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Neo Board Review > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Developmental stages of lung development

A

Embyronic, pseudoglandular, canalicular, terminal sac (saccular), aveolar and vasculature

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2
Q

Embyronic stage: GA development, structural devo, developmental abnormalities

A

0-5 weeks
ventral lung bud forms, asymmetric bronchi, 5 lobes, pulm vascular devo
problems: laryngeal cleft, tracheal stenosis, TEF, bronchogenic cysts

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3
Q

Pseudoglandular stage: GA development, structural devo, developmental abnormalities

A

5-16 weeks
branching up to terminal bronchi, broncho-pulm epithelium produces fluid, vasculature of aa & vv, separation of thorax & peritoneal cavity
problems: branching abn, CDH, congenital lobar emphysema, CPAM, pulm lymphangiectasia

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4
Q

Canalicular stage: GA development, structural devo, developmental abnormalities

A

16-25 weeks
respiratory bronchioles, prelim gas exchange unites, T2 pneumocytes -> T1
problems: pulm hypoplasia, surf deficiency, alveolar capillary dysplasia

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5
Q

Saccular stage: GA development, structural devo, developmental abnormalities

A

25-36 weeks
alveolar ducts, gas exchange via alveolar capillary membrane
problems: pulm hypoplasia, surf deficiency

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6
Q

Alveolar & vasculature stage: GA development, structural devo, developmental abnormalities

A

36+ weeks
alveoli increase in diameter, microvascular growth & vessel maturation
problems: surf deficiency, congenital lobar emphysema, pulm HTN

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7
Q

O2 content =

A

O2 content = O2 bound + O2 unbound
= [(1.34 x Hb) x O2 sat] + [(0.003) x paO2]

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8
Q

A-a gradient =

A

A-a gradient = pAO2 - paO2
= [FiO2 x (pB - H2O)] - paCO2/R - paO2

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9
Q

O2 delivery =

A

O2 delivery = CO x O2 content

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10
Q

O2 consumption =

A

O2 consumption = (blood flow x O2 content in arterial blood) - (blood flow x O2 content in venous blood)
= CO x (1.34 x Hb) x (arterial O2 sat - venous O2 sat)

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11
Q

SP A

A

Expressed early 3rd trimester
Tubular myelin and host defense

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12
Q

Sp B

A

Expressed at end of 1st trimester
Surfactant function
Tubular myelin
Surface adsorption of phospholipids
Surfactant administration in the setting of Sp B deficiency is ineffective

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13
Q

Sp C

A

Expressed at end of 1st trimester
Surfactant function
Surface adsorption of phospholipids

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14
Q

Sp D

A

Expressed last, after early 3rd trimester
Host defense
Anti oxidant
Surfactant lipid homeostasis

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15
Q

Laplace’s law

A

P = 2T / r
P is distending pressure or pressure needed to resist alveolar collapse

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16
Q

Boyle’s Law

A

P1V1 = P2V2

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17
Q

Hering Breuer inflationary reflex

A

Lung overdistention -> inspiration arrest

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18
Q

Hering Breuer deflation reflex

A

^RR with abrupt deflation of lungs

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19
Q

Chemoreceptors that sense CO2 changes

A

In the medulla, and actually more sensitive to H changes

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20
Q

Chemoreceptors sensitive to O2 changes

A

Carotid and aortic bodies (peripheral)
These are less sensitive in preterm infants and so they, instead of having initial hyperpnea and then decreased ventilation in term infants, preterm infants respond to hypoxemia with respiratory depression

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21
Q

Alveolar ventilation equation

A

VA = (TV - dead space) x RR

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22
Q

Bohr equation of physiologic dead space

A

Dead space V = TV x ((alveolar CO2 - expires CO2) / alveolar CO2)

In patients without significant venous-to-arterial shunts then arterial pCO2 represents the pCO2 of perfused alveoli

Physiologic dead space = TV x ((arterial CO2 - expires CO2) / arterial CO2)

23
Q

Resistance equation

A

R = change in P (cm H2O) / change in flow (L/sec)
Normal is 40-55
Due to chest wall (1/4), airway (1/2), lung tissue (1/4)

24
Q

Resistance relationships in laminar flow

A

Increased radius decreases resistance
Increased length increase resistance
Laminar flow unaffected my density of gas

R = (length x viscosity) / radius^4

25
Q

Poiseuille law for laminar flow

A

Flow = (change in P x pie x radius^4) / (8 x length x viscosity)

