2025 Spring Final Flashcards
(176 cards)
1
Q
How long/wide is the trachea? Internal diameter?
A
10-13 cm long
2 cm wide
Internal diameter - width of thumb
2
Q
How much of the trachea is extrathoracic?
A
4 cm - the majority is intrathoracic
3
Q
What connects the cartilage of the trachea?
A
annular ligaments
4
Q
How many cartilage rings make up the trachea?
A
20
5
Q
Why is the tracheal cartilage not continuous posteriorly?
A
Helps with swallowing
Enfolding when coughing to increase velocity - divides the trachea into portions
6
Q
Which mainstrem is longer, why is it longer? Wider?
A
Right - wider
Left - longer (4-6 cm) vs R (2 cm)
Position of the heart makes the left have to be longer
7
Q
What are the angles of each mainstem?
A
R - 25 degrees from vertical
L - 45 degrees from vertical
8
Q
What is the total angle of bifurcation of the 2 mainstems?
A
70 degrees
9
Q
Which ligament is used for a cricothyrotomy?
A
Median cricothyroid ligament
10
Q
How does the position of the head change the size of the trachea?
A
Head back - trachea longer, internal diameter narrower
Head to chest - trachea shorter, internal diameter wider
11
Q
What is the largest ligament in front of the larynx? What does it connect?
A
Thyrohyoid membrane - thyroid cartilage to hyoid bone
12
Q
What is a fancy name for the vocal cords?
A
Transglottic space aka Rima Glottidis
13
Q
Where can you feel the ETT cuff inflate?
A
Sternal angle/notch - top of sternum
14
Q
When the cricothyroid muscle contracts, what happens to the cords?
A
Cords get tighter, the front of the Adam’s apple moves down, but the cords don’t get closer
- voice gets higher in pitch
15
Q
Which laryngeal muscle is external?
A
Cricothyroid muscle
16
Q
Which laryngeal muscle runs parallel to the cords and tightens the cords?
A
Vocalis muscle - no effect on open/closed state
17
Q
Which laryngeal muscle is attached to the thyroid cartilage and arytenoid cartilage and functions to tighten the cords?
A
Thyroarytenoid muscle - cartilage spins and closes the cords (adduct)
- L spins clockwise, R spins counterclockwise
18
Q
Which laryngeal muscle pulls the arytenoid cartilage together? What is the effect?
A
Transverse arytenoid muscle - closes the cords (adduct)
19
Q
Which laryngeal muscle causes the back portions of the arytenoid cartilages to pull closer together? What is the effect?
A
Posterior cricoarytenoid muscle - opens the cords (abduct)
20
Q
What is the only laryngeal muscle that causes the cords to open?
A
Posterior cricoarytenoid muscle
21
Q
Which laryngeal muscle will cause difficulty breathing if it malfunctions
A
- Posterior cricoarytenoid
22
Q
Which muscles cause vocal cords to adduct?
A
- Thyroarytenoid
- Transverse arytenoid
- Lateral cricoarytenoid
23
Q
Which muscles cause vocal cords to abduct
A
Posterior cricoarytenoid
24
Q
Which laryngeal muscle is attached to the cricoid cartilage and arytenoid cartilage and functions to tighten the cords?
A
Lateral cricoarytenoid muscle
- L spins clockwise, R spins counterclockwise
25
What are the skeletal muscle groups responsible for laryngospasm?
Pharyngeal constrictor set
26
The majority of facial sensation is innervated by the _____ nerve
trigeminal (CN V)
27
What are the 3 divisions of the trigeminal nerve?
V1 - ophthalmic
V2 - maxillary
V3 - mandibular
28
If you're whispering, your vocal cords aren't _______
vibrating - cords are too open
29
What is the position of the vocal cords during phonation?
closed
30
Which nerves are responsible for controlling the muscles in the voicebox?
Laryngeal nerves - inferior (recurrent) and superior
31
Why can we still speak when one of the laryngeal nerves is damaged?
More laryngeal muscles function to close the cords
32
Higher altitudes have _____ atmospheric pressure, while lower altitudes have _____ atmospheric pressure
lower, higher
33
The summit of Mt Everest is ~ _____ km
The barometric pressure is _____ mmHg, and the PIO2 is ______ mmHg
9,000m/ 9km
253
43.1
34
What is the ventilation response to compensate in high altitude?
