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Respiratory
KYCOM Block 7
179
Physiology
Graduate
04/13/2013

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Cards

Term
what are the parts and function of the conducting system
Definition
nose
larynx
trachea

R. bronchus > 3 secondary > 10 tertiary for the bronchopulmonary segments

left bronchus > 2 secondary > 8 tertiary for the bronchopulmonary segments

function: warm, moisten, filter air
Term
tntubation
Definition
reestablishing flow past an obstruction in trachea
passing a tube from mouth or nose to larynx and trachea
Term
tracheostomy
Definition
incision in trachea below cricoid when larynx is obstructed
Term
what is a lobule
Definition
bundles of lymphatic, arterioles, venules, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli in the bronchopulmonary segments
Term
what are the types of alveoli (pneumocyte) cells (and cells around alveoli) what are their functions
Definition
type 1: simple squamous, site of gas exchange

type 2: secrete alveolar fluid with surfactant to lower surface tension and prevent collapse on expiration

alveolar dust cells: wandering macrophages
Term
what are the layers of the respiratory membrane
Definition
pneumocyte cell membrane
epithelial basement membrane
capillary basement membrane
capillary / endothelial wall
Term
explain how the histology of the lungs changes from top to bottom
Definition
epithelium: pseudostratified cilliated columnar to non-ciliated simple cuboidal
cartilage: incomplete rings to smooth muscle to connective tissue
Term
what controls muscle tone of the bronchi and their segments
Definition
autonomic nervous system
vagus constricts via parasympathetic (M3)
sympathetic dilates (B2)
Term
how is pressure calculated, what is atmospheric pressure in kPa, torr, and mmHg
Definition
pressure = force / area
101.3 kPa, 760 torr, 760 mmHg
Term
what contributes to pleural pressure
Definition
pressure in the pleural cavity which can be increased by contraction of the diaphgram
elastic recoil of chest wall tries to pull chest out and recoil of the lungs tries to pull it in
Term
what contributes to alveolar pressure
Definition
pressure inside the alveoli
Term
how is transpulmonary pressure calculated
Definition
transpulmonary pressure = alveolar pressure - pleural pressure
Term
explain the difference between positive and negative pressure and suction and vaccum
Definition
vaccum is the absence of a gas
negative pressure is below atmospheric and cause suction
positive pressure is above atmospheric
Term
what are the laws of gasses
Definition
PV=PV
V/T=V/T volume is constant
P/T=P/T pressure is constant
(PV)/T=(PV)/T
Term
quiet inspiration muscle, air, and pressure changes explination
Definition
diaphragm contraction, external intercostals
increases volume air goes in (negative pressure breathing)
alveolar pressure 758 mmHg
Term
forced inhalation muscle movements and pressure changes
Definition
SCM, scalenes, pec minor
same air and pressure theory as quiet inspiration
Term
quiet expiration air, muscle, and pressure changes
Definition
alveolar pressure > atmospheric
elastic recoil decreases volume and increases pressure
alveolar pressure 762 mmHg
Term
what is active respiration
Definition
labored breathing when air movement out of the lungs is impeded
Term
forced expiration air, muscle, and pressure changes
Definition
contraction of internal intercostals and abdominal muscles (force diaphragm up)
same air and pressure as quiet
Term
how do you calculate compliance, what is the relationship to recoil
Definition
C = volume / pressure
inversly proportional to recoil
Term
what is ohm's law
Definition
resistance = (pressure in mouth - pressure in alveoli) / flow rate
Term
hoe is laminar flow claculated
Definition
R = (8nl) / (pi r^4)
radius is most important
Term
what is the opposition to flow
Definition
resistance
Term
what is eupena
Definition
normal respiration, adult 12-20 breaths per minute, infant higher
Term
bradypenia: what, why
Definition
slow breathing
in post anesthetic, barbituate overdose, hypnotics
Term
trachypenia: what, why
Definition
fast breathing
exercise, oxygenation issue, ridding CO2
Term
kussmaul breathing: what, why
Definition
deep, noisy (sigh), high rate
ill patient, blood gas issue, diabetic ketoacidosis
Term
biot's respiration: what, why
Definition
abrupt and irregular periods of apenia
increased intracranial pressure
Term
chyene-stokes respirations: what, why
Definition
small, shallow, increase in frequency and amplitude then go to apena in a 2 min cycle
damage to respiratory center, in newborns with premature respiratory systems
Term
apenia: what, why
Definition
cessation of breathing
