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PathoPhysiology Respiratory - CP > Respiratory Pathophysiology > Flashcards

Respiratory Pathophysiology Flashcards

1
Q

Purpose of the pulmonary system

A

supply oxygen from the atmosphere to the blood and remove CO2, maintain acid base balance, phonation, pulmonary defense, oxygen for metabolism

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2
Q

Partial pressure of gases in air

A

79% Nitrogen, 600 mmHg
21% Oxygen 159.6 mmHg
1% Carbon Dioxide and other gases

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3
Q

Glycolysis in anaerobic metabolism

A

not sustainable for life
inefficient because it only yields 2 ATP
happens in the cytoplasm

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4
Q

Byproducts of the Aerobic metabolism

A

CO2, H2O, heat

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5
Q

Anaerobic metabolism

A

glycolysis –> 2 ATP and goes thru fermentation turning pyruvate into lactate

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6
Q

Purpose of the nose

A

used for filtration, smell, and humidification of incoming air

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7
Q

3 paired cartilages of the larynx

A

corniculate, arytenoid, and cuneiform

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8
Q

3 unpaired cartilages of the larynx

A

epiglottis, thyroid, cricoid

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9
Q

Why is the right mainstem bronchus more likely to be intubated over the left?

A

shorter, wider, and more vertical (25 degree angle)

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10
Q

the right lung makes up ____ TLC and is divided into ___ lobes

A

55%; 3

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11
Q

the left lung makes up ___ TLC and is divided into ___ lobes

A

45%; 2

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12
Q

Conducting zones of the airway

A

trachea –> bronchi –> bronchioles
No gas exchange occurs - anatomic dead space
has goblet cells- secrete mucus
the terminal bronchioles measure 1mm in diameter and lose cartilaginous plates

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13
Q

Resiratory/Transitional zones of the airway

A

terminal bronchioles –> alveolar ducts –> alveolar sacs
where gas exchange occurs - gas moves by diffusion
no goblet cells
respiratory bronchioles have diameter of 0.5 mm

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14
Q

What is the primary muscle of ventilation?

A

the diaphragm

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15
Q

What innervates the diaphragm?

A

C-3-4-5 roots to the phrenic nerve

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16
Q

When are intercostal muscles primarily used?

A

exertion
external - forced inhalation
internal - forced expiration

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17
Q

What the 3 types of pneumocytes in the lungs?

A

type 1 - structural
type 2 - surfactant producing
type 3 - macrophages

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18
Q

The distance from front incisors to carina is

A

26 cm
front incisors to larynx - 13 cm
larynx to carina - 13 cm

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19
Q

Blood supply to the conducting zone

A

from systemic circulation

from thyroid, bronchial, and internal arteries

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20
Q

Blood supply to the respiratory/transitional zone

A

from the pulmonary circulation

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21
Q

Anatomic dead space can be estimated by:

A

150 mLs (for a 70kg 6’0” man)
1/3 of tidal volume
1 mL/lb. or 2 mLs/kg of body weight (IBW)

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22
Q

Mechanics of inspiration

A

phrenic nerve innervates diaphragm to contract
drop in intrathoracic pressure - air pulls in
external intercostal help lift sternum and elevate ribs (increases AP diameter)

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23
Q

Does loss of intercostal function have an effect on ventilation?

A

not really

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24
Q

Mechanics of expiration

A

passive
increase in intrathoracic pressure - push air out
the elastic forces of the lung, chest wall, and abdomen compress the lungs
internal intercostals help with forceful expiration

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25
Q

What are the inspiratory accessory muscles?

A

sternocleidomastoid

scalene

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26
Q

What are the expiratory accessory muscles?

A

rectus, internal/external obliques, transversus abdominus

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27
Q

Transpulmonary pressure is the difference

A

between intrapleural and intra-alveolar pressures

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28
Q

What does the transpulmonary pressure determine?

A

the size of the lungs

a higher pressure = larger lung

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29
Q

Components of WOB

A

elastic and resistance forces of the lung and chest wall

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30
Q

Dorsal respiratory group stimulates

A

inspiration

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31
Q

Ventral respiratory group stimulates

A

inspiration/expiration (helps with forced inspiration/expiration)

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32
Q

the pneumotaxic center control of the lungs

A

decreases tidal volume

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33
Q

where is the pneumotaxic center located?

