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Y3 TRANSITION > Physiology > Flashcards

Physiology Flashcards

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1
Q

What is respiratory acidosis? How is it corrected?

A

Accumulation of CO2 due to a disease of the lungs or a problem with the mechanics of respiration
The body tries to hold alkali by reabsorbing HCO3 from the kidneys

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2
Q

What is respiratory alkalosis? How is it corrected?

A

Relative lack of acid because of the loss of CO2 due to hyperventilation
Appropriate response is to lose HCO3 but this is too slow and rarely happens

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3
Q

What is metabolic acidosis? How is it corrected?

A

Excess of H+ due to disease e.g. lactic acidosis, DKA, renal failure, sepsis
The body tries to get rid of acid by getting rid of CO2 by hyperventialation

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4
Q

What is metabolic alkalosis? How is it corrected?

A

Net loss of acid from the body leaving an alkali surplus (typically vomiting)
To counteract the surplus the body tries to hold onto acid by hypoventilating and retaining CO2

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5
Q

How does respiratory acidosis appear on ABG? Give three examples

A

Reduced pH
Increase in CO2
Little or no change in HCO3 (increase in chronic)
Respiratory depression (opiates), asthma, COPD

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6
Q

How does respiratory alkalosis appear on ABG? Give three examples

A

Elevated pH
Hyperventilation with a low CO2
Little change in HCO3
Anxiety, pain, PE, pneumothorax

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7
Q

How does metabolic acidosis appear on ABG? Give three examples

A

Reduced pH
Tachypnoea with a reduced CO2
Reduced HCO3 as it used up by the pH
DKA, diarrhoea, renal tubular acidosis

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8
Q

How does metabolic alkalosis appear on ABG? Give three examples

A

Elevated pH
Marginal increase in CO2 (hypoventilation relatively ineffective)
Vomiting, diarrhoea, HF, cirrhosis, renal failure, diuretics

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9
Q

List respiratory causes of SOB

A 
Asthma
COPD
Pneumonia
Lung cancer
Pulmonary fibrosis
Pleural effusion
Pneumothorax
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10
Q

List cardiovascular causes of SOB

A 
Heart failure
IHD
Hypertension
Valvular HD
Cardiomyopathy
Arrhythmia
Pulmonary embolism
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11
Q

List other causes of SOB

A 
Anaemia
Acidosis
Panic attack
Exercise
Obesity
Pregnancy
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12
Q

State the two respiratory centres in the brainstem and give their role in respiration

A

Pons (modifies respiration)

Medulla (rhythm generator)

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13
Q

State the two main stimuli that influence respiratory centres in the brainstem

A

Central chemoreceptors

Peripheral chemoreceptors

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14
Q

Peripheral chemoreceptors sense tension of…

A

Oxygen
Some carbon dioxide
Hydrogen in the blood

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15
Q

Central chemoreceptors sense tension of…

A

Hydrogen in the CSF

Carbon dioxide

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16
Q

What is the most potent stimulant of respiration in normal people?

A

Arterial PCO2 acting through central chemoreceptors

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17
Q

Hypoxic drive of respiration is controlled by what type of chemoreceptors?

A

Peripheral chemoreceptors

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18
Q

List the major muscles of inspiration

A

Diaphragm

External intercostals

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19
Q

List the accessory muscles of inspiration

A

Sternocleidomastoid

Scalenus

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20
Q

List the muscles of active expiration

A

Internal intercostals

Abdominal muscles

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21
Q

What is the transmural pressure gradient?

A

Differences between intra-alveolar pressure and intrapleural pressure during the respiratory cycle

