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Pulmonary
FA complete review part 2 Physiology
| Question | Answer |
|---|---|
| In lung volume terms, a capacity is: | The sum of at least 2 or more physiologic volumes |
| What is the inspiratory reserve volume? | Air that can still be breathed in after normal inspiration |
| What is the the term used for the amount of air that can be breathed in or inspired after a normal inspiration? | Inspiratory reserve volume |
| What is the tidal volume? | Air that moves into lung with each quite inspiration |
| What i sthe normal or most common value of Tidal volume? | 500 mL |
| A person with a _________ mL tidal volume is consider normal. | 500 |
| Deficinot of Expiratory reserve volume | Air that can still be breathed out after normal expiration |
| In lung volume terminology the word "reserve" is used to describe: | Amount of air that can be still be inspired or expired after NORMAL, inspiration or exahalation, respectively. |
| What is the residual volume? | Air in lung after maximal expiration |
| What lung volume is the one that describes air left in lung after a person performs a maximal expiration? | Residual volume |
| RV or any lung capacity that includes RV cannot be measured by ____________. | Spirometry |
| What lung volume causes inability to measures lung volumes with Spirometry? | Residual volume |
| IRV + TV = | Inspiratory capacity |
| Air that can be breathed in after normal exhalation. | Inspiratory capacity |
| What two volumes are added to achieve Inspiratory capacity? | Inspiratory reserve volume and Tidal volume |
| Why is FRC not measured by Spirometry? | FRC includes RV |
| What is the definition of Functional residual capacity? | Volume of gas in lungs after normal expiration |
| Maximum volume of gas that can be expired after a maximal inspiration. | Vital capacity |
| What volumes make up Vital capacity? | TV+IRV+ERV |
| Total lung capacity (TLC) = | IRV + TV + ERV + RV |
| What is the definition of TLC? | Volume of gas present in lungs after a maximal inspiration |
| What is the approximate volume of TLC? | 6.0 Liters |
| RV approximately is ____________ liters. | 1.2 |
| What is the abbreviation of physiologic dead space? | V D |
| What makes up the Physiologic dead space? | Anatomic dead space of conducting airways plus alveolar dead space. |
| What part of the lung is the major contributors to alveolar dead space? | Apex |
| Volume of inspired air that does not take part in gas exchange | Physiologic dead space |
| What is the equation for Physiologic dead space? | VT x (PaCO2 - PECO2)/ (PaCO2) |
| What conditions may increase Physiologic dead space? | Lung diseases with V/Q defects |
| What is the equation for Minute Ventilation? | = VT x RR |
| What is the abbreviation of minute ventilation? | VE |
| What is the definition of Alveolar ventilation? | Volume of gas that reaches alveoli each minute |
| VA = | Alveolar ventilation |
| VA = (equation) | (VT - VD) x RR |
| Elastic recoil definition | Tendency for lungs to collapse inward and chest wall to spring outward |
| Which point the inward pull of lung is balanced by outward pull of chest wall? | At FRC |
| What kind, (-) or (+), intrapleural pressure prevents atelectasis? | Negative |
| At FRC (pressure related): | 1. Airway and alveolar pressures equal atmospheric pressure 2. Intrapleural pressure is negative |
| What is compliance? | Change in lung volume for a change in pressure |
| Compliance is inversely proportional to ___________ ____________. | Wall Stiffness |
| High compliance = | Lung is easier to fill |
| What conditions are associated with high compliance? | Emphysema and normal aging |
| Low compliance = | Lung is harder to fill |
| What conditions are associated with low lung compliance? | Pulmonary fibrosis, pneumonia, NRDS, and pulmonary edema |
| How is surfactant related or associated with compliance? | Surfactant increases compliance |
| What is hysteresis? | Lung inflation curve follows a difference curve than the lung deflation curve due to need to overcome surface tension forces in inflation. |
| What are the changes seen in lung compliance and chest wall compliance in the elderly? | Increase lung compliance and a decrease chest wall compliance |
| What are the two forms of hemoglobin? | 1. Deoxygenated 2. Oxygenated |
| How many polypeptides subunits compose the hemoglobin? | 4 subunits |
| What are the polypeptides subunits that make up hemoglobin? | 2 alpha and 2 beta |
| Which form of hemoglobin has low affinity for Oxygen? | Deoxygenated |
| _________________ has a very high affinity for oxygen. | Oxygenated |
| Which type of Hb has higher oxygen affinity, fetal or adult? | Fetal hemoglobin |
| What are the subunits of fetal hemoglobin? | 2 alpha and 2 gamma |
| Hemoglobin acts as a ________ for H+ ions. | Buffer |
| How is myoglobin composed? | A single polypeptide chain associated with one heme moiety. |