sleep apena, upper airway obstruction
Term
dyspenia: what, why
Definition
difficulty breathing, shortness of breath with no relief
COPD, heart failure
Term
costal breathing: what, why
Definition
uses intercostals and extracostals to increase ventilation
singing, diaphragmatic breathing
Term
explain the process of coughing
Definition
deep inspiration, closure of rima glottis, blast of air out
Term
explain the process of hiccuping
Definition
spasmodic contraction of diaphragm and quick closure of rima glottis with a sharp inspiratory sound
Term
pneumothorax
Definition
pleural pressure = 0
lung collapses
Term
surfactant lack
Definition
in premature babies, alveoli collapse on exhalation
Term
what could reduce lung compliance
Definition
TB, scar tissue, pulmonary edema, reduced surfactant, paralysis
Term
what could increase lung compliance
Definition
emphysema
Term
what is the difference between diffusion and perfusion
Definition
diffusion: movement of gas across alveolar and capillary walls
perfusion: blood flow through pulmonary capillaries
Term
what is daltons law
Definition
each gas in a mix exerts its own pressure as it all other gasses wernt present
Term
what is henry's law
Definition
increasing pressure causes in crease in gas dissolving (in ratio with the solubility coefficient)
Term
what are the partial pressures in O2 and CO2 in the alveoli, arteries, and veins,
Definition
alveoli: 150 mmHg O2, 40 CO2
arteries: 100 O2, 40 CO2
cells: 40 O2, 45 CO2
veins: 40 O2, 45 CO2
Term
what factors effect rate of diffusion
Definition
partial pressure of the air (PO2 is 160)
surface area (70m2)
diffusion distance (1/2 micron)
solubility (CO2 is more soluble)
molecular weight
altitude
Term
functional residal capacity
Definition
volume of air in lungs after passive expiration (2,400 mL)
Term
expiratory reserve
Definition
exhaling after a normal passive exhale (1,200 mL)
Term
redidual volume
Definition
air in lungs after expiratory reserve (1,200 mL)
Term
calculating functional residual capacity
Definition
expiratory reserve + residual volume = 2,400 mL
Term
inspiratory reserve
Definition
inhaling after a normal inhale (3,100 mL)
uses SCM, scalenes, pec minor
Term
tidal volume
Definition
air in/out in quiet breathing (500 mL)
uses external intercostals and diaphgram only
Term
minute volume and how to calculate
Definition
gas inhaled per minute (6,000 mL)
tidal volume x respirations/min
Term
respiratory capacity and calculation
Definition
inspiratory reserve + tidal volume - 3,600 mL
Term
functional residual capacity and calculation
Definition
expiratory reserve + residual volume = 2,400 mL
Term
vital capacity and calculation
Definition
total lung capacity - residual volume = 4,800 mL
Term
what is the normal for alveolar ventilation (Va), how many breaths does it take to fully exchange functional residual capacity, why do we care
Definition
4,200 mL
6-7 breaths
slow turnover stabilizes respiratory control mechanisms and avoids large O2, CO2 and pH variations
Term
what is the Q V ratio
Definition
rate of O2 absorbed by blood via perfusion (Q)
rate of O2 entry into the lungs (V)
keeping them in proper ratio is important for function
Term
what is max Q/V for O2, what is normal
Definition
max: 250 mLO2/min
normal: 1000 mLO2/min
Term
what is normal V and normal Q
Definition
normal V = 4.2 L/min
normal Q = 5 L/min
Term
explain how the Q/V ratio is regluated
1. decreased O2 (dec. ventilation)
2. increased CO2 systemic
3. decreased CO2 systemic
4. increased CO2 lungs
Definition
1. constrict pulmonary arteries to redirect flow to areas with more gas
2. arterioles dilate
3. arterioles constrict
4. bronchioles dilate
Term
what is lung diffusion capacity, how is it tested
Definition
how well O2/CO2 are transferred (diffusion testing)
inhale CO, hold, and exhale. measure for CO in exhaled portion.
CO<40% is severe impairment
note: higher when supine due to increased pulmonary capillary volume
Term
what sould someone have a low lung diffusion capacity (DL)
Definition
membrane thickness, capillary surface area or volume, Hb concentration issues
obstructive lung disease, interstitial lung disease
left heart failure (pulmonary edema)
pneumonia
Term
what does body size tell us about the lungs
Definition
body size, lung SA, and lung volume are all prortional
Term
explain how Q/V is adjusted in exercise
Definition
1. increased cardial output, distends pulmonary capillaries increasing ventilation/perfusion matching
2. lung diffusion capacity increases SA to shorted diffusion time
(may cause incomplete O2 transfer)
Term
what is the difference between hypoexmic, anemia, ischemia, and histotixic hypoxia
Definition
hypoxemia: low PO2 <80 mmHg

