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respiratory physio > Final > Flashcards

Final Flashcards

1
Q

where is the larynx located in an adult

A

anterior to 3rd to 6th vertebre

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2
Q

where is the larynx located at birth

A

c3-c4

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3
Q

A-O extension is usually

A

35 degrees

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4
Q

MP Class 1

A

full view of uvula and tonsillar pillars, soft palate

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5
Q

MP Class 2

A

partial view of uvula or uvular base, partial view of tonsils, soft palate

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6
Q

MP Class 3

A

soft palate only

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7
Q

MP class 4

A

hard palate only

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8
Q

MP status is based on

A

size of tongue and pharyngeal structures visible on mouth opening

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9
Q

what does the sphenopalatine ganglion (middle division of CN V) innervate

A

nasal mucosa, superior pharynx, uvula, tonsils

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10
Q

what does the Glossopharyngeal nerve (CN IX) innervate

A

lingual back 1/3, pharyngeal, tonsillar nerves - pray pharynx, supraglottic region

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11
Q

what does the internal branch of the SLN (CNX) innervate

A

mucous membrane above the VC’s, glottis

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12
Q

what does the recurrent laryngeal nerve innervate (CNX)

A

trachea below VC’s

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13
Q

SLN divides into two nerves:

A

Internal and external SLN

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14
Q

Internal SLN function

A

provides sensation to supraglottic and ventricle compartment

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15
Q

stimulation of the ____ causes laryngospasm

A

internal SLN

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16
Q

External SLN function

A

provides motor innervation of cricothyroid membrane

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17
Q

left RLN passes at

A

aortic arch

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18
Q

RLN sensory =

A

sensory innervation to infra glottis (below the cords)

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19
Q

two nerves of larynx

A

SLN and RLN

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20
Q

does RLN provide sensory, motor, or both?

A

both!

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21
Q

RLN motor

A

innervates all larynx except cricothyroid

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22
Q

stimulation of RLN causes ___ of VC

A

ABduction of VC

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23
Q

damage to RLN causes ___ of VC

A

ADduction

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24
Q

at what level does the trachea divide

A

carina T5-T7

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25
Q

trachea extends from

A

c6 to t5

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26
Q

where does gas exchange begin

A

respiratory bronchiole

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27
Q

which nerve transmits motor stimulation to diaphragm

A

phrenic - c3,4,5

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28
Q

which nerves send signals to the external intercostal muscles?

A

intercostal nerves T1-11

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29
Q

the act of inhaling is

A

negative pressure ventilation

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30
Q

TLC =

A

IRV+TV+ERV+RV

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31
Q

VC =

A

IRV + TV + ERV

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32
Q

FRC=

A
  • ERV + RV *
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33
Q

IC =

A

TV + IRV

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34
Q

spirometry cannot measure___ so which two capacities cannot be determined using spirometry alone?

A

residual volume. FRC/TLC

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35
Q

3 ways to measure FRC and TLC directly

A

helium dilution, nitrogen washout, body plethysmography

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36
Q

flow volume loops

A

.

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37
Q

FEV1

A

.

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38
Q

which part of flow volume loop is effort dependent

A

.

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39
Q

fixed obstruction

A

.

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40
Q

extra thoracic obstruction

A

.

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41
Q

intra thoracic obstruction

A

.

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42
Q

surfactant lowers ___ of alveoli and lung

A

surface tension

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43
Q

poisueille’s law describes

A

resistance of flow in a tube

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44
Q

poisueille’s law - resistance is proportional to

A

length and viscosity

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45
Q

poisueille’s law - resistance is inversely proportional to

A

radius

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46
Q

*poisueille’s law reducing r by 16% will ___ the R

A

double

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47
Q

*poisueille’s law reducing r by 50% will

A

increase R 16-fold

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48
Q

what are the two mechanisms for the decrease in PVR that occurs as vascular pressures are raised

