Resp II Flashcards
V/Q
apex zone 1 - high V/Q
zone 2 - Pa greater than PA greater than Pv
base zone 3 - low V/Q
both ventilation and perfusion greater at base of lung than apex
exercise and V/Q
apical vasodilation - decreased V/Q
ideal V/Q
1
apex = 3 base = 0.6
TB infection
thrive high O2
apex of lung
V/Q = 0
shunt - airway obstruction
V/Q = infinite
blood flow obstruction
CO2 transport in blood
HCO3 - 90%
carbamino Hb - HbCO2 - 5%
-bound to Hb at N terminus of globin - favor taut
dissolved CO2 - 5%
CO2 bound to Hb
to N terminus of globin
favor taut
-O2 unloading
lung CO2 and O2
in lung
- O2 of Hb - prevent dissociation H+ from Hb
- equilbrium shift to CO2 formation
- CO2 released in lungs
haldane effect
bohr effect
peripheral tissue
-elevated H+ - shift curve right - unload O2
chloride shift
into RBC
exchange for HCO3
high Cl in RBC in venous blood
high altitude
low PaO2 - ventilation - low PaCO2
-resp alkalosis
increased EPO production
increased 2,3 BPG production - Hb release more O2
acetazolamide - augment bicarb excretion from kidney
chronic hypoxic pulmonary vasoconstriction - right ventricle hypertrophy
rhinosinusitis
MCC - viral URI
may lead to secondary bacterial infection
-strep pneumo, h. flu, m. catarrhalis
epistaxis
nose vleed
anterior nostril - kiesselbach plexus
life-threatening - posterior segment - sphenopalatine a - branch of maxillary artery
DVT
virchow triad
- stasis
- hypercoag
- endo injury
homan sign
pain dorsiflex calf - DVT
lines of zahn
interdigitating area pink and red - in thrombi formed before death
with pulmonary embolus
distinguish pre-post mortem clots
hypoxemia, neuro abnormal, petechial rash
triad - fat emboli
air emboli
nitrogen bubble - precipitate ascending diver
tx - high pressure O2
obstructive lung disease
air trap in lung
-elevated RV and decreased FVC
very low FEV1
low FVC
low FEV1/FVC ratio**
V/Q mismatch
chronic - cor pulmonale
chronic bronchitis
emphysema
asthma
bronchiectasis
blue bloater
chronic bronchitis
hyperplasia mucus gland
-reid index more than 50% thickness
productive cough more than 3 months for more than 2 years
hypoxemia - shunting
CO2 retention - hypercapnia
secondary polycythemia
pink puffer
emphysema
enlarge air space, less recoil, more compliance
destruction of alveoli wall
-more elastase activity
barrel chested
-exhale through pursed lips
centriacinar
smoking
panacinar
a1 antitrypsin
curschmann spiral
shed epithelium - form whorled mucus plug
-with asthma
charcot leyden crystals
eosinophilic, hexagonal, double point, needle like crystals
from breakdown of eosinophils in sputum
with asthma
bronchiectasis
chronic necrotizing infection of bronchi
dilated airways
and hemoptysis
association - kartagener, smoking, CF, allergic aspergillosis
restrictive lung disease
decreased lung volume
decreased FVC and TLC
FEV1/FVC ratio greater than 80%
lots of causes:
- ARDS, NRDS
- poor breathing
- pneumoconiosis
- sarcoidosis
- idiopathic pulmonary fibrosis
- goodpasture
- wegener
- langerhans cell histiocytosis
- hypersens pneumonitis
- drug toxicity - bleo, busulfan, amiodarone, methotrexate
obstructive vs. restrictive lung disease
obstructive - higher lung volume
- FEV1 - larger decrease
- result in decreased FEV1/FVC ratio
restrictive - lower lung volume
-FEV1/FVC ratio - increased
both - FEV1 and FVC decreased - but obstructive has larger decrease FEV1
normal FEV1/FVC ratio = 80%
hypersensitivity pneumonitis
mixed type 3 and 4 HS
-to env antigen
pneumoconiosis
coal workers, silicosis, asbestosis
risk cor pulmonale
caplan syndrome - RA and pneumoconiosis with intrapulmonary nodules
asbestosis
pleural plaques - pathognomonic
risk of cancer - bronchogenic cancer greatest
-also mesothelioma
affect lower lobe
berylliosis
aerospace and manufacturing industry
granulomas form - respond to steroid
affect upper lobes
coal workers pneumoconiosis
coal dust
-macro with carbon
black lung disease
-anthracosis
affect upper lobe
silicosis
sand blasting, foundries, mines
macro - release fibrogenic factor - fibrosis occurs
silica - disrupt phagolysosome - impair macros
more susceptible to TB
risk for bronchogenic carcinoma
eggshell calcifications