Hyperventilation
35
What are the long-term effects of living at high altitude?
Kidney's oxygen sensors in inner medulla inc EPO production, which inc HCT
36
How does growing up at high altitude affect the lungs?
More surface area (more alveoli) is available for gas exchange in the lungs
37
The limiting factor in exercise is ____
CO
38
How much lung area do we have compared to what we need?
Have 3x more than what we need
39
At a depth of 500 ft, the pressure is ____x normal
16 (16x 760 mmHg)
40
What is the main concern with diving pressures?
Nitrogen - air emboli bc nitrogen is insoluble in blood
41
Hyperbaric chambers usually go to pressures of
3 atm
42
To increase the oxygen content in blood, which portion of oxygen has to increase?
dissolved oxygen
43
What are the 4 dangerous oxygen molecules (ROS)?
Superoxide: O2- (extra unpaired electron)
Peroxynitrite: OONO- (mutates DNA, formed from superoxide and NO)
Hydrogen Peroxide: H2O2
Nitric oxide: NO, forms other dangerous molecules
44
Which enzymes regulate the dangerous oxygen molecules?
Superoxide dismutase, peroxidases, catalase, and acetylcysteine
45
What medication is used to treat acetaminophen OD?
N-acetylcysteine (scavenges ROS and protects liver)
46
How do iron lungs work?
Lower than normal pressures inside to pull the diaphragm down; less trauma than PPV
47
How do the lungs fill in PPV?
Alveoli closest to the large airways fill first
48
How do the lungs fill in normal breathing?
The outer alveoli open first and pull the inner alveoli open
49
What is the response in the lungs at high altitude?
hypoxic pulmonary vasoconstriciton - makes it hard for the R heart to pump
50
What is the normal pH of blood?
7.35-7.45
51
What does volatile mean?
able to transition into gas
52
What is the main volatile in the body?
CO2
53
CO2 is a (weak/strong) ______ (acid/base) _______; H2CO3 is a a (weak/strong) ______ (acid/base) _______
CO2 - weak acid
carbonic acid (H2CO3) - weak acid
54
What is the conjugate base of carbonic acid? Is it strong or weak?
HCO3- = strong conjugate base
55
A strong acid produces a ______ conjugate base; a weak acid produces a ______ conjugate base
weak; strong
56
What is the ratio of CO2 to H2CO3 in the body?
1,000:1
57
What are the non-volatile acids found in the body?
Sulfuric acid, phosphoric acid, HCl, lactate (lactic acid)
58
Where do non-volatile acids come from? How are they removed from the body?
breakdown of proteins; not through lungs - liver or kidney
59
What pathologic acids are produced in poorly managed diabetics?
1. acetoacetic acid (also after drinking alcohol)
2. Butyric acid
60
Example of a strong acid? Weak acid? Weak base? Strong base?
SA: HCl
WA: carbonic acid or vinegar
WB: NaF - toothpaste buffer
SB: NaOH - drain cleaner
61
How does pH effect blood proteins?
inc bound H+
protein shape changes and doesn't work as well
62
What is the Bohr effect?
Inc [H+] makes oxygen fall off of Hb (dec affinity)
63
How do changes in pH affect the Na+/K+ pump?
acidosis and hyperkalemia
64
Where is ATP produced? By what?
mitochondria by ATPases
65
What is an example of a drug that is a strong base?
Sodium pentobarbital
66
Small changes in pH result in ______ changes in [H+]
large - change in 1 pH = 10 fold change in [H+]
67
Where are the lowest and highest pH's in the body?
Gastric acid = 1 (most acidic)
Pancreatic secretion = 8 (most alkaline)
68
Increased gastric motility leads to ____ pH
lower - pancreatic secretion doesn't have enough time to neutralize stomach acid
69
What are the units for [H+]?
mol/L
70
What is the [H+] for a neutral pH?
100 nmol/L
71
What is the livable range of pH according to Schmidt?
6.9-7.8
72
What is the [H+] for a pH of 7.4?
40 nmol/L
73
What are the main buffers in the body?
HCO3-
Proteins (Hb)
Phosphate
Lungs
74
What is the predominant acid in the blood?
CO2
75
What does the slope indicate on the bicarb/pH graph? What changes the slope?
Steeper slope = greater buffering capacity (sufficient blood proteins)
More horizontal slope = less effective buffer (inadequate amount of protein)
76
At a pH of 7.4, the amount of bicarb in the blood is ____
24 mmol/L (or mEq/L)
77
What happens to the bicarb and proton concentrations when pH is higher than normal?
