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Cardiopulmonary A & P > Chap 11, 18, 19, and 20 > Flashcards

Chap 11, 18, 19, and 20 Flashcards

1
Q

The growth and development of the lungs is essentially complete by about what age

A

20 years of age

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2
Q

Most of the pulmonary function indices reach their maximum levels between

A

20 and 25 years of age and then progressively decline

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3
Q

Functional residual capacity

A

is the volume remaining in the lungs when the elastic recoil of the lungs exactly balances the natural tendency of the chest wall to expand

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4
Q

What decreases with aging causing what to increase

A

The elastic recoil of the lungs, causing the compliance to increase. Illustrated as a shift to the left of the volume pressure curve

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5
Q

The decrease in lung elasticity develops because what

A

the alveoli progressively deteriorate and enlarge

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6
Q

What age do the alveoli progressively deterioate and enlarge at

A

after age 30

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7
Q

Senile emphysema or senile hyperinflation of the lungs

A

Structurally, the alveolar changes resemple the air sav changes associated with emphysema

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8
Q

What happens to the costal cartilages with aging

A

progressively calcify, causing the ribs to slant downward, and this structural change causes the thorax to become less compliant, causing the transpulmonary pressure difference

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9
Q

Transpulmonary pressure difference is responsible for

A

holding the airway open- diminished with age

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10
Q

which is greater the reduction in chest wall compliance or the increase in lung compliance

A

Reduction in chest wall compliance is slightly greater than the increase inlung compliance, resulting in an overall moderate decline in total compliance of the respiratory system

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11
Q

Work expendicture of a 60 yr old to overcome static mechanical forces during normal breathing is how much greater than in a 20 year old

A

20 percent greater

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12
Q

What essentially remains the same throughout the life retaining to the lungs

A

Total lung capacity (TLC), if it shall decrease it is prob due to the decreased height that typically occurs with age

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13
Q

Residual volume with age

A

increases, due to age related alveolar enlargement and to small airway closure

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14
Q

as the RV increases, what also increases

A

RV/ TLC ratio

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15
Q

RV/TLC ratio increases from approx what at age 20 to what at age 60

A

20 percent at age 20, to 35% at age 60, increase occurs predominantly at after age 40

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16
Q

What decreases as the RV increases

A

Expiratory reserve volume (ERV). FRC increases with age as well, just not as much as RV and RV/TLC

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17
Q

Because the FRC typically increases with age, the what decreases

A

Inspiratory capacity (IC)

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18
Q

Vital capacity is equal to what

A

TLC minus the RV

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19
Q

VC inevitably decreases as the what increases

A

RV

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20
Q

In men the VC decreases how much per year

A

25mL, and 20mL/year in women.

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21
Q

In general, the VC decreases about what percent by age 70

A

40-50 percent

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22
Q

one of the most prominent physiologic changes associated with age is

A

the reduced efficiency in forced air expulsion

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23
Q

Estimated that these dynamic lung functions decrease approx

A

20-30 percent throughout the average adults life

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24
Q

FEV in men/ women and age

A

decreases about 30 mL/ year in men, and about 20mL/ year in women after about age 20. Debatable why

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25
Q

Pulmonary Diffusion Capacity

A

Progressively decreases after about 20 years of age. About 20% over the course of an adult life. (2ml/min/mm Hg in men and 1.5mL/min/mm Hg in women)

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26
Q

Decline results from pulmonary diffusion capacity

A

from decreased alveolar surface area caused by alveolar destruction, increased alveolar wall thickness, and decreased pulmonary capillary blood flow, all of which are known to occur with aging

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27
Q

Alveolar Dead Space Ventilation

A

increases with advancing age. due to decreased cardiac index associated with aging and the structural alterations of the pulmonary capilaries that occur as a result of normal alveolar deterioration

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28
Q

Natural loss of lung elasticity results in

A

an increase in lung compliance, which in turn leads to an increase in dead space ventilation. Estimated that the alveolar dead space vent increases about 1mL/ year throughout adult life

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29
Q

Pulmonary Gas Exchange

A

The alveolar arterial oxygen tension difference P(A-a)O2 prog increases with age. Factors include Physiologic shunt, the mismatching of ventilation and perfusion, and a decreased diffusion capacity

