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Block 2 > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What thoracic structures protrude above first rib?

A

Apex of lung

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2
Q

What type of nerve is phrenic nerve?

Where does it originate?

Components?

A

Spinal nerve

C3,4,5

Somatomotor, general sensory, postganglionic sympathetic

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3
Q

Parietal pleura extends farther than the lungs do.

A
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4
Q

Fissures in lungs

Position relative to the diaphgram

A

Right horizontal tissue 4th rib

Right oblique fissure 6th rib

Right bolique fissure 6th rib

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5
Q

How far does the lung / parietal pleura extends in mid-clavicular line?

How far does the lung / parietal pleura extends in mid-axillary line?

(passive respiration)

A

6th rib / 8th rib

8th rib / 10th rib

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6
Q

Pulmonary recesses

A

Costodiaphragmatic recess

Mediastinal recess

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7
Q

What is the root of the lung?

A

Pulmonary arteries, bronchi, and pulmonary veins

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8
Q

Point where the root of the lung enters the lung?

What type of airway enters the left lung?

What type of airway enters the right lung?

A

Hilum

Single primary bronchus

2 Secondary bronchi (1 splits in two to go to middle)

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9
Q

Right lung vein/artery arrangement/bronchi

A

Pulmonary arteries lie anterior to bronchi

Pulmonary veins lie anterior/inferior to arteries (to all structures)

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10
Q

Left side

A

Pulmonary arteries lie superior to bronchus

Pulmonary veins lie inferior and aterior to all other structures

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11
Q

What are the units of lung supplied by tertiary bronchus

A

Bronchopulmonary segments

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12
Q

What is the difference in blood supply to bronchopulmonary segments?

A

Arteries are intrasegmental

Veins are intersegmental

Surgery in removing bronchopulmonary segment *

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13
Q

Which main bronchus is wider and is more vertical?

A

Right

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14
Q

At what level does the trachea divides?

A

At the junction of the ascending aorta and the arch

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15
Q

In which mediastinum is the trachea located?

A

Superior mediastinum

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16
Q

Name of the splitting trachea

A

Carina

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17
Q

Does viceral pleura feel pain?

Does parietal pleura feel pain?

A

No

Yes

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18
Q

What nerves are connected to lungs?

A

Cardiopulmonary plexus:

Vagus

Sympathetic

Same as heart

Visceral afferent

Visceral motor

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19
Q

What part of lungs feels pain?

A

Pleura (parietal)

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20
Q

Blood supply to lungs

A

Pulmonary artery

Superior and inferior left bronchial arteries

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21
Q

Where is the lymph drained to in lung?

A

Bronchopulmonary nodes

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22
Q

Where does the thoracic duct enters the venous system?

A

Between left subclavian and jugular

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23
Q

What are the lymph nodes around trachea?

A

Paratracheal

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24
Q

What is contained in superior mediastinum?

A

Aortic arch

Roots of great vessels

Esophagus

Trachea

Vagal

Phrenic

Cardiac Nerves

Thymus

Azygous drainings

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25
Q

Layers of superior mediastinum

A

Glandular

Venous

Arterial

Respiratory

Digestive

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26
Q

How is vagus located with the respect to the root of lung?

A

It is on the posterior side

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27
Q

How far from top to bottom does the posterior inferior mediastinum extends?

A

From T5 to T12 not (T9 like anterior)

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28
Q

Contents of posterior mediastinum

A

Descending aorta

Esophagus

Esophageal plexus

Azygos

Hemi azygos

Thoracic duct

Lymph nodes

Greater, lesser, and least thoracic splanchnic nerves

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29
Q

Where does the left vagus contributes to?

What also contributes to this plexus?

Where does the right vagus contributes to?

After the plexus where do the fibers converge on?

A

Anterior Esophageal plexus

Sympathetic from thoracic splanchnics

Posterior Esophageal plexus

Anterior and posterior vagal trunks

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30
Q

What are the branches of thoracic aorta

A

Esophageal

Bronchial

Posterior intercostal

Superior phrenic

Two subcostals

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31
Q

What artery supplies esophagus that starts from inferior to the diaphragm?

A

Esophageal artery that originates from celliac trunk

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32
Q

How azygos and hemiazygos veins are connected?

A

Dirrect connection to the ascending lumbar veins

Esophageal venous plexus

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33
Q

Where does esophageal venous plexus system drains to?