anemic: normal O2, low Hb or saturation

ischemic: decreased flow, normal O2

histotoxic: cells cant use O2, perfusion issue (cyanide)
Term
concentration of O2 dissolved in plasma is proportional to...
Definition
PO2
Term
how much O2 is transported on Hb, describe the Hb molecule
Definition
98%
globulin and heme pigment and 4 Fe
Term
when Hb is 100% saturated, how much O2 does it have
what is the normal amount of Hb per 100 mL blood, at what point is this considered to be low
Definition
1.34 mL

15g/100mL (low is <13.5g male and 12g female)
Term
for 100 mmHg PaO2 how many mL O2 are there
Definition
20 mL O2/dL
Term
what raises the Hb saturation curve (more saturated)
what lowers it
Definition
raises: increased pH, decreased CO2, temp, BPG
lowers: decreased pH, increased CO2, temp, BPG
Term
what is the normal mmHg of O2 in...
1. systemic A
2. veins
3. veins during exercise
Definition
1. 60-100 mmHg
2. 40 mmHg
3. 20 mmHg
Term
what do thyroxae and HG do to the body
Definition
increase BPG in increased altutide, can cause airway obstruction and low tissue O2 (which would lead to increased BPG)
Term
how do you calculate Hb saturation
Definition
Hb amount (g/dL) x venous O2 content (g of O2/Hb) = max Hb saturation
Term
how do you calculate O2 amount in the blood
Definition
Hb amount (g/dL) x (mL of O2 /dL) = max O2 capacity
max O2 capacity x saturation % = O2 in the blood (mL/dL)
Term
how is CO2 transported, how much by each method
Definition
7% dissolved in plasma
23% on Hb globin (carbaminoHb)
70% on bicarbonate
Term
what is steady state
Definition
O2 consumed = O2 added
CO2 made = CO2 expired
Term
what is the respiratory quotient (RQ), what does it depend on, what is the average for aerobic and anaerobic respiration
Definition
CO2 made / O2 consumed
depends on nutrients needed in the body
0.8 average for aerobic
>1 for anaerobic
Term
explain the chloride shift, what is the function, what is the reaction
Definition
RBC releases Cl to plasma at the lungs and takes up a bicarbonate
RBC releases bicarbonate to plasma at the cells and takes up a Cl
function: keep plasma ion balance, buffer H+
enzyme: carbonic anhydrase
HCO3 + H -> H2CO3 -> CO2 in alveolar capillary (releasing Cl)
Term
what is the haldane effect
Definition
deoxygenation increases RBC CO2 affinity and decreases O2 (via bohr effect)
H + HbO2 <-> H + Hb + O2
enhances CO2 removal and RBC release when O2 combines
Term
where are the capillaries in the lungs, explain the walls and pressure
Definition
in alveolar septa
low pressure (but higher than venous)
thin, distensible
Term
what are the systolic, diastolic, mean and capillary pressures of the pulmonary artery and capillaries
Definition
systolic: 25 mmHg
dastolic: 8 mmHg
mean: 15 mmHg
capillary: 8-12 mmHg
Term
what is the pulmonary capillary wedge pressure, how is it calculated, what is the function
Definition
estimates pulmonary artery pressure at distal port and RA pressure at proximal port
central venous pressure (measured at the vena cava) is basically the same as RA EDP (preload) and can show changes in blood volume (LV faulure, MV stenosis)
Term
explain the effects of gravity on the lungs
Definition
going above the heart decreases pressure and below increases
pressure increases at base of lungs and decreases at apex (due to hydrostatic pressure involvement)
PA is constant, Pa and Pv change
Term
why would one have a high central venous pressure
Definition
deceased venous compliance (sympathetic activation, ang II, catecholamines)

