Exam 3 Flashcards
1
Q
In which layer of the bronchi are goblet and ciliated cells located?
A
Epithelial lining
2
Q
Olfactory epithelium is innervated by which nerve?
A
Olfactory nerve CN I
3
Q
T/F Acute pericarditis w/out effusion does not alter cardiac function.
A
True
4
Q
Treatments for acute pericarditis?
A
ASA/NSAIDS Toradol Steroid for refractory CP
5
Q
What is the chief support of the larynx?
A
The hyoid bone
6
Q
How many alveoli are present at birth? By adulthood?
A
10-25 million at birth; 300 million by adulthood
7
Q
What is contained in the anterior division of the mediastinum?
A
Thymus
*B/w sternum and pericardium*
8
Q
Which two muscles adduct the arytenoids?
A
Lateral cricoarytenoid (which closes the glottis)
Transverse arytenoid (which only adducts arytenoids-no mention of glottic closure)
9
Q
Define closing volume.
A
The volume at which small airways close or collapse. Ideally small airways stay open throughout an expiration, but in disease states, they close at high tidal volumes prior to the end of expiration. Obesity and COPD tend to have high CVs and therefore airway collapse early in expiration. Low closing volumes are desirable because it means less volume is required to keep them open and patent.
10
Q
What is the dip and plateau?
A
This is seen in constrictive pericarditis and indicates the equalization of R and L side filling pressures ie diastolic pressure. The waveforms will have drastically different SBP but DBP are essentially same d/c inability to fill appropriately.
11
Q
What is contained in the middle division of the mediastinum?
A
Heart
Distal trachea
Mainstem bronchi
Great vessel trunks
*Located b/w anterior and posterior division*
12
Q
What separates the oropharynx from the nasopharynx?
A
Soft palate
13
Q
Diagnostic factors of constrictive pericarditis? CXR, ECG, CATH
A
ECG not useful d/t minor changes ECHO will show abnormal motion and thickening of pericardium CXR size of lungs and heart may be normal CATH: elevated CVP, R & L side filing pressures near equal, and dip and plateau on pressure waveform
14
Q
What is significant about the pyriform fossa?
A
Tendency to trap food and it is landmark for SLN blockade
15
Q
What are the 2 functions of the alveolar-capillary membrane?
A
1) transport of respiratory gases
2) production of local & humoral substances
16
Q
What is the last airway component NOT capable of gas exchange?
A
Terminal bronchioles
17
Q
What designates the laryngopharynx or hypopharynx?
A
The epiglottis to the cricoid cartilage
C3-C6
18
Q
Function and innervation of vocalis muscle?
A
Relaxes the cords
RLN
19
Q
intrinsic muscles of the larynx functions? (3)
A
1) open vocal cords during inspiration
2) close cords & laryngeal inlet during deglutition
3) alter tension of cords during phonation
20
Q
What does CN IX innervate?
A
Posterior 1/3 of tongue (taste & sensory), roof of pharynx, underside soft palate
Vallecula & superior surface of epiglottis
21
Q
Most common cause of acute pericarditis?
A
Viral infection
22
Q
What is ventricular discordance?
A
RV and LV pressure tracings show increased peak RV SBP during inspiration and reduced LV SBP; during expiration RV SBP is decreased and LV SBP is increased.
23
Q
What are the 3 clinical manifestations of pericardial disease?
A
- Acute pericarditis 2. Constrictive pericarditis 3. Cardiac Tamponade
24
Q
What is responsible for suspending the larynx from the hyoid bone?
A
The thyrohyoid membrane
25
Significance of laryngeal inlet?
Connects the pharynx to the larynx
26
False cords are also known as?
Vestibular ligament
27
What makes up the hilum? What is its significance?
The hilum of the lung is found on the medial aspect of each lung, and it is the only site of entrance or exit of structures associated with the lungs. \*All conduits to the lung pass through the hilum\*
* Mainstem bronchus
* Pulmonary artery & vein
* Bronchial arteries & veins
* Lymphatics
* Lymph nodes
* Pulmonary nerve plexuses
* Pulmonary ligament
28
Name the tonsils and their location.
