Review
What is the A-a Gradient if the patient is at sea level on room air and has a PaO2 of 55 and a PaCO2 of 30?
(760-47) x .21 = 150
150 - (30/.8) = 112.5
112.5 - 55 = 57.5
A-a gradient = 57.5
What does D stand for in ABCDEFGHI?
Diaprhagm
What 3 CNS Structures primarily control respiration?
Pons, Medulla, Cortex
What blood pH is considered alkaline and what pH is considered acidic?
Alkaline >7.4
Acidic <7.4
What type of hypersensitivity is an allergic reaction?
Type 1
What 3 volumes/capacities that can’t be measured by spirometery?
Residual Volume, Functional residual capacity, Total Lung Capacity
PA and Lateral
Which control center/group is responsible for the expiratory motor control and what muscles do they target?
Ventral Respiratory Group
Intercostals and Abdominals
What is the normal CO2 and HCO3- concentrations in the body?
CO2: 40 mm HG
HCO3-: 24 meq/L
What anatomical structures prevent large particles from passing through the nasopharynx and what size are the larger particles?
10 micrometers
What are the 5 possible causes of Hypoxemia?
V/Q mismatch, Diffusion Impairment, Shunt, Hypoventilation, and Low PIO2
What does each letter in the ABCDEFGHI approach stand for?
A: Airway/Assessment of quality
B: Bones
C: Cardiac
D: Diaphragm
E. Effusions/ Extra soft tissue
F: Fields/ Fissures/ Foreign Bodies
G: Great Vessels/ Gastric Bubble
H: Hila and Mediastinum
I: Impression
What are the names of the centers that can be found in the Pons and Medulla respectively?
Pons: Pneumotaxic center and Apneustic Center
Medulla: Dorsal Resp Group, Ventral Resp Group, and Central Chemoreceptors
What are the 3 forms by which CO2 is transported in the blood?
Dissolved, Bicarbonate, Proteins
What is the difference between an immediate allergic reaction and a late-stage reaction?
immediate reaction is mast cells depositing the contents it has stored like histamine. Late stage is the mast cells depositing producing new products that cause an inflammatory response.
Loss of surface area
What does a positive Spine Sign show us that helps us diagnose what issue?
Consolidation in the lower lobes.
Pneumonia in the lower lobes
Where can you find peripheral chemoreceptors?
Carotid Bodies and Aortic arch
What is the acid-base abnormality for a patient with a pH of 7.32, PaCO2 of 50, and a HCO3- of 25? In what way has the body compensated for the abnormality?
Acute Respiratory Acidosis
It hasn’t yet but it will go through renal compensation in a few days
What pathogens are especially opportunistic against a patient with Cystic Fibrosis? (4)
P. aeroginosa, B. cepacia, S. aureus, H. Influenza
What are all of the different things that would cause a DLCO to increase (7)?
Obesity, Asthma, Shunt, Mild Left Heart Failure, Polycythemia, Pulmonary Hemorrhage, High Altitude.
What in an X-ray would indicate that your patient has a pneumothorax?
Deviated trachea, increased darkness/lucency in the pleural space on one side, a pleural line.
What is the name of all the respiratory control centers and what do they detect? (8)
Central Chemoreceptors: CO2 and pH via H+ directly
Peripheral Chemoreceptors: PO2 <60, CO2, and pH
Pulmonary Stretch Receptors: Lung Stretch during lung inflation
Rapid Adapting Receptors: Rate of change of inflation
J-Receptors: Chemicals in pulmonary circulation and changes in ISF Volume
C-Receptors: Histamines and Prostaglandins
Muscle Receptors: Chest wall effort
Airway flow receptors: Decreases in temperature (Wind chill)
What is the compensation method for when a cell has too high of a pH and too low of a pH?
Too High: HCO3- is transported out in exchange for Cl-
Too Low: H+ is out, Na+ is in.
What does respiratory mucus contain that protects it from pathogens and what is the mechanism of cystic fibrosis that effects the mucus?
Mucus contains: IgA, lysozymes, lactoferrin, and peroxidases.
Cystic Fibrosis is the loss of the protein that prevents chloride transport out of the cell resulting in dehydrating and thickening o the mucus.