increased venous return (increased BV)

right sided heart failure

standing to supine
Term
why would someone have a low central venous pressure
Definition
hypovolemia, decreased venous return
Term
explain the effects of gravity in the different zones of the lungs
Definition
zone 1 apex: PA > Pa > Pv
zone 2 3cm above heart: Pa > PA > Pv
zone 2 RV systole: Pa > PA
zone 2 RV diastole: PA > Pa
zone 3 base: PA > Pv > Pa
Term
how is vascular resistance calculated, why is it low
Definition
capillaries have thin walls (high compliance), minimal resting tone, short vessels

R = change in P / Q
Term
how is pulmonary vascular resistance calculated
Definition
PVR = (pulmonary MAP - LA pressure) / CO
normal = 10-15 which is 1/12 or SVR
Term
what things vasoconstrict
Definition
sympathetic, a-adrenergic agonist, thromboxane, endothelial, angiotensin, histamine, alveolar hypoxemia
Term
what things vasodilate
Definition
parasympathetic, ACh, B adrenergic, PEF1, prostacycline, NO, bradykinin
Term
how is systemic vascular resistance (SVR) calculated
Definition
SVR = (MAP - RA pressure) / CO
Term
how is blood flow calculated
Definition
flow = (Pa - Pv) / R
pulmonary flow (Q) = CO
Term
what is fick's principal
Definition
CO = (O2 consumption) / (PvO2 - PaO2)

VO2 = Q (CaO2 - CvO2)
oxygen consumption = Q(arterial O2 - venous O2)
Term
how is capillary flux calculated
Definition
Jv = Kf x NFP
Kf increases when capillary is less permeable. tells number or pores, size, and SA of capillary
Term
what does the reflection coefficient measure (RC)
Definition
capillary permeability
1 is impermeaible
Term
what are the starling's forces in the pulmonary capillaies
Definition
HP: 13 mmHg (varies with gravity)
IFHP: 0 or slighty negative
OP: 25 mmHg
IFOP: 17 mmHg
reflecion coefficient: 0.5
Term
jydrothorax
Definition
serous transudate due to CHF, renal failure, nephrosis, liver failure, or cancer
Term
emphymeia
Definition
pus in pleural cavity due to bacteral infection from adjacent pneumonia, abcess rupture, or trauma
Term
chylothorax
Definition
effusion of lymphe (chyle) due to trauma, inflammation, or obstruction
Term
hemothorax
Definition
blood in pleural cavity due to surgery, injury, tumor, or aneurysm
Term
what does bronchial circulation supply, where does it branch from, where does it drain
Definition
CT or lungs and airwas with blood
comes from aorta, veins drain into pulmonary veins
Term
what are the steps of respiration regulation
Definition
sensory
sensory neuron
central controler
somatic motor neuron
effector
Term
what are the sensors that gather information to regulate respiration
Definition
chemical influences
chemoreceptors
pulmonary receptors
Term
what are the central controllers of respiration regulation, what are they controlled by overall
Definition
involuntary: medulla respiratory center, pons respiratory center (pneumotaxic and apneustic), limbic system, reticular activating system

volunary: cerebral cortex, avoiding noxious gas or water

overall control: somatic motor system
Term
where are central chemoreceptors, what are they sensitive to
Definition
chemosensitive area of medulla connected to respiratory center
sensitive to CO2 and H (especially in brain tissue)
Term
where are peripherial chemoreceptors, what makes them activate, what are they connected to and how
Definition
in aortic and carotid bodies
activated at O2 80mmHg (normal 95-100)
activated at CO2 > 40mmHg
activated at pH < 7.4

connected to respiratory center by CN IX and CN X
Term
what are the pulmonary receptors that regulate respiration, what are they stimulated by, what reflexes do they do
Definition
pulmonary stretch (mechanoreceptors): hering-breuer volume and deflation reflexes

lung irritant receptors: reflex hyperpena

proprioceptors: respond to muscle movement and joint reflex, transmits directly to respiratory center

