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JKC Med Phys Spring '24 > Respiratory- Part 2 > Flashcards

Respiratory- Part 2 Flashcards

1
Q

What are the two reasons that blood will never be at 100% O2 saturation? What system is this associated with?

A

amixture of deoxy and oxygenated blood

Ventilation Perfusion mismatch

High pressure/Low flow- 120/80

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2
Q

Describe the Low Pressure/ High flow circulation. Where does it empty?

A

Right side of the heart, very thin, does not pump under very high pressure- 25/8

All of the blood needs to go to the lungs to get oxy aka HIGH FLOW

5000ml of blood

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3
Q

Describe the High pressure/Low flow circulation

A

Straight out of the aorta, going to tissues of the lungs, supplies lungs with nutrition, empties into the left atrium, 2% of cardiac output, amixture of deoxy and oxygenated blood

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4
Q

What does FEV1 demonstrate?

A

the amount of air that a person can exhale in the first second of exhalation. Measured in Liters a second

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5
Q

What is used to determine if a person has an obstructive lung disease? What would it look like?

A

Looking at their FEV1- (think flow)

The amount of air expelled would decrease

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6
Q

What is restrictive lung disease?

A

the inability of the alveoli in the lungs to expand

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7
Q

What does forced vital capacity (FVC) measure?

A

The total amount of air (think volume)

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8
Q

**A person with restrictive lung disease, what test do you look at?

A

Forced vital capacity (volume)

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9
Q

**Of the air you are breathing in, you should get ____% out in the first second- (This is a magic number)

How is this number calculated? - Need the formula

A

80%

FEV1/FVC * 100

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10
Q

What are the common types COPD. Are these problems with (inhalation/exhalation)?

A

Asthma, bronchitis and emphysema

Exhalation

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11
Q

Vocal cord disfunction and laryngeal spasms are problems with (inhalation/exhalation)?

A

inhalation

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12
Q

How do blood gases travel in the body?

A

through simple diffusion

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13
Q

What are the two blood gases?

A

Oxygen and CO2

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14
Q

Does Oxygen or CO2 diffuse faster through the bilipid layer?

A

CO2

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15
Q

Name some factors that determine how fast things cross the bilipid layer?

A

-Solubility of the gas
-Cross sectional area of the fluid
- Distance through which the gas must diffuse
- molecular weight
- Temperature

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16
Q

***For a patient that has fibrosis (increased thickness in the alveolar membrane) will FEV1 or FVC be negatively impacted?

A

FVC, because the thickness of the membrane makes it harder for the alveolar to expand, forced vital capacity

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17
Q

Name some factors that affect the rate of gas diffusion through the respiratory membrane

A

-thickness of the membrane
- surface area of the membrane
- diffusion coefficient of the gas
- partial pressure difference

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18
Q

Describe some things that are associated with emphysema. What enzyme can cause it?

A

-patients have decreased surface area but the alveoli in the lungs coalesce into one big ball instead of a cluster of grapes

-Elastase

-hard to exhale due to collapsed terminal airways

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19
Q

Give 2 reasons why the partial pressure can change

A

high altitude

supplemental oxygen

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20
Q

***____% of oxygen in the atmostphere

A

20.93%

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21
Q

What % is Nitrogen in the atmosphere?

A

79.03%

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22
Q

What percent is CO2 in the atmosphere?

A

0.04% CO2

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23
Q

Define partial pressure

A

the pressure exerted by any 1 gas in a gas mixture

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24
Q

At higher altitudes is there (more/less) pressure?

A

LESS pressure

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25
Q

What is the partial pressure of Oxygen

A

159mmHg

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26
Q

What is the partial pressure of nitrogen

A

600mmHg

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27
Q

What is the partial pressure of Carbon Dioxide?

A

1mmHg

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28
Q

Be able to draw this picture

A

memorize and be able to draw this picture

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29
Q

When the V/Q is normal, How much are you breathing?

A

Breathing just enough to keep the partial pressure of oxygen at 100

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30
Q

Is it more important to keep the Oxygen or CO2 at its normal level in the blood.

A

Keeping the CO2 @ 40 is more important than keeping the Oxygen @100

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31
Q

In a physiologic shunt, what happens to the VA/Q ratio?