A

higher region of the pons

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34
Q

the apneustic center controls

A

increases in tidal volume for long and deep breathing

output is limited by baroreflex input from the lung and pneumotaxic center

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35
Q

where is the apneustic center located?

A

lower region of the pons

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36
Q

what do central chemoreceptors respond to?

A

hydrogen ion levels

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37
Q

what do peripheral chemoreceptors respond to?

A

CO2, pH, hypoxemia

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38
Q

What is the normal stimulus to breathe?

A

Hypercapnia

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39
Q

Which cranial nerve carries the aortic arch and lung stretch signals to the DRG?

A

CN X (vagus)

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40
Q

Which cranial nerve carries the carotid body signals to the DRG?

A

CN IX (glossopharyngeal)

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41
Q

Parasympathetic influence on the airway

A

causes mucus secretion, increased vascular permeability, vasodilation, bronchospasm

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42
Q

Activation of which receptors causes bronchoconstriction?

A

M3

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43
Q

Sympathetic influence on airway

A

inhibit mediator release from mast cells, increase mucociliary clearance

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44
Q

Activation of which receptors causes bronchodilation?

A

Beta 2

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45
Q

Which weight should we use for setting a Vt?

A

always IBW!

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46
Q

What are the 4 lung volumes?

A

residual
expiratory reserve
tidal
inspiratory reserve

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47
Q

Which volume cannot be measured by spirometry?

A

residual volume

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48
Q

What are the 4 lung capacities?

A

inspiratory = IRV + Vt
vital = IRV + Vt + ERV
functional residual = RV + ERV
total lung = IRV + Vt + ERV + RV

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49
Q

FRC definition

A

represents the point where elastic recoil of the lung is in equilibrium with the elastic recoil of the chest wall
“oxygen reserve”

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50
Q

Factors that affect FRC

A

upright and prone position = increases FRC
supine position = decreases FRC
muscle relaxation = decreases FRC
insufflation = decreases FRC

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51
Q

What is the respiratory quotient?

A

0.8

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52
Q

Which pleura covers the lung and which pleura covers the chest wall?

A

lung: visceral pleura

chest wall: parietal pleura

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53
Q

What is the space between the visceral and the parietal pleura called?

A

pleural cavity

54
Q

Compliance =

A

change in volume / change in pressure

55
Q

static compliance definition

A

compliance of the lung and chest wall WITH NO AIR MOVEMENT

don’t consider airway resistance*

56
Q

What causes decreased static compliance?

A

fibrosis, obesity, edema, vascular engorgement, ARDS, external compression, atelectasis

57
Q

What is the equation to calculate static compliance?

A

Tidal volume / (plateau pressure - PEEP)
ex. 500 / (12-5) = 71
normal value 60-100 mL/cmH2O

58
Q

How do we measure plateau pressure?

A

have to set an inspiratory pause on the vent

usually can only do in volume control mode

59
Q

dynamic compliance definition

A

compliance of the lung and chest wall during a breath

airway resistance plays a large role!

60
Q

What causes decreased dynamic compliance?

A

bronchospasm, tube kinking, mucous plugs, increased RR

really anything that increases airway resistance…

61
Q

How to calculate dynamic compliance

A

tidal volume / (peak pressure - PEEP)
ex. 500 / (20-5) = 33
normal 50-100mL/cmH2O

62
Q

Where are elastic forces greatest?

A

in collapsed and hyperinflated alveoli

require a greater change in pressure to achieve a set increase in volume

63
Q

What plays the largest role in reducing surface tension

?

A

surfactant

64
Q

Laminar flow is mostly

A

in small airways

65
Q

Turbulent flow is mostly

A

in large airways

66
Q

Where is the greatest airway resistance?

A

in the medium sized bronchi

67
Q

What does the Reynolds number predict?

A

when flow will be laminar or turbulent

68
Q

What has the biggest impact on the Reynolds number?

A

diameter of the vessel

69
Q

Which west zone should a PA catheter tip be placed in?