J receptors (juxtacapillary): respond to decrease in oxygenation (pulmonary edema, emboli, pneumonia)
Term
explain the hering-breuer volume reflex
Definition
receptors between smooth muscle of airways prevent over inflation
sends AP via vagus to respiratory center inhibiting inspiration area of medulla and apneustic area of pons
Term
explain the hering-breuer deflation reflex
Definition
shortens exhalation when lung is deflated
excessive deflation activates inspiratory neurons
prevents atelectasis (deflation), opens collapsed lung
Term
how are neurons organized in the medulla respiratory center
Definition
ventral: inspiration and expiration
dorsal: mostly inspiration
some cells function for both
Term
what area of the brain determines breathing rhythm, explain the rhythm, how does it do this
Definition
medulla respiratory center
inspiratory neurons active 2 sec
expiratory neurons inactive in quiet breathing (3 sec if active)

it does this with pre-botzinger complex
Term
what is the pre-botzinger complex
Definition
neuron with intrinsic bursting properities that stimulate neurons dorsal root ganglion in upper medilla respiratory center
Term
where is the pneumotaxic center, what does it do
Definition
upper pons
inhibits apneustic center, coordinates transition between inspiration and expiration, establishes normal respiratory rhythm
Term
what does the apneustic center do
Definition
sends impulse to prolong inspiration, controling depth
can kick start inspiration if you are not breathing
Term
how does the limbic system regulate respiration
Definition
causes emotional responses
Term
how does the reticular activating system regulate respiration
Definition
cholinergic and adrenergic compounds exhibit synergic and competitive effects that regulate thalamocortical activity and correspond with behavior
stimulates respiratory ventilation when active and reduces it whe not active (sleep)
Term
what are dissorders of the reticular activating system
Definition
schozophrenia, PTSD, parkinsons, REM behavior disorder, narcolepsy, progressive supranuclear palsy (PSP), depression, autism, alsheimers, ADD, sleep apnea
Term
what is the difference between sleep apnea, obstructive apnea and central apena
Definition
sleep: decreased ventilation during sleep

central: reduced CNS respiratory drive and intermitent cesation. hypoxia wakes them up. obesity and CNS malformation relations.

obstructive: increased upper airway resistance (laryngospasm, fat on neck) hypoxia wakes someone up

all can cause sudden infant death syndrome
Term
what can depress respiratory center spontaneous activity
Definition
drug overdose, ondine's curse, congenital central hypoventilation syndrom
Term
how can vonuntary control of the respiratory system be overridden
Definition
increased H or CO stimulation in respiratory centers
Term
what somatic motor neurons control respiraton, what muscles, what is a rule for them
Definition
inspiratory neurons: control muscles of inspiration
expiratory neurons: control muscles of axpiration, only active when forced

they are mutually inhibitory: not active at the same time
Term
hypo vs hyper ventilation
Definition
hypo: not enough for metabolic need CO2 > 42 mmHG

hyper: too much ventilation for need CO2 < 38 mmHg
Term
hyper vs hypo capnia
Definition
hyper: increased CO2 and H. stimulates central chemoreceptors and respiratory center, causes inspiration and hyperventilation

hypo CO2 < 40 mmHg. chemoreceptors not stimulated, body waits until CO2 accumulates to 40 mmHg
Term
what does decreased ventilation cause in the body
Definition
decreased BP, fear (via limbic system), increased temp, prolonged pain
Term
what occurs in valsalva
Definition
air is pushed against closed glottis, external sphinctor relaxed, increased intra-abdnominal pressure, respiratory muscles contract filling lungs and increasing pressure, pressure on sigmoid and rectum
Term
what occurs that affects respiration in a smoker
Definition
nicotine: constricts terminal bronchiles
mucous: in excess due to irritants trapping WBC so they cant fight
CO: binds to Hb
irritants: increase mucous, inhibit cilia, destory elastic causing emphysema
scar tissue: replaces elastic tissue
Term
PACO2 = PaCO2 = ?
what is the equation that utilizes this relationship
Definition
40 mmHg

