Exam II Flashcards
(121 cards)
1
Q
what two components make up VO2?
A
(1) Q (cardiac output)
2) a-vO2 difference (amount of O2 utilized
2
Q
how many lobes does the right lung have?
A
3
3
Q
how many lobes does the left lung have?
A
2
4
Q
what is anatomical dead space?
A
any space in the respiratory system that doesn’t reach the alveoli
5
Q
what is physiologic dead space?
A
portion of the alveolar volume with poor ventilation/perfusion ratio
6
Q
what direction is it often the easiest to access the lungs for tubes and other things?
A
lateral sides of the lungs
7
Q
what is ventilation?
A
air flow in and out due to a pressure gradient (flows from high pressure to low pressure)
8
Q
what is Boyle’s Law?
A
pressure is inversely proportional to volume
9
Q
what are the inspiratory muscles involved with ventilation?
A
(1) diaphragm
(2) external intercostals
(3) scalenes (as breathing becomes labored scalenes will elevate the ribs)
10
Q
what are the muscles involved with expiration at rest?
A
passively
11
Q
what are the muscles involved with expiration at during exercise?
A
(1) abdominals (push diaphragm up)
2) internal intercostals (pull ribs down
12
Q
why is being slumped over a more difficult position to expand the lungs and breathe?
A
(1) decreases space in the thoracic area
2) increases the pressure (more difficult to get air in
13
Q
what is a pneuomothorax? what effect does it have on the lungs?
A
(1) presence of air / gas in the pleural cavity
(2) effects the volume pressure gradient of the lungs and can cause a collapsed lung
14
Q
what MOI may cause a pneumothorax?
A
(1) MVA (can cause broken ribs which puncture the lungs)
(2) CPR
(3) test tubes placement
15
Q
what are some s/s of a pneuomothroax?
A
(1) SOB / difficulty breathing
(2) tracheal deviation
16
Q
what areas of the brain control depth and rate of breathing?
A
Pons and Medulla
17
Q
what are the 3 components of the respiratory center in the brain?
A
(1) medullary rhythmicity area
(2) pneumotaxic area
(3) apneustic area
18
Q
what is the medullary rhythmicity area responsible for?
A
maintains the rhythm of inspiration and expiration (autonomous like the SA node)
19
Q
what is the pneumotaxic area area responsible for?
A
(1) continuous inhibitory impulses to the inspiratory neurons
(2) stimulates expiration (prevents lungs from filling too much)
20
Q
what is the apneustic area responsible for?
A
(1) sends impulses to the inspiratory area
(2) stimulates inspiration
21
Q
which system always overrides the other, the pneumotaxic or apneustic system? why?
A
(1) pneumotaxic always overrides the apneustic
(2) this is so you don’t over inflate and explode your lungs
22
Q
chemically, how does the body sense a need to increase inspiration or expiration?
A
(1) CO2 levels
(2) pH levels
23
Q
what is the bicarbonate equation?
A
H20 (+) CO2 >< H2CO3 >< H+ (+) HCO3
24
Q
what occurs when there is a build up of CO2 in the body?
A
respiratory acidosis
25
what occurs when there is a build up of H+ and bicarbonate in the body?
metabolic acidosis
26
what is an increased level of CO2 within the blood called?
hypercapnia
27
what is a decreased level of CO2 within the blood called?
hypocapnia
28
what is stimulated when hypercapnia occurs within the body?
(1) apneustic stimulation (causing increased breathing)
| (2) example: holding breath causes buildup of CO2, and when you breathe again CO2 is equalized
29
what is stimulated when hypocapnia occurs within the body?
(1) inspiration is not stimulated
| (2) example: hyperventilation causes decreased CO2; response is to take more time between breaths
30
what is the Hering Breuer Reflex? how does it occur?
(1) prevents over inflation of the lungs due to stretch receptors in the lungs
(2) stretch of the lungs causes vagus nerve stimulation, which inhibits apneustic area allowing pneumotaxic area to dominate causing expiration
31
why does an increased temperature increase respiration rate?
attempting to lose body heat (ex. a dog panting when they're hot)
32
why does decreased temperature decrease respiration rate?
in an attempt to conserve body heat
33
how does sympathetic stimulation affect respiration?
increases respiratory rate
34
how does blood pressure affect respiration rate?
(1) increased BP = decreased respiration
| (2) decreased BP = increased respiration
35
what is tidal volume?
amount of air moved in / out with each breath
36
what is inspiratory reserve?
amount of air inspired above tidal volume
37
what is expiratory reserve?
amount of air expired below tidal volume
38
what is residual volume?
remaining air in the lungs once you've blown all the air out
39
what is vital capacity?
max amount of air expired after max inhalation (inspiratory reserve volume + tidal volume + expiratory reserve volume)
40
what is total lung capacity?
total volume the lungs can hold (vital capacity + residual volume)
41
what is functional residual capacity?
expiratory reserve volume + residual volume
42
what is inspiratory capacity?
tidal volume + inspiratory reserve volume
43
what is FEV1?
