AP II Unit 4 Flashcards
Describe the basics of the FEF 25-75 test
It’s the same information as the FEV1/FVC test, you just ignore the first 25% and last 25% and focus on the middle 50%. The idea is that if there is going to be variability in the test it is most likely to show up during this portion of the FVC measurement
What specifically is the FEF 25-75 supposed to be sensitive to?
Small/medium airway obstruction
Per lecture, what is the most sensitive PFT to changes and why?
Closing capacity test; because it measures airway collapse without forceful expiration
What is the “ballpark” desirable range for the FEF 25-75 in an asthmatic?
500 - 1000 cc/second
What change would occur to lung volumes if the lung had less inward recoil?
The chest wall still has the same opposing recoil and is now greater than the lungs inward recoil, lung volume would expand (volume would increase)
What happens to lung volumes as you lose/gain elastance?
Less elastance = less recoil opposing the chest wall = higher lung volumes (think obstructive lung disease)
More elastance = more recoil opposing the chest wall = lower lung volumes (think restrictive lung disease)
How does supine vs standing affect chest recoil?
Upright = more outwards chest recoil
Supine = less outwards chest recoil (this contributes to lower FRC when supine)
What happens to lung volumes after you give a paralytic?
The diaphragm loses all tone and relaxes, this allows the diaphragm to creep upwards and reduce lung volume
What controls our rate/depth of breathing?
The medulla
What is the main element of blood/CSF that central chemoreceptors are concerned with?
Protons
What is the main component of the blood that peripheral chemoreceptors are concerned with?
Oxygen
What is the normal arterial/CSF pH and concentration CO2?
Arterial = 7.4 pH and PCO2 of 40
CSF = 7.31 pH and PCO2 of 50
Exactly where would you expect to find central chemoreceptors?
The antro-lateral medulla
What fraction of blood gas management is performed by the central and peripheral chemoreceptors?
Central = 85%
Peripheral = 15%
What houses peripheral chemoreceptors? Where would you find them?
Bodies, 2 pairs are at the bifurcation of the internal/external carotids and 3-5 are in the region of the aorta
What transmits information from the carotid and aortic chemoreceptors?
Carotid = Glossopharyngeal nerve (CN IX)
Aortic = Vagus nerve (CN X)
At what PO2 do peripheral chemoreceptors begin to rapidly fire?
less than 60 mmHg of PO2
What are the 2 primary ways the body can respond to changes in blood gas CO2?
By modifying ventilation or respiratory rate
If the body wants to increase respiration, what is the most effective change to make?
Increase tidal volume before increasing RR (increasing Vt doesn’t increase dead space ventilation, whereas an increase in RR will increase dead space ventilation)
Per lecture, what is a non-pharmacologic method to reduce BP?
Hyperventilate = blow off CO2 = less metabolic byproducts in circulation, BP should decrease
What is the relationship of CO2 to iCal?
As you blow off CO2, less protons occupy albumin, as they leave albumin this leaves room for the Ca++ to occupy sites on albumin and plasma iCal should decrease which slows down HR or reduce CO
Why do infants not handle changes to blood gases?
Their respiratory systems haven’t fully developed and the brainstem isn’t able to fully respond to blood gas changes
What are the pulmonary pleural layers?
Visceral = attached to the lung tissue
Parietal = attached to the chest wall
How does each layer of the intercostals affect breathing?
External = help with inspiration
Internal = help with expiration
What muscles help keep the rib cage from moving downwards when breathing?
Scalene muscles and the sternocleidomastoid muscles
What muscles other than the diaphragm assist with breathing (discount muscles that stabilize the rib cage for this question)?
Internal/external intercostals, serratus anterior and the abdominal muscles
What muscle are you optimizing when you put your hands on your knees when trying to breath?
Pectoralis minor
What are the abdominal muscles involved with expiration?
rectus abdominus, the internal/external obliques and transverse abdominus
What are the 2 names of the ear canal?
pharyngotympanic tube or the eustachian canal
2 primary functions of the nose?
Humidification and filtration
Why do DIC patients frequently experience nosebleeds?
Because the nose gets its blood from vessels with protected circulation (meaning they get blood no matter what is going on in the body), the internal/external carotids
What is the primary source of blood for the nose?
External carotid artery
What vessels bridges the internal carotid to the smaller nasal blood vessels?