A

recruitment and distension

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49
Q

recruitment is

A

opening closed segments to increase capillary volume

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50
Q

functional capillary volume is ___ at rest, and ___ at maximal anatomical volume

A

70, 200

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51
Q

total capillary surface area almost always equals

A

alveolar surface area

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52
Q

__ % of alveolar surface area is covered by capillary bed

A

70-80

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53
Q

zone 1 pressures

A

PA > Pa > PV

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54
Q

zone 2 pressures

A

Pa> PA> PV

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55
Q

zone 3 pressures

A

Pa > PV > PA

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56
Q

as you go from zone 1 to zone 3 of the lung, v/q mismatch

A

decreases

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57
Q

reduced PAO2 causes pulm vaso___

A

constriction

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58
Q

increased PCO2 causes pulm vaso___

A

dilation

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59
Q

histamine causes pulm vaso ___

A

constriction

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60
Q

increased PA02 causes pulm vaso ___

A

dilation

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61
Q

nitric oxide causes pulm vaso ___

A

dilation

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62
Q

thromboxane, a-adrenergic catecholamines, angiotensin, prostaglandins, neuropeptides, leukotrienes, serotonin, endothelin, norepinephrine cause pulm vaso ___

A

constriction

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63
Q

prostacyclin, B-adrenergic catecholamines, acetylcholine, bradykinin, dopamine, isoproterenol cause pulm vaso___

A

dilation

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64
Q

what causes hypoxic pulmonary vasoconstriction

A

alveolar hypoxia

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65
Q

HPV is a ___ response of pulm arterioles

A

localized

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66
Q

HPV is enhanced by what two things

A

hypercapnia and acidosis

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67
Q

how does HPV balance v/q ratio

A

shifts flow to better ventilated pulmonary regions

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68
Q

normal alveolar PO2 is ___mmhg

A

100

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69
Q

normal alveolar pCO2 is ___mmhg

A

40

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70
Q

alveolar PCO2 increases in proportion to CO2 ___

A

excretion

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71
Q

PCO2 decreases in inverse to

A

alveolar ventilation

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72
Q

normal CO2 production at rest is ____ ml/min

A

200 ml/ min

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73
Q

alveolar air is expired at

A

end-exhalation

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74
Q

ficks law describes

A

diffusion of gas thru a tissue membrane

75
Q

diffusion is proportional to

A

cross sectional area, partial pressure difference, gas coefficient

76
Q

diffusion is inversely proportional to

A

tissue thickness

77
Q

PVO2 =

A

40mmHg

78
Q

PVCO2 =

A

46 mmhg

79
Q

PACO2 =

A

40 mmhg

80
Q

PaO2 =

A

100 mmHg

81
Q

PaCO2 =

A

40 mmHg

82
Q

physiologic shunt - V/Q is __ normal

A

below

83
Q

shunt = ___ perfusion, ___ ventilation

A

adequate perfusion, no ventilation

84
Q

the greater the shunt,

A

the greater the amt of blood fails to be oxygenated in the lungs

85
Q

physiologic dead space. V/q is ___ normal

A

above

86
Q

dead space = ___ ventilation and ___ perfusion

A

adequate ventilation, no perfusion

87
Q

physiologic dead space includes

A

wasted ventilation and anatomical dead space.

88
Q

rough rule - PaO2 40,50,60 for sat

A

70 80 90

89
Q

hb P50 point

A

sat is 50 , paO2 is 27

90
Q

when sat is 75 , paO2 is

A

40 (mixed venous blood in PA)

91
Q

which is more detrimental to O2 transport: change in shape or change in position of HbO2 equilibrium curve?

