Exam 4 Flashcards
(158 cards)
1
Q
The trachea is usually about ___ to __ centimeters in length
A
10 to 13
2
Q
the width of your ____ is typically pretty close to the inner diameter of the trachea
A
thumb
3
Q
The vast majority of the trachea is seated _____
A
inside the thorax (intra-thoracic)
4
Q
How many cm of the trachea is extrathoracic?
A
4 cm!
We’ve got about 4 centimeters at the top of the trachea that is extra-thoracic, so it comes out at the top of the chest and is accessible in the neck→so we’ve got just a few centimeters that’s extra-thoracic, but the vast majority of it is intra-thoracic.
5
Q
How many cartilaginous rings in an average adult trachea?
A
20 pieces connected via annular ligaments
6
Q
Two benefits of the cartilaginous rings of the trachea not being continuous (in the posterior part of the trachea)
A
-Helps us swallow
-Helps us cough
7
Q
Usually we’re generating up to ____ mph winds when we’re coughing.
A
100 miles per hour
8
Q
Right lung is probably going to have ___ bronchopulmonary segments, and the left lung is going to have ___.
A
right: 10
left: 8
9
Q
Why does the left lung only have 8 bronchopulmonary segments?
A
through fusion during development of two pairs of bronchopulmonary segments.
10
Q
Right lung mainstem is ____ and ___ compared to left lung
A
Wider, shorter
11
Q
The left main stem is more ___ and ____
Why?
A
More narrow, longer
This is where the heart is positioned, need a longer left mainstem to route incoming/outgoing air past the position where the heart is sitting
12
Q
How long is the left mainstem?
A
4-6 cm
13
Q
Which mainstem is more vertical?
A
Right
14
Q
Which mainstem is more horizontal?
A
Left!
Less vertical, more horizontal
15
Q
Right main stem deviates from the vertical line by about ___ degrees.
A
25
16
Q
Left main stem deviates from the vertical line by about ___ degrees.
A
45
17
Q
Total angle of bifurcation of the mainstems
A
70 degrees
45 degrees on left + 25 degrees on right
18
Q
Those are two invasive airway locations:
A
You can either put an opening in the trachea itself or make an incision in the median cricothyroid ligament and go from there.
19
Q
50% of our inspired breath comes from our
A
Nose
other 50% from mouth
20
Q
How does extending a patient’s neck impact the length / diameter of the trachea?
A
It will make it longer / narrower
21
Q
Biggest ligament of larynx
A
Thyrohyoid membrane
22
Q
only continuous piece of cartilage that we have that forms a full circle is the
A
Cricoid cartilage
23
Q
Narrowest point of larynx in those 10 years old or younger
What about an adult?
A
-Kids –> Cricoid cartilage
-Adult –> transglottic space
(width between vocal cords)
24
Q
Where can you feel ETT cuff inflate?
A
Sternal notch
25
What is the only laryngeal muscle that is fully exterior?
Cricothyroid muscle
26
How does the cricothyroid muscle impact:
Vocal cords?
Rima Glottidis?
Tighten vocal cords
No impact on rima glottidis
27
How does the vocalis muscle impact:
Vocal cords?
Rima Glottidis?
Action of Vocalis Muscle:
-Tightens Vocal Cords
-Effect on Rima Glottis: None
28
When the Thyroarytenoid Muscle closes the cords, the left piece of cartilage rotates ____
What about the right piece?
Left: clockwise
Right: counter clockwise
29
How does the thyroarytenoid muscle impact:
Vocal cords?
Rima Glottidis?
The thyroarytenoid muscle:
-adducts the cords
-ends up closing the rima glottis
30
How does the transverse arytenoid muscle impact:
Vocal cords?
Rima Glottidis?
-adducts cords
-closes rima glottis
31
How does the posterior cricoarytenoid muscle impact:
Vocal cords?
Rima Glottidis?
-abducts cords
-opens rima glottis
32
How does the lateral cricoarytenoid muscle impact:
Vocal cords?
Rima Glottidis?
-adducts cords
-closes rima glottis
33
The highest location on the earth is about ____ meters in the air
9000
(or 9 km)
| This is the summit of mount everest
## Footnote
its actually 8800 but Schmidt says close to 9000 m
34
What is the barometric pressure at the summit of mount everest?
What about inspired PO2?