Ophthalmic artery
What are the 2 names of the structures that create air turbulence in the nose?
Concha or turbinates
Which of the concha is most fragile?
The middle and superior concha as they are made up of the ethmoid bone
Describe the basic nerve innervation of the upper airway
Trigeminal nerve (V) = Mouth and nose
Glossopharyngeal (IX) = covers the area above larynx
Vagus (X) = back of the throat, trachea and larynx
What tonsils are at the back of the throat? Back of the nose? under the tongue?
Throat = palatine tonsils
Nose = pharyngeal tonsils
Tongue = lingual tonsils
What are the 3 salivary glands listed in lecture?
Side of the cheek = Parotid (most important)
Under the tongue = sublingual
Further back and under the mandible = submandibular
Per lecture, what is the 100% most correct/scientifically accurate way to describe a brain freeze?
ICE CREAM FOG
What nerve is responsible for creating a brain freeze?
Trigeminal (V)
What are the 3 divisions of the trigeminal (V) nerve?
V1 = comes off the top and turns into the ophthalmic branch
V2 = maxillary division
V3 = mandibular division
What innervates somatic sensation of the tongue?
Front 2/3 = V3 branch of the trigeminal (V) nerve
Back 1/3 = Glossopharyngeal nerve (IX)
What innervates taste to the tongue?
Glossopharyngeal (IX) and facial nerve VII
What nerve is the primary source of innervation to the epiglottis?
Vagus (X) nerve
Filtration of the nose relies on what?
Momentum
What kind of particles are unlikely to be trapped in mucus?
Small particles, like smoke
Per lecture, what does smoke inhibit?
A1-alpha antitrypsin
Why would coughing dramatically increase 2 weeks after smoking cessation?
The cilia have now grown back and are now assisting to expel things from the lungs
Other than smoking, per lecture, what else could disrupt the cilia?
Insertion of an ET tube
What blade is seated in the vallecula to help with DL?
Miller blade
What blade gets behind the lingual tonsil to help with DL?
MAC blade
What cartilage forms a complete circle?
Cricoid cartilage
Per lecture, what is a potential downside of using cricoid pressure?
Increased gastric pressure blowing out the LES
What 3 ligaments connect the hyoid bone to the thyroid cartilage?
Median thyrohyoid ligament, thyrohyoid membrane and thyrohyoid ligament
What enters the foramen in the thyrohyoid membrane?
The internal superior laryngeal artery/vein and nerve
What do the internal/external superior laryngeal nerves innervate?
External = motor function of the cricothyroid muscles
Internal = sensory function of the larynx
What is the only muscle involved with phonation that is not innervated by the internal branch of the superior laryngeal nerve?
Cricothyroid muscles
Describe the R/L area of recurrence for the laryngeal nerves
L = aorta, R = brachiocephalic artery/trunk
What points connect the thyroid cartilage and the hyoid bone via the thyrohyoid membrane?
The superior horns connect to the hyoid bone
What connects the inferior horns of the thyroid cartilage to the cricoid cartilage?
The cricothyroid joint
What are the pivot points on the cricoid cartilage called?
Facet joints
Name the upper facet
articular facet for arytenoid cartilage
Name the lower facet
articular facet for the thyroid cartilage
What connects the cricoid cartilage to the trachea?
Crico-tracheal ligament
Per lecture, what is the advantage of not having continuous tracheal rings?
It allows for flexibility, resist crush injury, and useful during coughing or when the esophagus needs to expand in the presence of food
What are the airflow velocities of a cough/sneeze?
Cough = 50 mph
Sneeze = 100 mph
What is the length of the trachea? How much is intra/extra thoracic?
11 - 13 cm total, 2-4 is extra-thoracic
How many tracheal rings are there? What connects them to each other?
20, and annular ligaments
What is the total angle between the mainstem bronchi? Angle of R/L?
70 total, R = 25 degrees, L = 45 degrees
Per lecture, what can change the angle of the mainstem bronchi?
Deep inspiration (narrows the angle less than 70 degrees)
What happens during swallowing if the cricothyroid muscles contract?
Helps pivot the thyroid cartilage down which pulls down the epiglottis
What muscles tighten the vocal cords?
Cricothyroid and vocalis muscles
What muscles have no effect on the opening of the rima glottidis?
Cricothyroid and vocalis muscles