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Body in Balance Midterm #2 > Pulmonary FKR > Flashcards

Pulmonary FKR Flashcards

1
Q

The lungs can compensate for metabolic acid/base derangements by:

A

Hyper-ventilating, to compensate for acidosis Hypo-ventilating, to compensate for alkalosis

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2
Q

Lung ventilation

A

a measurement of the volume of air moved between the lungs and environment. It can be further subdivided into the:

Minute ventilation (VE ) is the volume of gas entering the lungs per minute. It is calculated with the following equation: VE = VT x RR

Alveolar ventilation (VA) is the volume of gas reaching the alveoli in a given time. It can be calculated with the following equation: VA = (VT - VD) x RR

VD = physiologic dead space, (volume of air that does not participate in gas exchange)
VT = tidal volume
RR = respiratory rate (respirations per minute)
VE = minute ventilation
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3
Q

The amount of O2 dissolved in the blood depends on:

A
  1. Atmospheric pressure (pressure of inspired air)
  2. Solubility of oxygen, which is inversely related to temperature
  3. Partial pressure of oxygen in plasma (PaO2)
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4
Q

Lung compliance pathology

A
  • Lung compliance is increased in the setting of emphysema and normal aging
  • Lung compliance is decreased in the setting of pulmonary fibrosis, pneumonia, and pulmonary edema
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5
Q

Physical exam findings of a patient with emphysema can include

A
  • Upon inspection, excessive use of accessory muscles, pursed lip breathing, and barrel chest
  • Upon percussion, hyper-resonance
  • Upon auscultation, there is a reduction of lung sounds
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6
Q

expiration/inspiration of restrictive lung disease

A

In restrictive lung diseases inspiration is impaired by restriction of lung expansion, and expiration can be normal or impaired depending on the nature of the restrictive disease.

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7
Q

Fetal hemoglobin and oxygen affinity

A

has a decreased affinity for 2,3-BPG when compared to adult hemoglobin. This allows for fetal hemoglobin to have a greater affinity for O2, which helps fetal blood maintain adequate oxygenation in utero.

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8
Q

right shift of oxygen-hemoglobin dissociation curve

A

When P50 > 26.7mmHg, the hemoglobin dissociation curve is said to exhibit a “right shift.” With a right shift, hemoglobin has less affinity for O2, which facilitates unloading of O2 in the tissues.

Right shift occurs with:

  • Increased temperature (ex: tissues with increased metabolic activity)
  • Increased [H+] (decreased pH)
  • Higher altitude
  • Increased [2,3-BPG] (aka 2,3-DPG)
  • CHRONIC anemia, which causes an increase in [2,3-BPG]
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9
Q

PAO2 and PaO2 at high altitude

A

At high altitude the decreased barometric pressure decreases alveolar PO2(PAO2) across the entire lung, resulting in decreased arterial PO2 (PaO2) and global pulmonary vasoconstriction. Low PaO2 stimulates increased ventilation (via peripheral chemoreceptors), which increases PaO2 and decreases PaCO2. The resulting respiratory alkalosis stimulates increased renal HCO3- excretion.

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10
Q

CO2 transport at the tissues

A
  • At the tissues (where [CO2] is high), HCO3- is made by RBCs. The following outlines the steps through which this occurs:
  • At the tissues, CO2 diffuses into red blood cells (RBCs) where carbonic anhydrase catalyzes the following reaction: CO2 + H2O → H2CO3
  • Then, the following reaction happens spontaneously inside the RBCs: H2CO3 → H+ + HCO3-
  • HCO3- is pumped out of RBCs in exchange for Cl- in the plasma via the HCO3-/Cl- exchanger on the red blood cell membrane. This is termed the “chloride shift.”
  • The H+ that is left behind is buffered predominantly by hemoglobin
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11
Q

Bronchiectasis

A
  • permanent dilation of the bronchi and bronchioles due to repeated episodes of necrotizing infections and inflammation.
  • Dilation of the airways in bronchiectasis is due to destruction of cartilage and elastic tissue by chronic necrotizing infections.
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12
Q

perfusion limited gases

A

Some gases diffuse so rapidly across the alveolar membrane that their diffusion into blood is only limited by the perfusion of the alveoli. Such gases include O2(in healthy lungs), CO2, and N2O and are referred to as “perfusion limited.”

