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Advanced Pulmonology > Pulmonology Week 2 > Flashcards

Pulmonology Week 2 Flashcards

1
Q

What are normal values for pH, pCO2, and HCO3?

A

pH: 7.4, pCO2: 40 mm Hg, HCO3: 24 mmol/L

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2
Q

Describe the Haldane Effect.

A

Oxygenation of hemoglobin decreases its affinity for CO2, aiding CO2 release in lungs

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3
Q

What is the formula for CO2 transport in the blood?

A

CO2 + H2O ⇄ H2CO3 ⇄ H+ + HCO3-

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4
Q

Define acidemia and alkalemia.

A

Acidemia: blood pH < 7.36, Alkalemia: blood pH > 7.44

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5
Q

What are common causes of respiratory acidosis?

A

Airway obstruction, severe asthma, COPD exacerbation, CNS depression, neuromuscular disease

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6
Q

What compensatory mechanism occurs in respiratory acidosis?

A

Acute: bicarbonate buffering; Chronic: renal HCO3 generation/absorption (48-72 hours)

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7
Q

What changes in pCO2 and HCO3 are expected in acute respiratory acidosis?

A

Acute: HCO3 increases by 0.1 mEq/L per 1 mm Hg pCO2 rise; Chronic: HCO3 increases by 0.4 mEq/L per 1 mm Hg pCO2 rise

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8
Q

List common causes of respiratory alkalosis.

A

Hyperventilation, anxiety, asthma, pulmonary embolism, sepsis, fever

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9
Q

What is a key difference between acute and chronic respiratory acidosis?

A

pH closer to normal in chronic (renal compensation); acute has larger pH decrease per pCO2 rise

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10
Q

How does the body respond to respiratory alkalosis?

A

Acute: HCO3 decreases by 0.2 mEq/L per 1 mm Hg pCO2 fall; Chronic: 0.4 mEq/L decrease

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11
Q

What is bronchodilator testing used for?

A

Assesses reversible airflow obstruction; improvement indicates asthma

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12
Q

What is bronchoprovocation testing?

A

Uses agents like methacholine to induce bronchoconstriction; confirms airway hyperreactivity

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13
Q

What is spirometry used to measure?

A

Airflow with forced expiration, lung volumes, and capacities

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14
Q

What are FEV1 and FVC?

A

FEV1: volume exhaled in first second; FVC: total exhaled volume from full lung capacity

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15
Q

What is the significance of the FEV1/FVC ratio?

A

A reduced ratio (<0.7) defines obstruction; helps assess lung emptying rate

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16
Q

What spirometric pattern indicates obstructive lung disease?

A

Low FEV1/FVC ratio, normal FVC

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17
Q

What spirometric pattern suggests restrictive lung disease?

A

Normal FEV1/FVC ratio with reduced FVC

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18
Q

What is DLCO and its purpose?

A

Measures gas diffusion across alveolar membrane; evaluates oxygen transfer efficiency

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19
Q

Name three conditions associated with low DLCO.

A

pulmonary fibrosis, ILD, pulmonary hypertension, and emphysema (PIPE)

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20
Q

What conditions can increase DLCO?

A

Polycythemia, asthma, obesity, hemoptysis (HOPA)

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21
Q

List three spirometric patterns for large airway obstruction.

A

Variable intrathoracic, variable extrathoracic, fixed obstruction

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22
Q

What does a ‘fixed obstruction’ pattern look like on flow-volume loop?

A

Both inspiratory and expiratory limbs are flattened

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23
Q

What is the approach to interpreting an ABG?

A
  1. Assess pH, 2. Check pCO2 and HCO3, 3. Determine compensation
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24
Q

Describe the mechanism of hypoxemia in high V/Q mismatch.

A

Ventilated alveoli lack adequate blood flow (dead space), leading to hypercarbia and hypoxia

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25
Q

What conditions are common causes of chronic respiratory acidosis?

A

COPD, obesity hypoventilation syndrome, neuromuscular impairment, chest wall restriction

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26
Q

How is the severity of obstructive lung disease classified?

A

Based on FEV1 (e.g., <70% mild, <35% very severe)

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27
Q

What is the primary abnormality in obstructive lung disease?

A

Airway narrowing causing difficulty in air expulsion (air trapping)

28
Q

What differentiates obstructive from restrictive disease on spirometry?

A

Obstruction: reduced FEV1/FVC; Restriction: reduced FVC with normal FEV1/FVC

29
Q

How does lung compliance change in restrictive disease?

A

Reduced compliance with smaller lung volumes (e.g., low TLC, FRC)

30
Q

What is the Bohr effect?

