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Spring 2020 - Physiology 1 > Respiratory Final > Flashcards

Respiratory Final Flashcards

(152 cards)

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1
Q

Where is the Larynx located in an Adult?

A

Anterior to 3rd-6th Cervical Vertebre

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2
Q

Where is the Larynx located at birth?

A

C3-4

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3
Q

What is the Larynx made of?

A

Multiple Cartilages & Muscles bound by Elastic Tissue

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4
Q

What is the Normal A-O Extension?

A

35 Degrees

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5
Q

Mallampati 1

A

Full Uvula

Tonsillar Pillars

Soft Palate

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6
Q

Mallampati 2

A

Partial Uvula

Partial Tonsils

Soft Palate

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7
Q

Mallampati 3

A

Soft Palate Only

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8
Q

Mallampati 4

A

Hard Palate Only

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9
Q

Sphenopalatine Ganglion

A

Middle of Cranial Nerve V

Nasal Mucosa, Superior Pharynx, Uvula, Tonsils

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10
Q

Glossopharangeal Nerve

A

Cranial Nerve IX - Back 1/3 of tongue, Pharyngeal, Tonsillar Nerves

Oral Pharynx, Supraglottic Region

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11
Q

Internal Superior Laryngeal Nerve (SLN)

A

Cranial Nerve X - Vagus Nerve

Mucus Membrane above Vocal Cords, Glottis

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12
Q

Recurrent Laryngeal Nerve (RLN)

A

Cranial Nerve X - Vagus Nerve

Trachea below cords

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13
Q

List 1 - 10

A
  1. SLN
  2. Internal SLN
  3. External SLN
  4. Vagus Nerve
  5. RLN
  6. Epiglottis
  7. Hyoid Bone
  8. Thyroid Cartilage
  9. Cricothyroid Membrane
  10. Cricoid Cartilage
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14
Q

What does the Internal SLN do?

A

Supraglottic & Ventricle Sensation

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15
Q

What happens when the Internal SLN is stimulated?

A

Laryngospasm

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16
Q

What does the External SLN do?

A

Motor Innervation to Cricothyroid Muscle

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17
Q

What does the RLN do?

A

Infraglotta Sensory

Motor innervation to all larynx except cricothyroid muscle

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18
Q

What does Stimulation of the RLN do?

A

Vocal Cord Abduction

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19
Q

What happens if there is damage tot he RLN?

A

Vocal Cord Adduction

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20
Q

What is the shape of the Larynx in an Adult vs a Child?

A

Adult: Cylindrical Larynx

Child: Cone-Shape Larynx

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21
Q

What is the Trachea?

A

Flexible Cylindrical Tube supported by 20-25 C-Shaped Catilages

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22
Q

What is the Diameter of the Trachea?

A

18-20 mm

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23
Q

What is the Length of the Trachea?

A

12.5 - 18 cm

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24
Q

Where is the Trachea located?