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30
Q

In normal adult,the PaO2

A

should be greater than 90 torr up to 45 years of age

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31
Q

after 45 years of age the PaO2

A

generally declines between age 45 and 75, then often increases slightly and levels off

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32
Q

Minimum low PaO2 should be

A

greater than 75 torr- regardless of age

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33
Q

PaCO2

A

remains constant throughout life- greater diffusion ability of CO2 through the alveolar-capillary barrier. Then the pH and HCO3 remains constant as well

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34
Q

Maximum arterial venous oxygen content difference C(a-V)O2 / factors

A

tends to decrease with age. Contributory factors include 1. Decline in physical fitness 2. less efficient peripheral blood distribution and 3. reduction in tissue enzyme activity

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35
Q

Anemia

A

common finding in the elderly. red bone marrow has a tendency to be replaced by fatty marrow, especially in the long bones.

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36
Q

Gastrointestinal atrophy

A

commonly associated with advancing age may slow the absorption of iron or vitamin B. bleeding is also more prevelant in the elderly

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37
Q

Control of ventilation with age

A

Ventilatory rate and heart rate responses to hypoxia and hypercapnia diminish with age. Due to a reduced sensitivity and responsivenessof the peripheral and central chemoreceptors and the slowing of central nervous system pathways with age

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38
Q

Neural output

A

slowed with age to respiratory muscles and the lower chest wall and reduces lung mechanical efficiency

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39
Q

Ventilatory response to hypoxia is decreased

A

more than 50% in the healthy male over 65 years of age

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40
Q

The ventilatory response to hypercapnia

A

is decreased by more than 40%

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41
Q

Defense mechanisms

A

Rate of Mucocilliary transport system declines with age.. decreased cough reflex is more than 70 % of the elderly population

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42
Q

Example of defense mechanisms disease

A

Dysphagia (impaired esophageal motility) increases the risk for aspiration and pneumonia

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43
Q

What limits exercise in elderly

A

Oxygen transport system is critically dependent on the cardiovascular system than on respiratory function

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44
Q

The maximum O2 uptake peaks at

A

age 20 and progressively and linearly decreases with age

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45
Q

Major causes of death in the aging population are

A

diseases of the cardiovascular system

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46
Q

between 30 and 80 years of age, the thickness of the left ventricular wall increases by about what

A

25 percent

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47
Q

Heart with age

A

Fibrosis, CT increases, less elastic, compliance of heart is reduced, pumps less efficiency, heart valves thicken

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48
Q

Maximum heart rate equation

A

Max heart rate= 220 - age

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49
Q

Stroke volume

A

diminishes with age

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50
Q

Cardiac Output

A

As stroke volume diminishes, the cardiac output inevitable declines (CO= SV x HR)

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51
Q

As the cardiac output declines what also decreases

A

Cardiac index

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52
Q

As an individual ages the

a. Residual volume decreases
b. Exp Reserve volume increases
c. fuctional residual capacity decreases
d. vital capacity decreases

A

D. Vital Capacity Decreases

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53
Q

Most of the lung fuction indices reach their maximum levels between

A

20-25 years of age

54
Q

With advancing age, the

  1. Lung Compliance decreases
  2. chest wall compliance increases
  3. lung compliance increases
  4. Chest wall compliance decreases
A
  1. lung compliance increases and 4. chest wall compliance decreases
55
Q

As an individual ages the

  1. forced vital capacity increases
  2. peak expiratory flow rate decreases
  3. forced expiratory volume in 1 sec increases
  4. maximum voluntary ventilation increases
A
  1. Peak expiratory flow rate decreases
56
Q

With advancing age, the

A

PaO2 decreases, C(a-V)O2 decreases

57
Q

Maximum HR of a 45 year old is

A

175 beats/min

58
Q

Over the course of life, the diffusion capacity decreases by about

A

20 percent

59
Q

Between 30 and 80 years of age, the cardiac output decreases by about

A

40 percent

60
Q

With advancing age the

  1. BP increases
  2. SV decreases
  3. CO increases
  4. Heart work decreases
A

BP increases, SV decreases, Heart work decreases

61
Q

Between 20 and 60 years of age, the RV/TLC

A

increases from 20 to 35 percent

62
Q

During Exercise

A

Ventilation may increase as much as 20-fold, oxygen diffusion capacity as much as 3- fold, CO as much as 6-fold, muscle blood flow as much as 25- fold, O2 consumption as much as 20 fold and heat prod as much as 20 fold

