Respiratory Pathophysiology II

COPD is a disease characterised by _____________ ______________ that is not fully ________________.
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COPD is a disease characterised by _____________ ______________ that is not fully ________________.
airflow limitation, reversible
COPD is usually both ______________ and associated with an abnormal ________________ ____________ of the lungs to noxious _________________ or ____________.
progressive, inflammatory response, particles, gases
What are the 3 components of COPD?
chronic mucus hypersecretion, emphysema, small airway inflammation
Chronic mucus hypersecretion in COPD is due to _______________ of ___________ ________ and ________________ of ___________ ________ leading to a chronic __________ and _____________ production.
hyperplasia, goblet cells, hypertrophy, mucus glands, cough, sputum
Emphysema is a ______________ process where _______________ __________ are destroyed.
destructive, alveolar walls
Abnormalities of gas exchange in COPD are due to _______ ______________, which is the most important cause of _______________.
V/Q mismatch, hypoxaemia
What are the 3 components of the lung based on the component model?
dead space, ideal, shunt/venous admixture
The dead space compartment is _______________ but not ________________.
ventilated, perfused
The shunt/venous admixture compartment is _______________ but not ________________.
perfused, ventilated
The compartment that is perfused but not ventilated is a ___________ of _____________ and _________________ blood producing the resultant _______________ blood.
mixture, venous, oxygenated, arterial
The term shunt is best confined to an ________________ abnormality resulting in __________ not reaching an _______________.anatomical, blood, alveolusAs patients smoke, there are more and more compartments that lie between _________ and __________ i.e V/Q between ____ and ____. They also have more __________ ______________ compartments but these do not contribute to _______________ ____________ ________.ideal, shunt, 1, 0, dead space, arterial blood gasAn ideal compartment has normal _______ and therefore has normal ______ content. However if _______ is lower than ____, blood is essentially __________ ________________ so has reduced ______ content and increased _________ content.V/Q, O2, V/Q, 1, mixed venous, O2, CO2When blood from both ideal and shunt compartments are mixed, there is a _____________ ______ content and ______________ ______ content.reduced O2, increased CO2In most patients, _________ provides the respiratory drive so ________________ results in ______________________.CO2, hypercapnia, hyperventilationThe respiratory centre is very sensitive to _______ and ____ ________ in the ________ associated with _____________ due to excess __________.PaCO2, H+ ions, CSF, acidosis, CO2We only respond to hypoxia once it is relatively ____________, down to ______ saturation.severe, 80%The resultant _________________ in presence of a shunt normalises ________ content, but we will remain _______________ because the only compartment that can be effectively ________________ is the _____________ compartment. In this compartment the _______ is already on the _________ region of the _______ __________________ curve, so increasing ________ through ___________________ has little effect ________ ___________________.hyperventilation, CO2, hypoxaemic, hyperventilated, normal, PO2, flat, O2 dissociation, PO2, hyperventilation, O2 saturationThe ________ __________________ curve is a different shape to the O2 curve so with ___________________ the _______ decreases and ________ _______________ also decreases.CO2 dissociation, hyperventilation, PCO2, CO2 contentOverall in the presence of a shunt, PO2 is ______________, PaCO2 is _____________ and pH is ______________ but this is through _________________ and _______________ ___________________.reduced, normal, normal, hyperventilation, metabolic compensationIn the presence of a shunt, the increased _______ is initially __________ ______ but as the patient continues to smoke the _______ gets worse until the level of __________________ cannot be maintained.CO2, blown off, V/Q, hyperventilationThe hyperventilation response to V/Q shunt can be impaired by _______________ _________ and/or _________________ _______________.abnormal load, neuromuscular incompetenceOnce the hyperventilation response cannot be maintained, the ________ starts to _________ and the ________________ are ________ driving the equation to the ___________, generating ____ which is _________________.CO2, climb, chemoreceptors, reset, right, H+, excretedChronic hypercapnia is reflected in a ____________ ______________ level i.e a ________________ ______________ acidosis.raised bicarbonate, compensated respiratoryWith chronic hypercapnia, the ______________ ____________ is no longer very responsive to ________, and the patient becomes dependent upon ______________ __________ for _________________ so she is very susceptible to having it ___________ _______.respiratory centre, CO2, hypoxic drive, ventilation, turned onThe A-a gradient equation is based on the assumption the patient is breathing _______ and _________ ___________, and since A-a must be greater than _____, __________________ must be less than ______ and if not the patient must be breathing _________________ ______________.air, sea level, 0, PaCo2/0.8+PaO2, 20, supplemental oxygenIn patients that are chronically hypercapnic, administering __________ ______ abolishes ______________ _________ resulting in ________________ of ______________, increasing ______ and leading to development of _____________.high O2, hypoxic drive, depression, ventilation, PaCO2, acidosisAnatomical shunt is an _____________ situation where a compartment _______________ the ____________ completely and can occur within the lung due to _______________ ___________ __________ i.e _________________ ______________, or at the ___________ level i.e from the _________ to the _________ side of the heart.uncommon, bypasses, alveolus, abnormal blood vessels, arteriovenous malformation, cardiac, right, leftA hole in the atria or ventricles would normally push blood from ____________ to ________ due to the _______________ ___________, hence this is insufficient to produce ___________ to ___________ shunts.left, right, pressure gradient, right, leftHigh colour (pallor) in hypoxaemia is because it stimulates _______ ______________ in the __________ resulting in excessive ________ _______________.EPO production, kidney, RBC productionHow are shunts distinguished from V/Q mismatch?administer 100% oxygen, measure PaO2The shape of the ______________ _______ vs ______________ _______ curve changes with worsening _______ ______________, but with increasing ________________ _______ all curves end up at the ____________ _________ where there is enough _______________ to get _____________ and therefore _____________ pO2 up to about ___________. This reflects the presence of a compartment that between __________ and ____________ _________________ rather than full _____________.inspired pO2, arterial pO2, V/Q mismatch, inspired pO2, same point, ventilation, alveolar, arterial, 600mmHg, normal, venous admixture, shuntWith worsening anatomical shunt, increasing ______________ ________ cannot reach an ______________ pO2 of __________ eg. with a 20% shunt the maximum ____________ pO2 is __________, although this still produces _________ saturation.inspired pO2, arterial, 600mmHg, arterial, 250mmHg, 100%Measuring ___________ _______________ cannot distinguish V/Q mismatch and shunt since it only measures __________________.pulse oximetry, saturationThe only clinical causes of hypoxaemia are ______________ and problems with ________ _______________.hypoventilation, gas exchangeHow is gas exchange assessed?calculate A-a gradient