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Fun Med Fall-AM > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Ultimate function of the lungs?

A

Maintain pO2 and pCO2 within normal physiologic range

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2
Q

What muscles are used to create negative thoracic pressure?

A

Diaphragm & accessory muscles (intercostals, SCM, pectorals

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3
Q

Conducting zone of the airway consists of:

A

Trachea, primary bronchus, brachial tree (terminal bronchioles?)

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4
Q

Respiratory zone of the airway consists of:

A

Respiratory bronchioles, alveolar sacs, and alveolus

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5
Q

Pulmonary arteries transport de-oxygenated blood ______ from the heart

A

Away

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6
Q

Pulmonary veins transport oxygenated blood ______ the heart

A

toward

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7
Q

What are the 2 types of cells that make up the alveolar epithelium? And how much is made up of each

A

Type I pneumocystis make up 95% of total alveolar area- they are large flattened squamous cells

Type II pneumocytes make up 5% of total alveolar area - they secrete surfactant (to decrease surface tension and prevent collapse)

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8
Q

What is the very thin layer of connective tissue which attaches capillary endothelial cells to alveolar cells called?

A

Basement membrane.

It contains elastin, collagen, and fibrin

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9
Q

Gas exchange at the alveolar level

A

respiration

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10
Q

Method to quantify gas diffusion across alveolar-capillary membranes, that typically measures CO.

A

Diffusion Capacity (DLCO)

Low DLCO means impaired gas transfer from alveoli to capillary blood.

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11
Q

How do we tell if lungs are getting enough O2 from air into the blood?

A

Use the A-A gradient, which is the measure of the difference between alveolar and arterial O2 pressures. These should have minimal differences.

If A-a is elevated, then the lungs are not getting adequate O2 (shunting is occurring)

A-a gradient normal? They are getting enough O2.

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12
Q

Pathologic condition in which alveoli are perfused with blood, but not ventilated.

A

Pulmonary shunting.

*most common cause of hypoxemia

Pulmonary vasculature attempts to minimize the effect of insufficient airflow through hypoxic pulmonary vasoconstriction. Often cannot compensate completely.

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13
Q

What is it called when low regional pO2 leads to pulmonary vascular smooth muscle constriction which leads to blood flow re-routed to areas of lung with better oxygenation

A

Hypoxic pulmonary vasoconstriction

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14
Q

In what way is Hypoxic pulmonary vasoconstriction good? How is it bad?

A

Good: shutting down an area of the lung that has an infection.

Bad: if extensive or bilateral low pO2, it can cause main pulmonary artery constriction leading to pulmonary HTN, which may lead to R heart failure from too much demand on the heart.

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15
Q

Alveolar destruction causes:

A

Loss of elastic recoil of the lungs

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16
Q

Sx of pulmonary disease

A
  • Dyspnea/SOB/air hunger/exercise intolerance
  • cough
  • wheezing
  • plus others like chest pain, headaches or lightheadedness, fever/chills, anorexia, anxiety or depression
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17
Q

Characteristics of obstructive lung disease

A

airways narrowed, stale air cannot escape the alveoli

Really full balloon but the hole is really small so cannot deflate

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18
Q

Characteristics of restrictive lung disease

A

Can’t get air into the lungs, often connected to thickening of alveolar-capillary membrane (or other things)

Balloon that you can’t inflate

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19
Q

How do we measure how quickly and efficiently the lungs are emptied and filled?

A

PFTs (pulmonary function tests):
Spirometry (O2 saturation in the blood), plethysmography (lung volume), DLCO.

Compare results to others of similar demographics. Results based on 1/3rd of inspired gas stays in conducting airways and 2/3rd reaches alveoli

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20
Q

In Spirometry, what do you call the amount exhaled in 1 sec

A

FEV1 (Forced Expiration Volume in 1 second)

21
Q

In Spirometry, what do you call the volume capacity with forceful exhale not relaxed sigh

A

FVC (Forced Volume Capacity)

22
Q

What percentage of Oxygen is in the air

A

21%

78% Nitrogen
1% CO2 and other gases

23
Q

Why is it necessary to have Nitrogen in the air we breathe?

A

pure oxygen will diffuse across the capillary membrane and the alveolar will collapse (absorption atelectasis)

24
Q

Benefits and limits of O2 saturation

A

Benefits: rapid, noninvasive, continuous, low cost, accurate =/- 2% of true O2 sat.

