Anesthesia Respiratory System Review

Front 1

What supplies motor innervation to the larynx?

Back 1

Motor Innervation- The external branch of the superior laryngeal nerve innervates the cricothyroid muscle. Because it supplies all other intrinsic muscles of the larynx except the cricothyroid, the recurrent laryngeal nerve is the major motor nerve of the larynx

Front 2

What supplies sensory innervation to the larynx?

Back 2

Sensory Innervation-The internal branch of the superior laryngeal nerve is the major sensory nerve of the larynx; it supplies laryngeal tissues from the vocal cords up, including the vocal cords. The recurrent laryngeal nerve supplies the sensory supplies the sensory innervation to the laryngeal mucosa inferior to vocal cords

Front 3

What are the functions of the intrinsic laryngeal muscles?

Back 3

Posterior cricoarytenoids-abducts vocal cords (“dilates” cords)
Lateral cricoarytenoids- adducts vocal cords
Transverse arytenoid- closes rima glottidis
Oblique arytenoid- controls sphincters to vestibule; decreases volume of larynx (narrows the inlet)
Aryepiglottics- controls sphincters to vestibules (narrows the inlet)
Thyroepiglottics-control sphincter to vestibule (narrows the inlet)
Cricothyroids-increases vocal cord tension (tenses the cords)
Thyroarytenoids-reduces cord tension (relaxes the cords)

Front 4

What occurs with unilateral laryngeal nerve damage? What about bilateral?

Back 4

Damage to the external branch of the superior laryngeal nerve produces weakness & huskiness of the voice. The cricothyroid muscle is paralyzed.
Unilateral right recurrent laryngeal nerve damage is characterized by hoarseness & a paralyzed cord that assumes an intermediate position
Bilateral recurrent laryngeal nerve damage results in aphonia & paralyzed cords. Each paralyzed cord assumes an intermediate position. Cords can flop together causing airway obstruction during inspiration

Front 5

1) Except for the cricothyroid muscle, the intrinsic muscle of the larynx are innervated by what motor nerve?
A)Internal branch of the superior laryngeal nerve
B)External branch of the superior laryngeal nerve
C)Recurrent laryngeal nerve
D)glossopharyngeal

Back 5

C) Recurrent laryngeal nerve

Front 6

2) What muscles adduct the vocal cords?
A) Cricothyroids

B) Thyrroarytenoids

C) Posterior cricoarytenoids

D) Lateral cricoarytenoids

Back 6

D) Lateral cricoarytenoids

Front 7

What happens when the patients left recurrent laryngeal nerve is injured during subtotal thyroidectomy?

Back 7

Midway abduction/adduction (Position of injured cord) Hoarsness (Phonation)

Front 8

What does the flat portion and the steep portion of the oxyhemoglobin dissociation curve facilitate in relation to O2

Back 8

The flat portion of the oxyhemoglobin dissociation curve facilitates the loading of oxygen by the blood. The steep portion of the oxyhemogloblin dissociation curve facilitates unloading of oxygen @ tissues.

Front 9

P50 is the partial pressure of oxygen @ which Hgb is ___% saturated by oxygen. Norm P50 is ___--___ mm Hg.

Back 9

P50 is the partial pressure of oxygen @ which Hgb is 50% saturated by oxygen. Norm P50 is 26 – 27 mm Hg.

Front 10

SO2 of 70 & 90% corresponds to PO2 of __ & __mm Hg

Back 10

SO2 of 70 & 90% corresponds to PO2 of 40 & 60 mm Hg

Front 11

When there is a leftward shift in the oxyhemoglobin dissociation curve, the amount of O2 carried by hemoglobin increases or decreases?

Back 11

When there is a leftward shift in the oxyhemoglobin dissociation curve, the amount of O2 carried by hemoglobin increases

Front 12

When there is a rightward shift in the oxyhemoglobin dissociation curve, the amount of O2 carried by hemoglobin is ______.