A

Azygos system

Portal system

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34
Q

What is the relationship between azygos and bronchus

A

It runs above

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35
Q
A
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36
Q
A
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37
Q
A
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38
Q

What are the parts of parietal pleura?

A

Costal, mediastinal, diaphragmatic, and cervical

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39
Q

What separates internal thoracic wall from costal parietal pleura?

A

Endothoracic fascia

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40
Q

What are two portions of respiratory system?

A

Conducting (7/8) begins in mouth

and respiratory

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41
Q

Order of structures in pulmonary system from mouth to aveoli

A

oral cavity

pharynx

larynx

trachea

extrapulmonary bronchi

interpulmonary bronchi

bronchioles

respiratory bronchioles

avolar ducts

alveoli

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42
Q

What is the purpose of conducting part of respiratory system?

A

Warm air

Clear air

Moisten air

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43
Q

What is the usuall direction of elastic fibers?

Where are they usually found?

What is the direction of smooth muscle?

A

Longitudinal

Lamina propia

Circular

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44
Q

6 cell types in respiratory epithelium

A

Ciliated columnar cells “ciliated pseudostratified epithelium”

Columnar cell

Mucous goblet cells

Brush Cell

Diffuse Endocrine

Basal Cells or Immature Cells

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45
Q

Respiratory epithelium: Columnar cell

Does it have cilia?

What does it secrete?

A

No

Serous

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46
Q

Respiratory epithelium: Brush cell

What does the brush cells has and does not?

What are different types of brush cells?

What is the purpose for nerve endings on brush cells?

What reflex are they responsible for?

A

No cilia but many microvili

Like goblet (release mucinogen) and second type will have nerve ending from trageminal nerve V (to act as O2/CO sensor/sneeze reflex)

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47
Q

Respiratory epithelium: Ciliated columnar

Where is it found?

What is specific about cilia?

A

Throughout entire respiratory system until respiratory portion

The cilia beat in one direction

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48
Q

Respiratory epithelium: Mucous cells

What do they secrete?

When this protein is secreted by mucus cells turned into mucous?

Purpose for this molecule?

A

Mucinogen

When hydrated

Trap bacteria and particles

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49
Q

Respiratory epithelium: Diffuse Endocrine or Small Granule Cells

Characteristic on EM?

Function?

A

Lots of dots

Thought to control mucous and seromucous secretion and vessel diameter

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50
Q

Respiratory epithelium: Basal Cells or Immature Cells

Where are they are? Charactersitict?

Function?

A

Short on the basement membrane. Part of pseudostratified epithelium that does not reach lumen.

Stem cells

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51
Q

How is smokers epithelium affected? (population of cells)

What is this transformational process called?

A

Goblet cells increased due to pollutants

Cilliated cells decreased due to increased carbon monoxide

Metaplasia

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52
Q

What is the opening to the nose called?

What keeps bugs and other stuff from entering the nose?

What is inside of nose?

A

Nostril or narris

Thick long hair

Nasal fossa surounded by inferior/middle/superior conchae/turbinates and spongy bone on the lateral side

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53
Q

What is the function of conchae/turbinates?

What are these structures lined with?

What cranial nerve is connected there?

A

They are covered with mucosa and produced mucous

To create channels

CN I - smell

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54
Q

What is released in nasal cavity from lamina propia? What is the cause of that?

Which concha is superior to the entrace to maxillary sinus?

What is the importance of maxillary sinus?

A

IgA and IgE binding to basophils and inflammation

Middle concha

The site of the drug delivery (access to superfincial venous plexus) beneath the nasal cavity mucosa)

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55
Q

Swell bodies

What are they?

When they become enlarged?

A

Venous plexus in lamina propria that enlarge alternately on two sides of nasal cavity (about every 30 minutes) giving mucosa on occluded side time to recover from desiccation and help to direct air to the olfactory epithelium

During cold cause blockage (not mucous)

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56
Q

What is vesitbule?

What is vibrissae?

A

Anterior portion of the nasal cavity

Nasal hair

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57
Q

Four types of cells in olfactory epithelium

How cells are identified?

A

Olfactory Cell

Sustentacular cells

Basal Cell

Brush cells?

By the position of their nuclei because there are many nuclei

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58
Q

Where are the olfactory cells located at?

