Resp Flashcards
What makes up the upper respiratory system?
Nose, nasal cavity, pharynx, and associated structures
what does the lower respiratory system consist of?
larynx(voice box), Trachea (windpipe), bronchi and lungs
what is the conducting zone
consists of a series of interconnecting cavities and tubes both outside and within the lungs-nose, nasal cavity, pharynx, larynx, trachea, bronchi, bronchioles and terminal bronchioles that filter warm and moisten air and conduct air into the lungs
What is the respiratory zone
tissues within the lungs where gas exchange occurs between air and blood- the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli
What is the entrance of the respiratory system
nose
what are the four paranasal sinuses
frontal, sphenoidal, maxillary and ethmoidal
The interior structure of the nose has 3 basic functions, what are they
1) filtering, warming and moistening incoming air
2) detecting olfactory stimuli
3) modifying the vibrations of speech sounds
What is a funnel-shaped tube that starts at the internal nares and extends partway down the neck
pharynx(throat)
functions as the passageway for air and food, provides a resonating chamber for speech sounds, and houses the tonsils, which participate in immunological response
what is a short tube of cartilage lined by mucous membrane that connects the pharynx with the trachea
larynx
What is the thyroid cartilage common name?
Adams apple
what is a ring of hyaline cartilage that forms the inferior wall of the larynx and is attached to the first tracheal cartilage
cricoid cartilage
What is the vestibular folds also known as
false vocal cords
what is the lower pair of larynx folds called
true vocal cords
what is the tubular passageway for air that is located anterior to the esophagus and extends from the larynx to the upper part of the fifth thoracic vertebra (T5) where it divides into right and left main bronchi?
Trachea
What is the double layered serous membrane that encloses and protects each lung
pleural membrane
what is the outer layer that is attached to the wall of the thoracic cavity and diaphragm
parietal pleura
what is the narrow space between the visceral and parietal pleurae and contains a lubricating fluid secreted by the membranes
pleural cavity
what is the broad bottom portion of the each lung called?
base
what is the narrow top portion of the lungs called
apex
the left lung has an indentation called what
cardiac notch, in which the heart lies
Which lung is smaller, the right or the left
the left lung is about 10 percent smaller than the right lung
Exchange of O2 and CO2 between air spaces in the lungs and the blood takes place by diffusion across alveolar and capillary walls which together form what?
Respiratory membrane
What are the layers of the respiratory membrane
- type I alveolar cells that form the wall of an alveolus
- epithelial basement membrane underlying the alveolar cells
- Capillary basement membrane that is often fused to the epithelial basement membrane
- endothelial cells of a capillary walls
What is the muscle that is used in quiet (unforced) inhalation?
diaphragm
Contraction of the diaphragm is responsible for about what percentage of air that enters the lungs during quiet breathing
75 percent
during deep, labored inhalations what muscles elevate the sternum
sternocleidomastoid
Because no muscular contractions are involved, quiet exhalation, unlike quiet inhalation is a what process
passive
Exhalation becomes active only during _____
Forceful breathing, such as playing a wind instrument or during exercise
as the lungs expand, the air molecules inside occupy a larger volume which causes the air pressure inside to
decrease
At rest just before an inhalation the air pressure inside the lungs is the same as the pressure of the atmosphere, which is about
760 mm HG at sea level
as the diaphragm and external intercostals contract and the overall size of the thoracic cavity increases the volme of the lungs increases and the alveolar pressure decreases from 760 to what
758 mm HG
Now there is a pressure difference between the atmosphere and the alveoli and air flows from the atmosphere (higher pressure) yo the lungs (lower pressure)
when the diaphragm and external intercostals relax, lung elastic recoil causes the lung volume to decrease and alveolar pressure rises from 758 to what
762 mm HG
the volume of one breath is called
tidal volume
how much air is moved in and out of the lungs on inhalation and exhalation
500 mL of air
what is minute volume
the total volume of air inhaled and exhaled each minute- is equal to breathing rate multiplied by tidal volume
MV = 12breaths/min x 500 mL
= 6000mL/min or 6 L a min
What percentage of tidal volume actually reaches the respiratory bronchioles and alveolar sacs, thus participating in gas exchange
70 percent (350ml)
The other 30 percent that does not participate in gas exchange because it remains in a space called
anatomical dead space
What is the apparatus commonly used to measure respiratory rate and the amount of air inhaled and exhaled during breathing
spirometer
(the record of this is called a spirogram)
when you take a deep breath the additional inhaled air is called what
inspiratory reserve volume
3100 ml in average adult male
1900 ml in average adult female
if you inhale normally and then exhale as forcible as possible the extra 1200 ml in males and 700 ml in females is called what
expiratory reserve volume
what is the sum of inspiratory reserve volume, tidal volume, amd expiratory reserve volume?
