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BB - Respiratory Review > Final Review - Personalized Pt 1 > Flashcards

Final Review - Personalized Pt 1 Flashcards

1
Q

Adult larynx position

A

3rd - 6th cervical vertebre

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2
Q

larynx position at birth

A

C3-4

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3
Q

Normal A-O extension

A

35 degrees

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4
Q

Prognathism

A

protruding jaw/mandible

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5
Q

Narrowest portion of adult and child airway

A

adult - glotis

child - cricoid ring

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6
Q

cartilages of larynx

3 paired, 3 unpaired

A

paired - arytenoid, corniculate, cuniform

unpaired - epiglottis, thyroid, cricoid

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7
Q

Intrinsic Muscles (2 sets)

A

1 - alters size and shape - aryepliglottic, thyroepiglottic, arytenoid
2 - move true vocal cords

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8
Q

SLN

A

Internal - sensation causes spasm

External - motor innervation of cricothyroid muscle

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9
Q

cricothyroid muscle

A

innervated by external SLN

tensor of VC, elongates

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10
Q

Posterior cricoarytenoid

A

abductor
innervated by RLN
(please come apart)

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11
Q

thyroarytenoid

A

relaxor of VC

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12
Q

RLN

A

innervated all of larynx except cricothyroid muscle

-sensory information for below cords

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13
Q

Tracheal anatomy

A

20-25 c shaped cartilages

C6-T5, divides at T5-7 (~25 cm from teeth)

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14
Q

R mainstem

A

straighter, larger

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15
Q

Conducting Airways

A

anatomical deadspace, ventilation but no perfusion

-last site at terminal bronchiole which has gas no exchange

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16
Q

goblet cells

A

mucous producers, increase with injury

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17
Q

clara cells

A

in small bronchioles that do not have goblet cells, produce watery substance

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18
Q

Type 1 pneumocyte

A

increase surface area
cannot heal quickly
95% of wall

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19
Q

Type 2 pneumocyte

A

secrete surfactant
repairs epithelium
can regenerate to Type 1
usually mature at 24 weeks gestation

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20
Q

surfactant

A

decrease surface tension
prevent alveolar collapse/promotes stability
prevents transudation of fluid into alveoli

-DPPC, hydrophobic and hydrophillic opposing ends

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21
Q

Lung weight

A

1.5% of body weight

1 kg in 70 kg pt

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22
Q

Alveolar surface area

A

70 meters squared internal surface area
40 x external body surface area
short diffusion pathway

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23
Q

Inspiration

A

active phase
phrenic nerve (C3, 4, 5) innervates diaphragm
*negative pressure ventilation

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24
Q

Intercostal Nerves

A

T1-11, send signals to external intercostal muscles

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25
Q

Diaphragm

A

responsible for 75% of inspiratory effort
contraction - downward and forward movement
ribs lifted and moved outward
*down 1 cm during normal, can but up to 10 cm forced
-denervated = paradoxical chest movement

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26
Q

External Intercostals

A
  • responsible for 25% respiration
  • originate from ventral rami of T1-11
  • contraction - ribs up and forward
  • denervated causes feeling of dyspnea
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27
Q

Accessory Muscels

A

-assist forced inspiration
scalene muscles - elevated first 2 ribs
sternocleidomastoid - raise sternum

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28
Q

Expiration

A

passive

muscles - abdominal and internal intercostals

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29
Q

Transpulmonary pressures

A

pressure different between intrapulmonary and intrapleural

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30
Q

Recoil Pressure

A

elastic forces

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31
Q

Lung Pleura

A

visceral - thin, serosal that envelopes lungs

parietal - lines inner surface of chest wall

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32
Q

Pleura Pressure

A

-5 cm H20 at rest,

during inspiration -7.5

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33
Q

FRC

A

2.5 L

ERV + RV

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34
Q

What can spirometry not measure?

A

RV, so FRC and TLC cannot be determined this way. must use helium dilution or nitrogen washout

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35
Q

Compliance reduced

A

higher or lower lung volumes
venous congestion
atelectasis or fibrosis

36
Q

Compliance increased

A

age, emphysema

old socks

37
Q

Is inspiratory and expiratory compliance the same?

A

no

38
Q

Elastic forces of lung

A

elastic tissue - elastin and collagen, natural state is coiled
surface air-fluid interface - 2/3 of elastic force in lung
surfactant

39
Q

Physiological dead space

A

anatomical + alveolar deadspace

anatomical deadspace = ~30% TV

40
Q

Closing volume

A

volume of lung at which small airways close
CV > FRC, then small airways collapse during normal TV
*bernouli

41
Q

Turbulence

A

directly proportional to density, velocity & resistance

42
Q

Chief site of airway resistance

A

medium sized bronchi

43
Q

Factors determining airway resistance

A

lung volume, bronchial smooth muscle & density/viscosty of inspired gas

44
Q

Work, of breathing

A

W = pressure x volume

-hyperventilation increases o2 cost

45
Q

Minute Ventilation

A

TV x frequency

amnt of air conducted into lungs per minute

46
Q

Poiseulle’s Law

A

decreased radius by 16% = double resistance

decrease radius by 50% = increase resistance 16 fold

47
Q

Pulmonary circulation

A

low pressure, low resistance system

PA is thin walled (1/3 thickness of aorta), very compliant

48
Q

Fick’s Principle

A

determining CO, bloodflow through lungs/min

49
Q

Extra-alveolar vessels

A

“store blood”
-not directly affected by lung pressures
bronchial vessels - oxygenated blood from systemic circulation (not for gas exchange), 1-2% of CO, empty into LA

