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SRNATOPICSIII > Nagelhout -RESPIRATORY > Flashcards

Nagelhout -RESPIRATORY Flashcards

1
Q

The ETT should not be directed

A

upward into the turbinates

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2
Q

What is choanal atresia?

A

Birth defect characterized by obstruction of the posterior nasal airway. May be life threatening in the obligate nose breathing newborn.

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3
Q

The respiratory mucosa lines the lower

A

2 thirds of the nose and consists of ciliated columnar epithelium with goblet cells that produce mucus.

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4
Q

The principal arterial supply of the nasal fossae arises from the

A

ophthalmic arteries through the anterior and posterior ethmoid branches

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5
Q

The sensory nerves from the upper respiratory tract come from the

A

ophthalmic nerve and the maxillary nerve

both are branches of cranial nerve V

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6
Q

Pharynx extends to

A

C6

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7
Q

Adult larynx extends from

A

C3-C6

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8
Q

Chief support of the larynx and it is the only bone

A

Hyoid bone

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9
Q

Furrow between the glossoepiglottic fold and the base of the tongue is

A

VALLECULAR EPIGLOTTICA

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10
Q

The largest cartilage is

A

Thyroid cartilage

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11
Q

In adults, narrowest portion is the opening between the

A

True vocal cords (aka cricoid opening or rima glottidis)

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12
Q

For children , narrowest portion of the larynx is the

A

cricoid cartilage

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13
Q

Recommended for the emergency establishment of an airway when both endotracheal intubation and mask ventilation are unsuccessful.

A

Cricothyrotomy

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14
Q

How is a transtracheal block performed?

A

performed by puncturing the cricothyroid membrane with a needle and
injecting a local anesthetic into the trachea.

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15
Q

Blood supply to the larynx is provided by the

A

superior thyroid artery (a branch of the external carotid artery) and the inferior thyroid artery (a branch of the thyrocervical trunk, which arises from the subclavian artery)

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16
Q

The trachea is lined by

A

pseudostratified ciliated columnar epithelium

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17
Q

The distance from the incisors to the larynx is approximately as is that from the larynx to the carina.

A

13 cm

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18
Q

Therefore the distance from the incisors to the carina is

A

approximately 26 cm (note the length markings on ETTs).

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19
Q

Nerve Supply to the Larynx

A

Both the superior and inferior laryngeal nerves are branches of cranial nerve X, the vagus nerve.

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20
Q

The trachea has a diameter of approximately

A

2.5 cm

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21
Q

The trachea extends down to the level of

A

T4–T5

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22
Q

Glottic Opening

• Opened by the

A

posterior cricoarytenoid muscles

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23
Q

Glottic Opening• Closed by the

A

transverse arytenoid and the lateral cricoarytenoid muscles

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24
Q

True Vocal Cords

• Lengthened by the

A

cricothyroid muscles

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25
Q

True Vocal Cords

Shortened by

A

thyroarytenoid muscles

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26
Q

The right bronchus takes a less

acute angle from the trachea, approximately whereas the

A

25 degrees,

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27
Q

Left bronchus takes off at

A

45 degrees.

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28
Q

Right lobes division

A

Upper 3
Middle 2
Lower 5

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29
Q

Left lobes division

A

Upper 4

Lower 4

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30
Q

Each successive division of the airways is referred to as a

A

generation

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31
Q

The lobar bronchi divide into the third generation of airways, called

A

segmental bronchi,

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32
Q

With succeeding generations
# of airway?____
Total Cross sectional area ?______
Airflow velocity decrease? ______

A

Increase in number airways
Larger cross sectional area
Decrease airflow velocity

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33
Q

How many generations before the alveoli?

A

20-25

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34
Q

By the 7th generation, the bronchioles size is

A

approximately 2mm

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35
Q

Bronchioles size in small airways

A

decreased to 1mm

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36
Q

The terminal bronchioles divide into the

A

respiratory bronchioles that are perfused by the pulmonary circulation and are the first place in the airway at which exchange of gas with the blood occurs.

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37
Q

The respiratory bronchioles divide into the several alveolar ducts that lead to circular spaced called

A

ATRIA

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38
Q

The lung volume at which small airways tend to close is called the

A

closing volume.

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39
Q

Obesity or chronic obstructive pulmonary disease (COPD), the closing volume

A

increases into the range of normal tidal breathing

40
Q

Small pores in the alveoli, known as the serve to

A

pores of Kohn

41
Q

Pores of Kohn serve to

A

allow collateral gas flow between alveoli and provide a mechanism of relief from gas stagnation from airway closure

42
Q

What comprises the respiratory zone?

A

The respiratory bronchioles
Alveolar ducts, sacs
Alveoli comprise the respiratory zone
where gas exchange takes place.

43
Q

What comprises the conducting zone?

A

All parts of the airway prior to this (nose to terminal bronchioles) conduct gas without exchanging gas with the blood and are referred to as the conducting zone.

44
Q

The typical maximum number of approximately

A

300 million alveoli is reached by age 9 years.

45
Q

There are three types of cells that form the alveoli: type I pneumocytesn; and

A

which are the structural cells

46
Q

Type II pneumocytes, which produce

A

surfactant to reduce alveolar collapse from surface tension

47
Q

Type III pneumocytes, which are

A

macrophages.

48
Q

Contraction of the muscles of inspiration __________intrathoracic pressure
and causes the volume of the thoracic cavity to ________

A

lowers; increase.

49
Q

This law explains that the increase in volume creates a reduction in pressure, which causes air to enter from the atmosphere.

A

Boyle’s law

50
Q

Each half of the diaphragm is innervated by a branch of the phrenic nerve, which arises from the

A

C3, C4, C5

51
Q

Spinal cord injuries above _____usually lead to dependence on mechanical ventilation.