Upon inhalation, these gases equilibrate with the blood early along the total length of the pulmonary capillary, and diffusion can only be increased if blood flow increases

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13
Q

expiratory reserve volume (ERV)

A

the volume of gas that can still be forcefully exhaled after a normal expiration.

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14
Q

The pathological hallmark of emphysema

A

destruction of alveolar walls due to increased elastase activity.

  • Because of this, elastic recoil fibers are lost and lung compliance increases. This results in enlarged airspaces and a barrel shaped chest.
  • Destruction of elastic tissue causes a loss of radial traction forces in the airways. These are the forces that normally act to keep the airways open throughout expiration. This causes a collapse of small airways during expiration, which ultimately results in air trapping.
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15
Q

The factors that cause a right shift in the oxygen hemoglobin dissociation curve can be remembered with mnemonic:

A

CADETs face right

  • CO2 (increased [CO2] )
  • Acidosis, Anemia
  • 2,3-DPG
  • Elevation
  • Temperature increase
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16
Q

obstructive lung disease have characteristic alterations to the pulmonary function tests:

A
  • Greatly decreased FEV1
  • Decreased or normal FVC
  • Decreased FEV1/FVC ratio ( < 0.7)
  • Increased Residual Volume (RV)
  • Increased Total Lung Capacity (TLC), due to increased residual volume
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17
Q

Carbon monoxide poisoning causes tissue hypoxia as a result of a “triple whammy”

A
  1. Hemoglobin (Hgb) can’t bind to O2 because Hb has a much higher affinity for CO than O2 2. Hgb can’t unload O2, because CO causes a left shift in the oxyhemoglobin dissociation curve 3. CO binds to cytochrome c oxidase, which disrupts oxidative phosphorylation at the tissues (with what already limited oxygen is delivered)
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18
Q

how far down do smooth muscle cells extend in the airways

A

Smooth muscle cells of the airways extend distally to the end of the terminal bronchioles.

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19
Q

spirometry changes in restrictive lung disease

A
  • Decreased FEV1
  • Decreased FVC (in a roughly equal proportion to the decrease in FEV1)
  • Normal or slightly increased FEV1/FVC ratio
  • Decreased Residual Volume (RV)
  • Decreased Total Lung Capacity (TLC)
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20
Q

Pneumothorax (PTX)

A
  • when air enters the pleural cavity, causing the lung to collapse.

There are 2 ways this generally occurs:

  1. Air enters the pleural space through the chest wall as a result of trauma
  2. Air enters the pleural space from the lung parenchyma through the visceral pleura
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21
Q

chronic bronchitis

A

productive coughlasting > 3 months per year for > 2 consecutive years. The diagnosis can only be made after other causes of chronic cough have been excluded

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22
Q

Left shift of oxygen hemoglobin dissociation curve

A

refers to when the p50 < 26.7 mmHg. A left shift reflects an increase in hemoglobin’s affinity for O2, which facilitates loading of O2 in the lungs.

A left shift of the oxygen hemoglobin curve can be caused by:

  • Decreased temperature
  • CO Poisoning
  • Decreased [H+] (increased pH)
  • Decreased [2,3-BPG]

Fetal hemoglobin is shifted to the left relative to adult hemoglobin. This is primarily due to a decrease in the affinity of fetal hemoglobin for 2,3-BPG.

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23
Q

Treatments for Emphysema

A
  • Smoking cessation
  • O2 therapy
  • Bronchodilators (long acting) with inhaled corticosteroids
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24
Q

Lung surfactant is secreted by

A

type II pneumocytes

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25
Q

Costodiaphragmatic​ recess:

A

the space between the diaphragm and costal pleura below the lungs.

