Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CVT > Module 8: Resp. A&P > Flashcards

Module 8: Resp. A&P Flashcards

1
Q

Airway

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Larynx 9 cartilages

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Larynx and Vocal Cords

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nerve supply to the larynx

  1. Superior and inferior laryngeal nerves (branches of the cranial nerve ______)
  2. The superior laryngeal nerve arises from the ganglion of the vagus and divides into:
  3. ___________ segment gives a branch to the inferior constrictor muscle of the pharynx & the cricothyroid muscle. It _____ or _____ tension of vocal cords. Damage results in ________.
  4. _______ segment enters the larynx, provides sensation from the laryngeal side of the epiglottis down to the true vocal cords. Damage = ____________.
A
  1. X
  2. 2 branches, the external and the internal.
  3. External, lengthens or increases; hoarseness
  4. Internal; difficulty phonating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nerve supply

  1. The inferior or recurrent laryngeal nerves – arise from the _________ nerve at 2 different levels.
  2. _______ nerve descends with the vagus and loops around the arch of the aorta to the neck.
  3. ______ nerve travels with the vagus to the subclavian artery, loops around the subclavian up to the neck.
  4. Damage to the recurrent laryngeal nerve during surgery can lead to unilateral or bilateral vocal cord paralysis with _______ or _______.
  5. Blood supply to the larynx is from the _____________(branch of the ____________) and also the _________ (branch of the ___________).
A
  1. vagus
  2. Left
  3. Right
  4. hoarseness or dyspnea
  5. superior thyroid artery (external carotid artery); inferior thyroid artery (thyrocervical trunk).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Trachea

  1. Lined with __________________ and extends from the inferior larynx to the carina.
  2. Distance from your incisors to the carina is _______ cm (or roughly _____ inches)
  3. Diameter is ______ cm
  4. Not a fixed structure
  5. Bifurcates into 2 main bronchi
  6. Blood supply is from the _____________.
A
  1. pseudo stratified ciliated columnar epithelium
  2. 26 ; 10.4
  3. 2.5
  4. inferior thyroid artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bronchi

  1. Cellular structure begins to change at this level
  2. From ________ to ___________.
  3. From the carina, the bronchi branch off slightly at different angles.
A
  1. columnar to cuboidal epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Right Bronchus

  1. Takes off at _________ degrees from trachea
  2. Mainstem is ______ and _______ than the left.
  3. Nearly _________ as compared to the left
  4. Divides into _______ lobar bronchi
  5. Mainstem bronchus ends ___________ cm from the carina and gives rise to the RUL bronchus
  6. After the RUL takeoff, main bronchus continues into _________ cm as the bronchus intermedius then divides into the middle and lower lobes
A
  1. 25
  2. wider; shorter (2cm)
  3. vertical
  4. 3
  5. 2 - 2.5
  6. 3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Left Bronchus

  1. Takes off at _______ degrees
  2. Left mainstem is _______ cm
  3. Divides into _______ lobar bronchi
  4. The left main bronchus is _______ cm long and terminates by bifurcation into the left _______ lobe bronchus and the left _______ lobe bronchus.
  5. The left ____ lobe bronchus divides into halves, and upper half and a lower half (lingular branch)
A
  1. 45
  2. 4
  3. 2
  4. 4; upper; lower
  5. upper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lung lobes and segments

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lung lobes and segments

  1. Each division is referred to as a generation. ___________ is the first generation.
  2. Third generation is called the ____________. Delivery of ventilation to the various bronchopulmonary segments of the lung.
  3. __________ segments create distinct units.
  4. _____-_____ generations before the alveoli
  5. __________ are the last structure perfused by the bronchial circulation and are at the end of the conducting airways.
  6. Terminal lead to _____________ that are perfused by pulmonary circulation .
A
  1. Mainstem bronchi
  2. segmental bronchi
  3. Bronchopulmonary
  4. 20-25
  5. Terminal bronchioles
  6. respiratory bronchioles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Transitional airways

  1. The _________ follows the terminal bronchiole and is the first site where gas exchange occurs.
  2. In adults, ___-___ generations of respiratory bronchioles lead to alveolar ducts, of which ___-___ generations, each with multiple openings into alveolar sacs.
  3. The final divisions of alveolar ducts terminate in _________ that open into alveolar clusters.
A
  1. respiratory bronchiole
  2. 2 - 3 ; 4 - 5
  3. alveolar sacs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Section of lung showing many alveoli and a small bronchiole. The pulmonary capillaries run in the walls of the alveoli.
The holes in the alveolar walls are the ________. They function as a means of collateral ventilation; that is, if the lung is partially deflated, ventilation can occur to some extent through these pores. They also allow air to pass through, this provides collateral ventilation and even distribution of air to the alveoli. They equalize the pressure in adjacent alveoli and thus play an important role in prevention of collapse of lung.

