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Anesthesiologist Assistant > Pulmonary + Respiratory Physiology > Flashcards

Pulmonary + Respiratory Physiology Flashcards

1
Q

Major functions of respiration

A

Inflow and outflow of air between the atmosphere and the alveoli​

Diffusion of O2 and CO2 between air and blood​

Transport of oxygen and CO2 in the blood and body fluids to and from tissue

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2
Q

Airway Anatomy parts

A

Trachea​

Right and Left Main Bronchi​

Lobar Bronchi​

Segmental Bronchi​

Terminal Bronchioles​

Respiratory Bronchioles​

Alveolar Ducts

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3
Q

Characteristics of conducting airways

A

Have NO alveoli

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4
Q

Acinus is distal to

A

terminal bronchioles

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5
Q

Conducting airways

A

Trachea​

Right and Left Main Bronchi​

Lobar Bronchi​

Segmental Bronchi​

Terminal Bronchioles

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6
Q

The Respiratory Zone

A

The Acinus​

What is this comprised of?​

Makes up most of the volume of the lung​

2.5-3 liters at rest

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7
Q

Each RBC spends about how long in the capillary network?

A

0.75 seconds in the capillary network​

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8
Q

What MPAP is needed to generate 6L of Flow?

A

15 mm hg needed to generate 6 liters of flow

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9
Q

Surfactant is made by

A

TYPE II alveolar epithelial cells​

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10
Q

Surfactant is a made of

A

phospholipids, proteins and ions​

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11
Q

Muscles of expiration function

A

pull rib cage down

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12
Q

Muscles of inspiration function

A

Pull rib cage up

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13
Q

Muscles of inspiration

A

primarily external intercostals. Also SCM, Anterior serrati, scaleni– elevate rib cage– sternum moves outward from vert column and AP diameter inc 20%​

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14
Q

Muscles of expiration

A

primarily abdominal recti, internal intercostals​

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15
Q

Pleural pressure

A

Pressure of fluid between lung pleura and chest wall pleura. -5 cm h20 at rest

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16
Q

Alveolar pressure

A

Pressure of the air inside the alveolus. When airway open and no flow- 0 cm h20​

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17
Q

Transpulmonary pressure

A

Difference between alveolar pressure and pleural pressure. Really a measurement of the elastic recoil of the lung​

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18
Q

Pleural pressure function

A

fights lung tissue elastic recoil

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19
Q

Alveolar pressure

A

zero at airway rest, must get negative to get air in​

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20
Q

greater TPP illustrates

A

greater compliance of the system​

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21
Q

Lung compliance formula

A

the amount the lungs will expand for each unit of increase in transpulmonary pressure

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22
Q

How much air is needed to increase TPP by 1cm

A

Normally 200 ml air

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23
Q

Compliance is determined by

A

elastance of lung tissue and surface tension of alveoli. Also compliance of system involves chest wall compliance. ​

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24
Q

Elastic forces of lung tissue determined mainly from

A

elastin and collagen fibers. Alveoli forces moderated by surfactant.​

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25
Q

Transpleural pressure elastance is mainly related to

A

surface tension btwn air and fluid​

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26
Q

The thoracic cage is what percentage of the total lung system?

A

50%

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27
Q

Anatomic Dead Space (Definition)

A

The volume of air in the conducting airways

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28
Q

Anatomic Dead Space (Amount)

A

~150mL

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29
Q

What factors can change the anatomic dead space amount?

A

posture, size of person, and at the extremes of physiology​

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30
Q

Physiologic Dead Space formula

A

(PacO-PeCo)
/PaCo

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31
Q

Alveolar ventilation is

A

the rate at which new air enters the alveoli​

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32
Q

Dead Space Volume (Formula)

A

Va= RR (Vt-Vd)
expressed in L/min

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33
Q

Which region of the lung ventilates better?

A

Lower regions of the lung ventilate better than upper regions​

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34
Q

Average tidal Volume

A

500mL

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35
Q

Average IRV

A

3100 mL

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36
Q

Average ERV

A

1200 mL

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37
Q

Average Residual volume

A

1200 mL

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38
Q

Tidal volume

A

Amount of air inhaled or exhaled with each breath under resting conditions

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39
Q

IRV

A

Inspiratory Reserve Volume
Amount of air that can be forcefully inhaled after a normal tidal volume inhalation

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40
Q

ERV

A

Expiratory Reserve Volume
Amount of air that can be forcefully exhaled after a normal tidal volume exhalation

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41
Q

RV

A

Residual Volume
Amount of air remaining in the lungs after a forced exhalation

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42
Q

TLC

A

Total Lung Capacity
Maximum Amount of air contained in lungs after a maximum inspiratory effort

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43
Q

TLC Formula

A

TLC= TV +IRV+ERV+RV

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44
Q

Vital capacity

A

Maximum amount of air that can be expired after a maximum inspiratory effort

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45
Q

Average Vital capacity

A

3100-4800 mL

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46
Q

Average TLC

A

4200-6000mL

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47
Q

AVerage inspiratory capacity

A

2400-3600 mL

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48
Q

Average Functional Residual Capacity

A

1800-2400 mL

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49
Q

Inspiratory capacity

A

Maximum amount of air that can be inspired after a normal expiration

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50
Q

inspiratory Capacity formula

A

IC= TV+IRV

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51
Q

Functional residual capacity

A

Volume of of air remaining in the lungs after a normal tidal volume expiration

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52
Q

FRC Formula

A

FRC=ERV+RV

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52
Q

Boyle’s Law (Formula)

A

P1V1=P2V2

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52
Q

Charles’ Law (Definition)

A

The volume of gas is directly proportional to its absolute temperature

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52
Q

Charles’ Law formula

A

V1/T1=V2/T2

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52
Q

Boyle’s Law (Definition)

A

As volume increases, the pressure of the gas decreases in proportion

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53
Q

Ideal Gas Law (formula)

A

PV=nRT

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53
Q

Diffusion Limited

A

The amount of gas that is taken up by the blood depends on the amount of blood and not all the blood-gas barrier

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54
Q

Perfusion Limited

A

the amount that gets into the blood is limited by the diffusion properties of the blood gas barrier and not by the amount of blood. ​

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55
Q

Shunting

A

blood entering the arterial system without going through ventilated areas of the lung.