Barometric pressure: 253 mmHg
Inspired PO2: 43 mmHg
35
Atmospheric oxygen concentration at the summit of mount everest
21% or 0.21
36
People tend to feel out of breath when they are about ______ feet up.
Do they hyper or hypoventilate at high altitudes initially?
15,000 feet
Hyperventilating (just as a compensation to the different environment).
37
Where are the kidneys oxygen sensors?
Inner medulla
## Footnote
if you grew up at sea level, then you go to 10,000 feet, then your hematocrit is gonna be higher after a few days as a result of the actions of EPO
38
Typically for average day-to-day activity or everyday activity like playing sports, usually the limiting factor to our performance is _______
the heart→ usually the cardiac output is the limiting thing (and not the lungs.)
39
Typically we have about ___ times more lung area than we really need over the course of our life.
3
40
What is the lowest altitude place on earth, according to Schmidt?
Death valley
41
If we dive to a depth of 500 feet, the pressure is ____x higher than atmospheric pressure at sea level
16
| 1 atm = 760 mmHg
16 atm --> 12,160 mmHg
42
At 5000 mmHg, PO2 is ____
PN2 is _____
O2 --> 1,044
N2 --> 3956
| CO2 pressures are probably also elevated while diving
43
A standard hyperbaric chamber has a pressure of ___ atm
3 atm
| 3x normal barometric pressure
44
In the OR, we give our patients ~ ___% inspired O2
30%
45
Name the four dangerous oxygen molecules
aka reactive oxygen species (ROS)
## Footnote
Peroxynitrite destroys DNA --> leads to cancer down the road
46
What things contain / control reactive oxygen species?
Superoxide dismutase, peroxidases, catalases, acetylcysteines
47
With negative pressure breathing the alveoli closest to _____ fill first.
With positive pressure ventilaiton the alveoli closes to ___ fill first
Negative --> superficial borders of the lung tissue
PPV --> alveoli closest to the large airways
## Footnote
Normally (negative pressure breathing) , the alveoli that are closest to the superficial borders of the lung tissue are going to be the ones that fill first because they're closest to the negative pressure that's filling/pulling on the lung.
Typically that will result in the deeper alveoli getting also stretched out and fuller
48
Why do planes fly at 40K feet instead of 10K feet?
Cheaper bc the air is thinner --> saves gas
| I know this is a dumb card but in case he asks how high planes fly
49
Typically, all modern jets are pressurized to basically mimic an _____ feet environmental condition.
8,000
50
If we are at 30K/40K feet the barometric pressure is somewhere around...
The PO2 is only about
200 mmHg maybe lower
PO2: ~29 mmHg
51
What type of chemical reaction happens in plane O2 source boxes with dropdown masks?
What is the problem with this?
exothermic
If it gets set off when it isn't supposed to, it has potential to produce a lot of heat and oxygen --> heat + O2 is a recipe for disaster --> fires
52
Normal arterial pH range
7.35-7.45
| 7.4 is right in the middle
53
Main volatile gas/acid in our body
CO2
54
CO2 and carbonic acid are ____ acids
weak
55
For every 1000 CO2 molecules we have ___ carbonic acid molecules
1
56
Name the 4 common non-voltaile acids we have around the body
-Sulfuric acid
-Phosphoric acid
-HCL
-Lactic acid
57
What kind of patients will produce acetoacetic acid? (2 examples)
-Diabetic patients with really poor blood sugar management
-Your body produces this when you have had a lot to drink
58
What kind of patient will have butyric acid production?
People with poor health and poorly managed diabetes
59
What organ transforms/eliminates most of the non-volatile acids?
Kidney!
| The liver can sometimes transform some of the less toxic ones
60
Sodium fluoride in toothpaste is a ___ base
weak
| or potassium fluoride
61
This is a strong base and a common component of drain cleaner
NaOH
| Sodium hydroxide
62
If you have to think of one super basic drug, think of this drug:
Sodium Pentobarbital
63
pH equation in relation to proton concentration
pH = -log [H+]
64
What is a neutral pH?
Acidic?
Alkaline?
pH of 7 → neutral
pH < 7 → acidic
pH >7 → alkaline
65
gastric acid has a pH of
1
| most acidic secretion in the body
66
pancreatic secretions have a pH of
8
| most alkaline secretion in the body
67
If you have high intestinal motility, you can become ____
Why?
Acidotic
you lose a lot of the bicarb that the pancreas is producing.