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22
Q

List forces keeping the alveoli open

A

Transmural pressure gradient
Pulmonary surfactant
Alveolar interdependance

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23
Q

List forces promoting alveolar collapse

A

Elasticity of fibres

Alveolar surface tension

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24
Q

Parasympathetic stimulation causes bronchoconstriction/dilatation

A

Bronchoconstriction

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25
Parasympathetic stimulation causes bronchoconstriction/dilatation
Bronchodilatation
26
Dynamic airway compression makes active expiration to be more difficult in patients with airway obstruction. Why is this?
Rising pleural pressure during expiration compresses the alveoli (helps push air out of the lungs) and the airway (more likely to collapse)
27
Compliance is measure of effort that has to go into stretching or distending the lungs. What is meant by less compliance clinically?
The less compliant the lungs are, the more work is required to produce inflation
28
List factors influencing the rate of gas transfer across the alveolar membrane
Partial pressure gradients Surface area of alveoli Thickness of blood-air barrier Diffusion coefficient (solubility of gas)
29
Define cardiac output
Volume of blood pumped by each ventricle per minute | CO = SV x HR
30
Define stroke volume
Volume of blood ejected by each ventricle per heart beat | SV = EDV - ESV
31
What is the Frank Starling Law?
The more blood that returns to the ventricle during diastole (EDV), the greater the volume of ejected bloods during systolic contraction (SV)
32
What is the primary factor that determines percent saturation of haemoglobin with O2?
Partial pressure of oxygen (PO2)
33
When is haemoglobin considered fully saturated?
All haemoglobin present is carrying its maximum oxygen load
34
List investigations for SOB
``` CXR ECG Full blood count Arterial blood gases Troponin T ```
35
What is the tidal volume?
Volume of air entering or leaving lungs during a single breath (500ml)
36
What is the inspiratory reserve volume?
Extra volume of air that can be maximally inspired over and above the typical resting tidal volume (3000ml)
37
What is the inspiratory capacity?
Maximum volume of air that can be inspired at the end of a normal quiet expiration (3500ml) IRV + TV
38
What is the expiratory reserve volume?
Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume (1000ml)
39
What is the residual volume?
Minimum volume of air remaining in the lungs even after a maximal expiration (1200ml)
40
What is functional residual capacity?
Volume of air in lungs at end of normal passive expiration (2200ml) FRC = ERV + RV
41
What is vital capacity?
Maximum volume of air that can be moved out during a single breath following a maximal inspiration (4500ml) VC = IRV + TV + ERV
42
What is total lung capacity?
Maximum volume of air that the lungs can hold (5700ml) | TLC = VC + RV
43
What is FEV1?
Volume of air that can be expired during the first second of expiration in an FVC (Forced Vital Capacity) determination Normal > 70%
44
State the spirometry results of a patient with airway obstruction
FEV1: low FVC: normal PEF: low (<70%)
45
State the spirometry results of a patient with lung restriction
FEV1: low FVC: low PEF: normal (>70%)
46
What is the mechanism behind SOB in asthma and COPD?
Increased airway resistance
47
What pathological condition abolishes the transmural pressure gradient?
Pneumothorax
48
What is the mechanism behind SOB in emphysema and lung collapse?
Reduced surface area of the alveolar membrane | Destruction of alveoli leading to reduced surface area of the alveolar membrane, need to breathe harder to push air out
49
What is the mechanism behind SOB in pulmonary fibrosis | and pulmonary oedema (HF)?
Increased thickness of the air-blood barrier across the alveolar membrane Reduced pulmonary compliance (have to work harder to open the lungs) and impaired gas diffusion
50
Pulmonary fibrosis impairs gas diffusion. How are PO2 and PCO2 affected?
% saturations are reduced PCO2 is normal PO2 is reduced This is because CO2 diffuses more readily across the membrane
51
What is the mechanism behind SOB in pulmonary embolism?
``` Increased thickness of the air-blood barrier across the alveolar membrane Reduced perfusion (VQ mismatch) ```
52
What pathological process impairs the oxygen carrying capacity of the blood?
Anaemia
53
In anaemia, the arterial PO2 is normal. True/ False?
True | Arterial PO2 is normal therefore oxygen saturations are normal (less haemoglobin but still fully saturated)
54
What is the mechanism behind SOB in panic attacks?
Increased central and autonomic arousal
55
What moves the oxygen haemoglobin dissociation curve to the right?
Reduced affinity of haemoglobin-oxygen Increased temperature Increased 2,3-DPG Increased H+
56
A low PO2 causes pulmonary vasoconstriction. True/ False? Why?
True | Blood doesn't want to travel to areas where there is low oxygen, and is diverted away from the lungs by vasoconstriction
57
Why is there hypotension in tension pneumothorax?
Increased intra-thoracic pressure may decrease venous return, thus leading to reduced diastolic filling, reduced EDV, and lower SV
58
What medications are given to treat nitrates acutely?
IV furosemide Nitrate infusion Cause venodilatation, reduce preoload
59
What is the most common mediation used to control anxiety in a palliative patient?
Lorazepam
60
In emphysema you get an increased/decreased lung capacity
Increased lung capacity | 'Barrel-shaped chest'

Y3 TRANSITION (10 decks)

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