A

On the roof of the nasal cavity and on the superior nasal conchae

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59
Q

Olfactory epithelium: Olfactory cells

What type of cells are olfactory cells?

What is on apical surface of the olfactory cell?

What is the basal portion?

What is special of olfactory cells with respect to division?

Where are the nuclei?

Is cillia motile?

A

Bipolar neurons

Dendirtes with cilia

Axon

Only neural cells that divide

Half way

No

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60
Q

Where is the nuclei located of Sustentacular cells and Basal cells?

What does basal cells communicate with?

A

Have nuclei at apical / basal surface surface

Bipolar neurons

61
Q

Spatio-temporal patterning

Olfactory adaptation

A

Smell connected to frontal cortex

Losing the smell after extended exposure

62
Q

What type of secretions are Bowman’s glands?

In what epithelium are they found?

Function?

In which layer are these glands found

Clinical importance?

A

Seromucous (more serous)

Olfactory

Windshield wipers over the olfactory epithelium (synthesis of an odorant binding protein)

Lamina propia

Can pass the BBB

63
Q

What are paranasal sinuses?

Examples?

A

Air spaces within cranial bone lined with respiratory epithelium

Frontal - black

Maxillary - red

Ethmoid - green

Posterior ethmoid - purpole

Sphenoid - yellow

64
Q

What are these procedures?

  1. Endoscopic sinus surgery
  2. Radiofrequency ablation
  3. Sinus stents
A

Endoscopic sinus surgery = opening sinus and removing its content

65
Q

What type of epithelium is in sinuses?

A

Respiratory epithelium

66
Q

What are two parts of larynx?

A

Glotis (vocal cords) / tracheal

Superglottis / lingual

67
Q

What type of epithelium is found on epiglottis and on which side?

A

Stratified squamous on oral cavity side

Pseudostratified on the other side

68
Q

What pushes epiglottis to prevent food going into trachea?

A

Tongue moving backward

69
Q

What type of cartilage is found in epiglottis?

A

Elastic

70
Q

What is the function of larynx?

A

Phonation (producing sounds)

71
Q

True vs. False vocal cords

Location? Glands? Muscle?

A

False: Upper fold; glands; no muscle

True: Lower fold; no glands; no muscle

72
Q

What separates true vocal cord from false vocal cord?

A

laryngeal ventricle

73
Q

How to open epiglottis?

A

Pull the tounge

74
Q

Name structures

A

(E) epiglottis

(F) false vocal cords

(T) true vocal cords

(V) opening of ventricles

(A) anterior commissure

(VL) vocalis ligament

(VM) vocalis muscle

(R) Reinke’s space (Reinke’s edema)

75
Q

What are two sturctures in true vocal cords under epithelium?

A

Vocalis ligament and vocalis muscle

76
Q

Reinke’s edema

A

Edema in Reinke’s spaces due to excessive talking

77
Q

Where does the laryngitis occur?

A

Between vocal cords

78
Q

Tracheae

List layers in trachea?

What is a component of lamina propria?

What is well defined in lamina propria?

What shape and where is the cartilage?

What connects the ends of cartilage?

What does the pericardium of the cartilage fuses with?

A

Respiratory epithelium, lamina propria, submucosa, adventitia

Collagen and elastic fibers

Elastic lamina

Adventitia / C-shape

Trachealis muscle

Submucosa and adventitia

79
Q

Two types of bronchi?

Where are they found?

Rigidness?

A

Extrapulmonary - outside of lungs

Intrapulmonary - inside of lungs

Exrapulmonary more rigid

80
Q

Where does cartilage becomes irregular?

In that region, what is between cartilage and lamina propia?

A

In extrapulmonary bronchi

Smooth muscle spirals

81
Q

Intrapulmonary Bronchi

What is the other name for secondary bronchi and where do they go to?
What is the other name for tertiary bronchi and where do they go to?

A

Lobar bronchi / lobes

Segmental / bronchopulmonary segments

82
Q

Mucosa

Layers?

How far do seromucous glands that are between cartilage plates and smooth muscle extend?

A

Mucosa (respiratory epithelim, lamina propia, and submucosa)

Muscularis

Submucosa

Hyaline Cartilage Lyaer

Adventitia

Lamina propia

83
Q

What is the defnition of bronchiole?

Do they have seromucous glands?

How does the epithelium changes in bronchioles?

What is the lamina propria composed of in bronchioles?

