Exam 4 - Lecture 7

Question 1

losing blood vessels and alveoli leads to what?

Answer 1

Increased PVR, stressing out the right heart, leading to Right heart failure.

From emphysema

Question 2

Digestive enzyme in lungs thats part of trypsin family?

Answer 2

Protease

Question 3

Name of specific protease enzyme responsible for destruction of lung tissue?

Answer 3

Neutrophil elastase

Question 4

What does a1-antitrypsin specifically inhibit?

Answer 4

Neutrophil elastase

Question 5

what is the main cause of increase of TLC in emphysema?

Answer 5

RV increase

Question 6

What does the increase of RV squeeze?

Answer 6

ERV smaller

Question 7

What else gets squeezed by emphysema at one point?

Answer 7

IRV

Question 8

Eventually, Tidal Volume (Vt) can become butted up against TLC. When this happens, there is no more excess Inspiratory Reserve Volume (IRV) and no excess inspiratory capacity. Inspiratory Capacity (IC) would just be equal to ?

Answer 8

Tidal Volume (Vt)

Question 9

Tidal volume in emphysema is typically? result of?

Answer 9

a little larger than normal; alveolar deadspace

Question 10

what decreases most in restrictive diseases?

Answer 10

RV

Question 11

Small particles, like smoke, have less _____ and low ________

Answer 11

mass; inertia

Question 12

The nose contains ____________ that send messages via the V2 sensory nerve back towards the brainstem.

Answer 12

irritant receptors

Question 13

The larynx and surrounding muscles are primarily innervated by the _______ on each side of the body.

Answer 13

vagus nerve

Question 14

Sensory for the trachea and lungs is basically the ___________specifically via branches of the inferior laryngeal nerve for the trachea.

Answer 14

vagus nerve

Question 15

On the patient’s______ , a portion of the vagus nerve splits off, goes underneath the ___________, and proceeds upward. This initial upward curve is called the left recurrent laryngeal nerve.

Answer 15

left side; aortic arch

Question 16

On the ______, there is similar anatomy, but the recurrence happens at the right subclavian artery, giving rise to the right recurrent laryngeal nerve, which is more around the carotid.

Answer 16

right side; right subclavian artery

Question 17

The inferior laryngeal nerve takes care of ________ of internal laryngeal muscles. These are skeletal muscles under voluntary control, requiring motor neuron innervation.
The sixth laryngeal muscle set, the ________, is innervated by a different nerve that comes down from above. What nerve is that?

Answer 17

five of the six sets; cricothyroid muscle; external branch of superior laryngeal nerve

Question 18

The superior laryngeal nerve has two branches:
The internal branch follows ___________________________________________________. This branch provides ______________. of the larynx. If something gets stuck in the larynx and triggers a cough, this branch is typically providing the signal.
The external branch sits outside the larynx. It comes into contact with the cricothyroid muscle, providing its motor innervation.

Answer 18

an artery and vein and goes through a little opening or foramen in the thyrohyoid membrane; sensory coverage

Question 19

The cricothyroid muscle makes it more difficult to intubate when _________

Answer 19

it is contracted.

Question 20

In many people, the inferior laryngeal nerve and the external branch of the superior laryngeal nerve meet and combine. This connection is called

Answer 20

Galen’s Anastomosis

Question 21

The opening for the internal branch of the superior laryngeal nerve and blood vessels is in the _________, which is above the thyroid cartilage and contacts ______________

Answer 21

thyrohyoid membrane; the bottom of the hyoid bone.

Question 22

There are _______ sets of pharyngeal constrictors wrapped around the larynx and upper airway areas. These are the ?

Answer 22

three; superior, middle, and inferior constrictors.

Question 23

While the superior set could be broken down into _ muscles, and the middle and inferior into _ each (totaling _), the lecture does not go into the individual muscle names. They are simply referred to as sets of pharyngeal constrictors or upper airway constrictors.

Answer 23

4; 2; 8

Question 24

These muscles are located above the hyoid bone and connected to structures above it, usually the jaw or skull.

