Final Exam Study Guide Flashcards
Which are not considered accessory muscles of expiration?
Scalene muscles
Transverse abdominis muscles
Internal intercostal muscles
Rectus abdominus muscles
Scalene Muscles
What is the leaf like cartilage that covers the larynx during swallowing? Helps prevent aspiration.
Epiglottis
What is responsible for removing foreign material and bacteria from the alveoli?
Macrophages
Which is not an anatomical division of the pharynx?
Tracheopharynx
Which best describes the conducting airways?
The distance from the nose or mouth to the terminal bronchioles.
Which best describes eupnea?
Normal spontaneous breathing
Calculate the minute ventilation for a person breathing 20 breaths/min, with a tidal volume of 300 mL.
6.0 L/min
Minute ventilation = tidal volume x respiratory rate
300 mL (.3) x 20 (breaths) = 6.0 L/min
What is it called when fluid collects in the pleural space, causing blunting of the costophrenic angles on a chest radiograph?
Pleural effusion
The volume contained in non-perfused alveoli is known as alveolar dead space. What does alveolar dead space represent?
There is decreased surface area for gas exchange.
What marks the beginning of the gas exchange zone in the lungs?
Respiratory bronchioles
What is the space located between the epiglottis and the tongue. This is an important landmark during endotracheal intubation?
Vallecula
Which nerves originate from C3 to C5? They innervate the diaphragm, and when injured may cause paralysis of the diaphragm.
Phrenic nerves
Which breathing pattern consists of progressively deeper breathing, followed by gradual decrease in tidal volume, followed by apnea. Also known as the death rattle.
Cheyne-Stokes respirations
Which is not a component of the upper airways?
Trachea
What is it called when a blood clot decreases or blocks blood flow in the pulmonary arteries or arterioles?
Pulmonary embolus
What is the anatomical dead space for a person with an ideal body weigh of 140 lbs?
140 mL
According to estimates, it is roughly 1 milliliters (mL) per pound or lb of optimum body weight.
What type of epithelium lines the trachea down to the respiratory bronchioles? It is also called the mucociliary escalator.
Pseudostratified ciliated columnar epithelium
What affects the way in which gases move?
I. Diffusion
II. Thickness of membranes
III. Partial pressures
IV. Solubility
All of them. Diffusion, thickness of membranes, partial pressures, and solubility.
What is it called when gas exchange occurs between blood, tissues, and cells of the body?
Internal respiration
What is the partial pressure of water vapor (PH2O) in the lung?
47 mm Hg
Which are accessory muscles of inspiration used in breathing?
I. Scalene muscles
II. Internal intercostal muscles
III. External intercostal muscles
IV. Sternocleidomastoid muscles
Scalene muscles, external intercostal muscles, and sternocleidomastoid muscles
What is the atmospheric pressure at sea level?
760 mm Hg or torr
What forms a sealed envelope surrounding each lung?
Pleural membranes
Which are true regarding anatomical dead space?
I. No gas exchange occurs
II. Includes the conducting airways
III. Gas exchange occurs
IV. Changes with surgical removal
No gas exchange occurs, includes the conducting airways, and changes with surgical removal.
Which alveolar epithelial cells produce surfactant?
Type II epithelial cells
What are the main functions of the nose?
I. Humidification
II. Warming
III. Filtering
IV. Immunity
Humidification, warming, and filtering.
Which of the following is not part of the epithelial lining of the conducting airways?
Mucus blanket
Basement membrane
Sympathetic nerve innervation
Epithelium
Sympathetic nerve innervation
What provides collateral ventilation to blocked or collapsed alveoli?
Pores of Kohn and Canals of Lambert
What is the normal respiratory rate range in adults?
12 to 20 breaths/min
What is the major muscle of inspiration?
Diaphragm
What is the normal pH range for the human body?
7.35 to 7.45
The movement of gas across the alveolar wall, is function of the integrity of the alveolar capillary membrane.
diffusion limited gas flow
According to Graham’s law, the rate of gas diffusion in the lung is inversely proportional to its molecular weight and directly proportional to which physical property?