A

pores of Kohn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Respiratory airways and alveolar-capillary membrane

Two primary functions:

A
  1. Transport of respiratory gases (oxygen & carbon dioxide).
  2. Production of a wide variety of local and humoral substances.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Respiratory Zone

  1. The respiratory zone is comprised of the:
  2. The respiratory zone is where:
A
  1. Respiratory bronchioles
    Alveolar ducts
    Sacs
    Alveoli
    1. Gas exchange occurs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Respiratory airways

  1. Gas transport is facilitated by the __________.
  2. These are the ________ capillary networks in the body.
  3. There are 3 types of alveolar cells – Type I, II and III.

Type I –

Type II –

Type III –

A
  1. pulmonary capillary beds
  2. densest

I - flattened, squamous cells, which covers ~80% of the
alveolar surface

II - polygonal cells have vast metabolic and
enzymatic activity and manufacture
surfactant.

III - alveolar macrophages, which are important to
immunologic lung defense. Permit ingestion
of foreign materials within alveolar spaces.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Two major circulatory systems supply blood
to the lungs:

A
  1. Pulmonary vascular networks
  2. Bronchial vascular networks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pulmonary Vascular system

  1. Delivers ____________ from the right ventricle to the pulmonary capillary bed via two pulmonary arteries.
  2. After gas exchange occurs, oxygenated blood returns to the left atrium via four pulmonary veins.
  3. Pulmonary veins run independently along the ________ planes.
  4. The pulmonary capillary system adequately provides the metabolic and oxygen needs of the ____________.
A
  1. mixed venous blood
  3. intra-lobar connective tissue
  4. alveolar parenchyma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Bronchial Vascular System

  1. Provides oxygen to the:
  2. Anatomic connections between the bronchial and pulmonary venous circulations create an absolute shunt of ~____-____ % of the total cardiac output, and represents a “normal” shunt.
A
  1. conductive airways and pulmonary vessels.
  2. 2 – 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Location and Contents

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pleura

  1. _________ lines the thoracic wall and lungs.
  2. The parietal pleura attaches to the ________,_______, and ___________.
  3. Reflected back to cover the lungs and thereafter referred to as the ___________.
  4. Closely opposed with a thin layer of pleural fluid in between them, a potential space, known as the ___________.
A
  1. Serous membrane
  2. chest wall, diaphragm and mediastinum.
  3. visceral pleura
  4. pleural space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pleura

  1. An accumulation of air in the _________ is referred to as a pneumothorax.
  2. ____________ – inspired air accumulates in the pleural space and is not expelled.
  3. The elastic recoil of the lung tends to favor lung collapse once the negative pressure of the pleural space is disrupted by the breach.
A
  1. Pleural space
  2. Tension pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lung Mechanics

