Chapter 27, Part 1- Review #3

Front 1

Almost no particle greater than approx __ mm in size is allowed to enter the trachea

Back 1

6

Front 2

GA affects noses ability to?

Back 2

heat/humidify air

Front 3

Which conchae is in the pathway of airflow in the nose?

Back 3

inferior

Front 4

What is most commonly injured during nasal intubation?

Back 4

inferior conchae

Front 5

Eustachian drainage can be obstructed when?

Back 5

inferior concha or adenoid tonsils become inflamed

Front 6

What is alar cartilage?

Back 6

cartilage around entrance to nostrils that flares during heavy breathing

Front 7

Nostril opening leads into?

Back 7

vestibule

Front 8

course hairs in the nostril opening are called?

Back 8

vibrissae

Front 9

Direction of motion of cilia is toward?

Back 9

exterior of the nasal cavity

Front 10

What is ligated for persistent nosebleeds?

Back 10

interior maxillary artery

Front 11

Where does the pharynx extend to?

Back 11

base of skull to C6

Front 12

Blood supply to pharynx is from?

Back 12

branches of external carotid artery

Front 13

Larynx extends from?

Back 13

C3-C6

Front 14

What is the chief support for larynx?

Back 14

hyoid bone

Front 15

rima glottidis is?

Back 15

the space between the true vocal cords

Front 16

What muscles lengthen the vocal cords?

Back 16

cricothyroid

Front 17

What muscles shorten the vocal cords?

Back 17

thryoarytenoid

Front 18

External SLN innervates?

Back 18

cricothyroid cartilages

Front 19

Internal SLN provides?

Back 19

sensation from epiglottis down to cords

Front 20

RLN supples sensation to the?

Back 20

larynx below the vocal cords

Front 21

RLN innervates?

Back 21

all muscles of larynx except cricothyroid

Front 22

Blood supply to larynx?

Back 22

superior/inferior thyroid artery

Front 23

Blood supply to trachea?

Back 23

inferior thyroid artery

Front 24

Sensory innervation of trachea is from?

Back 24

vagus nerve

Front 25

If you flex the neck, the ETT moves?

Back 25

downward and endobronchial intubation may result

Front 26

If you extend the neck, the ETT moves?

Back 26

upward and extubation may occur

Front 27

What thoracic levels correspond anteriorly to the angle of Louis on the sternum?

Back 27

T4-T5

Front 28

How many generations exist before the alveoli?

Back 28

20-25

Front 29

Where is the first place that gas exchange occurs?

Back 29

respiratory bronchioles

Front 30

What are the pores of Kohn?

Back 30

small pores in alveoli that allow collateral gas flow between alveoli

Front 31

What is the respiratory zone comprised of?

Back 31

respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli

Front 32

What is the conducting zone comprised of?

Back 32

all parts of the airway (from nose to terminal bronchioles) that conduct gas without exchanging gas with the blood

Front 33

The left lung respresents ___% of TLC

Back 33

45

Front 34

The right lung represents ____% of TLC

Back 34

55

Front 35

What law describes that as increased volume causes decreased pressure?

Back 35

boyles

Front 36

What muscles contract during normal breathing?

Back 36

diaphragm and external intercostals

Front 37

Each half of the diaphragm is innervated by what nerve?

Back 37

phrenic

Front 38

What muscles may be used to augment exhalation?

Back 38

intercostal muscles

Front 39

How far does the diaphragm descend?

Back 39

1-2 cm

Front 40

What is a condition that impedes chest excursion?

Back 40

thoracic kyphosis (increase chest diameter)

Front 41

When the diaphragm contracts during inspiration, what two things occur?

Back 41

1. Raises intraabdominal pressure
2. Lowers intrathoracic pressure

Front 42

When the diaphragm is paralyzed it cannot? and what occurs?

Back 42

contract, moves upward from normal position
-results in paradoxical movement

Front 43

For air to move into alveoli, alveolar pressure must be less than?

Back 43

atmospheric pressure

Front 44

Compliance is _______ dependent

Back 44

volume

Front 45

Lung is less compliant at?

Back 45

very high and very low lung volumes

Front 46

Slope of inspiratory curve is less at?

Back 46

both very low and high volumes

Front 47

Where does most of the energy come from to expand lungs at particularly low volumes?

Back 47

surface tension

Front 48

How do you calculate static effective compliance?

Back 48

TV/(plateau pressure - PEEP)

Front 49

How can you observe a plateau pressure on a ventiator?

Back 49

inspiratory pause

Front 50

How do you calculate dynamic compliance?

