Patho Respiratory-S3 Flashcards
Movement of air into and out of the lungs?
Ventilation
Movement of gases between air spaces in the lungs and the bloodstream?
Diffusion
Movement of blood into and out of the capillary beds of the lungs to body organs and tissues?
Perfusion
Pulmonary system does what two things?
Ventilation and Diffusion
Cardiovascular system does what?
Perfusion
What separates the thoracic and abdominal cavities?
Diaphragm
Epiglottic, thyroid, cricoid cartilages?
Unpaired
Artyenoids, corniculates, cuneiform cartilages?
Paired
What type nerves supply the larynx?
Superior and inferior(recurrent) laryngeal nerves
Which nerve divides into external and internal branches?
Superior
Which nerve divides into left and right?
Inferior(recurrent)
Which nerve segment does inferior constrictor muscles of the pharynx and cricothyroid muscles. Lengthens or increases tension and damage leads to hoarseness?
External segment
Which nerve enters the larynx and provides sensation to epiglottis down to vocal cords. Damage leads to difficulty phonating and full paralysis?
Internal segment
This nerve descends with the vagus nerve and loops around the arch of the aorta?
Left nerve
This nerve travels with the vagus to subclavian artery and loops back up to the neck?
Right nerve
Blood supply to the larynx is from what?
Superior and inferior thyroid artery
This bronchus takes off at 25 degrees from trachea
Divides into 3 lobar bronchi
2-2.5 cm from the carina.
Right Bronchus
Most common
This bronchus takes at 45 degrees from trachea
Divides into 2 lobar bronchi
mainstem is 4cm
Left Bronchus
This is the space between the lungs, containing the heart, great vessels and esophagus?
Mediastinum
The conducting airways which move air in and out contain?
Nasopharynx
Oropharynx
Larynx
Trachea
Bronchi
Terminal bronchioles
What connects the larynx to the bronchi?
Trachea
This is the ridge where the trachea divides into the right left bronchi?
Carina
This is where the right and left bronchi enter the lungs, along with blood and lymph vessels?
Hila
These cells produce mucus?
Goblet cells,
1L produced daily
These hairlike structures help propel foreign material upwards?
Cilia
The first generation of the lung lobes is called?
Mainstem
The third generation of the lung is the?
Segmental bronchi
These are the last structure perfused by the bronchial circulation and the end of the conducting airways?
Terminal bronchioles
16
Terminal bronchioles lead to ____ that are perfused by pulmonary circulation?
Respiratory bronchioles
First site of gas exchange begins where?
Respiratory bronchioles
What comes after the respiratory bronchioles?
Alveolar ducts
Alveolar sacs
The gas exchange airways are?
Respiratory bronchioles
Alveolar Ducts
Alveoli (Acinus)
Primary gas exchange units are?
Alveoli (acinus)
These are the mean of collateral ventilation, equalize pressure and prevent lung collapse?
Pores of Kohn
Type I alveolar cells
Structure
Type II alveolar cells
Surfactant production, prevent lung collapse, contain macrophages
2 primary functions of respiratory airways and alveolar membrane?
- Transport of respiratory gases
- Production of a wide variety of local and humoral substances.
Conducting zone contains what?
The nose to the terminal bronchioles
If your patient cannot exceed dead space you are ventilating but not__?
Respirating
Gases in non-respiratory airways?
Anatomic deadspace
Non-perfused alveoli is what deadspace?
Approx: 2 mL/kg
Alveolar deadspace
The respiratory zone is comprised of ?
Respiratory bronchioles
Alveolar ducts
Sacs
Alveoli
WHERE GAS EXCHANGE OCCURS
Where does gas exchange occur?
Respiratory bronchioles
Alveolar ducts
Sacs
Alveoli
Which vascular system delivers mixed blood from right ventricle via 2 pulmonary arteries and after gas exchange to left atrium via 4 pulmonary veins?
Pulmonary vascular system
This capillary system adequately provides the metabolic and oxygen needs of the alvolar parenchyma?
Pulmonary capillary system
This vascular system provides oxygen to the conductive airways and pulmonary vessels?
Bronchial vascular system
Absolute shunt of 2-5% CO
This circulation facilitates gas exchange.
Delivers nutrients to lung tissue
Blood reservoir for left ventricle
Filtering system, removes clots and air.
Pulmonary Circulation
Lower pressure than system
Pulmonary artery divides and enters the lung at the __?
Hilum
This is formed by shared alveolar and capillary walls and is where gas exchange occurs?
Alveolocapillary membrane
Gas exchange occurs here
Which membrane is responsible for gas exchange?
Alveolocapillary membrane
Gas exchange airways are served by the ___ circulation?
Pulmonary
Seperate divison of circulatory system
Bronchi and other lung structures are served by a branch of the systemic circulation?
Bronchial circulation
1% CO
No gas exchange
PA>Pa>Pv
Zone 1
collapse
Pa>PA>Pv
Zone 2
Waterfall
Pa>Pv>PA
Zone 3
Distention
Which zone contains alveolar deadspace?
Zone 1
Normal V/Q ratio?
0.8
Anatomic shunt
V/Q is 0
Cannot correct with increased Fi02
Which shunt?
Absolute shunt
Low but finite V/Q ratio
can partially correct with increased Fi02
Which shunt?
Relative shunt
Effects of anesthesia on gas exchange?
Increased deadspace
hypoventilation
increased shunting
increased scatered V/Q ratio
Atelectasis
Hypoxic vasoconstriction 2 MAC
Prolonged high Fi02 >0.5 increase absolute shunt
Most important cause of pulmonary artery constriction?
Low Pa02
Membrane covering the lungs?
Visceral pleura
Membrane lining the thoracic cavity?
Parietal pleura
Minute volume calculation?
RR x TV
Alveolar ventilation is measured by what?
ABG
Respiratory center is located where?
In the brainstem, Pons specifically
Dorsal respiratory group does what?
Sets basic automatic rhythm, receives impulses from peripheral chemoreceptors in carotid and aortic bodies.
Pneumotaxic and apneustic centers are located where?
Pons. Modify depth and rate of breathing
Reflects PaC02
Stimulated by H+ in CSF
Increases respiratory rate and depth
Central chemoreceptors
Located in aorta and carotid bodies
Stimulated by hypoxemia (PaO2)
Responsible for increase in ventilation
Peripheral chemoreceptors
Central chemoreceptors are located where?
medulla and brainstem
Peripheral chemoreceptors are located where?
Carotid bodies and aorta body.
Glossopharyngeal nerve
These receptors are sensitive to noxious substances and cause cough, bronchoconstriction and increased RR?
Irritant receptors
These receptors protect against excess lung inflation and decrease RR and volume?
Stretch receptors
These receptors are sensitive to increased pulmonary capillary pressure, shallow breathing, laryngeal constriction?
Juxtapulmonary capillary receptors
J
These receptors cause smooth muscles to contract and control airway caliber?
Parasympathetic
These receptors cause smooth muscles to relax?
Sympathetic
What are the major muscles of inspiration?
Diaphragm and external intercostals
What are the accessory muscles of inspiration?
Sternocleidomastoid and scalene
Accessory muscles of expiration?
Abdominal and internal intercostal
NO major muscles as this is passive
Surfactant does what to surface tension?
Reduces surface tension to keep alveoli open and free of fluid
Low compliance is associated with?
Increased work of inspiration and stiff lungs
High compliance is associated with?
Increased work of expiration, easy to inflate and lost some elastic recoil
Four steps of delivery of oxygen to the cells of the body?
- ventilation of lungs
- diffusion of oxygen from alveoli into capillary blood
- perfusion of systemic capillaries with oxygenated blood
- diffusion of oxygen from systemic capillaries into cells
Perfusion exceeds ventilation where?
Base of lungs
Ventilation exceeds perfusion where?
Apex of lungs
What determines arterial oxygenation?
hemoglobin
oxygen content
Right shift of oxyhemoglobin?
Decreased affinity= more unloading
Low pH
high CO2
high temp
high 2-3 DPG
Left shift of oxyhemoglobin?
Increased affinity
High pH
low CO2
low temp
low 2-3 DPG
methemoglobin
Fetal hemoglobin
Sickle cell anemia associated with which shift oxyhemoglobin?
Right shift
The oxyhemoglobin curve becomes very steep where?
90% or 60mmHg of O2
Normal P50?
26-27 mmHg
> 27mmHg p50 means?
Right shift
<26mmHg p50 means?
Left shift
CO2 carried in the blood in what 3 forms?
Bicarbonate 60%
With proteins 30%
Dissolved 10%
Deoxygenation of blood increases its ability to carry CO2 is called what?
Haldane effect
Most important storage source of oxygen?
O2 contained in the lungs at FRC
Increased dead space
hypoventilation
increased intrapulmonary shunting
increased V/Q ratio
Atelectasis
all associated with what?
Anesthesia effects
The volume of air remaining in the lung after a maximal expiration, only lung volume not measured with a spirometer?
Residual volume
Lung volume at which the small airways in dependent parts of the lung begin to close?
Closing Capacity
ACLSS
Maximum volume of air that can be forcefully expelled from the lungs following maximal inspiration?
Vital capacity
Volume of air contained in the lungs at the end of a maximal inspiration?
Total lung capacity
The volume of air remaining in the lung at the end of a normal expiration?
Functional residual capacity FRC
Problems with inspiration?
Called
Extrathoracic
Problems with expiration?
Called
Intrathoracic