  1. The ______ and _________ are the muscles that contract during normal breathing (eupnea).
  2. Contraction of the muscles of inspiration ______ intrathoracic pressure → the volume of thoracic cavity to ________.
  3. Boyle’s law: ↑ volume creates ↓ pressure.
  4. This causes air to enter the atmosphere.
  5. Spontaneous respiration is ________ movement of gas.
A
  1. diaphragm and external intercostals
  2. ↓; ↑
  3. -
  5. passive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
# Mechanics of Breathing 1. Each half of the diaphragm is innervated by a branch of the phrenic nerve arising from _____,_____,____(“keeps me alive!”) 1. Eupneic expiration results from passive recoil of the chest wall. _______________ may be used to augment exhalation. (Signs of respiratory distress) 1. During forced exhalation (coughing), the ________ may be used. 1. Sternocleidomastoid and scalene muscles contract in conjunction with the diagram and intercostal muscles for _____________. (Alternatively, they can be used for __________ per your textbook!)
1. C 3, 4 and 5 2. Internal intercostal muscles 3. abdominal muscles 4. forceful exhalation; forceful inhalation,
26
# Lung mechanics 1. Lung movement occurs secondary to __________. 1. During spontaneous ventilation, external forces are produced by the _________.. 1. The response to the lungs to these forces is governed by:
1. external forces. 2. ventilatory muscles 3. - ease of elastic recoil of the chest wall - resistance to gas flow within the airways
27
# Mechanics of Ventilation: Elastic Resistance 1. ________ has a tendency to expand outward. 1. _________ have a tendency to collapse. 1. As a result, __________ pressure is ________. 1. Because the outward force of the thoracic cage _______ the inward force of the lung, the overall tendency is for the lungs to remain inflated.
1. Chest 1. Lungs 1. Intrapleural; negative 1. Exceeds
28
# Elastic work 1. FRC (functional residual capacity) represents the gas volume in the lungs when the outward and inward forces on the lung are _______. 1. FRC is defined as the volume of air remaining in the lung at the end of a ____________. 1. Gravitational forces create a more sub-atmospheric pressure in the ________ areas of the lung than the _______ areas of the lung. 1. A ___________ allows lung to collapse and thorax to spring out.
1. equal 2. normal expiration 3. nondependent; dependent 4. pneumothorax
29
# Mechanics of Ventilation 1. ________ forces occur at an air-fluid interface 1. Produces forces that reduce the area of the ________. 1. Favor alveolar ___________. 1. Gas-fluid interface lining the alveoli  behave like bubbles. For a bubble to remain inflated, the gas pressure within a bubble, which is contained by surface tension must be ↑ than surrounding gas pressure.
1. Surface tension 2. interface 3. collapse
30
# Mechanics of Ventilation 1. Unlike a bubble, alveolar gas communicates with the atmosphere via airways 1. As alveolar radius decreases during exhalation, Law of Laplace's (P = 2T/r) is satisfied and the alveoli do not _______. 1. Pressure = EQUATION? 1. Pressure = inside the bubble (alveolus) ## Footnote Alveolar collapse 1. directly proportional to 1. inversely proportional to
1. - 2. collapse 3. P = 2 x Surface Tension of the liquid/ Radius of the bubble 4. ## Footnote 1. surface tension 2. alveolar size
31
# Mechanics of Ventilation: Elastic Resistance 1. Surface tension of the liquid in the lung : * Increases during ________ * Decreases during ________ ## Footnote 1. Unlike a bubble, pressure within the alveolus ___________ as the radius decreases 1. Creates gas flow from larger to smaller alveoli 1. Maintains structural stability and prevents lung collapse
1. * Increases during inspiration * Decreases during expiration ## Footnote 1. decreases 2.
32
# Mechanics of Ventilation: Elastic Resistance 1. Pulmonary Surfactant ___________ alveolar surface tension; directly proportional to its concentration within the alveolus 1. The smaller the alveolus, the more __________ the surfactant, and the more effectively surface tension is _______. 1. Over distended alveoli surfactant is less concentrated and surface tension ________. 1. Net effect is to stabilize alveoli. Small ones prevented from collapsing and large ones prevented from getting larger.
1. decreases 2. concentrated; reduced; increases
33
# Physiologic Work of Breathing 1. ________ is defined as the work required to overcome the elastic recoil of the pulmonary system. This occurs during ________ as expiration is passive during normal breathing. 1. _______ is defined as work to overcome resistance to gas flow in the airway and includes equipment-imposed resistance such as the endotracheal tube (ETT).
1. Elastic work; inspiration 2. Resistive work;
34