LIngual (base of tongue)
Palatine (tonsilar fossa at boundary of oral cavity and oropharynx) T
ubal (behind Eustachian tube)
Pharyngeal (lateral walls of nasopharynx)
29
What is the surface for gas exchange of an alveolus?
60-80 m2
30
Stylopharyngeus muscle Fxn and innervation?
Assists folding of thyroid cartilage
Glossopharyngeal nerve
31
What is the only intrinsic muscle external to the larynx?
Cricothyroid
32
What is the ring of Waldeyer?
Circumferential ring of lymphatic tissue
33
Which bones form the septum?
Formed by ethmoid (perpendicular plate) ; vomer bones superiorly; vomeronasal ; nasal septal cartilages inferiorly
34
Epiglottis is conected to arytenoids by what 2 structures?
Aryepiglottic ligaments and folds
35
Which teeth #s are at highest risk for injury during intubation?
Top 7-10 and Bottom 23-26
36
What are the sensory nerves of the upper airway? (4)
Trigeminal (V)
Facial (VII)
Glossopharyngeal (IX)
Vagus (X)
37
What signifies the 1st generation in the lungs?
Right and left mainstem bronchi at the carina.
38
What does CN V (Trigeminal) innervate?
:
Divisions to mucous membranes of nose, hard & soft palate, anterior 2/3 tongue
39
At what rate is pleural fluid produced?
0.01-0.02 mL/kg/hr
Absorbed continously to maintain 0.1-0.2 mL/kg in body
40
Cricoid cartilage vertebral level in adults?
In kids?
C6 adults
C3-4 in kids
41
What is the epiglottis anchored/attached to?
Anchored to hyoid bone
Attached to body of thyroid cartilage by thyroepiglottic ligament (above vocal cords) & to base of tongue by glossoepiglottic folds
42
Distance from incisors to larynx?
13 cm
43
What is a broad definition of constrictive pericarditis?
Stiff and fibrous tissue encircles the heart and limits expansion during diastole
44
Thyroepiglottic Muscle fxn and innervation
Mucosal inversion of aryepiglottic folds
RLN innervates
45
Purpose of Type II cells?
Surfactant production mainly
Also modulate local electrolyte balance, enothelial and lymphatic cell function
46
3 Compartments of laryngeal cavity?
**Supraglottic/Vestibule-b/w false and true cords**
* False cords to tip of epiglottis; on each side is pyriform fossa
**Laryngeal ventricles**
* Area b/w false cords and true cords
**Infraglottic -subglottic**
* Below true cords and above beginning of trachea
47
What is the only unpaired inrinsic muscle of the larynx?
Transverse arytenoid
48
Unique ECG changes for acute pericarditis
4 stages: 1. ST elevation 2. ST normalizes 3. T wave inversion 4. T wave normalizes \*CHANGES ARE USUALLY PRESENT IN ALL LEADS\*
49
Thyrohyoid muscle fxn and innervation
Depresses the larynx
C1-C2
Hypoglossal nerve
50
What level vertebra is the carina?
T4-T5
51
What are two primary functions of the larynx?
1. Protection "Watchdog of respiratory tract"
2. Phonation
52
S/S of constrictive pericarditis
\*Symptoms of RHF and tamponade\* increased CVP, JVD, hepatic congestion, ascites, edema, equalization of RAP, RVEDP, PAOP, atrial dysrhythmias.
53
What type of cells are located in the mainstem bronchi?
Cuboidal epithelium
54
What will happen with unilateral injury to the RLN? Bilateral?
Unilateral: hoarseness
Bilateral: acute injury will see stridor, respiratory distress; with chronic injury you will see aphonia
55
Which nerve loops around the aortic arch?
Left Recurrent laryngeal
56
What are Pores of Kohn?