Back 12

When there is a rightward shift in the oxyhemoglobin dissociation curve, the amount of O2 carried by hemoglobin is reduced.(unloading of O2 facilitated)

Front 13

Name factors that would cause leftward shifts in the oxyhemoglobin dissociation curve (loading of O2)

Back 13

Leftward Shift Factors (Loading of O2)
↓ Temp
↑ pH (decrease H+ concentration)
↓ PCO2
↓ 2,3 DPG
Fetal Hgb
CarboxyHgb
Methemoglobin
P50 < 26-27 mmHg “less is Left”

Front 14

Name factors that would cause rightward shifts in the oxyhemoglobin dissociation curve (unloading of O2)

Back 14

Rightward Shift Factors (Unloading of O2)
↑ Temp
↓pH (increase H+ concentration)
↑ PCO2
↑ 2,3 DPG
Sickle Cell
Maternal Hgb
P50 >26-27 mmHg

Front 15

What is the Bohr effect?

Back 15

The Bohr effect refers to the shift in oxyHgb dissociation curve in response to an ↑ or ↓ in PCO2
Systemic Circuit: the oxyHgb curve shifts right, & this rightward shifts facilitates the unloading of O2 from the blood
Pulmonary Circuit: the oxyHgb curve shifts left & this leftward shift facilitate the loading of O2 into the blood.

Front 16

What is Haldane effect?

Back 16

Haldane effect describes how a change in partial pressure of oxygen (PO2) in the blood influences the blood CO2 dissociation curve.
The CO2 dissociation curve shifts up & left when PO2 decreases and shifts down & right when PO2 increases.
90% of CO2 transported by the blood is in the form of HCO3
CO2 is carried in the blood in: (1) dissolved form, (2) as HCO3 , (3) chemically bound to proteins
The exchange of Cl- for HCO3 is the Chloride shift, which is also referred to as the Hamburger shift

Front 17

The oxyhemoglobin curve becomes steep when PaO2 falls below:
A) 60 mm Hg

B) 70 mm Hg

C) 80 mm Hg

D) 90 mm Hg

Back 17

A) 60 mm Hg

Front 18

The oxyhemoglobin dissociation curve shifts left in response to:
A) Hypercapnia

B) Hypothermia

C) Increased 2,3-DPG

D) Metabolic acidosis

Back 18

B) Hypothermia

Front 19

Which of the following conditions is associated with an increase in the P50?
A) Sickle cell anemia

B) Fetal hemoglobin

C) Carboxyhemoglobin

D) Methemoglobin

Back 19

A) Sickle cell anemia

Front 20

The patient is given meperidine for premedication. What happens to the oxyhemoglobin dissociation curve and to the carbon dioxide blood dissociation curve?

Back 20

OxyHGB Dissociation Curve shifts right

CO2 Curve shifts left

Front 21

The patients PaO2 increases from 100 mm Hg to 500 mm Hg. The amount of dissolved oxygen in the arterial blood increases by how much?
A) 0.3 ml O2/100 ml

B) 1.2 ml O2/ 100 ml

C) 1.5 ml O2/100 ml

D) 2.1 ml O2/100 ml

Back 21

B) 1.2 ml O2/100 ml

Front 22

What is the PaO2 when the SaO2 is 90%

A) 40 mm Hg

B) 50 mm Hg

C) 60 mm Hg

D) 70 mm Hg

Back 22

C) 60 mm Hg

Front 23

What percent of total CO2 is carried in the blood as bicarbonate?
A) 20%

B) 50%

C) 70%

D) 90%

Back 23

D) 90%

Front 24

What enzyme(s) is (are) responsible for producing bicarbonate in the red blood cell?
A) Nonspecific esterases

B) Carbonic anhydrase

C) Creatine kinase

D) Acetylcholinesterase

Back 24

B) Carbonic anhydrase

Front 25

12) If PaCO2 is 30 mm Hg, how much CO2 is dissolved in the blood?
A) 2.01 ml CO2/100ml blood

B) 2.53 ml CO2/ 100 ml blood

C) 3.12 ml CO2/100 ml blood

D) 4.88 ml CO2/100 ml blood

Back 25

A) 2.01 ml CO2/ 100 ml blood

Front 26

After it is produced, bicarbonate diffuses out of the red blood cell in exchange for:
A) Hydrogen ions

B) Chloride ions

C) Calcium ions

D) Phosphate ions

Back 26

B) Chloride ion

Front 27

What are the control of ventilation/respiratory in the brain?

