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Advanced A&P II > Final Exam - Last Schmidt Lecture > Flashcards

Final Exam - Last Schmidt Lecture Flashcards

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1
Q

List the brief patho of emphysematous lungs:

A
  • Loss of trypsin inhbition leads to loss of alveoli and thinned walls
  • Loss of alveoli also means loss of alveolar capillaries (departitioning)
  • Air becomes trapped in large stretched out alveoli
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2
Q

What is the specific enzyme that is a part of the trypsin protease family that destroys elastic recoli tissue?

A

Neutrophil Elastase

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3
Q

RV is greatly elarged in ephysema, how does this affect the other lung volumes?

A
  • TLC enlarges
  • All other lungs volumes are “squeezed” by the enlarging RV
  • Eventually the IC may only be comprised of Vt (cannot inspire deeply)
  • Vt is larger than normal due to alveolar deadspace (need more volume to overcome deadspace)
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4
Q

What happens to the lung volumes in restrictive lung disease?

A

All volumes are decreased

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5
Q

What does increasing RV in emphysema tell you about disease severity?

A

The larger RV gets, the worse the disease

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6
Q

Where can large particles be caught after inhaling them?

A

They get stuck in the back of the nasopharynx and probably digested in the stomach

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7
Q

Why can’t we filter out smoke through the nose?

A

They have a small mass and therefore a low inertia, so they don’t get slammed into the muscous membranes or hairpin turn at the back of the nose

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8
Q

What causes us to sneeze?

A

Activation of the maxillary division (V2) of the trigeminal nerve containing irritant receptors transmits signals to the brain to sneeze

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9
Q

How can we cause lateral inhibition to stop a sneeze?

A

Manipulate the nearby sensors
1. Drink water
2. Pinching the upper lip

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10
Q

Label the image

A
  1. Vagus Nerve (X)
  2. Left inferior laryngeal nerve
  3. Left recurrent laryngeal nerve
  4. Right inferior laryngeal nerve
  5. Right recurrent laryngeal nerve
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11
Q

Which nerves innervates the laryngeal muscles?

A

Inferior laryngeal nerve - 5/6 muscles
External branch of superior laryngeal nerve - cricothyroid muscle

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12
Q

The superior laryngeal nerve is a branch of what?

A

The vagus nerve

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13
Q

What nerve provides sensory coverage of the larynx?

A

Internal branch of the superior laryngeal nerve

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14
Q

Label the image

A
  1. Cricothyroid muscle
  2. Left Inferior laryngeal nerve
  3. External branch of superior laryngeal nerve
  4. Internal branch of superior laryngeal nerve
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15
Q

What may be difficult if the cricothyroid muscle is contracted?

A

Intubation

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16
Q

Label the image
What is its function?

A

Galen’s anastomosis - where inferior and superior laryngeal nerve meet
No signals are sent between the 2 nerves

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17
Q

What provides sensory innervation to the trachea?

A

Inferior laryngeal nerve (branch of vagus nerve)

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18
Q

Label the image

A
  1. Thyrohyoid membrane
  2. Foramen for internal superior laryngeal nerve
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19
Q

Label the image and their function

A
  1. Superior pharyngeal muscles (4)
  2. Middle pharyngeal muscles (2)
  3. Inferior pharyngeal muscles (2)

Squeeze the upper airway

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20
Q

List the suprahyoid muscles:

A
  • Diagastric muscle; Anterior and posterior bellies
  • Stylohyoid muscle
  • Mylohyoid muscle
  • Geniohyoid muscle
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21
Q

Label the image and what they attach to

A

1a: Diagastric muscle; anterior belly - attaches hyoid to mandible
1b: Diagastric muscle; posterior belly - attaches hyoid to mastoid process
2: Stylohyoid - connects styloid to hyoid
3: Mylohyoid - inside of mandible to hyoid
4: Geniohyoid - nside of mandible to hyoid

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22
Q

How many tendons does the diagastric muscle have?
How does it attach to the hyoid bone?

A
  • 3 tendons
  • Fastened to connective tissue sling that is over intermediate tendon
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23
Q

How can you tell if a human skull is real in an anatomy lab?