# Mechanics of Ventilation: Compliance (CL) 1. Defined as: 1. ____________ – is the pressure-volume relationship for a lung when the air is not moving. (e.g., fibrosis, obesity, vascular engorgement, edema, ARDS, external compression, etc.) 1. Static compliance can be increased by _______ which destroys the elasticity of lung tissue (e.g., problem with ______, not _______). 1. Compliance changes as lung volume changes. It is _________ dependent. ___________ compliant at both very high or very low volumes.
1. The change in volume divided by the change in pressure V/P 2. Static compliance 3. emphysema (deflation; inflation 4. volume; Less
35
# Mechanics of Ventilation: Compliance (CL) 1. **Sum of the pressure-volume relationships of the _____ and _______  (∆V/∆P) ** 2. Results in a sigmoidal pressure-volume curve (compliance curve) * Vertical line at end expiration ---> ________ * Normally breathe on the ________ part of sigmoidal curve * Where compliance (∆V/∆P) or slope is ________ 3. **Restrictive pulmonary disease** (↓ compliance) * curve shifts to the ________ * _______ slope, * or both * Results in smaller FRC 4. **↓ Compliance ** * Larger changes in ____________ needed to create the same TV * Expend more _______ to get the same volume into the lungs * Tend to breathe more ____ and _____ * ___________ will increase TV and slow RR
1. thorax and lung 2. - FRC. - steepest - highest 3. - right - decreased 4. - intrapleural pressure - elastic work - rapid and shallow - CPAP
36
# Mechanics of Ventilation: Elastic Resistance 1. Reduced compliance: (4) 1. Increased compliance (2)
1. * Increase in fibrous tissue in the lung (pulmonary fibrosis) * Alveolar edema (prevents inflation of some alveoli) * Unventilated lung for a long period * Increased pulmonary venous pressure 2. * Pulmonary emphysema * Normal aging lung
37
# Mechanics of Ventilation: Elastic Resistance 1. Chest Wall Compliance (~ ________ ml/cm H2O) CW = 1. Total compliance of lung and chest wall together ~_______ ml/cm H2O 1. When the patient lies supine, then chest wall compliance _______ and the weight of abdominal contents against the diaphragm.
1. 200 2. 100 3. reduced
38
# Resistance to Gas Flow Patterns of gas flow in the respiratory tract * Laminar (distal to small bronchioles) * Turbulent (large airways) * Mixed Resistance 1. ________ in proportion to gas flow 1. ________ proportional to gas density 1. _________ proportional to the radius 1. If radius is halved, resistance ↑ ________ 1. Doubling the length only _______ the resistance
1. Increases 2. Directly 3. Inversely 4. 16-fold 5. doubles
39
# Turbulent Gas Flow 1. Laminar flow occurs when low flow rates move through a straight tube result in a series of concentric cylinders of gas flowing at different velocities. They are ______ to sides of tube and have a velocity of _________ at the cylinder wall . The maximum velocity at the ________ of the advancing “cone.” _________ is relevant under laminar flow. 1. Turbulent flow occurs when ______ to gas flow is significant. Random movement of gas molecules down air passages . It is very loud and audible. ## Footnote Four conditions that will change laminar flow to turbulent flow:
1. parallel; zero; center; Viscosity 2. resistance ## Footnote high gas flows sharp angles within the tube branching in the tube decrease in the tube’s diameter
40
41
At low flow rates, stream lines are parallel to the sides of the tube. As the flow rate increases, unsteadiness develops, especially at branches and separation of stream lines occurs with formation of local eddies. At Higher flow rates, there is complete disorganization of the stream lines.
42
# Volume-Related Airway Collapse * ________ lung volumes and loss of _______ increases contribution of small airways to total resistance. * Airway resistance becomes ________ proportional to lung volume. * Increasing lung volume up to normal with ______ can ________ airway resistance.
1. Low; radial traction 2. inversely 3. PEEP; reduce
43
# Flow-Related Airway Collapse 1. Forced exhalation causes a reversal of normal transmural pressure and can cause dynamic airway compression, which limits air flow during a forced expiration. This results in a large pressure ________ across intrathoracic airways. 1. ____________ is defined as the point along the airways where dynamic compression occurs. 1. ____________: destroys elastic tissues that support smaller airways 1. _________: bronchoconstriction and edema intensify airway collapse 1. __________ or premature termination of exhalation helps to prevent reversal of transmural pressure gradients and trapping of air.
1. drop 2. Equal Pressure Point 3. Emphysema 4. Asthma 5. Pursed-lip breathing
44
# Ventilation 1. ________ Dead Space are the gases in non-respiratory airways. 1. ________ dead space involves alveoli that are not _______. 1. Physiologic dead space = the sum of the two . 1. Physiologic dead space refers to areas of the lung that are ventilated but poorly perfused. ## Footnote 1. Dead space * normally about _______ ml/Kg * nearly all _______
1. Anatomic 2. Alveolar; perfused ## Footnote * 2 * anatomic
45