68
If you are continuously vomiting, you can become _____
Why?
Alkalotic
Losing large amounts of acid from the stomach
69
What is the concentration of protons in gastric acid?
Show how you got it.
0.1 mol / Liter
1 x 10^-1
70
How many protons do we have in an aqueous solution with a neutral pH of 7
Show how you got it :)))))
100 nmol / liter
1 x 10^-7 =0.0000001 mmol / l
0.0000001 mmol = 100 nmol / l
71
If our pH changes from 7.4 to 7.7 our proton concentration is cut in ____
half
72
3 most important buffers
Proteins, bicarbonate, phosphate
## Footnote
Phosphate is an intracellular buffer
Good example for a protein is Hb
73
Normal bicarb at a pH of 7.4
24 mmol/L
| Pay attention to units!!!
## Footnote
same things as mEq/L
74
Name the 3 important buffers
1. Bicarb→Bicarb is a dominant extracellular buffer.
2. Proteins→ are the most important buffer behind bicarb.
3. Phosphate→ is also an important buffer. (Mainly ICF but important plasma buffer as well)
75
The pK of bicarb as a buffer is _____
6.1
76
When referring to the gain of the control system, many systems in the body can correct for at least ____ the problem
Half
77
Which cervical nerves does the phrenic nerve come from? :)
C3,C4, C5
78
Idk if he'll as this but just in case..
Coolant leaking from a european car will be ____
Coolant leaking from japanese or american car will be___
Euro --> blue
Japanese/American --> green
79
Oxidative metabolism produces ___ ATP per 1 glucose molecule
38
80
Glycolytic metabolism produces ___ ATP per 1 glucose molecule
2
| aka this way sucks
81
For anion gap, sodium is ___ mEq/L
Chloride is __ mEq/L
HCO3 is ___ mEq/L
Na --> 142
Cl --> 106
HCO3 --> 24
82
Normal anion gap and marigin of error
Show how ya got it
12 mEq/L +/- 4 mEq/L
How?
[Na+] = [Cl+] + [HCO3-]
142 = 106 + 24
142 = 130
83
What is a big reason for the deficit of the anion gap?
Negatively charge proteins!
## Footnote
Most proteins have a net negative charge.
There's all sorts of regions of these protons and in any one of those regions there could be a negatively charged area that could accommodate a proton or at least reduce its activity in the solution. So proteins are probably a big chunk of this deficit/anion gap.
84
If you have somebody who has a pretty loud cough, typically a loud cough is the equivalent of about ____ liters moving in and then out of the lungs quickly.
2
85
The place in the brainstem where breathing regulation happens primarily is the _______
medulla of the brainstem
86
What three things do the sensors that are involved with respiratory regulation (chemoreceptors) look at?
pH (proton concentration)
PCO2
PO2
| Protons are the most important / strongest impact on ventilation
## Footnote
Most important: protons, Pco2 then O2
87
Our main peripheral chemoreceptors /gas sensors are the ____ chemoreceptors
The secondary peripheral blood gas monitor is located at the ___
Main: Carotid
2nd: Aortic Arch
88
The central chemoreceptors are most responsive to changes in ___
Protons
| They can respond to a number of things, but typically its protons
## Footnote
Changes in pH in the CSF as a result of proton concentration changes, that typically is the trigger that is going to regulate most of our breathing.
89
If someone has a lot of non-volatile acids in their body, why does it take a little bit for the central chemoreceptors to be set off?
The protons associated with those types of acids don't cross over the BBB very well
| On the other hand, CO2 can cross over easy! Response is fast!!!
90
In terms of the peripheral chemoreceptors responding to changes in arterial oxygen, sometimes they don't kick in until the PO2 is down to ~____, so you really have to have a big drop in your oxygen levels for that to result in increased ventilation.
70 mmHg
91
What is the first thing adjusted when we pick up our activity, in terms of ventilation?
First: Tidal Volume
then: RR
92
The motor neurons that are in the respiratory system are almost all _____ neural fiber type.
A-alpha
| They regulate what our tidal volume is going to be
## Footnote
Myelinated
93
Where are irritant receptors located?
Lung and airways!
94
What nerve transmits tracheal sensory information?
Vagus nerve
## Footnote
-Much of the input from these irritant receptors, stretch sensors, pressure sensors gets transmitted via the vagus nerve back to the brain stem.
-We have irritant receptors, again, in the lung itself and in the airways.
