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NUR 942 Thurman > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

In which layer of the bronchi are goblet and ciliated cells located?

A

Epithelial lining

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2
Q

Olfactory epithelium is innervated by which nerve?

A

Olfactory nerve CN I

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3
Q

T/F Acute pericarditis w/out effusion does not alter cardiac function.

A

True

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4
Q

Treatments for acute pericarditis?

A

ASA/NSAIDS Toradol Steroid for refractory CP

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5
Q

What is the chief support of the larynx?

A

The hyoid bone

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6
Q

How many alveoli are present at birth? By adulthood?

A

10-25 million at birth; 300 million by adulthood

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7
Q

What is contained in the anterior division of the mediastinum?

A

Thymus

*B/w sternum and pericardium*

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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)

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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.

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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.

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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*

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12
Q

What separates the oropharynx from the nasopharynx?

A

Soft palate

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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

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14
Q

What is significant about the pyriform fossa?

A

Tendency to trap food and it is landmark for SLN blockade

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15
Q

What are the 2 functions of the alveolar-capillary membrane?

A

1) transport of respiratory gases
2) production of local & humoral substances

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16
Q

What is the last airway component NOT capable of gas exchange?

A

Terminal bronchioles

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17
Q

What designates the laryngopharynx or hypopharynx?

A

The epiglottis to the cricoid cartilage

C3-C6

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18
Q

Function and innervation of vocalis muscle?

A

Relaxes the cords

RLN

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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

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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

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21
Q

Most common cause of acute pericarditis?

A

Viral infection

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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.

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23
Q

What are the 3 clinical manifestations of pericardial disease?

A
  1. Acute pericarditis 2. Constrictive pericarditis 3. Cardiac Tamponade
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24
Q

What is responsible for suspending the larynx from the hyoid bone?

A

The thyrohyoid membrane

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25
Q

Significance of laryngeal inlet?

A

Connects the pharynx to the larynx

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26
Q

False cords are also known as?

A

Vestibular ligament

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27
Q

What makes up the hilum? What is its significance?

A

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
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28
Q

Name the tonsils and their location.

A

LIngual (base of tongue)

Palatine (tonsilar fossa at boundary of oral cavity and oropharynx) T

ubal (behind Eustachian tube)

Pharyngeal (lateral walls of nasopharynx)

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29
Q

What is the surface for gas exchange of an alveolus?

A

60-80 m2

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30
Q

Stylopharyngeus muscle Fxn and innervation?

A

Assists folding of thyroid cartilage

Glossopharyngeal nerve

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31
Q

What is the only intrinsic muscle external to the larynx?

A

Cricothyroid

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32
Q

What is the ring of Waldeyer?

A

Circumferential ring of lymphatic tissue

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33
Q

Which bones form the septum?

A

Formed by ethmoid (perpendicular plate) ; vomer bones superiorly; vomeronasal ; nasal septal cartilages inferiorly

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34
Q

Epiglottis is conected to arytenoids by what 2 structures?

A

Aryepiglottic ligaments and folds

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35
Q

Which teeth #s are at highest risk for injury during intubation?

A

Top 7-10 and Bottom 23-26

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36
Q

What are the sensory nerves of the upper airway? (4)

A

Trigeminal (V)

Facial (VII)
Glossopharyngeal (IX)

Vagus (X)

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37
Q

What signifies the 1st generation in the lungs?

A

Right and left mainstem bronchi at the carina.

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38
Q

What does CN V (Trigeminal) innervate?

:

A

Divisions to mucous membranes of nose, hard & soft palate, anterior 2/3 tongue

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39
Q

At what rate is pleural fluid produced?

A

0.01-0.02 mL/kg/hr

Absorbed continously to maintain 0.1-0.2 mL/kg in body

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40
Q

Cricoid cartilage vertebral level in adults?

In kids?

A

C6 adults

C3-4 in kids

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41
Q

What is the epiglottis anchored/attached to?

A

Anchored to hyoid bone

Attached to body of thyroid cartilage by thyroepiglottic ligament (above vocal cords) & to base of tongue by glossoepiglottic folds

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42
Q

Distance from incisors to larynx?

A

13 cm

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43
Q

What is a broad definition of constrictive pericarditis?

A

Stiff and fibrous tissue encircles the heart and limits expansion during diastole

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44
Q

Thyroepiglottic Muscle fxn and innervation

A

Mucosal inversion of aryepiglottic folds

RLN innervates

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45
Q

Purpose of Type II cells?