26
Q

Turbulent flow and resistance relationships

A

Inc length -> inc R
Inc radius -> Dec R
Inc density of gas -> inc R
R proportional to (length x density) / radius^5

27
Q

Elastance equation

A

Elastance = change in P / change in volume

28
Q

Compliance equation

A

Compliance = change in V / change in P

29
Q

Work of breathing equation

A

Work of breathing = pressure (or force) x volume (or displacement)

30
Q

Power equation

A

Power = work x frequency

31
Q

Time constant equation

A

Time constant = resistance x compliance

Time = (P/flow) x (V/P)

32
Q

Time constant healthy newborn

A

Healthy teen time constant = 0.09-0.15 and it takes 3-5 time constants for inspiration and expiration = 0.45 second

33
Q

Time constant in RDS

A

Smaller time constant (0.05) because compliance is very even though resistance is higher

34
Q

Time constant in CLD

A

Time constant is high (>0.15) (because of very high resistance even though compliance is low)

35
Q

Alveolar gas equation

A

pAO2 = pIO2 - (paCO2/R) + f

F is a correction factor (usually 2mmHg)
pIO2 = FiO2 x (pB - pH2O)

36
Q

What increases oxygen consumption?

A

Increased caloric intake
Decreased body temperature
Neonate&raquo_space; adult
Term > preterm
AGA > SGA

37
Q

Altitude calculations

A

(pB - H2O) x FiO2 = (pB - H2O) x FiO2

38
Q

Total CO2 equation

A

Total CO2 = dissolved CO2 + HCO3- + carbamino compounds

39
Q

Bohr effect

A

Changes in O2 bound to Hb based on response to pCO2 in lungs vs body because of shifts of the oxyhemoglobin dissociation curve with CO2/pH changes

40
Q

Haldane effect

A

Changes in CO2 binding to Hb based on amount of O2
So when O2 is removed in the tissues, CO2 can bind
But when O2 binds in lungs, CO2 unloaded
This effects co2 content rather than pCO2

41
Q

Henderson Hasselbach equation

A

[Hydrogen] = (24 x pCO2) / [bicarb]

42
Q

MAP equation (mean airway pressure)

A

MAP = k(PIP-PEEP) x [itime / (itime + etime)] + PEEP

K is a constant

43
Q

Ventilator triggers, limits and cycles

A

Triggers: time, pressure, flow, or chest impedance/abdominal movement

Limits: pressure or volume

Cycle: time, volume, or flow (assist/control, pressure support)

44
Q

Units for Hertz

A

Hz = 1 cycle / second
So 11 hz = (11 cycles / second) x 60 seconds/min = 660 breaths per minute

45
Q

Etiology of apnea

A

Prematurity (typically starts after 24 HOL)
Infection
Metabolic abnormalities
Arrhythmia
Hypoxemia
Anemia
Hypothermia
Hyperthermia
Medications (I.e, PGE)
Maternal meds (narcotics, mag, beta blocker)
Upper airway malformation leading to increases secretions or anatomical blockage
CNS disorder (IVH, congenital anomaly)

46
Q

Intrapulmonary shunt equation

A

Qs/Qtotal = %shunt = (O2 content pulm cap - O2 content systemic artery)/(O2 content pulm cap - O2 content mixed venous)

47
Q

Lung compliance in a healthy newborn vs RDS vs CLD

A

Healthy newborn: 3-5 mL/cm H2O
RDS: 0.5-1 mL/cm H2O
CLD: <1 mL/cm H2O

48
Q

Resistance in healthy newborn vs RDS vs CLD

A

Healthy newborn: 20-40 cm H2O/L/sec
RDS: >40 cm H2O/L/sec
CLD: >150 cm H2O/L/sec

49
Q

Time constant for healthy newborn vs RDS vs CLD

A

Healthy newborn: 0.09-0.15
RDS: 0.05
CLD: >0.15

50
Q

Base deficit correction

A

Give enough to correct half the base
Bicarb to be administered = BD x kg x 0.3

51
Q

Causes of neonatal pneumonia

A

Early: GBS, E. coli, klebsiella, listeria
Late: above plus S aureus, pseudomonas, fungal, chlamydia, ureaplasma, CMV, herpes, RSV, enterovirus, rubella, syphilis

52
Q

Pulmonary interstitial emphysema causes within lung?

A

Decreased lung compliance
V/Q mismatch
Increased dead space

53
Q

CDH LHR mortality

A

LHR < 1.0 is poor prognosis
LHR > 1.4 is good prognosis
If liver and LHR <0.8 then high mortality

Neo Board Review (12 decks)

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