Exam 4 Flashcards by Erin Baker

The trachea is usually about ___ to __ centimeters in length

10 to 13

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the width of your ____ is typically pretty close to the inner diameter of the trachea

thumb

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The vast majority of the trachea is seated _____

inside the thorax (intra-thoracic)

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How many cm of the trachea is extrathoracic?

4 cm!

We’ve got about 4 centimeters at the top of the trachea that is extra-thoracic, so it comes out at the top of the chest and is accessible in the neck→so we’ve got just a few centimeters that’s extra-thoracic, but the vast majority of it is intra-thoracic.

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How many cartilaginous rings in an average adult trachea?

20 pieces connected via annular ligaments

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Two benefits of the cartilaginous rings of the trachea not being continuous (in the posterior part of the trachea)

-Helps us swallow
-Helps us cough

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Usually we’re generating up to ____ mph winds when we’re coughing.

100 miles per hour

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Right lung is probably going to have ___ bronchopulmonary segments, and the left lung is going to have ___.

right: 10
left: 8

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Why does the left lung only have 8 bronchopulmonary segments?

through fusion during development of two pairs of bronchopulmonary segments.

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Right lung mainstem is ____ and ___ compared to left lung

Wider, shorter

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The left main stem is more ___ and ____

Why?

More narrow, longer

This is where the heart is positioned, need a longer left mainstem to route incoming/outgoing air past the position where the heart is sitting

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How long is the left mainstem?

4-6 cm

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Which mainstem is more vertical?

Right

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Which mainstem is more horizontal?

Left!

Less vertical, more horizontal

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Right main stem deviates from the vertical line by about ___ degrees.

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Left main stem deviates from the vertical line by about ___ degrees.

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Total angle of bifurcation of the mainstems

70 degrees

45 degrees on left + 25 degrees on right

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Those are two invasive airway locations:

You can either put an opening in the trachea itself or make an incision in the median cricothyroid ligament and go from there.

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50% of our inspired breath comes from our

Nose

other 50% from mouth

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How does extending a patient’s neck impact the length / diameter of the trachea?

It will make it longer / narrower

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Biggest ligament of larynx

Thyrohyoid membrane

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only continuous piece of cartilage that we have that forms a full circle is the

Cricoid cartilage

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Narrowest point of larynx in those 10 years old or younger

What about an adult?

-Kids –> Cricoid cartilage

-Adult –> transglottic space
(width between vocal cords)

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Where can you feel ETT cuff inflate?

Sternal notch

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What is the only laryngeal muscle that is fully exterior?

Cricothyroid muscle

How does the cricothyroid muscle impact: Vocal cords? Rima Glottidis?

Tighten vocal cords No impact on rima glottidis

How does the vocalis muscle impact: Vocal cords? Rima Glottidis?

Action of Vocalis Muscle: -Tightens Vocal Cords -Effect on Rima Glottis: None

When the Thyroarytenoid Muscle closes the cords, the left piece of cartilage rotates ____ What about the right piece?

Left: clockwise Right: counter clockwise

How does the thyroarytenoid muscle impact: Vocal cords? Rima Glottidis?

The thyroarytenoid muscle: -adducts the cords -ends up closing the rima glottis

How does the transverse arytenoid muscle impact: Vocal cords? Rima Glottidis?

-adducts cords -closes rima glottis

How does the posterior cricoarytenoid muscle impact: Vocal cords? Rima Glottidis?

-abducts cords -opens rima glottis

How does the lateral cricoarytenoid muscle impact: Vocal cords? Rima Glottidis?

-adducts cords -closes rima glottis

The highest location on the earth is about ____ meters in the air

9000 (or 9 km) | This is the summit of mount everest ## Footnote its actually 8800 but Schmidt says close to 9000 m

What is the barometric pressure at the summit of mount everest? What about inspired PO2?

Barometric pressure: 253 mmHg Inspired PO2: 43 mmHg

Atmospheric oxygen concentration at the summit of mount everest

21% or 0.21

People tend to feel out of breath when they are about ______ feet up. Do they hyper or hypoventilate at high altitudes initially?

15,000 feet Hyperventilating (just as a compensation to the different environment).

Where are the kidneys oxygen sensors?

Inner medulla ## Footnote if you grew up at sea level, then you go to 10,000 feet, then your hematocrit is gonna be higher after a few days as a result of the actions of EPO

Typically for average day-to-day activity or everyday activity like playing sports, usually the limiting factor to our performance is _______

the heart→ usually the cardiac output is the limiting thing (and not the lungs.)

Typically we have about ___ times more lung area than we really need over the course of our life.

What is the lowest altitude place on earth, according to Schmidt?