A

Surfactant production mainly

Also modulate local electrolyte balance, enothelial and lymphatic cell function

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46
Q

3 Compartments of laryngeal cavity?

A

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
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47
Q

What is the only unpaired inrinsic muscle of the larynx?

A

Transverse arytenoid

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48
Q

Unique ECG changes for acute pericarditis

A

4 stages: 1. ST elevation 2. ST normalizes 3. T wave inversion 4. T wave normalizes *CHANGES ARE USUALLY PRESENT IN ALL LEADS*

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49
Q

Thyrohyoid muscle fxn and innervation

A

Depresses the larynx

C1-C2

Hypoglossal nerve

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50
Q

What level vertebra is the carina?

A

T4-T5

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51
Q

What are two primary functions of the larynx?

A
  1. Protection “Watchdog of respiratory tract”
  2. Phonation
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52
Q

S/S of constrictive pericarditis

A

*Symptoms of RHF and tamponade* increased CVP, JVD, hepatic congestion, ascites, edema, equalization of RAP, RVEDP, PAOP, atrial dysrhythmias.

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53
Q

What type of cells are located in the mainstem bronchi?

A

Cuboidal epithelium

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54
Q

What will happen with unilateral injury to the RLN? Bilateral?

A

Unilateral: hoarseness

Bilateral: acute injury will see stridor, respiratory distress; with chronic injury you will see aphonia

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55
Q

Which nerve loops around the aortic arch?

A

Left Recurrent laryngeal

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56
Q

What are Pores of Kohn?

A

Small pores in alveoli allowing collateral gas flow between alveoli and a mechanism of relief from gas stagnation from airway closure.

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57
Q

RLN innervates 7 muscles. What are they?

A

Posterior cricoarytenoid

Lateral cricoarytenoid

Transverse arytenoid

Oblique arytenoid

Aryepiglottic

Vocalis

Thyroarytenoid

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58
Q

What are the layers that comprise the bronchi?

A
  1. Epithelial
  2. Smooth muscle
  3. Connective tissue
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59
Q

What designates/demarcates the orpharynx?

A

Soft palate to the tip of the epiglottis, anteriorly it is bound by the tonsillar pillars

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60
Q

Terminal bronchioles are defined as

A

<1 mm

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61
Q

Which nerve innervates the trachea?

A

The RLN of the Vagus

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62
Q

What is contained in the posterior division of the mediastinum?

A

Esophagus

Thoracic Aorta

Thoracic duct

*B/w vertebral column and posterior pericardium*

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63
Q

What is contained in the superior division of the mediastinum?

A

Thymus

Esophagus

Trachea

Great Vessels

*Above the level of the sternal angle*

64
Q

Lungs are free in the pleural cavity except for which two areas which they have attachment to the mediastinum?

A

Hilum and pulmonary ligaments

65
Q

Diameter of the trachea?

A

2.5 cm

66
Q

What designates the nasopharynx?

A

Posterior nares to end of soft palate

67
Q

What are the 3 types of cells in an alveolus?

A

Type 1

Type 2

Macrohages (type 3)

68
Q

What does CN VII innervate?

A

Taste sensation to anterior 2/3 of tongue, vallecula & epiglottis

69
Q

Alveoli begin to appear after how many generations?

A

20-25

70
Q

Name the structure in the image.

A

Palatoglossal Arch

71
Q

What is 3rd generation in the lungs?

A

Segmental bronchi

72
Q

Lack of cartilage in small airways predisposes them to what?

A

Collapse/closure

73
Q

What is the only intrinsic laryngeal muscle which abducts the cords?

A

Posterior cricoarytenoid

74
Q

What will happen with unilateral injury to the SLN? Bilateral?

A

Unilateral: subtle changes

Bilateral: hoarseness or tiring of voice

75
Q

What are the 3 pairs of major salivary glands?

A
  1. Parotid 2. Submandibular 3. Sublingual
76
Q

What type of cells line the trachea?

A

Pseudostratified ciliated columnar epithelium

77
Q

Laryngeal inlet is closed by?

A

Aryepiglottic and oblique arytenoid muscles

78
Q

What is Dressler syndrome?

A

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
Q

Are alveolar walls symmetrical? Describe their structure/function.

A

Walls are asymmetrical

Thin side functions in gas exchange

Thick side provides support, and fluid and solute exchange

80
Q

Extrinsic muscles of the larynx are responsible for?

