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Marcus' A&P S24 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is normal exhaled nitrogen concentration?

A

75-85%

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2
Q

What is contained in the first part of exhalation during the Fowler’s test?

A

Should be 100% O2 & 0% nitrogen

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3
Q

In the Fowler’s test, when does dead space measurement begin & end?

A
  • Begins at start of expiration.
  • Ends at midpoint of transitional phase
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4
Q

What needs to be done before starting a Nitrogen washout test?

A

Check initial nitrogen content

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5
Q

How long will a nitrogen washout test take in a healthy Pt?

A

3mins or less

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6
Q

What results in an abnormal nitrogen washout test & why does it happen?

A
  • It is considered abnormal if >7 mins.
  • It is due to uneven distribution of inspired air
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7
Q

What equipment is needed for a nitrogen washout test?

A
  • Stopwatch
  • Nitrogen meter
  • 100% O2 source
  • Pneumotachograph
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8
Q

What is the concentration goal of the nitrogen washout test?

A

Get to a nitrogen ≤ 2.5%

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9
Q

What do nitrogen spikes on the nitrogen washout test mean?

A
  • Pt has poorly vented areas to start with.
  • These get ventilated, then open up & let nitrogen out
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10
Q

What does a Closing volume/capacity test look at?

A
  • Looks at behavior of the tissue in the lungs
  • Dead space
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11
Q

Explain the steps of a closing volume/capacity test?

A

1) Expire to RV
2) Inspire 100% O2 to TLC
3) Exhale

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12
Q

What is the total lung’s nitrogen concentration (%) on a healthy person before exhalation while performing a closing volume/capacity test?

A

1) Calculate N2 concentration in RV
2) PiN2 is 564 mmHg
3) 564 mmHg / 760 mmHg= 74.21%
4) 0.7421 x 1,500 mL= 1,113.15 mL/N2
5) 1,113.15 mL / 6,000 mL= 0.1855
6) Total lung N2 concentration is 18.55%

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13
Q

Phase 1 of a Closing volume/capacity test should show?

A

Expired oxygen only as it coming from the dead space.

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14
Q

What will the transitional phase of a Closing volume/capacity test should show?

A

Should start seeing expiration of N2

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15
Q

Where is the volume coming from during phase 3 of Closed volume test?

A

Expired air from all parts of the lungs

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16
Q

Phase 4 of a Closing volume/capacity test shows?

A
  • A sharp upstroke of expired N2.
  • Base of lung is collapsed.
  • Expired N2 comes from top of lungs
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17
Q

When do airways start closing during a closing volume test & what is the order?

A
  • At end of phase 3 & beginning of phase 4.
  • Areas right above the diaphragm start closing first then superior sections.
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18
Q

At what point is expired N2 concentration equal from the entire lung?

A

During phase 3 of a closing volume test

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19
Q

Where does the closing volume air come from?

A

From the upper parts of the lungs

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20
Q

How is closing capacity calculated?

A

RV + closing volume

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21
Q

What volumes/capacities increase w/ age & which decrease?

A
  • Increase: RV, CC, FRC
  • Decrease: ERV, IC, VC
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22
Q

At what age is FRC equal to closing capacity?

A

At age 50ish

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23
Q

What happens to the airway during forced expiration?

A

It widens

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24
Q

How much VC should a healthy 20yo move in 1 sec?

A

About 80%

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25
Q

A healthy person can force expire at what rate?

A

10 L/sec

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26
Q

What happens during effort independence?

A
  • It happens closer to RV.
  • The small airways collapse d/t + pleural pressure. At that point air will only come out so fast, not matter how hard one pushes.
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27
Q

Someone with emphysema has a shorter or longer effort independence?

A
  • Longer.
  • They take longer to get the air out.
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28
Q

What will expiratory flow curve look like in someone with a restrictive disease?

A

It will be narrower than normal

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29
Q

Compared to normal, restrictive disease will result in a ___ FEF?

A

Lower

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30
Q

In someone with restrictive disease the TLC will be___ & the RV will be___?

A

Lower & lower

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31
Q

At RV, zone 3 & 4 will be ___% full & zone 1 will be ____% full?

A
  • 20%
  • 30%
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32
Q

At RV where is most of the nitrogen located?

A

In the upper zones

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33
Q

How is Ptp calculated?

A

Ptp = Alveolar pressure – pleural pressure

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34
Q

How is alveolar pressure calculated?

A

PA= pleural pressure + elastic recoil pressure

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35
Q

During forced expiration the diaphragm is relaxed or contracted?

A

It is relaxed

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36
Q

Which muscles contract during forced expiration?

A
  • The internal intercostals
  • accessory muscles
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37
Q

How can alveolar collapse be prevented in a non-intubated Pt?