Lower [H+], higher [HCO3-]
78
What are the common causes of respiratory acidosis?
1. depression of respiratory control centers (sedatives, opioids, brain injury)
2. neuromuscular disorders (spinal cord injury, polio, tetanus, MG) and paralytics
3. chest wall restriction/dec compliance (kyphoscoliosis and extreme obesity)
4. lung restriction (fibrosis, pneumo, PE)
5. Pulmonary parenchymal dz (pneumonia, pulm edema)
6. airway obstruction (COPD or upper airway)
79
What is the pk of bicarb?
6.1
80
What is the Isohydric Principle
Multiple buffers work on same pool of protons, their combined activity is greater than any of their individual
81
If the buffer line is steeper, which way do the isobars move?
Move inward closer to normal
Bicarb more capable to handling changes in pH. Less change in pH from changes in CO2 levels.
82
How fast can lungs start to compensate for metabolic acidosis/alkalosis?
<3min
83
Which spinal nerves innervate the phrenic nerve
C3-5
84
Compare the sites of albumin vs hemoglobin
Albumin: osmotic pressure in the CV system, plasma
Hgb: within RBCs, intracellular fluid
85
pH changes are handled by the ______ short-term and the ______ long-term
lungs - short
kidneys - long
86
What is the gain of a control system?
How much of a problem the body can correct for - the efficiency of a system in maintaining homeostasis
87
What is the name of the graph that looks like a star and details the differences between types of acidosis and alkalosis?
nonogram
88
What are the common causes of respiratory alkalosis?
1. CNS: anxiety, hyperventilation syndrome, inflammation, cerebrovascular disease, tumors
2. Drugs: salicylates, progesterone
3. Bacteremias, fever
4. Pulmonary disease: asthma, pulmonary embolism
5. Overventilation via mechanical ventilation
6. Hypoxia with high altitude
89
What are the common causes of metabolic acidosis?
1. Ingested drugs/toxins: methanol, ethanol, salicylates, ethylene glycol, ammonium chloride
2. Loss of bicarb: diarrhea, pancreatic fistulas, renal dysfunction
3. Lactic acidosis: hypoxemia, anemia, CO, shock, severe exercise, ARDS
4. Ketoacidosis: DM, alcoholism, starvation
5. Inability to excrete H+: renal dysfunction
90
What are the common causes of metabolic alkalosis?
- Vomiting
- Gastric fistula
- Diuretic therapy
- Overproduction of steroids (hyperaldosteronism)
- Ingestion/infusion of excess bicarb
91
How much ATP is made from each glucose molecule?
oxidative metabolism - 38 ATP
glycolytic metabolism - 2 ATP
92
What are the main anions/cations and their amounts in the anion gap?
Cation: sodium (142)
Anions: chloride (106) and bicarb (24)
93
How much is the anion gap?
12 +/- 4 mEq/L more anions than cations
94
What is mainly responsible for the anion gap?
Proteins (negatively charged)
95
What is the difference between metabolic acidosis with normal vs increased anion gap?
Normal - loss of HCO3- or Cl- (common issues)
Increased - presence of non-volatile acids (less common situations)
96
How much air is moved in a strong cough?
2 L in and out quickly
97
What are the 3 parts of the brainstem? Which is responsible for controlling breathing?
Midbrain, pons, medulla
- medulla
98
What are the peripheral blood gas sensors?
Chemoreceptors in the aortic arch and carotid bifurcation
99
What 3 things do chemoreceptors monitor?
1. H+
2. PCO2
3. PO2
100
What is the main response to changes in metabolism?
Change in ventilation - tidal volume 1st, RR 2nd
101
To change the CO2 when ventilating a patient, what should you change first?
Tidal volume
102
What is the main type of motor neuron in the respiratory system?
A alpha - large and fast
103
What are the main types of pain motor neurons?
C and A delta
104
The trachea is innervated by the ______ nerve
vagus
105
What kinds of receptors in the airway provide feedback to the brainstem?
Irritant and stretch receptors
106
List the muscles for breathing in order based on involvement
1. Diaphragm
2. External Intercostals
3. Internal Intercostals and accessory muscles
107
What are the two areas of the medulla?