A

VA/Q ratio is BELOW normal

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32
Q

The bottom part of the lung (less/more) ventilated

A

Less ventilated

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33
Q

Physiological shunt is due to….

A
  • poor ventilation
  • does not fully oxygenate the blood flowing through the alveolar capillaries
  • some venous blood passes to the pulmonary capillaries that are NOT oxygenated
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34
Q

In a physiologic dead space, what happens to the VA/Q ratio?

A

The VA/Q is GREATER than normal

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35
Q

Physiologic shunt is due to poor (ventilation or perfusion). Name some examples. What does it do to the ratio?

A

Poor ventilation but there is adequate blood flow

COPD
Emphysema- sometimes caused by smoking

V/Q ratio decreases

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36
Q

Physiological dead space is due to poor (ventilation or perfusion). Name some examples. What does it do to the ratio?

A

Poor perfusion

In areas of the lung where alveolar walls have been destroyed but some ventilation is occurring

High V/Q ratio

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37
Q

What is wasteful breathing?

A

having to breath lots of air to get rid of the CO2

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38
Q

The ideal lung has ????

A

lowest alveolar ventilation for a given VCO2

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39
Q

At rest, what the physiological dead space is about _____ of the tidal volume

A

1/3

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40
Q

During exercise, what the physiological dead space is about _____ of the tidal volume

A

1/5

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41
Q

What is the normal A-a difference?

A

normal is 5-10mmHg

42
Q

What does “A” stand for?

A

A= Alveoli

43
Q

What does “a” stand for?

A

a= arterial

44
Q

If there is a problem with the alveoli/lung tissue, what happens to the A to a difference?

A

difference will be large

45
Q

Name some things that cause inefficient breathing?

A

Kyphosis
Brain not telling your muscles to breathe

46
Q

**In order for 1 Liter of CO2 to be expelled, you need ____ liters of air

A

25 Liters of air

47
Q

What does it tell you if it takes a patient MORE than 25 Liters of air to exhale 1 liter of CO2

A

That their breathing is inefficient

48
Q

What two things is hemoglobin made from? What does it form?

A

Succinyl-CoA and glycine

Pyrrol molecule

49
Q

4 Pyrrols molecules combine to form ____

A

Protoporphyrin

50
Q

Protoporphyrin combines with iron to form _____

A

Heme molecules

51
Q

The heme component has how many types? Name them

A

2

Alpha and Beta

52
Q

When hemoglobin changes shape, what does this affect? What is another name for it.

A

Changes its ability to hold on to and/or let oxygen go

Affinity for oxygen

53
Q

How many oxygens does it take to saturate a hemoglobin?

A

4

54
Q

What is shunt blood?

A

Blood that went by the alveoli but did NOT get oxygenated

55
Q

Oxygen dissociation curve: What does 20% Volumes represent

A

The amount of oxygen that can be carried for every 100mL of blood

Oxygen carrying capacity

Oxygen content of the arterial blood

56
Q

Oxygen dissociation curve: What is the constant associated with ____mL/Hb

A

1.34

57
Q

What does the a-VO2 difference represent?

A

The amount of oxygen extracted by the tissues

58
Q

What is the a-VO2 difference for skeletal tissues?

A

5mL for every 100mL of blood

59
Q

At the tissues, would you want a low or high oxygen affinity? Why.

A

low oxygen affinity because you want oxygen to be released into the tissues

60
Q

At the lung, would you want a low or high oxygen affinity? Why.

A

high affinity

61
Q

If the partial pressure decreases, what happens to the affinity?

A

the affinity decreases aka oxygen gets released easier

62
Q

What does the steep part of the oxygen dissociation curve represent?

A

tissues are releasing more and more oxygen until the partial pressure increases

63
Q

What 4 things can cause the oxygen dissociation curve to shift to the RIGHT:

A
  1. Increase in hydrogen ions (becoming more acidic)
  2. Increase CO2
  3. Increase in temperature
  4. Increased BPG
64
Q

What does BPG promote?

A

hemoglobin transition from a high-oxygen-affinity state to a low-oxygen-affinity state

65
Q

Give me an example of the Oxy Dissociation curve shifting to the right?

Left?

