Term
| What is the difference between type 1 and type 2 respiratory failure? |
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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 |
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Term
| List a clinical cause for cardiogenic and non-cardiogenic pulmonary edema. |
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Definition
| Cardio- CHF; Non-cardio ARDS - Acute Respiratory Distress Syndrome |
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Term
| In ARDS what three things cause proteinaceous fluid leak into the lung? |
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Definition
| The diffuse alveolar damage results in vascular epithelial permeability, low HP, and low colloid osmotic pressure. |
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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? |
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Definition
| Trick question: they all occur in both, but ARDS is more severe than ALI. |
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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? |
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Definition
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Term
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Definition
| A collapse of part or all of a lung, specifically referring to collapsed alveoli. |
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Term
| Why can PCO2 be normal even with hypoxemia in ARDS? |
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Definition
| J-receptors sense stretch with edema causing increased RR, usually causing hypocapnia. |
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Term
| If ARDS is not treated what permanent change can take place over time to the lung? |
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Definition
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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. |
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Definition
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Term
| What are two adverse effects of PEEP? |
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Definition
| Decreased CO due to increased thoracic pressure, over-inflation, shifts but does not reduce edema |
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Term
| What are the benefits of PEEP? |
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Definition
| Change shunting to V/Q mismatch which allows the lung to respond to oxygen, no de-recuitment of alveoli, increase PaO2, increase FRC |
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Term
| With a mechanical ventilator over-stretching of the lung can exacerbate injury, what is the way to minimize this? |
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Definition
| Lower tidal volumes and use pressure limited ventilation |
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Term
| What is the mortality rate of ARDS? |
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Definition
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Term
| What is a person’s PaO2 during hypoxic failure? |
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Definition
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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? |
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Definition
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Term
| When a patient is hypoxic you calculate the A-aPO2, what is the equation to calculate alveolar PO2? |
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Definition
| 713xFiO2-(PaCO2/R), R is usually .8, FiO2 in room air is .21 |
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Term
| What happens to the A-a gradient when a patient has hypercapnic respiratory failure versus hypoxic failure? |
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Definition
| Hypercapnic= gradient is normal, hypoxic= gradient increased |
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Term
| If a patient has hypoxia and you calculate the A-a gradient how would you diagnose the respiratory failure? |
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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. |
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Term
| Hypercapnic respiratory failure is defined as respiratory acidosis with pH<7.4 and PaCO2>______? |
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Definition
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Term
| Which of the following result in higher CO2 production- fever, sepsis, burns, thyroidtoxicosis, exercise, over-feeding patients with bad lungs. |
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Definition
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Term
| In hypercapnic respiratory acidosis what is the most common problem? |
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Definition
| Decreased alveolar ventilation, i.e. breath holding or rapid shallow breathing |
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Term
| What happens to patients with COPD who are given too much O2? |
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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. |
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Term
| How do you treat hypercapnic respiratory failure? |
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Definition
| Treat the cause and use mechanical ventilation |
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Term
| What are the big 3 pulmonary function tests and the other 3? |
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Definition
| FEV1, FVC, FEV1/FVC%; and TLC, RV, DLCO |
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Term
| What is the definitive diagnostic spirometry test that ID’s whether a disease is obstructive and restrictive? |
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Definition
| Obstructive - FEV/FVC ratio less than 80%; Restrictive - reduced TLC |
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Term
| In a flow versus volume curve what shape does an obstructive disease make versus a restrictive disease? |
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Definition
| Obstructive - wide alligator shaped coving, restrictive - narrowed version of normal curve |
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Term
| What two spirometry tests are the gold standard for determining whether a treatment is creating a statistically significant change? |
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Definition
| FVC and FEV1, with a change being greater than 13% and 11% respectively. |
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Term
| Since DLCO measures volume of gas transfer what 3 things affect the amount of gas transferred? |
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Definition
| Changes in cross-sectional area of tissue, thickness, and hemoglobin |
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Term
| What does a pulse oximeter measure? |
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Definition
| Arterial hemoglobin oxygen saturation by measuring total bound hemoglobin |
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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? |
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Definition
| Anatomical dead space, then, mix of dead space and alveolar gas, then only alveolar gas; the rapid drop is due to inspiration. |
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Term
| Complete the fetal airway development: lung primordium, ____________, branching morphogenesis, _____________. |
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Definition
| Tracheal morphogenesis, alveologensis |
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Term
| Put the following in chronological fetal developmental order according to lung development stage - alveolar, canalicular, saccular, embryonic, psuedoglandular. |
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Definition
| Embryonic 4-6wks, psudeoglandular 6-16wks, canalicular 17-28wks, saccular 24-36wks, alveolar 32wks-18mos postnatal |
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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? |
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Definition
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Term
| What type of cells in the alveoli predominate before and after birth? |
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Definition
| Before - type 1, after type 2 |
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Term
| Premature babies expressing respiratory distress syndrome basically have a deficiency of what? |
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Definition
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Term
| Bronchopulmonary Dysplasia results in dilated terminal airways and alveolar simplification, what are the causes of it? |
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Definition
| A premature birth exposes lungs to supplemental O2, nutrition, mechanical ventilation, and possible infection which can lead to inflammation and BPD |
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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? |
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Definition
| Management of the patent ductus arteriosus. |
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Term
| What is the anion gap formula? |
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Definition
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Term
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Definition
| 1.5xHCO3+8= PCO2 predicted +/- 2 |
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Term
| Isotonic NaHCO3 loss, like from diarrhea, causes hypochloremia not an anion gap. |
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Definition
| False, it causes hyperchloremia without an anion gap. |
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