A

above the level of C-5

52
Q

During forced exhalation (e.g., with coughing and the clearing of secretions), What abdominal muscles are used?

A

Rectus abdominis, the transversus

abdominis, and the external and internal oblique muscles, are used

53
Q

For air to move into the alveoli, alveolar pressure must be

A

less than atmospheric pressure

54
Q

During forceful inspiration muscles used are

A

the sternocleidomastoid and scalene muscles contract in conjunction with the
diaphragm and intercostals.

55
Q

When the diaphragm contracts during
spontaneous inspiration, it flattens and moves the abdominal contents downward ______intraabdominal pressure whilst_________intrathoracic
pressure.

A

raising ; lowering

56
Q

Explain paradoxical movement of diaphragm?

A

When the normal diaphragm contracts (moving downward), the paralyzed diaphragm moves upward, and when the
normal diaphragm relaxes (moving upward), the paralyzed diaphragm moves downward, resulting in paradoxical movements

57
Q

Lung compliance is defined as the

A

change in volume divided by the

change in pressure (V/P).

58
Q

Static effective compliance describes

A

the pressure-volume relationship

for a lung when air is not moving;

59
Q

Static compliance is decreased by conditions

that make the lung difficult to inflate, such ast)

A

fibrosis, obesity, vascular engorgement, edema, acute respiratory distress syndrome (ARDS), and external compression (e.g., that caused by tight dressings or a surgeon
leaning on the patient’s chest

60
Q

Static effective compliance

A

tidal volume/ Plateau pressure - PEEP

61
Q

It is important to note that compliance changes as

A

lung volume changes.

62
Q

Static compliance is increased by

A

emphysema, which destroys the elastic tissue of the lung

63
Q

When an alveolus is collapsed, a great increase

A

in pressure is necessary for inflation to begin.

64
Q

At low volumes,.

A

more energy is required (more negative pressure, i.e., less compliant) to begin to
expand the lungs

65
Q

At high volumes, the alveoli are almost at capacity, and

A

further changes in pressure result in less change in volume (less
volume per given pressure = less compliant).

66
Q

Normal Static compliance

A

60 to 100 mL/cm H2O is considered normal.

67
Q

The most useful clinical application of compliance measurement is in

A

monitoring trends to evaluate changing physical status or the effectiveness of PEEP or other treatment modalities.

68
Q

Dynamic compliance is the

A

compliance of the lung when the air is

moving.

69
Q

Can greatly decrease dynamic compliance.

A 
Airway obstruction (e.g., that caused by bronchospasm or the presence of
foreign bodies in the airway)
70
Q

Dynamic compliance is calculated as the

A

tidal volume / peak inspiratory pressure − PEEP

71
Q

This concept is often attributed to the law of

A

Laplace (P = T/r), which states that if surface tension (T) is constant, pressure (P) would increase as radius (r) decreases

72
Q

Surfactant consists of

A

proteins and phospholipids, primarily, dipalmitoylphosphatidylcholine.

73
Q

The classical application of Laplace described the concept of alveoli as distinct
balloon-like structures wherein pressure differentials can cause

A

alveoli to collapse and expel their gas into larger ones.

74
Q

Prevalent cause of respiratory distress syndrome (RDS) in premature infants.

A

Lack of surfactant

75
Q

is sometimes performed to determine

whether mature surfactant levels are present in the premature fetus

A

Amniocentesis

76
Q

What indicates the amount

of mature surfactant ?

A

The ratio of lecithin to sphingomyelin (the L/S ratio

77
Q

In the fetus, surfactant is not produced until approximately and

A

28 to 32 weeks of gestation

78
Q

Fetal surfactant, Does not reach mature levels until approximately

A

35 weeks’ gestation.

79
Q

Transpulmonary pressure is

A

the difference between intraalveolar pressure and intrapleural pressure

80
Q

In laminar flow, the gas in the center of the stream moves

A

faster than that closer to the wall

because frictional resistance slows molecules near the vessel wall

81
Q

Re =

A

pvd/n
= velocity of fluid flow, d = diameter of the vessel, p = density
of the fluid, and η = viscosity of the fluid

82
Q

Products up to 2000 predicts

A

predict laminar flow;

83
Q

Above 4000 predict

A

turbulent flow,

84
Q

Transitional flow

A

2000-4000

85
Q

True laminar flow occurs in

A

smaller airways

86
Q

Turbulence is greatest in

A

large airways, and turbulence caused by branching of the airways produces
the breath sounds heard on auscultation

87
Q

Resistance (R) to laminar airflow is directly proportional to the

A

length (l) of the

tube and inversely proportional to the fourth power of the radius (r).

88
Q

Therefore doubling the radius of the tube decreases resistance by

A

16 (24)

89
Q

Under normal circumstances, the greatest resistance to airflow resides in

A

medium-sized bronchi

90
Q

Bronchodilators will reduce resistance to

airflow by

A

increasing the radius of the pathway, as predicted by Poiseuille.

91
Q

The reduction in density is the conceptual basis for combining

A

helium with oxygen (“heliox”) to improve pulmonary gas distribution in obstructive lung disease

92
Q

The volume of gas left in the lung after a maximal exhalation

A

The residual volume (RV)

93
Q

The Closing capacity is the sum of the

A

closing volume plus the residual volume

94
Q

The closing volume increases from approximately

A

30% of the TLC at age 20 years to approximately 55% at age 70 years.

95
Q

%VD =

A

(PaCO2 −PECO2) PaCO2

96
Q

Conditions PE what happens to dead space and ETCO2 such as pulmonary embolus,

A

increase the alveolar dead space and can abruptly decrease the end-tidal CO2 (ETCO2) levels monitored with capnography.

SRNATOPICSIII (1 decks)

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