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Spring 2020 - Physiology 1 > Respiratory Final > Flashcards

Respiratory Final Flashcards

1
Q

Where is the Larynx located in an Adult?

A

Anterior to 3rd-6th Cervical Vertebre

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2
Q

Where is the Larynx located at birth?

A

C3-4

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3
Q

What is the Larynx made of?

A

Multiple Cartilages & Muscles bound by Elastic Tissue

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4
Q

What is the Normal A-O Extension?

A

35 Degrees

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5
Q

Mallampati 1

A

Full Uvula

Tonsillar Pillars

Soft Palate

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6
Q

Mallampati 2

A

Partial Uvula

Partial Tonsils

Soft Palate

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7
Q

Mallampati 3

A

Soft Palate Only

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8
Q

Mallampati 4

A

Hard Palate Only

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9
Q

Sphenopalatine Ganglion

A

Middle of Cranial Nerve V

Nasal Mucosa, Superior Pharynx, Uvula, Tonsils

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10
Q

Glossopharangeal Nerve

A

Cranial Nerve IX - Back 1/3 of tongue, Pharyngeal, Tonsillar Nerves

Oral Pharynx, Supraglottic Region

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11
Q

Internal Superior Laryngeal Nerve (SLN)

A

Cranial Nerve X - Vagus Nerve

Mucus Membrane above Vocal Cords, Glottis

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12
Q

Recurrent Laryngeal Nerve (RLN)

A

Cranial Nerve X - Vagus Nerve

Trachea below cords

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13
Q

List 1 - 10

A
  1. SLN
  2. Internal SLN
  3. External SLN
  4. Vagus Nerve
  5. RLN
  6. Epiglottis
  7. Hyoid Bone
  8. Thyroid Cartilage
  9. Cricothyroid Membrane
  10. Cricoid Cartilage
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14
Q

What does the Internal SLN do?

A

Supraglottic & Ventricle Sensation

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15
Q

What happens when the Internal SLN is stimulated?

A

Laryngospasm

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16
Q

What does the External SLN do?

A

Motor Innervation to Cricothyroid Muscle

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17
Q

What does the RLN do?

A

Infraglotta Sensory

Motor innervation to all larynx except cricothyroid muscle

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18
Q

What does Stimulation of the RLN do?

A

Vocal Cord Abduction

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19
Q

What happens if there is damage tot he RLN?

A

Vocal Cord Adduction

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20
Q

What is the shape of the Larynx in an Adult vs a Child?

A

Adult: Cylindrical Larynx

Child: Cone-Shape Larynx

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21
Q

What is the Trachea?

A

Flexible Cylindrical Tube supported by 20-25 C-Shaped Catilages

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22
Q

What is the Diameter of the Trachea?

A

18-20 mm

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23
Q

What is the Length of the Trachea?

A

12.5 - 18 cm

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24
Q

Where is the Trachea located?

A

C6 - T5

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25
Q

At what level does the Trachea divide into two Bronchi?

A

Carina

T5-T7

25cm from Teeth

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26
Q

Which part of the airway does Gas Exchange begin?

A

Respiratory Bronchiole

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27
Q

Which Nerve transmits Motor Stimulation to the Diaphragm?

A

Phrenic Nerve (C 3,4,5)

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28
Q

Which Nerves send signals to the External Intercostal Muscles?

A

Intercostal Nerves (T1 - T11)

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29
Q

Which phase of breathing is considered the active phase?

A

Inspiration

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30
Q

What is considered Negative-Pressure Ventilation?

A

The Act of Inhaling

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31
Q

What directions do the Ribs and Diaphragm move on Inspiration?

A

Ribs: Up and Out

Diaphragm: Down

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32
Q

What is Tidal Volume?

A

Volume Inspired/Expired w/ each normal breath

500 mL

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33
Q

What is Inspiratory Reserve Volume?

A

Extra Volume inspired above normal breathing.

3000 mL

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34
Q

What is Expiratory Reserve Volume?

A

The extra volume after normal expiration

1100 mL

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35
Q

What is Residual Volume?

A

Volume of air remaining after max expiration.

1200 mL

Can’t Be Measured by Spirometry

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36
Q

What is the Inspiratory Capacity

A

The maximum amount of air that a person can breathe in.

Tidal Volume + Inspiratory Volume Reserve

3500 mL

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37
Q

What is Functional Residual Capacity?