A

shape

92
Q

Hb curve to the right __ affinity for O2

A

decreases

93
Q

Hb curve to the left __ affinity for O2

A

increases

94
Q

how does increase in H+ affect HbO2 curve

A

shift right

95
Q

how does increase in PCO2 affect HbO2 curve

A

shift right

96
Q

how does increase in temp affect HbO2 curve

A

shift right

97
Q

how does increase in 2,3, DPG affect HbO2 curve

A

shift right

98
Q

how does decrease in PCO2 affect HbO2 curve

A

shift left

99
Q

right shift, ___ O2

A

release

100
Q

left shift, ___ O2

A

“loves” (higher affinity)

101
Q

Bohr effect causes shift of curve to the

A

right

102
Q

O2 content in blood (CaO2) formula

A

CaO2 = (SO2 x hb x 1.31) + (PO2 x 0.003) see slide 44

103
Q

DO2 (oxygen delivery) =

A

CaO2 x CO

104
Q

most CO2 is transported as

A

bicarbonate (HCO3)

105
Q

DRG controls what two things

A

inspiration and respiratory rhythm

106
Q

which 2 nerves reliever sensory info to the DRG

A

vagal (X) and glossopharyngeal (IX)

107
Q

DRG receives signals from three sources:

A

peripheral chemoreceptors, baroreceptors

108
Q

chemosensitive area of the brain - where is it located

A

ventral medulla surface

109
Q

chemosensitive area of the brain is sensitive to changes in

A

PCO2 or H ion concentration

110
Q

CO2 is highly permeable to BBB so….

A

blood and brain concentrations are equal

111
Q

ventilation is greatly increased with blood PCO2 above

A

35 mmHG

112
Q

change in respiration due to CO2 is 10 times less with blood Ph range between

A

7.3 and 7.5

113
Q

peripheral chemoreceptors are found in

A

carotid and aortic bodies

114
Q

chemoreceptors are sensitive to PaO2 from __ to ___ mmhg

A

60 to 30

115
Q

high risk FEV1

A

<2L

116
Q

high risk FEV1/FVC

A

<0.5

117
Q

high risk VC

A

<15cc/kg in adult and <10cc/kg in child

118
Q

high risk VC percentage

A

< 40 to 50% than predicted

119
Q

intubation criteria: resp rate

A

> 35

120
Q

intubation criteria: MIF

A

more neg than -20cmH20

121
Q

intubation criteria: PaO2

A

<70 on FiO2 of 40%

122
Q

intubation criteria: A-a gradient

A

> 350mmhg on 100% O2

123
Q

intubation criteria: PaCo2

A

> 55

124
Q

intubation criteria: vd/vt

A

> 0.6

125
Q

intubation criteria: clinical signs

A

airway burn, chemical burn, epiglottis, mental status change, rapidly deteriorating pulmonary status, fatigue

126
Q

extubation criteria: resp rate

A

<30

127
Q

extubation criteria: PaO2 and PaCO2

A

paO2 >70, PaCO2 <55

128
Q

extubation criteria: MIF

A

more negative than -20

129
Q

extubation criteria: vital capacity

A

> 15 cc/kg

130
Q

*an increase of Pco2 by 10mmhg causes a ___ in pH by ___

A

decrease 0.08

131
Q
  • a decrease of Pco2 by 10mmhg will ___ pH by ___
A

increase 0.08

132
Q

A-a gradient measures

A

efficiency of lung

133
Q

normal A-a is approx

A

age/3

134
Q

A-a gradient is ___ with hypoventilation or low Fio2

A

normal

135
Q
  • a decrease in bicarb by 10 __ the ph by ___
A

decreases 0.15

136
Q
  • an increase in bicarb by 10 __ the ph by ___
A

increases 0.15

137
Q

total body bicarb deficit =

A

base deficit x wt in kg x 0.4. usually replace half of deficit

138
Q

infrared is ___nm

A

940 (100% sat)

139
Q

infrared is for

A

oxyhemoglobin

140
Q

red is ___nm

A

660

141
Q

red is for

A

deoxyhemoglobin (50% sat)

142
Q

if someone has carboxyhemoglobin, what will their pulse ox show?

