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Respiratory > Oxygen & Resp Failure & PFTs > Flashcards

Oxygen & Resp Failure & PFTs Flashcards

1
Q

What is the difference between type 1 & 2 respiratory failure?

A

Type 1 - short of oxygen Type 2 - short of oxygen AND too much carbon dioxide

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2
Q

What happens in bad lungs when there is a high pCO2?

A

The carbon dioxide associates into acid, the kidneys produce carbonate to compensate but in the presence of a virus this process is affected and leads back to acidosis

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3
Q

What does it mean if someone is sensitive to oxygen?

A

As the pO2 increased the pCO2 rises leading to acidosis

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4
Q

Describe V/Q mismatching

A

Areas of poor ventilation have reactive vasoconstriction . When oxygen is given vasodilatation occurs leading to good perfusion but poor ventilation. Dilated vessels bring back lots of carbon dioxide but this cannot be exhaled so is shunted into the arterial system.

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5
Q

What is the haldane effect?

A

Oxygen can displace carbon dioxide from haemoglobin

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6
Q

What is the bohr effect?

A

high concentrations of carbon dioxide prevent oxygen binding to haemoglobin

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7
Q

Explain hypoxic drive

A

Carbon dioxide chemoreceptors are desensitised. Oxygen chemoreceptors become the primary drive fro respiration. Tidal volume smaller than deadspace leads to hypercarbia Hyperventilation causes low carbon dioxide but if small enough can cause high carbon dioxide

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8
Q

What is the treatment for hypercarbia?

A

Oxygen management (88-92%) Increase ventilation using a non invasive ventilator

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9
Q

What are they signs of hypoxaemia?

A
  • cyanosis - dyspnoea - tachypnoea - arrhythmias
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10
Q

State to pO2 for each of the following scenarios; hyperventilation loss of consciousness death

A

less than 5.3kPa c. 4.3kPa c. 2.7kPa

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11
Q

Describe circulatory hypoxia

A

Oxygenated blood cannot get to the tissues due to the pump not working. This leads to obstruction of vessels, oedema and heart failure

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12
Q

Describe anaemic hypoxia

A

Usually due to vitamin deficiencies - B12, Folate, Iron Blood loss is also a common cause

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13
Q

What is toxic hypoxia?

A

Carbon monoxide poisoning, CO irreversibly binds to haemoglobin stopping oxygen release Cyanide inhibits ATP leading to anaerobic respiration Blood remains oxygenated so appears bright red

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14
Q

Name six causes of alveolar hypoventilation

A
  1. opiates
  2. laryngeal obstruction
  3. obesity
  4. bronchial obstruction
  5. anaesthesia
  6. kyphoscoliosis
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15
Q

What is meant by impaired diffusion?

A

Failure of the alveolar endothelial interface

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16
Q

Name and describe two causes of impaired diffusion

A
  1. Interstitial thickening - pulmonary fibrosis - lymphagitis - sarcoidosis 2. vascular dysfunction -pulmonary vasculitis - endothelial malignancy
17
Q

Describe this graph

A

black - normal

blue - asthma same total volume just takes longer

red - COPD reduced total volume

18
Q

How can forced expiratory volumes/flow rates be measured?

A

Spirometry

19
Q

Name two diseases where airway closure is dependent on volume

A
  • asthma
  • chronic bronchitis
20
Q

Name a disease where airway closure is dependent on pressure

A

emphysema

21
Q

In obstructive disease what happens to the follwing

  • peak flow
  • FEV1
  • FVC
  • FEV1/FVC
  • Gas transfer
  • FEV1 response to beta two agonist
A
  • reduced
  • reduced
  • normal
  • <75%
  • decreased in emphysema but normal in asthma
  • >15% response in asthma but <15% response in COPD
22
Q

In restrictive disease what happens to the follwing

  • peak flow
  • FEV1
  • FVC
  • FEV1/FVC
  • Gas transfer
  • FEV1 response to beta two agonist
A
  • normal
  • reduced
  • reduced
  • >75%
  • Decreased
  • No response
23
Q

State three ways of bronchial challenge testing

A
  • exercise
  • methacholine/histamine/mannitol
  • allergens/ chemicals
24
Q

How can you test bronchial challenge usuing histamine/methacholine?

A

They are markers of airway hyper-responsiveness, you measure the concentration required to reduce FEV1 by 20%

25
Q

What do the results of exercise testing show?

A

A low FEV1 or PEF suggests asthma

Low oxygen sats during exercise suggest intertitial lung disease and can be used to monitor treatment response

26
Q

What do static lung volumes show?

A

Effort independent test involving helium dilution/nitrogen washout

increase TLC in hyperinflation

decrease TLC in restrictive lung disease

27
Q

How is transfer factor measured? What does it show?

A

Carbon monoxide diffusion across alveolar - capillary barrier. Total lung carbon monoxide (TLCO)

Decrease suggests;

  • anaemia
  • emphysema
  • ILD
  • Pulmonary oedema
  • PE
  • bronchiectasis
28
Q

How is airway resistance measured?

A

Plethysmography or impulse oscillometry

Impulse oscillometry mesures resistance during quiet tidal breathing at resonant frequencies

29
Q

What disease is exhaled breath condensate useful for?

A

Asthma

It is a non-invasive marker of eosinophilic airway inflammation in asthma. High levels suggest uncontrolled asthma

Respiratory (20 decks)

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