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56
Q

Shunt Equation

A

Qs/Qt= (Cco2-Cao2)/(CcO2-cvO2)

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57
Q

Qs/Qt

A

Shunt fraction
Shunt flow divided by Total Cardiac output

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58
Q

Dead Space Equation

A

VD/VT= (Paco-peCo)/(Paco)

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59
Q

FiO2

A

Fraction of inspired oxygen

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60
Q

Room air FiO2

A

0.21 in room air

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61
Q

PaO2

A

Partial pressure of Alveolar Oxygen

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62
Q

atmospheric pressure

A

760 mmHg at sea level

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63
Q

PH2O

A

H2O Vapor pressure in the alveolus :
Usually 47 mmHg at 37C

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64
Q

West Zone 1

A

where alveolar pressure is higher than arterial or venous pressure

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65
Q

West Zone 2

A

where alveolar pressure is higher than arterial or venous pressure

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66
Q

West Zone 3

A

where both arterial and venous pressure is higher than alveolar​

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67
Q

West Zone 4

A

where the interstitial pressure is higher than alveolar or pulmonary venous pressure.​

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68
Q

West Zone 1 formula

A

PA > Pa > Pv

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69
Q

West Zone 2 Formula

A

Pa > PA > Pv

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70
Q

West Zone 3 Formula

A

Pa > Pv > PA

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71
Q

West Zone 4 Formula

A

Pa > Pi > Pv > PA

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72
Q

Respiratory system resistance

A

a combination of resistance to gas flow in the airways and resistance to deformation of tissues of both the lung and chest wall​

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73
Q

Airway Resistance Formula

A

RrS=Rt+K1+K2V

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74
Q

Rt (in airway resistance)

A

The resistance from deformation of the lungs and chest wall

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75
Q

K1 (in airway resistance)

A

empirical constant representing gas viscosity

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76
Q

K2 (in airway resistance)

A

An empirical constant representing gas density and airway geometry

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77
Q

V (in airway resistance)

A

the flow as volume per unit of time

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78
Q

Tissue resistance from lung parenchyma

A

~70%

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79
Q

Tissue resistance from chest wall

A

~30%

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80
Q

What contributes to the work of breathing

A

Elastic work
Resistive work

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81
Q

Elastic work​

A

Work done to overcome elastic recoil of the lung​

Work done to overcome elastic recoil of the chest (which is subtracted from the work done to overcome the elastic recoil of the lung)​

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82
Q

Resistive work

A

Work done to overcome tissue resistance, otherwise referred to as viscous resistance​

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83
Q

Contributors to resistive work

A

Chest wall resistance​

Lung resistance

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84
Q

Work done to overcomeairway resistance,which includes

A

Airway resistance​

Resistance of airway devices and circuits

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85
Q

Respiratory Control Centers (controllers)

A

Nucleus retroambiguous
nucleus paraambigualis
Nucleus ambiguous

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86
Q

nucleus retroambiguous role and efferents/effectors

A

Upper motor neuron axons to contralateral expiratory muscles

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87
Q

Nucleus paraambigualis Role and efferents/effectors

A

Upper Motor neuron axons to contralateral inspiratory muscles

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88
Q

Nucleus ambiguous Role and efferent/effectors

A

vagus nerve: to larynx, pharynx and muscularis uvulae
Glossopharyngeus muscle to stylopharyngeus muscle

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89
Q

Pre-botzinger complex role and efferrent/effectors

A

Respiratory pacemaker (Central pattern generator)
Interneurons connecting to other respiratory control regions

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90
Q

Botzinger Complex- role and efferent/effectors

A

Expiratory Function
inhibitory interneurons to phrenic motor neurons and other respiratory control regions

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91
Q

Pontine respiratory group role and efferrent/effectors

A

Integrates descending control of respiration from the CNS
Interneurons connecting to other respiratory control regions

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92
Q

Cerebral Cortex role and efferrent/effectors

A

Volitional and behavioral respiratory control
Pontine respiratory group

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93
Q

mechanoreceptors in the bronchial and lung tissue (stimulus/Afferent nerve)

A

inflation/Deflation
Vagus Nerve

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94
Q

Central chemoreceptors (Stimulus/afferent nerve)

A

ph
No Nerve

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95
Q

Aortic Glomerulus Cells- in the aortic arch, subclavian arteries and pulmonary trunk
(Stimulus/Afferent nerve)

A

Aortic nerve (branch of the vagus)
PaO2
Changes in O2 delivery (anemia, carboxyhemoglobin, hypotension),
PacO2

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96
Q

Carotid body glomus
Type I cells- sited at the bifurcation of the common carotid
(Stimulus/Afferent nerve)

A

Stimuli- PaO2, PaCo2, pH, temp, Glucose (hypoglycemia)
Afferent nerve- Glossopharyngeal

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97
Q

Sniffing position

A

Helps to align Oral,
Pharyngeal, and Laryngeal
axes for optimal intubating
conditions
* Neck flexion (~35 deg) with
head/AO extension (~85-90
deg)

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98
Q

FIBEROPTIC BRONCHOSCOPE (FOB)

A

Consists of an light source,
handle, insertion cord (shaft), and
sometimes a screen
* Handle contains eyepiece (if no
screen), working channel ports,
control lever, and focusing ring

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99
Q

FOB uses

A

Diagnostic or therapeutic
bronchoscopy
* Placement tracheal tubes or gastric
tubes
* Advantageous in patients with difficult
airways or where rigid laryngoscopy is
not an option

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100
Q

Disadvantages of FOB

A

Fragile
Difficult to use
Difficult to clean
Longer time to secure airway
Difficult with blood/secretions
Risk of laryngeal trauma

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101
Q

Nasopharynx can be obstructed by

A

choanal atresia, septal
deviation, mucosal swelling or foreign material (blood,
mucous, objects)

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102
Q

Oropharynx entry can be blocked by

A

the soft palate lying
against the posterior pharyngeal wall

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103
Q

The pathway of gas can be restricted by the epiglottis in the

A

hypopharynx

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104
Q

Laryngeal obstruction related to spasm (laryngospasm) must
be treated by

A

positive airway pressure, deeper anesthesia,
muscle relaxants or endotracheal intubation

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105
Q

Laryngeal closure can occur from

A

intrinsic or extrinsic muscles of the larynx

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106
Q

Tight airway closure results from

A

Contraction of external laryngeal muscles, which force the mucosal folds of the quadrangular membrane into apposition

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107
Q

Stridor suggests

A

Glottic (laryngeal) obstruction or
laryngospasm (most often on inspiration)

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108
Q

Williams Oral airway

A

 Was designed for blind
orotracheal intubations

 Can be used as an aid to
fiberoptic intubations

 If using for fiberoptic, the
tracheal tube connector has
to be removed during
intubation

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109
Q

Contraindications of nasopharyngeal airways

A

 Hemorrhagic disorders
 Anticoagulation therapy
 Sepsis
 Basilar skull fracture
 History of epistaxis
 Nasal packing in place

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110
Q

FiO2 of supplemental oxygen delivered is dependent on

A

flow rate and device used

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111
Q

In nasal cannula, what is max flow rate?

