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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
When is the only time the TPP goes negative?
Forced expiration
26
How does Vd affect the PaCO2- ETCO2 gradient?
The more dead space the larger the gradient
27
Which conditions increase dead space?
Hypotension (Reduces blood flow) Atropine (Bronchodilator which increases volume) Positive pressure ventilation (Increases alveolar pressure)
28
Where is ventilation the greatest in the lung? Perfusion?
Both in the BASE of the lung
29
Is CO2 greater in the dependent or nondependent of the lung? What about O2?
CO2 -Dependent O2 - Non dependent (Because of gas exchange)
30
Normal V/Q mismatch? What is shunt vs dead space?
0.8 Shunt - perfusion without ventilation (infinity) Dead Space- Ventilation without perfusion (0)
31
What is the most common cause of hypoxemia in the PACU?
V/Q mismatch - specifically, atelectasis
32
How does the body respond to V/Q mismatch?
Zone 1 bronchioles constrict (reduces dead space) Zone 3 - HPV reduces blood flow by constricting vasculature
33
Is there pulmonary blood flow in Zone 1?
No
34
Lung Zones***
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
Which things increase AA gradient?
Aging Vasodilator R-L shunt Diffusion limitation
36
Which conditions reduce FRC?
Obesity Pulmonary Edema
37
Volumes for Total Lung Capacity VC Inspiratory FRC Closing capacity
Total Lung Capacity - 5800 VC - 4500 Inspiratory C - 3500 FRC - 2300 Closing capacity - Variable
38
Can spirometry measure TLC?
No because it can not measure residual volume CANT measure TLC, or FRC, or RV Also can't measure Closing volume or capacity
39
How does COPD and PEEP affect FRC?
Increases the FRC Old age and sigh breathes also increase FRC
40
When CC is greater than FRC, what happens?
Airways collapse
41
What is FEV1? What is normal?
How much volume can be exhaled after maximal inhalation in 1 second >80% predicted
42
What is FVC? Normal?
Volume of air that can be exhaled after maximal inhalation Male- 4.8 Female - 3.7
43
FEV1 to FVC ratio? Normal?
Compares the two ratios 75-80% predicted value
44
Forced expiratory flow at 25%-75% vital capacity or MMEF? Normal?
Measures the airflow in the middle of FEV 100 +/- 25% of predicted value
45
Maximum Voluntary Ventilation (MMV) ? Normal?
How much air can be moved over 1 minute Male - 140L Female 120L
46
Diffusing Capacity? (DLCO) Normal?
How much carbon monoxide can transverse (based on ficks law) 17-25 mL/min/ mmHg
47
What test is the most sensitive to small airway?
Forced expiratory flow at 25%-75% vital capacity or MMEF
48
Flow Volume Loop
49
Best way to reduce anesthesia induced atelectasis?
PIP to 40 cm H2O for 8 seconds
50
What PFTs are normal in restrictive disease ? What are the results of the others that are normal?
FEV1 to FVC ratio and FEF 25-75% is normal EVERYTHING ELSE IS DECREASED
51
What PFTs are normal in obstructive disease ? What are the results of the others that are normal?
PFTS are decreased RV, FRC, and TLC are normal or increased
52
PFT with restrictive vs obstructive
53
Restrictive vs obstructive graph
54
What is an example of the 4 spirometry for lung disease
Normal Fixed - Tracheal stenosis Restrictive - Pulmonary Fibrosis Obstructive - COPD
55
Is asthma obstructive or restrictive? What PFTs are changed?
Obstructive FEV1 FEV1/FVC ratio FEF 25-27% are all reduced
56
What ABG is seen with asthma?
Respiratory alkalosis with hypocarbia
57
What PFTs are seen in COPD?
Decreased FEV1 FEV1/FVC ratio 25-75% Increased RV FRC TLC
58
What is Mendelson syndrome?
Aspiration pneumonitis Gastric pH < 2.5 Gastric volume > 25mL
59
Best way to treat restrictive disease?
Small TV (6mL/kg) Faster rate (14-18) Prolong inspiratory time (I:E - 1:1)
60
Is lung sliding normal?
Yes
61
Most sensitive diagnostic tool for venous air embolism ?
TEE
62
Treatment for venous air embolism?
100% FiO2 Flood the field D/C insufflation Durant maneuver(left lateral)
63
**What increases PVR?
Hypoxemia Pain SNS stimulation Nitrous Ketamine Des Hypercarbia Acidosis Hypothermia
64
Absolute indications for DLT?
Infection Hemorrhage Bronchopleural fistula
65
Steps to approach hypoxemia during OLV?
1. 100% O2 2. Check placement 3. rule out other causes 4. CPAP to non dependent lung 5. PEEP to dependent
66
During a mediastinoscopy, where should the pulse ox and BP cuff be placed?
Worried about innominate artery compression R arm - pulse ox L arm - BP cuff Place large bore IV in LE Review imaging before
67
Which lab value is a predictive marker for postop pulmonary complications?
Albumin < 3.5 Means poor nutrition

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