A

Real skulls have broken styloid processes almost always

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24
Q

Label the image

A
  1. Geniohyoid
  2. Mylohyoid
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25
Label the image
1. Mylohyoid 2. Diagastric anterior belly 3. Styloid process 4. Mastoid process 5. Diagastric posterior belly 6. Stylohyoid 7. Intermediate tendon of diagastric muscle
26
List the infrahyoid muscles:
- Thyrohyoid - Sternohyoid - Sternothyroid - Omohyoid; superior and inferior belly
27
Label the image
1. Mylohyoid 2. Anterior belly of diagastric 3. Posterior belly of diagastric 4. Stylohyoid 5. Thyrohyoid 6. Sternothyroid 7. Sternohyoid 8. Superior belly of omohyoid 9. Inferior belly of omohyoid
28
What 2 infrahyoid muscles share an attachment point?
Thyrohyoid and sternothyroid - connect at thyroid cartilage
29
What infrahyoid muscle has 3 tendons? Where is its intermediate tendon attached?
Omohyoid Top of the thorax
30
Why do we need all of these hyoid muscles?
* The infrahyoid muscles move the the hyoid down * The suprahyoid muscles pull the hyoid up * Movement of the hyoid causes the larynx to move up and down also
31
Label the image
5: Omohyoid 6: Sternohyoid 7: Sternothyroid 8: Thyrohyoid
32
Which is more anterior, the thyrohyoid or sternohyoid?
Sternohyoid
33
Label the view of each image of the hyoid bone
Top left: Anterior view Top right: Posterior view Bottom: Left lateral view
34
Which horns on the hyoid bone are more anterior and pointed?
Lesser horns
35
What is the breathing pattern called? Description? What causes it?
- Cheyne-Stokes - Varying periods of increasing depth interpersed with apnea - Head injuries
36
What defines bradypnea?
RR less than 10
37
What defines tachypnea?
RR greater than 20
38
What defines hyperventilation?
Rapid/deep ventilation in excess of metabolic needs
39
What is the breathing pattern called? Description? What causes it?
- Kussmaul - Rapid, deep, labored breathing - DKA - body attempting to blow off acid d/t to high levels of non-volatile acids
40
What is the breathing pattern called? Description? What causes it?
- Biot - Irregularly interspersed periods of apnea in a disorganized sequence of breaths - Opioid OD
41
Another term for stretch receptors?
J receptors
42
What is the Hering-Breuer reflex? Problems with this is empysema?
* The inhibition of inspiration via stretch receptors * In emphysema the lungs are always stretched out so these patients will have abnormal inspiration
43
What would you expect the capnograph to look like during hypoventilation?
Slow rate and taller waves (increased CO2)
44
What would you expect the capnograph to look like during hyperventilation?
Rapid rate and stunted waves (low CO2)
45
What would cause a progressive decrease in capnography waveform?
MI resulting in decreased CO → decreased pulmonary BF → decreased CO2 delivery and offloading (more deadspace)
46
What would cause a progressive spike in capnography?
- Increased metabolism → MH - ROSC after CPR
47
What would cause this capnograph waveform?
"Shark fin" - uneven ventilation;bronchospasm
48
What would cause a flat capnograph?
- Esophageal intubation - Self extubation or disconnection
49
List the things that can increase CO2 waveform:
- Fever; increased metabolism - Bicarb infusion; turns into CO2 - Release of turniquet; release of acids into blood - Increased CO/BP (transient); more CO2 delivery - Hypoventilation - MH - Pregnancy
50
When may you see a CO2 waveform like this?
Pregnancy, d/t operating at lower lung volumes
51
What may cause this CO2 waveform?
An awake patient that burps or has carbonation in the stomach
52
What would cause this CO2 waveform
- Single lung transplant - Good lung empties before the bad lung
53
List the things that decrease CO2 waveform:
- Circuit disconnection - Hypothermia; reduced metabolism - MI/reduced CO or BP - PE; decreased pulm BF - Hyperventilation - Alveolar deadspace - Airway obstruction
54
What A-a gradient pattern do you expect with CO2 and O2?
CO2: a > A O2: A > a | Makes sense because gas has to move from higher to lower concentrations
55
What would you expect the pleural pressures to be in the lung for an anesthetized patient that is supine?
The posterior lung would have a more positive pleural pressure d/t gravity The lungs are at very low volumes
56
Where would the highest ventilation and perfusion be in supine anesthetized patient? How can you manage this?
* Ventilation highest in anterior lung bc posterior lungs have *very* little volume and may be closed * Blood flow highest in posterior lung from gravity * **This creates a V/Q mismatch** * Increasing lung volumes and/or PEEP can improve V/Q matching
57
Downsides to using PEEP?
Increased RH strain
58
How do lung volumes change when awake and supine?
FRC goes from 3L to 2L
59
Describe V/Q matching in an awake supine patient?
V/Q matching is pretty good because the lungs are more compliant in the posterior causing ventilation to go there; perfusion is already higher posterior d/t gravity
60
How does being sedated and supine change ventilation?
Lung volumes arent too low and V/Q matching is still adequate
61
What do you need to know about Boyle's Law?
That is states that gas is compressible: P1V1=P2V2
62
What is Dalton's Law?
Pp = [gas] x Ptotal
63
Graham's Law?
Describes rate of diffusion of a gas 1 ÷ √MW gas
64
Fick's Law using diffusivity?
D = solubility ÷ √MW
65
Ohm's Law?
V = I x R ▵P = F x R
66
What is Poiseulles Law?
A change in radius causes a exponential change in flow

Advanced A&P II (23 decks)

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