A

C6 - T5

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25
At what level does the Trachea divide into two Bronchi?
Carina T5-T7 25cm from Teeth
26
Which part of the airway does Gas Exchange begin?
Respiratory Bronchiole
27
Which Nerve transmits Motor Stimulation to the Diaphragm?
Phrenic Nerve (C 3,4,5)
28
Which Nerves send signals to the External Intercostal Muscles?
Intercostal Nerves (T1 - T11)
29
Which phase of breathing is considered the active phase?
Inspiration
30
What is considered Negative-Pressure Ventilation?
The Act of Inhaling
31
What directions do the Ribs and Diaphragm move on Inspiration?
Ribs: Up and Out Diaphragm: Down
32
What is Tidal Volume?
Volume Inspired/Expired w/ each normal breath 500 mL
33
What is Inspiratory Reserve Volume?
Extra Volume inspired above normal breathing. 3000 mL
34
What is Expiratory Reserve Volume?
The extra volume after normal expiration 1100 mL
35
What is Residual Volume?
Volume of air remaining after max expiration. 1200 mL **Can't Be Measured by Spirometry**
36
What is the Inspiratory Capacity
The maximum amount of air that a person can breathe in. Tidal Volume + Inspiratory Volume Reserve 3500 mL
37
What is Functional Residual Capacity?
The air in the lungs after normal expiration Expiratory Reserve Volume + Residual Volume 2300 mL
38
What is Vital Capacity?
The max amount of air a person can blow out after taking the biggest breath they can. Inspiratory Reserve Volume + Tidal Volume + Expiratory Reserve Volume 4600 mL
39
What is Total Lung Capacity?
The max volume of air the a person can breath in Vital Capacity + Residual Volume 5800 mL
40
What are the techniques used to measure FRC and which is the most accurate?
* Helium Dilution * Nitrogen Washout * Body Plethysmography - sit in a sealed box and try to inhale through closed mouthpiece - more accurate
41
What are the Functions of Surfactant?
Lower Surface Tension Stablizes Alveoli Prevents Fluid Leaking into Alveoli
42
What is the Concept of Poiseuille's Law?
Relates to Resistance, Length, Viscocity, and Radius **Decrease Radius by 16% = Doubles Resistance** **Decrease Radius by 50% = Increase Resistance 16x**
43
Right Atrial Pressure
2-5 mmHg
44
Left Atrial Pressure
6 - 12 mmHg
45
Right Ventricle Pressure
25/0 mmHg
46
Left Ventricle Pressure
120/0 mmHg
47
Pulmonary Capillary Pressure
10.5 mmHg
48
Pulmonary Artery Pressure
25/8 mmHg Mean: 15
49
Pressure of the aorta
120/80 Mean: 90
50
What are the mechanisms to decrease Pulmonary Vascular Resistance?
Recruitment & Distension
51
How much of the Alveolar surface is covered by Capillaries?
70-80%
52
How much can the Capillary Volume increase from Recruitment?
Resting: 70mL Max: 200mL
53
Lung Zone 1
PA \> Pa \> PV
54
Lung Zone 2
Pa \> PA \> PV
55
Lung Zone 3
Pa \> PV \> PA
56
As you move Down and Upright Lung, the V/Q Ratio \_\_\_\_\_\_\_\_
As you move Down the Upright Lung, the V/Q Ratio **decreases**
57
What are the Pulmonary Vasoconstrictors?
**↓PaO2** **↑PaCO2** **Histamine** Alpha Catecholamines/Norepi Thromboxane Prostaglandins Endothelin
58
What are the Pulmonary Vasodilators?
**↑PaO2** **Nitric Oxide** Beta Catecholamines Prostacyclin ACh Bradykinin Dopamine
59
What produces the Localized Response of Hypoxic Pulmonary Vasoconstriction (HPV)?
Alveolar Hypoxia
60
What is the Purpose of Hypoxic Pulmonary Vasoconstriction?
Shift blood flow to better ventilated areas of the lung to improve V/Q
61
What is the Normal Alveolar PO2 and PCO2?
PO2: 100 mmHg PCO2: 40 mmHg
62
How much CO2 is produced at rest?
200 mL/min
63
Air is Expired in two parts, which is first and second?
