Review Flashcards
1
Q
Upper respiratory system consists of?
A
- Nose
- Pharynx
- Associated structures
2
Q
Lower respiratory system includes?
A
- Larynx
- Trachea
- Bronchi
- Lungs
3
Q
What zone consists of a series of interconnecting cavities and tubes?
A
Conducting Zone
- nose, pharynx, larynx, trachea, bronchi, bronchioles, and terminal bronchioles that conduct air into the lungs
4
Q
What zone consists of tissue within the lungs where gas exchange occurs?
A
Respiratory zone
- respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli
5
Q
What is the double layered serous membrane that encloses and protects each lung?
A
Pleural membrane
6
Q
What is the outer layer that is attached to the wall of the thoracic cavity and diaphragm?
A
Parietal pleura
7
Q
What is the inner layer that is attached to the lungs?
A
Visceral pleura
8
Q
What is the narrow space located between the visceral and parietal pleura which contains a lubricating fluid secreted by the membrane?
A
Pleural cavity
9
Q
How does the pleural cavity keep the pleural membrane adhered to one another during inhalation?
A
by generating surface tension
10
Q
What secretes alveolar fluid which keeps the surface between the cell and the air moist?
A
Surfactant cell
11
Q
What is a mixture of phospholipids and lipoproteins that reduces the tendency of alveoli to collapse?
A
Surfactant cells
12
Q
What are wondering phagocytes that removes fine dust particles and other debris in the alveolar spaces?
A
Alveolar Macrophages
13
Q
Contracting of the diaphragm is responsible for what percentage of the air that enters the lungs during quiet breathing?
A
75%
14
Q
What muscles are used during deep labored inhalation?
A
- Sternocleidomastoid
- Scalene
- Pectoralis
15
Q
When is exhalation active?
A
only during forceful breathing
16
Q
During forced exhalation what muscles are used?
A
- Internal and External obliques
- Transverse and Rectus abdominis
- Internal intercostal
17
Q
At rest just before inhalation, the air pressure inside the lungs is the same as the pressure of the atmosphere. What is the pressure of the atmosphere?
A
760 mmHg at sea level
18
Q
Air flows from an area of high pressure within the alveoli to the area of lower pressure in the atmosphere
A
Air flows from an area of high pressure within the alveoli to the area of lower pressure in the atmosphere
19
Q
Each inhale and exhale moves what amount of air in and out of the lungs?
A
500ml
20
Q
What is the term for volume of 1 breath?
A
Tidal volume
21
Q
What percentage of tidal volume actually reaches the respiratory bronchioles and alveolar sacs and participates in gas exchange?
A
70%
22
Q
What percentage does not participate in gas exchange and where does it go?
A
30% goes to the anatomical dead space
- conducting zone
23
Q
What is the volume of air that remains even after expiratory reserve volume is expelled?
A
Residual Volume (RV)
- 1200 in male, 700 in females
24
Q
What is the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume?
A
Vital Capacity (VC)
- 4800 in males, 3100 in females
25
Normal pattern of quiet breathing?
Eupnea
26
Shallow breathing, upward and outward movement of the chest?
Costal breathing
27
Deep breathing, outward movement of the abdomen?
Diaphragmatic breathing
28
Partial pressure of oxygen?
158.8 mmHg
29
What is the most abundant gas in the atmosphere?
Nitrogen
30
What is the diffusion of O2 from air in the alveoli of the lungs to the blood in the pulmonary capillaries and the diffusion of CO2 in the opposite direction. Occurs in the lungs?
External respiration
31
What is the exchange of O2 and CO2 between systemic capillaries and tissue throughout the body?
Internal Respiration
32
What percentage of O2 is contained in the blood plasma?
1.5%
33
What percentage of O2 is bound to hemoglobin?
98.5%
34
What factors influence O2 release from hemoglobin?
- CO2
- Acidity
- Temp
35
What percentage of CO2 dissolves in the blood plasma?
7%
36
What percentage of CO2 is bound to amino acid?
23%
37
What is the area from which nerve impulses are sent to the respiratory muscles to control respiratory rates?
Where is it located?
Respiratory Center
- located in both the pons and medulla oblongata
38
What is located in the medulla and controls the basic rhythm of respiration?
Medullary respiratory center
39
What generates nerve impulses establishing basic rhythm of quiet normal breathing, causes contraction of the diaphragm via the phrenic nerve and external intercostal muscles via the intercostal nerves, and impulses last about 2 seconds?
Dorsal respiratory group (DRG)
40
The neurons of what area supply nerve impulse for forceful breathing and remain inactive during quiet breathing?