Small pores in alveoli allowing collateral gas flow between alveoli and a mechanism of relief from gas stagnation from airway closure.
57
RLN innervates 7 muscles. What are they?
Posterior cricoarytenoid
Lateral cricoarytenoid
Transverse arytenoid
Oblique arytenoid
Aryepiglottic
Vocalis
Thyroarytenoid
58
What are the layers that comprise the bronchi?
1. Epithelial
2. Smooth muscle
3. Connective tissue
59
What designates/demarcates the orpharynx?
Soft palate to the tip of the epiglottis, anteriorly it is bound by the tonsillar pillars
60
Terminal bronchioles are defined as
\<1 mm
61
Which nerve innervates the trachea?
The RLN of the Vagus
62
What is contained in the posterior division of the mediastinum?
Esophagus
Thoracic Aorta
Thoracic duct
\*B/w vertebral column and posterior pericardium\*
63
What is contained in the superior division of the mediastinum?
Thymus
Esophagus
Trachea
Great Vessels
\*Above the level of the sternal angle\*
64
Lungs are free in the pleural cavity except for which two areas which they have attachment to the mediastinum?
Hilum and pulmonary ligaments
65
Diameter of the trachea?
2.5 cm
66
What designates the nasopharynx?
Posterior nares to end of soft palate
67
What are the 3 types of cells in an alveolus?
Type 1
Type 2
Macrohages (type 3)
68
What does CN VII innervate?
Taste sensation to anterior 2/3 of tongue, vallecula & epiglottis
69
Alveoli begin to appear after how many generations?
20-25
70
Name the structure in the image.
Palatoglossal Arch
71
What is 3rd generation in the lungs?
Segmental bronchi
72
Lack of cartilage in small airways predisposes them to what?
Collapse/closure
73
What is the only intrinsic laryngeal muscle which abducts the cords?
Posterior cricoarytenoid
74
What will happen with unilateral injury to the SLN? Bilateral?
Unilateral: subtle changes
Bilateral: hoarseness or tiring of voice
75
What are the 3 pairs of major salivary glands?
1. Parotid 2. Submandibular 3. Sublingual
76
What type of cells line the trachea?
Pseudostratified ciliated columnar epithelium
77
Laryngeal inlet is closed by?
Aryepiglottic and oblique arytenoid muscles
78
What is Dressler syndrome?
Occurs weeks to months after an ischemic event d/t autoimmune process from entry of necrotic myocardium into the circulation. \*Compared to post MI pericarditis which is 1-3 days post MI and is the interaction b/c necrotic myocardium and pericardium\*
79
Are alveolar walls symmetrical? Describe their structure/function.
Walls are asymmetrical
Thin side functions in gas exchange
Thick side provides support, and fluid and solute exchange
80
Extrinsic muscles of the larynx are responsible for?
Responsible for movement during phonation, swallowing, breathing
81
Purpose of Type I cells?
Support and structure
Gas exchange
82
What is the last airway component perfused by bronchial circulation and NOT pulmonary circulation?
Terminal bronchioles
83
Inferior pharyngeal constrictor muscle Fxn and innervation?
Assists in swallowing
Vagus (pharyngeal plexus)
84
Name the structure in the image.
Palatopharyngeal Arch
85
Blood supply to the trachea comes from which arteries?
inferior thyroid artery which comes from subclavian artery
Also some supply from superior thyroid, bronchial & internal thoracic arteries
86
Which muscle forms the floor of the mouth?
The myohoid
87
Only muscle innervated by SLN? What is its function? Which branch of SLN?
Cricothyroid
Tensor of cords
External branch...internal is sensory
88
What are the 2 cartilages in the aryepiglottic fold?
Corniculate and cuneiform
89
Distance from incisors to carina?
26 cm
90
Thyroarytenoid fxn and innervation?
**Relaxes tension on cords**
\*Thurman also uses the term "shortens vocal cords" and says that the CT which tense the cords "lengthen" them\*
**RLN**
91
True cord are also known as?