A

6L/min

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112
Q

simple mask flow rates

A

No less than 5 L/min to
avoid CO2 rebreathing
(usually 6-10 L/min

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113
Q

Reservoir masks Can deliver FiO2 up to

A

1.0
(15L/min)

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114
Q

Peak pressures > 20 cm h2O can cause

A

gastric distention

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115
Q

Pulmonary veins

A

Four pulmonary veins (RUPV, RLPV, LUPV, LLPV)
 Empty into left atrium
 Oxygenated blood from the lungs

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116
Q

Pulmonary artery

A

 Originates at the RV apex/pulmonic valve
 Divides into right and left main branches
 Very compliant system
 Mixed venous blood pumped by the RV

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117
Q

Bronchial vessels

A

Bronchial arteries originate from the systemic circulatory system (1-2% CO)
 Transport arterial blood (oxygenated)
 Empties into pulmonary veins after passing through the tissues

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118
Q

High pressure, low flow circulation (Pulmonary) Source

A

Systemic arterial blood from bronchial arteries (branches of the
thoracic aorta)

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119
Q

High pressure, low flow circulation (Pulmonary) Supplies

A

Trachea, bronchial tree, supporting tissues of the lung, adventitia of
pulmonary arteries and veins

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120
Q

Low pressure, high flow circulation
 Source

A

Venous blood from body  pulmonary artery  alveoli (gas
exchange)

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121
Q

Low pressure, high flow circulation Supplies

A

Returns via pulmonary veins to the LA  LV and then pumped
systemically

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122
Q

Pulmonary arterial system

A

 Low pressure system
 Thin vessel walls
 Relatively little smooth muscle

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123
Q

The lung is required to always be able to accept

A

the entire CO

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124
Q

Pulmonary Artery Circulation pressure

A

25/10 mmHg

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125
Q

Pulmonary artery cathether uses

A

Uses: assessment of patients with pulmonary hypertension, cardiogenic shock, and unexplained dyspnea

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126
Q

Pulmonary artery cathterization

A

an intravascular catheter is inserted through a central vein (femoral, jugular, antecubital or brachial) to connect to the right side of the heart and advance towards the pulmonary artery

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127
Q

The “extra-alveolar” vessels are exposed to lower pressure (than alveolar pressure). These can be pulled open by

A

the radial traction of the surrounding lung parenchyma

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128
Q

PVR is normally small but can reduce even further as

A

pressure within the vessels increases

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129
Q

Recruitment

A

Opening of previously closed vessels

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130
Q

Distension

A

 Increase in caliber of vessels
 Change in shape from near flat to circular

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131
Q

Distension is the predominant mechanism for

A

decreased PVR at higher vascular pressures

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132
Q

PVR is highest at

A

very large lung volumes

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133
Q

Lung Volume affects

A

PVR

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134
Q

PVR is also high at

A

very low lung volumes

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135
Q

Resistance is the least when?

A

at normal TV breathing

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136
Q

If the lung is completely collapsed

A

Requires much more pressure to
allow blood flow
 Critical opening pressure

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137
Q

What else affects PVR

A

 Extra-alveolar vessels contain smooth muscle
 Substances that cause contraction of smooth muscle will increase PVR

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138
Q

Substances that cause contraction of smooth muscle

A

 Serotonin
 Histamine
 Norepinephrine
 Thromboxane A2
 Endothelin
 Nitrous oxide
 (Hypoxia)

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139
Q

What are some vasodilators?

A

 Nitric oxide
 Phosphodiesterase inhibitors
 Calcium channel blockers
 Prostacyclin

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140
Q

Calculation of pulmonary resistance

A

Resistance = Change in Pressure / Flow
PVR = [(mPAP – PCWP)/CO] x 80

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141
Q

SVR Equation

A

SVR = [(MAP – CVP)/CO] x 80

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142
Q

Change in Pressure

A

 Mean Pulmonary Artery Pressure (mPAP)
 Left atrial pressure (is approximated by Pulmonary Capillary Wedge Pressure
(PCWP)

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143
Q

Qp = Qs =

A

Cardiac Output

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144
Q

Hypoxic Pulmonary Vasoconstriction (HPV)

A

 Decreased O2 concentration in alveoli  blood vessel constriction
 This is the opposite of what happens in the systemic circulation

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145
Q

Gravity and positioning affect blood flow and
therefore

A

gas exchange

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146
Q

When upright, what area of the lungs receives the least amount of bloodflow?

A

Apex receives least amount of blood

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147
Q

When Supine, how is blood distribution in the lungs allocated?

A

 Apex and base are now about equal
 Posterior (or dependent) portion of the lung receives more
blood flow than the anterior portion

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148
Q

When hanging upside down, what area of the lungs receives the most blood flow?

A

Apex receives most blood flow

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149
Q

how does exercise affect blood flow throughout the lungs

A

Exercise causes the blood flow in increase throughout
and the differences between the areas becomes less

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150
Q

West Zone 1 doesn’t occur under normal conditions. When might this occur?

A

 Reduced arterial pressure
 Increased alveolar pressure

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151
Q

Which west zone mimics normal blood flow?

A

Zone 3

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152
Q

In hypoxic pulmonary vasoconstriction, Hypoxia (PO2 in the
alveoli) causes

A

local action on the artery without requiring CNS connections

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153
Q

Hydrostatic pressure (formula)

A

Pc – Pi

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154
Q

Colloid osmotic pressure

A

𝜋c - 𝜋i

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155
Q

Starling’s equation

A

Net fluid out = K[(Pc – Pi)– 𝜎(𝜋c - 𝜋i)]
K = filtration coefficient

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156
Q

Pulmonary edema

A

Fluid can leak into the interstitial space (perivascular/peribronchial space) and eventually get into the alveoli (obviously this is going to interfere with gas exchange)

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157
Q

Angiotensin I in pulmonary circulation

A

Converted to Angiotensin II by ACE

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158
Q

Angiotensin II in Pulmonary circulation

A

unaffected

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159
Q

Vasopressin in pulmonary circulation

A

Unaffected

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160
Q

bradykinin in pulmonary circulation

A

Up to 80% inactivated

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161
Q

Serotonin in pulmonary circulation

A

Almost completely removed

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162
Q

Norepinephrine in pulmonary circulation

A

Up to 30% removed

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163
Q

histamine in pulmonary circulation

A

not affected

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164
Q

Dopamine in pulmonary circulation

A

not affected

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165
Q

E2 and F2x in pulmonary circulation

A

Almost completely removed

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166
Q

A2 in Pulmonary circulation

A

not affected

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167
Q

PGI2 in pulmonary circulation

A

not affected

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168
Q

Leukotrienes in pulmonary circulation

A

Almost completely removed

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169
Q

What is a normal pressure in the right atrium?
 A: 5
 B: 10
 C: 15
 D : 20

A

A: 5

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170
Q

What is the normal pressure in the right ventricle?
 A: 25/15
 B: 10/0
 C: 15/5
 D: 25/0

A

 D: 25/0

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171
Q

When floating a pulmonary artery catheter, how can you tell that
you’ve entered the main pulmonary artery?