Answer 24

Suprahyoid Muscles

Question 25

There are _____ suprahyoid muscles total, one of which has _____ parts.

Answer 25

4; 2

Question 26

This is an odd muscle with two muscular parts (bellies).

Answer 26

Digastric muscle

Question 27

digagastric has _____ tendons? whats the middle one called? others?

Answer 27

3; intermediate tendon; The parts are the anterior belly (1a) and the posterior belly (1b).

Question 28

The anterior belly helps fasten the?

Answer 28

hyoid bone to the mandible.

Question 29

The posterior belly connects the

Answer 29

hyoid bone to the mastoid process (behind the ear).

Question 30

Stylohyoid muscle (Muscle #2):

Answer 30

Attaches the hyoid bone to the styloid process.

Question 31

Mylohyoid muscle (Muscle #3):

Answer 31

Located at the base of the floor of the mouth. Attaches the inside of the mandible to the top part of the hyoid bone.

Question 32

Geniohyoid muscle (Muscle #4):

Answer 32

A large muscle running in the midline at the floor of the mouth. Attaches the front of the mandible to the middle part of the top of the hyoid bone.

Question 33

Contracting the suprahyoid muscles would bring the hyoid bone

Answer 33

up

Question 34

There are ______infrahyoid muscles total, one of which has two parts.

Answer 34

four

Question 35

Omohyoid muscle (Muscle #5):

Answer 35

Another muscle with two parts (bellies) and three tendons. It has a superior belly and an inferior belly, connected by an intermediate tendon. The intermediate tendon is typically tied down to an attachment point at the top of the thorax, possibly the clavicle (professor was unsure but thought clavicle). Connects the hyoid bone to this attachment point on the thorax. It is tied down by a loop or clamp similar to the digastric.

Question 36

Sternohyoid muscle (Muscle #6): Connects the hyoid bone to the sternu

Answer 36

Sternohyoid muscle (Muscle #6): Connects the hyoid bone to the sternum

Question 37

Sternothyroid muscle (Muscle #7):

Answer 37

Connects the sternum to the thyroid cartilage. It attaches to the same place on the thyroid cartilage as the thyrohyoid muscle but extends down to the sternum.

Question 38

Thyrohyoid muscle (Muscle #8):

Answer 38

A small muscle connecting the hyoid bone to the thyroid cartilage.

Question 39

Hyoid Bone The thick middle part is called the

Answer 39

body.

Question 40

There are two horns on each side of hyoid: The _______ horn (small horns in front that project upward). The _________ horn (posterior horns at the back).

Answer 40

lesser; greater

Question 41

hyoid bone: Muscles likely attach to the

Answer 41

horns and the body.

Question 42

Cheyne-Stokes breathing:

Answer 42

Periodic bursts of inspirations that progressively get larger, then slow down, followed by a period of apnea, and then the cycle repeats. It is similar to apneustic breathing but different. Oftentimes seen in people with brain damage or blunt force trauma.

Question 43

Biot breathing (BiOT):

Answer 43

Irregularly interspersed breathing that is much lower than the normal rate and depth and totally irregular. Characterized by a couple of breaths, then a pause, then one breath, another pause, three breaths, etc.. Seen in opiate overdose.

Question 44

Bradypnea:

Answer 44

Abnormally slow breathing, probably slower than about 10 breaths per minute.

Question 45

Tachypnea:

Answer 45

Rapid breathing, faster than 20 breaths per minute.

Question 46

Hyperventilation (Hyperpnea):

Answer 46

Defined as ventilation that is an excess of metabolic requirements. It is possible to have tachypnea that is not hyperventilation if the breaths are shallow and only meet metabolic needs.

Question 47

Kussmaul breathing:

Answer 47

Rapid, deep, labored breathing. Typically a form of hyperventilation. A result of Diabetic Ketoacidosis (DKA). The body's response to try to buffer the acids being produced by blowing off CO2. The brainstem tries to get rid of CO2, but it cannot get rid of non-volatile acids this way, so the rapid, deep breathing continues. Typically, Kussmaul breathing is not as risky as simple hyperventilation (e.g., from nervousness) in terms of causing the patient to pass out, as there is usually an underlying acidosis.