A

Less than 1mm and no cartilage

No

Goes from columnar cillated to cuboidal Clara cells; less golbet cells and more clara cells

Smooth muscle and elastic fibers

84
Q

Clara Cells

What structures do they have on apical surface?

What enzyme do they contain?

What do they secrete?

Can they divide?

What is a shope of these cells?

A

Microvilli (not cillia)

p450 in smooth ER

Glycoproteins that protect the mucosa

Yes they can; they regenerate epithelium

Dome

85
Q

One of four diseases of COPD = asthma

Drugs?

What is it?

What part of NS innervates brohchiole?

Symptoms?

A

Widespread constriction

Albuterol mimics sympathetic response

Sympathetic and parasympathetic

Wheezing, difficulty expelling air from lungs (expiration)

86
Q

How structures change down toward aveoli?

A
87
Q

Respiratory bronchile

What is it lined with?

Describe lamina propia

A

Clara Cells

Very thin smooth muscle and elastic fibers at alveolar openings

88
Q

Alveolar Ducts

What are they lined with?

Do they contain lamina propia?

A

Simple Squamous epithelium (Type 1 pneumocytes)

Yes, with smooth muscle and lots of elastic fibers

89
Q

Alveoli

When are they developed?

Cells in linings?

A

85% of alveoli develop after birth until the age of 10

Both type 1 and typ2 pneumocytes

90
Q

Type 1 pheumocytes

Shape?

Can divide?

% of these cells in aveoli?

Function

A

Simple squamous epithelium

No

95%

Gas exchange

91
Q

Type II Pheumocyte

Shape?

% of these cells in aveoli?

What connections do type I and type II cells form?

Can the regenerate?

What is the function?

A

Cuboidal

5%

Occuding junctions

Yes

Surfactant production

92
Q

Intraveolar septum: thin portion (TnP)

Function?

Parts (blood-gas-barrier)?

A

Exchange of gases

  1. surfactant layer
  2. cytoplasm of type I pneumocyte
  3. fused basal lamina between type I and capillary endothelium
  4. cytoplasm of capillary endothelium
93
Q

Intraveolar septum: thick portion

What is found in thick portion?

Function?

Are there lympathics?

A

Elastic, collage, and reticular fibers; fibroblasts, macrophages and mast cells

Fluid removal – the fluid is drawn into interalveolar septum

No, aveoli are too small; lymphatics follow bronchial tree

94
Q

Surfactant

When is it produced?

Where is it stored?

Function?

What is given to mother to induce surfacant production in baby?

A

26-28 weeks

Lamellar bodies (TEM)

Reduces surface tension

Glucocorticoids

95
Q

Intraavolar septum: macrophages

2 types (dust cells)?

Relation to heart failure?

A

Associated with alveolar wall (fixed population)

Macrophages that roam free

Leakage of blood; phagocytosis; lungs stain for iron

96
Q

Pores of Koh

Function?

A

Connect aveoli and equlibrate pressure

Allow passage of roaming macrophages

Allow collateral ventilation in case of bronchole obstruction

97
Q

Pulmonary vs. Systemic blood pressure in lungs

A

Pulmonary artery 12-25 mmHg

Bronchial artery 110-135 mmHg (follow bronchial tree to level of respiratory bronchioles)

they anastomose

98
Q

Emphyseme

What is a1-antitrypsin?

What is it?

How is smoke related?

Herediaty?

A

a1-antitrypsin is a protein that protects the lung from action of elastase

Emphysema is a destruction of the inner alveolar wall. Decreased elasticity, poor expiration.

Substances that inhibit a1-antitrypsin

2-3% due to mutation in a1-antitrypsin

99
Q

Tension vs. Open Pneumothorax

A

The hole locks during expiration leading to a buildup pressure in chest cavity

In open pneumothorax, expiration and inspiration is reversed.

100
Q

What fluid can take over pulmonary cavity?

A

Pneumothorax

Hemothorax

Hydrothorax

101
Q

Pneumothorax mainfestation

A

Respiratory distress

Cyanosis

Tracheal deviation

Chest pain

Hyper resonance

102
Q

Sources of blood in hemothorax

A

Lung

Intercostal vessels

Internal thoracic (internal mammary artery)

Thoracicoactromial

Lateral thoracic

Mediastinal great vessels

Heart

Abdominal sturcture

103
Q

What is pleural effusions?

