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BB - Respiratory Review > Final Review - Personalized Pt 1 > Flashcards

Final Review - Personalized Pt 1 Flashcards

1
Q

Adult larynx position

A

3rd - 6th cervical vertebre

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2
Q

larynx position at birth

A

C3-4

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3
Q

Normal A-O extension

A

35 degrees

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4
Q

Prognathism

A

protruding jaw/mandible

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5
Q

Narrowest portion of adult and child airway

A

adult - glotis

child - cricoid ring

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6
Q

cartilages of larynx

3 paired, 3 unpaired

A

paired - arytenoid, corniculate, cuniform

unpaired - epiglottis, thyroid, cricoid

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7
Q

Intrinsic Muscles (2 sets)

A

1 - alters size and shape - aryepliglottic, thyroepiglottic, arytenoid
2 - move true vocal cords

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8
Q

SLN

A

Internal - sensation causes spasm

External - motor innervation of cricothyroid muscle

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9
Q

cricothyroid muscle

A

innervated by external SLN

tensor of VC, elongates

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10
Q

Posterior cricoarytenoid

A

abductor
innervated by RLN
(please come apart)

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11
Q

thyroarytenoid

A

relaxor of VC

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12
Q

RLN

A

innervated all of larynx except cricothyroid muscle

-sensory information for below cords

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13
Q

Tracheal anatomy

A

20-25 c shaped cartilages

C6-T5, divides at T5-7 (~25 cm from teeth)

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14
Q

R mainstem

A

straighter, larger

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15
Q

Conducting Airways

A

anatomical deadspace, ventilation but no perfusion

-last site at terminal bronchiole which has gas no exchange

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16
Q

goblet cells

A

mucous producers, increase with injury

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17
Q

clara cells

A

in small bronchioles that do not have goblet cells, produce watery substance

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18
Q

Type 1 pneumocyte

A

increase surface area
cannot heal quickly
95% of wall

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19
Q

Type 2 pneumocyte

A

secrete surfactant
repairs epithelium
can regenerate to Type 1
usually mature at 24 weeks gestation

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20
Q

surfactant

A

decrease surface tension
prevent alveolar collapse/promotes stability
prevents transudation of fluid into alveoli

-DPPC, hydrophobic and hydrophillic opposing ends

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21
Q

Lung weight

A

1.5% of body weight

1 kg in 70 kg pt

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22
Q

Alveolar surface area

A

70 meters squared internal surface area
40 x external body surface area
short diffusion pathway

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23
Q

Inspiration

A

active phase
phrenic nerve (C3, 4, 5) innervates diaphragm
*negative pressure ventilation