A

C: The diastolic pressure will increase

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172
Q

Calculate the PVR for this patient: mPAP 20, PCWP 7, CO 5.5.
 A: 166
 B: 189
 C: 275
 D: 392

A

B: 189
PVR = [(mPAP – PCWP)/CO] x 80

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173
Q

Which of the following would be most consistent with West Zone
2?
 A: Pa > Pv > PA
 B: PA > Pa > Pv
 C: Pa > PA > Pv

A

C: Pa > PA > Pv

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174
Q

At what lung volume would PVR be the highest?
 A: TV end-exhalation
 B: Vital capacity end-inhalation
 C: Vital capacity end-exhalation
 D: Total lung capacity

A

 B: Vital capacity end-inhalation

175
Q

At what lung volume would PVR be the lowest?
 A: TV end-exhalation
 B: Vital capacity end-inhalation
 C: Vital capacity end-exhalation
 D: Total lung capacity

A

A: TV end-exhalation

176
Q

Which of the following is most important in the HPV phenomenon?
 A: PaO2
 B: PvO2
 C: PAO2
 D: PACO2

A

C: PAO2

177
Q

Which of the following would cause pulmonary edema by
increased hydrostatic pressure?
 A: TRALI
 B: ARDS
 C: CHF
 D: Diffuse alveolar hemorrhage

A

C: CHF

178
Q

Which of the following is metabolically unaffected by passing
through the pulmonary circulation
 A: Angiotensin I
 B: Serotonin
 C: Angiotensin II
 D: Bradykinin

A

C: Angiotensin II

179
Q

how is oxygen carried throughout the blood

A

Attached to hemoglobin
Dissolved in blood

180
Q

once o2 has diffused from alveoli, what happens?

A

It is transported to the peripheral tissue capillaries almost entirely in combination with hemoglobin

181
Q

Oxygen carrying capacity formula

A

CaO2= (1.39 x Hgb x (sat/100))+ (0.003. x PaO2)

182
Q

Henry’s Law

A

The amount of a gas that is dissolved in the blood is proportional to
the partial pressure of that gas

183
Q

Normal arterial blood with a PaO2 of 100mmHg
contains

A

0.3ml O2/100ml (i.e. very little)

184
Q

For every mmHg of PO2, there is 0.003 ml O2/100ml of

A

Blood

185
Q

hemoglobin

A

An iron-porphorin compound attached to a protein globulin made of alpha and beta polypeptide chains

186
Q

normal Adult hemoglobin

A

HgbA

187
Q

normal fetal Hemoglobin

A

Hgb F

188
Q

How does Hgb F compare to Hgb A?

A

higher affinity for o2 than HgbA

189
Q

HgbF is for what age of people?

A

Newborn
Gradually replaced over 1st 6-8 mo of post-natal life

190
Q

Abnormal hemoglobin S=

A

Sickle Cell

191
Q

Sickle Cell abnnormal Hgb

A

Contains Valine instead of Glutamic acid in Beta chains
Decreased affinity for O2 and rightward shift in the hgb/o2 curve

192
Q

Methemoglobinemia

A

Ferrous ion of Hgb A (Fe2+) is oxidized to the ferric form (Fe3+)

193
Q

Elevated concentration of methemoglobin in RBCs

A

Methemoglobinemia

194
Q

Methemoglobinemia results in

A

Overall reduced ability of RBC to release oxygen to tissues

195
Q

Causes of methemoglobinemia

A

 Nitrites
 Some local anesthetics (Benzocaine)
 Congenital

196
Q

Oxygen + hemoglobin =

A

HgbO2

197
Q

hemoglobin in the oxygenated state is said to be

A

Relaxed or R State

198
Q

hemoglobin in the deoxygenated state is said to be

A

tensed or T state

199
Q

Oxygen rapidly binds to hemoglobin up to a PaO2 of

A

about 50 mmHg, then rate of binding slows

200
Q

maximum amount of O2 that can be bound

A

O2 capacity

201
Q

O2 Saturation

A

Percentage of available O2 binding sites that have o2 attached

202
Q

O2 Saturation formula

A

Sat= (O2 combined with hemoglobin/ O2 capacity) x100

203
Q

in strenuous exercise, o2 requirements

A

may increase by up to 20x normal

204
Q

Diffusing capacity for O2 increases almost 3x during exercise due
to

A

increased surface area of capillaries participating in diffusion

205
Q

What primary mechanism allows your PVR to drop during exercise

A
206
Q

shunt flow in o2 Transport

A

Blood from the lung will mix with
blood that passed from the aorta
through the bronchial circulation

207
Q

Shunt blood has PO2 of

A

40 mmHg

208
Q

Pulmonary venous blood has PO2
of

A

104 mmHg

209
Q

Venous admixture –> PO2 of

A

95
mmHg

210
Q

Tissue PO2 is determined by a balance between

A

Rate of O2 transport to the tissues from the blood
* Rate at which O2 is used by the tissue

211
Q

What partial pressure of O2 is needed to fulfill normal cellular function
requirements???

A
212
Q

P50

A

= PO2 at which 50% of
hemoglobin is saturated
 Normal is about 27 mmHg

213
Q

Right Shift in oxygen dissociation curve

A

O2 bound to Hgb with less affinity

214
Q

Right shift in Oxygen dissociation curve characteristics

A

 Increased H+ (Acidosis)
 Increased PCO2 (Bohr Effect)
 Increased Temperature
 Increased 2,3-diphosphoglycerate
Sickle Cell anemia

215
Q

Left Shift in oxygen dissociation curve

A

Left Shift

216
Q

right shift in Oxygen dissociation curve characteristics

A

 Alkalosis
 Lowered PCO2 (redundant)
 Hypothermia
 Decreased 2,3-diphosphoglycerate
 Carbon monoxide

217
Q

CO2 is carried in blood in 3 different forms

A

 Dissolved
 Bicarbonate
 Combination with proteins as carbamino coumpounds (bound to hemoglobin)

218
Q

Similar to O2, carbon dioxide obeys

A

Henry’s Law
The amount of a gas that is dissolved in the blood is proportional to
the partial pressure of that gas

219
Q

Co2 vs o2 solubility

A

CO2 is about 20x more soluble than O2

220
Q

Carbamino Compounds

A

Formed by combination of CO2 with terminal amine groups in blood proteins
 Most importantly, globin of hemoglobin
 Hgb -> carbaminohemoglobin

221
Q

Carbamino synthesis

A

Reaction occurs rapidly without an enzyme and reduced Hgb can bind more
CO2 as carbaminohemoglobin than HgbO2

222
Q

Haldane effect

A

The lower the saturation of Hb with O2, the larger the CO2 concentration for a given
PCO2
 Reduced Hb has more ability to accept H+ ions produced when carbonic acid
dissociates and forms carbaminohemoglobin
 “Oxygenated blood carries less CO2 for the same PaCO2”
 CO2 curve is steeper and more linear than O2 curve.
 CO2 curve is right-shifted by increases in oxygen saturation.