A

Exercising - shifts right

High altitude- shifts left

66
Q

Be able to draw this curve, including being able to label everything

A

DO NOT FORGET, be able to draw and label this

67
Q

**Anemic patient, would it affect the total oxygen carrying content of the blood or blood oxygen saturation? or both?

A

Anemic patient have less total number of RBC but the RBC they do have are completely saturated. Total oxygen carrying content would be less

68
Q

___% of CO2 is transported by the same hemoglobin units that transport oxygen

A

23%

69
Q

Once the oxygen has been dumped off hemoglobin, there is (more/less) affinity for CO2

A

More, the affinity for CO2 increases once oxygen has been dumped

70
Q

CO2 has the ability to float around where? What is this expressing?

A

in your plasma

the partial pressure

71
Q

What is the main way CO2 is transported?

A

in the form of bicarbonate in the plasma

72
Q

What enzyme is responsible for combining CO2 and water. What does it form?

A

Carbonic anhydrase

Carbonic acid :H2CO3

73
Q

Carbonic acid naturally wants to separate into what 2 things

A

Bicarb (HCO3) and H Ion

74
Q

What happens when the bicarb leaves the RBC? What is it called?

A

bicarb leaves the RBC and goes into the plasma and Cl goes in

Chloride shift

75
Q

How did the CO2 get transported to the lungs?

A

as plasma bicarbonate

76
Q

KNOW THIS EQUATION. If you take something away from the left side of the equation, what direction will it shift? How?

A

To the left, by breathing it out

77
Q

To get the equation to go right, what do you add?

A

Tissues add CO2

78
Q

To get the equation to go left, what do you need to do?

A

Lungs needs to blow off CO2

79
Q

**Diabetic patient, that could not use carbs and was blowing off fats at way too high of a rate what would their body be producing?

A

Ketones, ketone acidosis

80
Q

Ketone acidosis ____ H+ ions

A

liberates

81
Q

What does lactic acid do in terms of this equation?

A

Lactic acid liberates H+ ions, adding H+ would shift the equation to the left, creates more water and CO2 which would increase your breathing in order to expel the increase in CO2

82
Q

What is Dr. Sheppard’s rule about CO2

A

treat CO2 as if it was acid

83
Q

How much hydrogen ion is in your body?

A

VERY SMALL 0.00004 mEq/L

84
Q

How is H+ regulated in your body?

A

very precisely by lots of enzymes

85
Q

What 3 organ systems help regulate pH

A
  1. Kidneys
  2. Lungs
  3. Breathing
86
Q

If HCO3 increases what 2 things happen

A
  • pH will rise
  • shift the acid-base balance towards alkalosis
87
Q

HCO3 is mainly regulated by what organ?

A

Kidneys

88
Q

PCO2 is mainly controlled by ______

A

rate of respiration

89
Q

An increase in HCO3 will cause (Acidosis/Alkalosis)

A

Alkalosis- becoming more basic

90
Q

An decrease in HCO3 will cause (Acidosis/Alkalosis)

A

Acidosis- becoming more acidic

91
Q

An increase in PCO2 will cause (Acidosis/Alkalosis)

A

Acidosis

92
Q

An decrease in PCO2 will cause (Acidosis/Alkalosis)

A

Alkalosis

93
Q

**If there is a problem with metabolism, clinically you should look at (HCO3/PCO2)

A

HCO3

94
Q

**If there is a problem with respiration, clinically you should look at (HCO3/PCO2)

A

PCO2

95
Q

If in respiratory alkalosis/acidosis, ____ will make the adjustment

A

Kidneys

96
Q

If you are having metabolic reason for acid/base mismatch, ____ will make the adjustment

A

Lungs

97
Q

Give some clinical causes of acid-base disorders

A

-brain damage that effects the respiratory system
-decrease in the lungs ability to eliminate CO2 due to COPD, Pneumonia, Emphysema

98
Q

Name 2 causes of respiratory alkalosis

A

-High altitude
-Psychoneurosis (hyperventilating due to anxiety)

99
Q

_____ is the most likely cause of metabolic acidosis

A

diarrhea

100
Q

Name some causes of metabolic alkalosis

A

-Diuretics
-Excess aldosterone
-Vomiting (due to loss of HCL-stomach acid)
-Ingestion of alkaline drugs (Sodium bicarb and treatment of gastritis or peptic ulcers)

JKC Med Phys Spring '24 (18 decks)

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