Exam II- Spring 2024 Flashcards
1
Q
Identify the 5 anatomical structures
A
- Central Tendon
- Esophageal Aperture
- Lumbar Spine- where diaphragm anchors itself to
- Aortic Aperture
- Caval Aperture
*alternate view
2
Q
Identify the 5 anatomical structures
A
- Epiglottis
- Thyrohyoid Membrane and Hyoid Bone
- Thyroid Cartilage
- Cricoid Cartilage
- Laryngeal Prominence (Adam’s Apple)
3
Q
Identify the 7 Anatomical Structures
A
- Epiglottis
- Cricoid Cartliages
- Vocal Folds (vocal cords)
- Thyroid Cartilage
- Thyrohyoid Ligament
- Hyoid Bone
- Tracheal Cartilage
4
Q
Identify the 2 anatomical structures
A
- Colliculus
- Thyroid Cartilage
lateral view
5
Q
What type of muscles are in the vocal folds and what innervates them?
A
- Skeletal muscles
- Recurrent laryngeal nerve
6
Q
What is the formula to calculate Transpulmonary Pressures (PTP)? What other pressure does this formula work for?
A
- PTP= Aveolar Pressure (PA) - Pleural Pressure (PIP)
- Elastic Pressure (PEL)
7
Q
What is the formula for Tidal Volume?
What is the formula in minute ventilation?
What are the normal values for each?
A
- VT= VDS + VA
- Minute Vent= VT x (RR)
- Resp. Rate= 12 bpm
- Tidal Volume= 500 mL; 6 L/min
- Dead Space Volume= 150 mL; 1.8 L/ min
- Aveolar Volume= 350 mL; 4.2 L/ min
8
Q
What are the normal volumes for:
Tidal Volume
Residual Volume
Expiratory Reserve Volume
Inspiratory Reserve Volume
A
- TV= 500 mL
- RV= 1.5 L
- ERV= 1.5 L
- IRV= 2.5 L
9
Q
Which volumes make up the following capacities and their normal values:
Total Lung Capacity
Inspiratory Capacity
Functional Residual Capacity
Working/ Vital Capacity
A
- TLC= 6 L
- IC= IRV+VT= 3.0 L
- FRC= ERV+RV= 3.0 L
- VC= IRV+VT+ERV= 4.5 L
10
Q
Abbreviations: A,a,C,P,V
A
A: alveolar
a: arterial
C: content
P: pressure
V: ventilation
11
Q
PA>Pv>Pa
A
- West Perfusion Zone 1
- no blood flow
- In a healthy lung, there should not be a zone 1
12
Q
Pa>PA>Pv
A
- West Perfusion Zone 2
- Pulsatile flow; “In between”
- Pulsatile blood flow during higer pressures times of the cardiac cycle and tapers off with a lower pulm blood pressure
- top portions of the lung
13
Q
Pa>Pv>PA
A
- West Perfusion Zone 3
- Continuous flow; “always on”
- Normally in the bottom 1/2 of the lung
14
Q
The effects of the weight of the lung on blood flow at the very base of the lung that sits on the diaphragm
A
- West Perfusion Zone 4
- A subset of Zone 3; reduces the amount of blood flow in the very bottom portion of the base
- the weight of the lungs compress the easily collapsable pulm vein and arteries
15
Q
Primary muscle for inpiration and ventilation
A
Diaphragm
16
Q
Supportive muscles that aid in inspiration? Expiration?
A
- Intercostal and scalene muscles
- Intercostal muscles and abdominal muscles (for max expiratory effort)
17
Q
How many scalene muscles are there and where are the attachment points?
A
- 3 Scalene Muscles
- 5: Anterior; C3-C6 and attach to Rib 1
- 6: Middle; C3-C7 and attach to Rib 1
- 7: Posterior; C5-C7 and attach to Rib 2
18
Q
Describe the diaphragm, innervation, and where is it attached?
A
- Dome-shaped striated skeletal muscle that is thought of as two leaflets or domes
- Phrenic nerve
- Anchored into the L-spine bodies
19
Q
What are the three openings and their orientation in the body?