Solubility coefficient
The amount of CO2 dissolved in the plasma is proportional to the PCO2 to which the plasma is exposed. This best describes which law?
Henry’s law
As (HCO3-) moves out of the red blood cell, (Cl-) moves into the red blood cell to maintain electrical neutrality. This describes the _____ ______.
chloride shift
the net movement of individual molecules from and area or high concentration to an area of low concentration
Diffusion
(CO2) is transported in the plasma in which three ways?
Dissolved CO2, Bicarbonate HCO3, and Carbamino compounds.
Under resting conditions, what percentage of arterial oxygen content is consumed by the tissues?
25%
Where is the majority of (O2) transported in the body?
Erythrocyte
According to Fick’s law, a decrease in oxygen diffusion is related to which factors?
A decrease in alveolar surface area, An increase in alveolar membrane thickness, and A decrease in the partial pressure of oxygen.
What is the average amount of carbon dioxide (CO2) produced by the body at rest?
200 mL/min
80% of CO2 is transported in the body in what form?
Bicarbonate (HCO3-)
What is the normal amount of oxygen consumed by the tissues?
250 mL/min
The movement of gas from and area of high pressure to an area of low pressure.
bulk gas flow
T or F: When critical oxygen delivery threshold has been reached in the body, hypoxia and lactic acidosis occur.
True
The amount of gas dissolving in a liquid at any given temperature is directly proportional to the gas partial pressure.
Henry’s law
What is the oxygen content of an anemic person’s blood while breathing 80% (O2), a (Hb) concentration of 6 g/dL, a (PaO2) of 400 mm Hg, and an (SpO2) of 98%?
Approximately 9 mL/dL
arterial oxygen content = (Hgb x 1.36)(Oxygen saturation/100)+(partial pressure of oxygen x 0.0031)
(6 x 1.36)(80/100) + (400 x 0.0031)
Which best describes hemoglobin that is not bound with oxygen?
Deoxyhemoglobin
What is the normal value for oxygen content (CaO2)?
20 mL/dL
Which are not normal values for hemoglobin saturations and oxygen partial pressures?
Arterial oxygen saturation (SaO2) is approximately 75%.
Which statements are true regarding the P50?
Normal P50 is 27 mm Hg.
The P50 represents the partial pressure at which hemoglobin is 50% saturated with oxygen.
P50 quantifies hemoglobin’s willingness to bond with oxygen.
Which acid molecule is formed when CO2 binds with H2O both in the plasma, and in the red blood cell?
Carbonic acid (H2CO3)
T or F: The reaction between CO2 and HCO3- is 13,000 X faster in the RBC than in the plasma.
True
Which phenomenon occurs when carbamino-hemoglobin has a decreased affinity for oxygen?
Bohr effect
What factors affect oxygen delivery?
Cardiac output, Hemoglobin concentration, Oxygen bound to hemoglobin
Hemoglobin’s affinity for CO2 increases as oxygen dissociates from hemoglobin at the tissue level. Which best describes this phenomenon?
Haldane effect
What is the normal hemoglobin level range in an adult?
12 to 15 g/dL
Using the alveolar air equation, calculate the (PAO2) of a person breathing 40% oxygen at sea level, with a (PaCO2) of 50 mm Hg.
Approximately 225 mm Hg
What is the normal (DLCO) range in a healthy adult?
20 to 30 mL/min/mm Hg
Why is carbon monoxide the ideal gas for measuring diffusion limited gas flow through the alveolar capillary membrane?
Because carbon monoxides affinity for hemoglobin is 210 times greater than oxygen.
Which term(s) are associated with a PaCO2 that is <35 mm Hg?
Hyperventilation and Hypocapnia
What is the most common cause of hypoxemia?
Ventilation/perfusion mismatch
Analyze the following blood gas values:
pH = 7.21
PaCO2 = 65 mm Hg
PaO2 = 50 mm Hg
HCO3- = 22 mEq/L
Uncompensated respiratory acidosis with moderate hypoxemia.