95
Name the muscles of breathing in order of importance
1. Diaphragm
2. External intercostals
3. Internal intercostals
4. Accessory muscles
96
This is probably involved in modulating the activity of the dorsal and ventral respiratory groups
PRG
Pontine respiratory group
97
CAUDAL
Tail
Lower and to the rear
98
Rostral
Beak
Front and forward
99
Where is the DRG located? General and specific
General: Reticular Formation
Specific: Nucleus tractus solitarius (NTS)
100
What center takes care of the majority of our inspiratory signals?
DRG
| Controls inspiratory rate
101
What inspiratory muscles does the DRG control?
Expiratory muscles?
Inspiratory: Phrenic nerve, inspiratory accessory muscles
Expiratory muscle: Abdominal muscles and internal intercostal muscles
102
This is located in the VRG and is the site of respiratory rhythmogenesis
Botzinger / Pre-Botzinger Complex
| Specifically Controls RR
103
Which respiratory group regulates the pharyngeal constrictor muscles?
VRG
-Helps keep the upper airways open
104
The ___ takes care of most of the motor for the inspiratory and expiratory muscles, the ___ controls how open the upper airway is
DRG, VRG
105
The ___ is going to be an important place where our irritant receptors send information
PRG
106
What does apneustic breathing look like?
What could cause this?
Long inspiration, quick expiration
We could see this if something is terribly wrong in the CNS
For example: If we have a lesion that separates the PRG from these medullary respiratory groups, our breathing is going to be abnormal
107
pH of CSF
7.31
Levistky says 7.32
108
What has a higher CO2 - aterial blood or CSF?
CSF
## Footnote
This is because as we’re going throughout our day, most of our neurons are working, and working neurons should probably produce CO2
109
CO2 is being produced within cells inside the CSF gives us a PCO2 of about ___mmHg for a good, healthy CSF.
50
110
Aortic bodies here, in the case of chemoreceptors, transmit information back to the brainstem via the ___ nerve
Caortid bodies transmit information via the ____ nerve
Aortic bodies: vagus (X)
Carotid bodies: glossopharyngeal nerve (IX)
111
Hering's nerve is a component of the ____ body pathway.
Carotid
112
Blood gas / acid information is fed into the _____
Whereas the irritant receptors and stretch sensors that are embedded in the lungs and the airway feedback into the ______
-Medullary Respiratory groups
-Pontine respiratory group.
113
1 in every ____ people have a genetic deficiency in alpha-1 antitrypsin
3,000
| They just don’t make it or they make a version of it that doesn’t work
114
If people have a genetic deficiency in alpha-1 antitrypsin (and develop emphysema) and do not receive a lung transplant it typically results in death by age ___
30
115
What is something that inhibits the action of alpha-1 antitrypsin
smoke!
| Smoke is a chemical inhibitor of alpha-1 antitrypsin
116
What organ produces alpha-1 antitrypsin?
Liver
117
genetic disorder that was potentially cured by some type of genetic therapy is _____ which is also a lung disorder.
cystic fibrosis
118
How many charges does the "good" iron have?
What is its name?
2 --> Fe++
Ferrous
119
How many charges does the "bad" iron have?
What is its name?
3 --> Fe +++
Ferric
## Footnote
-oxidation typically involves removing an electron, which is essentially the same as adding a positive charge on an atom.
-If we have lots of oxidative stress, we will have more of this other type of iron.
-The oxidized iron has three positive charges and is thought of as ferric iron.
120
Does Ferric have an issue with: binding or releasing oygen?
Releasing! It binds permenantly can't be released where it is needed
Not a binding issue
121
About ____% of our circulating Hb is in the Ferric form
1.5%
122
Why does a blood sample have an O2 sat of 97.4% instead of 100%?
-Venous admixture from bronchiolar circulation mixing with oxygenated blood in LA
-a portion of our Hb are in a state of oxidation where they can not do a whole lot of work. 1.5% of Hb is in ferric form
123
What enzyme is responsible for reducing Ferric iron into Ferous iron?
Methemoglobin Reductase
| It adds an electron which negates one of the positive charges on Ferric
## Footnote
Oxidation is loss of electron (OIL)
Reduction is gain of electrons (RIG)
124
What is another name for hemoglobin that has this bad iron on it?
Methemoglobin
125
Adult Hb has two ___ and two ____ chains
Alpha, Beta
126
What is the drug that is used for sickle cell and activates fetal genes?