First: Dead Space Air Second: Mix of Dead Space air & Alveolar Air **Alveolar air is expired at the** **_End of Exhalation_**
64
What is Fick's Law?
Diffusion of Gas thru tissue membrane involving Size & Thickness of membrane & Partial Pressure Difference
65
What is the quantity of V/Q if there is perfusion, but no ventilation
V/Q = 0
66
What is the quantity of V/Q when there is ventilation, but no perfusion?
V/Q = Infinity
67
What is the PO2 and PCO2 in normal deoxygenated Blood?
PO2 = 40 mmHg PCO2 = 45 mmHg
68
When is V/Q Below Normal
Shunt: Perfusion, no Ventilation
69
When is V/Q greater than Normal?
Dead Space: Ventilaton, no Perfusion
70
How does SpO2 relate to PaO2? 100% = ? 95% = ? 90% = ? 75% = ? 60% = ? 50% = ?
100% = 100 mmHg 95% = 75 mmHg 90% = 60 mmHg 75% = 40 mmHg 60% = 30 mmHg 50% = 27 mmHg (40, 50, 60 mmHg = 70, 80, 90%)
71
What does a Right Shift on the Oxyhemoglobin Curve indicate?
Hb releases O2 easier & Blood O2 saturation will be less
72
What does a Left Shift on the Oxyhemoglobin curve indicate?
Hb holds on to O2, and Blood O2 Saturation will be more
73
What causes a Right Shift of the Oxyhemoglobin Curve?
↑CO2 ↑Temperature ↑2,3-DPG ↓pH Bohr Effect
74
How is the amt of O2 in the Blood Calculated?
CaCO2 = (SO2 x Hb x 1.31) + (PO2 x 0.003) ## Footnote SO2 = Pulse Ox
75
How is Oxygen Delivery (DO2) Calculated?
DO2 = CaCO2 x Cardiac Output ## Footnote CaCO2 = Amt of O2 in Blood​
76
In what form is the majority of CO2 transported?
Bicarbonate (HCO3-)
77
CO2 Transport
1. Tissues use O2 and Produce CO2 2. CO2 + H2O (Carbonic Anhydrase) --\> H2CO3 (Carbonic Acid) 3. H2CO3 splits into H+ & HCO3- (Bicarb) 4. Bicarb exits cell, Cl- enters to balance 5. Cell goes to Pulmonary Capillary 6. Cl- exits and Bicarb Re-Enters 7. HCO3- (Bicarb) + H+ --\> H2CO3 (Carbonic Acid) 8. Carbonic Anyhydrase splits H2CO3 --\> CO2 + H2O 9. CO2 leaves cell and goes into Alveoli
78
What are the different forms that CO2 is tranpsorted as?
* **CO2**: 7% * **Hgb + CO2**: 23% * **HCO3-**: 70%
79
What part of breathing does the Dorsal Respiratory Group control?
Inspiration & _Rhythm_
80
Where is the Dorsal Respiratory Group located?
Along the medulla in the Nucleus of the Tractus Solitarius
81
Which Nerves deliver Sensory Info to the Dorsal Respiratory Group?
Vagus Nerve (X) ``` & Glosspharyngeal Nerve (IX) ```
82
What are the sources of the Dorsal Respiratory Group signals?
Peripheral Chemoreceptors Baroreceptors Lung Receptors
83
Where are the Central Chemoreceptors located?
Highly Sensitive area on Ventral Medulla Surface
84
What does the Chemo-Sensitive Area of the Brain respond to?
PCO2 or H+ Stimulates other parts of the Respiratory Center
85
What is the difference in CO2 concentrations b/t the Blood & Brain?
Equal b/c CO2 is highly permable to Blood-Brain Barrier
86
What happens when CO2 enters the Brain?
1. Reacts w/ H2O to form Carbonic Acid 2. Carbonic Acid breakds down into H+ & HCO3- 3. H+ in brain stimulates Respiratory Center
87
What _Greatly_ increases Ventilation?
PCO2 \> 35 mmHg pH has less effect
88
Where are the Peripheral Chemoreceptors located?
Aortic Arch & Carotid Body
89
Which Cranial Nerve does Peripheral Chemoreceptors send signal thru when coming from the Carotid Body?
Cranial Nerve IX - Glossopharyngeal Nerve
90
Which Cranial Nerve do Peripheral Chemoreceptors send thru to the DRG from the Aortic Bodies?
Cranial Nerve X - Vagus Nerve
91
What is the FEV1 for High Risk patients?
\< 2 L
92
What is the FEV1/FVC for High Risk patients?
\< 0.5
93
What is the VC for High Risk Adults and Kids?
Adults: \< 15cc/kg Kids: \<10cc/kg **or** VC \< 40-50% predicted