Back 50

TV/(PIP-PEEP)

Front 51

What does LaPlace's Law state? does it occur in the lung?

Back 51

P=T/r, does not occur in the lung

Front 52

Why does LaPlace's law not occur in the lung?

Back 52

pulmonary surfactant produced by type II cells

Front 53

What does pulmonary surfactant consist of?

Back 53

phospholipid dipalmitoyl lecithin

Front 54

Does surfactant preferentially decrease surface tension more in small or large alveoli?

Back 54

small

Front 55

L/S ratio stands for?

Back 55

lecithin to sphingomyelin

Front 56

What is transpulmonary pressure?

Back 56

difference between intraalveolar and pleural pressure

Front 57

Pleural pressure is normally?

Back 57

slightly negative

Front 58

Transpulmonary pressure does what?

Back 58

oscillates b/t slightly negative during inspiration to slightly positive during expiration

Front 59

True laminar occurs where?

Back 59

in smaller airways

Front 60

Resistance to laminar flow follows _________ law

Back 60

Poiseuille's

Front 61

Where does the greatest resistance of airflow reside?

Back 61

in medium-sized bronchi

Front 62

SNS and sympathomimetic drugs (NE, EPI, isoproterenol) produce?

Back 62

bronchodilation

Front 63

PSNS and parasympathomimetic drugs (ACh) produce?

Back 63

bronchoconstriction

Front 64

Parasympatholytic drugs (atropine and ipratroprium) cause?

Back 64

bronchodilation

Front 65

restrictive lung diseases result in_______ lung volumes.

Back 65

decreased

Front 66

What is the calcualtion for alveolar ventilation?

Back 66

(VT-2ml/kg) x RR

Front 67

Define residual volume?

Back 67

amt of gas left after maximal exhalation (1.5L)

Front 68

Define ERV?

Back 68

volume of gas expelled from lungs during maximal forced exhalation

Front 69

Define IRV?

Back 69

volume of gas inhaled into lungs during a maximal forced inhalation

Front 70

TLC is the sum of what four lung volumes?

Back 70

RV+ERV+IRV+VT

Front 71

VC?

Back 71

amount of air forcibly exhaled from lungs after maximal inspiratory effort

Front 72

FRC?

Back 72

volume of gas contained in the lungs after normal quiet expiration
sum of ERV and RV

Front 73

Closing volume is approx what % of TLC at age 20?

Back 73

30%, increases to approx 55% at age 70

Front 74

During inspiration, intraalveolar pressure does what?

Back 74

becomes slightly negative with respect to atmospheric pressure (causes air to flow inward)

Front 75

During expiration, intraalveolar pressure does what?

Back 75

increases to 1 mm Hg above atmospheric pressure
(air flow outward)

Front 76

Anatomic dead space is?

Back 76

volume of conducting airways

Front 77

Alveolar dead space

Back 77

alveoli that are ventilated but not perfused

Front 78

What is physiologic dead space (Vds)?

Back 78

sum of anatomic dead space plus alveolar dead space
-calculated with Bohr equation

Front 79

What is the total surface area for gas exchange?

Back 79

60-80 m2

Front 80

At FRC, what alveoli are more compliant?

Back 80

dependent

Front 81

Respiratory quotient

Back 81

ratio of amount of CO2 produced to quantity of O2 consumed
~normally 0.8

Front 82

What is the partial pressure of water vapor?

Back 82

47 mm Hg

Front 83

PVR is ____ of SVR

Back 83

1/8

Front 84

PVR is increased by what 5 things? combo of physiologic effects and drugs

Back 84

NE, serotonin, histamine, hypoxia, hypercapnia

Front 85

PVR is decreased by what 2 drugs?

Back 85

acetylcholine and isoproterenol

Front 86

Bronchial veins anastomose with?

Back 86

pulmonary veins, contributes to the addition of unoxygenated blood to the left side of the heart

Front 87

Pulmonary blood flow is regulated by changes in?

Back 87

oxygen and carbon dioxide tension

Front 88

High oxygen tension and hypocapnia ________ pulmonary vessels

Back 88

vasodilate

Front 89

Hypercarbia and acidosis ________ pulmonary vessels

Back 89

vasoconstrict

Front 90

Zone 1?

Back 90

PA>pa, no blood flow, alveolar dead space

Front 91

Zone 2?

Back 91

PA>pa>pv

Front 92

Zone 3?

Back 92

Pa>Pv>PA, continous blood flow

Front 93

Distance across respiratory membrane is less than?

