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*Barash > Respiratory Function > Flashcards

Respiratory Function Flashcards

1
Q

True or false

In a normal lungs, breathing can be performed exclusively by the lungs

A

True

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2
Q

The adult tip of the orotracheal tube moves at an average of how many cm by fkexion/extension?

It can travel by as much as how far?

A
  1. 8 cm

6. 4 cm

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3
Q

In infants, displacement by how much can move the tube

A

1 cm

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4
Q

The adult RIGHT MAIN STEM BRONCHUS is how long before it branches into lobar bronchi.

A

2.5 cm

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5
Q

In 10% of adults, the right upper lobe bronchus departs from the right main stem bronchus less than how long below the carina?

A

2.5 cm

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6
Q

True or false

The right upper lobe bronchus opens directly into the trachea, above the carina.

A

True

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7
Q

What is the most sensitive clinical index of lung compliance?

A

Spontaneous respiratory rate

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8
Q

Carotid and aortic bodies are stimulated at what range of PaO2 values?

A

60 to 65 mmHg

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9
Q

What are the three etiologies of hyperventilation.

A
  1. Arterial hypoxemia
  2. Metabolic acidemia
  3. Central etiologies
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10
Q

Increase in dead space ventilation increases what factor?

A

CO2 elimination

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11
Q

Increase in physiologic shunt affects?

A

Arterial oxygenation

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12
Q

What is the ratio of alveolar ventilation to dead space ventilation during SPONTANEOUS VENTILATION?

A

2:1

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13
Q

What is the ratio of alveolar ventilation to dead space ventilation during POSITIVE PRESSURE VENTILATION?

A

1:1

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14
Q

What is the difference between paco2 vs petco2?

A

Dead space ventilation

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15
Q

The most common ACUTE increase in dead space ventilation is?

A

Decreased cardiac output

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16
Q

Calculating of what is the best tool for evaluating for the lung’s efficiency in oxygenating the arterial blood.

A

Shunt fraction

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17
Q

Pulmonary function tests are requested for only 2 purposes.

A
  1. To ascertain presence of reversible pulmonary dysfunction

2. Define the severity of advanced pulmonary disease

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18
Q

Patients who smoke should be advised to stop smoking for at least how long to decrease postop pulmonary complications.

A

2 months

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19
Q

Is one of the most important determinants of the risk of PPC.

A

Operative site

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20
Q

The highest risk for PPC is?

A

Nonlaparoscopic upper abdominal operations

Followed by lower abdominal and intrathoracic operations

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21
Q

The single most important aspect of postoperative pulmonary care and prevention of PPC is?

A

Early ambulation

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22
Q

The sternal angle is located in what thoracic level?

A

T4 or T5

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23
Q

This plane separates the superior from the inferior angle.

A

Sternal angle

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24
Q

During work of breathing the predominant changes in thoracic diameter occur in the ____ in the upper thoracic region and in the _____ in the lower thorax.

A

Anteroposterior

Lateral or transverse

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25
Q

Is the energy expenditure of ventilatory muscles

A

Work of breathing

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26
Q

What are the ventilatory muscles comprised of

A
  1. Diaphragm
  2. Intercostal muscles
  3. Abdominal muscles
  4. Cervical strap muscles
  5. Large back and intervertebral muscles of the shoulder girdle
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27
Q

During nonstrenuous breathing, what structure performs most of the muscle work.

A

Diaphragm

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28
Q

What are the most powerful muscles of expiration?

A

Muscles of the abdominal wall

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29
Q

Are the most important inspiratory accessory muscles

A

Cervical strap muscles

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30
Q

At FRC, the intrapleural space normally has a slightly subambient pressure which is?

A

-2 to -3 mmHg

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31
Q

The lung parenchyma is subdivided into three airway categories

A
  1. Conductive
  2. Transitional
  3. Respiratory
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32
Q

Conductive airways

A

Trachea to terminal bronchioles

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33
Q

Transitional airways

A

Respiratory bronchioles (gas transport) to alveolar ducts (limited gas exchange)

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34
Q

Respiratory airways

A

Alveoli to alveolar sacs

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35
Q

Conventionally large airways with how much diameter create 90% of total airway resistance

A

2 mm

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36
Q

How much alveoli at birth?