A

The air in the lungs after normal expiration

Expiratory Reserve Volume + Residual Volume

2300 mL

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38
Q

What is Vital Capacity?

A

The max amount of air a person can blow out after taking the biggest breath they can.

Inspiratory Reserve Volume + Tidal Volume + Expiratory Reserve Volume

4600 mL

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39
Q

What is Total Lung Capacity?

A

The max volume of air the a person can breath in

Vital Capacity + Residual Volume

5800 mL

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40
Q

What are the techniques used to measure FRC and which is the most accurate?

A
  • Helium Dilution
  • Nitrogen Washout
  • Body Plethysmography - sit in a sealed box and try to inhale through closed mouthpiece - more accurate
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41
Q

What are the Functions of Surfactant?

A

Lower Surface Tension

Stablizes Alveoli

Prevents Fluid Leaking into Alveoli

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42
Q

What is the Concept of Poiseuille’s Law?

A

Relates to Resistance, Length, Viscocity, and Radius

Decrease Radius by 16% = Doubles Resistance

Decrease Radius by 50% = Increase Resistance 16x

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43
Q

Right Atrial Pressure

A

2-5 mmHg

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44
Q

Left Atrial Pressure

A

6 - 12 mmHg

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45
Q

Right Ventricle Pressure

A

25/0 mmHg

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46
Q

Left Ventricle Pressure

A

120/0 mmHg

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47
Q

Pulmonary Capillary Pressure

A

10.5 mmHg

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48
Q

Pulmonary Artery Pressure

A

25/8 mmHg

Mean: 15

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49
Q

Pressure of the aorta

A

120/80

Mean: 90

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50
Q

What are the mechanisms to decrease Pulmonary Vascular Resistance?

A

Recruitment & Distension

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51
Q

How much of the Alveolar surface is covered by Capillaries?

A

70-80%

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52
Q

How much can the Capillary Volume increase from Recruitment?

A

Resting: 70mL

Max: 200mL

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53
Q

Lung Zone 1

A

PA > Pa > PV

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54
Q

Lung Zone 2

A

Pa > PA > PV

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55
Q

Lung Zone 3

A

Pa > PV > PA

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56
Q

As you move Down and Upright Lung, the V/Q Ratio ________

A

As you move Down the Upright Lung, the V/Q Ratio decreases

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57
Q

What are the Pulmonary Vasoconstrictors?

A

↓PaO2

↑PaCO2

Histamine

Alpha Catecholamines/Norepi

Thromboxane

Prostaglandins

Endothelin

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58
Q

What are the Pulmonary Vasodilators?

A

↑PaO2

Nitric Oxide

Beta Catecholamines

Prostacyclin

ACh

Bradykinin

Dopamine

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59
Q

What produces the Localized Response of Hypoxic Pulmonary Vasoconstriction (HPV)?

A

Alveolar Hypoxia

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60
Q

What is the Purpose of Hypoxic Pulmonary Vasoconstriction?

A

Shift blood flow to better ventilated areas of the lung to improve V/Q

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61
Q

What is the Normal Alveolar PO2 and PCO2?

A

PO2: 100 mmHg

PCO2: 40 mmHg

62
Q

How much CO2 is produced at rest?

A

200 mL/min

63
Q

Air is Expired in two parts, which is first and second?

A

First: Dead Space Air

Second: Mix of Dead Space air & Alveolar Air

Alveolar air is expired at the End of Exhalation

64
Q

What is Fick’s Law?

A

Diffusion of Gas thru tissue membrane involving

Size & Thickness of membrane

&

Partial Pressure Difference

65
Q

What is the quantity of V/Q if there is perfusion, but no ventilation

66
Q

What is the quantity of V/Q when there is ventilation, but no perfusion?

A

V/Q = Infinity

67
Q

What is the PO2 and PCO2 in normal deoxygenated Blood?

A

PO2 = 40 mmHg

PCO2 = 45 mmHg

68
Q

When is V/Q Below Normal

A

Shunt: Perfusion, no Ventilation

69
Q

When is V/Q greater than Normal?

A

Dead Space: Ventilaton, no Perfusion

70
Q

How does SpO2 relate to PaO2?

100% = ?

95% = ?

90% = ?

75% = ?

60% = ?

50% = ?