A

Responsible for movement during phonation, swallowing, breathing

81
Q

Purpose of Type I cells?

A

Support and structure

Gas exchange

82
Q

What is the last airway component perfused by bronchial circulation and NOT pulmonary circulation?

A

Terminal bronchioles

83
Q

Inferior pharyngeal constrictor muscle Fxn and innervation?

A

Assists in swallowing

Vagus (pharyngeal plexus)

84
Q

Name the structure in the image.

A

Palatopharyngeal Arch

85
Q

Blood supply to the trachea comes from which arteries?

A

inferior thyroid artery which comes from subclavian artery

Also some supply from superior thyroid, bronchial & internal thoracic arteries

86
Q

Which muscle forms the floor of the mouth?

A

The myohoid

87
Q

Only muscle innervated by SLN? What is its function? Which branch of SLN?

A

Cricothyroid

Tensor of cords

External branch…internal is sensory

88
Q

What are the 2 cartilages in the aryepiglottic fold?

A

Corniculate and cuneiform

89
Q

Distance from incisors to carina?

A

26 cm

90
Q

Thyroarytenoid fxn and innervation?

A

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
Q

True cord are also known as?

A

Vocal ligament

92
Q

Weight of L and R lungs?

A

R: 625 grams

L: 565 grams

93
Q

Which arteries supply the nasal cavity?

A

Ophthalmic, maxillary & facial arteries supply walls, floor & roof

94
Q

Which bones form the hard palate?

A

Formed by palatine processes of maxilla & horizontal plates of palatine bones

95
Q

What is the length of the pharynx?

A

12-15 cm

96
Q

Sternohyoid and Sternothyroid muscle Fxn and innervation?

A

Indirect depressor of larynx

Cervical plexus C1-C3 (Ansa Hypoglossi)

97
Q

The larynx is innervated by which two major arteries?

A

External carotid and subclavian

98
Q

What is another name for the lung pedicle?

A

Pulmonary root

99
Q

What is CN X sensory innervation?

A

Base of tongue from internal branch of superior laryngeal nerve

*REMEMBER SLN is vocal cords and RLN is subglottic.*

100
Q

What is the 2nd generation in the lungs?

A

Lobar bronchi

101
Q

Which two muscles close the glottis?

A

Oblique arytenoid

Aryepiglottic

102
Q

What is the motor nerve of the upper airway?

A

Hypoglossal (XII) (tongue)

103
Q

Laryngeal inlet is opened by?

A

Thyroepiglottic muscle

104
Q

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”?

A

Diffusing Capacity

105
Q

What is the diffusing capacity of O2 at rest? in mL/min/mmHg

A

21 mL/min/mmHg

106
Q

What is the rate at which the body uses O2 at rest? mL/min

A

230 mL/min

107
Q

What is the maximum diffusing capacity of O2?

A

65 mL/min/mmHg

*3x the capacity at rest*

108
Q

What is the diffusing capacty of CO2? (at rest and during exercise)

A

Rest: 400-500 mL/min/mm Hg

Exercise: 1200-1300 mL/min/mm Hg

*Remember 20x higher than O2*

109
Q

What does a VQ of 0 mean?

A

No ventilation but there is perfusion of the alveolus.

No gas exchange b/c no ventilation.

110
Q

What does VQ of infinity mean?

A

There is ventilation but no perfusion; blood flow is absent.

No gas exchange is occuring b/c no perfusion.

111
Q

Bronchial circulation is responsible for what percent of CO?

A

2% which nourishes lung parenchyma, bronchi, nerves, pulmonary vessels, and visceral pleura.

112
Q

Bronchial veins return deoxygenated blood; which veins do they empty into?

A

Azygos

Hemiazygos

Posterior intercostal

Remainder of deoxygenated blood is returned by the pulmonary veins

113
Q

Pulmonary veins carry deoxygenated blood from _______ ________ and _distal __bronchi and oxygenated blood from the respiratory units.

A

Visceral pleura

114
Q

Total flow into LA and LV is ___%-____% higher than RV output.

A

1%-2%

115
Q

THe pulmonary arteries are ____x more compliant than systemic arteries.

A

7x

116
Q

What allows a decrease in PVR when blood flow increases in the pulmonary vasculature? (2)

A

Recruitment-opening of new vessels to perfusion

Distensibility-increase in diameter

117
Q

Blood passes through pulmonary capillaries in how many seconds?

