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SEE Resp Flashcards

1
Q

Airway Anatomy

A
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2
Q

Which nerve controls all sensory function on the posterior side of the epiglottitis?

A

SLN Internal Branch

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3
Q

Which nerve controls all intrinsic muscles below the vocal cords?

A

RLN

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4
Q

Which nerve provides motor function to the cricothyroid?

A

SLN external Branch

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5
Q

Are all “hyoid” muscles intrinsic or extrinsic? Which muscle also is?

A

Extrinsic

Digastric is also extrinsic

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6
Q

Which cranial nerve provides innervation to the face?

A

Trigeminal (CN5)

V1-Opthalamic (Nares + anterior 1/3 of nasal septum)

V2- Maxillary (Turbinate’s and septum)

V3-Mandibular (Anterior 2/3 tongue)

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7
Q

Which cranial nerve innervates the posterior 1/3 of tongue to the anterior side of the epiglottis?

A

Glossopharyngeal (CN9)

Afferent limb of the gag reflex
Soft Palate
Tonsils
Vallecula

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8
Q

Which cranial nerve does the RLN and SLN arise from?

A

Vagus (CN10)

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9
Q

Rocking Horse is a sign of?

A

Laryngospasm

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10
Q

What are the three borders for the Larsons Maneuver?

A

Breaks Laryngospasm

Superior - skull base
Anterior- Ramus of mandible
Posterior - Mastoid Process

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11
Q

What is Muller’s Maneuver ?

A

Inhalation against a closed glottis

***Risk for pulmonary edema

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12
Q

Which muscle opens the

Nasopharynx?
Oropharynx?
Hypopharnx?

A

Naso - tensor palatine

Oro - Genioglossus

Hypo - Hyoid

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13
Q

Which muscle relaxation is the most common airway obstruction?

A

Tongue - genioglossus

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14
Q

Where does the trachea begin and end?

A

Begins at C6 and ends at T4

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15
Q

What does the angle of Lewis correspond with?

A

Carina

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16
Q

What do type 1, 2, and 3 pneumocytes do?

A

1 - Gas exchange with tight junctions

2 - Produce surfactant

3 - Macrophages that fight infection

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17
Q

Which mainstem is likely to be intubated ? Why?

A

More likely to Right main stem because the angle is less.

Right - 25 degrees
Left - 45 degrees

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18
Q

What increases as the airway bifurcates?

A

Number of airways

and

total cross-sectional area

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19
Q

Which structures permit air movement between alveoli?

A

Pores of Kohn

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20
Q

Where does anatomic dead space begin and end?

A

Begins in the mouth and ends at the terminal bronchioles

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21
Q

Which muscles help with inspiration?

A
  • Sternocleidomastoid
  • Scalene’s
  • External intercostals
  • Diaphragm
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22
Q

Which part of the airway is the transitional zone?

A

Respiratory bronchioles

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23
Q

Which part of the airway is the respiratory zone?

A

Alveolar Ducts
Alveolar Sacs

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24
Q

What is the Transpulmonary Pressure? What happens if this is negative or positive?

A

The difference inside and outside the airways?

If TPP is positive, then airways stay open

If TPP is negative, then airways stay closed

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25
Q

When is the only time the TPP goes negative?

A

Forced expiration

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26
Q

How does Vd affect the PaCO2- ETCO2 gradient?

A

The more dead space the larger the gradient

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27
Q

Which conditions increase dead space?

A

Hypotension (Reduces blood flow)

Atropine (Bronchodilator which increases volume)

Positive pressure ventilation (Increases alveolar pressure)

28
Q

Where is ventilation the greatest in the lung? Perfusion?

A

Both in the BASE of the lung

29
Q

Is CO2 greater in the dependent or nondependent of the lung? What about O2?

A

CO2 -Dependent

O2 - Non dependent

(Because of gas exchange)

30
Q

Normal V/Q mismatch? What is shunt vs dead space?

A

0.8

Shunt - perfusion without ventilation (infinity)

Dead Space- Ventilation without perfusion (0)

31
Q

What is the most common cause of hypoxemia in the PACU?

A

V/Q mismatch - specifically, atelectasis

32
Q

How does the body respond to V/Q mismatch?

A

Zone 1 bronchioles constrict (reduces dead space)

Zone 3 - HPV reduces blood flow by constricting vasculature

33
Q

Is there pulmonary blood flow in Zone 1?

A

No

34
Q

Lung Zones***

A

Zone 1 - Dead space
(PA>Pa>Pv)

Zone 2 - Waterfall
(Pa>PA>Pv)

Zone 3 - Shunt
(Pa>Pv>PA)

Zone 4 - Pulmonary edema
(Pa>Pis>Pv>PA)

PA (alveolar) goes right now in order (1st, 2nd, 3rd, 4th)

35
Q

Which things increase AA gradient?