# Distribution of Ventilation 1. Alveolar ventilation is unevenly distributed * ______ receives more than _______. 2. ________ areas tend to be better ventilated * Alveoli in upper lung areas are nearly maximally inflated and relatively ___________. * Smaller alveoli in dependent areas are more _______ and undergo greater ________.
1. Right; left 2. Dependent - noncompliant - compliant; expansion
46
# **Pulmonary Perfusion** 1. Blood flow ______ L/min (Cardiac Output) 1. ~ ____ -______ ml at any one time in pulmonary capillaries undergoing gas exchange 1. Supine to erect position decreases pulmonary blood volume up to ________%. 1. Trendelenburg has the opposite effect. Pulmonary vascular tone ----> vasoconstriction * _______ is the most powerful stimulus. * Pulmonary arterial and alveolar hypoxia reduces pulmonary blood flow from _________ areas to ________ areas and prevents hypoxemia.
1. 5 2. 70 to 100 3. 27 ## Footnote - Hypoxia - non-dependent; dependent
47
# Hypoxic Pulmonary Vasoconstriction (HPV) HPV and Bronchoconstriction allow the lungs: * To maintain optimal _________ * Stimulated by __________ * Severely decreases _____________ * Decreased regional pulmonary blood flow results ___________ and diminishes the degree of __________ ventilation.
* V/Q matching * alveolar hypoxia * blood flow * bronchoconstriction; dead space
48
# Hypoxic Pulmonary Vasoconstriction HPV and ____________ protect the lungs, particularly during one-lung ventilation. When either a shunt or dead space occurs, the unit of the lung effectively becomes a “silent” unit in which little _____ or _______occurs.
* Bronchoconstriction * ventilation or perfusion
49
Factors that reduce effectiveness of HPV (10)
1. Hypervolemia 1. Hypovolemia 1. Excessive tidal volume or PEEP 1. Hypocapnia 1. Acidosis 1. Hypothermia 1. Volatile agents > 1.5 MAC 1. Vasoactive medications 1. Calcium channel blockers (may) 1. Vasodilators (may)
50
# Distribution of Pulmonary Perfusion Pulmonary blood flow is not uniform. The ___________ portions receive greater flow than the ___________ portions. Gravity exerts a significant influence on blood flow. 3 lung zones based on * Alveolar pressures * Arterial pressures * Venous pressures
dependent; upper
51
The zones of the lung divide the lung into four vertical regions, based upon the relationship between the pressure in the alveoli (PA), in the arteries (Pa), in the veins (Pv) and the pulmonary interstitial pressure (Pi) : Zone 1: Zone 2: Zone 3: Zone 4:
Zone 1: PA > Pa > Pv Zone 2: Pa > PA > Pv Zone 3: Pa > Pv > PA Zone 4: Pa > Pi > Pv > PA
52
# Distribution of Pulmonary Perfusion Zone 1 (upper zone) * Alveolar ___________ * Alveolar pressure continually occludes the Zone 2 (middle zone) * Pulmonary capillary flow is __________ and * Varies during __________ * According to _________-________ gradient Zone 3 (lower zone) * Pulmonary capillary flow is _______ * Proportional to the ________-_______pressure gradient
Zone 1: * dead space * pulmonary capillaries Zone 2 (middle zone) * intermittent * respiration * arterial-alveolar pressure gradient Zone 3 (lower zone) * continuous * arterial-venous
53
# Ventilation/Perfusion Ratios 1. (V) Alveolar ventilation ~ ______L/min 1. (Q) Pulmonary capillary perfusion ~ L/min 1. Overall V/Q ratio ~ _______ 1. No ventilation  intrapulmonary shunt 1. No perfusion  alveolar dead space ## Footnote Throughout the lungs, V/Q normally ranges from ___ -______ Majority are close to ________
1. 4 2. 5 3. 0.8 ## Footnote - 0.3 to 3 - 1
54
# Ventilation/Perfusion Ratios Pulmonary venous blood from areas with low V/Q ratios * has low ________ and high_______ tension. * tends to depress arterial O2 tension more profoundly than CO2 tension. Compensatory increase in O2 uptake cannot take place where V/Q is __________ * ________________ blood usually already maximally saturated with O2.
* O2 tension; CO2 *normal, pulmonary end-capillary
55
# Shunts * Desaturated, mixed venous blood from the right heart returns to the left heart without being re-saturated with O2 in the lungs. * Overall effect dilutes arterial O2 content. * Absolute shunt are: __________ shunts lung units where V/Q is “________” _________ partially correct with increased FIO2 ## Footnote Relative shunt __________ but finite V/Q ratio __________ correct with increased FIO2
- anatomic - 0 - cannot ## Footnote - low - can partially
56
# Effects of Anesthesia on Gas Exchange 1. _______ dead space 1. _______ventilation 1. ________ intrapulmonary shunting 1. _______ scatter of V/Q ratios 1. Atelectasis and airway collapse increases ___________ 5 to 10 %. 1. Inhalation agents can inhibit hypoxic __________ in high doses (2 MAC) 1. Prolonged high FIO2 (> ________) increases the _________ shunt and can result in “absorption atelectasis,” a complete collapse of alveoli with previously low V/Q once all O2 within the alveoli is absorbed. 1. There is no other gas left in the alveoli to keep it open (ie nitrogen)
1. Increased 2. hypoventilation 3. Increased 4. Increased 5. venous admixture (physiologic shunt) 6. vasoconstriction 7. 0.5; absolute
57
