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Y3 TRANSITION > Physiology > Flashcards

Physiology Flashcards

1
Q

What is respiratory acidosis? How is it corrected?

A

Accumulation of CO2 due to a disease of the lungs or a problem with the mechanics of respiration
The body tries to hold alkali by reabsorbing HCO3 from the kidneys

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2
Q

What is respiratory alkalosis? How is it corrected?

A

Relative lack of acid because of the loss of CO2 due to hyperventilation
Appropriate response is to lose HCO3 but this is too slow and rarely happens

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3
Q

What is metabolic acidosis? How is it corrected?

A

Excess of H+ due to disease e.g. lactic acidosis, DKA, renal failure, sepsis
The body tries to get rid of acid by getting rid of CO2 by hyperventialation

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4
Q

What is metabolic alkalosis? How is it corrected?

A

Net loss of acid from the body leaving an alkali surplus (typically vomiting)
To counteract the surplus the body tries to hold onto acid by hypoventilating and retaining CO2

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5
Q

How does respiratory acidosis appear on ABG? Give three examples

A

Reduced pH
Increase in CO2
Little or no change in HCO3 (increase in chronic)
Respiratory depression (opiates), asthma, COPD

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6
Q

How does respiratory alkalosis appear on ABG? Give three examples

A

Elevated pH
Hyperventilation with a low CO2
Little change in HCO3
Anxiety, pain, PE, pneumothorax

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7
Q

How does metabolic acidosis appear on ABG? Give three examples

A

Reduced pH
Tachypnoea with a reduced CO2
Reduced HCO3 as it used up by the pH
DKA, diarrhoea, renal tubular acidosis

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8
Q

How does metabolic alkalosis appear on ABG? Give three examples

A

Elevated pH
Marginal increase in CO2 (hypoventilation relatively ineffective)
Vomiting, diarrhoea, HF, cirrhosis, renal failure, diuretics

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9
Q

List respiratory causes of SOB

A 
Asthma
COPD
Pneumonia
Lung cancer
Pulmonary fibrosis
Pleural effusion
Pneumothorax
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10
Q

List cardiovascular causes of SOB

A 
Heart failure
IHD
Hypertension
Valvular HD
Cardiomyopathy
Arrhythmia
Pulmonary embolism
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11
Q

List other causes of SOB

A 
Anaemia
Acidosis
Panic attack
Exercise
Obesity
Pregnancy
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12
Q

State the two respiratory centres in the brainstem and give their role in respiration

A

Pons (modifies respiration)

Medulla (rhythm generator)

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13
Q

State the two main stimuli that influence respiratory centres in the brainstem

A

Central chemoreceptors

Peripheral chemoreceptors

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14
Q

Peripheral chemoreceptors sense tension of…

A

Oxygen
Some carbon dioxide
Hydrogen in the blood

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15
Q

Central chemoreceptors sense tension of…

A

Hydrogen in the CSF

Carbon dioxide

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16
Q

What is the most potent stimulant of respiration in normal people?

A

Arterial PCO2 acting through central chemoreceptors

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17
Q

Hypoxic drive of respiration is controlled by what type of chemoreceptors?

A

Peripheral chemoreceptors

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18
Q

List the major muscles of inspiration

A

Diaphragm

External intercostals

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19
Q

List the accessory muscles of inspiration

A

Sternocleidomastoid

Scalenus

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20
Q

List the muscles of active expiration

A

Internal intercostals

Abdominal muscles

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21
Q

What is the transmural pressure gradient?

A

Differences between intra-alveolar pressure and intrapleural pressure during the respiratory cycle

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22
Q

List forces keeping the alveoli open

A

Transmural pressure gradient
Pulmonary surfactant
Alveolar interdependance

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23
Q

List forces promoting alveolar collapse

A

Elasticity of fibres

Alveolar surface tension

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24
Q

Parasympathetic stimulation causes bronchoconstriction/dilatation

A

Bronchoconstriction

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25
Q

Parasympathetic stimulation causes bronchoconstriction/dilatation

A

Bronchodilatation

26
Q

Dynamic airway compression makes active expiration to be more difficult in patients with airway obstruction. Why is this?

A

Rising pleural pressure during expiration compresses the alveoli (helps push air out of the lungs) and the airway (more likely to collapse)

27
Q

Compliance is measure of effort that has to go into stretching or distending the lungs. What is meant by less compliance clinically?

A

The less compliant the lungs are, the more work is required to produce inflation

28
Q

List factors influencing the rate of gas transfer across the alveolar membrane

A

Partial pressure gradients
Surface area of alveoli
Thickness of blood-air barrier
Diffusion coefficient (solubility of gas)

29
Q

Define cardiac output

A

Volume of blood pumped by each ventricle per minute

CO = SV x HR

30
Q

Define stroke volume

A

Volume of blood ejected by each ventricle per heart beat

SV = EDV - ESV

31
Q

What is the Frank Starling Law?