A
- Caval Aperture- most anterior
- Aortic Aperture- most posterior
- Esphogeal Aperture- between the two
20
Q
Which aperture is most anterior and which is most posterior?
A
- Caval Aperture is most anterior
- Aortic Aperture is most posterior
21
Q
What is the largest cartilaginous part of the larynx (voice box)?
A
- Thyroid Cartilage
22
Q
During growth and development, _____ segments in the ______ lung fuse together.
A
4; left
23
Q
Generation 0-16 is known as the ______.
Generation 0 is the ______.
A
- Conducting Zone
- Trachea
24
Q
What are airways with no cartilage?
A
Bronchioles
25
Starting from the trachea, list the path of air during inspiration.
Trachea> bronchi> bronchioles> terminal bronchioles> respiratory bronchioles> alveolar ducts> alveolar sacs
26
Vocal cords are fastened anteriorly at the ______.
Thyroid cartilage
27
The larynx is innervated by what nerve?
Recurrent laryngeal nerve
28
Generations 17-23 are known as ?
Transitional and Respiratory Zones
29
Starting generation point for alveoli to show up
Generation 17
30
How many generations total do we have?
24; trachea is zero
31
All the surface area of all the alveoli of the lungs equals ________.
70 m^2
32
The lungs have _______ more capacity for gas exchange if it needs it.
3x
33
When does cyanosis occur as it pertains to deoxyhemoglobin?
When deoxyhemoglobin >5 g/ dL
34
What is the Fick Equation?
CO= O2 absorbed per min (mL/ min)/ Arteriovenous O2 difference (ml/ L)
35
What is Guyton's formula for calculating PVR?
What is normal?
PVR= MPAP-LAP/ C.O.
Normal= .14 PRU
36
What is Miller's Formula for calculating PVR?
What is normal?
PVR= MPAP- PAWP/ C.O. *(x 80 converts units to CGS)*
Normal= 96 mmHg/L/min
37
What is a CGS?
What are its units?
What is the equivalent PRU?
* Centimeters Gram Second
* mmHg/ L/ min or dyne x sec/ cm^5
* 1 CGS= 1333 x PRU
38
What volumes make up the vital capacity?
Expiratory Reserve Volume (ERV), Tidal Volume (TV), and Inspiratory Reserve Volume (IRV)
39
What volumes make up functional residual capacity (FRC)?
ERV, RV
40
Alveolar resistance gets higher ___ , gets lower ___
Lung volumes get higer; as lung volume gets lower
41
The higher the pulmonary blood flow, the lower the ______.
PVR
42
What are the two ways that our body reduces PVR when C.O. increases?
Recruitment and distension
43
What happens with right heart failure?
With decreased C.O., lungs decruit and vessels narrow, increasing PVR, increasing afterload for RH
44
What would increase PVR?
* Decreased/ Increased lung volume (above FRC)
* Decreased RH C.O.
* PPV
* Loss of alveoli
* Increased Interstitial pressure
45
What would decrease PVR?
* Increased C.O.
* Increased PAP
* Increased LAP
46
What are the pulmonary capillary pressures?
* Pc= 7 mmHg
* ∏p= 28 mmHg
* Pic= -8 mmHg
* ∏if= 14 mmHg
47
What is the formula for calculating net filtration and net flow?
* Net filtration= Pc-Pif-∏p+∏if
* Net flow= Kf x (Pc-Pif) - (∏p-∏if)
48
HPV is primarily an effect of what gas?
Primarily O2; secondarily CO2
49
2/3 of lungs elastic recoil pressure is ____ ____ and 1/3 is from the ____ itself.
Which is more important?
Surface tension; Tissue
The behavior of the tissue is most important because as long as the lungs are healthy, there should always be enough surfactant.
50
Top of lung doesnt get emptier than ?
Bottom lung doesn’t get emptier than ?