# Central Respiratory Centers 1. ________ = origin of basic breathing rhythm 1. _________ respiratory group * Primarily active during inspiration 3. _________ respiratory group * Active during expiration ## Footnote 1. Respiratory rate and rhythm are “fine tuned” by 2 _________ areas (i.e., “pons” in the brainstem) 1. Influence _______ medullary center 1. Lower pontine (_________ ) center is considered “_________.” 1. Upper pontine (__________) center is considered “___________.”
1. Medulla 2. Dorsal 3. Ventral ## Footnote 1. pontine 2. dorsal 3. apneustic, excitatory 4. pneumotaxic, inhibitory
58
# Central Sensors 1. Central chemoreceptors located on the surface of the __________. 1. Respond primarily to changes in -________ 1. Elevated ________ elevates CSF H+ and activates the chemoreceptors 1. Secondary stimulation of the adjacent respiratory medullary centers increases alveolar ventilation 1. Very high PCO2 tension depresses the ventilatory response (“_________”) ## Footnote Apneic threshold 1. PCO2 at which ventilation is _________ 1. Awake state, cortical influences prevent apnea 1. ___________ depresses central chemoreceptor activity.
1. medulla 2. CSF H+ 3. PCO2 4. - 5. CO2 narcosis ## Footnote 1. zero 2. Hypoxia
59
# Peripheral Chemoreceptors 1. Carotid bodies 1. Aortic bodies (surrounding the aortic arch) Bifurcation of the common carotid arteries 1. Principal peripheral chemoreceptors 1. Sensitive to changes in: 1. Interact with central respiratory centers via the ____________ nerves Reflex increases in alveolar ventilation in response to: 1. reduction in PO2, arterial perfusion 1. Elevations in H+ and PCO2 1. Most sensitive to PO2 1. Receptor activity does not increase until PO2 < _________ mmHg
- PO2, PCO2, pH, and arterial perfusion pressure - glossopharyngeal - 50 (60-65)
60
# Lung Receptors 1. Impulses carried centrally by the _________ nerve Stretch receptors * Distributed in ________ _______ of airways * (Hering-Breuer inflation reflex): Inhibit inspiration when lung is inflated to excessive volumes Deflation reflex 1. Shortening of ________ when lung is deflated 1. Normally plays a minor role ## Footnote Irritant receptors 1. Tracheobronchial mucosa 1. React to noxious gases, smoke, dust, and cold gases 1. Reflex increase in RR, bronchoconstriction, coughing
- vagus Stretch receptors - smooth muscle Deflation reflex - exhalation
61
# Lung Receptors _____________ receptors * Located in interstitial space within alveolar walls * Induce dyspnea in response to expansion of interstitial space volume and various chemical mediators following tissue damage Other Receptors: Muscle and joint receptors * pulmonary muscles and chest wall * Input probably important during exercise * Pathological conditions associated with decreased compliance
* J (juxtacapillary)
62
# Effects of Anesthesia General anesthesia: - Promotes _____________ Dual mechanism: ## Footnote Increased anesthetic depth: - Apneic threshold __________ and slope of minute ventilation curve ________ - This is partially reversed by surgical stimulation
* hypoventilation Dual mechanism: * Central depression of the chemoreceptor * Depression of external intercostal muscle activity ## Footnote increases, decreases
63
# Effects of Anesthesia The peripheral response to __________ is more sensitive than the central ________ response. The peripheral response is nearly abolished by even sub-anesthetic doses of most inhalation agents, including N2O, and many IV induction agents.
- hypoxemia, CO2
64
# Effects of Anesthesia Pulmonary Mechanics and Induction of anesthesia: * Additional _____ to _______% reduction in FRC beyond that which occurs in the supine position alone (~ _____ml). * _______ _______ part of the diaphragm moves cephalad when lying in the supine position. * Rib cage moves _________ due to loss of muscle tone. * Change in intrathoracic volume secondary to _________ blood volume in the lung. ## Footnote Changes in chest wall shape * __________ lung volume * ___________ FRC * Not related to ______________ * May persist for _____________.
* 15 - 20%; 400 * Dorsal (dependent) * inward * increased ## Footnote Changes in chest wall shape * Decrease lung volume * Decreased FRC * Not related to anesthetic depth * May persist for several hours
65
# Effects of Anesthesia Steep Trendelenburg > 30 degrees * may reduce FRC even further as intrathoracic blood volume ____________ Airway Resistance * The bronchodilating properties of inhaled agents tend to overcome increased resistance due to decreased FRC. ## Footnote Effects of Anesthesia Pathological factors Tongue Laryngospasm Bronchoconstriction Secretions Equipment Small ETT/connectors Malfunction of valves Obstruction of breathing circuit
- increases
66
# Oxygen 1. Carried in the blood in two forms: dissolved and combined with Hb 1. _________ Law (dissolved O2) The amount dissolved is proportional to the partial pressure * For each mmHg of PO2 --> ___________ ml O2/ 100 ml blood * Arterial PO2 of 100 mmHg = __________ ml O2 / 100 ml blood
1. - 2. Henry’s * 0.003 * 0.3
