Resp Flashcards
1
Q
Lung Capacities Photo
A
2
Q
TLC? Volume and Definition
A
5.8L
All volumes added together
IRV+TV+ERV+RV
3
Q
VC? Volume and Definition
A
4.5L - Everything that you can inhale and exhale
All volumes except RV
IRV+TV+ERV
4
Q
FRC? Volume and Definition
A
2.3L - The lung volume at end expiration
RV+ERV
5
Q
CC? Volume and Definition
A
Variable - Absoulte volume of gas contained in the lungs when small airways close
RV+CV
6
Q
IRV? Volume and Definition
A
3L - Volume of gas that can be forcibly inhaled after a normal tidal inhalation
7
Q
TV? Volume and Definition
A
500mL - Normal breath during tidal breathing
8
Q
RV? Volume and Definition
A
1.2L - Volume that can not be exhaled from the lungs
9
Q
CV? Volume and Definition
A
30% of TLC at age 20
55% of TLC at age 70
The volume above residual volume where the small airways begin to close
10
Q
What increases closing volume? What is the mnemonic?
A
CLOSE-P
COPD
LV failure
Obesity
Surgery
Extreme Age
Pregnancy
11
Q
What is normal carry capacity ? Equation? CaO2
A
12
Q
What is normal DO2? Equation? What does it tell you?
A
13
Q
Normal partial pressure of O2 on OxyHgb curve? What about for fetal Hgb?
A
Adult - 26.5
Fetal - 19
14
Q
OxyHgb Curve photo
A
15
Q
How is Co2 primarly transported in the blood?
A
70% - Bicarb
23% - Bound to Hgb
7% - Dissolved in plasma
16
Q
What is the Bohr effect?
A
Describes O2 carriage
As CO2 increases, the erythrocyte releases O2.
“The scary Bohr, scares the O2 to jump off”
Releases O2
17
Q
What is the Haldane effect?
A
Describes CO2 carriage
As O2 increases, it causes CO2 to be released in the lungs
Opposite of the bohr
18
Q
What is the pacemaker of the respiratory center? Where is it?
A
Located in the Medulla
The Dorsal group causes respiratory inspiration
19
Q
What controls respiratory expiration?
A
The ventral center in the Medulla
20
Q
What stimulates the Dorsal Respiratory Center? Where is it located?
A
The apneustic center in the lower pons
21
Q
What inhibits the Dorsal Respiratory Center? Where is it located?
A
Pneumotaxic center in the upper pons
22
Q
Where are central chemoreceptors? What does it respond to?
A
Located in the medulla, responds to increased hydrogen in the CSF
23
Q
Where are peripheral chemoreceptors? What does it respond to?
A
Carotid bodies (nerves of herring to Glossopharyngeal CN9)
Aortic arch (Vagus CN10)
Respond to decreased O2 and increased CO2
24
Q
What prevents overinflation of the lungs?
A
Hering-Breuer inflation reflex
25
What is Hypoxic Pulmonary Vasoconstriction? What triggers it?
It reduces blood flow through poorly ventilated alveoli
Low alveolar PO2 NOT arterial PO2
26
PFT photo
27
How do PFTs change with Restrictive disease?
Everything is decreased except the ratio values.
Intact flow rates
FEV1 to FVC ratio
FEF 25-75%
28
How do PFTs change with obstructive disease ?
Everything is decreased except for values that requires getting air out
Easy to get air in, not out
Increased;
RV
FRC
TLC
29
Flow loop photo
30
How does a patient with a flail chest look? (movement of chest wall)
On inspiration the chest moves inward
On expiration the chest moves outward
31
What is the definition of pulmonary hypertension?
PAP > 25
32
How is carbon monoxide poisoning measured? Will the patient be blue?
With a co-oximeter
No the patient will appear cherry red
33
What are the steps for hypoxemia during OLV?
1. 100% FiO2
2. Confirm placement
3. CPAP 2-10cm to nondependent (non-ventilated lung)
4. PEEP 5-10 to dependent lung
5. Recruitment maneuver
6. Clamp PA to non-ventilated lung
7. Resume two lung ventilation
34
If there is severe hypoxemia during OLV, what must be done ?
Resume 2 lung ventilation
35
Youngest age for OLV? Alternative?
8 years old
Can use bronchial blocker
36
What are the top two complications of a mediastinoscopy?
1. Hemorrhage
2. Pneumothorax
37
Mallampati exam photo
38
What does incisor gap tell you? What is normal?
Ability to align oral, pharyngeal, and laryngeal axes
2-3 fingers or 4cm
39
What does thyromental distance tell you? What is normal?
The size of the submandibular space
6-9cm
40
What does the mandibular protrusion test tell you?
Temporomandibular joint mobility
41
Mnemonic for difficult mask ventilation?
BONES
Beard
Obese
No teeth
Elderly
Snoring
42
NPO guidelines?
2 hours = Clear
4 hours = Breast milk
6 hours = milk, formula, solids
8 hours = fried or fatty foods
43
Maximum cuff pressures for ET and LMA?
ET - < 25
LMA - < 60
44
LMA sizing
45
Airway anatomy
46
What muscle tenses the vocal cords?
