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Resiratory SCE > Physiology > Flashcards

Physiology Flashcards

1
Q

Bronchial artery

A

Blood supply nose to bronchioles
Branch Aorta

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2
Q

Pulmonary artery

A

Blood supply to to the alveoli

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3
Q

Lung function categories

A

Spirometry
Lung volumes
Gas diffusion

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4
Q

Volume time curve

A

Tidal volume air moved normal breath

ERV exhalation past normal volume

IRV inhaled past normal volume

RV air left past max exhalation

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5
Q

Sum volumes

A

IC is TV + IRV
FRV Is ERV + RV so volume of air exhaled in total
VC= IRV+ TV + ERV
TLC = IRV+ TV + ERV+ RV

FEV1 is volume of air exhaled in 1s of forced expiration

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6
Q

Percentiles

A

Positive higher and negative lower
5th percentiles lowest or highest

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7
Q

Z score

A

SR +- 1.65 acceptable as 90% data in this range

5% split above and below abnormal
LLN decreases with age so over diagnose obstruction older men but under in young women

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8
Q

PEFR

A

PEFR maximum volume exhaled

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9
Q

Obstructive vs restrictive

A

Fev1/fvc less than 0.7 is obstructive
More than 0.7 is restrictive

Volumes
Obstructive RV and TLC raised

Restrictive
All volumes reduced

Mixed
Obstructive
Low TLC

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10
Q

Measuring lung volumes

A

He dilution
N washout
Advantage simple and cheap
X doesn’t measure bullae

Body plesmography
Most accurate
X expensive

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11
Q

Variable extrathoracic obstruction

A

Inspiratory limb box so bottom
During inspirational obstruction sucked into trachea with partial obstruction

Vocal cord paralysis
Extrathoracic goitre
Laryngeal tumour

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12
Q

Variable intrathoracic

A

Expiratory limb top box
Trachea sucked out inspiration then expiration partial obstruction trachea

Tracheal stenosis
Tracheomalacia
Airway tumour

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13
Q

Fixed obstruction

A

Both Inspiratory and expiratory box

Tracheal stenosis
Goitre
Airway tumour

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14
Q

TLCO

A

TLCO Co diffusion per min per pressure or gas exchange surface available
Kco when divided by total lung volume

= kco ( thickness alveolar membrane) x va (alveolar surface area )

Low
Thickness membrane so reduced kco eg late Ild or pulm oedema or PH
VA low and kco low as alveoli gone in emphysema
Anaemia

High TLCO and kco in pulmonary haemorrhage or Polycythaemia or obese or altitude or hyperthyroid or AVM so left to right shunt

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15
Q

Differentials

A

Restrictive
Low DLCO Ild
Normal DLCO extrathoracic so chest wall or nmd or obesity

Obstructive
Low DLCO in emphysema
Normal DLCO chronic bronchitis

Normal spiro
Low DLCO Normal lung function
Low DLCO pulmonary vascular disease

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16
Q

PAo2

A

Is (barometric pressure x fio2) - paco2

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17
Q

Pressures lung

A

Trans pulmonary is 4
Intrapulmonary is -4
Intrapulmonary pressure is 0

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18
Q

Mechanism hypoxia

A

A-a = fio2 -(pco2x1.25)-po2
normal 1-2
Raised VQ and shunt
Normal alveolar hypoventilation

VQ mismatch
- plug so less ventilation so pneumonia or Atelectasis
- no perfusion eg PE or PH or shock

Shunt RtoL
- anatomical eg pda or pfo or asd or vsd/ lung/ hps - don’t respond to o2
- physiological eg ARDS or severe copd or Atelectasis or Pneumonectomy

Alveolar hypoventilation eg CNS or drugs or NM or ohs

Reduced fio2 eg altitude

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19
Q

Indication CPET

A

Fitness
Dx cause of limitation fitness
Disease severity
Pre procedure
Response to treatment

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20
Q

Stop cpet

A

Exhausted
Chest pain with ecg change
Arrhythmia
St depression more than 2mm with symptoms or 4mm no symptoms
Heart block
Hypotension or be over 250/120
hypoxia less than 80
Near syncope

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21
Q

V02

A

= CO x Cao2 x cvo2

Normal is more than 80% predicted

Cao2 lower
Lung disease
Anaemia
L to right shunt
PVD

Cvo2 low
Reduced consumption O2 eg myopathy or neuropathy

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22
Q

Cpet was it a maximal test

A

Vo2 above 15ml/kg or more than 80%
RER above 1.15 switch aerobic to anaerobic
Max HR 95% predicted so low HRR
Breathing reserve more than 20% gap
Rise in lactate
AT reached where vco2 rises faster than vo2

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23
Q

9 plot examples

A

Top right vo2
Top middle cardiac
All left vertical ventilation

Normal values
VO2 more than 80% predicted
Max HR should be more than 80% max (220-age)
VE should reach 80% so should have reserve
Desat more than 4% lung issue or PVD or RtL shunt
Oxygen pulse more than 10ml surrogate CO
AT should be more than 40% vo2

Vo2 max below reference 80% # cardiac or Resp
RER over 1.15 maximal
OHES oxygen uptake efficiency low then cardiac
Resp limit less than 20% between peak TV vs MVV (Fev1x40) then ventilatory limitation

Vo2 less than 80
Resp
low breathing reserve
Ve over vco2 increased dead space increased
Ve over 80%
Max hr not reached

