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Apex > 1 Resp Physio > Flashcards

1 Resp Physio Flashcards

1
Q

Where dead space and respiratory zone begin/end

A

Dead space: nose/mouth to terminal bronchioles. Resp: resp bronchioles to alveoli

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2
Q

What makes up transpulmonary pressure

A

Alveolar pressure (pressure inside lungs) - intrapleural pressure (pressure outside of lungs)

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3
Q

During tidal breathing transpulm pressure is always ___. When intrapleural pressure becomes positive

A

Positive. Ptx or forced expiration, otherwise always negative

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4
Q

2 muscles that contract on inspiration

A

Diaphragm and ext intercostals

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5
Q

Muscles that contribute to active exhalation

A

TIRE: transverse abd, int oblique, rectus abd, ext oblique

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6
Q

Vital capacity req for an effective cough

A

15 ml/kg

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7
Q

Primary determinant of CO2 elimination

A

Alveolar ventilation

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8
Q

Dead space in avg pt, what increased Vd leads to

A

2 ml/kg, about 150 ml. Wides paco2-etco2 gradient and causes co2 retention

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9
Q

Minute ventilation: how to calculate, rough amount

A

TV X RR. 5LPM

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10
Q

Alveolar ventilation: what it measures, how to calculate, rough amt

A

Fraction of min vent that is available for gas exchange. (TV - dead space) x RR. 3.5LPM

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11
Q

Alveolar vent: ___ prop to CO2 produc and ___ prop to PaCO2

A

Directly to production, inversely to PaCO2

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12
Q

Anything that inc Vd/Vt ratio inc ___ __ and __ __. Most common cause under GA is what

A

Dead space, dec alveolar vent. Reduction in co

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13
Q

Causes of inc Vd:

A

Face mask, moisture exchanger, PPV, anticholinergics, old age, neck extension, dec CO or pulm bf, COPD, PE, sitting pos

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14
Q

Causes of dec Vd

A

ETT, LMA, Trach, neck flexion, supine or prone pos

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15
Q

Physiologic dead space can be calc w/___ eqn, eqn itself:

A

Bohr. (PaCo2- exhaled CO2) / paco2

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16
Q

In sitting position what things are higher in base than the apex

A

Partial pressure of alveolar CO2 and blood flow

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17
Q

In sitting position what is higher in apex than base

A

PA02 and V/Q ratio

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18
Q

The best ventilated alveoli are the most _____, which are at the ___ of the lung

A

Compliant, base

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19
Q

Perfusion is greatest at the base due to ____, ventilation is best at the ___ due to alveolar ___

A

Gravity, base, compliance

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20
Q

Non dependent lung: vent, perf, v/q, 02, co2, n2

A

Low, low, high, high, low, same

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21
Q

Dependent lung: vent, perf, v/q, 02, co2, n2

A

High, high, low, low, high, same

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22
Q

Vent perf mismatch: what happens in zone 1, blood passing underventilated alveoli does what, mismatch ____ the a-a gradient, and it minimizes ____

A

Bronchioles constrict to minimize it, retains CO2, increases, shunt

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23
Q

Atelectasis causes ___ to ___ shunt

A

Right to left

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24
Q

An alveolus can transfer more ___ than ____

A

More co2 than 02

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25
Q

With v/q mismatch the paco2 gradient becomes ___, the pa02 gradient becomes ___

A

Smaller, larger

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26
Q

When pneumocytes begin making surfactant, peak

A

22-26 weeks, peak 36 weeks

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27
Q

Each alveolus has ___ ___ of surfactant, larger vs smaller concentration

A

Same amount, larger has smaller concentration

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28
Q

Zone 1 is inc by what 3 things

A

Low bp, PE, or high a/w pressure

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29
Q

Sites of normal anatomic shunt: 3 , what this means

A

Thebesian veins (drain l heart), bronchiolar veins, pleural veins. Bypasses lungs and never gets 02

