RT 211 - Advanced Cardiopulmonary Physiology

1. Demonstrate an understanding of the respiratory muscles involved in breathing.
   1. Identify and describe the structure and explain the function of the thorax.
   2. Identify and describe the surface structure of the lungs.
   3. Identify and describe the structure and explain the function of the pleura.
   4. Identify and describe the structure and explain the function of the following muscles:
      1. Diaphragm
      2. External intercostal
      3. Scalene
      4. Sternomastoid
      5. Pectoralis major
      6. Internal
      7. intercostal
      8. Abdominal
   5. Identify and describe the structure and explain the function of the mediastinum.
   6. Identify and describe the structure and explain the function of the upper airway.
   7. Identify and describe the structure and explain the function of the lower airways.
   8. Identify and describe the structure and explain the function of the mucus blanket.
   9. Identify and describe the structure and explain the function of the lung parenchyma.
   10. Identify and explain the function of the nerve supply to the lung.
2. Demonstrate an understanding of lung volumes and capacities.
   1. Define and explain the significance of the following:
      1. Tidal Volume (VT)
      2. Expiratory Reserve Volume (ERV)
      3. Inspiratory Reserve Volume (IRV)
      4. Residual Volume (RV)
      5. Vital Capacity (VC)
      6. Functional Residual Capacity (FRC)
      7. Inspiratory Capacity (IC)
      8. Total Lung Capacity (TLC)
   2. Explain the changes in the above volumes and capacities with obstructive and restrictive diseases.
   3. Calculate the above volumes and capacities when given the appropriate information.
   4. Define and explain the significance of the Radford nomogram.
   5. Define:
      1. Anatomic Dead Space
      2. Alveolar Dead Space
      3. Physiologic Dead Space
   6. Explain the use of the modified Bohr equation.
   7. Calculate and explain the significance of the VD/VT ratio.
   8. Explain factors that affect anatomic and alveolar dead space.
3. Demonstrate an understanding of compliance and effects of surfactant therapy.
   1. Define and calculate the following:
      1. Compliance
      2. Transairway pressure
      3. Transpulmonary pressure
      4. Transchestwall pressure
   2. Explain the relationship between and give normal values for the following:
      1. CL
      2. CT
      3. CLT
   3. Describe how each of the above is measured, and explain any limitations of the method of measurement.
   4. Explain the significance of specific compliance.
   5. Interpret pressure-volume curves for the:
      1. Chest wall
      2. Lungs
      3. Lungs and chest wall
      4. Alveoli
   6. Explain the concept of hysteresis in terms of lung pressure- volume curves.
   7. Explain each of the determinants of lung compliance:
      1. Surface tension
      2. Surfactant
   8. Explain the Law of LaPlace and relate it to respiratory physiology.
   9. Discuss causes and describe the results of surfactant deficiency.
   10. Describe the effect of other diseases on lung compliance.
   11. Explain how changes in lung compliance will affect a patient's ventilatory pattern.
4. Demonstrate an understanding of air flow resistance.
   1. Describe the factors that determine the rate of gas flow.
   2. Discuss the laws relating to laminar (Poiseuille’s Law), turbulent, and mixed gas flow.
   3. Describe the effect of gas density on flow.
   4. Describe the factors that contribute to the non-elastic resistance to gas flow.
   5. Define and give the mathematical expression for RAW.
   6. Give the normal values for RAW.
   7. Explain the relationship between RAW and lung volume.
   8. Define and give the mathematical expression for GAW.
   9. Explain the relationship between GAW and lung volume.
   10. Define “specific” GAW.
   11. Describe the physiologic factors affecting RAW.
   12. Explain the concept of lung time constants and relate it to the frequency dependence of dynamic compliance.
   13. Describe the factors that limit expiratory flow rate.
   14. Discuss the:
       1. Mechanical work of breathing
       2. Metabolic work of breathing
   15. Describe the pathologic factors increasing RAW.
   16. Explain what is meant by the “quiet zone” of the lung.
   17. Explain why phases of the expiratory flow-volume are described as effort dependent and effort independent.
   18. Explain how changes in airway resistance will affect a patient’s ventilation pattern.
5. Demonstrate an understanding of bronchial and systemic circulation.
   1. Explain the function and describe which tissues are supplied by the bronchial circulation.
   2. Describe the structure of the systemic circulation as you move from artery to arteriole to capillary.