A

24 million

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37
Q

Final adult count of alveoli

By what age is this number reached?

A

300 million

8 to 9 years old

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38
Q

Surface area of alveoli

A

70 m2

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39
Q

Length of trachea

Outer diameter of trachea

A

10 to 12 cm

20 mm

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40
Q

How many U-shaped hyaline cartilages are there?

With the opening of the U facing in what direction?

A

20

Posteriorly

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41
Q

Level of the cricoid cartilage

A

6th cervical vertebral body

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42
Q

Which mediastinum does the trachea enter?

A

Superior

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43
Q

Where does the trachea bifurcates?

A

Sternal angle (lower border of the fourt thoracic vertebrae)

Half is intrathroracic and half is extrathoracic

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44
Q

The adult carina can move superiorly as much as how much?

A

5 cm

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45
Q

In the adult, the right bronchus leaves the trachea at approximately how much angle from the vertical tracheal axis?

Whereas the left bronchus is about?

A

25 degrees

45 degrees

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46
Q

What age in children that the angles created by the left and right main-stem bronchi are approximately equal?

How much take-off angle is there?

A

3 years old

55 degrees

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47
Q

What is the diameter of the bronchioles?

They are devoid of what structure?

What structure are they abundant with?

A

1 mm

Cartilage

Smooth muscles

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48
Q

First site of tracheobronchial tree where gas exchange occurs.

A

Respiratory bronchioles

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49
Q

Right upper lobes (3)

A

Apical
Anterior
Posterior

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50
Q

Right middle lobes (2)

A

Medial

Lateral

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51
Q

Right lower lobes (5)

A 
Superior
Medial basal
Lateral basal
Anterior basal
Posterior basal
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52
Q

Left upper lobes (2)

A

Apical posterior

Anterior

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53
Q

Lingular lobes (2)

A

Superior

Inferior

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54
Q

Left lower lobes

A
  1. Superior
  2. Posterior basal
  3. Anteromedial basal
  4. Lateral basal
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55
Q

The alveolar-capillary membrane has 2 functions

A
  1. Transport of gases

2. Production of local and humoral substances

56
Q

What type of alveolar cells cover 80% of the alveolar surface.

A

Type 1

57
Q

Alveolar wall consists of the ff structures (4)

A
  1. Capillary epithelial cells
  2. Basement membrane
  3. Pulmonary capillary endothelial cell
  4. Surfactant lining layer
58
Q

How much enzymatic activity is needed to produce surfactant?

A

50%

59
Q

These alveolar cells are important in immunologic lung defense.

A

Type 2

60
Q

Two circulatory system supply blood to the lungs (2)

A
  1. Pulmonary

2. Bronchial

61
Q

Lung movements occur due to forces external to the lungs. The response of the lungs to these external forces is governed by two main characteristics

A
  1. Ease of elastic recoil

2. Resistance to gas flow

62
Q

How much difference in intrapleural pressure is there during an upright position from top to bottom?

A

7 cmH2O

63
Q

What is relevant under conditions of laminar flow

A

Viscosity

64
Q

Read

A

Turbulent flow : fresh gas will not reach the end of the tube until the amount of gas entering the tube is almost equal to the volume of the tube.

65
Q

4 conditions that will change laminar to turbulent flow

A
  1. High gas flow
  2. Sharp angles
  3. Branching
  4. Decreased diameter
66
Q

True or false

A

In lamiar flow, resistance is inversely proportional to gas flow rate. In turbulent flow it is in proportion to flow rate.

67
Q

The normal response to increased inspiratory resistance is?

A

Inc inspiratory effort

Little change in FRC

68
Q

True or false

An increased paco2 in the setting of increased airway resistance warrants serious attention as it suggests that the patient’s compensatory mechanisms are nearly exhausted.

A

True

69
Q

Acute ventilatory failure secondary to muscle fatigue is evidenced by?