Back 93

1 micron

Front 94

What tends to hold fluid in the pulmonary capillaries?

Back 94

plasma colloid oncotic pressure

Front 95

Does pulmonary edema affect oxygenation more than CO2?

Back 95

yes, b/c CO2 is 20x more diffusible than O2

Front 96

Ventilation is approximately how many L/min?

Back 96

4

Front 97

Pulmonary blood flow is approximately how many L/min?

Back 97

5

Front 98

V-Q perfusion ratio=

Back 98

4/5=0.8

Front 99

Alveoli that are ventilated but not perfused, Q= ___?, V/Q= ___?

Back 99

Dead space, Q=0, V/Q= infinity

Front 100

Alveoli that are perfused but not ventilated, V=___? V/Q= ___?

Back 100

physiologic shunt, V=0, V/Q= 0

Front 101

Low CO results in?

Back 101

low pulmonary blood flow and increased deadspace, reflected by low ETCO2

Front 102

With PPV, distribution of ventilation becomes?

Back 102

more uniform to the lung

Front 103

Mean pulmonary transit time for blood is ?

Back 103

4-5 seconds

Front 104

Blood spends approximately _____ seconds in pulmonary capillaries.

Back 104

0.75

Front 105

In a normal lung, it takes approxmiately ____ seconds to equilibrate between alveolar air and pulmonary capillary blood.

Back 105

0.25

Front 106

Diffusivity?

Back 106

the solubility divided by the square root of the MW

Front 107

Hematocrit is approximately = to?

Back 107

Hgb x3

Front 108

Bohr effect?

Back 108

influence of pH and PCo2 on HgbO2 dissociation curve

Front 109

P50 is?

Back 109

the Pa02 at which 50% of the Hgb is saturated

Front 110

Normal P50 is?

Back 110

26-27

Front 111

What is nitrate poisoning or NTG overdose treated with?

Back 111

O2 therapy and methylene blue (1-2mg/kg IV over 5 minutes)

Front 112

Normal Ca02?

Back 112

20 mL of 02 per 100 ml of arterial blood

Front 113

Normal Cv02?

Back 113

15 mL of 02 per 100 mL mixed venous blood

Front 114

What is the normal arteriovenous O2 content difference?

Back 114

5mL/dL of blood

Front 115

A difference >5 indicates?

Back 115

low Co

Front 116

A difference < 5 indicates?

Back 116

systemic arteriovenous shunts

Front 117

How is CO2 carried mainly?

Back 117

as bicarbonate ions, 80-90% carried this way
-when bicarb leaves the blood cells, chloride ions enter to maintain electical neutrality

Front 118

when blood contains mainly oxygenated Hgb, the Co2 dissociation curve shifts to the ?

Back 118

right

Front 119

when blood contains mainly deoxygenated Hgb, the Co2 dissociation curve shifts to the ?

Back 119

left

Front 120

The shift according to oxgenated vs deoxygenated Hgb and CO2 is due to what effect?

Back 120

Haldane (Bohr effect)

Front 121

Respiratory acidosis?

Back 121

Elevation in PaC02, decrease in pH

Front 122

An acute change in PaC02 of _____ mm Hg changes ph ____ units

Back 122

10, 0.08

Front 123

Metabolic acidosis?

Back 123

Decreased HCO3, decrease in pH

Front 124

A bicarbonate increase of ____ mEq/L increases the pH ____ units

Back 124

10, 0.15

Front 125

Mixed acidosis can produce a dramatically ____ ph

Back 125

decreased

Front 126

Respiratory alkalosis

Back 126

decreased PaC02, increase ph

Front 127

Metabolic alkalosis

Back 127

increased HCO3, increase in pH

Front 128

The respiratory system can rapidly compensate for?

Back 128

metabolic acidosis or alkalosis by altering alveolar ventilation

Front 129

What changes to increase or decrease alveolar ventilation?

Back 129

Hydrogen ions

Front 130

Kidneys can compensate for respiratory and metabolic acidosis of NONRENAL origin by?

Back 130

excreting fixed acid and retaining bicarbonate

Front 131

Kidneys compensate for respiratory and metabolic alkalosis of NONRENAL origin by?

Back 131

decreasing H ion excretion and decreasing retention of bicarbonate

Front 132

Should respiratory acidosis be treated with bicarbonate?

Back 132

no

Front 133

Should severe metabolic acidosis be treated with bicarbonate?

Back 133

yes

Front 134

Acidosis from renal failure is best treated with?

Back 134

dialysis

Front 135

How do you treat lactic acidosis?

Back 135

bicarbonate