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A1 > Respiratory final > Flashcards

Respiratory final Flashcards

1
Q

Adult larynx location

A

c3-c6

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2
Q

Larynx level at birth

A

c4-c5

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3
Q

Normal AO extension

A

35 degrees

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4
Q

Mallampatis

A

1- pillars (anterior and posterior tonsillar)
2- uvula
3- soft
3-hard

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5
Q

Which CN are responsible for airway innervation

A

CN5- Trigeminal (anterior ethmoidal/ opthalmic, maxillary (sphenopalatine), and mandibular(lingual))
CN9- Glossopharyngeal
CNX- SLN/RLN

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6
Q

Airway CN locations

A

CN5- trigeminal- V1- nares, V2- turbinates, V3- anterior 2/5 tongue
CN9- glosspharyngeal- Posterior 1/3 tongue to the top of the epiglottis
CNX- vagal- SLN IB- Sensory from bottom of epiglottis to above the glottis SLN EX- motor to cricothyroid, RLN- motor below the cords, and motor to all except cricothyroid

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7
Q

Which RLn passes the aortic arch?

A

L

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8
Q

Narrowest part of adult and kids airway

A

Adult- glottis
Kids fixed- cricoid ring
Kids dynamic- glottis

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9
Q

How many rings of trachea?

A

20-25How mny

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10
Q

Cm from teeth to carina

A

25cm

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11
Q

Where does gas exchange begin

A

Respiratory bronchioles

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12
Q

Where do impulses to breathe come frmo and go to?

A

From brainstem (DRG/VRG)
To muscle contraction

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13
Q

Phrenic nerve roots

A

C345 keep a man alive

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14
Q

Intercostal nerve roots and where they send message to

A

t1-t11 to external intercostals

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15
Q

What cant spirometry measure?

A

RV, and thus FRC and TLC,

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16
Q

How to measure FRC and TLC

A

Helium wash in
Nitrogen washout
Body pleth

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17
Q

Extra vs intra thoracic vs fixed FV loop

A

Extra- top heavy bc cant breathe in- lesion is high
Intra- bottom heavy bc cant breathe out- lesion is low
Fixed (infra or extra)- square around center0 tracheal stenosis

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18
Q

Poiselles law

A

8ln/pi x r4

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19
Q

Functional capillary volume

A

70 ml at rest
210 ml at exercise

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20
Q

Zones formula

A

PA Pa Pv
Pa PA Pv
Pa Pv {A

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21
Q

PVR vasoconstrictors

A

reduced pao2
Increased pco2
TXA2
Histamines
A adrenergics
AT2
PG

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22
Q

PVR vasodilators

A

NO
Prostacyclin
B adrenergics
ACH
Bradykinin
inreased pao2

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23
Q

What causes HPV

A

low PAo2 (alveolar hypoxia)

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24
Q

Normal PAo2

A

100mmHg

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25
Q

Normal PAco2

A

40

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26
Q

Normal CO2 production

A

200ml/min

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27
Q

Saturation and Pao2

A

100- 100
90- 60
80- 50
70- 40
50-27
40 50 60- 70 80 90

28
Q

Left shift on oxyhemoglobin association curve

A

hypothermia
alkalosis
decreased 2 3 dpg
hypocarbia

29
Q

R shift on oxyhemoglobin association curve

A

hyperthermia
acidosis
increased 2 3 dpg
hypercarbia
sepsis

30
Q

Cao2 formula

A

(1.34 x hgb x spo2 in decimal) + (pao2 in full x .003)