| Does myoglobin and hemoglobin have higher affinity to oxygen? | Myoglobin |
| What are the effects of adverse hemoglobin modifications? | Tissue hypoxia from decreased oxygen saturation and decreased oxygen content. |
| What 2 common conditions that lead to hemoglobin modifications? | Methemoglobin and Carboxyhemoglobin |
| What is methemoglobin? | The replacement of Fe2+ in hemoglobin by Fe3+. |
| What is the common or regulate of iron in Hb? | Reduced state (Fe2+) |
| What is the common presentation of methemoglobinemia? | Present with cyanosis and chocolate-colored blood. |
| What is the common treatment for Methemoglobinemia? | Methylene blue and vitamin C |
| How do nitrates cause poisoning? | By oxidizing Fe2+ to Fe3+ |
| What is Carboxyhemoglobin? | Form of Hb bound to CO in place of oxygen. |
| What kind of shift in the oxygen-Hb curve is seen with Carboxyhemoglobin? | Left shift |
| Relation between CO and Hb: | CO binds to Hb and with 200x greater affinity to than oxygen |
| Which, carbon monoxide or Hb, has greater oxygen affinity? | Carbon monoxide |
| What is the clinical presentation of CO poisoning? | Headaches, dizziness, and cherry red skin |
| Cherry red skin is a key features of: | CO poisoning |
| What are common causes of CO poisoning? | Fires, car exhaust, or gas heaters |
| What is the treatment for CO poisoning? | 100% oxygen and hyperbaric O2 |
| Cyanide poisoning is due to: | Inhibition of aerobic metabolism via complex IV inhibitor leading to hypoxia unresponsive to supplemental oxygen and increase anaerobic metabolism. |
| What are the classic findings of CN poisoning? | Almond breath odor, pink skin, and cyanosis |
| What is the treatment of CN poisoning? | Induced methemoglobinemia |
| What is the first step in Induced methemoglobinemia in treating CN poisoning? | Nitrates (oxidize hemoglobin to methemoglobin, which traps cyanide) |
| How do nitrates work in treating cyanide poisoning? | Hb oxides into methemoglobinemia, which can trap cyanide, converting it into cyanmethemoglobin |
| What is the second step of CN poisoning treatment by induced methemoglobinemia? | Thiosulfates, in order to concert cyanide to thiocyanate, and be renally excreted |
| What is the shape of the oxygen-hemoglobin curve? | Sigmoidal |
| Why does myoglobin does not show positieve cooperativity? | Because it is monomeric |
| What does a shift to the right represent in the Oxygen - hemoglobin curve? | Decrease in HB affinity for O2 ( facilitates unloading O2 to tissue) |
| Shifting to the curve (O2-Hb) to the left ---> | Decreased O2 unloading --> renal hypoxia --> increased EPO synthesis |
| What is synthesized in increased amounts when there is a shift to he left in the Oxygen-Hb curve? | EPO |
| What direct stimulation causes increased synthesis of EPO during a Left-shift of Oxygen - Hemoglobin curve? | Renal hypoxia |
| Fetal Hb has a _____________ shift in the oxygen-hemoglobin curve. | Left |
| Common actions/levels that cause a right shift of the Oxygen hemoglobin curve: | Increase in: H+ content (decrease pH) PCO2 Exercise 2, 3-BPG High altitude Temperature |
| What is the abbreviation of partial pressure of O2 in arterial blood? | PaO2 |
| With a decrease in Hb, what are the changes in O2 content, O2 saturation, and PaO2? | - DECREASE in Oxygen content in arterial blood - No changes in O2 saturation and PaCO2 |
| Which condition is seen with an obvious increase in Total O2 content? | Polycythemia |
| How is the normal/healthy description of the Pulmonary circulation? | Low-resistance and high compliance |
| What two pressures exert exact opposite effects on Pulmonary and systemic circulation? | PO2 and PCO2 |
| What is the result in pulmonary circulation with a decrease in PAO2? | Hypoxic vasoconstriction that shifts blood away from poorly ventilated regions of lung to well-ventilated regions of lung. |
| Normal health is described with a ________________ limited pulmonary circulation and gas exchange. | Perfusion |
| What does a Perfusion limited circulation entails in respect to gas equilibrium? | O2, CO2, and N2O equilibrates early along the length of the capillary |
| What conditions lead to a person to become Diffusion limited in respect to Pulmonary circulation? | Emphysema, fibrosis, and exercise |
| Which type of lung diffusion depicts that gas does not equilibrate by the time blood reaches he end of the capillary? | Diffusion limited |
| What are the most common consequences of Pulmonary hypertension? | Cor pulmonale and subsequent right ventricular failure. |
| Area available for optimal gas exchange is decreased in _________________. | Emphysema |
| What condition/pathology decreases the alveolar wall thickness making less optimal for gas exchange? | Pulmonary fibrosis |
| What is DLCO? | The extent to which CO, a surrogate for Oxygen, passes from air sacs of lungs into blood. |
| Decreased oxygen delivery to tissue | Hypoxia |
