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88 Cards in this Set

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What is the tidal volume, and what's its normal value?
Tidal volume is the amount of inspired air with a normal breath. It's normally 500-600 mL.
What is the inspiratory reserve volume, and what's its normal value?
Inspiratory reserve volume is the maximal amount of air that can be inspired after a normal inspiration. It's normally 2500 mL.
What is the expiratory reserve volume, and what's its normal value?
Expiratory reserve volume is the maximal amount of air that can be expired after a normal expiration. It's normally 1000 mL.
What is the residual volume?
Residual volume is the amount of air remaining in the lung after maximal expiration.
What is the vital capacity?
Vital capacity is the maximum amount of air that can be moved voluntarily.
What is the total lung capacity?
Total lung capacity is the total air content of the lung after maximal inspiration.
What is the inspiratory capacity?
Inspiratory capacity is the amount of air that can be inspired after a normal expiration.
What is the functional residual capacity?
Functional residual capacity is the amount of air remaining in the lung after a normal expiration.
What is the forced expiratory capacity (forced vital capacity, FVC)?
Forced expiratory capacity (FVC) is the amount of air that can be expired after a maximum inspiration.
What is the forced expiratory volume (FEV1)?
Forced expiratory volume (FEV1) is the volume of air that can be expired within one second after a maximum inspiration.
What is the Tiffeneau index?
Tiffeneau index is the FEV1/VC ratio. It shows whether the decrease in FEV1 and VC is proportional. Used to differentiate obstructive and restrictive disorders.
What is the forced inspiratory volume?
Forced inspiratory volume is the volume of air that can be inspired within one second after a maximum expiration.
What is the peak expiratory flow?
Peak expiratory flow is the maximum flow speed of air on exhalation.
What is the normal value for airway resistance?
Airway resistance is normally below 0.3 kPa/L/s
What is the normal value for lung compliance?
Lung compliance is normally 2 L/kPa.
What can cause restrictive lung disorders?

Restrictive lung disorders can be caused by:




- Inflammation


- Pneumonia


- Heart failure


- Atelectasis


- Occlusion of alveoli


- Pulmonary fibrosis


- Kyphoscoliosis

Which lung parameters will change in restrictive lung disorders, and how will they change?

In restrictive lung disorders will we see the following changes:




- VC ↓


- TLC ↓


- RV ↓


- FRC ↓


- FVC ↓


- FEV1 ↓


- Tiffeneau index is normal or elevated

What can cause obstructive lung disorders?

Obstructive lung disorders can be caused by:




- Swelling of bronchial mucosa (chronic bronchitis)


- Spasm of bronchial smooth muscles (asthma)


- Enhanced secretion of mucus


- Collapse of alveoli (emphysema)

Which lung parameters will change in asthma and chronic bronchitis, and how will they change?

In asthma and chronic bronchitis will we see the following changes:




- FEV1 ↓


- FRC ↑


- Tiffeneau index ↓


- Airway resistance ↑

Which lung parameters will change in emphysema, and how will they change?

In emphysema will we see the following changes:




- FEV1 ↓


- Tiffeneau index ↓


- FVC ↓


- FRC ↑


- Diffusion capacity ↓

In physiological condition, the partial pressure of which gas controls ventilation?
In physiological condition does the pCO2 control ventilation.
In what condition will the partial pressure of oxygen control ventilation?
pO2 will control ventilation when there is hypocapnia.
What causes CO2-narcosis?

Patients with chronic hypercapnia have decreased CO2-sensitivity in the respiratory centre. Their breathing is driven by pO2 instead of pCO2. If they receive oxygen therapy, their low pO2 will increase and become normal.




However, now that pO2 is normal is there nothing that drives the respiratory centre! Ventilation will slow down so a severe hypercapnia develops, causing narcosis or coma.

What characterizes Cheyne-Stokes breathing?

In Cheyne-Stokes breathing does this breathing pattern occur:




Hyperpnoea - hypopnoea - apnoea - hyperpnoea - hypopnoea - apnoea - and so on

What can cause Cheyne-Stokes breathing?

