Witwer Barton Lower Resp Tract

Question 1

Type one alveolar cells comprise the cell well while type two have the important function of producing 1._______. Which reduces 2.______ ______ and prevents alveolar collapse

Answer 1

1. Surfactant

2. surface tension

Question 2

The respiratory membrane between the capillary and alevolus is about ______ to _____ micron ( an RBC is 8 microns )

Answer 2

.5 to 1 micron

Question 3

Witwer would really like you to know that surfactant does what…

Answer 3

increases lung compliance

Prevents atelectasis

Question 4

The primary muscles of inspiration are

Answer 4

Diaphragm

external intercostals

Question 5

Active breathing occurs when

a. always
b. excercise and pathological states
c. only when sleeping

Answer 5

b. exercise & pathological states

Question 6

this effing guy poiseuille made a law. Basically the ______ of the airway plays a big role in respiration a. lengthb. elasticity c. diameter d. blood flow

Answer 6

c. diameter

straw analogy

Question 7

Pressure in the alveoli is _______ to the pressure in the environment a. the same b. lessc. more

Answer 7

a. the same

Question 8

In obstructive respiratory diseases what is the source of the pathology, the airway or the ability of the lung to fuly expand

Answer 8

the airway

Question 9

Elasticity is _____ related to compliance a. directly b. not related c. inversley

Answer 9

c. inverse

Question 10

Elasticty is …..

Answer 10

recoil property of the lungs and chest wall

Question 11

Compliance

Answer 11

measure of the ability of the lungs and chest wall to expand / distend (change in volume for a given pressure)

Question 12

In restrictive disease the compliance is ______

Answer 12

low (the lungs are stiff)

Question 13

increase in intrathoracic pressure will ______ the diameter of the airways and result in increased expiratory ______a. decrease, resistanceb. increase, resistance c. decrease, compliance

Answer 13

a. decrease

Question 14

One liter of blood hold ______ ml of O2a. 300b. 200c. 400

Answer 14

b 200mL of O2

Question 15

Ideal V/Q ratio is _____a. 1.0b. 1.5 c. 2

Answer 15

a. 1.0
because the ideally one liter of blood should have 200 ml of o2 and one liter of air should have 200 ml of o2 200/200= you get it

Question 16

Ideal V/Q ratios do not acutally happen. Normally the ratio is actually ______.

Answer 16

0.8 the alveolar ventilation in L/ min is 80 % of the value for pulm blood flow per minute

Question 17

Upper lungs have the _____ blood flow and ventilation. Lower lungs have ____a. greatest, lowest b. equal c. Lowest, greatest

Answer 17

c. LOWEST, GREATEST

Question 18

When there is perfusion but NO GAS EXCHANGE there is_____

Answer 18

right to left pulmonary shunt
in this situation there is always hypoxemia.

This hypoxemia cannot be corrected with oxygen admin

Question 19

In right to left cardiac shunts hypoxemia occurs NOT because there is no gas exchange but because there is ……

Answer 19

mixing of oxygenated and deoxygenated blood

dont get this confused with pulm shunts

Question 20

When there is ventilation and no perfusion there is ______

Answer 20

dead space

this can occur with a PE

Question 21

value of tidal volume

Answer 21

.5 L

Question 22

Value of vital capacity

Answer 22

4.5 L

This is what is used in the Forced Vital Capacity FEV1 Test

Question 23

Value of anatomic dead space

Answer 23

150ml

Question 24

Alveoli that do not participate in gas exchange

Answer 24

functional dead space

Question 25

The acinar unit is composed of

Answer 25

bronchioles alveoli pulmonary blood vessels

Question 26

Most common cause of Lung CA (80% of cases)

Answer 26

Non Small Cell Lung Cancer (NSCLC)

Question 27

Pancoast Tumor cause | Findings?

Answer 27

primary small cell lung cancer Destruction of Cervical Sympathetic Ganglion>Horner’s Syndrome

Question 28

Asbestosis

Answer 28

1. occupational dz 2. no longer used 3. thickening of plura, superimposed mesothelioma.

Question 29

Rational For O2 therapy beware of?

Answer 29

1. Supplemental O2 2. COPD SPO2 <88% or PaO2 <55mmHg (target 88-92%) O2 toxicity Retrolentil fibroplasia in infants=blindness ↓ O2 drive to breathe (COPD)= worsening Hypercapnea

Question 30

Mechanical ventilation goals (4)? Method used?

Answer 30

1. Oxygenation- critically ill or under anesthesia 2. CO2 elimination 3. Maintain adequate Tidal Vol 4. Maintain RR (+) Pressure ventilation

Question 31

Indications for Mechanical Ventilation

Answer 31

``` 1. Acute Resp Failure (PNA, Sepsis, Postop infect, HF, ARD, Trauma, Aspiration) 2. Coma 3. COPD exacerbation 4. Neuromuscular weakness ```

Question 32

Mechanical Ventilation Variables

Answer 32

1. TV 2. RR 3. PEEP 4. Fraction of inspired O2= FIO2 3. Peak Pressure 4. Plateau Pressure 5. Trigger sensitivity 6. Flow Rate 7. Flow Pattern

Question 33

PEEP too mcuh/too little precautions?

Answer 33

Positive End Expiratory Pressure = alveolar pressure above ATM pressure @ END EXPIRATION (1mmHg=3-5cmH2O) This keeps alveoli, bronchioles, bronchi open prevents collapse too much PEEP= blow out alveoli too little PEEP= alveoli wont open

Question 34

Mechanical Ventilation Precautions (7)

Answer 34

1. Lung Inj 2. Overinflation 3. Sheer stress between adjacent structures 4. Collapse of bronchi, bronchioles, and alveoli 5. Alveolar damage w/ loss of surfactant 6. Atelectasis 7. Oxygen Toxicity to lungs occurs above a FIO2 of 50%

Question 35

What is obstructed in Obstructive Lung Dz?

Answer 35

The air flowing through airways. Work needed to overcome flow resistance in abnormal airways

Question 36

What is obstructed in Restrictive Lung Dz?

Answer 36

The ability of the lung to expand. Work needed to overcome elastic forces of abnormal lung

Question 37

What is obstructed in Restrictive Lung Dz?

Answer 37

The ability of the lung to expand. Work needed to overcome elastic forces of abnormal lung

Question 38

Residual volume

Answer 38

1.5L

Question 39

Total lung capacity

Answer 39

6L

Question 40

Inspiratory capacity

Answer 40

4.5L

Question 41

Neonate respiratory distress syndrome is a risk of premies born before _____ since this is when _______ is produced.

Answer 41

1. 28th week | 2. Surfactant

Question 42

What happens to lung volumes in Obstructive lung Dz? Lung capacities?

Answer 42

Decreased vital capacity INCREASED functional residual capacity (HIGH increase in residual volume) FEV1/FVC decrease FEV1 decreased even more so. (ratio <0.8)

Question 43

Resistance to Inspiration – alveoli don’t open adequately

Answer 43

Restrictive lung disease

Question 44

Restrictive lung Dz examples

Answer 44

``` -Stiff lungs with thick alveolar walls (inflammatory, connective tissue disease) -Stiff chest wall -Respiratory Muscle weakness -Central Sleep Apnea ```

Question 45

What happens to lung volumes in Restrictive lung Dz? Lung capacities?

Answer 45

Decrease Vital Capacity Decreased Functional Residual Capacity Esp decrease total ratio of FEV1/FVC will be close to NL but overall low