Ventral Respiratory Group
41
What area is active during inhale and exhale, transmit nerve impulses to the DRG in the medulla, plays a role in both inhalation and exhalation by MODIFYING/MODERATE the rhythm of breathing generated by the VRG?
Pontine respiratory group
42
What receptors in the medulla, responds to changes in the H+ and CO2 levels in the cerebrospinal fluid?
Central Chemoreceptors
43
What is located within the arc of the aorta and common carotids are sensitive to levels of O2, H+, and CO2 in the blood?
Peripheral Chemoreceptor
44
What is the increase of arterial PCO2, even slightly above the normal 40mmHg?
Hypercapnia
45
What responds vigorously due to the resulting increase in H+ caused by elevated CO2?
Central chemoreceptors
46
Term for when arterial PCO2 falls below 40 mmHg?
central and peripheral chemoreceptors are not stimulated and no impulses are sent?
Hypocapnia
47
What is a deficiency of O2?
What receptors are stimulated?
Hypoxia
Peripheral Chemoreceptors
48
What increases rate and depth of respiration due to anticipation of activity or emotional anxiety?
Limbic system
49
What increases the rate and depth of respirations due to input from proprioceptors as result of joint and muscle movement. These proprioceptors stimulate the inspiratory area of the medulla. Respiration increases even before changes in PO2, PCO2, or H+ occur?
Proprioceptor Stimulation
50
The subcostal angle of a pregnant service member progressively increase to?
103.5%
51
What is heard over most of the lung fields , they are soft and low pitched?
Vesicular sounds
52
What sound is hear over the main stem bronchi and over the upper right posterior lung field, they are medium pitched?
Broncho vesicular sounds
53
What sounds are heard only over the trachea and are high pitched?
Bronchial/tracheal
54
What is the most common type of asthma?
Allergic asthma
55
What is a chronic disorder of the airway characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation?
Asthma
56
What is used for the evaluation of asthma?
Spirometry
57
Pink Puffer?
Emphysema
58
Blue Bloater?
Chronic bronchitis
59
What presents with a productive cough for 3 months in each of 2 successive years?
Chronic bronchitis
60
What is the essential test to confirm the diagnosis and establish the staging of COPD to establish and FEV score?
Spirometry
61
In most patients with cardiogenic pulmonary edema, and underlying cardiac abnormality can usually be detected clinically by what test?
ECG
62
Production of pink frothy sputum is a sx of what disease?
Pulmonary edema
63
What can occur in response to pulmonary edema and may itself cause hypoxemia and dyspnea?
Bronchospasm
TX: Beta-adrenergic
64
Clots that form pulmonary emboli are most commonly from where?
Femoral or Pelvic venous beds
65
PE will develop in what percentage of patients with proximal DVT?
50-60%
66
What percentage of patients with symptomatic PE will have lower extremity DVT?
50-70%
67
Streptokinase, urokinase, and recombinant tissue plasminogen activator aka?
Clot Busters
68
The most important initial study for all patients presenting with hemoptysis is?
Chest X-ray
69
What is the most common cause of severe upper airway obstruction in adults?
Laryngeal edema from thermal injury or Angioedema
70
What is the injury of the lung parenchyma with hemorrhage and edema without associated laceration?
Pulmonary contusion
71
What is the most common complication of pulmonary contusions?
Pneumonia
72
What diagnosis presents with fleeting pain in the chest wall, usually follows an injury or illness, px worsened by cough/sneezing/deep breathing/movement?
Pleuritis
73
What is the most common bacterial pathogen identified in most studies of community acquired pneumonia?
Streptococcus
74
What is the most common viral cause of community acquired pneumonia?
Influenza
75
Parenchymal infiltrate on a chest radiograph is indicative of?
Pneumonia
76
Cough associated with midline burning chest px, fever, and dyspnea is indicative of?
Bronchitis
77
What is the primary clinical difference between bronchitis and pneumonia?
Presence of an infiltration on the chest x-ray in the cause of pneumonia
78
What is the most frequent acute illness in the united states and throughout the industrialized world?
URI
79
What is the initial step in the management of hemoptysis?
O2
80
Malaise, HA, and cough are associated sx of?
URI
81
What is clinically defined as massive hemoptysis?
- >500mL of expectorated blood over 24hrs
- >100mL/hour
82
Although unspecific for PE and ECG may show?
ST and T wave abnormalities
83
What presents with an onset of sx within 24hrs after exposure with persistence for at least 3 months?
Reactive airway disease
84
What is the leaf-shaped piece of elastic cartilage that is covered with epithelium?
