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Apex > Respiratory Physiology II > Flashcards

Respiratory Physiology II Flashcards

1
Q

State the alveolar gas equation

A
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2
Q

What is the A-a gradient?

A

The difference between the oxygen content in the alveoli (A) and the oxygen content in the blood (a)

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3
Q

There are five causes of hypoxemia. Which ones are associated with changes in the A-a gradient?

A

A-a gradient is normal in hypoxic mixture and hypoventilation

A-a is increased by diffusion limitation, V/Q mismatch, and shunt

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4
Q

Hypoxemia is defined as a PaO2 < ______

A

80

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5
Q

How do you go about determining the A-a gradient?

A

You use the alveolar gas equation to calculate A and draw a blood gas to determine a

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6
Q

When breathing room air, what is a normal A-a gradient?

A

< 15 mmHg

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7
Q

What are some scenarios that increase the A-a gradient?

A

Age

Vasodilators (reduce the lungs ability to perform hypoxic vasoconstriction)

Right to left shunt (atelectasis, pneumonia, bronchial intubation, intracardiac defect)

Diffusion limitation (anything that thickens the alveolocapillary membrane)

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8
Q

How can you calculate the degree of shunting?

A

You can estimate that shunt (the amount of blood moving through without undergoing gas exchange)

increases 1% for every 20mmHg increase in the A-a gradient

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9
Q

What’s the difference between lung volumes and lung capacities?

A

Capacities are the combination of two or more volumes

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10
Q

INSPIRATORY RESERVE VOLUME

DEFINITION

NORMAL VALUE

A

Volume of gas that can be forcibly inhaled after a tidal inhalation

3000ml

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11
Q

TIDAL VOLUME

DEFINITION

NORMAL VALUE

A

volume of gas that enters and exits the lungs during tidal breathing

500ml

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12
Q

EXPIRATORY RESERVE VOLUME

DEFINITION

NORMAL VALUE

A

volume of gas that can be forcibly exhaled after a tidal exhalation

1100ml

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13
Q

RESIDUAL VOLUME

DEFINITION

NORMAL VALUE

A

volume of gas that remains after a forced exhalation

gas that CANNOT be exhaled

1200ml

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14
Q

CLOSING VOLUME

DEFINITION

NORMAL VALUE

A

volume above residual volume when the airways start to collapse

Conveyed as a percentage of the total lung capacity

for young people it’s around 30%

Old people around 55%

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15
Q

TOTAL LUNG CAPACITY

DEFINITION

NORMAL VALUE

A

IRV + TV + ERV + RV

5,800ml

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16
Q

VITAL CAPACITY

DEFINITION

NORMAL VALUE

A

IRV + TV + ERV

4,500 ml

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17
Q

INSPIRATORY CAPACITY

DEFINITION

NORMAL VALUE

A

IRV + TV

3500mL

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18
Q

FUNCTIONAL RESIDUAL CAPACITY

DEFINITION

NORMAL VALUE

A

RV + ERV

volume of the lung at end-expiration

2300 mL

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19
Q

CLOSING CAPACITY

DEFINITION

NORMAL VALUE

A

absolute volume of gas contained in the lungs when the small airways close

RV + CV

Variable

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20
Q

What are the weight-based calculations for Vt, VC, and FRC?

A

Vt: 6-8 ml/kg

VC: 65-75 ml/kg

FRC: 35 ml/kg

BASED ON IBW NOT ACTUAL WEIGHT

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21
Q

How do lung volumes differ in females?

A

25% smaller

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22
Q

Lung volumes are _____ when sitting and ____ when supine

A

larger

smaller

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23
Q

Patients with obstructive lung disease have increased:

A

residual volume

closing capacity

total lung capacity

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24
Q

Spirometry cannot measure ______

A

residual volume

so it also can’t measure total lung capacity or FRC

also can’t measure closing volume or capacity

25
Q

Functional Residual Capacity is:

A

the volume of air in the lungs at the end of expiration

26
Q

At the point of FRC, the lungs are in a state of:

A

static equilibrium

The inward elastic recoil is exactly equal to the outward elastic recoil

27
Q

_______ is the volume of air that prevents hypoxemia during apnea

A

FRC

28
Q

How can we determine how long a patient can remain apneic before becoming hypoxemic?

A

FRC / VO2

29
Q

Conditions that reduce the FRC tend to reduce _____ or _____

A

Outward lung expansion

Lung compliance

30
Q

What are some causes of decreased FRC in the OR?

A
31
Q

What factors increase closing volume?

A
32
Q

What’s the difference between CaO2 and DO2?

A

CaO2 is the carrying capacity of the blood

DO2 is the delivery of oxygen to tissues per minute

33
Q

Most oxygen forms a reversible bond with hemoglobin. The remainder dissolves into the blood according to _______ law

A

Henry’s

34
Q

How can you calculate the carrying capacity of the blood?

A
35
Q

What is this number?

A
36
Q

What is this number?

A
37
Q

_____ is the driving mechanism of DO2

A

Cardiac Output

38
Q

What is the equation for DO2?

A
39
Q

What is the calculation for VO2?

A

Fick’s Equation!

40
Q

What causes a decreased p50?

A
41
Q

What causes increased p50?

A
42
Q

Most hemoglobinopathies effect the oxyhemoglobin dissociation curve by causing a shift to the:

A

Left

43
Q

What is the Bohr Effect?

A

An increase in PaCO2 and a decrease in pH cause hemoglobin to release oxygen

44
Q

What is 2,3 - DPG?

A

It’s a by-product of RBC glycolysis

THINK: RBCs are in glycolysis when there isn’t enough oxygen

DPG causes a right shift, making it easier for oxygen to be released

It makes sense that in chronic hypoxic states, 2,3-DPG is VITAL to adapting

45
Q

Why is it significant that banked blood is low in 2,3-DPG?

A

Banked blood is shifted to the left. It will not released oxygen as easily, reducing DO2

46
Q

Why is fetal blood always shifted to the left?

A

Because HgB F does not have 2,3-DPG

47
Q

Where is ATP stored in the body?

A

It isn’t! ATP cannot be stored, so the supply must be continuously replenished

48
Q

What is the byproduct of glycolysis?

A
49
Q

What happens after glucose is broken down into pyruvic acid?

A
50
Q

The primary purpose of the Kreb’s cycle is to:

A

Produce large amounts of H+ ions in the form of NADH

51
Q

In oxidative phosphorylation, _____ is the final electron accepter

A

Oxygen

52
Q

What are the end products of oxidative phosphorylation?

A

34 ATP

Water

53
Q

What is the Hamburger shift?

A

The shifting of Cl- into venous blood cells to keep the cell electrically neutral after bicarb is transferred to the plasma

54
Q

What is carbonic anhydrase?

Where is it found?

A

Facilitates formation of carbonic acid out of water and CO2

It is present inside of erythrocytes, NOT in the plasma

55
Q

Why is venous hematocrit always higher than arterial hematocrit?

A

When Cl ions shift into the cells, water moves osmotically with them

Venous erythrocytes are always a little larger, and therefore take up a greater percentage of the blood volume

56
Q

Solubility of CO2 and O2 is a function of ______ law

A

Henry’s

57
Q

In the presence of oxygenated hemoglobin, the CO2 dissociation curve shifts to the _____

A

Right

Blood has less affinity for CO2 and it is therefore “released”

58
Q

In the presence of deoxygenated Hgb, the CO2 dissociation curves shifts to the ______

A

left

When there’s not as much O2, the blood “loves” CO2

Apex (46 decks)

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