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Block 2 - Theme 7
Belperio's Revenge (We love you Shar)
40
Biology
Graduate
12/06/2008

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Cards

Term
What is the difference between type 1 and type 2 respiratory failure?
Definition
Type 1 involves problems with the lung itself and oxygenation, i.e. ARDS; type 2 involves problems with the lung pump and developing hypercapnia, i.e. respiratory muscle problems or central depression
Term
List a clinical cause for cardiogenic and non-cardiogenic pulmonary edema.
Definition
Cardio- CHF; Non-cardio ARDS - Acute Respiratory Distress Syndrome
Term
In ARDS what three things cause proteinaceous fluid leak into the lung?
Definition
The diffuse alveolar damage results in vascular epithelial permeability, low HP, and low colloid osmotic pressure.
Term
Which pathophysiologic events occur with ALI versus ARDS: damage to alveolar-capillary membrane, interstitial and alveolar edema, neutralized surfactant, airway closure, reduced lung volumes?
Definition
Trick question: they all occur in both, but ARDS is more severe than ALI.
Term
Both ALI and ARDS are identified with PWCP being <18 and CXR showing bilateral opacities, but which shows an oxygenation abnormality with PaO2/FiO2 ratio being <300 and which is <200?
Definition
ALI<300, ARDS<200
Term
What is atelectasis?
Definition
A collapse of part or all of a lung, specifically referring to collapsed alveoli.
Term
Why can PCO2 be normal even with hypoxemia in ARDS?
Definition
J-receptors sense stretch with edema causing increased RR, usually causing hypocapnia.
Term
If ARDS is not treated what permanent change can take place over time to the lung?
Definition
Fibrosis
Term
Which of the following are seen in ARDS - stiff lungs, reduced compliance, fall in FRC, shunt, V/Q mismatch, hypoxemia, substantial blood flow to unventilated areas.
Definition
All of them
Term
What are two adverse effects of PEEP?
Definition
Decreased CO due to increased thoracic pressure, over-inflation, shifts but does not reduce edema
Term
What are the benefits of PEEP?
Definition
Change shunting to V/Q mismatch which allows the lung to respond to oxygen, no de-recuitment of alveoli, increase PaO2, increase FRC
Term
With a mechanical ventilator over-stretching of the lung can exacerbate injury, what is the way to minimize this?
Definition
Lower tidal volumes and use pressure limited ventilation
Term
What is the mortality rate of ARDS?
Definition
40-50%
Term
What is a person’s PaO2 during hypoxic failure?
Definition
<60mm Hg
Term
Of the six causes of hypoxic failure- V/Q mismatch, shunt (pulmonary or ASD), diffusion impairment, low FiO2, low mixed venous blood with abnl lungs, hypoventilation- which respond to O2 therapy?
Definition
Everything except shunt
Term
When a patient is hypoxic you calculate the A-aPO2, what is the equation to calculate alveolar PO2?
Definition
713xFiO2-(PaCO2/R), R is usually .8, FiO2 in room air is .21
Term
What happens to the A-a gradient when a patient has hypercapnic respiratory failure versus hypoxic failure?
Definition
Hypercapnic= gradient is normal, hypoxic= gradient increased
Term
If a patient has hypoxia and you calculate the A-a gradient how would you diagnose the respiratory failure?
Definition
If the gradient is OK then it is due to hypoventilation, if the gradient is increased it is either V/Q miss or shunt.
Term
Hypercapnic respiratory failure is defined as respiratory acidosis with pH<7.4 and PaCO2>______?
Definition
50mm Hg
Term
Which of the following result in higher CO2 production- fever, sepsis, burns, thyroidtoxicosis, exercise, over-feeding patients with bad lungs.
Definition
All of them
Term
In hypercapnic respiratory acidosis what is the most common problem?
Definition
Decreased alveolar ventilation, i.e. breath holding or rapid shallow breathing
Term
What happens to patients with COPD who are given too much O2?
Definition
Areas that can’t ventilate normally and have vasocontricted will dilate taking blood away from good areas; the lessened hypoxemia will then decrease respiratory drive and CO2 will accumulate.
Term
How do you treat hypercapnic respiratory failure?
Definition
Treat the cause and use mechanical ventilation
Term
What are the big 3 pulmonary function tests and the other 3?
Definition
FEV1, FVC, FEV1/FVC%; and TLC, RV, DLCO
Term
What is the definitive diagnostic spirometry test that ID’s whether a disease is obstructive and restrictive?
Definition
Obstructive - FEV/FVC ratio less than 80%; Restrictive - reduced TLC
Term
In a flow versus volume curve what shape does an obstructive disease make versus a restrictive disease?
Definition
Obstructive - wide alligator shaped coving, restrictive - narrowed version of normal curve
Term
What two spirometry tests are the gold standard for determining whether a treatment is creating a statistically significant change?
Definition
FVC and FEV1, with a change being greater than 13% and 11% respectively.
Term
Since DLCO measures volume of gas transfer what 3 things affect the amount of gas transferred?
Definition
Changes in cross-sectional area of tissue, thickness, and hemoglobin
Term
What does a pulse oximeter measure?
Definition
Arterial hemoglobin oxygen saturation by measuring total bound hemoglobin
Term
During a normal wave of a capnogram, from which areas do gasses come out first, middle, and last to give the graph its hump shape?
Definition
Anatomical dead space, then, mix of dead space and alveolar gas, then only alveolar gas; the rapid drop is due to inspiration.
Term
Complete the fetal airway development: lung primordium, ____________, branching morphogenesis, _____________.
Definition
Tracheal morphogenesis, alveologensis
Term
Put the following in chronological fetal developmental order according to lung development stage - alveolar, canalicular, saccular, embryonic, psuedoglandular.
Definition
Embryonic 4-6wks, psudeoglandular 6-16wks, canalicular 17-28wks, saccular 24-36wks, alveolar 32wks-18mos postnatal
Term
In the fetal heart, since approx. 70% of the total blood flow hits the pulmonary artery, what percentage of total blood flow actually makes it to the lungs?
Definition
Only 7%
Term
What type of cells in the alveoli predominate before and after birth?
Definition
Before - type 1, after type 2
Term
Premature babies expressing respiratory distress syndrome basically have a deficiency of what?
Definition
Surfactant
Term
Bronchopulmonary Dysplasia results in dilated terminal airways and alveolar simplification, what are the causes of it?
Definition
A premature birth exposes lungs to supplemental O2, nutrition, mechanical ventilation, and possible infection which can lead to inflammation and BPD
Term
In addition to managing the causes of BPD in premies, what is the primary way to manage a premie baby to reduce occurrence of BPD?
Definition
Management of the patent ductus arteriosus.
Term
What is the anion gap formula?
Definition
Na-(Cl+HCO3)
Term
What is Winters formula?
Definition
1.5xHCO3+8= PCO2 predicted +/- 2
Term
Isotonic NaHCO3 loss, like from diarrhea, causes hypochloremia not an anion gap.
Definition
False, it causes hyperchloremia without an anion gap.
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