A

100%

143
Q

if someone has methemoglobinemia what will their pulse ox show

A

85%

144
Q

what causes methemoglobinemia

A

nitrates, nitrites, sulfonamides, benzocaine, nitroglycerine, nitroprusside

145
Q

how do you treat methemoglobinemia

A

low dose methylene blue or absorbic acid

146
Q

capnography reliably indicates ____ intubation but does not reliably detect ___ intubation

A

esophageal, endobronchial

147
Q

capnograph: A-B

A

beginnning exhalation, dead space gas

148
Q

capnograph: B-C

A

exhalation , mixing of gases

149
Q

capnograph: C-D

A

alveolar plateau, alveolar rich gas

150
Q

capnograph: D

A

highest CO2

151
Q

capnograph: DE

A

start inspiration

152
Q

in the awake and lateral position, the ____ lung is better perfused and ventilated

A

dependent

153
Q

positive pressure ventilation favors the ___ lung because it is more compliant

A

upper

154
Q

muscle paralysis, rigid bean bag, and open ptx all favor the ___ lung

A

upper

155
Q

factors that inhibit HPV: pulm artery pressures

A

very high or very low

156
Q

factors that inhibit HPV: ____capnia

A

hypocapnia

157
Q

factors that inhibit HPV: vaso___

A

dilators - nitroglycerin, nitroprusside, B-adrenergic agonists (dobutamine), CCB’s

158
Q

inhalation agents ___ hypoxic pulmonary vasoconstriction

A

inhibit

159
Q

pulmonary infections ___ hypoxic pulmonary vasoconstriction

A

inhibit

160
Q

in one lung ventilation, add 5cm ___ to nondependent lung, and 5cm ___ to dependent lung

A

CPAP, PEEP

161
Q

first and most sensitive sign of MH

A

unexplained tachycardia

162
Q

most specific sign of MH

A

increasing EtCO2, hypercapnia 2-3x

163
Q

MH will show an initial ___ then a combined ___

A

metabolic acidosis then combined metabolic and resp acidosis

164
Q

what age has the highest MAC requirement

A

term infant to 6 months

165
Q

hyperthermia ___ MAC

A

increases

166
Q

chronic ETOH abuse ___ MAC

A

increases

167
Q

hypernatremia __ MAC

A

increases

168
Q

for every 1 deg C drop in body temp, MAC decreases by

A

2-5%

169
Q

pregnancy ___ MAC

A

decreases

170
Q

lithium ___ MAC

A

decreases

171
Q

alpha 2 agonists and CCB’s ___ MAC

A

decrease

172
Q

hyperthyroid or hypothyroid affect on MAC

A

none

173
Q

4 things no affect on MAC

A

duration of anesthesia, gender, K, hypo/hyper carbia

174
Q

second gas effect

A

the ability of a large volume uptake of a first gas (nitrous) to accelerate the rate of rise of the alveolar partial pressure of a concurrently administered companion gas (agent) thus speeding induction

175
Q

what does nicotine stimulate

A

sympathetic ganglia, catecholamines released from adrenal medulla increasing HR, BP, and SVR

176
Q

nicotine stimulation persists for

A

30 min after last cigg

177
Q

advise smoking at least ___ hours prior to surgery

A

12

178
Q

airway reactivity decreases after __ days of cessation and is near the level of a nonsmoker after __ days of cessation

A

2, 10

179
Q

cessation of > __ weeks will reduce post-op pulm complications

A

8

180
Q

cessation of __years reduces risk of MI to that of non-smoking population

A

2

181
Q

vent adjustment for severe emphysema

A

requires longer exp times (normal I:E is 1:2, so in COPD 1:3)

182
Q

a rapid correction of CO2 in someone who is a chronic retainer will cause

A

metabolic alkalosis

183
Q

which two gases cause airway stimulation with light anesthesia

A

des and iso

184
Q

bronchospasm - avoid ___ releasing drugs such as

A

histamine - pentothal, morphine, atracurium, mivacurium, neostigmine.

respiratory physio (12 decks)

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