Vital capacity
what is the sum of vital capacity and residual volume called?
total lung capacity
what is the term for a normal pattern of quiet breathing
eupnea
what is a pattern of shallow (chest) breathing called
costal breathing (upward and outward movement of the chest)
what is a pattern of deep (Abdominal) breathing called
diaphragmatic breathing
breathing also provides humans with methods for expressing emotions such as laughing, sighing, and sobbing. Exhaled air can be used to expel foreign matter through actions such as sneezing or coughing. What is a term that describes these actions
modified breathing
what is the diffusion of oxygen from air in the alveoli in the lungs to blood in the pulmonary capillaries and diffusion of CO2 in the opposite direction called?
External respiration, also termed pulmonary gas exchange
What are the partial pressures of o2 and co2 in atmospheric air?
Po2= 159 mm HG
Pco2= 0.3 mm hg
what is the partial pressures of o2 and co2 in alveolar air?
Po2= 105 mm hg
Pco2= 40 mm HG
(o2 inhaled —> pulmonary capillaries)
What is the partial pressure of o2 and co2 in oxygenated blood?
Po2= 100 mm hg
Pco2= 40 mm hg
What is the partial pressure of o2 and co2 in the systemic tissue cells?
Po2 = 40 mm HG
Pco2= 45 mmhg
(Where internal respiration happens, gas exchange between systemic capillaries and tissue cells. This happens after blood is oxygenated)
What is the partial pressure of o2 and co2 in deoxygenated blood?
Po2 = 40mm hg
Pco2 = 45 mm hg
(same as systemic tissue cells)
How much o2 in blood is dissolved into blood plasma?
1.5 %
oxygen doesnt dissolve easily in water
What percent of blood o2 is bound to hemoglobin in red blood cells
98.5%
What other factors influence the amount of 02 released by hemoglobin
Carbon dioxide
Acidity
Temperature
What percent of co2 is dissolved into blood plasma
7 %
upon reaching the lungs it diffuses into alveolar air and is exhaled
what percent of co is bound to amino acids
23 %
Hemoglobin that has bound to co2 is termed carbaminohemoglobin (Hb-CO2)
The greatest percentage of CO2 is transported in blood plasma as bicarbonate ions what percent is this
70%
HCO3-
Clusters of neurons located in the brain stem are collectively called the respiratory center can be divided into what two principal areas on the basis of location and function
medullary respiratory center in the medulla oblongata
The pontine respiratory group located in the pons
what are the two collections in the medullary resp center called
Dorsal respiratory group (DRG)
Ventral Respiratory group (VRG)
The VRG becomes activated when what occurs
Forceful breathing is required such as during exercise or at high altitudes
What plays a role in both inhalation and exhalation by modifiying basic rhythm of breathing generated by the VRG, as when exercising, speaking or sleeping?