A

Hemoglobin’s decreased affinity for oxygen at lower pH, aiding oxygen release in tissues

31
Q

What are common findings in aging lungs?

A

Increased compliance, decreased chest wall compliance, loss of elastic recoil

32
Q

What is the Bohr effect in relation to hemoglobin?

A

Hemoglobin releases more oxygen at lower pH (higher CO2), enhancing oxygen delivery in tissues

33
Q

Define acute respiratory acidosis.

A

Elevated pCO2 and decreased pH due to sudden hypoventilation or airway obstruction

34
Q

Define chronic respiratory acidosis.

A

Elevated pCO2 with near-normal pH due to renal compensation over time (e.g., in COPD)

35
Q

What compensatory response is seen in metabolic acidosis?

A

Hyperventilation to reduce CO2 and increase pH

36
Q

What causes a right shift in the oxygen-hemoglobin dissociation curve?

A

Increased pCO2, H+, temperature, and 2,3-BPG, enhancing O2 release

37
Q

What is the primary abnormality in restrictive lung disease?

A

Reduced lung compliance and decreased lung volumes (e.g., TLC, FVC)

38
Q

What pulmonary function test finding confirms a restrictive defect?

A

Low total lung capacity (TLC) with normal FEV1/FVC ratio

39
Q

What are common causes of restrictive lung disease?

A

ILD, chest wall deformities, neuromuscular disease, obesity

40
Q

What causes metabolic alkalosis?

A

Excess HCO3 or loss of H+ due to vomiting, diuretics, or bicarbonate ingestion

41
Q

Define respiratory alkalosis.

A

Decreased pCO2 and increased pH due to hyperventilation

42
Q

What role does the kidney play in respiratory acidosis compensation?

A

Increases HCO3 reabsorption to buffer pH

43
Q

What is the difference between acute and chronic compensation for respiratory alkalosis?

A

Acute: HCO3 decreases by 0.2 per 1 mm Hg pCO2 drop; Chronic: 0.4 decrease

44
Q

Describe the flow-volume loop for obstructive disease.

A

Scooped-out expiratory curve with reduced peak flow

45
Q

Describe the flow-volume loop for restrictive disease.

A

Narrow loop with reduced peak flow but proportional inspiratory and expiratory volumes

46
Q

What are common symptoms of respiratory acidosis?

A

Confusion, lethargy, headache, shortness of breath

47
Q

What changes occur in the lungs with aging?

A

Increased compliance, loss of elastic recoil, decreased chest wall compliance

48
Q

What is the primary cause of decreased diffusing capacity (DLCO) in emphysema?

A

Loss of alveolar surface area for gas exchange

49
Q

How does pulmonary fibrosis affect DLCO?

A

Decreases DLCO due to thickened alveolar-capillary membrane

50
Q

What is the mechanism of hypercapnia in emphysema?

A

Reduced alveolar ventilation due to air trapping and decreased surface area

51
Q

What is Kussmaul breathing?

A

Deep, labored breathing pattern seen in metabolic acidosis (e.g., DKA)

52
Q

What is the effect of altitude on pCO2?

A

Hypoxia at high altitude causes hyperventilation and decreased pCO2 (respiratory alkalosis)

53
Q

What is the normal range for arterial pCO2?

A

35-45 mm Hg

54
Q

What condition is often associated with low DLCO?

A

Pulmonary hypertension, emphysema, or interstitial lung disease

55
Q

What factors increase DLCO?

A

Polycythemia, asthma, exercise

56
Q

What defines a positive bronchoprovocation test?

A

FEV1 decreases by at least 20% after methacholine inhalation

57
Q

What is hypoxemia?

A

Low oxygen levels in the blood, measured by low PaO2 or SpO2

58
Q

What is hypercapnia?

A

Elevated CO2 levels in the blood, usually due to hypoventilation or obstructive lung disease

59
Q

What effect does anemia have on DLCO?

A

Decreases DLCO due to reduced hemoglobin for gas binding

60
Q

What is tidal volume (VT)?

A

The volume of air inhaled or exhaled during a normal breath

61
Q

What is FEV1?

A

Forced expiratory volume in the first second of a forced breath, measuring airflow

62
Q

How does hyperventilation affect pH?

A

Increases pH by lowering pCO2 (respiratory alkalosis)

63
Q

What is the effect of obesity on PFTs?

A

Restrictive pattern with decreased FVC and TLC

64
Q

What does a decreased FEV1/FVC ratio indicate?

A

Obstructive pattern, seen in asthma and COPD

65
Q

What is the role of chemoreceptors in respiratory regulation?

A

Detect CO2 and pH changes, adjusting ventilation rate accordingly

Advanced Pulmonology (5 decks)

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