(1) forced expiratory volume (1 second)
| (2) the amount of air you can expire in one second
44
what is restrictive lung disease?
can't get air in their lung
45
what is obstructive lung disease?
can't exhale air
46
what is a normal FEV1?
80-85% of air
47
what is the GOLD classification scale for COPD?
```
All are FEV1 Scores
Gold 1 (Mild): >= 80% predicted
Gold 2 (Moderate): 50-80%
Gold 3 (Severe): <50%
Gold 4 (Very Severe): <30%
```
48
with obstructive lung diseases, how is residual volume affected?
very large residual volumes (can't exhale so the RV increases)
49
physiologically what happens with obstructive diseases such as COPD and emphysema?
(1) alveoli lose their ability to recoil
| (2) mucus in bronchial trees cause inflammation, decreasing diameter and increasing resistance
50
how does height affect vital capacity?
(1) the taller you are the greater vital capacity (increased thoracic cavity size)
51
how does body position affect vital capacity?
sitting while flexed decreases vital capacity because it limits the ability of the chest to expand
52
what is minute ventilation? what factors affect minute ventilation?
(1) amount of air moved in and out in 1 minute
| 2) respiratory rate and tidal volume (how deep your breath is
53
what is alveolar ventilation? how can it be optimized?
(1) air that reaches the alveolar chamber
| (2) deep breathing
54
how is alveolar air calculated?
tidal volume minus dead air
55
how is ventilation affected by exercise?
(1) total ventilation can be increased up to 30x
| 2) RR and depth increase (depth being the more important factor so more O2 can reach the alveoli
56
what is V/Q?
ratio of alveolar ventilation to pulmonary blood flow
57
physiologically, what happens with restrictive lung disorders?
(1) lung expansion is restricted; difficult to get air in the lungs
(2) decreased lung or chest wall compliance or ventilatory muscle dysfunction
58
what are some signs and symptoms of restrictive lung disorders?
(1) dyspnea
(2) tachypena
(3) coughing
(4) fatigue
59
what are some pulmonary conditions that cause restrictive lung disorders? (9)
(1) interstitial pulmonary fibrosis
(2) pneumonia
(3) tuberculosis
(4) atelectasis
(5) pleural effusion
(6) pneumothorax
(7) pulmonary edema
(8) pulmonary embolism
(9) acute respiratory distress syndrome
60
what are some extrapulmonary conditions that cause restrictive lung disorders? (7)
(1) chest wall trauma and surgery
(2) neuromuscular disorders
(3) pectus carinatum
(4) scoliosis
(5) ankylosing spondylitis
(6) diaphragm paralysis
(7) obesity
61
how are the lung volumes and capacities affected with restrictive lung disorders?
ALL of the following are reduced:
(1) IRV
(2) TV
(3) ERV
(4) VC
(5) TLC
62
how are FEV1 and FVC affected with restrictive lung disorders?
(1) FEV1 and FVC absolute values are reduced
(2) FEV1 / FVC Ratio is NORMAL to HIGH
(can't get air in, but has no trouble expelling air, so ratio is preserved)
63
what is the general pathophysiology of interstitial pulmonary fibrosis?
(1) chronic inflammation injures normal tissue, causing the tissue to be replaced by fibrous tissue
(2) fibrous tissue reduced compliance, leading to decreased ventilation and increases work of breathing
(3) causes impaired gas exchange (hypoxemia)
64
what is atelectasis? what are typical causes?
(1) when segments of the lungs have collapsed
| a) airway obstruction (bronchoconstriction, secretions / mucus plugging
(b) restrictive conditions (hypoventilation)
65
what is pneumonia? what are typical causes?
(1) acute inflammation of lung parenchyma
| (2) caused by bacterial, viral, or fungal infection; also by aspiration of food, fluid, or vomit into the lungs
66
what is a pneumothorax? what are typical causes?
(1) accumulation of air or gas in the pleural space, causing the lung to collapse on the affected side
(2) caused by a defect in the visceral or parietal pleura
67
what are the ways that a primary spontaneous, secondary spontaneous, and a traumatic pneumothorax can occur?
(1) primary: young, tall thing men (idiopathic)
(2) secondary: COPD, blebs, bullae
(3) traumatic: central line, gun shot, knife wound, rib fracture
68
what occurs with a tension pneumothorax? why is it considered a medical emergency?
(1) occurs with a pneumothorax and air enters the pleural space, but can't escape
(2) increasing pressure causes progressive lung collapse and may compromise venous return and CO
69
what is pulmonary edema? what are the most common causes?