67
# Hemoglobin Heme: * Iron-porphyrin compound joined to the protein globin * Consists of _______ polypeptide chains * _____ and ______ chains Amino acid sequence gives rise to various types of human Hb A normal adult F fetal, which is gradually replaced over the first year of postnatal life ## Footnote S sickle, which has a _________ O2 affinity (shift in O2 dissociation curve to the right) Deoxygenated form, which is poorly soluble and crystallizes within the RBC; cell changes from biconcave to sickle shape
Heme: - 4 - Alpha and beta ## Footnote - reduced
68
# Oxyhemoglobin Dissociation Curve * The oxyhemoglobin dissociation curve describes the non-linear tendency for oxygen to bind to hemoglobin. At an SaO2 of _______% or less, small differences in hemoglobin saturation reflect large changes in PaO2. * At pressures above _______ mmHg, the standard dissociation curve is relatively flat, which means that the oxygen content of the blood does not change significantly even with large increases in the oxygen partial pressure. * This can be correlated clinically. When the SaO2 decreases to 90% (or 60mmHg pp of O2) the curve becomes very steep. You will have a very sudden dramatic decrease.
* 90% * 60
69
# Oxyhemoglobin Dissociation Curve Shift to the right  more unloading of O2 at a given PO2 into the tissue capillary ↓ O2 affinity of Hb ↑ H+ ion concentration ↑ PCO2 ↑ Temperature ↑ Concentration of 2,3-DPG, which is the end product of RBC metabolism (hypoxia, high altitude chronic lung disease); may be depleted in bank blood (impaired unloading). Shift to the left will have the opposite effect ## Footnote It is common to use the concept of P50 to describe the affinity of hemoglobin for oxygen. The P50 is the PO2 at which the hemoglobin becomes 50% saturated with oxygen. As the P50 decreases, oxygen affinity increases and visa verse.
70
# Oxygen - Hemoglobin Affinity The normal P50 is ____-_____ mmHg * Remember, this is at a temperature of 37◦ C and a pH of 7.4 * Anything greater than 27 mmHg referred to as a shift to the right. * Anything less than 26 mmHg is referred to as a shift to the left.
26 - 27
71
# Carbon Dioxide * CO2 is ~ ______ x more soluble than O2 * Carried in the blood in 3 forms: ## Footnote _________ Effect * deoxygenation of blood increases its ability to carry CO2
- 20 1. As bicarbonate (~ 60%) 1. In combination with proteins (~ 30%) carbamino compounds (most important is carbaminohemoglobin) 1. Dissolved (~10%) ## Footnote Haldane
72
# Carbon Dioxide Reduced Hb is less _______ than the oxygenated form * ________ acceptor * Presence of reduced Hb in the peripheral blood (deoxyhemoglobin) helps with the loading of CO2 * Oxygenation in the pulmonary capillary (oxyhemoglobin) assists in the unloading
acidic: - Proton
73
# Oxygen Stores 1. O2 consumption ~ _______ ml/min with cardiac output (CO) of ____ L/min 1. During apnea, the patient relies on the O2 remaining in the lungs, dissolved in body fluids and bound to hemoglobin. 1. Most important source --> O2 contained in the lungs at ________ 4. O2 content = 5. Room air  0.21 x 2300 ml = ~ 480 ml of O2 in the lungs Hypoxemia in ~ 90 seconds 6. Increase FIO2 prior to apnea FIO2 1.0 x 2300 ml = 2300 ml of O2 Delays hypoxemia for 4 – 5 minutes
1. 250; 5 2. O2 3. FRC 4. FRC x FIO2
74
Physiologic changes in respiratory function associated with aging:
* Dilation of alveoli * Enlargement of the airspaces * Decrease in exchange surface area * Loss of supporting tissue * Decreased lung recoil leads to an increase in residual volume and FRC.
75
# Physiologic Dead Space: The part of the tidal volume not participating in alveolar gas exchange is known as _______ dead space. Composed of: Anatomic Deadspace: gases in non-respiratory airways Alveolar Deadspace: non-perfused alveoli Approximately _____ mL/kg or ______ mL/lb
* physiologic * 2 or 1
76
# Intrapleural pressure: * Between the parietal pleura of chest wall and visceral pleura covering the lung * Usually slightly subambient (_____-_______ mmHg) because lungs recoil inward and chest wall recoils outward **Inward and outward forces are equal at _______ **During inspiration: intrapleural pressures become more _________ as the chest wall expands ## Footnote Intrapulmonary pressure * Zero at ___________; * negative at start of inspiration (air enters lungs because intrapulmonary pressure is less than atmospheric pressure).
* -2 to -3 ** FRC ** negative ## Footnote - end-expiration
77
The amount of gas inspired or expired with each breath.
Tidal Volume (TV).  
78
Maximum amount of additional air that can be inspired from the end of a normal inspiration.
Inspiratory Reserve Volume (IRV).  
79
The maximum volume of additional air that can be expired from the end of a normal expiration.
Expiratory Reserve Volume (ERV).  
80
denotes the lung volume from the beginning of airway closure to the end of maximum expiration, the residual volume.
Closing Volume (CV)
81
The volume of air remaining in the lung after a maximal expiration.  This is the only lung volume which cannot be measured with a spirometer.