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30
Q

What zone 4 is

A

Pulmonary edema. Pa>Pist>Pv>PA. Fluid overload, mitral stenosis, laryngospasm, neg p pulm edema

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31
Q

Alveolar oxygen equation

A

Fio2 x (PB 760-Ph20 47) - PaCO2/RQ

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32
Q

What comprises the respiratory quotient, >1 means what, 0.7 means what

A

CO2 production / oxygen consumption. >1= lipogenesis. 0.7= lipolysis

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33
Q

Causes of hypoxemia with normal A-a gradient (2), can they be fixed with supplemental 02

A

Reduced fio2 and hypoventilation. Yes

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34
Q

Causes of hypoxemia w inc A-a gradient, can they be fixed with 02

A

Diffusion limitation (yes), v/q mismatch (yes), shunt (no)

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35
Q

Nml values: IRV, TV, ERV

A

3000, 500, 1100 (mls)

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36
Q

Nml value: RV, TLC, VC

A

1200, 5800, 4500 (mls)

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37
Q

Normals: IC, FRC

A

3500, 2300 mls

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38
Q

Tv ___ ml/kg, VC ___ ml/kg, FRC ___ ml/kg dosed on ___

A

7, 70, 35. IBW

39
Q

4 things that cant be measured with spirometry

A

CV, CC, TLC, FRC

40
Q

How peep restores FRC

A

Reducing zone 3 (when FRC is reduced, zone 3 increases)

41
Q

Things that decrease FRC

A

GA, obese, preg, neonates, adv age, supine, lithotomy, tberg, paralysis, light during anes, excessive IVF, high fio2, reduced pulm compliance in disease states (pulm edema, pulm fibrosis, acute lung injury, Etc)

42
Q

Things that increase FRC

A

Adv age, prone, sitting, lateral, obstructive lung disease, peep, sigh breaths

43
Q

Closing capacity= ___ + ____

A

Residual volume + closing volume

44
Q

Factors that inc closing volume

A

Close p: COPD, LV failure, obesity, supine, ext of age, preg

45
Q

By age 30 CC=FRC when, age 44 they’re equal when, 66 equal when

A

30= GA, 44= supine, 60= standing

46
Q

CaO2 calc

A

(1.34 x hgb x sao2) + (pao2 x 0.003)

47
Q

How to calc DO2, nml value

A

CaO2 x CO X 10. 1000 ml02/min

48
Q

VO2 eqn, nml values

A

CO X (CaO2 - cvo2). 3.5 ml/kg/min, roughly 250 ml/min

49
Q

Dec p50= ___ shift, inc p50= ___ shift

A

Dec= left. Inc= right

50
Q

Left shift occurs in ____, right shift occurs where.

A

Left= lungs, right= metabolically active tissue

51
Q

What is the Bohr effect

A

CO2 and h+ cause hgb to release 02

52
Q

____ inc 2,3 dpg. 2,3 dpg is a compensation mechanism in ___

A

Hypoxia. Anemia

53
Q

Hamburger shift

A

Cl transferred to RBC in exchange for HCO3 as buffer

54
Q

Venous CO2 and ph

A

5 higher than PaCO2, 7.36

55
Q

Methods of co2 transport, which most common

A

Bicarb (70%), bound to hgb (23%), dissolved in plasma (7%)

56
Q

CO2 solubility= ___ law

A

Henrys

57
Q

Haldane effect

A

CO2 carriage: 02 causes rbc to release co2

58
Q

Bohr effect

A

02 carriage: co2 and dec ph cause rbc to release 02

59
Q

C02 dissoc curve: when right v left means, how po2 relates

A

Left love right release. Lower po2= more co2 carried

60
Q

4 consequences of hypercarbia

A

Hypoxemia, inc myo 02 demand, hyperkalemia, dec 02 carrying capacity

61
Q

Paco2=

A

CO2 production / alveolar ventilation

62
Q

Causes of inc co2 production

A

Sepsis, overfeeding, MH, shivering, seizures, thyroid storm, burn

63
Q

Causes of dec co2 elim

A

A/w obstruct, inc dead space, ARDS, COPD, resp center depression, drug OD, inadequate NMB reversal