(1) pulmonary congestion
(2) develops with left sided heart failure; also due to ARDS, altitude sickness, and reperfusion injury following surgery
70
what is a pulmonary embolus? what are the most common causes?
(1) floating clot of thrombus that lodges in pulmonary artery
(2) usually due to a DVT
71
what is acute respiratory distress syndrome (ARDS)? how is someone classified as having ARDS?
(1) acute / rapid onset of respiratory failure
(2) PaO2 <60 mm Hg
PaCO2 >55 mm Hg
72
what population does acute respiratory distress syndrome (ARDS) occur in?
critically ill; usually results from acute extensive lung inflammation
73
physiologically, what happens with obstructive lung disorders?
(1) weakening, narrowing, and obstruction of airways (difficulty getting air out of the lungs)
(2) this obstruction of the airways causes air trapping, causing hyper inflation and an impaired gas exchange
74
what are the two disorders that make up COPD?
(1) emphysema
| (2) bronchitis
75
what are other chronic obstrutive diseases but the dysfunction is variable? (3)
(1) asthma
(2) bronchiectasis
(3) cystic fibrosis
76
how are the lung volumes and capacities affected with obstructive lung disorders?
(1) ERV decreases
(2) RV increases
(3) VC decreases
(4) FRC and TLC increases
77
how are FEV1 and FVC affected with obstructive lung disorders?
(1) FEV1 and FVC absolute values are reduced
| (2) FEV1 / FVC Ratio is significantly reduced
78
what are the most common causes of chronic bronchitis? what is the general pathophysiology of the disease?
(1) smoking, pollutants, infections
(2) inflammtion causes hyper-secretion of mucus, causing ciliary dysfunction (mucus isn't moving) and hyperactive bronchi (constriction)
(3) the above cascade causes scarring and thickening of bronchi and bacterial infections due to stagnant mucus
79
what is required for a person to be diagnosed with chronic bronchitis?
(1) chronic cough and sputum
| (2) most days for at least 3 months of the year for at least 2 years
80
what are signs and symptoms of chronic bronchitis?
(1) dyspnea
(2) use of accessory muscles
(3) pursed lipped breathing
(4) digital clubbing
(5) adventitious or decreased breath sounds
(6) hypoxemia
81
what is emphysema? what are the most common causes?
(1) enlargement and destruction of alveoli
(2) 95% of cases develop gradually (caused by chronic bronchitis, smoking, and pollutants)
5% is genetic (trypsin enzyme digests lung tissue)
82
what is the general pathophysiology of emphysema?
(1) loss of elastic properties and ability to gas exchange in the acini
(2) these non functional acini form bullaer or blebs
(3) the above causes alveoli to collapse during expiration causing air to become trapped leading to hyperinflation of the lungs
83
what happens to the O2 and CO2 in the blood in patients with emphysema?
hypoxemia and hypercapnia
84
what are signs and symptoms of emphysema?
(1) dyspnea and cough
(2) use of accessory muscles
(3) pursed lipped breathing
(4) digital clubbing
(5) adventitious or decreased breath sounds
(6) hypoxemia
85
what is the normal pulmonary arterial pressure (PAP)?
(1) 8-18 mmHg
(2) SBP: 15-30 mmHg
(3) DBP: 4-12 mmHg
86
what is considered elevated mean pulmonary arterial pressure (PAP)?
(1) Rest: >25 mmHg
| (2) Exercise: >30 mmHg
87
what can elevated mean PAP cause?
(1) right sided heart failure
(2) right ventricular hypertrophy
(3) increased peripheral vascular resistance (PVR)
88
what is cor pulmonale? what can this condition lead to?
(1) pulmonary hypertension SECONDARY to a pulmonary disease
| 2) right ventricular hypertrophy, right sided heart failure, and increased peripheral vascular resistance (PVR
89
what medications are used to manage COPD?
(1) oxygen
(2) bronchodilators (vasodilation of bronchioles)
(3) glucocorticosteroids (reduce inflammation)
90
when is mechanical respiration indicated for a patient with COPD?
when either condition occurs:
(1) PaO2 <60 mmHg
(2) PaCO2 >55 mmHg
91
what is asthma? what are the most common causes?
(1) chronic airway inflammation leading to reversible episodes of airway obstruction (episodes can resolve spontaneously or with medications)
(2) airways are hypersensitive to various stimuli (pollen, mold, food, smoke, cold air, exercise, stress)
92
what is the general pathophysiology of asthma?
(1) inflammation causes smooth muscle spasms in the lungs, causing bronchoconstriction and excessive mucous production
(2) leads to decreased expiratory flow, air trapping, hyperventilation and eventually an impaired gas exchange
93
what are signs and symptoms of asthma?
(1) dyspnea
(2) wheezing
(3) chest tightening
(4) cough
(5) decreased FEV1, FVC, FEV1/FVC ratio
94
what is bronchiectasis? what are the most common causes?