A

0.75-0.8 sec

118
Q

T/F Pulmonary blood flow is equal to CO.

A

True

119
Q

Total pulmonary volume can range b/w ____-____.

A

50-1000 mL

Average is 450 (9% of total blood volume)

120
Q

CO can increase by how much before PAP pressures increase?

A

4X

121
Q

5L/min of blood flow through lungs, of this volume, how much is in capillaries undergoing gas exchange?

A

70-100 mL

122
Q

T/F Local factors are more important than ANS in influencing pulmonary vascular tone.

A

True

123
Q

Pulmonary vessesls constrict when O2 concentration in the alveoli decreases below _____?

A

73 mmHg

124
Q

How does hypercapnia affect pulmonary vessel tone? Hypocapnia?

A

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
Q

What do Endothelins cause?

A

Pulmonary vasosconstriction; administer endothelin antagonists for pulmonary HTN

126
Q

T/F Prostacyclin stimulates guanynyl cyclase.

A

False

Activates adenyl cyclase pathway

Nitric oxide activates guanynyl cyclase which activates cGMP.

127
Q

Formula for CaO2

A

(Hgb X 1.39 X SaO2) + (PaO2 X 0.003)

128
Q

Formula for VO2

A

CO X (CaO2 - CvO2)

129
Q

Formula to estimate CO

A

CO= VO2/ (CaO2 - CvO2)

130
Q

What is the waterfall zone?

A

Zone 2

Pulmonary flow is solely dependent on arterial flow

Blood flow is intermittent

131
Q

What 2 things can increase Zone 1 area?

A

High levels of PEEP

High airway pressures

132
Q

Does VQ increase or decrease from dependent to nondependent lung areas?

A

Increase b/c more ventilation and but less perfusion

“deadspace like” alveoli

133
Q

Will “deadspace” like alveoli have high or low VQ? PO2, CO2?

A

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
Q

Will “shuntlike” alveoli have low or high VQ? PO2, PCO2?

A

Low VQ bc perfused but poorly ventilated

Low PO2, High PCO2

*if no ventilation, blood and alveoli begin to equilibriate*

135
Q

O2 and CO2 levels of normal venous blood

A

PO2 40 mm Hg

PCO2 45 mm Hg

136
Q

Formula for alveolar ventilation

A

VA = RR x (VT - VD)

VT=tidal volume

VD=dead space (typically 150 mL)

137
Q

What is the Bohr Equation?

A

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
Q

What is the most common cause of acutely increased physiologic dead space?

A

Abrupt d/c in CO

139
Q

What are some factors that increase alveolare deadspace?

A

COPD

ARDS

PPV

140
Q

Right mainstem intubation would cause what kind of VQ mismatch?

A

Right to left shunt

141
Q

What is the most common cause of hypoxemia under anesthesia?

A

Shunt

142
Q

T/F Hypoxemia from a relative shunt does not improve with O2

A

False. Hypoxemia from an absolute shunt does not improve with O2, but a relative does.

143
Q

Where are alveoli more compliant in a normal upright lung, apex or base?

A

Base

144
Q

Which lung receives more ventilation?

A

Right

145
Q

Pleural pressure d/c about 1 cm H20 per ___cm decrease in lung height

A

3 cm

So lower lung areas have more NEGATIVE pleural pressures and thus allow for better ventilation towards the bases

146
Q

What is the respiratory quotient?

A

Ratio of CO2 produced to quantity of O2 consumed

RQ= mL CO2 produced/O2 consumed

Normal 0.8

147
Q

What is the main cause of shunting in GA?

A

Atelectasis; 10% shunt

148
Q

GA and NMBA effects on chest wall compliance, respiratory system compliance, and FRC?

A

Increased chest wall compliance

Decrease FRC

Decrease in respiratory system compliance

149
Q
A
150
Q

Which muscle(s) are pictured?

A

Posterior cricoarytenoids

151
Q

Which muscle is shown?

A

Oblique arytenoids

152
Q

Which muscle is shown?

A

Lateral cricoarytenoid

153
Q

Which muscle is shown?

A

Lateral cricoarytenoid

154
Q

Which muscle is shown?

A

Cricothyroid

155
Q

Label the muscles in the image

Red

Green

Purple

Blue

A

Red: Thyroarytenoid

Green: Posterior cricoarytenoid

Purple: Transverse arytenoid

Blue: Lateral cricoarytenoid

NUR 942 Thurman (6 decks)

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