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Witwer Nightingale Lower Resp Tract Flashcards

1
Q

A person at rest breathes about ____ liters of air per minute – Tidal Volume X Breaths per minute

A

6+

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2
Q

Systemic Arterial and Pulmonary Venous Blood
•Partial pressure O2 (PaO2) in systemic arterial blood?
•Partial pressure CO2 (PaCO2) in arterial blood?

A

100mmHg

40mmHg

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3
Q

-Systemic Venous and Pulmonary Arterial Blood
•Partial pressure of O2 (PvO2) in systemic venous blood?
•Partial pressure of CO2 (PvCO2) in systemic venous blood?

A

40mmHg

46mmg

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4
Q

With altitude, the Barometric Pressure __?

A

decreases

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5
Q

Partial Pressure of O2 (PiO2) in dry inspired air (760 x .21 =)160 mmHg
Partial Pressure of O2 in alveoli= 100mmHg
why?

A

Some is converted to water vapor in lungs

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6
Q

Dissolved O2 contributes to the partial pressure of O2 in blood, but O2 bound to hemoglobin does not. O2 bound to hemoglobin contributes to the ____ _____.

A

O2 saturation

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7
Q

Diffusion is a 1. _______ process.
It requires a 2. ______ gradient and is affected by
3.______ _____ _____.
What diseases will decrease the alveolar surface area??

Diffusion is affected by 4.______ the molecules must diffuse across.
What diseases will thicken the alveolar/pulmonary membranes??

Diffusion depends on the amount of capillary blood flow= 5.______.

A
  1. passive
  2. pressure
    - emphysema
  3. membrane surface area
    - edema
  4. distance
  5. perfusion
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8
Q

Partial pressure gradient of O2 & CO2 across the alveolar-capillary membrane?

A

O2= 60mmHg

CO2=6mmHg

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9
Q

CO2 diffuses ____x and CO diffuses _____x faster than O2

A

CO2= 20x

CO=200x

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10
Q

Remember the “driving force” for gas exchange is the pressure differential between the partial pressure of the gas in the alveoli and the partial pressure of the _____ gas in the blood (not gas bound within red cells).

A

soluble

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11
Q

Under normal conditions, Oxygen diffusion from the alveolar air into the pulmonary capillary blood is _______ limited, ie the ability of the gas to diffuse depends on the amount of ______ ______ through the capillary adjacent to the alveolus.

A
  1. perfusion

2. blood flow

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12
Q

Under some abnormal conditions, however, this diffusion capacity decreases and Oxygen diffusion becomes _____ limited.

A

Diffusion

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13
Q

2 conditions that decrease diffusion capacity & examples of each

A

increase in alveolar capillary membrane thickness (pulm fiborisi & pulm edema)

decrease in effective area for diffusion
(Atelectasis, emphysema, ARDS, pulm emboli)

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14
Q

when is CO2 perfusion limited?

A

NL and abnormal states

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15
Q 
Note ideally the 
Arterial/Alveolar Gradient
for oxygen is:
Normally, the Gradient is:
what happends w/age?
A

100-100=0
NL 5-10

increase 1mmHg per decade

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16
Q

Hypoxemia secondary to a _____ or _______cause will _______the A-a gradient by _______ mmHg.

A

pulmonary or cardiac
increase
30mmHg+

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17
Q

Hypoxemia secondary to an extrapulmonarycause will have a ______ A-a gradient.

A

normal

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18
Q

Name the defect:
Alveoli perfused, but O2 not delivered to alveoli – ie_____

A-a gradient?

A

Ventilation defect

atelectasis

increases

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19
Q

Name the defect:
Alveoli ventilated but no perfusion of the alveoli – i.e ______
A-a gradient?

A

Perfusion defect

pulm embolism

increases

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20
Q

Name the defect:
O2 cannot diffuse through alveolar-capillary interface – 3 examples?
A-a gradient?

A

Diffusion Defect

Interstitial fibrosis, pulm edema, pneumonia

increases

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21
Q

Name the defect:
Tetralogy of Fallot, Transposition of Great Vessels, Truncus Arteriosus
A-a gradient?

A

Right to Left Cardiac Shunts

increases

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22
Q

Name the defect:

barbiturates, brain injury

A-a gradient?