| Decrased PaO2 is known as ___________________. | Hypoxemia |
| Ischemia is defined | Loss of blood flow |
| What conditions lead to Hypoxemia with an increased A-a gradient? | V/Q mismatch, Diffusion limitation, right-to-left shunt |
| What are conditions that produce hypoxemia with a NORMAL A-a gradient? | High altitude and hypoventilation |
| A person on heroin will produce---> | Hypoxemia due to hypoventilation but with a normal A-a gradient |
| What is the ideal value to V/Q? | 1 |
| What is the approximated V/Q at the apex? | 3 |
| What is the approximated V/Q at the base? | 0.6 |
| Which part of the lung has "wasted ventilation"? | Apex |
| Which part of lung, apex or base, has "wasted perfusion"? | Base |
| Both, perfusion and ventilation are greater at the _____________ of the lung. | Base |
| Why do exercise causes V/Q to approach to 1? | Vasodilation of apical capillaries |
| An organism that likes or thrives on high oxygen will be found most likely in which part of the lung? | Apex |
| A shunt or obstruction cause the V/Q to approach to _______. | Zero |
| A blood flow obstruction will produce that the V/Q approaches to ____________________. | Infinity |
| A V/Q value that approaches infinity indicates? | Blood flow obstruction |
| What is a common example of blood flow obstruction causing an infinity value of V/Q? | Physiologic dead space |
| Which kind of pathological cause of V/Q changes is treated or improved with 100% oxygen? | Blood flow obstruction |
| A pulmonary embolism will cause the V/Q to reach ____________. | Infinity |
| P A > Pa > Pv is seen in which zone of the lung? | Zone 1 |
| Pa> Pv > P A is representative of which lung zone? | Zone 3 |
| Decreased in V/Q is seen in Zone ____ of the lung. | 3 |
| What form is most carbon dioxide (CO2) transported in the body? | HCO3- |
| What is the abbreviation of carbaminohemoglobin? | HbCO2 |
| How much CO2 is transported as HbCO2? | 21-25% |
| Approximate percentage of CO2 transported as HCO3-? | 70% |
| What is the least form of CO2 transportation? | Dissolved CO2 (5-9%) |
| At which part does CO2 bind to Hb? | At the N-terminus |
| What type of Hb is favored by CO2? | Deoxygenated |
| The oxygenation of Hb in the lungs causes? | Dissociation of H+ from Hb |
| What is the Haldane effect? | The oxygenation of Hb in lungs promotes the dissociation of H+ from Hb, which shifts equilibrium toward CO2 production; this CO2 is released then from RBCs |
| The Haldane effect occurs in the ______________. | Lungs |
| Where does the Bohr effect take place? | Peripheral tissues |
| Incrase H+ form tissue metabolism shift curve (oxygenation) to right, unloading Oxygen. | Bohr effect |
| Which part of blood carries most of CO2? | Carried as HCO3- in plasma |
| What is an important enzyme inside the RBC involved in CO2 transport? | Carbonic anhydrase |
| What enzyme is required in the RBC to convert CO2 + water into HCO3- and be transported properly? | Carbonic anhydrase |
| What happens once CO2 is converted to HCO3- within the RBC? | It gets shunted to the plasma to be transported. |
| What effect does chronic high altitude conditions cause to ventilation? | Increase |
| High altitude increases the synthesis of _________________, which cases increased levels of _______- and ____________. | Erythropoietin; Hematocrit and Hemoglobin |
| What is the renal compensation to high altitude? | Increase renal excretion of HCO3- to compensate for respiratory alkalosis |
| What diuretic is used to further compensate renal excretion of HCO3- in cases of respiratory alkalosis? | Acetazolamide |
| What are important lung complications of high altitude? | Chronic hypoxic pulmonary vasoconstriction reesults in pulmonary hypertension and RVH. |
| Pulmonary hypertension and RVH are possible/severe consequences of chronic hypoxic pulmonary vasoconstriction due to _________________________________. | High altitude |
| What is the response of pH during exercise? | Decrease pH due to secondary lactic acidosis |
| What are common responses to exercise in respect to respiratory conditions? | 1. Increased CO2 production 2. Increased O2 consumption 3. Increased ventilation 4. Increased pulmonary blood flow due to incrase cardiac output |
| What condition or environment causes increased mitochondria production? | Response to high altitude |
| What are the changes to PaO2 and PaCO2 to exercise? | No changes |
| What type of blood, venous or arterial, is seen with changes in levels as response to exercise? | Venous |
| What occurs to the VENOUS CO2 content in blood during exercise? | Increases |
| Is venous O2 (oxygen) content, increased or decreased, as response to exercise? | Decreased |
| Describe the venous content of carbon dioxide and oxygen is a person that just finished a marathon? | Increased venous CO2 and decreased venous O2, but normal PaO2 and PaCO2. |
Created by:
rakomi
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