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35 Cards in this Set

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What are causes of decreased PaO2 (hypoxemia) that have a normal A-a gradient?
High altitude (because barometric pressure is reduced so that PAO2 will decrease according to the alveolar gas equation), hypoventilation (barbiturates, CNS injury- alveolar ventilation is inversely proportional)
What are causes of decreased PaO2 (hypoxemia) that have an increased A-a gradient?
V/Q mismatch (most lung diseases such as asthma, pneumonia, pulmonary edema), diffusion limitation (interstitial fibrosis), Right-to-left shunt (ASD, pulmonary AVM)
What are caused of decreased O2 to tissue (hypoxia)?
Decreased cardiac output, hypoxemia, anemia (decreases oxygen CONTENT of blood even though PaO2 is normal- because Hb is decreased and most oxygen is bound to Hb), cyanide poisoning (Irreversibly inactivates mitochondrial enzymes so that ox-phos is stopped and the oxygen is not utilized), CO poisoning (decreases Hb saturation)
What are causes of ischemia (decreased blood flow)?
Impeded arterial flow (arterial occlusion), reduced venous drainage, hypotension
What is the V/Q ratio at the apex of the lung?
3 (wasted ventilation because perfusion is decreased)
PA > Pa > Pv
What is the V/Q ratio at the base of the lung?
0.6 (wasted perfusion because ventilation is decreased). However, both ventilation and perfusion are increased at the base of the lung compared to the apex.
Pa > Pv > PA
What is the V/Q ratio of a shunt?
V/Q = 0 because there is an airway obstruction. 100% O2 will not improve the PO2
What is the V/Q ratio of a blood flow obstruction?
V/Q approaches infinity because there is no flow. This is what happens with a PE. If there is < 100% dead space, 100% O2 will improve the PO2
How far do pseudostratified ciliated columnar cells extend?
To the respiratory bronchioles
How far do the goblet cells extend?
Bronchi
Where would an object go if aspirated while upright?
Lower portion of right inferior lobe
Where would an object go if aspirated while supine?
Superior portion of right inferior lobe
What is the relationship of the pulmonary artery to the bronchus at each lung?
Right- Anterior
Left- Superior

RALS
What is collapsing pressure?
Collapsing pressure = 2(surface tension)/radius

surfactant decreases surface tension
What is dead space
VD = VT (PaCO2 - PeCO2)/PaCO2; the apex of the lung is the largest contributor to dead space because volume of inspired air in that does not take part in gas exchange.
What DECREASES compliance?
Pulmonary fibrosis, pulmonary edema, insufficient surfactant
What shifts the hemoglobin dissociation curve to the RIGHT?
INCREASE:
Cl-, H+, CO2, 2,3BPG, temperature, high altitude, increased metabolic needs
What shifts the hemoglobin dissociation curve to the LEFT?
Decreased:
Metabolic needs, CO2, temperature, H+, 2,3DPG, Fetal Hb, carboxyhemoglobin (CO)
What is diffusion?
Diffusion = Area/Thickness x Dk(P1-P2)

A decreases in emphysema
T increases in fibrosis
What does BMPR2 do?
Inhibits vascular smooth muscle proliferation- mutated in primary pulmonary hypertension
What PFTs are seen in obstructive lung disease?
markedly decreased FEV1, decreased FVC, decreased FEV1/FVC (hallmark), V/Q mismatch, increased RV
What is the Reid index?
gland depth/total thickness of bronchial wall
Asthma findings
Pulsus paradoxus, decreased I/E ratio
What PFTs are found in restrictive lung disease?
Decreased everything, FEV/FVC > 80%. There is increased expiratory flow rate because of increased elastic recoil pressure and increased radial traction on the conducting airways by the fibrotic pulmonary interstitium.
What physical findings are found in bronchial obstruction?
Decreased/absent breath sounds over lesion, decreased resonance, decreased fremitus, trachea deviates TOWARD lesion
What physical findings are seen in pleural effusion?
Decreased breath sounds over the effusion, dullness, decreased fremitus
What physical findings are seen in lobar pneumonia?
Bronchial sounds over the lesion, dullness, INCREASED fremitus
What physical findings are seen in tension pneumothorax?
Decreased breath sounds, HYPERRESONANT, absent fremitus, trachea deviates AWAY from lesion
What are the airway, alveolar, and intrapleural pressures at FRC?
Airway and alveolar = 0
Intrapleural - negative to prevent pneumothorax
What are causes of secondary pulmonary hypertension?
Mitral stenosis (increased resistance and pressure), recurrent thrombemboli (decreased cross-sectional area of pulmonary vascular bed), autoimmune disease (systemic sclerosis; inflammation leading to intimal fibrosis and medial hypertrophy), L-R shunt (shear stress), sleep apnea, high altitude (hypoxic vasoconstriction)
When does arterial PO2 decrease?
In chronic lung disease because the physiologic shunt decreases the oxygen extraction ratio?
What determines oxygen delivery to tissues?
CO x (oxygen content of blood)
What is a complication of bronchiectasis?
Aspergilliosis- allergic bronchopulmonary aspergillus infection
What does asbestosis look like?
Ivory white calcified pleural plaques; affects LOWER lobes
What are causes of decreased lung compliance?
Pulmonary fibrosis, pulmonary edema, insufficient surfactant