Resp 2

Question 1

What is the delta PaO2 between PaO2 in the lungs?

Answer 1

110mmHg (high delta)

Question 2

What is the PaO2 in the blood that is driving gas exchange?

Answer 2

40mmHg

Question 3

What must hgb go through to before binding to Hgb in RBCs?

Answer 3

Several fluids and epithelial layers

That is why it is important to maintain a high PaO2 in the alveoli to ensure it dissolves.

Question 4

What are some diseases that causes changes in the PaO2 in the alveoli or in Delta PaO2 and therefore cause a drop in the Diffusion Limit of O2?

Answer 4

Fibrosis
COPD
Emphysema

Question 5

How does Fibrosis drop the diffusion limit?

Answer 5

Increases the thickness of the membrane

Question 6

How does COPD drop the diffusion limit?

Answer 6

Reduces the SA to volume ratio

Question 7

How does Emphysema drop the diffusion limit?

Answer 7

Decrease the surface area

Question 8

Excess fluid, excess thickness will affect diffusion of O2 and therefore O2 and therefore O2 ___________ in the blood.

Answer 8

Tension

Question 9

How is the diffusion of O2 and O2 tension measured in the blood?

Answer 9

DLCO (Carbon Monoxide tracer)

Question 10

T/F: Changes in overall morphology in lungs causes a reduced DIFFUSION capacity of O2.

Answer 10

True

Question 11

What is being measured in the oxyhemoglobin dissociation curve?

Answer 11

PO2:Partial pressure of oxygen
VO2: Volume of O2
SaO2: Oxygen saturation

How well we exchange gases

Question 12

What causes a R shift?

Answer 12

Acidosis
Inc temp
Inc 2,3 DPG

Question 13

What happens during a Right shift?

Answer 13

Oxygen will readily RELEASE from hgb

Question 14

What causes a L shift?

Answer 14

Alklalosis
Dec temp
Dec 2,3 DPG

Question 15

What happens during a L shift?

Answer 15

Oxygen will LATCH to hgb

Question 16

What happens to the alveolar capillaries as the lungs expands?

Answer 16

Stretch of the alveolar wall compresses the alveolar capillaries and elevates PVR.

Question 17

What happens to the extra alveolar vessels as the lungs expands?

Answer 17

They are pulled open due to recoil forces. The opposite is true at low lung volumes.

Question 18

The net result is that perfusion of the pulmonary vasculature is ____________ at or near _____________.

Answer 18

Optimal; FRC

Question 19

The compression of alveolar capillaries causes increased pulmonary pressures with ___________ & _________. This will create a back up causing Pulm HTN.

Answer 19

Emphysema;COPD

Question 20

What is perfusion of the lungs dependent upon?

Answer 20

The driving pressure (pulmonary artery pressure-pulmonary vein pressure) and the resistance of the regional vascular bed.

Question 21

What lung zone will you have big alveoli (high ventilation) and low resistance?

Answer 21

Zone 1.

D/t being above the heart, more gravity->less perfusion

Question 22

What lung zone are alveoli well ventilated and will also have good perfusion?

Answer 22

Zone 2

“Normal” working parameters of the lungs

Question 23

What happens in zone 3 of the lungs?

Answer 23

Alveoli are poorly ventilated, d/t gravity, good perfusion.
Low V/Q ratio
Gets a mixture of deoxygenated blood with oxygenated blood (Shunt)

Question 24

What happens during during zone 1 mismatch?

Answer 24

To prevent dead space, the body will bronchoconstrict areas that are being ventilated and not perfused->shunting away from there.

Dependent on Bronchodynamics: Ince or Dec air resistance or bronchiolar resistance.

Question 25

What happens during Zone 3 mismatch?

Answer 25

A shunt normally means low O2 in the venous blood Hypoxia: regulator for vasoconstriction

Question 26

What is considered a shunt in Zone 3?

Answer 26

Shunt=hypoxic vasoconstriction, which reduces perfusion to areas not well ventilated. Improvement: Control of blood flow and PVR

Question 27

During PNA, edema, etc, what causes vasodilation?

Answer 27

Inflammatory cytokines Reduced PVR>don't get hypoxic

Question 28

Describe what happens during Obstructive DO.

Answer 28

Increased compliance Decrease in resistance Drop in FEV1/FVC ratio Dif getting air out

Question 29

Where does Obstructive DO occur?

Answer 29

Alveolar Space

Question 30

Name examples of Obstructive DO

Answer 30

COPD Asthma Chronic bronchitis Emphysema Bronchiectasis

Question 31

Where do Restrictive DO occur?

Answer 31

Interstitial space

Question 32

Name examples of Restrictive DO?

Answer 32

"Osis" diseases Interstitial pneumonias Granuloma diseases Carcinomas TB

Question 33

Where do Vascular DO take place?

Answer 33

Capillaries/blood vessels of the lungs

Question 34

Name examples of Vascular DO

Answer 34

Pulm edema Pulm HTN Pulm emboli

Question 35

Name examples of Combo DO

Answer 35

ALI/Resp Distress Bacterial PNA

Question 36

What happens during Combo DO?

Answer 36

Infection in lungs->fluid shifts (interstitial edemas, pulm edema)->leads to obstruction and restrictive patterns

Question 37

Are Combo DO acute or chonic?

Answer 37

Most of the time they are Acute Not doing PFTs on them Rely on physical exam, labs, and CXR

Question 38

What do you see in infective disorders?

Answer 38

Fever, WBCs

Question 39

What do you see in PNA?

Answer 39

Opacifications

Question 40

What is an example of an inspiratory disorder in children?

Answer 40

Extrathoracic Obstructions (child aspirated something)

Question 41

What curve does most process diseases processes occur?

Answer 41

Expiratory Curve Measures peak flow

Question 42

What happens to the FEV1/FVC ratio in Restrictive D/O?

Answer 42

It is above normal, usually high

Question 43

What occurs during Restrictive DO?

Answer 43

Hard time getting air IN Total volume change is lower, but flow rate is really high They can get air out in the first second

Question 44

What happens to the diaphragm in COPD?

Answer 44

It flattens

Question 45

What is the Meniscus sign?

Answer 45

Fluid in the pleural space