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24
Q

Intercostal Nerves

A

T1-11, send signals to external intercostal muscles

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25
Diaphragm
responsible for 75% of inspiratory effort contraction - downward and forward movement ribs lifted and moved outward *down 1 cm during normal, can but up to 10 cm forced -denervated = paradoxical chest movement
26
External Intercostals
- responsible for 25% respiration - originate from ventral rami of T1-11 - contraction - ribs up and forward - denervated causes feeling of dyspnea
27
Accessory Muscels
-assist forced inspiration scalene muscles - elevated first 2 ribs sternocleidomastoid - raise sternum
28
Expiration
passive | muscles - abdominal and internal intercostals
29
Transpulmonary pressures
pressure different between intrapulmonary and intrapleural
30
Recoil Pressure
elastic forces
31
Lung Pleura
visceral - thin, serosal that envelopes lungs | parietal - lines inner surface of chest wall
32
Pleura Pressure
-5 cm H20 at rest, | during inspiration -7.5
33
FRC
2.5 L | ERV + RV
34
What can spirometry not measure?
RV, so FRC and TLC cannot be determined this way. must use helium dilution or nitrogen washout
35
Compliance reduced
higher or lower lung volumes venous congestion atelectasis or fibrosis
36
Compliance increased
age, emphysema | old socks
37
Is inspiratory and expiratory compliance the same?
no
38
Elastic forces of lung
elastic tissue - elastin and collagen, natural state is coiled surface air-fluid interface - 2/3 of elastic force in lung surfactant
39
Physiological dead space
anatomical + alveolar deadspace | anatomical deadspace = ~30% TV
40
Closing volume
volume of lung at which small airways close CV > FRC, then small airways collapse during normal TV *bernouli
41
Turbulence
directly proportional to density, velocity & resistance
42
Chief site of airway resistance
medium sized bronchi
43
Factors determining airway resistance
lung volume, bronchial smooth muscle & density/viscosty of inspired gas
44
Work, of breathing
W = pressure x volume | -hyperventilation increases o2 cost
45
Minute Ventilation
TV x frequency | amnt of air conducted into lungs per minute
46
Poiseulle's Law
decreased radius by 16% = double resistance | decrease radius by 50% = increase resistance 16 fold
47
Pulmonary circulation
low pressure, low resistance system | PA is thin walled (1/3 thickness of aorta), very compliant
48
Fick's Principle
determining CO, bloodflow through lungs/min
49
Extra-alveolar vessels
"store blood" -not directly affected by lung pressures bronchial vessels - oxygenated blood from systemic circulation (not for gas exchange), 1-2% of CO, empty into LA
50
Capillary Resistance
alveolar network dimensions are not regulated by autonomic or humoral control alveolar capillary walls - contribute 40% of resistance alveolar arterioles - contribute 50% resistance
51
Pulmonary Capillaries
70 ml volume at rest | 200 ml maximal anatomical volume
52
Bronchial Circulation
blood flows at systemic pressures, 1-2% of CO 50% returns via azygos veins rest returns via small anastamosis, normal R-->L shunt
53
Pulmonary Lymphatics
hydrostatic starling forces, ~20 ml/hr
54
Capillary recruitments
opening, increases capillary volume | chief mechanism for fall in PVR
55
capillary distention
expanding, compensates but can lead to lung congestion and heart failure
56
Pulmonary Vascular Resistance
minimal when lung volumes are close to FRC | increased with higher and lower lung volumes
57
Hydrostatic Pressure
zero point - R atrium and middle of lung minimized in supine or prone cause distention and recruitment in lung bases
58
What determines perfusion zones?
relationship between alveoli and blood pressure in pulmonary arteries and veins -hydrostatic pressures, gravity, transmural pressure and lung volume
59
Vasconstrictors
``` increase PVR w/i pulmonary bed reduced PAO2 increased PCO2 thromboxane A2 alpha adrenergic catecholamines histamine ```
60
Vasodilators
``` decrease resistance increased PAO2 nitric oxide prostacyclin beta-adrenergic catecholamines acetylcholine ```
61
Thromboxane A2
vasoconstrictor product of arachidonic acid metabolism produced during acute lung damage half life is seconds, effect is limited
62
Prostacyclin (Prostaglandin I2)
Vasodilator inhibitor of platelet activation product of arachidonic acid metabolism
63
Nitric Oxide
Vasodilator localized effect, short half life smooth muscle relaxation through synthesis of cGMP higher affinity to hgb than oxygen
64
Hypoxic Pulmonary Vasoconstriction
adaptive response, shunts blood away from poorly oxygenated region minimizes shunt
65
Pulmonary HTN
generalized alveolar hypoxia increases PVR, chronic high PVR d/t vasoconstrictor activity causes increased RV work --> RV hypertrophy, tricuspid regurg, cor pulmonae
66
Which portion of lung tends to be better ventilated?
apex
67
normal A-a PO2 difference
10-15 mmHg | larger indicates intrinsic pulmonary disease
68
true anatomical shunts
bronchopulmonary venous anastamosis intracardiac thesbian veins mediastinal veins pleural veins
69
Mechanical Ventilation effects
increases zone 2 | pos-press ventilation can decrease CO or increase VQ mismatch
70
Henry's Law
solubility of a gas in a liquid depends on temperature, partial pressure and nature of solvent and gas
71
When dissolved molecules are attracted by water...
more can be accumulated without building excess pressure, highly soluble
72
How many times more soluble is carbon dioxide than oxygen?
20x
73
What determines rate of net diffusion
difference of partial pressures
74
Vapor pressure when gas is fully humidified?
47 mmHg
75
760 mmHg = __ mmHG air + __ mmHg water
713 mmHg air | 47 mmHg water
76
Factors that effect gas diffusion rates
``` pressure differences gas solubility in fluid area of fluid distance which air must diffuse molecular weight of gas temp of fluid ```
77
Diffusion coefficient
directly proportional to solubility inversely proportional to molecular weight smaller molecules = faster diffusion rate
78
Alveolar air is expired at
end expiration
79
Fick's Law of Diffusion
diffusion of gas through tissue membrane | factors - cross sectional area, driving pressure, gas coefficient and tissue thickness
80
Diffusing capacity of oxygen
21-65 mm/min/mmHg
81
Diffusing capacity of carbon dioxide
400-1200 mm/min/mmHg | *technically not measurable
82
PO2 and PCO2 in deoxygenated blood...
``` PO2 = 40 mmHg PCO2 = 45 mmHg ```
83
PO2 and PCO2 of inspired air....
``` PO2 = 150 mmHg PCO2 = O mmHg ```
84
Physiologic Shunt
VQ below normal, airway obstruction blood not participating in gas exchange Q, no V
85
Physiologic Dead Space
ventilated, not perfused | V, no Q

BB - Respiratory Review (5 decks)

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