A

Depresion of medullary respiratory center

A-a gradient NL

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23
Q

Name the defect:
Epiglottitis, Croup, Laryngeal edema

A-a gradient?

A

Upper airway obstruction

A-a gradient NL

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24
Q

Name the defect:
Paralyzed diaphragm, ALS, spinal cord injury
A-a gradient?

A

Muscular dysfunction

A-a gradient NL

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25
Q

What is measured wABG?

Pulse Ox?

A

PaO2

SPO2

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26
Q

Sigmidal shape of Oxygen-Hemoglobin DIssociation curve, why?

A

with increasing
levels of PO2 that there will not be
a significant increase in the Hb
saturation.

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27
Q

What will shift the Oxygen-Hemoglobin DIssociation curve right.
what does it mean?

A 
an Increase in:
temp
PCO2
2,3 DPG
a decrease in:
pH

More offloading of O2 at tissues (less affinity to bind to Hgb)

28
Q

BETWEEN WHAT VALUES OF PaO2 IS
THERE A SAFETY MARGIN FOR %Hb
SATURATION?

BELOW ________ THERE IS A RAPID
FALL OFF OF Hb SATURATION

A

60-100 mmHg

60mmHg

29
Q

The Bohr Effect facilitates the binding of oxygen to hemoglobin in the _____ capillaries and releasing of oxygen in the ______capillaries

A

lung

tissues

30
Q

Haldane Effect: Facilitates the release of CO2 from RBCs in the _______

31
Q

T/F: In the placenta, oxygen will flow from the mother’s hemoglobin to the fetus’ hemoglobin

32
Q

T/F: Hemoglobin bound O2 does not contribute to partial pressure of blood.

33
Q

T/F: atmospheric pressure INCREASES with altitude

A

false. it drops

34
Q

T/F: As the atmospheric pressure drops with altitude, the partial pressure of inspired oxygen inspired will drop also

35
Q

The decrease in _______ ______is the basic cause of high-altitude hypoxia.

A

Barometric pressure

36
Q

Acclimatization can add _____-_____ more PAO2- partial pressure of ALVEOLAR air.

37
Q

Adaptation to low oxygen levels

A

Acclimatization

38
Q

pt 1. ACUTE ADAPTATION TO LOW O2:
With immediate exposure to low PO2, 1. ____receptors sense lower oxygen and 2. ___ RR and alveolar ventilation.
With this 3. ___ ventilation, 4. ______(respiratory or metabolic) 5.______ can occur. Initially, this will 6._______ the Central Medullary Chemoreceptors (Slide 114) counteracting the stimulus of low PO2.

A
  1. Chemo
  2. ↑
  3. ↑
  4. Respiratory
  5. alkalosis
  6. inhibit
39
Q

pt 2. ACUTE ADAPTATION TO LOW
O2
After several days, however,
the 1.____ of the 2.______ __________Chemoreceptors will 3. ______.
When this occurs, the peripheral and central 4. ___________stimulate the respiratory centers to 5. ________ventilation up to 5 times.

A
  1. inhibition
  2. central medullary
  3. ↓
  4. chemoreceptors
  5. ↑
40
Q

LONG TERM adaptation to low O2 is characterized by (8)

A

↑ in pulmonary ventilation
↑ in lung diffusion capacity (2/2 ↑ pulmonary capillary blood volume)
↑ lung volume
↑ pulmonary arterial pressure
↑ blood volume by 20-30%
↑ RBC production (rising hematocrit up to as high as 60)
↑ in systemic capillaries in Right Ventricular myocardium and skeletal muscles
↑ ability of tissue cells to use Oxygen.

41
Q

LONG TERM adaptations to low O2 can cause pulmonary artery pressure ↑, ie _______ _______

A

Pulmonary hypertension

42
Q

CYANOSIS

  1. The color is dependent on an ________quantity of deoxyhemoglobin. Seen more easily in patients with ____ _________count than in anemic pts.
  2. ____ _____can be associated with chronic cyanotic conditions.
A
  1. absolute, high hemoglobin

2. nail clubbing

43
Q

Combination of cyanosis and clubbing suggests ______ _______ _______ (R→L shunt) or chronic pulmonary disease.