64
Q

Effects of hypercarbia

A

Hypoxemia, inc p50/right shift, myo depression, sns stim, oculocardiac, in k and ca and ICP, dep loc

65
Q

When co2 narcosis occurs

A

> 90 paco2

66
Q

Acute resp acidosis: paco2 and ph change

A

Inc 10mmhg, dec 0.08

67
Q

Chronic resp acidosis paco2 and ph change

A

Inc 10, dec 0.03

68
Q

When paco2 and min vent change in linear fashion

A

Paco2 20-80q

69
Q

When paco2 is a resp depressant

A

> 80-100

70
Q

Mac of co2

A

200

71
Q

Causes of L shift co2 response curve

A

PaO2 <60, metab acid, IC htn, fear, salicylates/aminophylline/doxapram/NE

72
Q

Causes of r shift co2 response curve

A

Metab alk, carotid endarterectomy, sleep, VA/Opioids/NMB

73
Q

What L v R shift CO2 response curve means

A

L: ve higher than expected for given co2. Resp alk. RL ve lower than given, resp acid

74
Q

L v R shift co2 response curve on apneic threshold

A

L = threshold dec, R: threshold inc

75
Q

Where pneumotaxic and apneustic centers are

A

Pons

76
Q

Where drg and vrg are

A

Medulla

77
Q

Dorsal resp center: where, func

A

Medulla/tractus solitarus. Insp pacer

78
Q

Ventral resp Central location and func

A

Medulla-tractus solitarus. Insp and exp- mainly exp when ve demand inc

79
Q

Pneumotaxic center: location and func

A

Upper pons, inhib DRC/triggers end insp. Strong stim= rapid shallow rr, weak= slow and deep

80
Q

Apneustic center: location and func , what is it inhibited by

A

Lower pons, stim DRC/causes insp. Inhib by pulm stretch receptors

81
Q

Which chemoreceptors respond to 02 vs co2

A

02= peripheral, CO2= central

82
Q

Most imp stim for central chemoreceptor, what it drives

A

H+ in the csf, DRC

83
Q

Window that hyperventilation effects bicarb

A

Few hours to 2 days

84
Q

Central chemo receptor is depressed by what

A

Profound hypercarbia and hypoxemia

85
Q

Peripheral chemoreceptors: location, what they dont respond To, 2ndary roles

A

Bifurcation of carotid artery. Dont:sa02 ca02. 2nd: pac02, h+, perfusion pressure monitoring

86
Q

What is hypoxic ventilatory response

A

02 <60 closes k channels in type 1 glomus cells, opens ca ch and inc NT release, AP along herrings nerve and CN 9, term in medulla = min vent inc

87
Q

What impairs hypoxic vent response

A

Carotid endarterectomy and 0.1 MAC of IA/TIVA

88
Q

2 conditions that dont impair hypoxic vent response

A

Anemia and CO poisoning

89
Q

Hearing Breuer inflation reflex

A

If inflation 1.5> FRC, reflex turns off the DRC and stops further inflation. Mediation by CN X and phrenic n

90
Q

Hearing Breuer deflation reflex

A

When lung vol too small helps prevent atelectasis by taking bigger breath

91
Q

J receptors: stim what, Activ by what

A

Stim tachypnea. Activ by PE/CHF

92
Q

Paradoxical reflex of head

A

Stim newborn to take first breath

93
Q

HPV: stim by what, impaired by what

A

Reduction in ALVEOLAR (not arterial) 02 tension. MAC VA >1.5, vasodilators, pde inhib, dobutamine, CCB, phenylephrine, epi, dopamine

94
Q

What may increased HPV shunt

A

Hypervolemia/LAP >25 and elev CO

Apex (21 decks)

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