Final Flashcards
(184 cards)
1
Q
where is the larynx located in an adult
A
anterior to 3rd to 6th vertebre
2
Q
where is the larynx located at birth
A
c3-c4
3
Q
A-O extension is usually
A
35 degrees
4
Q
MP Class 1
A
full view of uvula and tonsillar pillars, soft palate
5
Q
MP Class 2
A
partial view of uvula or uvular base, partial view of tonsils, soft palate
6
Q
MP Class 3
A
soft palate only
7
Q
MP class 4
A
hard palate only
8
Q
MP status is based on
A
size of tongue and pharyngeal structures visible on mouth opening
9
Q
what does the sphenopalatine ganglion (middle division of CN V) innervate
A
nasal mucosa, superior pharynx, uvula, tonsils
10
Q
what does the Glossopharyngeal nerve (CN IX) innervate
A
lingual back 1/3, pharyngeal, tonsillar nerves - pray pharynx, supraglottic region
11
Q
what does the internal branch of the SLN (CNX) innervate
A
mucous membrane above the VC’s, glottis
12
Q
what does the recurrent laryngeal nerve innervate (CNX)
A
trachea below VC’s
13
Q
SLN divides into two nerves:
A
Internal and external SLN
14
Q
Internal SLN function
A
provides sensation to supraglottic and ventricle compartment
15
Q
stimulation of the ____ causes laryngospasm
A
internal SLN
16
Q
External SLN function
A
provides motor innervation of cricothyroid membrane
17
Q
left RLN passes at
A
aortic arch
18
Q
RLN sensory =
A
sensory innervation to infra glottis (below the cords)
19
Q
two nerves of larynx
A
SLN and RLN
20
Q
does RLN provide sensory, motor, or both?
A
both!
21
Q
RLN motor
A
innervates all larynx except cricothyroid
22
Q
stimulation of RLN causes ___ of VC
A
ABduction of VC
23
Q
damage to RLN causes ___ of VC
A
ADduction
24
Q
at what level does the trachea divide
A
carina T5-T7
25
trachea extends from
c6 to t5
26
where does gas exchange begin
respiratory bronchiole
27
which nerve transmits motor stimulation to diaphragm
phrenic - c3,4,5
28
which nerves send signals to the external intercostal muscles?
intercostal nerves T1-11
29
the act of inhaling is
negative pressure ventilation
30
TLC =
IRV+TV+ERV+RV
31
VC =
IRV + TV + ERV
32
*FRC*=
* ERV + RV *
33
IC =
TV + IRV
34
spirometry cannot measure___ so which two capacities cannot be determined using spirometry alone?
residual volume. FRC/TLC
35
3 ways to measure FRC and TLC directly
helium dilution, nitrogen washout, body plethysmography
36
flow volume loops
.
37
FEV1
.
38
which part of flow volume loop is effort dependent
.
39
fixed obstruction
.
40
extra thoracic obstruction
.
41
intra thoracic obstruction
.
42
surfactant lowers ___ of alveoli and lung
surface tension
43
poisueille's law describes
resistance of flow in a tube
44
poisueille's law - resistance is proportional to
length and viscosity
45
poisueille's law - resistance is inversely proportional to
*radius*
46
*poisueille's law reducing r by 16% will ___ the R
double
47
*poisueille's law reducing r by 50% will
increase R 16-fold
48
what are the two mechanisms for the decrease in PVR that occurs as vascular pressures are raised
recruitment and distension
49
recruitment is
opening closed segments to increase capillary volume
50
functional capillary volume is ___ at rest, and ___ at maximal anatomical volume
70, 200
51
total capillary surface area almost always equals
alveolar surface area
52
__ % of alveolar surface area is covered by capillary bed
70-80
53
zone 1 pressures
PA > Pa > PV
54
zone 2 pressures
Pa> PA> PV
55
zone 3 pressures
Pa > PV > PA
56
as you go from zone 1 to zone 3 of the lung, v/q mismatch
decreases
57
reduced PAO2 causes pulm vaso___
constriction
58
increased PCO2 causes pulm vaso___
dilation
59
histamine causes pulm vaso ___
constriction
60
increased PA02 causes pulm vaso ___
dilation
61
nitric oxide causes pulm vaso ___
dilation
62
thromboxane, a-adrenergic catecholamines, angiotensin, prostaglandins, neuropeptides, leukotrienes, serotonin, endothelin, norepinephrine cause pulm vaso ___
constriction
63
prostacyclin, B-adrenergic catecholamines, acetylcholine, bradykinin, dopamine, isoproterenol cause pulm vaso___
dilation
64
what causes hypoxic pulmonary vasoconstriction
alveolar hypoxia
65
HPV is a ___ response of pulm arterioles
localized
66
HPV is enhanced by what two things
hypercapnia and acidosis
67
how does HPV balance v/q ratio
shifts flow to better ventilated pulmonary regions
68