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26
Q

Hypoxia can be caused by:

A
  • Decreased cardiac output
  • Hypoxemia
  • Anemia
  • CO poisoning
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27
Q

The clinical presentation of bronchiectasis includes:

A
  • Productive cough with purulent/foul-smelling sputum
  • Hemoptysis
  • Digital clubbing
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28
Q

test essential for diagnosis of asthma

A

spirometry (pulmonary function tests)

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29
Q

causes of restrictive lung diseases

A

Disorders of the chest wall (decreased pulmonary compliance)

  • Myasthenia gravis
  • Scoliosis, which can limit the expansion of the lungs depending on the severity
  • Obesity, which can compress the lungs

Chronic interstitial/infiltrative causes (decreased pulmonary compliance and depending on the severity of the disease, decreased diffusion capacity)

  • Acute Respiratory Distress Syndrome (ARDS)
  • Sarcoidosis
  • Neonatal Respiratory Distress Syndrome
  • Wegener Granulomatosis
  • Histiocytosis X Syndrome
  • Asbestosis
  • Idiopathic Pulmonary Fibrosis
  • Iatrogenic causes (drugs)
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30
Q

The only lung volume that is not measured with a spirometer is

A

residual volume (RV), which is the volume of air remaining in the lungs after a maximal (forceful) expiration (~ 20% of the total lung volume).

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31
Q

equation for diffusion of gas across the alveolar membrane

A

can be represented by Fick’s law of diffusion: Vgas = (A/T) x Dk x ΔP

A = total diffusing surface area of alveoli
T = alveolar wall thickness
Dk = diffusion constant (based upon the solubility and molecular weight of the gas) 
ΔP = difference in the partial pressures of the gas across the membrane (P1 - P2)
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32
Q

diffusion limited gases

A

Gases that diffuse slowly across the alveolar membrane and do not equilibrate in the time that the blood traverses the pulmonary capillary

Such gases include CO, as well as O2 in the setting of emphysema or pulmonary fibrosis.

Gases that are diffusion limited (CO is most classically used) can be used to evaluate the diffusion capacity of a person’s lungs

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33
Q

Symptoms of asthma include:

A
  • Wheezing
  • Dyspnea
  • Productive cough
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34
Q

inspiration and expiration patterns of obstructive lung disease

A

inspiration is normal, but airway obstruction causes impairment of expiration (expiration is prolonged). This can result in air being trapped in the lungs and hyperinflation of the lungs chronically

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35
Q

Pharmacologic agents that can precipitate an acute asthma exacerbation include:

A
  • NSAIDs (e.g. aspirin)
  • β-blockers (e.g. propanolol)
  • Cholinomimetics (e.g. bethanechol)
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36
Q

Blunting of the costodiaphragmatic angle

A

occurs in pathological conditions that cause either hyperinflation or pleural effusion. This includes: - Congestive Heart Failure - Acute Respiratory Distress Syndrome - Infections with parapneumonic effusions (pleural space fluid accumulates in the costodiaphragmatic space when patients are upright) - Emphysema

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37
Q

The pathological hallmarks of chronic bronchitis are:

A
  • Increased number of goblet cells (due to both hypertrophy and hyperplasia)
  • Increased thickness of the submucosa in the bronchi and terminal bronchioles
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38
Q

functional residual capacity (FRC)

A

the volume of gas remaining in the lungs after a normal expiration. It can be calculated with the following equation: FRC= RV + ERV

FRC is normally around 40% of the vital capacity.

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39
Q

tension pneumothorax

A

when the visceral pleura or parietal pleura are involved in a tissue defect that forms a one-way valve that lets air into the pleural space (but not back out). This results in trapping of the air in the pleural cavity.

– is a medical emergency because positive pressure in the pleural space displaces and compresses the other structures in the mediastinum (most notably cardiovascular structures). If untreated, a tension pneumothorax will quickly lead to death.

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40
Q

diffusion problems in emphysema and pulmonary fibrosis

A

In emphysema, destruction of the alveoli reduces the total area (A) for gas diffusion in the lungs, thereby reducing the diffusion capacity of the lungs. In pulmonary fibrosis, the total alveolar wall thickness (T) is increased, thereby decreasing the diffusion capacity across the alveoli.