50
Q

Capillary Resistance

A

alveolar network dimensions are not regulated by autonomic or humoral control
alveolar capillary walls - contribute 40% of resistance
alveolar arterioles - contribute 50% resistance

51
Q

Pulmonary Capillaries

A

70 ml volume at rest

200 ml maximal anatomical volume

52
Q

Bronchial Circulation

A

blood flows at systemic pressures, 1-2% of CO
50% returns via azygos veins
rest returns via small anastamosis, normal R–>L shunt

53
Q

Pulmonary Lymphatics

A

hydrostatic starling forces, ~20 ml/hr

54
Q

Capillary recruitments

A

opening, increases capillary volume

chief mechanism for fall in PVR

55
Q

capillary distention

A

expanding, compensates but can lead to lung congestion and heart failure

56
Q

Pulmonary Vascular Resistance

A

minimal when lung volumes are close to FRC

increased with higher and lower lung volumes

57
Q

Hydrostatic Pressure

A

zero point - R atrium and middle of lung
minimized in supine or prone
cause distention and recruitment in lung bases

58
Q

What determines perfusion zones?

A

relationship between alveoli and blood pressure in pulmonary arteries and veins
-hydrostatic pressures, gravity, transmural pressure and lung volume

59
Q

Vasconstrictors

A 
increase PVR w/i pulmonary bed
reduced PAO2
increased PCO2
thromboxane A2
alpha adrenergic catecholamines
histamine
60
Q

Vasodilators

A 
decrease resistance 
increased PAO2
nitric oxide
prostacyclin
beta-adrenergic catecholamines
acetylcholine
61
Q

Thromboxane A2

A

vasoconstrictor
product of arachidonic acid metabolism
produced during acute lung damage
half life is seconds, effect is limited

62
Q

Prostacyclin (Prostaglandin I2)

A

Vasodilator
inhibitor of platelet activation
product of arachidonic acid metabolism

63
Q

Nitric Oxide

A

Vasodilator
localized effect, short half life
smooth muscle relaxation through synthesis of cGMP
higher affinity to hgb than oxygen

64
Q

Hypoxic Pulmonary Vasoconstriction

A

adaptive response, shunts blood away from poorly oxygenated region
minimizes shunt

65
Q

Pulmonary HTN

A

generalized alveolar hypoxia increases PVR, chronic high PVR
d/t vasoconstrictor activity
causes increased RV work –> RV hypertrophy, tricuspid regurg, cor pulmonae

66
Q

Which portion of lung tends to be better ventilated?

A

apex

67
Q

normal A-a PO2 difference

A

10-15 mmHg

larger indicates intrinsic pulmonary disease

68
Q

true anatomical shunts

A

bronchopulmonary venous anastamosis
intracardiac thesbian veins
mediastinal veins
pleural veins

69
Q

Mechanical Ventilation effects

A

increases zone 2

pos-press ventilation can decrease CO or increase VQ mismatch

70
Q

Henry’s Law

A

solubility of a gas in a liquid depends on temperature, partial pressure and nature of solvent and gas

71
Q

When dissolved molecules are attracted by water…

A

more can be accumulated without building excess pressure, highly soluble

72
Q

How many times more soluble is carbon dioxide than oxygen?

A

20x

73
Q

What determines rate of net diffusion

A

difference of partial pressures

74
Q

Vapor pressure when gas is fully humidified?

A

47 mmHg

75
Q

760 mmHg = __ mmHG air + __ mmHg water

A

713 mmHg air

47 mmHg water

76
Q

Factors that effect gas diffusion rates

A 
pressure differences
gas solubility in fluid
area of fluid
distance which air must diffuse
molecular weight of gas
temp of fluid
77
Q

Diffusion coefficient

A

directly proportional to solubility
inversely proportional to molecular weight
smaller molecules = faster diffusion rate

78
Q

Alveolar air is expired at

A

end expiration

79
Q

Fick’s Law of Diffusion

A

diffusion of gas through tissue membrane

factors - cross sectional area, driving pressure, gas coefficient and tissue thickness

80
Q

Diffusing capacity of oxygen

A

21-65 mm/min/mmHg

81
Q

Diffusing capacity of carbon dioxide

A

400-1200 mm/min/mmHg

*technically not measurable

82
Q

PO2 and PCO2 in deoxygenated blood…

A 
PO2 = 40 mmHg
PCO2 = 45 mmHg
83
Q

PO2 and PCO2 of inspired air….

A 
PO2 = 150 mmHg
PCO2 = O mmHg
84
Q

Physiologic Shunt

A

VQ below normal, airway obstruction
blood not participating in gas exchange
Q, no V

85
Q

Physiologic Dead Space

A

ventilated, not perfused

V, no Q

BB - Respiratory Review (5 decks)

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