Cheyne-Stokes breathing can occur in:




- Sleeping neonates


- High altitude


- Congestive heart failure

What characterizes Biot breathing?
In Biot breathing is both frequency and depth of breathing chaotic.
What can cause Biot breathing?
Biot breathing is usually seen in premortal patients.
What characterizes Kussmaul breathing?
In Kussmaul breathing is there hyperpnoea. Breaths are very deep.
What can cause Kussmaul breathing?
Kussmaul breathing is caused by acidosis, often by ketoacidosis in diabetes.
What is the most common cause of obstructive sleep apnoea?
The most common cause of obstructive sleep apnoea is low muscle tone in the pharynx and soft palate.
What are the consequences of sleep apnoea syndrome?

The consequences of sleep apnoea syndrome are:




- Daytime fatigue


- Global respiratory failure


- Catecholamine surge during apnoeic periods -> can cause acute coronary syndrome

What is the normal compliance of the lung?
The normal compliance of the lung is above 2 L/kPa
Which part of the lung has the highest compliance?
The base of the lung has the highest compliance, while the apex has the lowest.
What is the normal value of airway resistance?
The normal value of airway resistance is <0.3 kPa/L/s
Which respiratory frequency and minute ventilation together give the lowest work of breathing?
A respiratory frequency of 14/min and minute ventilation of 500 mL gives the lowest work of breathing.
Which diseases can increase the elastic resistance in the lung?

The following (and more) diseases can increase the elastic resistance of the lung:




- Pneumonia


- Granulomatoses


- Fibrosis


- Respiratory distress syndrome


- Pneumothorax


- Pulmonary oedema


- Pulmonary congestion

Which diseases can disrupt the movement of respiration?

These diseases (and more) can disrupt the movement of respiration:




- Kyphoscoliosis


- Ankylosing spondylitis


- Myasthenia gravis


- Pickwick syndrome (obesity)


- Guillain-Barré syndrome

Which diseases can abnormally decrease the elastic resistance of the lung?
Emphysema is the only disease where the elastic resistance of the lung is severely decreased.
What is the diagnostic criterium for alveolar hypoventilation?
The definition of alveolar hypoventilation states that the arterial pCO2 must be above 44 mmHg.
What can be the consequence of primary alveolar hypoventilation?
Primary alveolar hypoventilation worsens the respiratory symptoms of chronic bronchitis and obesity.
What is the main consequence of alveolar hypoventilation?
The main consequence of alveolar hypoventilation is global respiratory failure.
What are the diagnostic criteria for alveolar hyperventilation?

The diagnostic criteria for alveolar hyperventilation are:




- Alveolar ventilation exceeds the actual need


- Arterial pCO2 < 36 mmHg

What are the consequences of alveolar hyperventilation?

The consequences of alveolar hyperventilation are:




- Hypocapnia -> cerebral vasoconstriction -> syncope


- Respiratory alkalosis


- Serum Ca2+ decreases -> tetanus


- Extracellular K+ decreases -> Arrhytmia


- O2-saturation curve of haemoglobin is left-shifted -> tissue oxygenation is reduced

Which diseases can decrease the V/Q ratio?

The following diseases can decrease the V/Q ratio:




- Chronic bronchitis


- Atelectasis


- Bronchial obstruction


- Asthma


- Hepatopulmonary syndrome


- Pulmonary oedema



Which diseases can increase the V/Q ratio?

The following diseases can increase the V/Q ratio:




- Emphysema


- Pulmonary embolism

What are the consequences of V/Q mismatching?


Early V/Q mismatching will cause partial respiratory failure while severe V/Q mismatching will cause global respiratory failure.
What is the normal pressure difference of oxygen across the diffusion membrane?
The normal pressure difference of oxygen across the diffusion membrane is 60 mmHg.
What is the normal pressure difference of carbon dioxide across the diffusion membrane?
The normal pressure difference of carbon dioxide across the diffusion membrane is 6 mmHg.
What is the normal contact time (diffusion time) in rest?
The normal contact time in rest is 0.75 seconds.
What is the normal contact time in exercise?
The normal contact time in exercise is 0.25 seconds.
What are the common symptoms in hepatopulmonary syndrome?