normal alveolar PO2 is ___mmhg
100
69
normal alveolar pCO2 is ___mmhg
40
70
alveolar PCO2 increases in proportion to CO2 ___
excretion
71
PCO2 decreases in inverse to
alveolar ventilation
72
normal CO2 production at rest is ____ ml/min
200 ml/ min
73
alveolar air is expired at
end-exhalation
74
ficks law describes
diffusion of gas thru a tissue membrane
75
diffusion is proportional to
cross sectional area, partial pressure difference, gas coefficient
76
diffusion is inversely proportional to
tissue thickness
77
PVO2 =
40mmHg
78
PVCO2 =
46 mmhg
79
PACO2 =
40 mmhg
80
PaO2 =
100 mmHg
81
PaCO2 =
40 mmHg
82
physiologic shunt - V/Q is __ normal
below
83
shunt = ___ perfusion, ___ ventilation
adequate perfusion, no ventilation
84
the greater the shunt,
the greater the amt of blood fails to be oxygenated in the lungs
85
physiologic dead space. V/q is ___ normal
above
86
dead space = ___ ventilation and ___ perfusion
adequate ventilation, no perfusion
87
physiologic dead space includes
wasted ventilation and anatomical dead space.
88
rough rule - PaO2 40,50,60 for sat
70 80 90
89
hb P50 point
sat is 50 , paO2 is 27
90
when sat is 75 , paO2 is
40 (mixed venous blood in PA)
91
which is more detrimental to O2 transport: change in shape or change in position of HbO2 equilibrium curve?
shape
92
Hb curve to the right __ affinity for O2
decreases
93
Hb curve to the left __ affinity for O2
increases
94
how does increase in H+ affect HbO2 curve
shift right
95
how does increase in PCO2 affect HbO2 curve
shift right
96
how does increase in temp affect HbO2 curve
shift right
97
how does increase in 2,3, DPG affect HbO2 curve
shift right
98
how does decrease in PCO2 affect HbO2 curve
shift left
99
right shift, ___ O2
release
100
left shift, ___ O2
"loves" (higher affinity)
101
Bohr effect causes shift of curve to the
right
102
O2 content in blood (CaO2) formula
CaO2 = (SO2 x hb x 1.31) + (PO2 x 0.003) see slide 44
103
DO2 (oxygen delivery) =
CaO2 x CO
104
most CO2 is transported as
bicarbonate (HCO3)
105
DRG controls what two things
inspiration and respiratory rhythm
106
which 2 nerves reliever sensory info to the DRG
vagal (X) and glossopharyngeal (IX)
107
DRG receives signals from three sources:
peripheral chemoreceptors, baroreceptors
108
chemosensitive area of the brain - where is it located
ventral medulla surface
109
chemosensitive area of the brain is sensitive to changes in
PCO2 or H ion concentration
110
CO2 is highly permeable to BBB so....
blood and brain concentrations are equal
111
ventilation is greatly increased with blood PCO2 above
35 mmHG
112
change in respiration due to CO2 is 10 times less with blood Ph range between
7.3 and 7.5
113
peripheral chemoreceptors are found in
carotid and aortic bodies
114
chemoreceptors are sensitive to PaO2 from __ to ___ mmhg
60 to 30
115
high risk FEV1
<2L
116
high risk FEV1/FVC
<0.5
117
high risk VC
<15cc/kg in adult and <10cc/kg in child
118
high risk VC percentage
< 40 to 50% than predicted
119
intubation criteria: resp rate
>35
120
intubation criteria: MIF
more neg than -20cmH20
121
intubation criteria: PaO2
<70 on FiO2 of 40%
122
intubation criteria: A-a gradient
>350mmhg on 100% O2
123
intubation criteria: PaCo2
>55
124
intubation criteria: vd/vt
> 0.6
125
intubation criteria: clinical signs
airway burn, chemical burn, epiglottis, mental status change, rapidly deteriorating pulmonary status, fatigue
126
extubation criteria: resp rate
<30
127
extubation criteria: PaO2 and PaCO2
paO2 >70, PaCO2 <55
128
extubation criteria: MIF
more negative than -20
129
extubation criteria: vital capacity
>15 cc/kg
130
*an increase of Pco2 by 10mmhg causes a ___ in pH by ___
decrease 0.08
131
* a decrease of Pco2 by 10mmhg will ___ pH by ___
increase 0.08
132
A-a gradient measures
efficiency of lung
133
normal A-a is approx
age/3
134
A-a gradient is ___ with hypoventilation or low Fio2
normal
135
* a decrease in bicarb by 10 __ the ph by ___
decreases 0.15
136
* an increase in bicarb by 10 __ the ph by ___
increases 0.15
137
total body bicarb deficit =
base deficit x wt in kg x 0.4. usually replace half of deficit
138
infrared is ___nm
940 (100% sat)
139
infrared is for
oxyhemoglobin
140
red is ___nm
660
141
red is for
deoxyhemoglobin (50% sat)
142
if someone has carboxyhemoglobin, what will their pulse ox show?