PACO2 = VCO2 /VA
VCO2: CO2 delivered to lungs
PACO2:how adequate ventilation is for CO2 production
VA: ventilation
Term
what causes high PACO2 / hypercapnia
Definition
ventilation is inadequate for CO2 production
failure in respiratory system
CNS depression
weak respiratory muscles
too much dead space
increased CO2 production
Term
when should you never administer a sedative and why
Definition
when CO2 is high because they decrease ventilation (VA)
Term
what causes low PACO2 / hypocapnia
Definition
ventilation is in excess of CO2 production
<35 mmHg
hyperventilation
Term
why cant you assess PACO2 at the bedside
Definition
cant determine dead space or rate of CO2 production
breathing hard does not always mean hyperventilation
no direct relationship to respiratory rate and PACO2
Term
how can PAO2 be calculated
what is normal PAO2
Definition
PAO2 = PiO2 - PACO2 / R

R= respiratory quotient

PAO2 = 99.7 mmHg
Term
what is the normal differene between PAO2 and PaO2
Definition
<12
or
8+ 20% of their age
Term
how is the respiratory quotient calculated
Definition
CO2 made / O2 consumed
Term
what determines PAO2
Definition
ventilation perfusion inbalance
pulmonary diffusion capacity
O2 entering pulmonary A
Term
what is the henderson-hasselbalch equation
what is the equation for the bicarbonate buffering syste,
Definition
pH = pKa + log(base/acid)

pH = pKa + log(bicarb/(0.3xPaCO2))
Term
what is the acute response to increased altitude
Definition
hypoxia driven hyperventilation
partial reversal of PAO2
increased VA > PCO2 decrease
Term
what is the chronic response to increased altitude
Definition
body adjusts to low PO2 (160 is normal)
hypoxia stimulates EPO production in kidney increasing RBC
Term
what does spirometry measure, how is it done
Definition
pulmonary funnction test
volume and speed of inhale and exhale
patient inhaled deep and exhales hard, then rapidly inhales (when asseessing upper airway obstruction)
Term
what are infectious agents of the respiratory system and they symptoms
Definition
most common: pneumococcus and strep

community aquired: strep
hospital aquired: S. aureus MRSA

cause inflammation, increased fluid, reduction of SA, reduced V/Q, hypoxia, hypercapnia
Term
what are the respiratory obstructive diseases, what are the symptoms / attributes / causes (6 conditions)
Definition
lumen: excess secretions, aspiration

airway: contraction of smooth muscle

alveoli: destruction

chronic inflammatory: allergins, infections, cold air, exercise, drugs. induce IgE and bronchoconstriction

COPD: noxious gas and genetics cause it. hypoxia, hypercapnia, airway narrowed, poorly reversible

bronchiectasis: irreversible dilation of bronchial tree, inflammation, and easy collapse. caused by necrotising bacteria, genetics, TB
Term
what are the restrictive diseases of the respiratory system
Definition
emphysema, cystic fibrosis, interstitial lung disease
Term
what are the effects on the lung in emphysema
Definition
loss of elastcity, increased compliance
alpha 1 antitrypsin deficiency
small airway collapse
panacinary
centroacinary
chronic bronchitis
Term
panacinary
Definition
destruction of alveoli in young adults with chronic bronchitis
Term
centroacinary
Definition
detruction of bronchiole mucosa in older adults with chronic bronchitis
Term
chronic bronchitis
Definition
cyanosis due to decreased sensitivity to CO2
prolonged PCO2 raised causes respiratory center to be insensitive to hypercapnia (blue bloaters)
Term
what are the differences when someone has mild emphysema
Definition
maintains O2 levels by hyperventilating (pink puffers)
Term
what causes respiratory (and GI) issues in cystic fibrosis
Definition
thick mucous in digesive tract causes poor growth, malnutrition, and infection
mucous in bronchi cause breathing issues
cystic fibrosis proteins and Cl channels do not let Cl out of cells
Term
what is another name for interstitial lung disease, what areas does this disease impat
Definition
diffuse parenchymal lung disease (DPLD)

impacts: interstitium of lung, alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues
Term
what are the causes of interstitial lung disease
Definition
inhaled substances
drugs (antibiotics, chemo)
CT disease (sclerosis, RA)
infection (pneumonia, TB, sarcodisis)
milgnancy
Term
what impact does interstitial lung disease have on the lung and body
Definition
hypoxemia
pulmonary hypertension
cor pulmonale: right sided heart failure
respitory failure
Term
what is pleuritis, what makes it worse
Definition
inflammation of pleura
worse by deep breath, may referr to shoulder
Term
what diseases have pleural effusion
Definition
hydrothorax, emphysema, ehylothorax, hemothorax, eudate
Term
what causes eudate
Definition
inflammation
malignancy
infection: TB, empyema
Term
what are the different types of pneumothoraxx
Definition
primary spontaneous: air filled blister on lung surface ruptures
secondary spontaneous: due to lung disorder (COPD)