What is it called when a chronic disturbance (non-causative) component changes so that the pH is now in normal range?
Compensated
Your patient is found to have a large hole in the septum separating the right and left ventricles. This hole allows deoxygenated blood from the right ventricle to mix with oxygenated blood from the left ventricle. What is this called?
Ventral septal defect
Your patient has a P(A-a)O2 of 20 mm Hg. What does this indicate?
Impaired O2 transfer across the lung.
What is the normal P(A-a)O2 while breathing room air?
5 to 10 mm Hg
Which of the following components is considered the open-buffer system?
Bicarbonate
According to the Bronsted-Lowry theory, what is an acid?
Any substance that donates a proton (H+) to and aqueous solution.
What is the normal range for arterial pH?
7.35 to 7.45
A 74-year-old male with a long standing history of emphysema and chronic bronchitis enters the emergency room in respiratory distress. His respiratory rate is (34 breaths/min) and breathing is labored. Heart rate is (115 beats/min), and blood pressure is (150/100). In addition to hypoxemia, how would you interpret this ABG?
pH = 7.55
PaCO2 = 55 mm Hg
PaO2 = 50 mm Hg
HCO3- = 34 mEq/L
Acute alveolar hyperventilation superimposed on chronic respiratory failure.
Which of the following term(s) are associated with a PaCO2 that is >45 mm Hg?
Hypoventilation and Hypercapnia
What is the most common cause of hypoventilation?
COPD
According to the Bronsted-Lowry theory, what is a base?
Any substance that accepts a proton (H+), removing it from a solution.
Which organ is responsible for the physical removal of (H+)?
Kidneys
What is the most important component in the non-bicarbonate buffer system?
Hemoglobin
What is the normal ventilation/perfusion ratio in the human lung?
0.8
Which of the following acids is considered volatile? In other words, it can be converted into a gaseous form and be excreted by the lungs.
Carbonic acid
Which are potential causes of respiratory acidosis?
CNS depression, COPD, and Neuromuscular disease
T or F: The ventilation/perfusion ratio (VA/QC) progressively increases from lung base to the lung apex in the upright lung.
True
What is it called when a chronic disturbance (non-causative) component is moving in the right direction, but has not had enough time to fully correct the pH?
Partially compensated
Which statements are true regarding a PaO2 of 40 mm Hg?
Your patient may be confused.
Your patient has moderate hypoxemia.
Which is considered a normal anatomical shunt?
When the blood from the bronchial systemic veins empties directly into the pulmonary veins.
Analyze the following blood gas values:
pH = 7.50
paCO2 = 20 mm Hg
PaO2 = 60 mm Hg
HCO3- = 24 mEq/L
Uncompensated respiratory alkalosis with mild hypoxemia
Because acute ventilatory changes are often seen in patients with chronic ventilatory failure (compensated acidosis), the respiratory therapist must be alert to this problem in patients with severe COPD. Which blood gas values represent acute alveolar hyperventilation superimposed on chronic respiratory acidosis?
Increased pH
Increased PaCO2
Increased HCO3-
Which best describes ventilation without perfusion?
Absolute dead space
Which disease causes intrapulmonary shunting?
Atelectasis
What is the normal range for bicarbonate (HCO3-)?
22 to 26 mEq/L
Which best describes perfusion with decreased ventilation?
Relative shunt
How would you classify a pH that is <7.35?
5 L/min
Which is not a potential cause of metabolic alkalosis?
Hyperchloremia
You are called to the emergency department to help stabilize a patient with significant head injury from a motorcycle accident. You note that the patient has prolonged inspiratory gasps that are interrupted by inadequate expirations. What is the most likely cause of this breathing pattern?
Both the vagus nerve and the brainstem are severed at mid pons.
T or F: The carotid bodies have more influence over respiratory centers in response to hypoxemia and acidosis than the aortic bodies.
True
Which area of the brain promotes rhythmic breathing? It “fine tunes” the medullary rhythm?
Pons
What is the normal daily urine output?
1.5 L/day
Movement of water and solutes from the plasma in the glomerulus, across the glomerular membrane, and into the Bowman’s capsule is a process known as?