The common symptoms in hepatopulmonary syndrome are:




- Platypnoea


- Orthodeoxia

What is the normal value of ΔA-VO2?
The normal value of ΔA-VO2 is 5 mL or 5%.
What is the normal alveolar pO2?
The normal alveolar pO2 is 100 mmHg.
What is the normal arterial pO2?
The normal arterial pO2 is 96 - 100 mmHg.
What is the normal pO2 in the tissues?
The normal pO2 in the tissues is 40 mmHg.
What is the normal pO2 in mixed venous blood?
The normal pO2 in mixed venous blood is 40 mmHg.
What is the normal pCO2 in alveoli?
The normal pCO2 in alveoli is 40 mmHg.
What is the normal pCO2 in arterial blood?
The normal pCO2 in arterial blood is 40 mmHg.
What is the normal pCO2 in the tissues?
The normal pCO2 in the tissues is 46 mmHg.
What is the normal pCO2 in mixed venous blood?
The normal pCO2 in mixed venous blood is 46 mmHg.
Which factors can cause left-shift of the haemoglobin-oxygen dissociation curve, and are they decreased or increased?

The following factors cause left-shift of the haemoglobin-oxygen dissociation curve:




- Decreased pCO2


- Decreased [H+] (alkalosis)


- Decreased 2,3-DPG


- Decreased temperature

Which factors can cause left-shift of the haemoglobin-oxygen dissociation curve, and are they decreased or increased?

The following factors cause right-shift of the haemoglobin-oxygen dissociation curve:




- Increased pCO2


- Increased [H+] (alkalosis)


- Increased 2,3-DPG


- Increased temperature

Which abnormal haemoglobin types cause left-shift of the haemoglobin-oxygen dissociation curve?

These abnormal haemoglobin types cause left-shift of the haemoglobin-oxygen dissociation curve:




- Hb Rainier


- Hb Barts


- Hb H


- Carboxygaemoglobin


- Methaemoglobin


- Foetal Hb

Which abnormal haemoglobin types cause right-shift of the haemoglobin-oxygen dissociation curve?

These abnormal haemoglobin types cause right-shift of the haemoglobin-oxygen dissociation curve:




- Hb Kansas


- Hb Seattle


- Hb S (sickle cell disease)

What are the characteristics of hypoxaemic hypoxia?
Hypoxaemic hypoxia occurs in tissues when the blood has low pO2 (hypoxaemia).
What can cause hypoxaemic hypoxia?

The following can cause hypoxaemic hypoxia:




- High altitude


- Alveolar hypoventilation


- V/Q mismatch


- Right-to-left shunt

What are the characteristics of ischaemic (stagnation) hypoxia?
When hypoxia is caused by too little or too slow blood flow will we have ischaemic or stagnation hypoxia.
What can cause ischaemic (stagnation) hypoxia?

Ischaemic hypoxia can be caused by:




- Circulatory shock


- Severe heart failure


- Congenital heart formation (blue baby syndrome)


- Cold environment


- Venous thrombosis


- Arterial obstruction

What are the characteristics of anaemic hypoxia?
In anaemic hypoxia the pO2 is normal but the haemoglobin content is low, so total arterial O2 content is low.
What can cause anaemic hypoxia?

Anaemic hypoxia can be caused by:




- Anaemias


- Iron-deficiency


- Folate or B12-deficiency


- Aplastic anaemia


- Haemolytic anaemias


- Methaemoglobinaemia


- Abnormal haemoglobins


- CO poisoning

What are the characteristics of histotoxic (cytotoxic) hypoxia?
In histotoxic hypoxia is the haemoglobin and oxygen content of the blood normal but the tissues can't utilize O2.
What can cause histotoxic (cytotoxic) anaemia?