Dorsal respiratory group (DRG)
Ventral respiratory group (VRG)
108
Where do the motor signals cross over?
Decussation of the pyramids in the medulla - contralateral control
109
What is the crosstalk called between the inspiratory and expiratory centers of the brain?
Reciprocal inhibition - when one area is active, it inhibits the other
110
What is the group in the pons called? What is it responsible for?
Pontine respiratory group (PRG) - modulating the activity of the DRG and VRG; irritant receptors - limiting time in respiration
111
The medullary respiratory center is also known as the ________
reticular formation
112
Where is the DRG located?
Nucleus tractus solitarius
113
What is the DRG responsible for?
Inspiration - where central sensors for PO2, pH, and pCO2 are located
114
What nerves feed into the DRG?
CN 9 and 10
Baroreceptor inputs
115
What are the expiratory neurons controlled by the DRG?
Abdominal and internal intercostal muscles
116
What are the 2 complexes in the VRG? What is their role?
Botzinger and pre-Botzinger complexes - control RR by feeding info into the DRG; respiratory rhythmogenesis
117
What motor output is produced by the VRG?
Pharyngeal constrictor muscles - keep the upper airways open
118
What would be the result of a lesion between the PRG and VRG/DRGs?
Apneustic breathing - inspiration long, expiration short
119
Why does the body not respond as fast to acidosis from non-volatile acids?
Non-volatile acids are charged and unable to cross the BBB like CO2 can
120
What is the pH of CSF?
7.31-7.32
121
How does the CSF buffer?
Produces its own bicarb - glial cells
122
123
What is the normal brain PCO2?
50 mmHg - concentration gradient for removing CO2 from the CNS to the blood
124
How does CO2 change BP?
Inc CO2 = inc BP
125
What is the main danger of blowing off too much CO2 in someone with heart problems?
As protons are removed, more (-) charge on albumin attracted Ca2+, resulting in a drop in iCa2+ in blood
126
When do chemoreceptors respond to decreased PaO2?
when PaO2 = 70 mmHg
127
What are the digestive enzymes of the lungs called?
Tryspin aka neutrophil elastase - protease
128
What molecule inhibits trypsin in the lungs?
Alpha1-antitrypsin
129
What happens if alpha1-antitrypsin doesn't work?
High trypsin levels break down elastic tissue in the lungs
130
What can inhibit the activity of alpha1-antitrypsin?
Smoke - chemical inhibitor
Liver problems - liver makes it
131
What state of iron is good? Bad?
Fe2+ = ferrous (reduced)
Fe3+ = ferric (oxidized)
132
Why is Hb only 97.4% saturated?
- venous admixture from bronchiolar circulation in L atrium
~1.5% of Hb in ferric form (MetHb)
133
What enzyme converts ferric Hb into ferrous Hb?
Methemoglobin reductase (adds an electron)
134
What is the structure of adult Hb?
2 alpha, 2 beta subunits = carries 4 oxygen molecules
135
What disease process is a result of a defect in the beta chains of Hb?
Sickle cell anemia - dec oxygen-carrying capacity and hemolytic anemia
136
Which is bigger: RBC or capillary? Why?
RBC - maximizes surface area for gas exchange
137
If one has the sickle cell trait, what can minimize symptoms?
Dec activity bc deoxygenation drives sickling
138
What drug is used to treat sickle cell anemia? How does it help?
Hydroxyurea - turns on fetal genes, gamma subunits instead of beta
139
What resistance can the sickle cell trait provide?
Malaria
140
What are other types of Hb?
- Myoglobin: uses iron to pull oxygen for skeletal muscles
- HbA1C: sugars sticking to Hb @ 1C position
- HbCO: normal ~1%, abnormal ~ 4%
141
With emphysema, how does the body adapt to chronically high levels of CO2?
Rely on O2 gas sensors for ventilation feedback info - why they stop breathing after receiving 100% O2 - respiratory acidosis
142
How often do we sigh? Why?
12-15 times/hr - deeper breath to keep alveoli open
143
__________ is the process of losing alveoli and blood vessels in emphysema
departitioning - d/t air trapping
144
What lung volume decreases in emphysema? Increases?
Dec: IRV - until IRV is gone and inspiratory capacity = tidal volume
- also ERV
Inc: VT and RV
145
What nerve is responsible for telling the brain to sneeze?
V2 - trigeminal nerve (V)
146
What is the difference between the R and L recurrent laryngeal nerves? What nerve do they come from?