Top: 30%
Bottom: 20%
51
FRC intrapleural pressure:
RV intrapleural pressure:
FRC: -5 cm H2O (-8.5; -1.5)
RV: +2 cm H2O (-2.2; +4.8)
52
Noble gas used for PFT
Xenon
53
Noble gas thats 2nd lead cause of lung cancer
The isotope of Radon
54
What makes up 62% of all surfactant's phospholipids?
Unsaturated Phosphatidylcholine and Dipalmitoyl Phosphatidylcholine
55
Hydrophobic surfact protein
SP-B and SP-C
56
Surfactant make up % between protein and lipids
90% lipid, 10% protein
57
Functions of Club Cells
* Found in the bronchioles, produces surfactant at much lower rate than alveoli type II cells
* Progenitor cell for damaged areas of lungs
58
Type 1 and Type 2 alveolar cell percentage
* Type 1: 90-95% of alveolar surface area
* Type 2: 5-10% of alveolar surface area
59
Increasing lung volume does what to PVR? Why?
Increases
At very high lung volumes Total PVR is elevated because **Alveolar resistance** is elevated
60
Decreasing lung volume does what to PVR? Why?
Increases
At very low lung volumes Total PVR is elevated because **extraalveolar resistance** is elevated
61
Decreasing lung volume does what to airway resistance?
Decreases
62
FRC volumes standing v supine
Standing- 3 L
Supine- 2 L
63
FRC drops in supine pt because of?
reduction in ERV
*“...diaphragm is getting pushed up from all the mass of the stuff that’s in your abdomen. So the volume that gets squeezed out is the ERV. “*
64
What is the normal airway compliance value for the lungs?
200 mL/ per cm H20
65
____% of expired air should be CO2
5%
66
At what transpulmonary pressure is TLC?
25-30 cm H2O
67
What are two causes for low Alpha1 Antitrypsin?
* Liver failure
* Genetic condtion where they lack the gene
*If untreated --> emphysema by age 30
68
What are the effects on volumes and capacities with **Restrictive Lung Disease**?
* Decrease: RV, ERV, TV, VC, FRC, and TLC
* IRV may be low to normal depending on how the stage of disease
69
What are the effects on volumes and capacties with **Obstructive Lung Disease**?
* Large increase in TLC
* Increase RV --> decrease in ERV and IRV
* VC decreases and is almost equal to TLC as the disease worsens
70
Which of the following conditions are reasonable explanations for a patient’s **decreased static pulmonary compliance** (the pressure-volume curve for the lungs shifted to the right)?
* Decreased functional pulmonary surfactant
* Fibrosis of the lungs
* Surgical removal of one lobe
* Pulmonary vascular congestion
71
Which of the following tend to increase airways resistance?
* Stimulation of the parasympathetic postganglionic fibers
innervating the bronchial and bronchiolar smooth muscle
* Low lung volumes
* Forced expirations
* Breathing through the nose instead of the mouth
72
Which of the following statements concerning alveolar pressure
is/are correct?
a. Alveolar pressure is lower than atmospheric pressure during a
normal negative-pressure inspiration.
b. Alveolar pressure is greater than atmospheric pressure during
a forced expiration.
c. Alveolar pressure equals the sum of the intrapleural pressure
plus the alveolar elastic recoil pressure.
d. Alveolar pressure equals atmospheric pressure at the end of a
normal tidal expiration.
73
Which of the following statements concerning small airways is/are
true?
a. The total resistance to airflow decreases with successive
generations of airways because there are increasing numbers
of units arranged in parallel.
b. The linear velocity of airflow decreases as the airways
decrease in size because their total cross-sectional area
increases.
c. Alveolar elastic recoil plays an important role in determining
the resistance to airflow in small airways because alveolar
septal traction helps to oppose dynamic compression.
d. Airflow in small airways is usually laminar.
74
____ are generation 1-3.
____ are generation 4.
Bronchi
Bronchioles
75
____ are generation 5-16
____ are generation 17-19
* Terminal Bronchioles
* Respiratory Bronchioles
76
____ are generation 20-22
____ are generation 23
Alveolar Ducts
Alveolar Sacs