63
Q

Muscle training can increase muscle size and stregnth

A

30-60 %

64
Q

Athletes heart chambers and mass

A

increased by 40%

65
Q

Anaerobic threshold

A

point at which anaerobic metabolism develops

66
Q

During normal quiet breathing, an adult exchanges about how many L of gas per minute

A

6

67
Q

During strenuous exercise adult exchanges about how much gas per minute

A

Can increase to 120 L/min

68
Q

Why must alveolar ventilation increase

A
  1. supply sufficient O2 to the blood 2. eliminate the excess CO2 prod by the skeletal muscles
69
Q

During very heavy exercise Vt and RR

A

Vt 60% of the vital capacity, and RR may be as high as 30 bpm

70
Q

Three distinct consecutive breathing patters are seen during mild and moderate exercise.

A

First stage, second stage, and third stage

71
Q

first stage

A

characterized by an increase in alveolar ventilation within seconds after the onset of exercise

72
Q

Second stage

A

slow, gradual further increase in alveolar vent developing during approx the first 3 min of exercise

73
Q

Third stage

A

final stage, alveolar ventilation stabilizes

74
Q

Normal Oxygen consumption at rest ml

A

250 mL/min, the skeletal muscles account for approx 35-40 %

75
Q

Oxygen consumption during exercise ml

A

3500 ml/min

76
Q

Mean alveolar - arterial oxygen tension difference of about 10 torr because of

A
  1. mismatching of ventilation and perfusion and 2. right to left pulmonary shunting of blood
77
Q

During exercise three essential physiologic responses must occur in order for the circulatory system to supply the working muscles with good amount of blood

A
  1. sympathetic discharge 2. increase in CO 3. increase in arterial blood pressure
78
Q

Increase O2 demands during exercise are met almost entirely by what

A

an increased CO

79
Q

The increased CO during exercise results from

A
  1. increased SV 2. increased HR 3. combination of both
80
Q

Greater the vasodilation in the working muscles

A

the greater the stroke volume and cardiac output (sympathetic discharge)

81
Q

Increased sympathetic stimulation causes

A
  1. increased HR 2. increased strength of contraction
82
Q

There is an increase in arterial blood pressure during exercise because of

A
  1. Sympathetic discharge 2. increased CO 3. Vasoconstriction of the blood vessels in the nonworking muscle areas
83
Q

at rest how much of the muscle capillaries are dilated

A

approx 20-25 %

84
Q

Heat stroke

A

As much as 5 to 10 pounds of body fluid lost in 1 hour.

85
Q

During strenuous exercise, an adults alveolar ventilation can increase

A

20 fold

86
Q

The maximum alveolar ventilation generated during heavy exercise under normal conditions is about what percent of the max voluntary ventilation

A

50-65 %

87
Q

During heavy exercise, the total cardiac output may increase as much as

A

8 fold

88
Q

At the onset of exercise sympathetic discharge causes the

A

Peripheral vascular system to constrict, heart to increase its stregnth of contraction, blood vessels of the working muscles to dilate

89
Q

During exercise, the SV reaches its peak when the CO is at about what percent of its maximum

A

50%

90
Q

During exercise, heat production may increase as much as

A

20 fold

91
Q

During exercise the oxygen consumption of the skeletal muscles may account for more than

A

95% of the total VO2

92
Q

During very heavy exercise, the

A

PaCO2 decreases, PaO2 remains constant, and pH decreases

93
Q

during maximum exercise, the O2 diffusion capacity may increase as much as

A

3 fold

94
Q

During exercise the P(A-a)O2 begins to increase when the oxygen consumption reaches about what percent of its max

A

40 %

95
Q

Peripheral chemoreceptors

A

when PaO2 falls low enough (to about 60torr) to stimulate the carotid and aortic bodies, kown as peripheral chemoreceptors. Which transmit signals to the medulla to increase ventilation