Death valley

If we dive to a depth of 500 feet, the pressure is ____x higher than atmospheric pressure at sea level

16 | 1 atm = 760 mmHg 16 atm --> 12,160 mmHg

At 5000 mmHg, PO2 is ____ PN2 is _____

O2 --> 1,044 N2 --> 3956 | CO2 pressures are probably also elevated while diving

A standard hyperbaric chamber has a pressure of ___ atm

3 atm | 3x normal barometric pressure

In the OR, we give our patients ~ ___% inspired O2

30%

Name the four dangerous oxygen molecules aka reactive oxygen species (ROS)

## Footnote Peroxynitrite destroys DNA --> leads to cancer down the road

What things contain / control reactive oxygen species?

Superoxide dismutase, peroxidases, catalases, acetylcysteines

With negative pressure breathing the alveoli closest to _____ fill first. With positive pressure ventilaiton the alveoli closes to ___ fill first

Negative --> superficial borders of the lung tissue PPV --> alveoli closest to the large airways ## Footnote Normally (negative pressure breathing) , the alveoli that are closest to the superficial borders of the lung tissue are going to be the ones that fill first because they're closest to the negative pressure that's filling/pulling on the lung. Typically that will result in the deeper alveoli getting also stretched out and fuller

Why do planes fly at 40K feet instead of 10K feet?

Cheaper bc the air is thinner --> saves gas | I know this is a dumb card but in case he asks how high planes fly

Typically, all modern jets are pressurized to basically mimic an _____ feet environmental condition.

8,000

If we are at 30K/40K feet the barometric pressure is somewhere around... The PO2 is only about

200 mmHg maybe lower PO2: ~29 mmHg

What type of chemical reaction happens in plane O2 source boxes with dropdown masks? What is the problem with this?

exothermic If it gets set off when it isn't supposed to, it has potential to produce a lot of heat and oxygen --> heat + O2 is a recipe for disaster --> fires

Normal arterial pH range

7.35-7.45 | 7.4 is right in the middle

Main volatile gas/acid in our body

CO2

CO2 and carbonic acid are ____ acids

weak

For every 1000 CO2 molecules we have ___ carbonic acid molecules

Name the 4 common non-voltaile acids we have around the body

-Sulfuric acid -Phosphoric acid -HCL -Lactic acid

What kind of patients will produce acetoacetic acid? (2 examples)

-Diabetic patients with really poor blood sugar management -Your body produces this when you have had a lot to drink

What kind of patient will have butyric acid production?

People with poor health and poorly managed diabetes

What organ transforms/eliminates most of the non-volatile acids?

Kidney! | The liver can sometimes transform some of the less toxic ones

Sodium fluoride in toothpaste is a ___ base

weak | or potassium fluoride

This is a strong base and a common component of drain cleaner

NaOH | Sodium hydroxide

If you have to think of one super basic drug, think of this drug:

Sodium Pentobarbital

pH equation in relation to proton concentration

pH = -log [H+]

What is a neutral pH? Acidic? Alkaline?

pH of 7 → neutral pH < 7 → acidic pH >7 → alkaline

gastric acid has a pH of

1 | most acidic secretion in the body

pancreatic secretions have a pH of

8 | most alkaline secretion in the body

If you have high intestinal motility, you can become ____ Why?

Acidotic you lose a lot of the bicarb that the pancreas is producing.

If you are continuously vomiting, you can become _____ Why?

Alkalotic Losing large amounts of acid from the stomach

What is the concentration of protons in gastric acid? Show how you got it.

0.1 mmol / Liter 1 x 10^-1

How many protons do we have in an aqueous solution with a neutral pH of 7 Show how you got it :)))))

100 nmol / liter 1 x 10^-7 =0.0000001 mmol / l 0.0000001 mmol = 100 nmol / l

If our pH changes from 7.4 to 7.7 our proton concentration is cut in ____

half

3 most important buffers

Proteins, bicarbonate, phosphate ## Footnote Phosphate is an intracellular buffer Good example for a protein is Hb

Normal bicarb at a pH of 7.4

24 mmol/L | Pay attention to units!!! ## Footnote same things as mEq/L

Name the 3 important buffers

1. Bicarb→Bicarb is a dominant extracellular buffer. 2. Proteins→ are the most important buffer behind bicarb. 3. Phosphate→ is also an important buffer. (Mainly ICF but important plasma buffer as well)

The pK of bicarb as a buffer is _____

6.1

When referring to the gain of the control system, many systems in the body can correct for at least ____ the problem

Half

Which cervical nerves does the phrenic nerve come from? :)

C3,C4, C5

Idk if he'll as this but just in case.. Coolant leaking from a european car will be ____ Coolant leaking from japanese or american car will be___

Euro --> blue Japanese/American --> green

Oxidative metabolism produces ___ ATP per 1 glucose molecule

Glycolytic metabolism produces ___ ATP per 1 glucose molecule

2 | aka this way sucks

For anion gap, sodium is ___ mEq/L Chloride is __ mEq/L HCO3 is ___ mEq/L

Na --> 142 Cl --> 106 HCO3 --> 24

Normal anion gap and marigin of error Show how ya got it

12 mEq/L +/- 4 mEq/L How? [Na+] = [Cl+] + [HCO3-] 142 = 106 + 24 142 = 130