Vagus
L - lower, recurrence underneath the aortic arch
R - more superior, recurrence around R subclavian artery
147
What nerves are responsible for speech?
Recurrent laryngeal nerves
148
After the recurrence of the laryngeal nerves, the nerves are called ______
inferior laryngeal nerves
149
What are the laryngeal muscles innervated by?
5/6 - inferior laryngeal nerve
1/6 (cricothyroid muscle) - external portion of the superior laryngeal nerve (branch of vagus nerve)
150
What are the two branches of the superior laryngeal nerve?
Internal - sensory for the larynx
External - motor for the cricothyroid muscle (want relaxed for intubation)
151
If the internal and external superior laryngeal nerve branches meet, the place where they meet is called ______
Galen's anastomosis - foramen of the thyrohyoid membrane
152
What are the sets of the pharyngeal constrictors?
Superior (4), middle (2), interior (2)
153
What are the suprahyoid muscles?
1. Diagastric muscle
2. Stylohyoid
3. Mylohyoid
4. Geniohyoid
154
What are the connections of the diagastric muscle?
Diagastric muscle - anterior and posterior bellies connected by an intermediate tendon (connective tissue sling)
- A - jaw to hyoid, P - hyoid to mastoid process
155
What are the connections of the Stylohyoid muscle?
hyoid bone to rear of skull (Styloid process)
156
What are the connections of the mylohyoid and geniohyoid muscles?
Inside of the mandible/floor of mouth to hyoid bone
157
What are the infrahyoid muscles?
1. Sternohyoid (sternum)
2. Thyrohyoid (thyroid cartilage)
3. Sternothyroid (sternum to thyroid)
4. Omohyoid - 2 bellies (superior and inferior) w/ intermediate tendon
158
What is the difference between tachypnea and hyperventilation?
Hyperventilation = excess of metabolic needs, deeper
159
What type of breathing occurs in DKA?
Kussmaul - rapid, deep, labored breathing
160
Another term for stretch receptors in the lungs is ______. What is the name of the reflex?
J-receptors, shut down inspiration when lungs get full aka Hering-Breuer reflex
161
What type of breathing occurs as a result of opioid OD?
Biot - irregularly interspersed periods of apnea in a disorganized sequence of breaths
162
What type of breathing occurs as a result of a head injury?
Cheyne-Stokes - varying periods of inc depth interspersed with apnea (similar to apneustic breathing)
163
What would be expected of a capnograph in hypoventilation? Hyperventilation?
Hypo - taller waves
Hyper - shorter/stunted waves
164
An abrupt, progressive decrease in waveforms of a capnograph is caused by what?
MI - dec pulmonary perfusion
- also could be esophageal intubation from air in stomach from mask ventilation
165
An abrupt, progressive increase in waveforms of a capnograph is caused by what?
MH (inc metabolism) or successful CPR
166
What does an upsloping plateau or "shark fin" appearance to a capnograph waveform?
Bronchospasm
167
A flat line in a capnograph could indicate what?
Esophageal intubation, disconnection, self-extubation
168
What factors can increase a CO2 waveform on a capnograph?
Fever, bicarb infusion, release of tourniquet, inc CO/BP, hypoventilation, MH, pregnancy, carbonation (burp)
169
What factors can decrease a CO2 waveform on a capnograph?
Hypothermia, dec CO/BP, pulmonary embolism, hyperventilation, airway obstruction, alveolar dead space development, extubation/esophageal intubation/circuit disconnection
170
A spike at the end of a waveform can indicate _______
pregnancy
171
What does a dip in the middle of the capnograph waveform mean?
Single lung transplant - healthy lung empties first
172
Arterial CO2 should be ______ than the alveolar CO2
equal to or higher
173
Arterial O2 should be ______ than the alveolar O2
equal to or less than
174
When sedated, paralyzed, ventilated, and supine, how do the lungs work? Which area receives more Q and V?
Low lung volume - can go below RV
- anterior portion more negative pleural pressure, ventilated more than post
- posterior pleural pressure positive, collapsed airway, blood flow higher than ant
175
How can V/Q mismatching under anesthesia be improved? What is the downside?
Higher lung volume - PEEP
- inc work of R heart
- FiO2 30%
176
If supine and awake, where do ventilation and blood flow go?
Posterior for both - still decent V/Q matching