96
Q

Hypoxic Ventilator response

A

when the medulla is signaled to increase ventilation

97
Q

The barometric pressure is about half the sea level value of 760 torr at an altitude of

A

18,000 -19,000 ft

98
Q

The O2 diffusion capacity of high altitude natives is about

A

20-25 percent greater than predicted

99
Q

Acute mountain sickness is characterized by

A

sleep disorders, headache, dizziness, palpitation, loss of appetite

100
Q

The symptoms of acute mountain sickness are generally most severe on the

A

second or third day after ascent

101
Q

When an individual is subjected to a high altitude for a prolonged period of time which of the following is seen

A

An increased RBC production, A decreased PaCO2, an Increased P(A-a)O2

102
Q

At high altitude the overal ventilation perfusion ratio improves T/F

A

true

103
Q

In individuals who have acclimatized to a high altitude, an increased CO is seen T/F

A

false

104
Q

Theres a linear relationship between the degree of ascent and the degree of pulmonary vasoconstriction and hypertension T/F

A

True

105
Q

Natives who have been at high altitudes for generations commonly demonstrate a mild resp alk

A

True

106
Q

The concentration of myoglobin in skeletal muscles is decreased in high altitude natives

A

False

107
Q

At what depth below the water surface does the pressure increase to 3.0 atm

A

99 ft

108
Q

If an indiv fully inhales to a TLC of 4.5 L at sea level (760 mmHg) and dives to a depth of 66 feet, the lungs will be compressed to about

A

1.5 L

109
Q

Diving reflex consists of

A

Decreased CO, bradycardia, peripheral vasoconstriction

110
Q

The half life of Carboxyhemoglobin when a victim is breathing RA at 1atm is approx

A

5 hours

111
Q

Hyperventilation prior to a breath hold dive can be dangerous T/F

A

true

112
Q

the fall in PAO2 as a diver returns to the surface is known as the hypoxia of ascent T/F

A

true

113
Q

chest pain and coughing caused by decompression sickness is known as the bends T/F

A

false

114
Q

the so called PCO2 resp drive breaking poing during a dive is about 55 torr T/F

A

true

115
Q

approx 0.3 mL of O2 is physically dissolved in each 100 ml of blood for every PaO2 increase of 100 torr T/F

A

truee

116
Q

Circulation during exercise

A

blood flow to the muscles increase, length and intensity of exercsie is limited , at the onset of exercise there is a sympathetic discharge, increase HR and strength of contraction, peripheral blood vessels contrict except for the muscles that are working which dilate

117
Q

Increase in CO demands met entirely by

A

Blood pressure

118
Q

Pulmonary vascular resistance goes down

A

dilates vascular bed and improves blood flow

119
Q

Systemic vascular resistance goes down

A

peripheral constriction is less than the dilation of the muscles so the net is a decrease in SVR

120
Q

Pulmonary rehab

A

works with patients to improve cardovascular exercise tolerance (phase 1: info gather, 2: Educate and exercise 3: output pt)

121
Q

Chronic oxygen deprivation from high altitude is similar to

A

chronic hypoxemia from lung disease

122
Q

barometric pressure goes which way as you go up

A

goes down as you go up

123
Q

if you go from one level to another you

A

acclimate

124
Q

acute mnt sickness starts after

A

6-12 hours, lasts 2-3 days, usually acclimated by 4th day

125
Q

Example of high altitude pulmonary edema

A

CHF

126
Q

Increase altitude=

A

Polycythemia, larger lung volumes or capacities

127
Q

low oxygen=

A

hypoxic environment

128
Q

if you hit anaerobic threshold

A

the minute ventilation climes more due to lactic acid which can be counteracted by a decrease in PaCO2

129
Q

Lactic acid causes an increase in

A

pH and PaCO2

130
Q

high altitude pulmonary edema

A

tachypnea, tachycardia, crackles in lung base (fluid). Pink frothy sputum, from increased PVR due to hypoxia and or increased permeability of membranes

131
Q

Increased CO due to low oxygen

A

Increased PVR due to low oxygen causing vasocontriction of pulmonary vessels

Cardiopulmonary A & P (5 decks)

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