A

The more blood that returns to the ventricle during diastole (EDV), the greater the volume of ejected bloods during systolic contraction (SV)

32
Q

What is the primary factor that determines percent saturation of haemoglobin with O2?

A

Partial pressure of oxygen (PO2)

33
Q

When is haemoglobin considered fully saturated?

A

All haemoglobin present is carrying its maximum oxygen load

34
Q

List investigations for SOB

A 
CXR
ECG
Full blood count
Arterial blood gases
Troponin T
35
Q

What is the tidal volume?

A

Volume of air entering or leaving lungs during a single breath (500ml)

36
Q

What is the inspiratory reserve volume?

A

Extra volume of air that can be maximally inspired over and above the typical resting tidal volume (3000ml)

37
Q

What is the inspiratory capacity?

A

Maximum volume of air that can be inspired at the end of a normal quiet expiration (3500ml)
IRV + TV

38
Q

What is the expiratory reserve volume?

A

Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume (1000ml)

39
Q

What is the residual volume?

A

Minimum volume of air remaining in the lungs even after a maximal expiration (1200ml)

40
Q

What is functional residual capacity?

A

Volume of air in lungs at end of normal passive expiration (2200ml)
FRC = ERV + RV

41
Q

What is vital capacity?

A

Maximum volume of air that can be moved out during a single breath following a maximal inspiration (4500ml)
VC = IRV + TV + ERV

42
Q

What is total lung capacity?

A

Maximum volume of air that the lungs can hold (5700ml)

TLC = VC + RV

43
Q

What is FEV1?

A

Volume of air that can be expired during the first second of expiration in an FVC (Forced Vital Capacity) determination
Normal > 70%

44
Q

State the spirometry results of a patient with airway obstruction

A

FEV1: low
FVC: normal
PEF: low (<70%)

45
Q

State the spirometry results of a patient with lung restriction

A

FEV1: low
FVC: low
PEF: normal (>70%)

46
Q

What is the mechanism behind SOB in asthma and COPD?

A

Increased airway resistance

47
Q

What pathological condition abolishes the transmural pressure gradient?

A

Pneumothorax

48
Q

What is the mechanism behind SOB in emphysema and lung collapse?

A

Reduced surface area of the alveolar membrane

Destruction of alveoli leading to reduced surface area of the alveolar membrane, need to breathe harder to push air out

49
Q

What is the mechanism behind SOB in pulmonary fibrosis

and pulmonary oedema (HF)?

A

Increased thickness of the air-blood barrier across the alveolar membrane
Reduced pulmonary compliance (have to work harder to open the lungs) and impaired gas diffusion

50
Q

Pulmonary fibrosis impairs gas diffusion. How are PO2 and PCO2 affected?

A

% saturations are reduced
PCO2 is normal
PO2 is reduced
This is because CO2 diffuses more readily across the membrane

51
Q

What is the mechanism behind SOB in pulmonary embolism?

A 
Increased thickness of the air-blood barrier across the alveolar membrane
Reduced perfusion (VQ mismatch)
52
Q

What pathological process impairs the oxygen carrying capacity of the blood?

A

Anaemia

53
Q

In anaemia, the arterial PO2 is normal. True/ False?

A

True

Arterial PO2 is normal therefore oxygen saturations are normal (less haemoglobin but still fully saturated)

54
Q

What is the mechanism behind SOB in panic attacks?

A

Increased central and autonomic arousal

55
Q

What moves the oxygen haemoglobin dissociation curve to the right?

A

Reduced affinity of haemoglobin-oxygen
Increased temperature
Increased 2,3-DPG
Increased H+

56
Q

A low PO2 causes pulmonary vasoconstriction. True/ False? Why?

A

True

Blood doesn’t want to travel to areas where there is low oxygen, and is diverted away from the lungs by vasoconstriction

57
Q

Why is there hypotension in tension pneumothorax?

A

Increased intra-thoracic pressure may decrease venous return, thus leading to reduced diastolic filling, reduced EDV, and lower SV

58
Q

What medications are given to treat nitrates acutely?

A

IV furosemide
Nitrate infusion
Cause venodilatation, reduce preoload

59
Q

What is the most common mediation used to control anxiety in a palliative patient?

A

Lorazepam

60
Q

In emphysema you get an increased/decreased lung capacity

A

Increased lung capacity

‘Barrel-shaped chest’

Y3 TRANSITION (10 decks)

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