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patho lung
altered ventilation/diffusion
| Question | Answer |
|---|---|
| ventilation regulation | medulla/pons (autonomic) ANS tone lung receptors chemoreceptors |
| central chemoreceptors | sense cerebrospinal fluid pH/PaCO2 which adjust rate/depth of breathing central indicating brainstem |
| what does CSF fluid represent | PaCO2 -- remember lung buffer system |
| peripheral chemoreceptors | carotid/aortic bodies sense PaO2 function to increase ventilation when low |
| PaO2 | partial pressure of O2 in arterial blood, measured in mmHg |
| PaCO2 | partial pressure of CO2 |
| what effect does exercise and fever have on blood gas | increased CO2 production resulting in increased drive |
| compliance (of lungs) | ease of lung/chest expansion |
| decreased lung compliance seen in | fibrosis edema ARDS |
| increased lung compliance seen in | emphysema |
| elastic recoil | spring force driving passive exhalation |
| what does loss of elastic recoil cause | small airway collapse/air trapping |
| airway resistance is determined by | airway radius (bronchus) |
| what causes increased airway resistance | increased with bronchospasm, mucus/edema |
| pursed lip breathing | gentle expiratory back pressure (as in PEEP) splint small airways open, slows flow and prolong exhalation = less air trapping + improve CO2 removal |
| tidal volume of adult | around 500 mL resting |
| FEV1 | forced expiratory volume in 1 second |
| FVC | forced vital capacity, total volume exhaled |
| FEV1/FEV ratio | decreased ratio (<1) = obstructive pattern normal/high ratio (>1) = restrictive pattern |
| restrictive FEV1/FEV ratio | greater than 1 |
| obstructive FEV1/FEV ratio | smaller than 1 |
| RV | residual volume |
| TLC | total lung capacity |
| VC | vital capacity |
| what spirometry findings indicate air trapping | increased residual volume (RV) increased RV/TLC ratio |
| type 1 alveolar cells | structure/gas exchange |
| type II alveolar cells | surfactant production |
| what does diffusion depend on | partial pressure solubility membrane thickness surface area |
| what gene is affected in cystic fibrosis | CFTR gene |
| SaO2 | pulse oximetry % hemoglobin binding sites occupied |
| states of hypoxemia (SaO2) | 91-94% = mild 86-90% = moderate <85% = severe |
| states of hypoxemia (PaO2) | 80-100 = normal 60-80 = mild 50-60 = moderate <50 = severe |
| hyperoxemia levels in SaO2 and PaO2 | 100% (SaO2) >120 mmHg (PaO2) |
| hypercapnia | elevated CO2 |
| DLCO | diffusing capacity for carbon monoxide measure how well O2 gas transfer across alveolar-capillary membrane |
| DLCO is low in | fibrosis and emphysema |
| mechanisms of impaired ventilation | airway narrowing/obstruction neural/muscular disruption |
| what results from impaired ventilation | increased resistance ineffective clearance hypoventilation |
| low V/Q (what is it and conditions it can represent) | shunting perfusion without ventilation PNA/atelectasis |
| high V/Q (what is it and conditions it can represent) | dead space ventilation w/o perfusion Pulm embolus |
| mixed uneven V/Q | COPD/Asthma |
| impaired diffusion | decreased surface area increased thickness decreased partial pressure gradient increased CO2 production |
| causes of decreased partial pressure gradient | altitude/low FiO2 |
| FiO2 | fraction of inspired oxygen % of O2 being breathed in |
| causes of increased membrane thickeness | fibrosis, edema , ARDS (hyaline membranes) |
| causes of decreased surface area | emphysema |
| hypoxemia leads to | hypoxia - cellular O2 deficit |
| hypercapnia leads to | respiratory acidosis |
| anaerobic metabolism leads to | lactic acidosis -> organ dysfunction |
| pulm embolus work up | V/Q scan or CT pulmonary angiography |
| POCUS | point of care ultrasound checks pleural effusion, pneumothorax |
| bronchoscopy purpose | remove foreign objects/obstruction lung biopsies |
| PEFR | peak expiratory flow rate bedside trend for asthma |
| pneumonia pathophysiology | infection of bronchiole/interstitium/alveoli inflammation -> exudate/consolidation -> impaired O2 diffusion dehydration risk |
| types of pneumonia | typical vs atypical vs viral |
| PNA signs and symptoms | fever/chills cough/purulent sputum (infection) pleuritic pain SOB and crackles confusion in older adults |
| diagnosis for PNA | CBC CXR sputum culture pulse ox/ABG V/Q scan (as necessary) |
| treatment for PNA | pathogen guided abx, O2 supplementation, IV fluids, CPT (chest physiotherapy) antipyretics/analgesia |
| COPD | progressive irreversible airflow limitation common to have emphysema + chronic bronchitis (and or asthma) |
| alpha 1 antitrypsin deficiency is seen in | emphysema |
| diagnosis for emphysema | PFT hyperinflation in CXR low A1AT |
| emphysema | irreversible alveolar destruction leading to decreased elastic recoil and air trapping |
| emphysema tx | bronchodilators, smoking cessation, steroids, mucolytics, abx prn, O2 supplementation A1AT augmentation LVRS/transplant |
| LVRS | lung volume reduction surgery, tx for emphysema |
| chronic bronchitis | chronic cough of 3 months every year for 2 or more consecutive years |
| what causes bronchitis | airway inflammation/edema, mucus gland hyperplasia, cilia loss, wall thickening/fibrosis |
| asthma triggers | IgE mediated allergens, smoke, dust mites, exercise, cold air, illness, anxiety |
| ARDS | acute respiratory distress syndrome severe lung inflammation (often sepsis, aspiration, trauma, toxic fumes) |
| ARDS pathophysiology | increased permeability -> pulmonary edema/loss of surfactant -> atelectasis hyaline membranes thicken A-C barrier causing profound diffusion impairment |
Created by:
sleepingbear
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