Back 27

DRG: Dorsal Respiratory Group (Pacemaker, Vital Center, Controls Diaphragm, & External Intercostal Muscles)
---Found in the medulla & consider the inspiratory pacemaker
VRG: Ventral Respiratory Group--Can influence both inspiration & expiration (Internal intercostal nerve)
---(Found in Medulla)
PnC & ApC: Pneumotaxic & Apneustic Center
---The pneumotaxic center shuts off inspiration
---The apneustic center promotes deep and prolonged inspiration.
---Work together to help control the rate & depth of inspiration (Found in Pons)

Front 28

What is Hering-Breuer reflex?

Back 28

Hering-Breuer reflex is a protective mechanism for preventing excess lung inflation (Stretch receptors in bronchi and bronchioles)-Inhibits
In adults reflex does not become important tidal volume exceeds 1.5 L
In neonates the reflex is strong & physiologically relevant
The reflex is carried by the vagus nerve (afferent)

Front 29

The central chemoreceptor are stimulated by ↑ __ ; an ↑ in CSF CO2 automatically leads to an ↑ in ___.

Back 29

The central chemoreceptor are stimulated by ↑ H+ ; an ↑ in CSF CO2 automatically leads to an ↑ in H+

Front 30

↑ of H+ & HCO3 in response to ↑ CO2 in CSF = ________ Principle from the law of mass action

Back 30

↑ of H+ & HCO3 in response to ↑ CO2 in CSF = LeChateliers Principle from the law of mass action

Front 31

CO2 drives normal respiration. Peripheral chemoreceptor are stimulated by ↑ ____ and/or ↓ ____(<60 mm Hg).

Back 31

CO2 drives normal respiration. Peripheral chemoreceptor are stimulated by ↑ PCO2 and/or ↓ PaO2 (<60 mm Hg).

Front 32

The ____ nerve carries sensory impulses from the carotid bodies & the ____nerve carries sensory impulses from the aortic bodies & also from stretch receptors found in lung parenchyma.

Back 32

The glossopharyngeal nerve carries sensory impulses from the carotid bodies & the vagus nerve carries sensory impulses from the aortic bodies & also from stretch receptors found in lung parenchyma.

Front 33

______ chemoreceptors are most responsive to ↓ in arterial blood O2 when PaO2 falls below 60mm Hg

Back 33

Peripheral chemoreceptors are most responsive to ↓ in arterial blood O2 when PaO2 falls below 60mm Hg

Front 34

The pacemaker of the respiratory system is found in the

A) Apneustic center

B) Pneumotaxic center

C) Ventral respiratory group

D) Dorsal respiratory group

Back 34

D) Dorsal respiratory group

Front 35

Central chemoreceptors are stimulated directly by

A) Carbon dioxide

B) Hydrogen ions

C) Both

D) Neither

Back 35

B) Hydrogen ions

Front 36

16) Peripheral chemorecptors are most sensitive to:

A) increased carbon dioxide

B) increased hydrogen ions

C) Decreased PaO2 (<60 mmHg)

D) Increased temperature

Back 36

C) Decreased PaO2 (<60 mm Hg)

Front 37

What nerve carries sensory information from the carotid, and what nerve carries sensory information from the aortic bodies?

Back 37

Carotid bodies- Glossopharyngeal

Aortic bodies-Vagus

Front 38

What respiratory center in the pons participates in shutting off inspiration?
A) Pneumotaxic center

B) Apneustic center

C) Both the pneumotaxic center and apneustic center

D) Neither the pneumotaxic center nor apneustic center

Back 38

A) Pneumotaxic center