A

100% = 100 mmHg

95% = 75 mmHg

90% = 60 mmHg

75% = 40 mmHg

60% = 30 mmHg

50% = 27 mmHg

(40, 50, 60 mmHg = 70, 80, 90%)

71
Q

What does a Right Shift on the Oxyhemoglobin Curve indicate?

A

Hb releases O2 easier & Blood O2 saturation will be less

72
Q

What does a Left Shift on the Oxyhemoglobin curve indicate?

A

Hb holds on to O2, and Blood O2 Saturation will be more

73
Q

What causes a Right Shift of the Oxyhemoglobin Curve?

A

↑CO2

↑Temperature

↑2,3-DPG

↓pH

Bohr Effect

74
Q

How is the amt of O2 in the Blood Calculated?

A

CaCO2 = (SO2 x Hb x 1.31) + (PO2 x 0.003)

SO2 = Pulse Ox

75
Q

How is Oxygen Delivery (DO2) Calculated?

A

DO2 = CaCO2 x Cardiac Output

CaCO2 = Amt of O2 in Blood​

76
Q

In what form is the majority of CO2 transported?

A

Bicarbonate (HCO3-)

77
Q

CO2 Transport

A
  1. Tissues use O2 and Produce CO2
  2. CO2 + H2O (Carbonic Anhydrase) –> H2CO3 (Carbonic Acid)
  3. H2CO3 splits into H+ & HCO3- (Bicarb)
  4. Bicarb exits cell, Cl- enters to balance
  5. Cell goes to Pulmonary Capillary
  6. Cl- exits and Bicarb Re-Enters
  7. HCO3- (Bicarb) + H+ –> H2CO3 (Carbonic Acid)
  8. Carbonic Anyhydrase splits H2CO3 –> CO2 + H2O
  9. CO2 leaves cell and goes into Alveoli
78
Q

What are the different forms that CO2 is tranpsorted as?

A
  • CO2: 7%
  • Hgb + CO2: 23%
  • HCO3-: 70%
79
Q

What part of breathing does the Dorsal Respiratory Group control?

A

Inspiration & Rhythm

80
Q

Where is the Dorsal Respiratory Group located?

A

Along the medulla in the Nucleus of the Tractus Solitarius

81
Q

Which Nerves deliver Sensory Info to the Dorsal Respiratory Group?

A

Vagus Nerve (X)

&
Glosspharyngeal Nerve (IX)
82
Q

What are the sources of the Dorsal Respiratory Group signals?

A

Peripheral Chemoreceptors

Baroreceptors

Lung Receptors

83
Q

Where are the Central Chemoreceptors located?

A

Highly Sensitive area on Ventral Medulla Surface

84
Q

What does the Chemo-Sensitive Area of the Brain respond to?

A

PCO2 or H+

Stimulates other parts of the Respiratory Center

85
Q

What is the difference in CO2 concentrations b/t the Blood & Brain?

A

Equal b/c CO2 is highly permable to Blood-Brain Barrier

86
Q

What happens when CO2 enters the Brain?

A
  1. Reacts w/ H2O to form Carbonic Acid
  2. Carbonic Acid breakds down into H+ & HCO3-
  3. H+ in brain stimulates Respiratory Center
87
Q

What Greatly increases Ventilation?

A

PCO2 > 35 mmHg

pH has less effect

88
Q

Where are the Peripheral Chemoreceptors located?

A

Aortic Arch & Carotid Body

89
Q

Which Cranial Nerve does Peripheral Chemoreceptors send signal thru when coming from the Carotid Body?

A

Cranial Nerve IX - Glossopharyngeal Nerve

90
Q

Which Cranial Nerve do Peripheral Chemoreceptors send thru to the DRG from the Aortic Bodies?

A

Cranial Nerve X - Vagus Nerve

91
Q

What is the FEV1 for High Risk patients?

92
Q

What is the FEV1/FVC for High Risk patients?

93
Q

What is the VC for High Risk Adults and Kids?

A

Adults: < 15cc/kg

Kids: <10cc/kg

or

VC < 40-50% predicted

94
Q

List 1 -6

A
  1. Pneumotaxic Center
  2. Apneutstic Center
  3. VRG (Expiration & Inspiration)
  4. Respiratory Pathways
  5. DRG (Inspiration)
  6. Fourth Ventricle
95
Q

Extubation Criteria

A
  • VSS, Awake & Alert
  • 40% FiO2 = PaO2 > 70 & PaCO2 < 55
  • NIF < -20cm H2O
  • VC > 15 cc/kg
96
Q

What criteria would be considered Respiratory Failure requiring Intubation?