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41
Q

If in the supine position at the time of aspiration, aspirated material most commonly localizes to the __lobe and the ___ lobe

A

posterior segment of the right upper ; superior segment of the right lower

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42
Q

treatment of bronchiectasis

A

aimed primarily at preventing exacerbations of the disease. This is accomplished primarily through the use of prophylactic antibiotics (macrolides) in bronchiectasis patients that are experiencing frequent exacerbations. In addition, the mucolytic agents guaifenesin and N-acetylcysteine can be used to loosen thick mucous

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43
Q

Treatments for CO poisoning include

A

100% oxygen Hyperbaric oxygen (in severe cases)

44
Q

Pleural recesses

A

spaces into which the lungs expand during inspiration

45
Q

Inspiratory capacity (IC)

A

the maximum amount of air one can inhale after a normal exhalation. It can be calculated with the following equation: IC = IRV + TV

46
Q

Bohr effect

A
  • describes the decrease in hemoglobin’s affinity for oxygen in the presence of increased CO2 and decreased pH.
  • increased temperature and [2,3-BPG] also act to decrease the affinity that hemoglobin has for oxygen. These conditions are created by cellular metabolism, thereby facilitating the unloading of oxygen where it is needed most
  • Decreased temperature, [H+], [2,3-BPG], and [CO2] increases hemoglobin’s affinity for O2, thereby promoting the loading of O2 in the lungs
  • In the tissues, increased temperature, [H+], [2,3-BPG], and [CO2] decreases hemoglobin’s affinity for O2, thereby promoting the unloading of O2
47
Q

Emphysema most commonly presents with:

A
  • Dyspnea (this is typically the first symptom)
  • Cough with minimal sputum
  • Prolonged expiration with pursed lips
  • Weight loss
  • Increased anterior-posterior (AP) diameter of the chest, otherwise known as “barrel chest”
  • Hypoxemia and cor pulmonale can occur late in the disease course
48
Q

use of metacholine in testing asthma patient

A

Methacholine is a bronchoconstrictor that can be used to measure the irritability of the airways. Patients with a drop of > 20% in FEV1 following administration of methacholine are said to have “reactive” airways.

49
Q

Causes of bronchiectasis include

A
  • Cystic fibrosis
  • Infections
  • Primary ciliary dyskinesia
  • Bronchial obstruction
  • Allergic bronchopulmonary aspergillosis
50
Q

RV in restrictive lung disease

A

The RV is decreased in restrictive lung diseases.

51
Q

The causes of hypoxemia with a normal A-a gradient are

A

hypoventilation and high altitude

52
Q

Pursed-lip breathing

A

create a positive end-expiratory pressure (PEEP), which helps to prevent small airway collapse during the early phase of expiration.

53
Q

physical exam of carbon monoxide poisoning

A

Physical exam and laboratory findings might include: - Altered mental status (coma, seizures, and irritability) - Cherry red skin and mucous membranes - Metabolic acidosis in severe poisoning (lactic acidosis due to end organ ischemia)

54
Q

arterial blood gas in an emphysema patient

A

PaCO2 and PaO2 are relatively normal (enough to avoid hypoxia) until late in the disease course. These findings can help distinguish a patient with emphysema from one with chronic bronchitis, in which PaCO2 and PaO2 are abnormal earlier on in the disease course.

55
Q

Some physical exam findings in a patient with a pleural effusion may include

A
  • Dullness to percussion over the area of effusion
  • Absent breath sounds
  • Absent tactile fremitus
  • Contralateral shift of the mediastinum (in large effusions)
56
Q

pleural effusion imaging

A

Imaging with a chest X-ray may show blunting of the costophrenic angle and obscuration of the diaphragm

57
Q

Antihistamines

A

a class of medications that act as reversible inhibitors at H1 histamine receptors. Through this mechanism, antihistamines reduce the itching, rhinorrhea and sneezing of various allergy-mediated conditions

antimuscarinic and anti alpha adrenergic properties

58
Q

alveolar gas equation

A
59
Q

Asthma also results in the following abnormalities on physical exam

A
  • A decreased inspiration/expiration time ratio is caused by a prolonged expiration due to obstruction.
  • Pulsus paradoxus is defined as a drop in blood pressure >10 mmHg during inspiration.
60
Q

Asthma

A

obstructive lung disease characterized by hyperreactivity of the airways that causes REVERSIBLE obstruction, and chronic inflammation.