A
  • Have to restrict outflow, which leads to elevated internal alveolar pressures.
  • Can do this with pursing the lips.
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38
Q

At RV the dependent pleural pressure is___ & the non-dependent pleural pressure is___?

A

+ 4.8
- 2.2

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39
Q

During passive expiration the pleural pressure is ___& the elastic recoil pressure is?

A

Negative & positive

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40
Q

How is elastic recoil pressure calculated?

A

Per= Alveolar pressure – pleural pressure

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41
Q

What are the expired PAO2 & PACO2?

A
  • 100 mmHg
  • 40 mmHg
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42
Q

What is the CO2 in the pulmonary vein & artery?

A
  • Vein: 40 mmHg
  • Artery: 45 mmHg
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43
Q

What is the PO2 in the pulmonary vein & artery?

A
  • Vein: 100 mmHg
  • Artery: 40 mmHg
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44
Q

How are wall tension & radius related?

A
  • Inversely
  • Decreased wall tension = increased radius
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45
Q

Where would a fixed obstruction be located & what is affected. What’s an example?

A
  • Located anywhere in the lung.
  • Affects peak inspiration & peak expiration rates.
  • An example would be an ETT.
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46
Q

What is a variable extrathoracic obstruction, where is it located & an example & what respiratory cycle part is most affected?

A
  • An obstruction during inspiration.
  • It is located in the trachea or above (scar tissue or paralyzed vocal cords).
  • Inspiration is greatly affected by narrowing of the airway.
  • During expiration obstruction gets pushed out of the way.
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47
Q

In a variable extrathoracic obstruction the PAW is___ than Patm during inspiration & ___ during expiration?

A

Less & greater

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48
Q

In a variable intrathoracic obstruction the PAW is___ than Ppl during inspiration & ___ during expiration?

A

Greater & lesser

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49
Q

What is most likely affected in a variable intrathoracic obstruction?

A

Expiration & the very small airways

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50
Q

Emphysema would correlate to what kind of obstruction?

A

A variable intrathoracic affecting expiration

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51
Q

Why does inspiration start before EtCO2?

A

The EtCO2 sample line has a bit of lag.

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52
Q

Relate alveolar ventilation to PaCO2 & EtCO2?

A

Doubling alveolar ventilation will half PaCO2 & EtCO2

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53
Q

How do the carotid & aortic arch blood gas sensors work?

A

If PaCO2 increases sensors will send feedback to CV system to increase CO, which also leads to increased BP.

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54
Q

What is an easy way to lower a ventilated Pt’s BP?

A

Blow off some CO2

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55
Q

Inspired PO2 & CO2 are ____ & equilibrated PO2 & CO2 are____?

A
  • 150 & 0 mmHg.
  • 100 & 40 mmHg
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56
Q

Inhaling 350cc fresh air drops the PACO2 to about___?

A

36-37 mmHg

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57
Q

What prevents great CO2 swings?

A

Volume of FRC.

58
Q

What is CO2’s Pp in the lungs at after normal inspiration?

A

1) FRC= 3L, PACO2= 40 mmHg
2) 40 mmHg/760 mmHg= 0.05263
3) 0.05263 x 3L= 0.157L
4) 0.157L = 157 mL/CO2
5) 0.157 L / 3.35 L= 0.047131
6) 0.047131 x 760 mmHg= 35.819 mmHg
7) 35.819 mmHg / 760 mmHg= 0.047
8) 0.047 x 3.35 L= 0.15788L
9) 0.15788L = 158 mL/CO2

59
Q

What are some causes for low EtCO2?

A
  • Low CO
  • MI
  • PE
  • moisture in equipment
60
Q

How much O2 does 1 dL contain in solution?

A

0.003 mL O2/mmHg PO2

61
Q

How much O2 does 1 dL contain at a Pp of 100 mmHg solution?

A

0.3 mL O2

62
Q

How much oxygen/dL is immediately available in a solution w/ a Pp of 80 mmHg?

A

80 x 0.003 mL O2/mmHg= 0.24 mL O2/dL

63
Q

How much O2 does 1 dL drop off?

A

5 mL

64
Q

What is normal Hgb for our class?

A

15 g/dL

65
Q

How much O2 can each gram of Hgb carry?

A

1.34 mL O2

66
Q

What is the max Hgb carrying capacity?

A

20.1 mL O2/dL

67
Q

How does carbon monoxide affect the oxygen in the blood?

A

CO reduces the ability of Hgb to unload its oxygen

68
Q

What 2 things does carbon monoxide do?

A

Binds to Hgb & prevents unloading of oxygen from Hgb

69
Q

What is MET hemoglobin?