223
Q

Haldane effect

A

Basically, if the PaCO2 remains
constant (x-axis) but the O2
saturation falls, the overall CO2
concentration is increased.
This plot is loosely referred to as the
“CO2 dissociation curve”
 Essentially the curve shifts to the
right with increasing SpO2

224
Q

Respiratory Acidosis

A

Increase in PCO2
 Decreases the HCO3-/PCO2 ratio and thus decreases the pH (acidosis)

225
Q

Respiratory Alkalosis

A

Decrease in PCO2
 Increases the HCO3-/PCO2 ratio and thus increases the pH (alkalosis)

226
Q

Metabolic Acidosis

A

Decrease in HCO3-
 Decreases the HCO3-/PCO2 ratio and thus decreases the pH (acidosis)

227
Q

Metabolic Alkalosis

A

Increase in HCO3-
 Increases the HCO3-/PCO2 ratio and thus increases the pH (alkalosis)

228
Q

The presence of hemoglobin in normal arterial blood increases it’s
oxygen concentration approximately how many times?
A. 10
B. 30
C. 50
D. 70
E. 90

A

D. 70

229
Q

Since O2 saturation of normal arterial blood is about 97%, the total
O2 concentration is given by

A

(1.39 x Hb x .97) + 0.3 mL O2/100 mL blood

230
Q

Therefore, presence of Hb increases O2 concentration by about

A

70
times

231
Q

A patient with CO poisoning is treated with hyperbaric oxygen that
increases the PaO2 to 2000mmHg. The amount of oxygen dissolved
in the arterial blood (in ml/100ml) is:
A. 2
B. 3
C. 4
D. 5
E. 6

A

E. 6

232
Q

A patient with severe anemia has normal lungs. You would expect
which of the following:
A. Low arterial PO2
B. Low arterial O2 saturation
C. Normal arterial O2 content
D. Low oxygen content of mixed venous blood
E. Normal tissue PO2

A

D. Low oxygen content of mixed venous blood

233
Q

In CO poisoning, you would expect of which of the following to be
true:
A. Reduced arterial PO2
B. Normal O2 content of arterial blood
C. Reduced oxygen content of mixed venous blood
D. O2 dissociation curve shifted to the right
E. Carbon monoxide has a distinct odor

A

C. Reduced oxygen content of mixed venous blood

234
Q

If the patient has normal pulmonary function, the arterial PO2 will
be normal, but the O2 content will be

A

Reduced

235
Q

Most of the CO2 transported in the arterial blood is in which form:
A. Dissolved
B. Bicarbonate
C. Attached to hemoglobin
D. Carbamino compounds
E. Carbonic acid

A

B. Bicarbonate

236
Q

90% of CO2 transported in the arterial blood is in the form of

A

bicarbonate

237
Q

A patient with chronic lung disease has arterial pH, PO2 and PCO2
values of 7.35, 50mmHg and 60mmHg. How would his acid-base
status best be described?
A. Normal
B. Partially compensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Metabolic acidosis
E. Metabolic alkalosis

A

C. Partially compensated respiratory acidosis

238
Q

A patient with chronic pulmonary disease undergoes emergency
surgery. Postoperatively, the arterial pH, PO2, and PCO2 are 7.2,
50mmHg, 50mmHg respectively. How would you describe the
patient’s acid/base status?
A. Mixed respiratory and metabolic acidosis
B. Uncompensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic acidosis
E. Fully compensated metabolic acidosis

A

A. Mixed respiratory and metabolic acidosis

239
Q

The lab provides the following report on arterial blood from a
patient: pH – 7.25, pCO2 – 32, HCO3 – 25. You conclude that there
is:
A. Respiratory alkalosis with metabolic compensation
B. Acute respiratory acidosis
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
E. A lab error

A

E. A lab error

240
Q

41yo patient on mechanical ventilation for several days develops a
fever and sepsis. ABG shows PaO2 of 72mmHg, unchanged from
the previous day. What physiologic changes would you expect?
A. Decreased CO2 production
B. Decreased shunt fraction
C. Increased arterial O2 concentration
D. Increased arterial O2 saturation
E. Increased P50 for hemoglobin

A

E. Increased P50 for hemoglobin

241
Q

Fever causes a ________ shift of the O2 hemoglobin dissociation curve

A

Rightward
i.e. at any level of PaO2, there
will be a lower O2 saturation
and therefore a lower O2
concentration.
 No effect on shunt fraction`

242
Q
A
243
Q

Recommendation: pressure on the lateral tracheal wall should be kept between

A

20-30 cm H20

244
Q

What clinical situations are most appropriate for reinforced tubes?

A

in situations where the tube is likely to
be bent or compressed as in head &
neck surgery

245
Q

Reinforced/armored tubes

A

have a metal or nylon spiral woven reinforcing wire
covered both internally and externally by rubber, PVC or
silicone

246
Q

Disadvantages of reinforced tubes

A

 Tube may rotate on the stylet during intubation
 Insertion through nose & intubating LMA is difficult
(connector is bonded to tube)
 Fixation of these tubes are more difficult
 If the patient bites the tube it will cause permanent deformity resulting in obstruction of the tube

247
Q

Advantages of reinforced tubes

A

 Resistance to kinking and compression
 The portion of the tube outside the patient can be easily angled away from the surgical field without kinking
 Can be used for patients with tracheostomies

248
Q

RAE Tube/ pre-formed/ Ring-Adai-Elwyn

A

 Preformed bend that facilitates the head & neck surgeries
 Available in cuffed, uncuffed ,nasal, and oral
 Each tube has a rectangular mark at the center of the bend

249
Q

Advantages of RAE tubes

A

 Easy to secure and reduce the risk of unintended extubation
 Breathing system remains away from surgical field

250
Q

Disadvantages of RAE tubes

A

 More resistance than conventional tubes
 Difficult to suction

251
Q

Advantage of MLT

A

The small diameter provides better
surgical access

252
Q

Disadvantages of MLTs

A

incomplete exhalation & occlusion (increased resistance)

253
Q

NIM Tube

A

 Designed to monitor recurrent laryngeal nerve EMG activity during surgery
 The tube is wire-reinforced & has 4 stainless steel electrodes above the cuff. The electrodes are connected to a monitor

254
Q

RV + ERV =

A

FRC

255
Q

TV + IRV

A

Inspiratory capacity

256
Q

IRV+ TV+ ERV=

A

Vital Capacity

257
Q

VC+ RV=

A

TLC

258
Q

IC+ FRC=

A

TLC

259
Q

IRV+ TV+ ERV+ RV=

A

TLC

260
Q

Flow rate of expired air is greatly
dependent on

A

lung volumes

261
Q

Flow is limited by

A

airway
compression

262
Q

After a small amount of air is exhaled

A

the flow rate begins to drop quickly as the lung volume decreases

263
Q

In restrictive diseases, what happens to flow rate and volume exhaled

A

They are REDUCED

264
Q

In restrictive diseases, given the low lung volumes, the flow rate can be quite high when?

A

near the end of exhalation because of increased lung recoil

265
Q

in obstructive diseases, how is the flow rate?

A

Flow rate is very low for a given
lung volume

266
Q

What does the flow volume curve look like in obstructive diseases?

A

A “scooped-out” appearance of the
flow volume curve appears

267
Q

In Restrictive diseases, inspiration is limited by

A

Reduced compliance of the lung or chest wall
 Weakness of inspiration muscles

268
Q

in obstructive diseases, ____is typically
abnormally large, but _____ ends
early

A

TLC
Expiration

269
Q

Early airway closure is secondary to

A

increased smooth muscle tone in the bronchi (asthma) or loss of radial traction (emphysema)

270
Q

The FEV1 (or FEF 25-75%) is reduced by

A

an increase in airway resistance or reduction in elastic recoil of the lung.
 Independent of airway expiratory effort

271
Q

The flow rate is independent of the resistance of the airways downstream of the collapse point but instead is determined by

A

the elastic recoil pressure
and the resistance of the airways
upstream of the collapse point

272
Q

Both the increase in airway resistance and
the reduction of lung elastic recoil pressure
can be important factors in reducing

A

FEV1

273
Q

in dynamic compression, Flow is determined by alveolar pressure
minus pleural pressure (not pressure at
the mouth) and is therefore

A

Effort independent

274
Q

Lung volumes are measured by

A

Spirometry

275
Q

What Lung volumes cannot be measured by Spirometry?