61
Q

RV in obstructive lung disease

A

The residual volume (RV) is increased in obstructive lung diseases

62
Q

Total lung capacity (TLC)

A

Total lung capacity (TLC) = IRV +TV + ERV + RV

IRV = Inspiratory Reserve Volume

TV = Tidal Volume

ERV = Expiratory Reserve Volume

RV = Residual Volume

63
Q

calculating A-a gradient

A

The A-a gradient can be calculated by subtracting the arterial partial pressure of oxygen from the alveolar partial pressure of oxygen (PAO2 – PaO2).

PAO2 = alveolar oxygen pressure
PaO2 = arterial oxygen pressure

A normal resting A-a gradient in healthy middle aged adults ~ 10-15 mmHg

64
Q

Emphysema

A

Emphysema is a lung condition highlighted by pathological enlargement of distal airways due to airway destruction. The 3 subtypes of emphysema are:

  • Centriacinar (Centrilobular)
  • Panacinar (Panlobular)
  • Paraseptal (Distal Acinar)
65
Q

pleura

A

a thin, transparent, serous membrane enveloping the lungs and lining the thoracic cavity

66
Q

Increased A-a gradient can occur in:

A
  • Shunting
  • V/Q mismatch
  • Aging
  • Diffusion impairments (ex: interstitial fibrosis or pulmonary edema)
67
Q

A-a gradient is normal during conditions of hypoxemia caused by:

A
  • Hypoventilation
  • High altitude
68
Q

carina

A

the cartilaginous ridge within the trachea that runs anteroposteriorly between the left and right main bronchi

69
Q

primary vs. secondary pneumothorax

A

A primary spontaneous pneumothorax (PSP) occurs in individuals with no known lung diseases.

  • In most cases, the affected individual has a previously unrecognized lung disease and the pneumothorax originates from the rupture of a subpleural bleb (aka bullae). The typical patient affected by a PSP is a tall male between the ages of 20 and 40 (a PSP is rare in individuals over 40).

A secondary spontaneous pneumothorax occurs in individuals with lung disease (ex: COPD)

70
Q

epistaxis

A

nosebleed

71
Q

The causes of hypoxemia that have an increased A-a gradient are:

A
  • Pulmonary shunts (right to left)
  • V/Q mismatch
  • Diffusion limitation (ex: pulmonary fibrosis)
72
Q

costophrenic angle

A

formed by the air/matter interface between the lung and the domes of the diaphragm. On a chest x-ray, the costodiaphragmatic angle usually appears sharp with very crisp borders.

73
Q

Transudate vs. Exudate Pleural Effusion

A
  • Transudative effusions are due to increased hydrostatic pressure or decreased oncotic pressure.
  • Exudative effusions are due to increased vessel permeability secondary to inflammation. Upon gross inspection, the fluid extracted from an exudative pleural effusion typically appears cloudy.
    • exudative effusions must contain protein
74
Q

tidal volume (TV)

A

the volume of gas that moves in and out of lungs during typical quiet respiration. The tidal volume is normally around 500 mL

75
Q

The Haldane effect

A

describes the property of hemoglobin that promotes the release of bound H+ in the presence of increased [O2]. The binding of O2 to hemoglobin makes the Hgb-H+ bond less stable, thus promoting the release of H+. The resulting increase in free [H+] facilitates CO2 formation and expiration at the lungs via the reaction catalyzed by carbonic anhydrase (H+ + HCO3- → H2CO3 → CO2 + H2O).