100%
143
if someone has methemoglobinemia what will their pulse ox show
85%
144
what causes methemoglobinemia
nitrates, nitrites, sulfonamides, benzocaine, nitroglycerine, nitroprusside
145
how do you treat methemoglobinemia
low dose methylene blue or absorbic acid
146
capnography reliably indicates ____ intubation but does not reliably detect ___ intubation
esophageal, endobronchial
147
capnograph: A-B
beginnning exhalation, dead space gas
148
capnograph: B-C
exhalation , mixing of gases
149
capnograph: C-D
alveolar plateau, alveolar rich gas
150
capnograph: D
highest CO2
151
capnograph: DE
start inspiration
152
in the awake and lateral position, the ____ lung is better perfused and ventilated
dependent
153
positive pressure ventilation favors the ___ lung because it is more compliant
upper
154
muscle paralysis, rigid bean bag, and open ptx all favor the ___ lung
upper
155
factors that inhibit HPV: pulm artery pressures
very high or very low
156
factors that inhibit HPV: ____capnia
hypocapnia
157
factors that inhibit HPV: vaso___
dilators - nitroglycerin, nitroprusside, B-adrenergic agonists (dobutamine), CCB's
158
inhalation agents ___ hypoxic pulmonary vasoconstriction
inhibit
159
pulmonary infections ___ hypoxic pulmonary vasoconstriction
inhibit
160
in one lung ventilation, add 5cm ___ to nondependent lung, and 5cm ___ to dependent lung
CPAP, PEEP
161
first and most sensitive sign of MH
unexplained tachycardia
162
most specific sign of MH
increasing EtCO2, hypercapnia 2-3x
163
MH will show an initial ___ then a combined ___
metabolic acidosis then combined metabolic and resp acidosis
164
what age has the highest MAC requirement
term infant to 6 months
165
hyperthermia ___ MAC
increases
166
chronic ETOH abuse ___ MAC
increases
167
hypernatremia __ MAC
increases
168
for every 1 deg C drop in body temp, MAC decreases by
2-5%
169
pregnancy ___ MAC
decreases
170
lithium ___ MAC
decreases
171
alpha 2 agonists and CCB's ___ MAC
decrease
172
hyperthyroid or hypothyroid affect on MAC
none
173
4 things no affect on MAC
duration of anesthesia, gender, K, hypo/hyper carbia
174
second gas effect
the ability of a large volume uptake of a first gas (nitrous) to accelerate the rate of rise of the alveolar partial pressure of a concurrently administered companion gas (agent) thus speeding induction
175
what does nicotine stimulate
sympathetic ganglia, catecholamines released from adrenal medulla increasing HR, BP, and SVR
176
nicotine stimulation persists for
30 min after last cigg
177
advise smoking at least ___ hours prior to surgery
12
178
airway reactivity decreases after __ days of cessation and is near the level of a nonsmoker after __ days of cessation
2, 10
179
cessation of > __ weeks will reduce post-op pulm complications
8
180
cessation of __years reduces risk of MI to that of non-smoking population
2
181
vent adjustment for severe emphysema
requires longer exp times (normal I:E is 1:2, so in COPD 1:3)
182
a rapid correction of CO2 in someone who is a chronic retainer will cause
metabolic alkalosis
183
which two gases cause airway stimulation with light anesthesia
des and iso
184
bronchospasm - avoid ___ releasing drugs such as
histamine - pentothal, morphine, atracurium, mivacurium, neostigmine.