Vocal ligament
92
Weight of L and R lungs?
R: 625 grams
L: 565 grams
93
Which arteries supply the nasal cavity?
Ophthalmic, maxillary & facial arteries supply walls, floor & roof
94
Which bones form the hard palate?
Formed by palatine processes of maxilla & horizontal plates of palatine bones
95
What is the length of the pharynx?
12-15 cm
96
Sternohyoid and Sternothyroid muscle Fxn and innervation?
Indirect depressor of larynx
Cervical plexus C1-C3 (Ansa Hypoglossi)
97
The larynx is innervated by which two major arteries?
External carotid and subclavian
98
What is another name for the lung pedicle?
Pulmonary root
99
What is CN X sensory innervation?
Base of tongue from internal branch of superior laryngeal nerve
\*REMEMBER SLN is vocal cords and RLN is subglottic.\*
100
What is the 2nd generation in the lungs?
Lobar bronchi
101
Which two muscles *close the glottis?*
Oblique arytenoid
Aryepiglottic
102
What is the motor nerve of the upper airway?
Hypoglossal (XII) (tongue)
103
Laryngeal inlet is opened by?
Thyroepiglottic muscle
104
What is this definition: "the volume of gas that will diffuse through the respiratory mebrane each minute for a partial pressure difference of 1 mm Hg"?
Diffusing Capacity
105
What is the diffusing capacity of O2 at rest? in mL/min/mmHg
21 mL/min/mmHg
106
What is the rate at which the body uses O2 at rest? mL/min
230 mL/min
107
What is the maximum diffusing capacity of O2?
65 mL/min/mmHg
\*3x the capacity at rest\*
108
What is the diffusing capacty of CO2? (at rest and during exercise)
Rest: 400-500 mL/min/mm Hg
Exercise: 1200-1300 mL/min/mm Hg
\*Remember 20x higher than O2\*
109
What does a VQ of 0 mean?
No ventilation but there is perfusion of the alveolus.
No gas exchange b/c no ventilation.
110
What does VQ of infinity mean?
There is ventilation but no perfusion; blood flow is absent.
No gas exchange is occuring b/c no perfusion.
111
Bronchial circulation is responsible for what percent of CO?
2% which nourishes lung parenchyma, bronchi, nerves, pulmonary vessels, and visceral pleura.
112
Bronchial veins return deoxygenated blood; which veins do they empty into?
Azygos
Hemiazygos
Posterior intercostal
Remainder of deoxygenated blood is returned by the pulmonary veins
113
Pulmonary veins carry deoxygenated blood from _______ \_\_\_\_\_\_\_\_ and \_**_distal_** \_\_**_bronchi_** and oxygenated blood from the respiratory units.
Visceral pleura
114
Total flow into LA and LV is \_\_\_%-\_\_\_\_% higher than RV output.
1%-2%
115
THe pulmonary arteries are \_\_\_\_x more compliant than systemic arteries.
7x
116
What allows a decrease in PVR when blood flow increases in the pulmonary vasculature? (2)
Recruitment-opening of new vessels to perfusion
Distensibility-increase in diameter
117
Blood passes through pulmonary capillaries in how many seconds?
0.75-0.8 sec
118
T/F Pulmonary blood flow is equal to CO.
True
119
Total pulmonary volume can range b/w \_\_\_\_-\_\_\_\_.
50-1000 mL
Average is 450 (9% of total blood volume)
120
CO can increase by how much before PAP pressures increase?
4X
121
5L/min of blood flow through lungs, of this volume, how much is in capillaries undergoing gas exchange?
70-100 mL
122
T/F Local factors are more important than ANS in influencing pulmonary vascular tone.
True
123
Pulmonary vessesls constrict when O2 concentration in the ***alveoli*** decreases below \_\_\_\_\_?
73 mmHg
124
How does hypercapnia affect pulmonary vessel tone? Hypocapnia?