   3. Contrast the arteries and veins of the systemic circulation in terms of structure and function.
   4. Explain why part of the bronchial circulation returns to the left side of the heart.
   5. Give the percentage of the total CO and source of the normal anatomic R-L shunt.
   6. Compare and contrast the pulmonary vs the systemic circulation in terms of structure and function.
   7. Describe the pressures around both the alveolar and extra-alveolar pulmonary blood vessels.
   8. Explain the role of each of the following in determining pulmonary vascular resistance:
      1. Recruitment
      2. Distension
      3. Lung volume
      4. Vasoactive drugs
   9. Describe the relationship between those factors that determine pulmonary blood flow in each of the four lung zones.
   10. Explain the mechanism and function of hypoxic vasoconstriction.
   11. Describe factors affecting fluid balance within the lung.
   12. Explain the metabolic functions of the pulmonary circulation.
6. Demonstrate an understanding of the ventilation/perfusion ratio.
   1. Describe both the physiologic and pathologic causes of nonuniform distribution of:
      1. Ventilation
      2. Perfusion
   2. State the normal value for a V/Q.
   3. Explain the significance of the distribution of V/Q in the lung.
   4. Relate the nonuniform distribution of V/Q to regional composition of alveolar gas.
   5. Describe physiologic adjustments to nonuniform distribution of V/Q.
   6. Describe various methods of measuring the distribution of V/Q.
   7. Calculate V/Q from ventilation and perfusion measurements.
7. Demonstrate an understanding of how various gas laws and the effects on diffusion.
   1. Describe the relationship between the factors that determine the rate of diffusion of a gas through a gas.
   2. Explain the following laws of diffusion:
      1. Henry’s
      2. Graham’s
      3. Fick’s
   3. State the solubility coefficients of O2 and CO2 in plasma.
   4. Compare the relative rate of diffusion of O2 to both CO2 and CO.
   5. Explain why the diffusion of O2 across the A-C membrane is considered perfusion limited.
   6. Explain the relationship between all of the factors that determine the rate of gas diffusion across the A-C membrane.
   7. Describe how the DL is determined.
   8. State the normal values for DLCO and DLO2.
   9. Describe the factors that affect DL.
   10. Explain what is meant by the term “transfer factor.”
   11. State the normal value for Vo2 and Vco2.
8. Demonstrate an understanding of hemoglobin.
   1. Describe the structure and function of adult hemoglobin.
   2. Explain the factors that affect the affinity of hemoglobin for O2.
   3. Describe the oxyhemoglobin dissociation curve.
   4. Explain how various physiologic factors affect the oxyhemoglobin dissociation curve and apply it to clinical situations.
   5. Define the following terms:
      1. Bohr Effect
      2. Haldane Effect
      3. Hamburger Phenomenon
   6. Describe how O2 and CO2 are transported in the blood.
   7. Define and calculate total CO2.
   8. Calculate:
      1. O2 content
      2. O2 consumption
      3. A-aDO2
      4. a-vDO2
      5. Qs/Qt
      6. Del O2
      7. O2 ER
   9. Explain how changes in O2 consumption, cardiac output, PaO2, and Hb will affect the following O2 transport studies:
      1. Del O2
      2. O2 consumption
      3. a-v Do2
      4. O2 ER
      5. SvO2
9. Demonstrate an understanding of acid, base, and pH.
   1. Define the following terms:
      1. Acid
      2. Base
      3. pH
   2. Explain the physiologic importance of hydrogen ion regulation.
   3. Using the Henderson-Hasselbach equation calculate pH.
   4. Describe conditions that cause acid-base disturbance.
   5. Explain the physiological mechanisms of acid excretion.
   6. Explain the compensation that takes place with respiratory or metabolic acid/base disturbances.
   7. Using the nomogram of Pco2/Hco2-/pH relationship, interpret arterial blood gases.
10. Demonstrate an understanding of the neurological control of respiration.
    1. Describe the role of each of the following in the neurologic control of ventilation:
       1. Medulla Oblongata
       2. Pons
       3. Cerebral cortex
       4. Vagus nerve
       5. Central chemoreceptors
       6. Peripheral chemoreceptors
    2. Explain the effect of each of the following on the peripheral chemoreceptors:
       1. PaO2
       2. PaCO2
       3. [H+]
    3. Explain the effect of each of the following on the central chemoreceptors:
       1. PaCo2
       2. [H+]
    4. Describe the major reflex control mechanisms involved in the reflex control of respiration.
    5. Describe the integrated physiological response to:

1. Chronic Hypoxemia
2. Chronic Hypercapnia
3. Chronic Metabolic Acidosis