A

Acute increase in arterial carbon dioxide

Precipitated by pneumonia or heart failure

70
Q

Physiologic aging of the lung is associated with what changes? (4)

A
  1. Dilation of the alveoli
  2. Enlargement of airspaces
  3. Decrease in surface area
  4. Loss of supporting tissue
71
Q

Changes in the aging lung result in decreased lung recoil (elastance) creating?

A

INCREASED residual volume and FRC

72
Q

Read

A

With aging, respiratory centers demonstrate decreased responsiveness to hypoxemia and hypercapnia

73
Q

This refers to the act of inspiring and exhaling

A

Breathing

74
Q

This refers to the movement of gas in and out of the lungs

A

Ventilation

75
Q

Occurs when energy is released from organic molecules in relation to the movement of gas molecules.

A

Respiration

76
Q

Term referring to the cessation of ventilatory effort with lungs filled at TLC

A

Apneusis

77
Q

Inspiratory center

A

Dorsal medullary reticular formation

78
Q

Serves as the pacemaker for the respiratory system. Also the source of elementary ventilatory rhythmicity.

A

DRG

79
Q

Serves as the expiratory coordinating center

A

Ventral respiratory group

80
Q

Electrical stimulation of this area results in inspiratory spasm

A

Apneustic center

81
Q

Primary function of this area is to limit the depth of inspiration

A

Pneumotaxic center

82
Q

Stimulation of this area increases the rate and amplitude of ventilation

A

Reticular activating system

83
Q

Stimulation of the carotid SINUS results in?

Stimulation of the carotid BODY CHEMORECEPTORS results in?

A

Decreases vasomotor tone and ventilation

Increase in both vasomotor tone and ventilation

84
Q

Which structure facilitate proprioception of the pulmonary system.

Which area has abundance of this structure?

A

Golgi tendon organs (tendon spindles)

Intercostal muscles

85
Q

The rate of rise of paco2 in anesthetized patients in the first minute and thereafter is?

A

12 mmHg

3.5 mmHg

86
Q

In awake normal adults, the apneic threshold normally occurs at a PaCO2 of around?

A

32 mmHg

87
Q

4 drugs stimulate ventilation of peripheral chemoreceptors

A
  1. Aminophylline
  2. Doxapram
  3. Salicylates
  4. Norepinephrine
88
Q

Usually PaCO2 increases up to how much during sleep

A

10 mmHg

89
Q

In the absence of other ventilatory patterns, this drug induce pathognomonic changes in ventilatory rate and Vt?

A

Decreased ventilatory rate with increased Vt

90
Q

Barbiturates shift carbon dioxide response curve to the?

What is the ventilatory rate and Vt pattern?

A

Right

Decreased tidal volume and increased ventilatory rate

91
Q

Diffusion becomes the predominant mode of gas transport?

A

Terminal bronchioles (sixteenth generation)

92
Q

The most frequent cause of hypoxemia is?

A

Shunt effect

93
Q

What is the most common reason for a measured decrease in diffusing capacity?

A

Mismatched ventilation and perfusion

94
Q

This lung zone (lung apex) where pulmonary artery pressure exceeds pulmonary arterial pressure (gravity independent area). PA > Ppa > Ppv

A

Zone 1 (alveolar dead space ventilation)

95
Q

Well-matched ventilation and perfusion occur in this area. Ppa > PA > Pv

A

Zone 2

96
Q

Most gravity dependent area. Ppa > Pa > Pv

A

Zone 3

97
Q

The ideal VQ ratio of 1 is believed to occur approximately the level of what rib?

A

1st rib

98
Q

Normal V/Q?
Shunt?
Silent unit?
Absolute dead space?

A

1:1
0:1
0:0
Infinity

99
Q

Increases in dead space ventilation primarily affect carbon dioxide elimination and have little influence on arterial oxygenation until dead space ventilation is of minute ventilation?

How about for physiologic shunt?

A

80% to 90%

75% to 80%

100
Q

Formula for tidal volume?

A

Alveolar ventilation (VA) + dead space ventilation (VD)

101
Q

Ratio of alveolar to dead space in a normal person

A

2:1

102
Q

How much is anatomic dead space?