A
  • Dysfunctional Hgb
  • Does not like to carry O2.
  • Makes up about 2% of Hgb
70
Q

As PaO2 decreases Hgb ___ oxygen?

A

Unloads

71
Q

What is the normal CvO2 in mL/dL at a PO2 of 40 mmHg?

A

15.2 mL/dL

72
Q

Increased PCO2 will cause a ___ shift?

A

Right

73
Q

An increase in pH will cause a ____ shift?

A

Left

74
Q

What kind of shift will cause the Hgb to hold on to oxygen?

A

A left shift (alkalosis, low CO2, low 2,3-bpg, low temp)

75
Q

What is 2,3-BPG? Spell it out?

A
  • Byproduct of metabolism.
  • 2,3-Biphosphoglyceric acid
76
Q

If we had no Hgb at all, what would our tissue oxygen deficit be in mL/dL?

A
  • Negative 4.7 mL O2/dL.
  • Each dL of blood drops off 5 mL O2.
  • Available dissolved O2 in solution is 0.3 mL O2/dL.
77
Q

What two things does dissolved gasses rely on?

A

Its solubility & partial pressure

78
Q

What is the venous Hgb saturation?

A

70-75% Venous PO2 is 40 mmHg

79
Q

What is the Hgb saturation at a PO2 of 70 mmHg?

A

94.1% with 19.12 mL O2/dL

80
Q

What kind of shift does fetal Hgb have & why?

A

Left shift d/t its higher affinity to oxygen

81
Q

Relate PO2 & the oxyhemoglobin curve?

A

A right shift in the oxyhemoglobin curve will lead to a higher PO2

82
Q

Where is myoglobin present?

A

In weight bearing skeletal muscles

83
Q

What is the P50 value for arterial blood?

A

26.5 mmHg

84
Q

What is the P50 value for venous blood?

A

~ 32-33 mmHg

85
Q

What does the Bötzinger Complex do?

A

It controls respiratory rhythm, sigh and gasping

86
Q

Where is the Apneustic center located & what does it do?

A
  • Located in the lower PONS.
  • Senses the environmental air & gradually increases firing rate of the inspiratory muscles
87
Q

What inhibits the Apneustic center?

A

The Pneumotaxic center

88
Q

What do the central chemoreceptors respond to?

A

H+, CO2 & pH (Do not respond to O2 level changes)

89
Q

What is the primary driver for peripheral bodies?

A

CO2

90
Q

How do chemoreceptors respond to increased CO2?

A

They increase firing rate

91
Q

Aortic bodies use the___ nerve/s & carotid bodies use the ___ nerve/s?

A
  • Vagus nerve
  • Hering’s & Glossopharyngeal nerves
92
Q

What is the length of a normal trachea?

A

11-13 cm & can extend another 2cm with extension

93
Q

How long is the Right main stem?

A

About 2cm

94
Q

The R bronchi has ___ segments & the Left bronchi has __ segments?

A

10 & 10 which fuses down to 8

95
Q

What is all part of the nasopharynx (that we covered in lecture)?

A
  • Pharyngeal tonsils
  • Pharyngotympanic tube orifice
96
Q

What are the 3 salivary glands from smallest to largest?

A
  • Sublingual gland
  • Submandibular gland
  • Parotid gland
97
Q

What enlarged structure can obstruct nasal air passage?

A

Enlarged pharyngeal tonsil (also called adenoid tonsil)

98
Q

What enlarged structure can obstruct oral air passage?

A

Enlarged palatine tonsils

99
Q

How many total tonsils do we have?

A

6
- 1 Pharyngeal tonsil
- 2 Tubal tonsils
- 2 Palatine tonsils
- 1 Lingual tonsil

100
Q

What nerves innervate the upper airway?

A
  • Trigeminal nerve
  • Glossopharyngeal
  • Vagus
101
Q

How many branches does the Trigeminal nerve have & what are their names?

A

3
- Ophthalmic (V1)
- maxillary (V2)
- mandibular (V3)

102
Q

The Glossopharyngeal nerve innervates what two structures in the upper airway?

A

Back of the tongue & nasopharynx

103
Q

What is the source of the “ice cream headache”?

A

The Maxillary branch of the Trigeminal nerve. Also called Palatine nerve

104
Q

What 3 airway structures are innervated by the Vagus nerve?

A
  • Epiglottis
  • Vallecula
  • posterior/inferior throat incl. trachea
105
Q

What 2 nerves innervate taste?

A
  • Glossopharyngeal (9) back third of tongue
  • Facial nerve (7) front 2/3 of tongue
106
Q

What tongue nerves are somatic?

A
  • Glossopharyngeal (9)
  • Trigeminal/Submandibular (5v3)
107
Q

Where does the Falx cerebri anchor to?