94
List 1 -6
1. Pneumotaxic Center 2. Apneutstic Center 3. VRG (Expiration & Inspiration) 4. Respiratory Pathways 5. DRG (Inspiration) 6. Fourth Ventricle
95
Extubation Criteria
* VSS, Awake & Alert * 40% FiO2 = PaO2 \> 70 & PaCO2 \< 55 * NIF \< -20cm H2O * VC \> 15 cc/kg
96
What criteria would be considered Respiratory Failure requiring Intubation?
* RR \> 35 * PaCO2 \> 55 mmHg * PaO2 \< 70 on 40% FiO2
97
What A-a gradient would you consider Intubating?
A-a Gradient \> 350 mmHg on 100% FiO2
98
At what Vital Capacity would you consider Intubating?
VC \< 15 cc/kg \< 10 cc/kg for kids
99
At what ratio of Dead Space to Tidal Volume would you consider intubating?
Vd/Vt \> 0.6
100
How much will pH decrease if the PCO2 increases by 10 mmHg?
pH will decreases by 0.08
101
What does the A-a Gradient measure?
A-a measures the difference b/t oxygen concentration in alveoli & arterial system
102
How do you treat abnormal A-a gradients?
Treat Underlying Cause O2, Adjust Ventilation, PEEP
103
How much would the pH decrease with a decrease of Bicarb by 10 mmoles?
pH will decreases by 0.15
104
How is Total Body Bicarb Deficit Calculated?
Total Bicarb Deficit = Base Deficit X Weight X 0.4 (Replace by 1/2 of Deficit)
105
How does the Pulse Ox work?
Two lights Infrared: 950nm - Oxyhemoglobin, 100% Saturation Red: 660nm - Deoxyhemoglobin, 50% Saturation
106
What can cause an overestimation of the true Oxygenation on the Pulse Ox?
Carboxyhemoglobin from CO Poisoning Shows as 100% on Pulse Ox Use Co-Oximeter for Distinguishing
107
What is Methemoglobin?
When the Iron in Hgb is converted to Ferric and cant trasport O2 Absorbed equally by Red & Infrared lights on pulse ox Shows SpO2 as 85%
108
What causes Methemogobinemia?
Nitrates Nitrites Nitroprusside (SNP) Nitroglycerine (NTG) Benzocain Sulfonamides
109
What are the treatments for Methemoglobinemia?
Methylene Blue or Vitamin C
110
How does Fetal Hemoglobin & Bilirubin affect the Pulse Ox?
No effect
111
What is the Gold Standard for Tracheal Intubation?
Capnography - EtCO2 Reliable for Esophageal Intubation, but _not_ for Endobronchial Intubation
112
List AB: BC: CD: D Point: DE:
**AB**: Start Exhalation, Dead Space Gas **BC**: Exhalation, Mixing of Gas **CD**: Alveolar Plateau, Alveolar Rich Gas **D Point**: Highest CO2 **DE**: Start Inspiration
113
What kind of EtCO2 Pattern is this?
Obstructive Pattern EX: COPD, Bronchospasm
114
What is going on in this EtCO2 Pattern?
Early Spontaneous Breath indicated by Curare Cleft
115
What is going on in this EtCO2 Pattern?
Expiratory Valve Failure or Depleted CO2 Absorber
116
What is going on in this EtCO2 Pattern?
Inspiratory Valve Failure
117
What is going on in this EtCO2 Pattern?
Cardiogenic Oscillation
118
What is going on in this EtCO2 Pattern?
Esophageal Intubation Declining End-Tidal Values
119
What is going on in this EtCO2 Pattern?
Surgeon Pushin on Chest
120
Know the Difficult Airway Algorithm
121
Which lung has Better Perfusion & Ventilation in the Awake & Lateral Position?
Dependent Lung - Down Lung d/t gravity
122
Which Lung in the Lateral Position has better Ventilation _after_ Induction, why?
Upper Lung Abdominal contents & Bean Bag restricts movement of down lung Open PTX to upper lung = better compliance & better positive pressure reception
123
What factors Inhibit Hypoxic Pulmonary Vasocontriction (HPV)?
**Hypocapnia** **Inhalation Agents** **Vasodilators (NTG, SNP, Beta Agonists, C-Channel Blockers)** Very High/Low PAP or Mix Venous PO2 Pulmonary Infections
124
How should you intubate to ensure proper ETT placement for one lung ventilation?