Question 48

Stretch receptors in the lungs are also known as

Answer 48

J-Receptors (J-R's).

Question 49

If the lungs are always stretched out (e.g., in emphysema), the sensors can behave

Answer 49

abnormally, potentially leading to abnormal breathing patterns.

Question 50

The reflex of shutting down inspiration as the lung gets full via J-R's is called the __________________. This reflex limits further air from being brought in.

Answer 50

Hering-Breuer Reflex or the Inflation reflex.

Question 51

Hypoventilation cap:

Answer 51

Expect elevated capnograph waveforms (higher than normal). The shape is typically normal.

Question 52

Hyperventilation cap:

Answer 52

Ventilation in excess of what's needed. Results in lower PCO2 levels in the blood and lower alveolar CO2. Expect lower capnograph waveforms than normal. It is common to somewhat hyperventilate patients in the OR.

Question 53

The first warning sign of MH is an _______ This is due to the drastically increased metabolism, which also leads to overheating (hyperthermia).

Answer 53

abrupt spike in end-tidal PCO2.

Question 54

Bronchospasm cap:

Answer 54

Can result in a shark fin pattern on the waveform.

Question 55

cap waveform for Bicarb infusion and why

Answer 55

Bicarbonate can turn into CO2, increased waveform.

Question 56

Pregnancy cap

Answer 56

: The body produces more CO2 (breathing for two); waveform is typically elevated even if respiratory rate/depth is slightly increased. Sometimes, there is an extra "blip" at the end of the plateau, potentially due to lower lung volumes. important to note that pregancy also causes metabolic ALKALOSIS

Question 57

Arterial CO2 is always going to be _________ than alveolar CO2.

Answer 57

equal to or higher

Question 58

Alveolar O2 will always be _______ than arterial O2.

Answer 58

equal to or higher

Question 59

When on your back, lung volume drops to about __ compared to about __ when upright. The very low lung volumes causing V/Q mismatch are even lower than this 2L supine volume, potentially below RV.

Answer 59

2L; 3L

Question 60

_______ is one method used to determine RV or FRC by measuring the concentration of helium in exhaled air after breathing a known mixture.

Answer 60

helium dilution

Question 61

Boyle's law states that gas is _______, and Volume and pressure are ________ related. what device works on this principle?

Answer 61

compressible; inversely; air compressors

Question 62

Poiseuille's Law:

Answer 62

Relates pressure drop (Delta P) to flow (V or F) and resistance (R). Describes how resistance is heavily influenced by the radius of a tube. For every 1 reduction in radius, resistance is increased to the 4th power. If radius is cut in half, resistance increases by 16x; if radius is doubled, resistance decreases 16x; if radius is tripled, resistance decreases 81x. The lecture phrasing was Delta P = VR1, but the explanation focused on the radius-resistance relationship.

Question 63

Fick's Law of Diffusion:

Answer 63

Describes the rate of gas diffusion across a barrier based on factors like Area, Diffusivity, Partial Pressure difference, and Thickness (Rate = Area x Diffusivity x DeltaP / Thickness). Fick's equation for Cardiac Output (CO) is related: CO = VO2 / (Arterial O2 - Mixed Venous O2 difference, or A-V).

Question 64

Ohm's Law:

Answer 64

Relates flow, resistance, and pressure/voltages (Delta P = F x R). Used to describe flow, resistance, and voltages.

Question 65

Dalton's Law:

Answer 65

The total pressure of a gas mixture is the sum of the partial pressures of the individual gases. The partial pressure of a gas equals its concentration times the total pressure (PPgas = [gas] x Ptot).

Question 66

Graham's Law:

Answer 66

States that if gases have similar solubility, their movement (diffusion or effusion) is entirely dictated by the size of the gas molecules. The rate of diffusion of a gas is inversely proportional to the square root of its molecular weight (MW). For gases with identical solubilities but different sizes, the smaller gas moves faster and the larger gas moves slower. The square root of MW is used to compare their movement.