A

The Crista galli of the Ethmoid bone

108
Q

What connects ethmoid bone to meninges?

A

The Crista galli

109
Q

A nasal ET tube passes through the___ in between the___ & the___?

A
  • Inferior meatus.
  • Inferior concha & maxilla palatine process
110
Q

The external carotid art. supplies the____ & the internal carotid art. supplies the___?

A
  • Posterior septum
  • Roof of the nose
111
Q

What are the 3 large cartilages?

A
  • Epiglottis
  • thyroid cartilage
  • cricoid cartilages
112
Q

What is the pinch point in adults?

A

The vocal cords

113
Q

What is the pinch point in children <10yrs of age?

A

The cricoid cartilage

114
Q

The vocal cords attach anteriorly to the___ & posteriorly to the___?

A
  • Thyroid cartilage
  • Arytenoid cartilage
115
Q

Which turbinates do not come of the ethmoid bone?

A
  • The inferior concha/turbinates.
  • They come off the maxilla
116
Q

What is the pharyngotympatic tube?

A

An opening that helps with equilibrium & pressure of the middle & inner ears

117
Q

A spirometer can be used to measure what volumes/capacities?

A

All except TLC, RV & FRC

118
Q

How does a low CO affect PvO2?

A

A low CO results in a high extraction of O2 from the blood to supply tissue

119
Q

What changes increase diffusion of a gas thru membrane according to Fick’s law?

A
  • Increased △P, area, solubility.
  • Decreased distance & MW
120
Q

How does breathing 100% O2 affect PaO2 with right to left shunts?

A

It has little effect on PaO2

121
Q

How does strenuous exercise affect arterial alveolar capillaries & Hgb saturation?

A

Strenuous exercise causes a decrease in alveolar arterial end oxygen & flow is faster thru alveolar capillaries, so it takes longer to fully saturate = more gradual rise (Right shift).

122
Q

How does the complete absence of Hgb, with normal lungs, affect PaO2

A

Without Hgb the PO2 would still be normal due to O2 dissolving in plasma

123
Q

How does anemia affect CaO2 & O2 saturation?

A

Leads to lower CaO2 & O2 saturation is not affected

124
Q

What does CO combined with Hgb form?

A

carboxyhemoglobin

125
Q

Carboxyhemoglobin causes what kind of a shift & how does it affect the tissues?

A

Carboxyhemoglobin creates a Left shift & Hgb holds on tight to O2, decreasing O2 to tissues

126
Q

What is the body’s major response to PaCO2?

A

Chemo sensors in medulla. CO2 diffuses across BBB & is converted to H+ acting on chemo sensors.

127
Q

The ____ center tells the ___ to limit inspiration time, which also leads to a decreased expiratory time & increased RR

A

Pneumotaxic & DRG

128
Q

What controls the basic respiratory rhythm?

A

The DRG, located within the NTS

129
Q

When does the VRG become active?

A

When greater than normal pulmonary ventilation is required

130
Q

What is the purpose of chloride diffusing into venous RBC’s?

A

To maintain electrical neutrality

131
Q

Compare the volume & chloride of venous & arterial RBCs?

A

Venous RBCs have larger volume & more Cl- than arterial RBCs

132
Q

How does decreased PaCO2 affect ventilation?

A

Decreased PaCO2 inhibits chemosensitive areas –> decreased ventilation until PaCO2 is normal.

133
Q

How does does constrictive lung disease affect TLC, RV & MEF?

A

Reduces TLC, RV & max expiratory flow

134
Q

What happens to ventilation when PaO2 falls to 60 mm Hg or less?

A

Ventilation doubles when PaO2 falls to 60 mmHg

135
Q

How does atelectasis of 1 lung affect:
- V/Q ratio
- Resistance
- Blood flow
- PaO2
- CaO2
- O2 saturation

A
  • V/Q ratio only changes minimally
  • Increased resistance to blood flow + vasoconstriction d/t hypoxia
  • blood flow shifting to other lung
  • small decrease in PaO2, CaO2 & Sats.
136
Q

Exhaled PO2 is greater of lower than PAO2

A

Greater

137
Q

Exhaled PCO2 is greater or lesser than PACO2

A

Lesser

138
Q

What muscles, besides the diaphragm are used for forced inspiration

A

External intercostal muscles

139
Q

Peripheral chemoreceptors increase ventilation by what mechanisms?

A

1) decreased PO2
2) increased PCO2
3) Increased H+
4) decreased pH

140
Q

What is the most important breathing drive in chronic hypercapnia?

A

The peripheral chemoreceptor hypoxic drive is more important

Marcus' A&P S24 (9 decks)

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