Hypercapnia: vasoconstricts; \*this is why acidosis and hypoxia should be avoided for patients w/ RHF, b/c PVR is increased\*
Hypocapnia: vasodilates; opposite of systemic circulation
125
What do Endothelins cause?
Pulmonary vasosconstriction; administer endothelin antagonists for pulmonary HTN
126
T/F Prostacyclin stimulates guanynyl cyclase.
False
Activates adenyl cyclase pathway
Nitric oxide activates guanynyl cyclase which activates cGMP.
127
Formula for CaO2
(Hgb X 1.39 X SaO2) + (PaO2 X 0.003)
128
Formula for VO2
CO X (CaO2 - CvO2)
129
Formula to estimate CO
CO= VO2/ (CaO2 - CvO2)
130
What is the waterfall zone?
Zone 2
Pulmonary flow is ***solely*** dependent on arterial flow
Blood flow is intermittent
131
What 2 things can increase Zone 1 area?
High levels of PEEP
High airway pressures
132
Does VQ increase or decrease from dependent to nondependent lung areas?
Increase b/c more ventilation and but less perfusion
"deadspace like" alveoli
133
Will "deadspace" like alveoli have high or low VQ? PO2, CO2?
High VQ b/c high ventilation, low perfusion
High PO2 and low PCO2
\*if no perfusion, then no blood flow to carry away O2 or bring CO2 to alveolus\*
134
Will "shuntlike" alveoli have low or high VQ? PO2, PCO2?
Low VQ bc perfused but poorly ventilated
Low PO2, High PCO2
\*if no ventilation, blood and alveoli begin to equilibriate\*
135
O2 and CO2 levels of normal venous blood
PO2 40 mm Hg
PCO2 45 mm Hg
136
Formula for alveolar ventilation
VA = RR x (VT - VD)
VT=tidal volume
VD=dead space (typically 150 mL)
137
What is the Bohr Equation?
Dead Space/Tidal volume
(PaCO2-ETCO2)/PaCO2
\* in an anesthetized patient it is rare for dead space to change-increase in PaCO2-PETCO2 gradient is d/t increased alveolar dead space\*
138
What is the most common cause of acutely increased physiologic dead space?
Abrupt d/c in CO
139
What are some factors that increase alveolare deadspace?
COPD
ARDS
PPV
140
Right mainstem intubation would cause what kind of VQ mismatch?
Right to left shunt
141
What is the most common cause of hypoxemia under anesthesia?
Shunt
142
T/F Hypoxemia from a relative shunt does not improve with O2
False. Hypoxemia from an absolute shunt does not improve with O2, but a relative does.
143
Where are alveoli more compliant in a normal upright lung, apex or base?
Base
144
Which lung receives more ventilation?
Right
145
Pleural pressure d/c about 1 cm H20 per \_\_\_cm decrease in lung height
3 cm
So lower lung areas have more NEGATIVE pleural pressures and thus allow for better ventilation towards the bases
146
What is the respiratory quotient?
Ratio of CO2 produced to quantity of O2 consumed
RQ= mL CO2 produced/O2 consumed
Normal 0.8
147
What is the main cause of shunting in GA?
Atelectasis; 10% shunt
148
GA and NMBA effects on chest wall compliance, respiratory system compliance, and FRC?
Increased chest wall compliance
Decrease FRC
Decrease in respiratory system compliance
149
150
Which muscle(s) are pictured?
Posterior cricoarytenoids
151
Which muscle is shown?
Oblique arytenoids
152
Which muscle is shown?
Lateral cricoarytenoid
153
Which muscle is shown?
Lateral cricoarytenoid
154
Which muscle is shown?
Cricothyroid
155
Label the muscles in the image
Red
Green
Purple
Blue
Red: Thyroarytenoid
Green: Posterior cricoarytenoid
Purple: Transverse arytenoid
Blue: Lateral cricoarytenoid