CricoThyroid
"Cords Tense"
47
Which muscle relaxes the vocal cords?
ThyroaRytenoid
"They Relax"
48
What muscle abducts the vocal cords?
Posterior CricoArytenoid
"Please Come Apart"
49
What muscle adducts the vocal cords?
Lateral Cricoarytenoid
Plus sign, ADD
Closes the airway
Brings together
50
All sensory innervation to the vocal cords is through which nerve?
RLN
51
What is the one sensory muscle innervated by the SLN external branch?
Cricothyroid
Cords Tense (elongates)
52
What do the extrinsic muscles end in? What is the one that doesn't?
All end in Hyoid except the Digastric
53
What are the two branches of the Vagus nerve?
RLN and SLN
54
What does the RLN innervate?
Motor function to all laryngeal muscles except the Cricothyroid
Sensory function below the level of cords
55
What does the SLN innervate
The internal branch is all sensory starting at the posterior side of the epiglottis to the level of the vocal cords
The external branch is motor to the cricothyroid
56
Airway innervation #2
57
What is the landmark for a glossopharyngeal block?
Palatoglossal arch
Insert no more than 0.5cm
Careful for carotid artery
58
What is the landmark for a SLN block?
Inferior border of the greater cornu hyoid bone
59
What is the landmark for a RLN block? What is another name for this block?
Puncture the cricothyroid membrane and advance needle caudal
Also called transtracheal
Tell the patient to take a deep breath and then cough after injection
60
What cervical level does the adult larynx sit?
C3-C6
61
How many paired and unpaired cartilages?
3 paired
3 unpaired
= 9 total cartilages
62
DL anatomy
63
What is the narrowest part in an adult? Child?
Cricoid in Child
Glottic opening in adult
64
Rocking horse
Inspiratory stridor
Lower rib flailing
Absent or altered End tidal
Are signs of what? Treatment?
Laryngospasm
Larson maneuver
FiO2 100%
CPAP 15-20
Deepen anesthesia
Succ
65
What are the borders for the laryngospasm notch?
Skull base
Ramus of mandible
Mastoid process
66
Difference between Valsalva's maneuver and Muller's
Valsalva - Exhalation against a closed glottis
Muller - Inhalation against a closed glottis (negative pressure pulmonary edema)
67
Which NonD NMB can be given IM?
Roc
68
What do the hyoid muscles do?
Opens the hypopharynx
69
What does the genioglossus muscles do?
Opens the oropharynx - most common obstruction with the tongue
70
What does the tensor palatine muscles do?
Opens the nasopharynx at the soft palate
71
What level does the trachea begin at?
C6
72
What level is the Carina at? What is a landmark?
T4-T5
Angle of Louis
73
What do type 2 pneumocytes cells do?
Produce surfactant
Capable of cell division
74
What do type 1 pneumocytes cells do?
Provide surface area for gas exchange
75
What do type 3 pneumocytes cells do?
They are macrophages to produce inflammatory response
76
What side is more likely to be mainstemed? Why?
The right side because the angle is less acute
25 degrees vs 45 degrees
77
What do goblet cells produce? Ciliated cells?
Goblet - produce mucus
Ciliated - Clear mucus
78
What structures permit air movement between alveoli?
Pores of Kohn
79
Does the muscular layer increase or decrease with airway bifurcation?
Muscular layer Increases
Amount of Cartilage decreases
80
Where does anatomic dead space begin and end?
Begins at the mouth and ends at the terminal bronchioles
81
Which muscles provide inspiration?
Scalene's
Sternocleidomastoid
External intercostals
Diaphragm
82
Which muscles provide expiration?
Internal intercostals
Rectus abdominis
Obliques
Transverse abdominis
83
Does the conducting zone participate in gas exchange?
No
The transitional zone does a little but mainly takes place in the respiratory zone
84
Is transpulmonary pressure always positive or negative? Why?
Always positive to prevent airways from collapsing
85
Is intrapleural pressure always positive or negative?
Always negative to keep the lungs inflated
86
When is the one time TTP becomes negative?
Forced expiration
87
What is the primary determinant of carbon dioxide elimination?
Alveolar ventilation
88
Normal dead space in an adult?
2mL/kg
89
What is the difference between alveolar ventilation and minute ventilation?
Alveolar ventilation subtracts dead space from the equation
90
What increases the PaCO2 to EtCO2 gradient? Some examples?
Anything that increases dead space
Ex: atropine, hypotension, positive pressure ventilation
Atropine is a bronchodilator
91
How is physiologic dead space calculated?
Anatomic Vd + Alveolar Vd
92
Where does dead space begin in the circle system?
At the Y piece
93
What is the Bohr effect?
94
A patient is in the sitting position, what is higher in the base of the lung compared to the apex?
There is more blood flow in the base and a higher partial pressure of alveolar carbon dioxide (think more gas exchange)
There is less blood flow and a higher partial pressure of oxygen in the apex compared to the base
95
Where is ventilation greatest? What about perfusion?
BOTH in the base of the lung
96
Does hypoxic pulmonary vasoconstriction minimize shunt or dead space?