Use Fiberoptic Scope
125
What do you do for Hypoxia during One Lung Ventilation?
* 80-100% FIO2 * Check TV & ETT Placement * Keep PaCO2 @ 40 mmHg * Add 5cm CPAP to Upper Lung & 5cm PEEP to Lower Lung Slowly * Clamp Upper PA * Return to 2 Lung
126
What triggers Malignant Hyperthermia?
Anesthetics Gases & Succinylcholine
127
What is the first and most sensitive sign of Malignant Hyperthermia?
Unexplained Tachycardia
128
What is the most specific sign of Malignant Hyperthermia?
Increasing EtCO2 @ 2-3X
129
What is the mortality rate of Malignant Hyperthermia?
10% 70% w/o Dantrolene \<5 % w/ Early Dantrolene
130
Once symptoms of Malignant Hyperthermia are controlled, what is the dosage to continue Dantrolene?
1 mg/kg IV q6h x 72 hrs
131
If a patient is on Dantrolene, what would cause life-threatening Hyperkalemia & Cardiac Depression?
Calcium Channel Blockers
132
How does Dantrolene work?
Directly on Ryanodine Receptor preventing Calcium Release from the SR.
133
What are late signs of Malignant Hyperthermia?
Organ Failure DIC / Coagulopathy Rhabdo Edema / Swelling Death
134
A patient's tendency for fever, heat stroke, strabismus, exercise myalgia, cramping, and history of muscle diseases may indicate what?
Risk for Malignant Hyperthermia
135
What is the Gold Standard PreOp test for MH?
Halothane-Caffeine Contracture Test
136
What is King-Denborough Syndrome?
Combination of musculoskeletal diseases and deformities that makes them a risk for Malignant Hyperthermia
137
If the patient has had prior uneventful general anesthetic, does this rule out MH?
No!
138
Which age group is Malignant Hyperthermia more common in?
Children
139
When do symptoms of MH occur?
Usually within 1 Hour, but can be also be hours after exposure
140
What factors Increase MAC?
Babies \< 6 months old - highest MAC needed Chronic EtOH Hyperthermia Hypernatremia Drugs that Increase Catecholamines
141
What factors Decrease MAC?
* **Pregnancy** * Hypothermia * Hypoxemia * Premature Babies & Elderly * Acute ETOH * Hyponatremia * Lithium * Alpha 2 Agonist/C-Channel Blockers * Bypass Machine
142
What is the Second Gas Effect?
Large intake of first gas (N2O) causes increase rate of intake of second gas (agent)
143
What is Diffusion Hypoxia?
When a lot of N2O is leaving the body into the lungs creating Hypoxia Prevention: Dont extubate on 70% N2O & Give 100% Oxygen
144
How much does smoking increase CarboxyHb and the the risks for CAD & Post-Op Lung complications?
CAD: 2x risk Post Op Lung Problems: 6x risk COHb: 15% increase
145
How does Nicotine affect the body?
Stimulates SNS to release catecholamiens --\> ↑HR, ↑BP, ↑SVR ## Footnote **Lasts 30 min from last cigg**
146
What steps should be taking for intubating smokers?
Preoxygenate Well Wait Until Patient is Deep before airway Manipulation
147
How long should patients stop smoking before surgery?
12 Hours Reduce COHb & Nicotine to normal levels
148
What happens after smoking is stopped for 8 Weeks?
Reduction of Post-Op Lung Problems
149
What happens after smoking stops for 2 Years?
MI risk will be the same as Non-Smoker
150
What happens after 2 to 10 days of not smoking?
Decrease in Airway Activity at 2 Days Same as Nonsmoker at 10 days
151
How should the vent be managed for COPD patients?
Change I:E to 1:3 Monitor PIP (rupture bullae/bleb) Keep EtCO2 near baseline
152
Which drugs should be avoided in COPD patients?
**Histamine Releasing Drugs** STP - Pentothal Morphine Atracurium Mivacurium Neostigmine Give Nebs b4 extubating

Spring 2020 - Physiology 1 (24 decks)

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