A

zone 3

70
Q

Zone 1 pressure in order of greatest to least

A

alveolar > arterial > venous

V/Q >1

71
Q

Zone 2 pressure in order of greatest to least

A

arterial > alveolar > venous

V/Q = 1

72
Q

Zone 3 pressure in order of greatest to least

A

arterial > venous > alveolar

V/Q = 0.8

73
Q

Zone 4 pressure in order of greatest to least

A

arterial > interstitial > venous > alveolar

V/Q < 1

74
Q

Denitrogenation always causes some degree of ___

A

atelectasis

75
Q

Closing volume definition

A

is the volume above residual volume where small airways close

76
Q

closing capacity definition

A

absolute volume of gas in the lung when small airways close (CV + RV)
increases from 30% of TLC at age 20 to 55% by age 70
increased by supine position, pregnancy, obesity, COPd, CHF, aging

77
Q

If closing volume is greater than FRC

A

airway closure occurs during tidal breathing leading to poorly ventilated alveoli and shunting

78
Q

oxygen in the blood is carried in two ways

A
  1. physical - dissolved in blood
  2. chemical - bound to Hgb
    Hgb rapidly and reversibly binds oxygen, allowing oxygen to be released into the tissues
79
Q

Each Hgb molecule binds up to ___ oxygen molecules

A

4

80
Q

Each gram of Hgb binds ____ mL of oxygen

A

1.34

81
Q

Right shift on oxy/hgb dissociation curve

A

lower affinity at tissue level (increase CO2, increase temp, decreased pH, decreased O2, increased 2,3 DPG)

82
Q

Left shift on oxy/hgb dissociation curve

A

higher affinity at lungs (decrease CO2, decreased temp, decrease 2,3 DPG, increase pH)

83
Q

Haldane effect

A

in the lung
oxygenation of blood displaces carbon dioxide from hemoglobin
shows relationship for blood’s ability to carry CO2 in different oxygen environments
curve shifts up and left when PO2 decreases

84
Q

Bohr effect

A

in the tissue

hemoglobin’s affinity for o2 is inversely related to CO2 levels

85
Q

SaO2 50% … PaO2 =

A

27

86
Q

SaO2 70% … PaO2 =

A

40

87
Q

SaO2 90% … PaO2 =

A

60

88
Q

CO2 is transported in the blood by

A
  1. physical solution 5-10% (dissolved in blood)
  2. chemically combined with amino acids of blood proteins 5-10% (bound to Hgb)
  3. bicarbonate ions 80-90%***
89
Q

What is the equation for rapid conversion of CO2 into bicarb?

A

CO2 + H2O –> carbonic anhydrase –> HCO3- + H+

90
Q

What is the chloride shift?

A

HCO2 leaves the RBCs, chloride enters to maintain electrical neutrality in the tissue capillaries

91
Q

What is the quickest compensation for acid base imbalances?

A

serum buffers

92
Q

Hypoxic hypoxia caused

A 
from:
decrease FiO2 <0.21
alveolar hypoventilation
V/Q mismatch
R --> L shunt
93
Q

Clinical examples of hypoxic hypoxia

A

high altitude, O2 equipment error, drug overdose, COPD, pulmonary fibrosis, PE, atelectasis, congenital heart disease

94
Q

Examples of circulatory hypoxia

A

reduced cardiac output

severe HF, dehydration, sepsis, SIRS

95
Q

Clinical examples of hemic hypoxia

A

reduced Hgb content/function

anemias, carboxyhemoglobinemia, methemoglobinemia

96
Q

Which hypoxia would supplemental oxygen be helpful?

A

hypoxic hypoxia* and demand/histotoxic hypoxia

97
Q

Clinical examples of demand/histotoxic hypoxia

A

increased O2 consumption or inability to utilize O2

fever, seizures, cyanide toxicity

98
Q

Hypoxic pulmonary vasoconstriction definition

A

reflex contraction of pulmonary vasculature in response to a low regional partial pressure of oxygen
intended to match regional perfusion to ventilation in the lungs

99
Q

how does the HPV response work

A

diverts blood away from hypoxic areas of the lungs to areas with better ventilation and oxygenation

100
Q

What does pulmonary circulation do in a hypoxic environment (acidic) ?

A

vasoconstrict

101
Q

How is HPV reduced/eliminated?

A

elevated FiO2, volatile anesthetics above 1 MAC

102
Q

Which disease has constant HPV if not treated and what can it lead to?

