives)
  3. underdiagnosis (can have preserved FEV1 even with asthma) - false negatives This is a limitation of the FEV1/FVC ration
30
Q

COPD and asthma are examples of (obstructive/restrictive) disorders

A

obstructive

31
Q

pleural, interstitial, neuromuscular, thoracic/extrathoracic are examples of (obstructive/restrictive) disorders

A

restrictive

32
Q

Obstructive or restrictive?

  1. Expiratory difficulty, cannot get air out.
  2. Increased lung compliance (“floppy” airways)
  3. Reduction in air-flow >> reduction in lung volume
  4. Reduced FEV1 (out of proportion to reduction in FVC) 5. Reduced FEV1/FVC ratio (
A

Obstructive

33
Q

Obstructive or restrictive?

  1. Inspiratory difficulty, cannot get air in.
  2. Decreased lung compliance (“stiff” airways)
  3. Reduction in lung volume >> reduction in air-flow
  4. Diagnosis by lung volume test, not spirometry
  5. Decreased FVC (out of proportion to reduction in FEV1)
  6. Normal or elevated FEV1/FVC ratio
  7. Decreased RV, FRC, and TLC
A

Restrictive

34
Q

Flow volume loop is lower and more prolonged

A

Obstructive

35
Q

Flow volume loop has decreased volume

A

Restrictive

36
Q

used to measure lung volumes and capacities

Volume/Pressure calibrated sealed box

Patient tidal breathes around FRC

When expiratory tube closed

̏ V1̏ P1 ≈ ̏ Vx̏ P2

A

Body Plethysmography

37
Q

used to measure lung volues and capacities

equilibrate FRC (functional residual capacity) with He

V1 x [He]i = (V1 +Vx) x [He}f

A

Helium Dilution

38
Q

Obstructive/restrictive?

over time due to chronic airflow obstruction, will inc reserve volume (air trapping) and hyperinflation –> inc TLC

A

Obstructive

39
Q

Obstructive/restrictive?

lung volume compressed - RV, TLC decreased

A

Restrictive

40
Q

T/F: You can diagnose obstructive physiology (FEV1/FVC ratio < 70%), but not restrictive physiology using spirometry

A

True: To diagnose restrictive physiology, lung volume needs to be measured

41
Q

(surface area * pressure gradient across the membrane) / diffusion distance = ?

A

Gas diffusion

42
Q

What are 3 ways in which gas diffusion is decreased in the alveoli?

A
  1. decreased surface area (e.g. alveolar destruction, lose capillaries, alveolar filling defect)
  2. Decreased pressure (e.g. bronchial obstruction, alveolar filling defect)
  3. Increased diffusion distance (e.g. wide alveolar-capillary space; fibrosis, edema)
43
Q

process of oxygen diffusing passively from the alveolus to the pulmonary capillary, where it binds to hemoglobin in red blood cells or dissolves into the plasma

A

Oxygenation

44
Q

Which mechanism of impaired alveolar oxygen diffusion results in pulmonary embolism?

A. Decreased surface area for diffusion

B. Decreased driving pressure

C. Increased diffusion distance

A

A. Decreased surface area for diffusion - Less capillaries

45
Q

Which mechanism of impaired alveolar oxygen diffusion results in COPD/emphysema?

A. Decreased surface area for diffusion

B. Decreased driving pressure

C. Increased diffusion distance

A

A. Decreased surface area for diffusion - due to alveolar destruction

46
Q

Which mechanism of impaired alveolar oxygen diffusion results in Pneumonia?

A. Decreased surface area for diffusion

B. Decreased driving pressure

C. Increased diffusion distance

A

A. Decreased surface area for diffusion

B. Decreased driving pressure (pus)

47
Q

Which mechanism of impaired alveolar oxygen diffusion results in pulmonary fibrosis?

A. Decreased surface area for diffusion

B. Decreased driving pressure

C. Increased diffusion distance

A
  1. Increased diffusion distance

Dec matrix around alveoli and the capillaries. As you increase this difference - gas diffusion will decrease

48
Q

Reduced partial pressure of oxygen in the alveolus results in _______

49
Q

Reduced oxygen content in arterial blood is referred to as _____

50
Q

Blood oxygenation is described in three ways:

  1. Amount of hemoglobin bound to oxygen (%) referred to as _________.
  2. Dissolved oxygen content (mmHg) referred to as _________.
  3. Sum of bound and dissolved oxygen (mL O2/dL) referred to as ______.
A
  1. Saturation - normal >95%
  2. Partial pressure - normal for pao2 = 104 - (0.3 x age) ; sea level, room air
  3. Content
51
Q

A-a gradient helps us with the differential of what causes arterial hypoxemia.

What does a normal A-a gradient indicate?

A
  1. Pure hypoventilation (hypercapneic failure)
  2. Reduced Inspired Oxygen Tension (altitude)

o2 making it to capillaries and blood but still low o2 bc hyperventilation (resp failure) or living at high elevations.

52
Q

A-a gradient helps us with the differential of what causes arterial hypoxemia.

What does an increased A-a gradient potentially indicate?

A
  1. Decreased surface area
  2. Decreased pressure
  3. Increased diffusion distance
53
Q

Alveolar - arterial Oxygen Difference

A

P[A-a]O2 = Alveolar oxygen content - arterial oxygen content

P[A-a]O2 = PAO2 - PaO2

or: P[A-a]O2 = [(FiO2 * {Patm - PH2O}) - (PaCO2 / R)] - PaO2
or: P[A-a]O2 = [150 - (PaCO2/0.8)] - PaO2: this is the A-a gradient

Normal P[A-a]O2 < 15 (age < 60)

54
Q

This is the difference between estimated alveolar oxygen content and the measured arterial oxygen content (determined by arterial blood gas.)

A

Alveolar-arterial oxygen difference

55
Q
  1. The “A-a” difference (increases/decreases) in lung diseases.
  2. The (larger/smaller) the P(A-a)O2 difference, the more severe the oxygenation impairment.
A
  1. The “A-a” difference increases in lung diseases.
  2. The larger the P(A-a)O2 difference, the more severe the oxygenation impairment.

Exam 2 Keystone (13 decks)

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