Epiglottis
85
What is the initial treatment for hemoptysis?
O2
86
How long does a URI last?
3-10 days
87
What diagnosis presents with subcutaneous emphysema after a MVA or trauma?
Broncho-tracheal injury
88
What percentage of Brach-tracheal injuries are identified?
25%
89
What is the mortality rate of bronchial -tracheal injuries?
80%
90
Patient with COPD present with what spine deformity?
Kyphosis
91
What is a long term sign of hemoptysis?
Clubbed fingers
92
Massive hemoptysis heart sounds?
Bruit
93
What is the number of days with sputum for TB?
3 days
94
Right sided bronchial injuries occur more commonly and are typically more severe, while almost 80% occur with 2cm of the?
Carina
95
All patients in respiratory distress with suspected trachea-bronchial injury should be?
Endotracheal intubated
96
What is the sum of vital capacity and residual volume?
Total lung capacity
97
Larynx aka?
Voice box
98
Trachea aka?
Wind pipe
99
The larynx lies midline of the neck and anterior to what vertebrae?
C4-C6
100
The mucus membrane of the larynx form what 2 pairs of folds?
- Vestibular folds (Upper Pair)
- Vocal folds (Lower Pair)
101
What fold can hold your breath against pressure in the thoracic cavity when you strain to lift a heavy object?
Vestibular fold
102
What fold is known as the false vocal cords?
Vestibular fold
103
What fold contains elastic ligaments stretched between pieces of rigid cartilage?
Vocal fold
104
What are the muscles of quiet unforced inhalation?
- Diaphragm
- External intercostal
105
What are the muscles of quiet unforced exhalation?
- Diaphragm
- External intercostal
106
Is quiet inhalation active or passive?
Active
107
Is quiet exhalation active or passive?
Passive
108
What is the volume of air that remains even after expiratory reserve volume is expelled?
Residual Volume
109
Is Residual volume part of Vital capacity?
NO!
110
What percentage of tidal volume actually reaches the respiratory bronchioles and alveolar sacs to participate in gas exchange?
70%
111
What nerve controls the diaphragm?
Phrenic
112
Hemothorax lung sounds?
Dull
113
Percussion finding for pneumothorax?
Hyper resonance
114
Partial Pressure
Atmosphere?
PO2 = 159
PCO2= 0.3
115
Partial Pressure
Alveolar?
PO2 = 105
CO2 = 40
116
Partial Pressure
Tissue?
PO2 = 100 mmHg
117
Partial Pressure
Oxygenated blood?
PO2 = 100
PCO2 = 40
118
Partial Pressure
Deoxygenated / systemic capillaries?
PO2 = 40
PCO2 = 45
119
What is the microscopic air pathway?
- Terminal Bronchioles
- Respiratory Bronchioles
- Alveolar ducts
- Alveolar sacs
- Alveoli
120
What is 2 or more alveoli that share a common opening to the alveolar duct?
Alveolar Sac
121
What is a cup-shaped outer pouching of the alveolar sac?
Alveoli
122
The L lung is how much smaller than the R lung?
10% smaller
123
What are deep groove that divide the lungs into lobes?
Fissures
124
What are the fissure of the R lung?
- Oblique
- Horizontal
125
What are the fissure of the L lung?
Oblique
126
What exchanges small amounts of air with the auditory tubes to equalize air pressure in the between the pharynx and middle ear?
Nasopharynx
127
What are the 2 tonsil pairs?
- Palantine
- Lingual
128
What are the 3 parts of the pharynx?
- Naso
- Oro
- Laryngo
129
How many rings does the trachea have?
16-20
130
What allows us to hold our breath voluntarily?
Cerebral Cortex
131
Where are Central chemoreceptors located?
Medulla
- responds to changes in the CSF
132
Where are Peripheral Chemoreceptors located?
Aortic arch
133
Term for dyspnea increase in upright position?
Platypnea
134
Term for SOB that begins or increases when the lies down?
Orthopnea
135
Term for curvature/deviation of the spine?
Scoliosis
136
Term for curvature of the lumbar spine?
Lordosis
137
Term for asthma during menstrual cycle?
Catamenial
138
What are the 3 subtypes of COPD?
- Emphysema
- Chronic Bronchitis
- Chronic Obstructive Asthma
139
The acute exacerbation of sx beyond day to day variations including increased dyspnea, increased frequency of cough, and increase sputum volume or character is a hallmark of what disease?
COPD
140
What is the essential test to confirm the diagnosis and establish the staging of COPD?