Hydroxyurea
## Footnote
The difference between our fetal genes and adult Hb genes is that instead of having our β subunit (like the adults have) is that the fetal Hb has gamma (𝛄) subunits → usually 2 𝛄 subunits
127
If you have the sickle cell trait, you are resistant to ___
Malaria
128
Name for Hb A1C?
Normal level?
-Acetylated Hb
-5 or lower
129
Typically, we might have ~__% carbon monoxide-occupied hemoglobin→That would be normal.
Then if you're in an environment that's abnormal, it probably goes up to about __%
| aka Carboxyhemoglobin
1%
4%
130
Arterial blood has __ mLs of CO2
Venous blood has a CO2 content of ___ mLs
48
52
131
Rank the compounds that chemoreceptors respond to from most to least important?
What about in COPD patients?
#1: H+
#2: PCO2
#3: PO2
In COPD patients --> PO2
COPD pt make the switch of going from looking at the CO2 and protons and managing/adjusting things to being almost entirely reliant on O2 levels as their primary gauge to change up their ventilation because their CO2/protons are chronically elevated
132
How often does an adult sigh per hour?
12-15
133
the junction of the ___ and the ___ is a place where we can have physical separation if you have a really bad brain injury.
pons, medulla
134
What does alpha-1 antitrypsin inhibit?
Neutrophil elastase
| This is a trypsin aka protease aka elastase :)
135
F
136
Why do you sometimes have a larger VT in patients with obstructive lung disease?
because they have increase alveolar dead space
137
Small particles have ___ inertia compared to bigger particles
less
## Footnote
Context: particles in nose such as smoke; So they have a little bit less momentum and typically real small molecules like smoke, they can make that hairpin turn pretty easily.
They don't have the inertia that keeps carrying them to slam into the back of the nose.
138
Muscles above the hyoid are called ___hyoid
Below the hyoid?
Above --> suprahyoid
Below --> inferior hyoid muscle
139
What are the three divisions of CN V?
Opthalmic (V1)
Maxillary (V2)
Mandibular (V3)
| Trigeminal nerve
140
Typically, we have irritant receptors that send messages back towards the brainstem via ___, and sometimes those messages alert us about contaminants in the nose.
V2
141
2 ways to use lateral inhibition to stop a sneeze
2 WAYS TO STOP SNEEZE: DRINK WATER OR PINCH UPPER LIP
142
Which laryngeal nerve is more inferior and goes underneath the aortic arch?
Left laryngeal nerve
143
The inferior laryngeal nerve ends up taking care of ___ of the six sets of laryngeal nerves.
five
## Footnote
The cricothyroid muscle is kind of an oddball in that it's innervated by something else.
144
What innervates the cricothyroid?
What nerve does this one branch off of?
-Superior laryngeal nerve
-Vagus nerve
145
Main nerve used for speaking
Inferior laryngeal nerve
146
The ___ branch of the superior laryngeal nerve is going to give us sensory coverage in our larynx.
**internal**
147
The place where the superior and inferior laryngeal nerve potentially meet is called _____
Galen's anastomosis.
148
Is Galen's anastomosis functional?
No
149
Which hyoid muscles have 3 tendons?
Omohyoid and digastric muscle
150
If we contract the suprahyoid muscles, the hyoid bone is going to move ___
upwards
151
The most similar to apneustic breathing would be _____ breathing
Cheyne-Stokes
152
______ reflex is just the inflation reflex that shuts down inspiration when we get to the planned/target lung volume
Spell it
Hering-Breuer
| involves J-R's
153
With a single lung transplant, which lung empties first?
The good (transplanted) lung is probably going to empty first and the bad lung second
154
Arterial CO2 is always going to be equal or __ than alveolar CO2
higher
## Footnote
For O2, alveolar has to be equal or higher to arterial
For CO2, arterial has to be equal or higher than alveolar
155
What law is important when pertaining to body Plethysmography?
Boyles law
| P1V1 = P2V2
156
What will arterial blood gases look like during consolidated pneumonia?
Arterial PO2 will be decreased, arterial O2 content will be decreased, and arterial PCO2 will be increased.
157
How many aortic bodies sitting on top of the aortic arch?
3-5
158
How many carotid bodies do we have?
2
One on each side of the neck right at the bifurcation of the internal and external carotid arteries.