A

Escape of fluid into the pleural cavity

104
Q

Define

Pleuritis (syn. pleurisy)

Development?

A

Inflammation of the pleura

Rough surfaces of the pleurae produce a so-called pleural friction rub

The inflamed surfaces of the pleura may also cause the parietal and visceral layers of the pleura to adhere pleural adhesions

105
Q

Define

Mesothelioma of Pleura

What is it associated with?

A

Primary malignant tumors arising from the visceral or parietal pleura.

Occupational harazd e.g. Asbestosis

106
Q

Define

Thoracentesis

A

Insertion of needle into pleural cavity.

*** Angle properly to avoid diaphragm and/or liver

107
Q

Trauma of thoracic wall

Possible locations?

Simple vs. Complicated?

A
108
Q

Trauma of thoracic wall

Define flail chest

Symptoms?

A

Fracture of several adjacent ribs

Complete sternocondral separation

109
Q

Define embolus

Examples?

Pulmonary embolism symptoms?

A

Blocks blood vessel

Blood clot, Air, Fat, Amniotic fluid, Foreign body, Mass of bacteria

Sudden onset of dyspnea, dyspnea, tachycardia

110
Q

Bronchogenic Carcinoma

Define

Typical location

A

The tumor arises from the bronchial epithelium.

Tumor typically located near hilum, projecting into bronchi.

111
Q

Define decision-making capacity and competency

Competence/incompetence?

Decisional capacity/incapacity?

A

Decisional-making capacity:

the ability to understand relevant information
appreciate the medical situation and its consequences
communicate a choice
engage in rational deliberation

—Competence/incompetence – legal terms
—Decisional capacity/incapacity – medical determination.

112
Q

Surrogate

Order of importance?

A

An authorized person making medical decisions and acting on the patient’s behalf

Sopouse - Children - Parents - Sibling - Nearest relative by blood

113
Q

Standards for Surrogate Decisions

A

—Substituted judgment

—Best interests

114
Q

Advanced Directives

Types

A

—Durable (or medical) power of attorney for health care
—Directive to Physicians
—Living Will
—POLST
Wallter cards

115
Q

List the 5 A’s involved in assessment of tobacco use

A
    • Ask about tobacco use.** This also involves addressing myths about quitting. For example, it is a myth that past attempts decrease ability to quit or that older smokers don’t benefit from quitting.
    • Advise users to stop.** Provide the patient with information on the medical benefits.
  • *Assess willingness to quit.** An important factor is to match the intervention with the stage of quitting (see below).
  • *Assist in quitting.**
    • Arrange for follow-up.**
116
Q

Treatments

Which component is important in therapy?

A

Books, Carbon monoxide monitor, Websites, Behavioral programs (coping skills)

Behavioral > Medicine

117
Q

Smoking

A
118
Q

What belongs to conducting zone vs. respiratory zone?

Volume of each?

A

Conducting (first 16 generations): trachea, bronchi, bronchioles, and terminal bronchioles; 150 ml

Respiratory (final 7 generations): respiratory bronchioles, alveolar ducts, alveolar sacs.; 3000ml

119
Q

Functional unit of respiratory part of lungs?

A

Acinus

120
Q

Lung volumes

A

Total Lung Capacity (TLC) = volume following maximal inspiration

Residual Volume (RV) = volume left after maximal expiration

Vital Capacity (VC) = TLC – RV

Tidal Volume (VT) = volume inspired under normal resting conditions

Functional Residual Capacity (FRC) = volume remaining at end of normal tidal expiration

Expiratory Reserve Volume (ERV) = volume expelled during maximal forced expiration starting at the end of normal tidal expiration

Inspiratory Reserve Volume (IRV) = volume inspired during maximal inspiratory effort starting at the end of normal tidal inspiration

Inspiratory Capacity (IC) = volume inspired during maximal inspiration starting after at the end of normal tidal expiration

121
Q

How to measure residual volume?

A

(1) Nitrogen washout C1 * V1 = C2 * V2 ; V1 = FRC
(2) Helium dillution C1 * V1 = C2 * (V1 + V2) ; V2 = FRC
(3) Boyle’s law P*V=K

ΔVbox = ΔVlungs

FRC = (ΔV/ΔP) x (P x ΔP)

122
Q

What muscle are responible for inspiration?