(1) permanent dilation and distortion of bronchi caused by destruction of elastic and muscular components of bronchial wall
(2) usually SECONDARY to other lung conditions such as (CF, recurrent pulmonary infections, and emphysema)
95
what is cystic fibrosis and the pathophysiology? what causes this disorder?
(1) genetic defect that causes very thick mucous production that can't be cleared by the cilia; this leads to bacterial growth, lung infections and eventually destruction of lung tissues
(2) it's an inherited disorder (both parents must carry the gene)
96
what is the partial pressure of O2 and CO2 at the alveolus, in arterial blood, and in venous blood?
```
(1) Alveolus and (2) Arterial Blood:
PO2: 100 mmHg
PCO2: 40 mmHg
(3) Venous Blood
PO2: 40 mmHg
PCO2: 46 mmHg
```
97
is CO2 or O2 more soluble?
CO2 25x more soluble than O2
98
how is oxygen transported in blood? (2)
(1) 1-2% dissolved in blood plasma
| (2) 98-99% bound to hemoglobin
99
what function does myoglobin play? where is myoglobin found in the body?
(1) myoglobin is essentially an oxygen reservoir that can transfer O2 to mitochondria when needed
(2) it's found in slow twitch muscle fibers of skeletal and cardiac muscle
100
how is carbon dioxide transported in blood? (3)
(1) 10% dissolved in blood plasma
(2) 20% bound to hemoglobin
(3) 70% as plasma bicarbonate ion
101
what is the equation for the formation of the bicarbonate ion?
CO2 + H20 >> H2CO3 >> H + HCO3
| H2CO3 is carbonic acid; HCO3 is biocarbonate ion
102
what are normal pH values for blood?
7.35 - 7.45 (mean: 7.4)
103
what are normal bicarbonate (HCO3) ion values for blood?
22 - 26 mmol/l (mean: 24)
104
what are normal PaCO2 values for arterial blood?
35-45 mmHg (mean: 40)
105
what causes respiratory acidosis?
(1) hypoventilation
| (2) hypercapnia
106
what causes respiratory alkalosis?
(1) hyperventilation
| (2) hypocapnia
107
what are some common causes of respiratory acidosis?
(1) COPD
(2) neuromuscular diseases (ex. SCI, ALS, GBS, MS)
(3) pneumonia
(4) trauma
(5) anesthesia
(6) drug OD
108
what are some signs and symptoms of respiratory acidosis?
(1) dyspnea
(2) anxiety / restlessness
(3) disorientation
(4) stupor / coma
(5) irritability
(6) HA
(7) hyperkalemia (causes cardiac arrhythmias)
109
how does the body compensate for respiratory acidosis? how can we as PTs help?
(1) kidneys produce more HCO3 or excrete more H+ to raise levels of HCO3
(2) increase and assist with ventilation
110
what are some common causes of respiratory alkalosis?
(1) anxiety, anger, hysteria (panic attack)
(2) pain
(3) Hypoxia (leads to hyperventilation) due to CHF, pulmonary emboli / fibrosis, brain trauma, fever, mechanical ventilation
111
what are some signs and symptoms of respiratory alkalosis?
(1) numbness / tingling
(2) muscular twitching
(3) tetany
(4) convulsions
(5) hypokalemia (causes cardiac arrhythmias)
112
how does the body compensate for respiratory alkalosis? how can we as PTs help?
(1) kidneys excrete more HCO3 (urination) to decrease the pH towards normal
(2) decrease or stop hyperventilation
113
what are some common causes of metabolic acidosis?
(1) DM
(2) renal failure
(3) lactic acidosis
(4) diarrhea
(5) hyperkalemia
114
what are some signs and symptoms of metabolic acidosis?
(1) nausea
(2) vomiting
(3) diarrhea
(4) HA
(5) stupor / coma
(6) hyperkalemia (causes cardiac arrhythmias)
115
what are some common causes of metabolic alkalosis?
(1) vomiting
(2) NG suctioning
(3) diuretics
(4) antacids
(5) hypokalemia
(6) hyperaldosteronism
(7) hypochloremia
116
what are some signs and symptoms of metabolic alkalosis?
(1) nausea
(2) vomiting
(3) diarrhea
(4) NG drainage
(5) numbness / tingling
(6) muscle twitching / tetany
(7) convulsions
(8) hypokalemia (causes cardiac arrhythmias)
117
what are the primary regulators of acid-base balance in the body?
(1) lungs (fast)
| 2) kidneys (slow
118
what should the O2 flow rate be for a nasal cannula?
1-6 L/min
119
what should the O2 flow rate be for a simple mask?
5-10 L/min
120
what should the O2 flow rate be for a aerosol mask?
10-12 L/min
121
what should the O2 flow rate be for a Venturi mask?
4-10 L/min