A

Aging
Vasodilator
R-L shunt
Diffusion limitation

36
Q

Which conditions reduce FRC?

A

Obesity

Pulmonary Edema

37
Q

Volumes for

Total Lung Capacity
VC
Inspiratory
FRC
Closing capacity

A

Total Lung Capacity - 5800
VC - 4500
Inspiratory C - 3500
FRC - 2300
Closing capacity - Variable

38
Q

Can spirometry measure TLC?

A

No because it can not measure residual volume

CANT measure

TLC, or FRC, or RV

Also can’t measure Closing volume or capacity

39
Q

How does COPD and PEEP affect FRC?

A

Increases the FRC

Old age and sigh breathes also increase FRC

40
Q

When CC is greater than FRC, what happens?

A

Airways collapse

41
Q

What is FEV1? What is normal?

A

How much volume can be exhaled after maximal inhalation in 1 second

> 80% predicted

42
Q

What is FVC? Normal?

A

Volume of air that can be exhaled after maximal inhalation

Male- 4.8
Female - 3.7

43
Q

FEV1 to FVC ratio? Normal?

A

Compares the two ratios

75-80% predicted value

44
Q

Forced expiratory flow at 25%-75% vital capacity or MMEF? Normal?

A

Measures the airflow in the middle of FEV

100 +/- 25% of predicted value

45
Q

Maximum Voluntary Ventilation (MMV) ? Normal?

A

How much air can be moved over 1 minute

Male - 140L
Female 120L

46
Q

Diffusing Capacity? (DLCO) Normal?

A

How much carbon monoxide can transverse (based on ficks law)

17-25 mL/min/ mmHg

47
Q

What test is the most sensitive to small airway?

A

Forced expiratory flow at 25%-75% vital capacity or MMEF

48
Q

Flow Volume Loop

A
49
Q

Best way to reduce anesthesia induced atelectasis?

A

PIP to 40 cm H2O for 8 seconds

50
Q

What PFTs are normal in restrictive disease ? What are the results of the others that are normal?

A

FEV1 to FVC ratio and FEF 25-75% is normal

EVERYTHING ELSE IS DECREASED

51
Q

What PFTs are normal in obstructive disease ? What are the results of the others that are normal?

A

PFTS are decreased

RV, FRC, and TLC are normal or increased

52
Q

PFT with restrictive vs obstructive

A
53
Q

Restrictive vs obstructive graph

A
54
Q

What is an example of the 4 spirometry for lung disease

A

Normal

Fixed - Tracheal stenosis

Restrictive - Pulmonary Fibrosis

Obstructive - COPD

55
Q

Is asthma obstructive or restrictive? What PFTs are changed?

A

Obstructive

FEV1
FEV1/FVC ratio
FEF 25-27% are all reduced

56
Q

What ABG is seen with asthma?

A

Respiratory alkalosis with hypocarbia

57
Q

What PFTs are seen in COPD?

A

Decreased
FEV1
FEV1/FVC ratio
25-75%

Increased
RV
FRC
TLC

58
Q

What is Mendelson syndrome?

A

Aspiration pneumonitis

Gastric pH < 2.5
Gastric volume > 25mL

59
Q

Best way to treat restrictive disease?

A

Small TV (6mL/kg)
Faster rate (14-18)
Prolong inspiratory time (I:E - 1:1)

60
Q

Is lung sliding normal?

A

Yes

61
Q

Most sensitive diagnostic tool for venous air embolism ?

A

TEE

62
Q

Treatment for venous air embolism?

A

100% FiO2
Flood the field
D/C insufflation
Durant maneuver(left lateral)

63
Q

**What increases PVR?

A

Hypoxemia
Pain
SNS stimulation
Nitrous
Ketamine
Des
Hypercarbia
Acidosis
Hypothermia

64
Q

Absolute indications for DLT?

A

Infection
Hemorrhage
Bronchopleural fistula

65
Q

Steps to approach hypoxemia during OLV?

A
  1. 100% O2
  2. Check placement
  3. rule out other causes
  4. CPAP to non dependent lung
  5. PEEP to dependent
66
Q

During a mediastinoscopy, where should the pulse ox and BP cuff be placed?

A

Worried about innominate artery compression

R arm - pulse ox
L arm - BP cuff

Place large bore IV in LE
Review imaging before

67
Q

Which lab value is a predictive marker for postop pulmonary complications?

A

Albumin < 3.5

Means poor nutrition

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