PRG
Pontine respiratory group
what sets the basic rhythm of breathing
DRG
Dorsal respiratory group
Voluntary control of holding your breath is limited due to what respiratory group being strongly stimulated and forcing you to resume breathing
DRG neurons
Nerve impulses from where stimulate the respiratory center and allow for modified breathing
hypothalamus and limbic system
what is rapid and deep breathing called
Hyperventilation
How does temperature effect breathing
fever = increases the rate of breathing
plunging into cold water causes temporary apnea
How does pain influence breathing
sudden, severe pain may cause brief apnea but prolonged somatic pain increases breathing rate
how does irritation of airways influence breathing
physical or chemical irritation of the pharynx or larynx brings about coughing or sneezing
What part does the inflation reflex play in breathing
pressure-sensitive stretch receptors and when stretched during overinflation the DRG is inhibited and as a result exhalation begins
what nerves stimulate the diaphragm to contract
phrenic nerves
the main muscles that power quiet breathing are the
diaphragm and external intercostals
how does aging play a role in decrease in lung capacity
aging results in decreased vital capacity, decreased blood level of O2 and diminished alveolar macrophage activity
What muscles are used in forced inhalation?
pectoralis minor, sternocleidomastoid, and scalene
what volumes make up vital capacity
tidal, inspiratory reserve, and expiratory reserve
what is the most abundant nutrient to the body
nitrogen
where are the central chemoreceptors located
CSF in medulla
What is hypercapnia and what is stimulated?
increase in CO2 and the central chemoreceptors are stimulated
What is hypoxia and what responds?
Deficiency in O2 and Peripheral chemoreceptors responds
If there is a decrease in CO2 what chemo receptors will respond
none will respond
When exercising and increasing RR what is first stimulated
Proprioceptors, they account for the increase in rate and decrease in oxygen. (theyre in the muscles and joints)
What type of exercise causes a change in proprioceptors
Moderate exercise
what is the most common type of asthma
Allergic
What is used to diagnose asthma
spirometry
what is the treatment for asthma
inhaled corticosteroid- Flovent (this is for maintenance of asthma)
SABA - Albuterol is used for abortive therapy
what are the three types of COPD
Chronic obstructive asthma
chronic bronchitis
emphysema
What is the number one sign/symptom of pulmonary edema
Pink frothy sputum
what is the initial treatment of pulmonary edema
diuretic (furosemide)
what tool is used to differentiate between cardiogenic pulmonary edema and noncardiogenic?
EKG
what will you see on a chest xray of someone with pulmonary edema
increased interstitial markings
what is the most common cause of pulmonary edema in developed countries
decompensated CHF
What is the treatment for pulmonary embolism
streptokinase = clot buster
Lovenox = preventative (blood thinner)
Both of these will require MO to approve
what is defined as massive hemoptysis
> 500 mL in less than 24 hours
100 mL in an hour
what position will you place a patient with hemoptysis
on the affected side
ex: R lung bleeding, you will lay the patient on their right side
How will you position a patient with pulmonary edema
Sitting up, with their feet dangling
dont lay them down
in a pulmonary contusion what is the most common complication
pneumonia
what is the most common cause, in healthy adults, of upper airway obstruction
angioedema (allergic reaction)
what is the treatment for angioedema upper airway obstruction?
Epinephrine
what is the first line treatment for almost every respiratory disease
oxygen
What is the initial treatment for hemoptysis
Oxygen
What imaging is used to confirm the diagnosis of hemoptysis
X ray
What is a complication of hemopthysis
Death
What is another term used to define URI
Common cold
What is the timeline for URI, soonest you will feel better to the latest you will feel better
3-10 days beyond that were thinking it may be bronchitis
How does bronchitis become chronic
A cough lasting longer than 3 months in 2 consecutive years
What lung sounds are associated with bronchitis
Rhonchi
What labs/imaging would you order for a person diagnosed with bronchitis
None are indicated
What sound will you hear upon percussion of the lungs with someone who has a hemothorax.