A

OSA, can lead to pulmonary HTN

103
Q

causes of deadspace

A

PE, hypovolemia, cardiac arrest, shock

anything that decreases pulmonary blood flow

104
Q

causes of shunts

A

mucus plugging, right mainstem intubation, atelectasis, pneumonia, pulmonary edema

anything that causes alveoli to collapse or fill

105
Q

difference between anatomic and alveolar dead space

A

anatomical - air in the airway that never reaches the alveoli and does not participate in gas exchange
alveolar - air in nonfunctioning alveoli (disease or abnormal blood flow)

106
Q

physiologic dead space =

A

alveolar + anatomic dead space

represents all of the air that is not being used for gas exchange

107
Q

Bohr’s Equation in terms of dead space

A

deadspace = Vt [(PaCO2 - PeCO2) / PaCO2]

ex. 55 x [(45 - 32) / 45] = 144 mL

108
Q

PeCO2 is normally ____ less than PaCO2

A

2-5 mmHg

due to mixing with anatomic deadspace during exhalation

109
Q

venous admixture is the result of

A

mixing of non-oxygenated blood with oxygenated blood distal to the alveoli

110
Q

mixed venous oxygen tension (PVO2) represents

A

overall balance between O2 consumption and o2 delivery

111
Q

factors that lower PVO2

A

decreased CO, increase O2 consumption, decreased Hgb concentration

112
Q

absolute shunt

A

V/Q = 0

hypoxia unresponsive to supplemental oxygen

113
Q

Shunt

A

wasted perfusion - airway obstruction, pneumonia

low V/Q

114
Q

Dead space

A

wasted ventilation - pulmonary embolism, cardiogenic shock

high V/Q

115
Q

Shunt like alveoli have ___ PO2 and ___ PCO2

A

low PO2 and high PCO2

116
Q

deadspace like alveoli have ___ PO2 and ___ PCO2

A

high PO2 and low PCO2

117
Q

Symptoms of URI

A

elevated WBC, mucopurulent nasal secretions, inflamed and reddened mucosa, congestion/rales, temp >37, tonsillitis, viral ulcer, fatigue, laryngitis, sore throat

118
Q

Histamine related allergy symptoms

A

sneezing, ash or boggy mucosa, itchy/runny nose, conjunctivitis, wheezing, hives, facial swelling, dry,red and cracked skin

119
Q

Fick’s Law of Diffusion

A

Rate of gas diffusion = D x A x deltaP / T
D = diffusion coefficient of gas
A = surface Area
deltaP = difference in partial pressure of gas across membrane
T = thicc ness ;-)

120
Q

Alveolar gas equation

A

PAO2 = (PB - PH2O) x FiO2 - (PACO2 / 0.8)
ex. (760 - 47) x .21 - (40 /0.8) = 100

PB = barometric pressure

121
Q

A-a Gradient

A

PAO2 - PaO2
ex. 100-92 = 8
normal 5-15
increases with age, obesity, supine position, heavy exercise

122
Q

What equation is a good indicator of overall gas exchange?

A

A/a ratio
PAO2 / PaO2
normal >75%

123
Q

Oxygen content equation

A

CaO2 = (HB x 1.34 x SaO2) + (PaO2 x 0.003)
CaO2 = 20.4
CvO2 = 15 mL o2/100mL blood
CaO2 - CvO2 = 5 mL O2/100 mL blood (consumption)

124
Q

Oxygen delivery

A

= CO x CaO2

ex. 5 x 200 = 1000mL/min

125
Q

Fick Equation/Oxygen consumption

A

VO2 = CO x (CaO2 - CvO2)

ex.. 5 x (200-150) = 250mL/min

126
Q

CO2/Alveolar ventilation equation

A

PaCO2 = VCO2 / VA

shows that PACO2 levels are inversely proportional to alveolar ventilation

127
Q

PaO2/FiO2 ratio (P/F ratio)

A

= PaO2 / FiO2
ex. 100 / .21 = 476
normal 400-500

128
Q

P/F ratio <300 indicates

A

mild ARDS

129
Q

P/F ratio <200 indicates

A

moderate ARDS

130
Q

P/F ratio < 100 indicates

A

severe ARDS

PathoPhysiology Respiratory - CP (4 decks)

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