Spirometry
141
Pulmonary opacity on a chest x-ray indicates what?
TB
142
Acid fast bacilli light microscopy testing for TB requires how many specimens?
3 consecutive morning
143
What is the first line of tx for flail chest?
O2
144
- Dyspnea
- Cough with or w/o sputum
- WHEEZING DURING INHALATION
- Acute chest illness
Asthma
145
- Dry cough x 3 months
- Hemoptysis
- Fever
- MIDLINE BURNING CHEST PX
- RHONCI THAT CLEARS WITH COUGH
- Crackles
- Wheezing
Bronchitis
146
- Fever
- Cough
- Smoking Hx
- Nasopharyngeal or GI bleed
- BLOOD STREAKING OF SPUTEM
- Gross blood from between the vocal cords or lungs
Hemoptysis
147
- Fever or Hypothermia
- Cough
- Dyspnea
- Chest disconfort
- Sweats or rigors
- RHONCI AND RALES ON AUSCULTATION
- Tachypnea
- Tachycardia
Pneumonia
148
- Decreased breath sounds
- Dullness to percussion
- Respiratory distress and hypotension
- Tachypnea
- HYPOTENSION AND FLATTENED NECK VEIN
Hemothorax
149
- ABSENT OR DECREASED BREATHE SOUNDS
- HYPER RESONANCE TO PERCUSSION
- PLEURITIC CHEST PX
- Dyspnea
- Decreased tactile fremitus
- Decreased chest movement
- Hyper resonance of the affected side
- TYPICALLY YOUNG, TALL, MEN WHO SMOKE 20-40 Y/O
Pneumothorax
150
- Tracheal deviation away from the pneumothorax with respiratory distress and hypotension
Tension Pneumothorax
151
- ACUTE ONSET OR WORSENING OF OF DYSPNEA AT REST
- Tachycardia
- Diaphoresis
- Cyanosis
- PULMONARY RALES IN ALL LUNG FIELDS, RHONCHI, EXPIRATORY WHEEZING
- PINKY FROTHY SPUTEM
Pulmonary Edema
152
- DAYTIME FATIGUE
- HISTORY OF LOUD SNORING WITH WITNESSED APNIC EVENTS
- Advancing age
- Male
- Obesity
- CRANOFACIAL MORPHOLOGY OR UPPER AIRWAY SOFT TISSUE ABNORMALITIES
Obstructive Sleep Apnea
153
- HX OF BLUNT FORCE TRAUMA OR MVA
- Localized px
- CREPTIUS
- Pain with inspiration
- Dyspnea
Rib fracture
154
- SUDDEN ONSET OF INTERMITTENT (FLEETING) PX IN CHEST WALL
- Usually follows an injury or ilness
- Px worsened by coughing, sneezing, deep breathing, or movement
- IN YOUNG OTHERWISE HEALTHY PT, PREVIOUS VIRAL RESPIRATORY ILLNESS OR PNEUMONIA
- Previous trauma to the chest wall such as rib fractures may be the cause
Pleuritis
155
- Px and respiratory distress
- Usually from significant blunt force trauma
Flail Chest
156
- Virchows Triad
- Dyspnea, cough, anxiety, and chest px
- Hemoptysis, tachycardia, tachypnea
- Low grade fever, Hypotension, cyanosis, DVT, pleural friction rub
PE
157
- FATIGUE, WEIGHT LOSS, FEVER, NIGHT SWEATS, PRODUCTIVE COUGH
- HX OF TRAVEL TO ENDEMIC AREA
- Crackles present upon inspiration
TB
158
- Clear rhinorrhea, nasal congestion
- Malaise, HA, cough
- Sx last 3-10 days
URI
159
- Most frequent injury of non penetration trauma
- Pneumonia is common
- Hypoxia
- Dyspnea
- Hemoptysis
- Tachycardia
Pulmonary contusion
160
- Usually results from MVA and crush injury
- Dyspnea
- SUBCUTANEOUS EMPHYSEMA OF THE NECK OR UPPER THORACIC REGION
- HOARSNESS
- Hemoptysis
- Hypoxia
- PERSISTENT PNEUMOTHORAX
Tracheobronchial injury
161
- STRIDOR
- UNABLE TO SPEAK
- VISIBLE SWELLING OR MAS ON NECK
- Tongue or other structures of the mouth may be swollen
Acute respiratory distress
162
Tx for Pneumonia
Macrolides
163
Tx for Pulmonary edema?
Diuretics
Nitrates
164
Tx for Flail chest?
O2
Opioids
165
Tx for acute respiratory distress caused by angioedema?
Epi