76
Q

Pleural Effusion Treatment

A

Treatment of underlying disorder

Treatment of the underlying disorder may involve

  • Antibiotics (for an infectious process)
  • Diuretics (if congestive heart failure is the cause)
  • Chemotherapy/radiation (if malignancy is involved)
77
Q

Costomediastinal recess

A

spaces between the costal pleura and mediastinum ““ anterior lungs expand into these spaces on inspiration

78
Q

FEV1/FVC ratio in restrictive and obstructive lung disease

A
  • In restrictive lung disease, the FEV1/FVC ratio is normal or increased
  • In obstructive lung disease, the FEV1/FVC ratio is decreased
79
Q

spirometry of asthmatic patients

A
  • an obstructive pattern on spirometry
  • an increase of FEV1 greater than 12% after bronchodilator administration
80
Q

Oxygen delivery to tissues depends on the following two factors

A
  • Cardiac Output = Heart Rate x Stroke Volume
  • Total oxygen content of blood
81
Q

Over time, the following metabolic changes also take place in response to high altitude

A
  • Red blood cells produce more 2, 3-BPG (shifting the hemoglobin binding curve)
  • The kidney produces more erythropoietin to increase hematocrit
  • Cells throughout the body synthesize more mitochondria
82
Q

Clinical findings of chronic bronchitis include

A
  • Wheezing
  • Crackles
  • Cyanosis
83
Q

what does A-a gradient represent

A

reflects the integrity of oxygen diffusion across the alveolar and pulmonary arterial membranes

84
Q

forced expiratory volume (FEV)

A

forced expiratory volume (FEV) is the volume of gas that can be exhaled forcefully in a specific time frame (ex: FEV1 is the volume that can be exhaled in 1 second). This can be measured and compared to the FVC to determine the FEV1/FVC ratio (normal ~ 0.8).

85
Q

the three forms of transported carbon dioxide:

A
  • Bicarbonate (70%)
  • Carbaminohemoglobin (21-25%)
  • Dissolved in blood as CO2 (5-9%)
86
Q

standard pulse oximetry (SpO2) in carbon monoxide poisoning

A

can not differentiate between carboxyhemoglobin and oxyhemoglobin, so it cannot be used to screen for carbon monoxide (CO) poisoning. - Patients with CO poisoning will show a falsely elevated SpO2 reading. - confirmed by CO-oximetry, which measures the amount of carboxyhemoglobin in the blood

87
Q

forced vital capacity (FVC)

A

maximum amount of air that one can exhale after a maximum inhalation. It can be calculated with the following equation: FVC = TV + IRV + ERV

88
Q

Displacement of the carina from its usual anatomical position can have several possible causes:

A
  • Metastasis of bronchogenic carcinoma into tracheobronchial lymph nodes - Enlargement of the left atrium - Conditions causing tracheal deviation (ex: tension pneumothorax)
89
Q

PO2 and PCO2 of the zones of the lung

A
  • Because the apex (zone 1) has the highest V/Q ratio (typically ~ 3.0), it has the highest local PAO2 and lowest PACO2 in the lung
  • Because the base (zone 3) has the lowest V/Q ratio (typically ~ 0.6), it has the lowest local PAO2 and highest PACO2 in the lung
  • Some infectious microorganisms grow much more efficiently in high [O2] environments (such as M. tuberculosis). For this reason, such pathogens tend to infect the upper lobes of the lung with greater frequency than the lower lobes
90
Q

Pleural Effusion

A

Accumulation of fluid in the pleural space; fluid can be exudate (protein rich fluid which accumulates due to inflammatory causes.) or transudate (fluid containing little or NO protein, which accumulates because of increased hydrostatic pressure or decreased oncotic pressure.)

91
Q

test to distinguish an obstructive pattern from a restrictive pattern of lung disease

A
  • the ratio of FEV1/FVC can help distinguish an obstructive pattern from a restrictive pattern of lung disease depending on the results.
  • A normal FEV1/FVC is around 0.8
  • FEV1 = forced expiratory volume in one second
  • FVC = forced vital capacity
  • obstructive: FEV1 is decreased and FVC is normal or slightly reduced, the FEV1/FVC ratio is decreased (< 0.7).
  • restrictive: restrictive lung disease, both FEV1 and FVC are decreased. Because of the variability in how much each of these is reduced, the FEV1/FVC ratio can either be normal or can be > 0.8 depending on the individual clinical scenario.
92
Q

calculation for oxygen content of the blood

A

Oxygen content = ([Hgb] x 1.34 x % saturation) + (0.0031 x PaO2)