A

congenital heart dz

44
Q

causes of central cyanosis

Central nervous system: (3
2/2 impaired ventilation/ventilatory drive)

A

Intracranial Hemorrhage
Drug overdose – heroin
Tonic-Clonic Seizure

45
Q

causes of central cyanosis

Respiratory System: (7
2/2 impaired O2 exchange)

A 
COPD/Emphysema
Pneumonia
Bronchospasm/Asthma
Bronchiolitis
Pulmonary Hypertension
Pulmonary Embolism
Hypoventilation
46
Q

causes of central cyanosis

  1. Cardiovascular Diseases:
  2. Heart Failure: Alveolar fluid impairs O2 exchange
A
  1. Congenital Heart Disease w/ R->L shunts:
    Tetralogy of Fallot,
    Transpostion of the Great Vessels,
    Truncus Arteriosus.
  2. Valvular Heart Disease
    Myocardial Infarction
47
Q

causes of central cyanosis

Blood – not caused by limited gas exchange: (3)

A
  1. Methemoglobinemia: Spurious cyanosis, can have normal arterial oxygen levels. Can be congenital or acquired with medications -
  2. Polycythemia:
  3. Congenital Cyanosis
48
Q

causes of central cyanosis

Others: (4)

A
  1. Altitude: Levels of > 8000 ft.
  2. High Altitude Pulmonary Edema
  3. Hypothermia
  4. Obstructive Sleep Apnea
49
Q

Causes of Central Cyanosis can cause peripheral cyanosis.

Peripheral cyanosis may be present in absence of central cyanosis.

causes: (8)

A 
Reduced Cardiac Output
Heart Failure
Hypovolemia
Cold Exposure
Arterial Obstruction 
Peripheral Vascular Disease – ASCVD
Raynaud Phenomenon
Venous Obstruction
50
Q

Carbon Dioxide is carried in the blood in three forms:

A

Carbon Dioxide
Carbonic Acid
Bicarbonate ion.

51
Q

Main mode of Carbon dioxide transport in the blood

A

bicarbonate buffer system (80+%).

52
Q

Equation of life

A

CO2 + H2O ↔ H2CO3↔ H2CO3- + H+

53
Q

where does carbonic anhydrase fit?

A

Co2+ H2O↔ H2CO3

54
Q

The bicarbonate ion is shifted out of the red blood cells by means of the __________

A

Chloride Shift.

55
Q

Where does BICARB hop onto the RBC and Cl leaves RBC to diffuse into plasma?

A

Alveolar level

56
Q

Where does BICARB hop OFF the RBC and Cl enters the RBC from the plasma?

A

Tissue level

57
Q

What are the four components to the control system

A

1) Chemoreceptors for Oxygen and Carbon Dioxide, PaO2 , PaCO2 , and arterial pH.
2) Mechanoreceptors in the lungs and joints (stretch)
3) Control Centers for breathing in the Brainstem – pons and medulla.
4) Respiratory muscles directed by brainstem centers.

58
Q

What is the rhythm generator for breathing?

A

Medullary Inspiratory center

brain stem

59
Q

What are the sensory inputs for the medullary inspiratory center

A

Glossopharyngeal & vagus Nerve

60
Q

What is the motor output for the medullary inspiratory center?

A

Phrenic nerve

61
Q

What is most important determinants of normal breathing and respond to changes in the pH of the CSF.

A

Central Medullary Chemoreceptors

62
Q

What is the most sensitive peripheral mechanism affecting breathing.

A

peripheral (aortic/carotid) chemoreceptors sensing a PaO2 <60mmHg

causes an increase in ventilation

63
Q

pons regulation of medulla

  1. ______ stimulates prolonged inspiration
  2. _______turns OFF inspiration
A
  1. apneustic ctr

2. Pneumotaxic ctr

64
Q

What are CENTRAL chemoreceptors sensitive to?

A

changes in the pH of the cerebral spinal fluid.

  1. decrease in the pH of the CSF stimulates hyperventilation
  2. Increases in the pH of the CSF produces hypoventilation
65
Q

Peripheral baroreceptors respond to _____

A

hypotension

66
Q

What are PERIPHERAL chemoreceptors sensitive to?

what are PERIPHERAL chemoreceptors MOST SENSITIVE to?

A 
low PO2 (<60 mm Hg)
 high PCO2 (MOST SENSITIVE)
low blood pH
67
Q

one cause of HA-> increased carbon dioxide in blood can cause ________.

A

Vasodilaion

Finals (24 decks)

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