31
Q

DO2 formula

A

CAO2 x co x 10

32
Q

How is co2 transported in the blood

A

70-hco3
25- co2 on hgb
5- dissolved

33
Q

What does DRG do

A

Pacemaker
Rate and rhythm

34
Q

Location of DRG

A

nucleus tractus solitarus in the medulla

35
Q

DRG gets signals from what 3 sources

A

Peripheral chemoreceptors
Baroreceptors
Lung receptors

36
Q

Which CN communicate with DRG

A

9, 10

37
Q

Location of peripheral chemoreceptors

A

Carotid body
Traverse aortic arch

38
Q

What triggers peripheral vs central chemoreceptors to breathe

A

Central- h ions from co2 in the blood
Peripheral- poa2 <60

39
Q

High risk fev1 level

A

<2L

40
Q

High risk fev1/fvc ratio

A

.5

41
Q

High risk VC

A

<15cc/kg in adult
<10 cc/kg in kids
OR
.5 predicted

42
Q

Intubation criteria- rr, vc, pao2, aa gradient, paco2, vd/vt, clinical diagnosis

A

> 35 rr
<15cc/kg VC
<70 pao2 on fio2 .4
350 aa gradient on fio2 1.0
55 paco2
0.6 vdvt
burns, aams, appiglotitis, rapid deterioration, fatigue
-20

43
Q

Extubation criteria rr, pao2, paco2, vc, MIF

A

<30
>70
<55
>15cc/kg
<-20

44
Q

An increase of pco2 by 10mmhg will decrease ph by ___

A

0.08

44
Q

Hypoxemia = pao2 < ___

A

75

45
Q

Aa formula

A

A-a = 5-15 normally
PAO2= (760-h20)x fio2 - (paco2/0.8)
Pao2-
Normal Aa - age/3

46
Q

What causes increased Aa gradient

A

Shunt
VQ mismatch
diffusion issue
PTX/ PE
NORMAL with hypoventilation / hypoxic mixture

47
Q

An increase in hco2 by 10 will increase ph by ___

A

0.15

48
Q

What can cause methemoglobinemia and tx

A

Nitrates/ nitrites
benzocaine spray
Sulfonamides
Meth blue or vit c

49
Q

Parts of the capnograph

A

ABCDE
AB bottom
CD top
E bottom
However- a angle is left top, b angle is top right

50
Q

What inhibits HPV?

A

Vasodilators- ntg, snp, ccb,
Vasoconstrictors and hypocapnia
All gasses 1-1.5 mac
TIVA are safe

51
Q

How to tx OLV hypoxia

A

fio2 1.0
suction ett
5 CPAP to nondependent
5cm peep to dependent
clamp nondependent pa

52
Q

MH tiggering agents

A

Succ
Volatile anesthetics (not n2o)

53
Q

First and most sensitive sign of MH

A

Tachycardia

54
Q

Most specific sign of MH

A

ETCO2 2-3x higher

55
Q

MH signs besides tachy and etco2

A

Rigidity, sweating, cyanosis, unstable bp, mottle, cocacola urin, exhaustion of co2 abosrber

56
Q

LAbs of MH

A

Hyperkalemia
acidosis (metabolic then both)
CK >1000

57
Q

What increases MAC

A

6months old
Hyperthermia/ hypersalt
acute cocaine use
chornic etoh

58
Q

What decreases mac

A

Age after 40
acute alcohol
chornic cocaine
pregnancy
hypothermia- 5% for every 1 degree c drop/ hyposalt

59
Q

What has no effect on mac

A

Sex
Thyroid
Duration of anesthesia
K, CO2

60
Q

How to prevent diffusion hypoxia

A

Dont extubate at .7 n2o
fio2 1.0 after n2o

61
Q

What does nicotine do inside body

A

Releases catecholamines and increases bp, hr, svr for 30 min after cig

62
Q

How to intubate smoker

A

Pre o2 well, wait until deep for instrumentation

63
Q

Preop smoking cessation

A

12 hours advice to reduce cohb and nicotine levels
8 weeks to reduce PPC
>2 years

64
Q

What are histamine releasing drugs to avoid during bronchospasm

A

morphine meperdine
STP
Atracurium / mivacurum

A1 (122 decks)

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