A

FRC and RV

276
Q

FRC can be measured by

A

helium dilution
 Helium is virtually insoluble in blood
 C1 = known concentration of helium

body plethysmograph

277
Q

How is a helium dilution test performed?

A

Subject takes several breaths and the helium concentration in the spirometer and the lung equilibrate

278
Q

Formula for determining FRC

A

C1 x V1= C2 x (V1+ V2)

279
Q

Body Plethysmograph

A

Subject makes respiratory efforts (↓P in
lungs)
 Expands the gas in the lungs (↑V in lungs)
and increasing lung volume which will
increase the pressure in the box because
there is less gas volume in the box (↑P and ↓
in the box)

280
Q

Formula for body Plesmythograph

A

P1xV1 = P2 (V1-△V) => Solve for △V

281
Q

Diffusing capacity for carbon monoxide (DLCO) is measured by

A

Diffusing capacity for carbon monoxide (DLCO) is measured by

282
Q

Diffusion capacity for O2 is measured

A

very difficult to measure (only done in research labs)

283
Q

Regional variation in ventilation and blood flow can be measured using

A

radioactive xenon

284
Q

blood preferentially flows to what part of the lung?

A

Lung bases

285
Q

Measuring ventilation inequality

A

Single breath method – very similar to Fowler method for determining anatomic dead space

286
Q

Multiple breath method

A

Patient breaths 100% O2 over multiple breaths, N2 is measured at
the lips as a function of time

287
Q

in the Multiple-breath method, If FRC = TV, then

A

N2 concentration should ”half” with each breath

288
Q

in the Multiple-breath method, in a diseased lung, we see

A

a non- linear washout of N2 (due to non- uniform ventilation

289
Q

PFT Test of flow

A

Forced Expiratory Spirometry
 FEV and FEV1
 FVC

290
Q

When can a FEV/FEV1/ FVC test be done?

A

Can be done before or after a bronchodilator to determine bronchodilator responsiveness

291
Q

Are Flow tests effort dependent or effort independent?

A

Effort independent

292
Q

Diffusion Capacity (DLCO)

A

Measures the ability of the lungs to transfer a gas from the alveoli into the RBCs in the pulmonary capillaries
* Reflects properties of the alveolar- capillary membrane

293
Q

In DLCO, how is exhaled concentration measured?

A

Patient breathes in 0.3% CO and
exhaled concentration is measured
* The greater the DLCO, the lower the
exhaled concentration

294
Q

The greater the DLCO

A

the lower the exhaled concentration

295
Q

Patient’s height, weight, sex and age have correlated

A

predicted “normal” values
 Lung volumes
 Flows

296
Q

 FEV1 - Decreased
 FVC – Decreased
 FEV1/FVC Ratio – Decreased
 DLCO – Decreased

A

Obstructive Disease

297
Q

 FEV1 – Normal (to slightly low)
 FVC – Decreased
 FEV1/RVC ratio – Normal (to increased)
 DLCO - Decreased

A

Restrictive Disease

298
Q

 Asthma
 COPD
 Chronic bronchitis
 Emphysema

A

Obstructive Disease (think difficulty exhaling)

299
Q

 Interstitial lung disease
 Pulmonary fibrosis
 Chest wall and pleural diseases
 Obesity
 Scoliosis
 Neuromuscular diseases
 ALS

A

Restrictive Disease (think difficulty inhaling)

300
Q

A fixed obstruction

A

will effect both exhalation and inhalation

301
Q

OSA

A

Patient has respiratory efforts but cannot move air due to upper airway obstruction

302
Q

How is OSA Diagnosed

A

Diagnosed via sleep study (measuring Apnea-Hypopnea Index = # of apneas and hypopneas per hour of sleep)

303
Q

AHI 0-5

A

No Disease

304
Q

AHI 21- 40

A

Moderate OSA

304
Q

AHI 6-20

A

Mild OSA

305
Q

AHI > 40

A

Severe OSA

306
Q

FEV1

A

volume of air forcibly exhaled in 1 second

307
Q

FVC

A

forced vital capacity

308
Q

All “Capacities” are

A

SUmmation of other volumes

309
Q

Closing Capacity

A

Closing Volume + Residual Volume

310
Q

Closing Volume

A

the volume of air in the lungs at which the airways in the dependent portion of the lung begin to close/collapse

311
Q

Residual Volume

A

the volume of air in the lungs following a maximum exhalation

312
Q

Closing Capacity

A
313
Q

Closing capacity > FRC

A

This is less than ideal

314
Q

How is closing capacity measured

A

Single Breath N2 washout method

315
Q

Single Breath N2 washout method

A

Patient is breathing room air (approximately 79% N2)
Then we have the patient take a vital capacity breath of 100% O2
We measure the N2 concentration at the lips on the subsequent exhalation
The concentration of N2 is measured and recognized in four phases

316
Q

Closing Capacity Phase 1

A

Pure Dead space

317
Q

Closing Capacity Phase 3

A

Pure alveolar gas

318
Q

Closing Capacity Phase 2

A

Mixture of dead space & alveolar gas

319
Q

Closing Capacity Phase 4

A

Occurs near the end of expiration, is signified by a sharp increase in N2 concentration

320
Q

Why is phase 4 of closing capacity signified by a sharp increase in N2 concentration?

A

The apex of the lungs are almost certainly always “open” or expanded so during a vital capacity breath, they will not expand much more
Therefore they don’t take in as much of the 100% O2 and they contain a lot of the N2 from the previous breaths

321
Q

A young person will have a closing volume that is approximately what percent of their vital capacity?