traumatic

tension: pleural pressure > atmospheric. air can enter but not leave
Term
what is atelectasis, what is the causes
Definition
incomplete expansion of lung
causes: post surfical, pleural effusion, obstruction
Term
what can cause issues with respiratory blood flow
Definition
pulmonary embolism
pulmonary hypertension
Term
pulmonary embolism: most likley spot, things that block stuff, symptoms
Definition
DVT is most likley
blocked by: thrombus, air pocket, fat, bone, tumor
syptoms: chest pain, dyspena, trachypena
Term
what causes acure respiratory distress syndrome
Definition
injury to respiratory membrane, aspiration of gastric contents, drugs, toxins, drounding, infection, trauma, shock
Term
what causes respiratory failure
Definition
impaired ventilation: obstruction, injury
ventilation perfusion miss match: COPD, pneumonia
impaired diffusion: edema, ARDS
Term
what is the cause of idiopathic (primary) pulmonary hypertension
Definition
inherited, not really known
Term
waht causes secondary pulmonary hypertension
Definition
increased pulmonary pressure: MV stensosis, LV heart failure
increased pulmonary BV: atria or ventricle septal defect
pulmonary vascular obstruction: embolism
hypoxemia: vasoconstriction
Term
what are the complicatins of pulmonary hypertension
Definition
cor pulmonale
blood clots
arrhythmia
hemoptysis (bleeding into lungs)
Term
what is physiological dead space
Definition
air not participating in gas exchange(nose, trachea, etc)
it is expired first, before alveolar air
Term
how do you measure dead space
Definition
patient takes in a deep breath of O2 (reminder: this does not replace all of the alveolar air) and expires. the first portion of air comes out of dead space. alveolar air has more nitrogen
Term
what is the normal dead space volume
Definition
150 mL, increases with age
Term
what is the difference between anatomic and physiologic dead space
Definition
anatomic dead space is normal: nose, throat, trachea, etc

alveoli that are not participating in gas exchange (abnormal) PLUS the anatomical dead space = physiological
Term
how is physiological dead space calculated
Definition
alveolar dead space + anatomical dead space
Term
what is alveolar ventilation
how is it calculated
what is the normal
Definition
total volume of new air enering the alveoli per minute

VA = VT - VD
VA: volume of alveolar ventilation per min
VT: tidal volume
VD: physiological dead space volume

normal VA: 4200 mL/min
Term
how is physiological dead space related to PeCO2
Definition
physiologic dead space / tidal volume
=
(arterial CO2 - CO2 of mixed expired air) / (arterial CO2)

VD/VT = (PaCO2 - PeCO2) / PaCO2
Term
how is the rate of diffusion calculated
Definition
V = (D x A x change in P) / change in X

D: diffusion coefficient
A: surface area
x: membrane thickess
P: gas partial lpressure
Term
how is the diffusion coefficient calculated
Definition
D is proportional to soulblity / sq root of MW
Term
what is the P of alveoli and pleura at rest, inhale, and exhale
Definition
rest: alv 760, pleural 756
inhale: alv 758, pleural 754
exhale: alv 762, pleural 756
Term
how much does the alveolar pressure and the pleural pressure deviate
Definition
alveolar: +- 2
pleuralo: -4 or -6
Term
how does the chest wall resist lung collapse, what is the result of this
Definition
holds lungs away making a negative pleural pressure
Term
what is the difference between resistance and compliance
Definition
resistance can be overcome over time
Term
what is the normal PO2 in alveoli, what is the max
Definition
104 mHg, 250
Term
when V/Q changes, what are the normal patterns of change
Definition
high V/Q is caused by decreased Q
low V/Q is caused by decreased B
Term
what causes low and high V/Q
Definition
high: pulmonary embolism, R. AV or pulmonary valve issue

low: asthma, COPD, pneumonia
Term
how do you calculate CaO2
Definition
[Hb] x (amount you could bind if fully saturated (1.34)) x (% saturated to correct)
Term
how is cardiac output calculated using fick's law
Definition
CO = VO2 / (Ca-Cv)
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