Minimizes shunt by moving blood away
97
What is a normal V/Q relationship?
0.8
98
What is the most common cause of hypoxemia in the PACU?
V/Q mismatch due to atelectasis
99
How does the body combat dead space?
It constricts the bronchioles to minimize ventilation to poorly perfused alveoli
100
How does the body combat shunt?
Hypoxic Pulmonary vasoconstriction reduces blood flow to the poorly ventilated alveoli
101
V/Q = 0 means what
V/Q = infinity means what
0 = shunt
Infinity = dead space
102
When does type 2 pneumocytes begin producing surfactant? Whren is the peak?
22-26 weeks
Peaks at 36 weeks
103
Which drugs are given to premature infants to hasten lung development?
Betamethasone (corticosteroids
104
lung zones
105
What lung zone does edema occur in?
Zone 4
106
What lung zone is the "waterfall" and V/Q is equal to 1?
Zone 2
107
What zone does the tip of the Pulmonary artery catheter reside?
Zone 3
108
What zone is increased by atelectasis? What about hypotension?
Atelectasis = 3
Hypotension = 1
109
What zone is increased by a PE or excessive airway pressure?
Zone 1
110
Does supplemental oxygen reverse hypercarbia?
No
111
What is the alveolar gas equation?
112
How is A-a gradient calculated?
PAO2 - PaO2
113
Examples of things that increase A-a gradient.
-Aging
-Vasodilator
-R-L shunt such as atelectasis, pneumonia, bronchial intubation
- Diffusion limitation
114
What can spirometry not measure?
Residual volume
which means no
FRC
TLC
Closing capacity
Closing volume
115
What increases FRC?
Advanced age (increased RV)
Prone
Sitting
Obstructive lung disease (increased RV)
PEEP
Sigh breaths
116
Examples of things that decrease FRC
General anesthesia
Obesity
Pregnancy
Neonates
Supine
NMB
Excessive fluids
High FIO2
Reduced lung compliance
117
What is closing volume?
The point where dynamic compression of airways begins
118
Things that increase closing volume?
CLOSE-P
COPD
LV failure
Obesity
Surgery
Extremes of age
Pregnancy
119
What happens if CC is greater than FRC?
The airways begin to collapse
120
At what age does CC approximate FRC under general anesthesia?
What about standing? Or supine?
30
Standing - 66
Supine- 44
121
What is normal VO2? (oxygen consumption)
VO2 = 3.5mL/kg/min
VO2 = 250mL/min
122
Carrying capacity equation?
123
Oxygen delivery equation?
124
Which electrolyte abnormality is most likely to occur in the setting of acute respiratory acidosis?
Hyperkalemia
125
Normal PaO2 on OxyHgb curve?
Adult - 26.5
Peds - 19
50% saturated and 50% unsaturated
126
Bohr affect?
Scares the oxygen OFF the Hgb
127
Does MetHgb and CarHgb shift the curve to the left or right?
Left
128
Increased 2,3 DPG shift the curve left or right?
Shifts it to the left
129
How much ATP is gained through oxidative phosphorylation? Kreb cycle? Glycolysis?
Oxidative phosphorylation - 34 ATP
Kreb cycle - 2 ATP
Glycolysis - 2 ATP
130
Aerobic vs anaerobic ?
Aerobic - used oxygen
Anaerobic - does not use oxygen and creates lactic acid which creates lactic acidosis
131
How is the vast majority of CO2 transported in the body?
1. Bicarb - 70%
2. Bound to Hgb - 23 %
3. Dissolved in plasma - 7%
132
Why is venous blood more acidic?
Because it is transported more acid to the lungs for disposal
Arterial pH - 7.4
Venous pH - 7.36
133
How many more times soluble is CO2 than oxygen?
20 times
(Henry's Law)
134
Which ion must maintain electroneutrality during the hamburger shift?
Cl
Chloride
135
What is the Haldane effect?
Oxygen causes CO2 to jump off
Opposite of the Bohr
136
Where in the body is the CO2 curve shifted right?
The lungs to facilitate the offloading of CO2
137
Where in the body is the CO2 curve shifted left?
Systemic capillaries
138
A right shift on the ventilatory response curve means what? Ex?
less likely to breathe
Natural sleep
Alkalosis
Volatile anesthetics
Carotid
Roc
139
A left shift on the ventilatory response curve means what? Ex?
More likely to breathe
Surgical stimulation
Salicylates
Increased ICP
Anxiety
Hypoxemia
Acidosis
140
Pacemaker of normal breathing?
Dorsal respiratory center in the Medulla
141
Pacemaker of exhalation?
Ventral respiratory center in the medulla
142
What inhibits the DRG? what stimulates?
Pneumotaxic inhibits in the PONS
Apneustic stimulates in the Lower Pons
143
Where is the central chemoreceptor located? How is it stimulated?
Located in the Ventral of the Medulla
Stimulated by pH changes in the CSF and responds to PaCO2
144
Can CO2 or hydrogen diffuse through the BBB?
CO2 CAN
H cannot
145
Which surgical procedure impairs the hypoxic ventilatory drive?
Carotid endarectomy