A

10%

322
Q

As you age, what happens to the closing volume

A

It increases
I.e. closing capacity increases

323
Q

At age 65, what happens to the closing capacity

A

is approximately the same as the FRC
About 40% of vital capacity

324
Q

Certain diseases increase closing capacity

A

COPD
Asthma
Pulmonary Edema

325
Q

Does Obesity affect closing capacity

A

Actually, this does not increase the closing capacity, but does decrease the FRC (by decreasing the ERV)

Closing volume can be greater than FRC –> V/Q mismatch, shunting, and hypoxia

Because of this, closing capacity will approach FRC at a younger age than would be expected

326
Q

Obstructive Lung Diseases (Inhale/exhale)

A

CAN’T EXHALE

327
Q

Restrictive Lung Diseases

A

CAN’T INHALE

328
Q

Obstructive Lung Diseases

A

Reduced elasticity or premature closure of small airways that results in increased lung volumes, but decreased ventilation

329
Q

COPD

A

Emphysema
Chronic bronchitis

330
Q

Asthma

A

Usually a temporary obstruction that is reversible (due to inflammation of airways)

331
Q

Restrictive Lung Diseases

A

Reduced lung volumes due to damage to the lung tissue itself or structural change/weakness of the thorax

332
Q

Intrinsic Restrictive Lung Diseases

A

pathology within the lung parenchyma (i.e. pulmonary fibrosis)

333
Q

Extrinsic Restrictive Lung Diseases

A

Chest wall or pleural dysfunction (i.e. severe scoliosis)

334
Q

Pink Puffer

A

Emphysema

335
Q

Blue Bloater

A

Chronic Bronchitis

336
Q

Obstructive Lung Diseases (Examples)

A

COPD
Emphysema (“pink puffer”)
Chronic bronchitis (“blue bloater”)
Asthma
Bronchiectasis
Cystic Fibrosis

337
Q

Restrictive Lung Diseases

A

Obesity
Pulmonary Fibrosis
Scoliosis (severe)
Neuromuscular Disease
ALS
Muscular Dystrophy
Myasthenia Gravis
Sarcoidosis (and other ILDs)
Auto-immune diseases
Truncal burns

338
Q

FEV1 in obstructive lung disease

A

Low

339
Q

FEV1 in Restricitve Lung disease

A

Normal or slightly low

340
Q

FEV1/FVC in Obstructive Lung disease

A

Low

341
Q

FEV1/FVC in Restrictive Lung Disease

A

Normal or high

342
Q

Peak expiratory flow rate in Obstructive Lung disease

A

Low

343
Q

Peak expiratory flow rate in restrictive lung disease

A

Normal

344
Q

Residual volume in obstructive lung disease

A

High

345
Q

Residual volume in restrictive lung disease

A

Low, Normal, or high

346
Q

Vital Capacity in Obstructive lung disease

A

Low

347
Q

Vital Capacity in Restrictive Lung disease

A

Low

348
Q

Total Lung capacity in Obstructive lung disease

A

High

349
Q

TLC in Restrictive lung disease

A

Low

350
Q

DLCO in Restrictive Lung disease

A

Depends

351
Q

DLCO in obstructive lung disease

A

Depends

352
Q

DLCO

A

DLCO is really a function of how well a gas transitions from the alveoli to the blood stream

353
Q

If you have less alveolar surface area (like in severe emphysema) less CO can be taken up by the blood, therefore DLCO would be

A

low in a patient with emphysema

354
Q

Low DLCO

A

conditions that decrease effective alveolar surface area

355
Q

COPD/emphysema effects on alveolar surface area

A

Less alveolar surface area

356
Q

Restrictive lung disease effet on alveolar surface area

A

(less lung volume/area

357
Q

Lung diseases that decrease effective blood supply to the lungs

A

CHF
Anemia

358
Q

Drugs that cause pulmonary toxicity

A

bleomycin, amiodarone

359
Q

Diseases that cause normal to high DLCO

A

Asthma
Polycythemia (increased Hgb)

360
Q

L -> R intra-cardiac shunt
effect on DLCO

A

Normal to high DLCO

361
Q

Alveolar hemorrhage effect on DLCO

A

Normal to high DLCO

362
Q

of the commonly tested “obstructive” diseases, which one has increased DLCO

A

Asthma

363
Q

Carboxyhemoglobin effects on DLCO

A

Reduces

364
Q

Anemia effects on DLCO

A

Reduces

365
Q

Altitude effects on DLCO

A

Increases

366
Q

Low DLCO with restriction

A

Interstitial lung disease
Pneumonitis

367
Q

Low DLCO with obstruction

A

Emphysema
Cystic fibrosis
Bronchiolitis
Lymphangioleiomyomatosis

368
Q

Increased DLCO thought to be increased lung/airway vascularity and pulmonary capillary blood volume in

A

Asthma

369
Q

Low DLCO with normal spirometry

A

Anemia
Pulmonary vascular disease
Early interstitial lung disease

370
Q

Anemia DLCO in normal spirometry

A

Mild decrease

371
Q

Pulmonary vascular disease DLCO in normal spirometry

A

Mild to severe decrease

372
Q

Early interstitial lung disease DLCO in normal spirometry

A

Mild to moderate decrease

373
Q

Increased DLCO situations

A

Polycythemia
Severe obesity
Asthma
Pulmonary hemorrhage
Left to right intracardiac shunting
Mild left heart failure
Exercise just prior to the test

374
Q

How would mild left heart failure affect DLCO

A

INcreased pulmonary capillary blood volume
and increased DLCO

375
Q

How would exercise just prior to the test affect DLCO

A

Increased cardiac output and increased DLCO

376
Q

How would left-to-right intracardiac shunting affect DLCO

A

Increased DLCO

377
Q

How does Severe Obesity affect DLCO

A

Increased DLCO

378
Q

Polycythemia effects on DLCO

A

Increased DLCO

379
Q

Perioperative management of obstructive lung diseases

A

Bronchodilator (albuterol)
Anti-Cholinergic (Ipratropium)
Steroids

380
Q

Intraoperative management of obstructive lung disease

A

Warm and humidify air
Increase I:E ratio (provide for longer exhalation)
Avoid hyperventilation (allow some permissive hypercapnia)

381
Q

Perioperative management of restrictive lung diseases

A

Avoid “elective procedures” in setting of acute respiratory events

If smokers: should stop (even 24h of cessation will reduce carboxyhemoglobin)

They have decreased compliance: many require increased PEEP, increased FiO2 and RR

May require post-op ventilation
Treat their pain (prevent splinting

382
Q

What 3 cardiopulmonary function tests are important for thoracotomy patients

A

Predicted post-op FEV1
Predicted post-op DLCO
Preoperative Vo2 Max assesses the interaction between cardiac and pulmonary function

Need to know the patient’s preoperative PFTs and cardiopulmonary
functional status
* Additionally - need to know a little bit about pulmonary anatomy (i.e. how
much are they planning to resect)

383
Q

What does Preoperative Vo2 assess?

A

the interaction between cardiac and pulmonary
function

384
Q

How many lung segments do humans have

A

42

385
Q

RUL has how many segments

A

6

386
Q

RML has how many segments

A

4

387
Q

RLL has how many segments

A

12

388
Q

LUL has how many segments

A

10

389
Q

LLL has how many segments

A

10

390
Q

3-Legged stool of Pre-thoracotomy respiratory assessment

A

Respiratory mechanics
Cardio-pulmonary reserve
Lung Parenchyma function

391
Q

If ppoFEV1 > 40%

A

Low risk for perioperative respiratory complications

392
Q

If ppoFEV1 < 30%

A

High-Risk

393
Q

VO2 max Pre-op > 20 ml/kg/min

A

Low Risk

394
Q

VO2 max Pre-op < 15 ml/kg/min

A

High Risk

395
Q

ppoDLCO > 40% of predicted

A

Low-Risk

396
Q

Is ppoDLCO a good indicator of long-term survival?