Note: The “1.34” in the equation refers to the fact that 1 g/dL of hemoglobin can carry 1.34 mL of O2

  • The first portion of the equation “([Hgb] x 1.34 x % saturation)” refers to the amount of oxygen that is carried by hemoglobin in the blood
  • The second portion of the equation “(0.0031 x PaO2)” refers to the amount of oxygen that is dissolved in the plasma of the blood
93
Q

commonly implicated drugs for restrictive lung diseases

A
  • Methotrexate
  • Nitrofurantoin
  • Carmustine
  • Bleomycin
  • Busulfan
  • Amiodarone
94
Q

Neonatal respiratory distress syndrome (NRDS)

A

insufficient production of surfactant, which increases alveolar surface tension and can lead to pulmonary collapse.

95
Q

differentiating chronic bronchitis from emphysema

A

Individuals with emphysema can maintain relatively normal PaCO2 until late in the disease course, whereas patients with chronic bronchitis have a chronically elevatedPaCO2 early in the course of disease.

96
Q

CO2 transport at the lungs`

A
  • The HCO3-/Cl- exchanger on RBCs reverses direction, and HCO3- enters RBCs in exchange for Cl-
  • The following reaction then occurs spontaneously H+ + HCO3- → H2CO3
  • Carbonic anhydrase then catalyzes the reaction H2CO3 → CO2 + H2O
  • CO2 diffuses out of the RBC and into the alveoli to be expired
97
Q

Types of Emphysema

A

centriacinar (centrilobular) – enlarged respiratory bronchiole but spared alveoli; occurs predominantly in heavy smokers; primarily affect upper lobes

panacinar (panlobular) – entire acinus is enlarged, including both the respiratory bronchioles and the alveoli; affects patients with α1-antitrypsin deficiency and primarily affects the lower lobes of the lung.

paraseptal (distal acinar) – healthy, tall young male presents with a spontaneous pneumothorax.

98
Q

To calculate the physiologic dead space, the following equation can be used:

A
99
Q

aspirated material more commonly enters the ____ bronchus (why?)

A

right; The right bronchus is steeper and wider than the left bronchus

100
Q

When ventilation is inadequate relative to perfusion, venous blood cannot exchange its contents with the alveoli as efficiently. As a result:

A
  • Decreased diffusion of O2 causes decreased arterial PO2
  • Decreased expiration of CO2 causes increased arterial PCO2
101
Q

perfusion and ventilation of the zones of the lung

A

Ventilation (V) and perfusion (Q) are greatest at the base of the lung, but the difference in perfusion between the base and apex is greater than the respective difference in ventilation. Because of this, the V/Q ratio is highest in the apex (zone 1) and lowest in the bases of the lungs.

During expiration the diaphragm forces more air out of the base of the lung than the apex, resulting in uneven distribution of end expiratory volume (more remaining in the apex). Because the base (zone 3) is more deflated than the apex, it can be better ventilated than the apex upon subsequent inspiration

102
Q

The oxygen-hemoglobin dissociation curve

A

a plot of percent saturation of hemoglobin as a function of pO2.

has a sigmoidal shape, which reflects the positive cooperativity of hemoglobin. Positive cooperativity of hemoglobin refers to the fact that when each O2 binds hemoglobin, the resulting conformational change in the hemoglobin molecule causes an increase in its affinity for additional O2 molecules (until fully saturated).

The p50 of a curve (pO2 at which 50% saturation is achieved) can be used to compare different curves with one another. The normal value for p50 is 26.7mmHg

103
Q

oxygen delivery to blood equation (estimation)

A

Oxygen Delivery = Cardiac Output (L/min) x Oxygen Content of Blood (mL of O2)

104
Q

When a patient is in the sitting or standing position, if aspirated material enters the lung it most commonly localizes to the ____ lobe

A

postero-basal segment of the right lower

105
Q

inspiratory reserve volume (IRV)

A

the volume of gas that can be forcefully inhaled after a normal inspiration.

106
Q

diphenhydramine

A

antihistamine

Body in Balance Midterm #2 (26 decks)

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