Pulmonology Lect 1

Front 1

what makes up the respiratory airways?

Back 1

Resp Bronchioles
Alveolar ducts and sacs

Front 2

how many segments are in the Right and Left lungs?

Back 2

R-10
L-8

Front 3

what are the contents of the superior mediastinum?

Back 3

brachiocephalic veins
branches from the aortic arch
trachea
esophagus

Front 4

when does pleurisy develop?

Back 4

Atelectasis
Infection

Front 5

what is tidal volume?

Back 5

Is the volume of air inspired or expired with each normal breath

Air exchange is approx. 500ml

Front 6

what is Inspiratory Reserve Volume (IRV)?

Back 6

Is the extra volume of air that can be inspired over and above the normal tidal volume(ie. taking a deep breath just before you go underwater)

It is approx 3000ml

Front 7

what is Expiratory Reserve Volume (ERV)

Back 7

Is the extra amount of air that can be expired by forceful expiration after the end of a normal tidal expiration

Is approx 1100mL

Front 8

what is the Residual Volume (RV)

Back 8

Is the volume of air remaining in the lungs after the most forceful expiration

The air that you can not get out of your lungs
Gets bigger as you get older
This is approx 1200mL

Front 9

what is the Inspiratory Capacity

Back 9

This equals the tidal volume (TV) + Inspiratory reserve volume (IRV)
This is the amount of air a person can breathe beginning at the normal expiratory level and distending the lungs to the maximum amount
IC=TV+IRV

Front 10

what is the Functional Residual Capacity (FRC)

Back 10

Expiratory reserve volume (ERV) + Residual Volume (RV)
This is the amount of air that remains in the lungs at the end of a normal expiration
This is the volume of air in lungs before you start a new breath
resting state: FRC normally < 50% of Total Lung Capacity (TLC)
FRC=ERV+RV

Front 11

what is the Total Lung Capacity (TLC)

Back 11

Is the maximum volume to which the lungs can be expanded with the greatest possible inspiratory effort
Approx 5800mL
TLC=VC+RV

Front 12

what is the Vital Capacity (VC)

Back 12

Is the inspiratory reserve volume (IRV) + the tidal volume (TV) + Expiratory reserve volume (ERV)

It is the total lung capacity (TLC) – the residual volume (RV)
This is the maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent

This is approx. b/t 3700-4600mL

Front 13

what is Forced Expiratory Volume in one second (FEV1)

Back 13

Deep breath, expire as hard and as fast as you can, the amount expired in 1 second is the FEV1
This is approx. 75-80% of the volume capacity

Front 14

what is the most sensitive indicator of diseased state?

Back 14

FEV1

Front 15

what is the Intrapleural Pressure (PPL)compared to the atmospheric pressure?

Back 15

Intrapleural Pressure (PPL)is lower than atmospheric (756 mm or -5 cm H2O vs atmospheric)

Front 16

what is PA & Pa?

Back 16

PA= intra-alveolar
Pa= intra-arteriolar

Front 17

what is compliance?

Back 17

the ease with which volume can be changed

C = change V /change P

Front 18

Babies <37 weeks gestation can suffer from?

Back 18

Respiratory Distress Syndrome (hyaline membrane disease)

Lack of surfactanct

Front 19

Name the 3 forms of CO2 transport in blood

Back 19

10% dissolved
30% bound to hemoglobin
60% as bicarbonate

Front 20

what enzyme catalyzes the conversion of CO2 and H2O into H+ and HCO3-?

Back 20

carbonic anhydase in RBC's

Front 21

what controls the fine tuning pattern of breathing?

Back 21

Medulla oblongata

If medulla is damaged, Kusmaul's, chain stokes and other irregular breathing patterns can happen

Front 22

where are the respiratory sensors found?

Back 22

Central
peripheral
chest wall
intrapulmonary

Front 23

where is oxygen monitored?

Back 23

carotid and aortic bodies

Front 24

what is the normal PaO2? (arterial)

Back 24

75-100 mmHg (altitude <3000 ft)

Front 25

what test is used to test for carbon monoxide poisoning?

Back 25

Carboxyhemoglobin test

Front 26

what is the main respiratory regulator?

Back 26

Carbon dioxide

Front 27

what is the normal CO2 level?

Back 27

40

Front 28

At what levels of PCO2 do you start seeing CNS depression?

Back 28

PCO2 above 70 - 80 mm depresses CNS; could cause acidosis

Front 29

what happens if you give high O2 to COPD or Emphysema pts?

Back 29

Pt will stop breathing; respiratory drive diminishes because their breathing drive depends on low O2 levels

Front 30

The corotid bodies are activated by?

Back 30

hypoxia
Low BP

Front 31

What are the normal ABG values?

Back 31

PO2 = 90 mm/Hg
PCO2 = 40 mm/Hg
pH = 7.40
Bicarb = 24

Front 32

oxygen saturation of 90% is approx what PO2?

Back 32

60 PO2

Front 33

Ventilation – perfusion mismatch can cause these conditions

Back 33

COPD
Atelectasis
Pneumonia
Pulmonary edema
Pulmonary fibrosis
Asbestosis

Front 34

What pulmonary disease states can cause hypocapnia?

Back 34

Sepsis
pulmonary embolus
pulmonary insufficiency

Front 35

Causes of hypoventilation which can lead to Resp Acidosis?

Back 35

1.Depression of resp center: CNS disorders, drugs, head trauma
2.Interruption of ventilatory motor nerves & muscles:Myasthenia gravis, drugs (muscle relaxants), severe kyphosis or scoliosis, severe arthritis (decreased ability to expand and contract intercostals)
3. Abnormal Lung Mechanism:
Pleural effusion, pneumonia, pulmonary fibrosis, pneumothorax, cancer, foreign body obstruction

Front 36

In acid/base, if you have a respiratory pt what 2 values do you look at? (ie COPD pt)

Back 36

pH and CO2

Front 37

In acid/base, if you have a metabolic pt what 2 values do you look at?

Back 37

pH and HCO3

Front 38

what happens during respiratory compensation?

Back 38

CO2 is either blown off or held depending on wether you're acidotic or alkolotic to try to get back to 7.4

Front 39

what happens first, respiratory or metabolic compensation?

Back 39

Respiratory(within the first couple of days)

Front 40

what are the causes of metabolic acidosis?

Back 40

Uncontrolled DM – ketoacidosis
ASA (aspirin) overdose
Renal failure – produces inadequate H+ excretion
Profuse diarrhea (unretractable)

Front 41

Causes of metabolic alkalosis

Back 41

Vomiting
NG suctioning
Diuretic overdose
Too much bicarbonate

Front 42

How does hypercapnia and respiratory acidosis occur?

Back 42

when impairment in ventilation occurs and the removal of CO2 by the lungs is less than the production of CO2 in the tissues

ie. asthma, COPD, hypoventilation

Front 43

what are the causes of high anion gap(metabolic acidosis)?

Back 43

MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, isoniazid (INH)
Lactic acid
Ethanol, ethylene glycol
Salicylates

Front 44

How does increasing the CO2 affect the oxyhemoglobin dissociation curve?

Back 44

There is a Left shift which increases O2 affinity

Front 45

What factors will decrease O2 affinity causing a Right shift in the curve?

Back 45

Fever
> in PCO2
2,3-DPG
< pH

Front 46

T/F Inspired gas will tend to ventilate the bases more than the apices in the upright individual

Back 46

TRUE

If not standing, ventilation will be greatest at the apices