Histotoxic hypoxia can be caused by:




- Cyanide poisoning


- Uraemia

Which types of hypoxia can cause cyanosis, and which cannot?

Cyanosis can occur in:




- Hypoxaemic hypoxia


- Ischaemic hypoxia




Cyanosis can not occur in:




- Histotoxic hypoxia


- Anaemic hypoxia

What are the three diagnostic criteria of COPD?

The three diagnostic criteria of COPD are:




- FEV1 < 80% of predicted


- Tiffeneau index < 70%


- Less than 12% amelioration of symptomps upon bronchodilator treatment

What characterizes chronic bronchitis?

Chronic bronchitis is characterized by:




- Increased bronchial secretion


- Chronic cough


- Enhanced sputum production

What are the causes of chronic bronchitis?


The causes of chronic bronchitis are:




- Smoking (90% of cases)


- Occupational dust exposure


- α1 antitrypsin deficiency


- Air pollution


- Blood group "A"


- Vitamin C deficiency


- Alcoholism

What are the pathomechanism for developing chronic bronchitis due to smoking?

The pathomechanism for developing chronic bronchitis due to smoking is as follows:




- Mucociliary clearence is paralyzed


- Neutrophil inflammation of the airways


- Hyperplasia of goblet cells


- Mucosa metaplasia


- Lys-oxidase is inhibited

What is the cause for centrilobular emphysema?

The cause for centrilobular emphysema is smoking.

What is the cause for panlobular emphysema?
The cause for panlobular emphysema is α1 antitrypsin deficiency.
What are the characteristics of bronchial asthma?
Bronchial asthma is characterized by episodes of paroxysmal bronchospasm including dyspnoea with wheezing.
Which cytokines and white blood cells are involved in bronchial asthma?
IL-4, IL-5, Th-2, APCs, B-cells and mast cells are involved in bronchial asthma.
What causes the bronchospasm in asthmatic attacks?
The cause of bronchospasms in asthmatic attacks is degranulation of mast cells where leukotrienes are released.
What is the definition of partial (type I) respiratory failure?

The definition of partial (type I) respiratory failure is:




- Arterial pO2 < 60 mmHg


- Normal pCO2

What can cause partial respiratory failure?
The following can cause partial respiratory failure:

- Mild or moderate V/Q mismatching


- Pneumothorax


- Disorders of alveolo-capillary diffusion


- Fibrosis


- Pulmonary oedema


- Emphysema


- Pneumonia

What is the definition of global (type II) respiratory failure?

The definition of global (type II) respiratory failure is:


- Arterial pO2 < 60 mmHg


- Arterial pCO2 > 50 mmHg

What can cause chronic global respiratory failure?

The following can cause global respiratory failure:




- Alveolar hyperventilation


- Sleep apnoea syndrome


- COPD


- Pickwick syndrome (obesity)


- Kyphoscoliosis

What are the consequences of global respiratory failure?

The consequences of global respiratory failure are:




pO2 low:


-> pulmonary vasoconstriction -> pulmonary hypertension -> cor pulmonale chronicum


-> erythropoietin increases -> polycythaemia -> blood viscocity increases -> blood pressure increases




pCO2 high:


-> systemic vasoconstriction -> blood pressure increases


-> cerebral vasodilation -> intracranial pressure increases -> cushing reflex -> blood pressure increases and bradycardia


-> CO2 sensitivity of respiratory centre decreases -> insufficienct response to hypercapnia -> ventilation is driven by hypoxia


-> Respiratory acidosis


-> Systemic vasoconstriction -> blood pressure increases


-> Myocardial contractility decreases -> heart failure


-> Capillary permeability increases -> pulmpnary oedema

What is the pathomechanism of dyspnoea (in simple terms)?

Dyspnoea develops when there is a mismatch between how ventilation should be and how ventilation currently is.




The brain compares afferent and efferent signals and if they mismatch will the sensation of dyspnoea develop.