A

Diaphragm

Cxternal intercostal = pull ribs up

Accessory muscles

  • *scalene** muscles, which lift the first two ribs
  • *sternomastoid** muscles, which raise the sternum
123
Q

What muscle are responsible for expiration?

A

abdominal
rectus abdominus
internal and external obliques
ütransversus abdominis

internal intercostals pull the rib cage down

124
Q

What causes changes in lung volume?

A

The transpulmonary pressure

125
Q

Equations / definitions:

Alveolar pressure

Intrapleural pressure

Transpulmonary pressure (PL) = alveolar pressure (PA) – intrapleural pressure (PIP)

Transrespiratory pressure (PRS) = alveolar pressure (PA) – atmospheric pressure (PB)

Transthoracic pressure (PCW) = intrapleural pressure (PIP) – atmospheric pressure (PB)

A
126
Q

How emphysema affects volume/pressure relationship of lungs?

A
127
Q

What is ΔV/ΔP?

What is ΔP/ΔV?

A

ΔV/ΔP = Compliance

ΔP/ΔV = Elastance

128
Q

What the pressure-volume graph for lungs is not a straight line?

When does compliance increases?

When does compliance decreases?

A

The compliance of the lung varies at different lung volumes. For example, the lung is much less compliant at high lung volumes. This is normal.

Emphesyma / low volume

Fibrosis / low high volume

129
Q

What is hysteresis?

A

The change depeends on initial state

130
Q

What causes elastic properies of lungs?

A

Elastin and collagen fibers that surround the bronchi and alveoli

131
Q

How filling the lung with saline affects compliance and hysteresis?

A

Eleminates hysteresis

Increases compliance

132
Q

Suface tension in lungs

Cause?

Contributes to what?

A

Liquid molecules in alveoli

Surface tension

133
Q

Leplace’s law

Why small aveoli does not collapse and large burst?

A

P = T/r

Surfactant

134
Q

Surfactant

What is it secreted by?

Composition?

Phospholipid component?

Mechanism of surfactant?

A

Type II aveolar cells

lipids (85-90%) and proteins (10-15%)

dipalmitoyl phosphatidylcholine (DPPC)

Their intramolecular repulsive forces oppose the attractive forces of the liquid responsible for creating surface tension

135
Q

What is hystersis due to?

A

Surface tension – not surfactant

By reducing surface tension, hysteresis is reduced

136
Q

Problems with surfactant

infant respiratory distress syndrome (RDS)

acute respiratory distress syndrome

Absence/loss of surfactant

A

Born premature <6 some <12 wk all

hypoxia/hypoxemia leads to a decrease in surfactant

increases effort required to inflate lungs because of decreased compliance;
increases tendency for alveoli to collapse

137
Q

What two forces determine functional residual capacity?

A

Elastic recoil properties of the chest wall

The elastic recoil properties of the lung that tend to collapse lung volume

138
Q

How fibrosis affects the airway pressure vs. vital capacity graph?

A
139
Q

How emphysema affects the airway pressure vs. vital capacity graph?

A
140
Q

Regional differences of lungs

Which system operates at lower volume?

Which part apex or base is more complaint?

A

The base operates at lower volume because of lower gradient

The base is more compliant = ventilated better

141
Q

What resistances need to be overcomed during ventilation?

A

Elastic

non-elastic (airflow/viscous)

142
Q

Poiseuille’s law

A

V = dP * PI * r^4 / (8 * n * l)

143
Q

Reynolds number

A

Re = 2 rvd/n

144
Q

What is the relationship between flow and pressure difference in turbulent flow?

A

V = sqrt(dP)

145
Q

Nervous system regulation of ariways

Other controls?

A

Sympathetic b2

Parasympathetic M

Inflammatory mediators = leukotrienes or histamne (astma)

146
Q

Normal pH status

Plasma?

Intracellular?

A

7.40 (7.35 to 7.45) = ph = -log[H+] = 40nM (35 to 45 nM)

Life between 6..8 and 7.8

Intracellular 7.0

147
Q

Isohydric principle

A

All acids use protons

148
Q

What are the main buffers in ECF?

A

Non-bicarbonate - non-volatile

Hemoglobin (important)

Plasma proteins (20% of Hb)

Phosphates (few% of Hb)

NOT NH4+

Bicarbonate - volatile

149
Q
A

Block 2 (7 decks)

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