A
  • RR > 35
  • PaCO2 > 55 mmHg
  • PaO2 < 70 on 40% FiO2
97
Q

What A-a gradient would you consider Intubating?

A

A-a Gradient > 350 mmHg on 100% FiO2

98
Q

At what Vital Capacity would you consider Intubating?

A

VC < 15 cc/kg

< 10 cc/kg for kids

99
Q

At what ratio of Dead Space to Tidal Volume would you consider intubating?

A

Vd/Vt > 0.6

100
Q

How much will pH decrease if the PCO2 increases by 10 mmHg?

A

pH will decreases by 0.08

101
Q

What does the A-a Gradient measure?

A

A-a measures the difference b/t oxygen concentration in alveoli & arterial system

102
Q

How do you treat abnormal A-a gradients?

A

Treat Underlying Cause

O2, Adjust Ventilation, PEEP

103
Q

How much would the pH decrease with a decrease of Bicarb by 10 mmoles?

A

pH will decreases by 0.15

104
Q

How is Total Body Bicarb Deficit Calculated?

A

Total Bicarb Deficit =

Base Deficit X Weight X 0.4

(Replace by 1/2 of Deficit)

105
Q

How does the Pulse Ox work?

A

Two lights

Infrared: 950nm - Oxyhemoglobin, 100% Saturation

Red: 660nm - Deoxyhemoglobin, 50% Saturation

106
Q

What can cause an overestimation of the true Oxygenation on the Pulse Ox?

A

Carboxyhemoglobin from CO Poisoning

Shows as 100% on Pulse Ox

Use Co-Oximeter for Distinguishing

107
Q

What is Methemoglobin?

A

When the Iron in Hgb is converted to Ferric and cant trasport O2

Absorbed equally by Red & Infrared lights on pulse ox

Shows SpO2 as 85%

108
Q

What causes Methemogobinemia?

A

Nitrates

Nitrites

Nitroprusside (SNP)

Nitroglycerine (NTG)

Benzocain

Sulfonamides

109
Q

What are the treatments for Methemoglobinemia?

A

Methylene Blue or Vitamin C

110
Q

How does Fetal Hemoglobin & Bilirubin affect the Pulse Ox?

111
Q

What is the Gold Standard for Tracheal Intubation?

A

Capnography - EtCO2

Reliable for Esophageal Intubation, but not for Endobronchial Intubation

112
Q

List

AB:

BC:

CD:

D Point:

DE:

A

AB: Start Exhalation, Dead Space Gas

BC: Exhalation, Mixing of Gas

CD: Alveolar Plateau, Alveolar Rich Gas

D Point: Highest CO2

DE: Start Inspiration

113
Q

What kind of EtCO2 Pattern is this?

A

Obstructive Pattern

EX: COPD, Bronchospasm

114
Q

What is going on in this EtCO2 Pattern?

A

Early Spontaneous Breath indicated by Curare Cleft

115
Q

What is going on in this EtCO2 Pattern?

A

Expiratory Valve Failure

or

Depleted CO2 Absorber

116
Q

What is going on in this EtCO2 Pattern?

A

Inspiratory Valve Failure

117
Q

What is going on in this EtCO2 Pattern?

A

Cardiogenic Oscillation

118
Q

What is going on in this EtCO2 Pattern?

A

Esophageal Intubation

Declining End-Tidal Values

119
Q

What is going on in this EtCO2 Pattern?

A

Surgeon Pushin on Chest

120
Q

Know the Difficult Airway Algorithm

121
Q

Which lung has Better Perfusion & Ventilation in the Awake & Lateral Position?

A

Dependent Lung - Down Lung d/t gravity

122
Q

Which Lung in the Lateral Position has better Ventilation after Induction, why?

A

Upper Lung

Abdominal contents & Bean Bag restricts movement of down lung

Open PTX to upper lung = better compliance & better positive pressure reception

123
Q

What factors Inhibit Hypoxic Pulmonary Vasocontriction (HPV)?

A

Hypocapnia

Inhalation Agents

Vasodilators
(NTG, SNP, Beta Agonists, C-Channel Blockers)

Very High/Low PAP or Mix Venous PO2

Pulmonary Infections

124
Q

How should you intubate to ensure proper ETT placement for one lung ventilation?

A

Use Fiberoptic Scope

125
Q

What do you do for Hypoxia during One Lung Ventilation?

