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80 Cards in this Set
- Front
- Back
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increased pulmonary vascular resistance
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decreased oxygen
increased carbon dioxide decreased pH symp. stimulation Epi, NE, and alpha adrenergic agonists Angiotensin II Thromboxane endothelin |
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decreased Pulmonary vascular resistance
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parasymp. stim and Ach
beta-2 agonists NO bradykinin PGI2 endothelin antagonists |
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decrease lung volume below FRC
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increase PVR by increasing compression of extraalveolar vessels
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lung volume > FRC
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increase PVR due to increased resistance in the pulmonary capillaries
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increased PAP, PBF, pulmonary blood volume, or LAP
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decrease pulmonary vascular resistance
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decreased PAP, PBF, pulmonary blood volume, or LAP
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increased PVR
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positive pressure effects on PVR and PAP
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increases both due to compression of alveolar vessels
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"zone 1 conditions"
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no perfusion of non-dependent lung regions
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V/Q in the apex
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V > Q
alveoli hyperinflated higher oxygen lower CO2 |
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V/Q at base
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V/Q decreased
alveoli hypoinflated lower O2 higher CO2 |
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100 mmHg O2
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hb 97% sat
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40 mmHg O2
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hb 75% sat
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27 mmHg O2
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P50 for O2 sat
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shift curve to right
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increased blood temp
decreased pH increased CO2 and DPG Hb variants with increased P50 |
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shift curve to left
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hypothermia
increased pH decreased CO2 and DPG fetal Hb Hb variants with decreased P50 Carbon monoxide |
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hypoxia
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decrease O2 levels at the tissues
hypoxemia, anemia, stagnant, and histotoxic |
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cyanide poisoning can cause
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histotoxic hypoxia
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classification of hypoxemia
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low alveolar PO2
diffusion impairment V/Q mismatch R-L shunting |
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V/Q = infinity
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ventilation but no perfusion, alveoli have same PO2 and PCO2 as humidified inspired air
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V/Q=0
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perfusion but no ventilation, alveoli have same PO2 and PCO2 values as that entering pulmonary capillaries
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Atelectasis, pneumonia, pulmonary edema, airway obstruction, and pneumothorax can cause
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R-L shunting
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causes of respiratory acidosis
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airway obstruction
chest wall restriction respiratory center depression neuromuscular disorders affecting respiration |
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causes of respiratory alkalosis
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resp. center stimulation- CNS, drugs/hormones (aspirin, progesterone, hyperthyroidism), and reflex
iatrogenic mech. overventilation liver failure |
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causes of metabolic alkalosis
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loss of hydrogen ions
antacids IV bicarb |
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Cushing's, hyperaldosteronism, and renal artery stenosis can cause
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metabolic alkalosis
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licorice and chewing tobacco ingestion
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metabolic alkalosis
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Bartter's, Liddle's, and Gitelman's syndromes
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metabolic alkalosis
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normal anion gap
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12 with range 8-16
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Normal anion gap M acidosis
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hyperchloremic MA
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elevated anion gap
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normochloremic MA
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causes of hyperchloremic metabolic acidosis
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diarrheal loss of HCO3
renal loss of HCO3 dilutional acidosis hyperalimentation |
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normochloremic metabolic acidosis causes
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lactic and ketoacidosis
toxic substances (aspirin, paraldehyde, methanol, and anti-freeze) renal failure |
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normal bicarb range
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22-26
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normal CO2 range
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35-45
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medullary respiratory center
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DRG
VRG Respiratory pattern generator |
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respiratory pattern generator
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pacemaker cells of pre-botzinger complex of VRG
site of generation of respiratory drive |
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Dorsal respiratory group
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inspiratory motor neurons of NTS
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Ventral respiratory group
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inspiratory and expiratory motor neurons
drives IC, abdominal, laryngeal, and pharyneal mm. |
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pontine respiratory centers
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apneustic center
pneumotaxic center |
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apneustic cetner
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caudal pons
promotes inspiration |
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pneumotaxic center = pontine respiratory groups
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rostral pons
inhibits inspiration allowing normal rate and depth of breathing |
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afferent pathway of carotid bodies
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CN IX
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afferent pw of aortic bodies
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CN X
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not stimulated by decreased PO2
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central chemoreceptors which are exposed to CSF
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provides most of ventilatory drive
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effects of CO2 on central CRs
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main stimulus for breathing in chronic hypoventilation
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decreased PO2
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patients with chronic hypercapnea should be treated with
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<40% O2
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metabolic acidosis stimulates
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carotid bodies leading to hyperventilation
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Hering-Breuer inflation reflex
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lung inflation stimulates pulmonary stretch receptors which act to terminate inspiration and decrease RR
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hering-breuer deflation reflex
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lung deflation causes tachypnea
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J-receptors
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stimulated by increased volume or pressures in the pulmonary vessels or interstitial space
cause tachypnea |
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muscle spindle reflex
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increase tidal volume by increase resp. mm. contraction when compliance is decreased
Afferent PW: spinal |
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joint proprioceptors
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Afferent PW: spinal reflex
movement of joint increases rate and depth of breathing |
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somatic pain elicits
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tachypnea
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deep visceral pain elicits
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brief periods of apnea
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Apnea
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cessation of breathing at end-expiration
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apneustic breathing
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cessation of breathing at end-inspiration
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caused by loss of inhibitory input from the pneumotaxic center of the rostral pons
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apneustic breathing
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Cheyne-stokes breathing
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C-D breathing interrupted by periods of apnea
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kussmaul breathing
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very deep, gasp-like breathing that is labored and irregular
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diabetic ketoacidosis
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kussmaul breathing
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Ondine's curse
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central hypoventilation
loss of autonomic control of breathing |
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Pulmonary edema caused by
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increased Pc
decreased cap. oncotic P increased cap. perm decreased interstitial pressure lymphatic obstruction head injury heroin overdose |
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consequences of pulmonary edema
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perfusion but no ventilation
decreased lung compliance increased airway resistance |
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PAWP estimates
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preload of LV
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normal PAWP
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<12 mmHg
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increased PAWP indicates
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LV failure
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hypoxic pulmonary vasoconstriction
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decreases blood flow to hypoventilated areas shifting it to better ventilated areas
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Cor pulmonale may result from
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hypoxic pulmonary VC
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restrictive diseases
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decreased compliance
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obstructive lung diseases
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increased compliance and airway resistance
decreased FEV1/FVC |
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types of restrictive diseases
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intrapulmonic- fibrosis, edema, pneumonia
extrapulmonic- kyphosis, rib fractures, pneumothorax, pleural effusion abdominal- surgery, ascites, pickwickian NM defects- guillian-barre, myasthenia, tetanus Resp. center depression- drugs, central sleep apnea |
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types of obstructive diseases
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bronchitis
emphysema asthma CF bronchiectasis |
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FVC, FEV1, and FEV1/FVC should all be
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atleast 80% of predicted
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serum anion gap
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[Na+] - [Cl-] - [HCO3-]
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Urinary anion gap
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[Na+] + [K+] - [Cl-]
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hyperchloremic acidosis usually comes down to
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renal tubular acidosis vs. diarrheal losses of HCO3
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metabolic acidosis can cause
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arrhythmias and increased neuromuscular irritability
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hypotension, pulmonary edema, and v-fib may be signs of
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metabolic acidosis
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triple acid-base disturbance
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combo of metabolic acidosis and alkalosis with either a respiratory acidosis or alkalosis
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