Dullness
30 y/o Caucasian male, 7 feet tall, 170 pounds and smoker comes in complaining of chest pain, what are you thinking the diagnosis could be
Spontaneous pneumothorax
32 year old male who had pneumonia 2 weeks ago, has no fever, coming in for 9/10 chest pain what are you thinking
Tension pneumothorax
What percussion sound will be heard on someone who has a pneumothorax
Hyper resonance
If you see flattening of the blood vessels, what are are you thinking is the cause
Hemothorax
If you see enlarged blood vessels in the neck, what are you thinking is the cause
Pneumothorax
The costal angle of the average person is 90 degrees, what does it go to when someone is pregnant
103 degrees
What type of back shape would you see in someone who is pregnant
Lordosis, because its compensating for the lung expansion
What type of test do you perform to determine if someone has long term respiratory problems
Shamrock test (clubbing of the finger nails)
What doe it mean if someone has increased tactile fremitus
Consolidation or fluid
What is the only sound you can hear on the anterior chest wall
Brachialtracheal
If you hear wheezing what diagnosis might the person have
Asthma, pulmonary edema
If you hear crackles, what diagnosis might the person have
Pneumonia, pulmonary edema
If you hear strider lung sounds, what might the diagnosis be
Obstruction, brachialtracheal injury or ARD
If someone has a barrel chest (1:1 ratio instead of 2:1) what diagnosis causes that to happen
COPD
Chronic asthma
Chronic bronchitis
Emphysema
Cystic fibrosis
What is associated with aspirated pneumonia
Bad teeth, foul smelling breath
If someone has a cinnamon smell to them, what diagnosis is associated with that
TB
What is normal breathing called
Eupnea
What is it called when you’re standing and having shortness of breath
Platypnea
What is it called when you’re laying down and having trouble breathing?
Orthopnea
What is rapid, labored breathing?
Kussmaul
What virus is associated with pneumonia
Influenza
If you hear a chest bruit or a murmur that increases with inspiration, what is this associated with
Large pulmonary arteriovenous malformation (AVM)
If someone comes in to be seen again after being treated for bronchitis and states they still don’t feel better, however the vital signs show no change (stable) what treatment are you going to do
Treat symptomatically
How long does it take for someone to recover from community acquired pneumonia
6 weeks or longer, especially if they are a smoker
If you palpate and feel subcutaneous emphysema and note some absent breath sounds what is likely happening
Tracheobronchial injury
O2, needle d, chest tube will all fail as well. So the MOI will assist in diagnosis (which is only caught 25% of the time anyway)
What antibiotics will you give for community acquired pneumonia
Azithromycin (macrolide)
Doxycycline (tetracycline)
Or moxifloxacin
What is the confirmatory test for pneumonia
Chest x ray
What connects both the esophagus and the larynx
Laryngopharnx
What is attached to the anterior rim of the thyroid cartilage and hyoid bone. It is also defined as a large, leaf-shaped piece of elastic cartilage that is covered with epithelium.
Epiglottis
What is a ring of hyaline cartilage that forms the inferior wall of the larynx and is attached to the first tracheal cartilage
Cricoid cartilage
What is the tubular passage way for air that is located anterior to the esophagus
Trachea (windpipe)
The primary bronchi contain what
Incomplete rings of cartilage and are line by pseudostratrified ciliated columnar epithelium
What are the fissures that divide the right and left lung
Oblique and horizontal in the right
ONLY OBLIQUE in the left
What is the main site of gas exchange
Alveoli
What is the purpose of surfactant
It is a mixture of phospholipids and lipoproteins that reduces the tendency of alveoli to collapse
What are alveolar macrophages (dust cells)
Wandering phagocytes that remove fine dust particles and other debris in the alveolar spaces
During forced exhalation what muscles are involved
Internal intercostal
External oblique
Internal oblique
Transverse abdominis
Recuts abdominis
These group of muscles contract to move the lower ribs downward and compress the abdominal visor a thus forcing the diaphragm upwards