A

No

397
Q

Closing Capacity is defined as
 A: TLC – RV
 B: FRC + RV
 C: Closing Volume + RV
 D: Closing Volume – RV
 E: Closing Volume/FRC

A

C: Closing Volume + RV

398
Q

True or False: An increased closing capacity improves respiratory mechanics and efficiency?

A

FALSE

399
Q

True or False: Obese patients will become hypoxic quicker than averaged sized patients (assuming no additional lung pathology) because they have increased closing capacity

A

FALSE

400
Q

Which statement about the predictive power of pre-operative assessment of pulmonary function prior to a thoracotomy for lobectomy is MOST likely true?
 A: A predicted post-operative FEV1 > 40% indicates a low risk for post- operative respiratory complications
 B: A normal pre-operative maximal oxygen consumption (VO2 max) is a poor predictor of post-thoracotomy outcome
 C: A DLCO = 50% of predicted suggests an unacceptable risk for pulmonary complications
 D: The FEV1 is the most useful predictor for post-thoracotomy outcome

A

A: A predicted post-operative FEV1 > 40% indicates a low risk for post-operative respiratory complications

401
Q

What would you expect to find in restrictive lung disease?
 A: Increased FVC
 B: Increased FEV1
 C: Normal to increased FEV1/FVC ratio
 D: Decreased FEV1/FVC ratio

A

C: Normal to increased FEV1/FVC ratio

402
Q

What would you expect to find in obstructive lung disease?
 A: Increased FVC
 B: Increased FEV1
 C: Normal to increased FEV1/FVC ratio
 D: Decreased FEV1/FVC ratio

A

D: Decreased FEV1/FVC ratio

403
Q

What lung volumes make up the Functional Residual Capacity?
 A: TV + ERV + RV
 B: TV + ERV
 C: ERV + RV
 D: TV + RV

A

C: ERV + RV

404
Q

Hypoxic Pulmonary Vasoconstriction is also known as

A

AKA von Euler-Liljestand mechanism

405
Q

Pulmonary Artery smooth muscle cells contract because of

A

increases in intracellular calcium
L type calcium channels and nonspecific cation channels

406
Q

in HPV, The hypoxia sensor is located in

A

the PASMC, thus it acts as sensor & effector

407
Q

Is HPV Present in the transplanted lung?

A

Yes

408
Q

When is HPV typically present in Anesthesia?

A

Most often during one-lung ventilation

409
Q

One-Lung Ventilation absolute indications

A

Isolation of one lung from the other to avoid spillage
Control of the distribution of ventilation
Unilateral bronchopulmonary lavage

410
Q

Is VATS an absolute indication for One-Lung Ventilation?

A

No, this is a relative indication

411
Q

What circumstances would we one-lung ventilate to avoid spillage?

A

In cases of infection or hemorrhage

412
Q

What circumstances would we one-lung ventilate to control the distribution of ventilation?

A

Bronchopleural fistula
Bronchopleural Cutaneous Fistula
Surgical opening of major conducting airway
Giant unilateral lung cyst or bulla,
Tracheobronchial tree disruption
Hypoxemia due to unilateral lung disease

413
Q

Relative indications for one-lung ventilation

A

High Priority surgical exposure
Medium Priority surgical exposure
Post-Cardiopulmonary bypass
Severe Hypoxemia (unilateral lung disease)

414
Q

What level of indication is one-lung ventilation in severe hypoxia due to unilateral lung disease

A

Absolute or Relative

415
Q

What level of indication is one-lung ventilation in

A
416
Q

What level of indication is one-lung ventilation in Isolation of one lung from the other to avoid spillage or contamination- infection, massive hemorrhage

A

Absolute

417
Q

What level of indication is one-lung ventilation in Control of the distribution of ventilation- bronchopleural fistula/ Bronchopleural cutaneous fistula?

A

Absolute

418
Q

What level of indication is one-lung ventilation in Surgical opening of a major conducting airway

A

absolute

419
Q

What level of indication is one-lung ventilation in a giant unilateral lung cyst or bulla

A

Absolute

420
Q

What level of indication is one-lung ventilation in life-threatening hypoxemia due to unilateral lung disease

A

Absolute

421
Q

What level of indication is one-lung ventilation in tracheobronchial tree disruption

A

Absolute

422
Q

What level of indication is one-lung ventilation in High-Priority Surgical exposure cases?

A

Relative

423
Q

What level of indication is one-lung ventilation in Medium Priority Surgical exposure cases

A

Relative

424
Q

What level of indication is one-lung ventilation in Post Cardiopulmonary bypass after removing totally occluding chronic unilateral pulmonary emboli

A

Relative

425
Q

High-Priority Exposure surgical cases include

A

Thoracic Aortic aneurysms, pneumonectomy, upper lobectomy, mediastinal exposure, Thoracoscopy

426
Q

Medium- Priority Exposure surgical cases include

A

Middle and lower lobectomies, subsegmental resections, esophageal resections, Procedures on the thoracic spine

427
Q

What are the predictors for intra-op hypoxia?

A

Side of the operation
Lung function abnormalities
Distribution of Perfusion

428
Q

PO2 low on 2 lungs is predictive of

A

PO2 on one lung

429
Q

Is obstructive lung disease helpful or harmful in one-lung ventilation

A

Can be both. If have emphysema than may auto peepCan be both. If have emphysema than may auto peep

430
Q

What diagnostic test can help determine the distribution of perfusion?

A

V/Q Scan

431
Q

What does a V/Q Scan help determine?

A

Distribution of perfusion

432
Q

What factors can alter distribution of perfusion

A

Central versus peripheral lesions

Supine versus lateral

Right versus left sided surgeries

433
Q

Patients with large central tumors will likely already have

A

less perfusion to the operative side compared with folks who have peripheral tumors

434
Q

Patients with large central tumors will have more hypoxia when in which position and why?

A

supine because less ability for gravity to move perfusion to the ventilated lung

435
Q

PAO2 with right side down and ventilated vs Supine

A

may be as much as 100 mm Hg higher

436
Q

2 Healthy women ascent to a mountain of 4500+ ft and after 12 hrs, PA Catheters are inserted.
Subject A has a Pulmonary Capillary pressure of 18mmHg, compared to only 10mmHg in subject B. For which of the following is Subject A at higher risk than subject B?

  • Delayed Airway closure on Expiration

-Decreased Alveolar Surface tension

-Increased volume of Anatomic dead space

-Decreased bronchial circulation blood flow

-Leakage of plasma and RBCs into the alveolar space

A

Leakage of plasma and RBCs into the Alveolar space

437
Q

Condition in which plasma and RBCs leak into the alveolar space

A

Pulmonary Edema

438
Q

A Newborn is hospitalized for tachypnea and hypoxemia for several days following birth and is determined to have a genetic defect affecting the primary structural elements of the cilia. For which of the following problems is this newborn at risk as a result?

-Decreased surfactant production

  • Increased diffusion distance across the blood-gas interface

-Decreased pulmonary blood flow

  • thickening of the alveolar basement membrane

-Decreased airway mucus clearance

A

Decreased airway mucous clearance

Increased risk of recurrent infection

439
Q
A

Anesthesiologist Assistant (13 decks)

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