CVS
O2 pulse reached first then cardiac
Early hr rise and low hr reserve

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24
Q

Contra indication cpet

A

Symptomatic aortic stenosis
Acute illness eg MI 5/7 or sbe or myocarditis or unstable angina or dissection
Severe pulmonary Hypertension
Acute Copd or asthma
Po2 less than 8
Recent DVT or acute PE
Heart failure
Syncope or pre syncope
Seizures

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25
Q

OSA flow volume

A

Sawtooth

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26
Q

Volume pathology

A

Older increase RV
Emphysema RV
Fibrosis all volumes reduced
Muscle weakness TLC low but RV high as cannot use expiratory muscle diaphragm
Obesity increase FRC more elastic recoil

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27
Q

Pneumonectomy DLCO

A

Reduced overall TLCO
Raised kco as blood to smaller area
VA reduced

28
Q

Empey index

A

Pefr over fev1 over 10
Fixed airway obstruction

29
Q

Mid 25 or 75 low

A

Small airway narrowing

30
Q

Not normally distributed

A

Pearson between two continuous variables

Wilcoxon compare two groups pre and post

Spearman rank association between ordinal or ranked data

31
Q

Obese lung function

A

Fev1/fvc more than 70%
FRC reduced as increased elastic recoil

32
Q

Diaphragm weakness

A

Lying vc 20% drop Ddx bilateral diaphragm weakness as gravity not helping inspiration
10-20% fall vc suspicious diaphragm weakness

Other
MIP and SNIP fall esp lying down
- men less than 70
- women less than 60

33
Q

VQ

A

Better at base
Ventilation increases higher rate than ventilation

34
Q

PaO2

A

Fio2. 0.75

35
Q

Pregnancy lung function

A

Reduced FRC and reduced ERV
Spiro normal
Increased o2 consumption
O2 reserve reduced
Minute ventilation increased
Ph normal / reduced pco2/ increased bicarbonate excretion

36
Q

Reconditioning cpet

A

Low vo2 max
Low hrr
High VE
O2 pulse border of low/ normal
AT 40-50% of vo2 max
Sats ecg and bp normal

37
Q

Cardiac disease cpet

A

Low vo2 max
Early rise hr
Low hrr
O2 pulse below lln
AT less than 40%
Abnormal BP

38
Q

Lung disease cpet

A

Low vo2 max
High hrr so ventilation limiting
Low VE reserve
Desaturation
High VEco2

39
Q

Submaximal effort cpet

A

Vo2 less than 80
Max HR less than 80
VE max less than 80

40
Q

Lung disease cpet

A

Vo2 max less than 80
Max hr less than 80
Ve max more than 80

41
Q

Pulmonary vascular cpet

A

Vo2 max less than 80%
Max hr more than 80%
Low hrr and steep chronotropic profile
Low AT
Desat 4%

42
Q

Cardiac disease cpet

A

Vo2 max less than 80% predicted
Max hr more than 80%
Less than 4% Desat

43
Q

Dysfunctional breathing cpet

A

Normal vo2 max
Normal AT
High erratic RER more than aer to anaerobic
High resting hr normal chronotropic profile

44
Q

Muscle disease cpet

A

Low vo2 max
Early AT
Early lactate rise
Steep chronotropic profile due to impaired peripheral o2 extraction
Low o2 pulse

45
Q

Peripheral vascular disease cpet

A

Low vo2 max
High hrr
High ve reserve
Low at
Heightened BP response

46
Q

Bronch oxygen

A

More than 1m
Desat less than 4%
Sats less than 90%

47
Q

Risks bronch

A

Arrhythmia sinus tachycardia
Bleeding 0.2%
Ptx 1/1000 so 0.1%

48
Q

Sedation bronch

A

Fent or alfent
Midas 2-5mg

Local anaesthetic
Max 9.6mg per kg

49
Q

Bronch sample

A

Visible tumour 85%

5x samples brush and wash

50
Q

Invasive Aspergillus bronch

A

Bal galactomanan and fungal culture

51
Q

Clean bronch

A

Automated endoscopic reprocessor

52
Q

Sedation bronch e+d

A

NBM 2 hours and clear fluids 4h

Post for 24h
No drive or heavy machinery
No sign documents

53
Q

CI spiro

A

Haemoptysis
Ptx
Cv disease
Nausea or vomiting
Recent chest or abdominal or eye sx

54
Q

LLN

A

Age
Gender
Ethnicity
Height

55
Q

Respiratory muscle weak

A

TLCO normal
Kco raised as lungs concentrated so co transfer better

56
Q

Lung volume detect Ptx or bullae

A

PSG and helium dilution gas volume

57
Q

Sensitivity

A

How likely test positive when has disease

A/A+C

58
Q

Specificity

A

Test negative in healthy

D/ d+ b

59
Q

Ppv

A

Positive test likelihood has disease

60
Q

NPV

A

Test negative likelihood healthy

61
Q

Likelihood ratio

A

Sensitivity
—————
1- specificity

62
Q

Variables

A

Qualitative
Binary vs ordinal

Quantitative
Discrete vs continuous

63
Q

Normally distributed data sets

A

Z and T test eg bp pre and post
Chi squared eg smoking vs non smoking
Anova eg effect drug dosages 3 or more

64
Q

Bronchoscopy death

A

1% serious
0.02% death

65
Q

LTOT and Hypercapnia

A

Co2 increase 1 then not for LTOT

66
Q

Low TLCO but High KCO due to extrapulmonary restriction

A

Pneumonectomy/ chest wall disease and NMD as alveoli more concentrated smaller area
Pleural disease
Alveolar haemorrhage or Polycythaemia
Asthma
Obesity

67
Q

Low TLCO and low KCO

A

Emphysema
ILD
IPAH
HPS

Resiratory SCE (13 decks)

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