Filtration
T or F: A decrease in blood pressure will cause a decrease in urine output.
True
Which reflex can be activated in patient’s with pneumothorax? Activation of this reflex causes increased rate and depth of breathing.
Hering-Breuer deflation reflex
What is the normal range for creatinine?
0.6 to 1.2 mg/dL
80% of (Na+) reabsorbed from the filtrate back into the blood occurs via which method of transport?
Primary active transport
What is the normal glomerular filtration rate (GFR)?
125 mL/min
Which of the following ions are considered electrolytes?
(HCO3-)
(K+)
(Cl-)
When BUN and creatinine are elevated in renal failure, which of the following acid-base disturbances is usually also present?
Metabolic acidosis
Which part of the respiratory center provides the main stimulus for inspiration?
Dorsal respiratory group (DRG)
What is the normal range for blood, urea, nitrogen (BUN)?
8 to 20 mg/dL
Which are potential causes of hypokalemia?
Diarrhea and Diuretic therapy
When it comes to (Cl-) regulation, (Cl-) passively diffuses with which cation?
Na+
What percentage of the total cardiac output does the renal vasculature receive?
20%
Which of the following are true regarding the ventral respiratory group (VRG)?
Contains inspiratory and expiratory neurons and Located in the medulla oblongata
Which statements are true regarding the central chemo-receptors in the brain?
They are directly stimulated by (H+) and They are indirectly stimulated by (CO2)
Which substance is secreted by the juxtaglomerular apparatus when systemic blood pressure decreases?
Renin
Which substance is not considered a “threshold substance?”
Creatinine
Which is not a potential cause of hypochloremia?
High-salt diets
Which part of the nephron does not actively secrete (H+)?
Thin segment of the loop of Henle.
Which substances do the kidneys remove from the body?
Urea, Uric acid, and Metabolites
Why does the pituitary gland secrete antidiuretic hormone?
In response to dehydration
Where are the peripheral chemo-receptors located in the body?
The arch of the aorta and The bifurcation of the common carotid arteries.
Why is it important for the kidneys to reabsorb sodium (Na+)?
Sodium is crucial in maintaining fluid balance in the body.
What medication can be administered to help lower plasma (K+) in life threatening hyperkalemia?
Albuterol
How does vasoconstriction of the afferent arterioles affect the glomerular filtration rate (GFR)?
Decreases the glomerular filtration rate.
Which best describes proprioceptors?
Positional sensors in muscles, tendons, joints, and pain receptors located in muscles and skin that send impulses to the medullary centers.
You have received patient in the trauma ED with a gunshot wound to the front temporal lobe, with and exit wound in the back of the head. The patients intracranial pressure is 20 mm Hg, HR is 41 beats/min, the patients right pupil is pinpoint, and the left is fixed and dilated. On the head CT scan, their is a 10 mm midline shift. The MD asks you to hyperventilate the patient on the way to the operating room at a respiratory rate of 35 breaths/min. Why would the MD as you to hyperventilate the patient?
Decreasing CO2 constricts blood vessels in the brain, decreasing blood flow and intracranial pressure.
Which are true regarding J-receptors in the lung parenchyma?
Stimulation causes rapid, shallow breathing and Stimulated by pulmonary vascular congestion and edema
Alveolar Air Equation
PAO2 = FIO2 (PB - 47) – (PaCO2 x 1.2)
Example: Normal ventilation on room air, PaCO2 = 40 mmHg
PAO2 = .21 (760 – 47) – (40 x 1.2)
* PAO2 = .21 (713) - 48
* PAO2 = 149.73 - 48
* PAO2 = 101.73 mm Hg
Oxygen Content Equation
CaO2 = Hb x 1.34 x Sat% + (PaO2 x 0.003)
Example: 100% O2
10 g/dL HB
550 mmHg PaO2
CaO2 = 10 x 1.34 x 1 + (550 x 0.003)
CaO2 = 13.4 + 1.65
CaO2 = 15.05 mL/dL