Residual Volume (RV).  
82
Lung capacities are subdivisions of total volume that include two or more of the 4 basic lung volumes. Two or more volumes represent a _______.
capacity
83
# Lung Capacities The volume of air contained in the lungs at the end of a maximal inspiration.  Called a capacity because it is the sum of the 4 basic lung volumes.
Total Lung Capacity (TLC). ## Footnote  TLC = RV+IRV+TV+ERV
84
The maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration.  Called a capacity because it is the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume.  
Vital Capacity (VC).   ## Footnote VC = IRV+TV+ERV=TLC-RV
85
The volume of air remaining in the lung at the end of a normal expiration.  Called a capacity because it equals residual volume plus expiratory reserve volume.  
Functional Residual Capacity (FRC).   FRC = RV+ERV
86
Maximum volume of air that can be inspired from end expiratory position.  Called a capacity because it is the sum of tidal volume and inspiratory reserve volume.  This capacity is of less clinical significance than the other three.  
Inspiratory Capacity (IC).   IC = TV+IRV
87
1. ______________ is the lung volume at which the small airways in dependent parts (i.e., small airways lacking cartilaginous support) of the lung begin to close. 1. CC is the sum of ______ and _________. 1. It is normally well below FRC, but rises steadily with ________ 1. Unlike FRC, closing capacity is unaffected by ___________. 1. When closing capacity (CC) exceeds FRC, there will be airway closure even during normal tidal breathing. 1. CC exceeds FRC in a person with normal lungs beyond age _____ when supine and beyond age ______ when standing. 1. As a result, there is airway closure during part of normal tidal breathing resulting in VQ mismatching and decreased arterial PaO2 in elderly.
1. Closing capacity (CC) 2. closing volume and residual volume 3. age 4. posture 5. - 6. 45; 65
88
89
forced expiratory volume 1 - the volume of air that is forcefully exhaled in one second.
FEV1
90
the volume of air that can be maximally forcefully exhaled
FVC - forced vital capacity
91
ratio of FEV1 to FVC, expressed as a %
FEV1/FVC
92
forced expiratory flow - the average forced expiratory flow during the mid (25 - 75%) portion of the FVC
FEF25 - 75
93
The peak flow rate during expiration
PEF - peak expiratory flow rate
94
# Pulmonary Function Test (PFTs) Normal values: FVC = FEV1 = Ratio = Normal = you get _______% of the capacity out in 1 second
Normal values: FVC = 5L FEV1 = 4L/sec Ratio = 0.8 Normal = you get 80% of the capacity out in 1 second
95
# Restrictive FVC: FEV1: FEV1/FVC: FEF 25-75: FRC: TLC: Mechanical ventilation is better tolerated with:
FVC: very low FEV1: very low FEV1/FVC: normal FEF 25-75: normal FRC: very decreased TLC: very decreased Mechanical ventilation is better tolerated with smaller tidal volumes and higher respiratory rates
96
# Obstructive FVC: FEV1: FEV1/FVC: FEF 25-75: FRC: TLC: Mechanical ventilation requires:
FVC: norm. to slight low FEV1: normal to low FEV1/FVC: very low FEF 25-75: very low FRC: Normal or increased TLC: normal or increased Mechanical ventilation requires higher volumes and lower rates to allow time for exhalation. Be cautious of barotrauma.
97
High index of suspicion for markedly impaired pulmonary function
Any chronic disease involving lungs Smokers Chest wall or spinal deformities Morbid obesity Persistent cough or wheeze Neuromuscular diseases Requirement for one-lung ventilation or lung resection Thoracic or upper abdominal surgery Age > 60
98
# *
99
100
101
102
Flow–volume loops were formerly useful in the diagnosis of large airway and extrathoracic airway obstruction prior to the availability of precise imaging techniques. Imaging techniques such as MRI give more precise and useful information in the diagnosis of upper airway and extrathoracic obstruction and superseded the use of flow–volume loops for diagnosis of these conditions. Therefore, it is rare that flow–volume loops are useful for preoperative pulmonary evaluation in the modern era of imaging. 
103
104
# Airway obstructions: Fixed: both inspiration and expiration are affected Variable: Extrathoracic: problems with __________ Intrathoracic: problems with __________
Fixed: both inspiration and expiration are affected Variable: Extrathoracic: problems with inspiration Intrathoracic: problems with expiration
105
* Patients who smoke should be advised to stop smoking at least __________ months prior to an elective procedure to decrease the risk of postoperative pulmonary complications (PPC). * The operative site is one of the most important determinations of the risk of PPC. The highest risk is associated with non-laparoscopic upper abdominal cases followed by lower abdominal and intrathoracic operations. * ___________ is the single most important consideration to prevent PPC.
* 2 * Early ambulation

CVT (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions