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Lindsays Flashcardlet > RE Chapter 26 Part 1 > Flashcards

RE Chapter 26 Part 1 Flashcards

0
Q

Which concha is most commonly injured during nasal intubation?

A

Inferior

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1
Q

What is choanal atresia?

A

A birth defect characterized by obstruction of the posterior nasal airway, may be life threaten ending in the obligate nose-breathing newborn.

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2
Q

The pharynx begins at the base of the skull and extends to ______

A

C6

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3
Q

The larynx extends from vertebrae _____ to _____

A

C3 to C6

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4
Q

The epiglottis is attached to the thyroid cartilage by the ______ ligament and to the base of the tongue by the ________

A

Thyroepiglottic ligament

Glossoepiglottic fold

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5
Q

The furrow between the glossoepiglottic fold and the base of the tongue is called the _______

A

Vallecula epiglottica

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6
Q

What are the 9 laryngeal cartilages of the larynx?

A 
Epiglottis
Thyroid
Cricoid
Aretynoids (2)
Corniculates (2)
Cuneiform (2)s
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7
Q

What is the narrowest portion of the airway in the adult? In children younger than 10?

A

Adult: vocal cords

Children: Cricoid cartilage

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8
Q

The Cricothyroid membrane lies between the ______ and _______ cartilages

A

Cricoid and thyroid

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9
Q

The true vocal cords are attached anteriorly to the ______ and posterior lay to the ______ in the larynx.

A

Anteriorly to the thyroid cartilage

Posterior lay to the arytenoids

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10
Q

Which muscles close the laryngeal inlet?

A

Aryepiglottic and oblique arytenoids muscles

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11
Q

What muscle opens the laryngeal inlet?

A

Thyroepiglottic muscle

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12
Q

What muscle opens the glottic opening?

A

Posterior cricoarytenoid muscle

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13
Q

What muscles close the glottic opening?

A

Transverse arytenoids and Lateral CricoArytenoid muscles (Let’s Close Airway)

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14
Q

What muscles lengthen the vocal cords?

A

CricoThyroid (Chords Tense)

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15
Q

What muscle shortens the vocal cords?

A

Thyroarytenoid muscles

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16
Q

Which nerve provides sensory innervation from the epiglottis to the vocal cords?

A

Internal SLN

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17
Q

Which nerve provides sensory innervation below the vocal cords?

A

RLN

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18
Q

Which nerve provides motor innervation to the Cricothyroid muscles?

A

External SLN

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19
Q

Which nerve provides motor innervation to all muscles of the airway except the Cricothyroid?

A

RLN

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20
Q

The ______ (right/left) RLN loops around the aortic arch and the ______ (right/left) RLN loops around the subclavian artery.

A

Left loops around aortic arch

Right loops around subclavian

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21
Q

Which arteries supply blood to the larynx?

A
  • Superior thyroid artery (branch of external carotid)

- Inferior thyroid artery (branch of the thyrocervical trunk which arises from the subclavian artery)

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22
Q

What is the distance from the incisors to the carina?

A

26 cm

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23
Q

The right bronchus has an angle off the trachea of ______ degrees and is about ______ cm long.

A

25 degrees, 2 cm

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24
Q

The left mainstem bronchus takes off the trachea at ______ degrees and is about ______ cm long

A

45 degrees, 4 cm

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25
Q

How many bronchial segments exist before the alveoli?

A

20-25

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26
Q

By the seventh generation the diameter of the bronchioles are 2 mm and are referred to as ________

A

Small airways

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27
Q

These are the last structures perfused by bronchial circulation and are the end of the conducting airways. They are about 1 mm in diameter

A

Terminal bronchioles

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28
Q

With progression of airway divisions the number of airways and cross sectional area ________(increases/decreases) while the airflow velocity _______(increases/decreases)

A

Increases

Decreases

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29
Q

What is the closing volume?

A

The lung volume at which small airways tend to close

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30
Q

What happens to closing volume in those with obesity and COPD

A

It increases into the range of normal tidal breathing. Some airways close before the intended tidal volume has been expired

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31
Q

Which structures consist of the respiratory zone and what is it?

A

The respiratory bronchioles and alveolar ducts, sacs, and alveoli.
It is the area where gas exchange takes place.

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32
Q

All parts of the airway prior to the respiratory zone that are not involved with gas exchange are referred to as _______

A

The Conducting Zone

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33
Q

What are type I pneumocytes?

A

Structural cells

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34
Q

What are type II pneumocytes?

A

Produce surfactant to reduce alveolar collapse from surface tension

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35
Q

What are type III pneumocytes?

A

Macrophages

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36
Q

What is the total surface area available for gas exchange?

A

60 - 80 m²

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37
Q

What is the hilum?

A

The connection of the mediastinum to each lung. Structures inside include the mainstem bronchus, pulmonary/bronchial arteries/veins, lymph nodes, nerves, & pulmonary ligaments.

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38
Q

What does the parietal pleura line?

A

Chest wall, mediastinum, and diaphragm

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39
Q

What does the visceral pleura cover?

A

The lungs.

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40
Q

The left lung represents ____% of total lung capacity while the right represents _____%

A

Left lung = 45% of TLC

Right lung = 55% of TLC

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41
Q

Which nerve is the diaphragm innervated by? What does this nerve arise from?

A

The phrenic nerve that arises from C3, C4, C5

“C3, 4, 5 keep the diaphragm alive”

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42
Q

What type of block may cause paralysis of the phrenic nerve?

A

Interscalene

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43
Q

What is lung compliance?

A

The change in volume divided by the change in pressure (V/P)

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44
Q

True or False? Compliance is volume dependent.

A

True, lungs are less compliant at very high and very low lung volumes.

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45
Q

What is static compliance?

A

The pressure-volume relationship for a lung when air is not moving reflecting the compliance of the lung and chest wall alone.

Static effective compliance = tidal volume/(plateau pressure - PEEP)

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46
Q

What is a normal static effective compliance?

A

60 - 100 mL/cm H2O

47
Q

What is dynamic compliance?

A

Compliance of the lung while air is moving

Dynamic compliance = tidal volume/(Peak insp. Pressure - PEEP)

48
Q

What is Laplace’s law?

A

P = T/r

If surface tension (T) remains constant pressure (P) increases as the radius (r) decreases.

49
Q

How does the presence of surfactant affect surface tension and the application of Laplace’s law on the alveoli?

A

As alveolar radius decreases, surface tension also decreases, so pressure remains constant.

50
Q

When is surfactant produced in the fetus?

A

28-32 weeks gestation and not mature levels until 35 weeks.

51
Q

What is transpulmonary pressure?

A

The difference between intraalveolar pressure and intrapleural pressure

52
Q

What is the equation for Reynolds number?

A

Re=pvd/n

p = density
v = velocity 
d = diameter of the vessel 
n =  viscosity of fluid
53
Q

What value of reynold’s number predicts laminar flow, turbulent flow, and transitional area

A

Laminar flow = <2000
Turbulent flow = >4000
Transitional area = 2000-4000

54
Q

Where does laminar flow occur in the respiratory system?

Where does turbulent flow occur in the respiratory system?

A

Laminar flow - Smaller airways

Turbulent flow - large airways

55
Q

What is Poiseuille’s law?

A

R = 8ln/r^4

Resistance to laminar airflow is directly proportional to the length of the tube and inversely proportional to the 4th power of the radius.

56
Q

Why is net resistance to airflow low in small airways?

A

Because there is a massive number of parallel pathways.

57
Q

Where is resistance to airflow the greatest?

A

Medium sized bronchi whose smooth muscle tone affects airway resistance.

58
Q

What is a normal tidal volume for a 70kg male?

A

350-500 mL

59
Q

What is minute volume?

A

Tidal volume x Respiratory rate

60
Q

What is alveolar ventilation?

A

(Tidal volume - anatomic dead space) x respiratory rate

*anatomic dead space ~ 2mL per kg

61
Q

Residual volume (RV)

A

Volume of air in lungs after maximal expiration

1200 mL

62
Q

Expiratory reserve volume (ERV)

A

Maximum volume of air expired from resting end expiratory level
1100 mL

63
Q

Inspiratory reserve volume (IRV)

A

Max volume of air inspired from resting end-inspiratory level
3000 mL

64
Q

Total lung capacity (TLC)

A

Volume of air in lungs after maximum inspiration
IRV+VT+ERV+RV
5800 mL

65
Q

Functional residual capacity (FRC)

A

Air remaining in the lungs at the end-expiratory level
RV+ERV
2300 mL

66
Q

Inspiratory capacity (IC)

A

Max volume of air inspired from the end expiratory level
IRV + VT
3500 mL

67
Q

Vital Capacity (VC)

A

Maximum volume of air expired from the maximum inspiration
IRV+VT+ERV
4500

68
Q

Closing volume vs. closing capacity

A

Closing volume: The volume above residual volume where small airways close

Closing capacity: The absolute volume in the lung when small airways close (closing volume + residual volume)

69
Q

Which conditions increase closing volume?

A

Supine positioning, pregnancy, obesity, COPD, CHF, and aging

70
Q

What is physiologic dead space?

A

Anatomic dead space + alveolar dead space

71
Q

What is the Bohr equation?

A

%VD = (PaCO2 - PECO2)/PaCO2

72
Q

What is the respiratory quotient?

A

Amount of CO2 produced/O2 consumed

Normal: 200/250 = 0.8

73
Q

What is the PO2 of inspired air 100% saturated with water vapor at body temp (PIO2)?

A

.21 X (760 mmHg - 47 mmHg) = 149 mmHg

**47mmHg is partial pressure of water vapor at body temp

74
Q

How is alveolar PO2 (PAO2) calculated?

A

PAO2 = PIO2 - (PACO2/RQ)

Ex. When PACO2 is 40 mmHg and breathing atmospheric air
PAO2 = 149 -(40/0.8)
= 99 mmHg

75
Q

Why is pulmonary vascular resistance about 1/8th of systemic vascular resistance

A

Pulmonary artery walls are less muscular & more distensible than the aorta and pulmonary vessels are much shorter (think poiseulle’s law)

76
Q

What increases pulmonary vascular resistance?

A

Norepinephrine, serotonin, histamine, hypoxia, endothelium, leukotriene, thromboxane, prostaglandin, and hypercapnia

77
Q

What decreases pulmonary vascular resistance?

A

Prostacyclin analogs (epoprostenol), endothelium receptor antagonists, posphodiesterase inhibitors (sildenafil), acetylcholine, and isoproterenol (minimally)

78
Q

West Zone 1

A

Palv > Pcap

This region is ventilated but not perfused, this represents alveolar dead space

79
Q

West Zone 2

A

Alveolar pressure related to respiration variably occludes capillary flow.

80
Q

West Zone 3

A

Palv < Pcap

Greatest proportion of ventilation in the lung and perfusion is greatest here, no obstruction of blood flow.

81
Q

West Zone 4

A

Compression of blood flow occurs from mechanical compression or interstitial fluid.

82
Q

Which zone should a pulmonary artery catheter be placed?

A

West Zone 3

83
Q

What is the normal ventilation-perfusion (V/Q) ratio

A

4 L/min / 5 L/min = 0.8

84
Q

What is a shunt in relation to the V/Q ratio?

A

Alveoli that are perfused but not ventilated

V = 0 so the V/Q ratio is 0

85
Q

What is dead space in relation to the V/Q ratio?

A

Alveoli that are ventilated but not perfused

Q = 0 so the V/Q ratio is infinity.

86
Q

Shuntlike alveoli with a low V/Q have a ______(high/low) PO2 and a _______ (high/low) PCO2

A

Low PO2

High PCO2

87
Q

Dead space-like alveoli with a high V/Q have a _______ (high/low) PO2 and a __________(high/low) PCO2

A

High PO2

Low PCO2

88
Q

_____% of the O2 carried in blood is bound to hemoglobin

A

99.7%

89
Q

With a PaO2 of 100 mmHg _____ mL of O2 is transported dissolved per 100 mL of plasma.

A

0.3

90
Q

A hemoglobin of 10 g/100mL at 100% saturation carries _____ mL of O2 bound to Hgb per 100 mL of blood

A

1.36

91
Q

Which conditions cause a left shift of the oxyhemoglobin dissociation curve?

A

Hypocapnea, hypothermia, decreased 2-3DPG.

*increased affinity of hemoglobin for oxygen (left latch)

92
Q

Which conditions cause a right shift in the oxyhemoglobin dissociation curve?

A

Hyperthermia, hypercapnia, acidosis, increased 2,3-DPG

*decreased affinity of hemoglobin for O2 (right release)

93
Q

What is the P50 on the oxyhemoglobin dissociation curve?

A

The portion where 50% of hemoglobin is saturated

Normal is 26-27 mmHg

94
Q

A right shift of the oxyhemoglobin dissociation curve increases or decreases the P50?

A

Increases

A left shift decreases

95
Q

What is the equation for arterial blood content (CaO2)?

A

(1.36 X Hgb x % arterial Hgb saturation) + (PaO2 x 0.003)

Normal is 20 mL per 100 mL of arterial blood

96
Q

What is the equation for mixed venous blood o2 content?

A

(1.36 x Hgb x % mixed venous Hgb saturation) + (Pvo2 x 0.003)

Normal 15 mL per 100 mL of blood
(Where Hgb is 15 and Pvo2 is 40)

97
Q

What is a normal arteriovenous O2 content difference?

What does a high or low value indicate?

A

Normal = 5mL/dL

High - low CO
Low- systemic arteriovenous shunts

98
Q

How is CO2 carried in blood?

A
  1. In physical solution (5-10% of bloods total CO2 content)
  2. Chemically combined with amino acids (5-10% of total CO2 content)
  3. As bicarbonate ions (90% of bloods CO2 content)
99
Q

In the presence of carbonic anhydrase CO2 and H2O yield ______.

A

Carbonic acid (H2CO3)

100
Q

Carbonic acid dissociates to _____ and _____

A

H+ and HCO3-

101
Q

What is the hamburger shift or chloride shift?

A

When HCO3- leaves blood cells, chloride ions enter to maintain electrical neutrality

102
Q

When blood contains mainly oxygenated hemoglobin bloods capacity to hold CO2 increases or decreases? Which way does the CO2 dissociation curve shift?

A

Decreases, shift to the right.

103
Q

When the blood contains mostly deoxyhemoglobin the capacity for blood to carry CO2 increases or decreases? Which way does the CO2 dissociation curve shift?

A

Increase, shift to left

104
Q

What is the Haldane effect?

A

Deoxyhemoglbin more readily accepts H+ produced by the dissociation of carbonic acid which permits more CO2 to be carried in the form of bicarbonate ions.

105
Q

What is the Bohr effect?

A

The association of H+ with the amino acids of hemoglobin lowers the affinity of Hgb for O2 at a low pH or high Pco2

106
Q

An acute increase in PaCO2 of 10mmHg is associated with a decrease in pH of _______

A

0.08

107
Q

A base increase of 10 mEq/L is associated with a pH change of _____

A

0.15

108
Q

Should respiratory acidosis be treated with sodium bicarbonate? Why or why not?

A

No. The bicarbonate dissociates into more CO2, worsening the acidosis

109
Q

Where is the respiratory center in the nervous system?

A

In the reticular formation of the medulla

110
Q

How does hypoxemia effect the ventilatory response to CO2?

A

It potentiates the response

111
Q

Are central and peripheral chemoreceptors stimulated by changes in PO2 or PCO2?

A

PCO2, they are not stimulated by hypoxia

112
Q

What is the FEV1/FVC ratio?

A

It measures airway resistance, a normal value is 80% and decreases occur with increased airway resistance.

113
Q

What is the FEF25%-75%?

A

The forced expiratory flow rate between 25% and 75% of the exhaled breath.
Normal is 4-5L/sec
Decreases indicate pulmonary disease, obstructive disease has sooner decreases than restrictive

114
Q

What are 3 causes of a decrease in FEV1 in COPD?

A
  1. Decrease in the intrinsic size of bronchial lumina
  2. Increase in the collapsibility of bronchial walls
  3. Decrease in elastic recoil of the lungs
115
Q

A low FEV1 and a low FEV1/FVC ratio is indicative of obstructive or restrictive lung disease?

A

Obstructive

116
Q

A low FEV1 with a normal FEV1/FVC ratio is indicative of restrictive or obstructive lung disease?

A

Restrictive

Lindsays Flashcardlet (27 decks)

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