Location?

A

2 mL/ideal body weight

Oropharynx to terminal and respiratory bronchioles

103
Q

What is the most likely cause if pulmonary blood decreases?

A

Decreased cardiac output

104
Q

At rest the required alveolar ventilation to carbon dioxide production of how much?

A

60 mL/kg/min

105
Q

The most common reason for acute increase in dead space ventilation is?

A

Decreased cardiac output

106
Q

In spontaneously breathing person normal Vd/Vt is?

In patients on positive pressure ventilation?

A
  1. 33 (0.2 to 0.4)

0. 5

107
Q

Refers to areas of the lungs that are ventilated but poorly perfused.

A

Physiologic dead space

108
Q

Area of the lungs that is perfused but poorly ventilated. Is that portion of the lung that returns to the heart and systemic circulation without receiving oxygen in the lung.

A

Physiologic shunt

109
Q

How much (%) is a normal intrapulmonary shunt?

A

5%

110
Q

Value of vital capacity?

A

60 mL/kg

111
Q

This lung volume is one of the few tests that can detect extrathoracic airway obstruction

A

Inspiratory capacity

112
Q

Is the gas remaining in the lungs at passive expiration.

Is the gas remaining in the lungs at forced maximal expiration

A

FRC

Residual volume

113
Q

When a subject lies supine the FRC is reduced by how much%.

A

10

114
Q

Forced vital capacity is equivalent to?

A

Vital capacity

115
Q

FVC values less than this is associated with an increased incidence of PPCs.

A

15 mL/kg

116
Q

Normal FEV1?

A

FEV1/FVC equal to or more than 75%

117
Q

Difference between restrictive vs obstructive based on FEV1/FVC

A

Restrictive : normal

Obstructive : increased

118
Q

Also called the maximum mid expiratory flow rate

A

Forced expiratory flow

119
Q

Normal forced expiratory flow

A

4.7 L/sec (280 L/min)

Decreased in obstructive
Normal in restrictive

120
Q

Is the largest volume if gas that can be breathed in 1 minute by voluntary effort. Is the best endurance test that can be performed in the laboratory.

A

Maximum voluntary ventilation

170 mL/min (healthy young adults)

121
Q

What is the partial pressure of carbon monoxide in the blood

A

Zero

122
Q

Factors that can influence DLCO (4)

A
  1. Hemoglobin concentration
  2. Alveolar paco2
  3. Body position
  4. Pulmonary capillary blood volume
123
Q

Using spirotmetry measures what pulmary values (3)?

A

VC
FEV1
FVC

124
Q

Decreased TLC (restrictive or obstructive)?

A

Restrictive

125
Q

FRC reaches its lowest point in how many minutes after anesthesia?

How about post operatively?

A

First 10 minutes

12 hours

126
Q

How does smoking affect pulmonary function? (2)

A
  1. Decreases ciliary motility

2. Increases sputum

127
Q

How many % of carboxyhemoglobin in non smokers?

In smokers?

A

1%

8 to 10%

128
Q

Duration of smoking cessation that can DECREASE carbon monoxide to near normal.

A

12 to 24 hours

129
Q

One of the main and most prevalent risk factor associated with postoperative morbidity.

A

Smoking

130
Q

NORMALIZATION OF MUCOCILIARY function requires how long abstinence from smoking?

A

2 to 3 weeks

131
Q

Smoking patients should be advised to STOP SMOKING for how long to elective procedures or for how long to benefit from improved mucociliary function and some reduction in PPC rate.

A

2 month

4 weeks

132
Q

The normal resting respiratory rate for adults is 12 breaths per minute, whereas for postoperative patient it is?

A

20 breaths per minute

133
Q

After upper abdominal operations, FRC recovers for how many days?

However, with the use of intermittent CPAP by mask, FRC will recover for how fast?

A

3 to 7

72 hours

134
Q

Does choice of anesthetic technique change the risk of PPC?

A

No

135
Q

Operations exceeding how many hours are associated with a higher rate of PPCs.

A

3 hours

*Barash (16 decks)

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