Limits: Can’t distinguish O2 from other molecules (like CO), inaccurate if poor perfusion (cold hands), cannot assess ventilation (CO2 level), less accurate is O2 sats <70%

25
Q

Low partial pressure of O2 in the blood

A

Hypoxemia

26
Q

insufficient O2 delivery to tissues

A

Hypoxia

27
Q

Adequate breathing requires both adequate oxygenation and _________

A

Ventilation

28
Q

PEEP stands for:

A

Positive end expiratory pressure

-heated high flow, vent, bypass

29
Q

What decreases pCO2?

A

increasing respiratory rate

increasing tidal volume (amount of air moved with each breath)

30
Q

In Arterial Blood Gas readings, what is normal pH?

A

7.35-7.45

31
Q

In Arterial Blood Gas readings, what is normal PaCO2?

A

35-45 mmHg

32
Q

In Arterial Blood Gas readings, what is normal PaO2?

A

80-100 mmHg

33
Q

In Arterial Blood Gas readings, what is normal HCO3?

A

22-26 mEq/L

34
Q

In Arterial Blood Gas readings, what is normal O2 saturation?

A

95-100%

35
Q

Pros and cons of Arterial Blood Gas (ABG) testing

A

Pros: low to moderate cost, more accurate than pulse oximetry, measures CO2, allows determination of cause of acid/base imbalance (metabolic vs rest)

Cons: invasive, painful, not continuous so requires rechecks

36
Q

Blood pH of <7.35

A

Acidosis

37
Q

Blood pH of >7.45

A

Alkalosis

38
Q

How is blood pH regulated?

A

A bicarbonate buffer system of CO2 ( in the lungs) and bicarbonate (in the kidneys)

39
Q

Continuous, noninvasive measurement and graphical display of end-tidal carbon dioxide

A

Waveform Capnography or ETCO2 or PETCO2

A sensor is attached to endotracheal tube or Bipap to detect CO2 in expired air

40
Q

When is a CXR indicated?

A 
shortness of breath
cough (severe or chronic)
chest pain
chest wall trauma
chest wall deformities
hypoxia
foreign body aspiration
41
Q

When is CT indicated

A 
Sx unexplained by a CXR
concern for PE
Pulmonary nodules/masses
mediastinal or hilar adenopathy
loculated or unilateral pleural effusion, pleural thickening
42
Q

What is “technique difference” on a radiology report

A

When the same nodule looks different in size when imaged several times because it may be captured at a different level

43
Q

What test might you order to rule in a PE?

A

ventilation/perfusion scan aka V/Q scan

  • does not rule out PE
  • can be used in pts with renal failure or other contraindications for IV contrast
  • reported as “low” “moderate” or “high-probability” of PE
44
Q

What is it called when a flexible scope is passed into the brachial tree?

A

Flexible Bronchoscopy
aka Bronch

  • may be used to visualize a mass or nodule, non resolving pneumonia, mediastinal adenopathy
  • $$$
  • allows for direct visualization of airways, can obtain a biopsy or cultures, perform interventions
  • risks include pneumothorax, bleeding, death
45
Q

When trouble-shooting breathing problems, what would you think about when the patient isn’t breathing?

A
  • Is your equipment working? (When in doubt, check vitals yourself)
  • CNS respiratory drive (toxins, opioids, brainstem tumor or stroke or TBI)
  • Is air composition appropriate? (carbon monoxide, low atmospheric pressure)
46
Q

When trouble-shooting breathing problems, what would you think about if fresh air isn’t getting in and out of the alveoli?

A
  • Airway dz (eg bronchospasm, bronchial thickening/inflammation, mucous plugging, infection, obstructive lung dz/air trapping, foreign body, tumor)
  • Musculoskeletal (obesity, chest wall trauma, kyphosis, congenital chest wall deformity, diaphragm dysfunction)
  • Extrinsic restriction (pleural effusion, pneumothorax, neck tumor)
47
Q

When trouble-shooting breathing problems, what would you think about if oxygen can’t cross the alveolar-capillary membrane?

A
  • Interstitial disease, pulmonary fibrosis, pulmonary vasculitis
  • Loss of alveolar surface area (emphysema/COPD)
48
Q

When trouble-shooting breathing problems, what would you think about if the capillary isn’t adequately perfused?

A

PE, CHF, low cardiac output, cardiac arrhythmia/arrest

Fun Med Fall-AM (5 decks)

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