A
  • 80-100% FIO2
  • Check TV & ETT Placement
  • Keep PaCO2 @ 40 mmHg
  • Add 5cm CPAP to Upper Lung & 5cm PEEP to Lower Lung Slowly
  • Clamp Upper PA
  • Return to 2 Lung
126
Q

What triggers Malignant Hyperthermia?

A

Anesthetics Gases & Succinylcholine

127
Q

What is the first and most sensitive sign of Malignant Hyperthermia?

A

Unexplained Tachycardia

128
Q

What is the most specific sign of Malignant Hyperthermia?

A

Increasing EtCO2 @ 2-3X

129
Q

What is the mortality rate of Malignant Hyperthermia?

A

10%

70% w/o Dantrolene

<5 % w/ Early Dantrolene

130
Q

Once symptoms of Malignant Hyperthermia are controlled, what is the dosage to continue Dantrolene?

A

1 mg/kg IV q6h x 72 hrs

131
Q

If a patient is on Dantrolene, what would cause life-threatening Hyperkalemia & Cardiac Depression?

A

Calcium Channel Blockers

132
Q

How does Dantrolene work?

A

Directly on Ryanodine Receptor preventing Calcium Release from the SR.

133
Q

What are late signs of Malignant Hyperthermia?

A

Organ Failure

DIC / Coagulopathy

Rhabdo

Edema / Swelling
Death

134
Q

A patient’s tendency for fever, heat stroke, strabismus, exercise myalgia, cramping, and history of muscle diseases may indicate what?

A

Risk for Malignant Hyperthermia

135
Q

What is the Gold Standard PreOp test for MH?

A

Halothane-Caffeine Contracture Test

136
Q

What is King-Denborough Syndrome?

A

Combination of musculoskeletal diseases and deformities that makes them a risk for Malignant Hyperthermia

137
Q

If the patient has had prior uneventful general anesthetic, does this rule out MH?

138
Q

Which age group is Malignant Hyperthermia more common in?

139
Q

When do symptoms of MH occur?

A

Usually within 1 Hour, but can be also be hours after exposure

140
Q

What factors Increase MAC?

A

Babies < 6 months old - highest MAC needed

Chronic EtOH

Hyperthermia

Hypernatremia

Drugs that Increase Catecholamines

141
Q

What factors Decrease MAC?

A
  • Pregnancy
  • Hypothermia
  • Hypoxemia
  • Premature Babies & Elderly
  • Acute ETOH
  • Hyponatremia
  • Lithium
  • Alpha 2 Agonist/C-Channel Blockers
  • Bypass Machine
142
Q

What is the Second Gas Effect?

A

Large intake of first gas (N2O) causes increase rate of intake of second gas (agent)

143
Q

What is Diffusion Hypoxia?

A

When a lot of N2O is leaving the body into the lungs creating Hypoxia

Prevention: Dont extubate on 70% N2O & Give 100% Oxygen

144
Q

How much does smoking increase CarboxyHb and the the risks for CAD & Post-Op Lung complications?

A

CAD: 2x risk

Post Op Lung Problems: 6x risk

COHb: 15% increase

145
Q

How does Nicotine affect the body?

A

Stimulates SNS to release catecholamiens –> ↑HR, ↑BP, ↑SVR

Lasts 30 min from last cigg

146
Q

What steps should be taking for intubating smokers?

A

Preoxygenate Well

Wait Until Patient is Deep before airway Manipulation

147
Q

How long should patients stop smoking before surgery?

A

12 Hours

Reduce COHb & Nicotine to normal levels

148
Q

What happens after smoking is stopped for 8 Weeks?

A

Reduction of Post-Op Lung Problems

149
Q

What happens after smoking stops for 2 Years?

A

MI risk will be the same as Non-Smoker

150
Q

What happens after 2 to 10 days of not smoking?

A

Decrease in Airway Activity at 2 Days

Same as Nonsmoker at 10 days

151
Q

How should the vent be managed for COPD patients?

A

Change I:E to 1:3

Monitor PIP (rupture bullae/bleb)

Keep EtCO2 near baseline

152
Q

Which drugs should be avoided in COPD patients?

A

Histamine Releasing Drugs

STP - Pentothal

Morphine

Atracurium

Mivacurium

Neostigmine

Give Nebs b4 extubating

Spring 2020 - Physiology 1 (24 decks)

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