Phys And Pathophys - Respiratory

Front 1

goals of respiration are

Back 1

provide oxygen to the tissue and to remove carbon dioxide

Front 2

conducting airways are

Back 2

the passageways between the ambient environment and the alveoli - no air exchange occurs here

Front 3

upper and lower airway are divided by

Back 3

the cricoid cartilage

Front 4

the upper airway consists of

Back 4

the nose, oral cavity, and the pharynx (nasopharynx, oropharynx, and laryngo or hypo pharynx)

Front 5

primary function of the nose is to

Back 5

filter, humidify, and warm the inspired air

Front 6

review the anatomy of the lungs and airways

Back 6

review the anatomy of the lungs and airways

Front 7

the lower airways are aka

Back 7

the tracheobronchial tree

Front 8

branchings of the lower airways are aka

Back 8

generations or orders

Front 9

two types of airways

Back 9

cartilagenous and non-cartilagenous airways

Front 10

function of cartilaginous airways

Back 10

conduct air between the external environment and the site of gas exchange

Front 11

function of the non-cartilaginous airways

Back 11

site of gas exchange

Front 12

the cartilaginous airway is lined with

Back 12

epithelial cells attached to a basement membrane with oval basal cells which replenish the cilia and mucous cells

Front 13

cilia is found

Back 13

on the epithelial cells but disappears by the terminal bronchioles and is completely absent in the respiratory bronchioles

Front 14

mucus is formed by

Back 14

the goblet cells or bronchial glands and forms a mucus layer over the epithelial lining

Front 15

the bronchial glands (goblet cells) are innervated by

Back 15

the vagus nerve

Front 16

how much mucus is produced a day

Back 16

100 ml

Front 17

the mucociliary escalator or (transport mechanism)

Back 17

propel the mucus forward to the pharynx (helped out by the cough reflex)

Front 18

why do we have a strong respiratory reaction to allergies?

Back 18

because mast cells secrete vasoactive substances that produce respiratory smooth muscle vasoconstriction - and mast cells are scattered throughout the smooth muscle and near the small blood vessels and the vagus nerve

Front 19

how long is the trachea

Back 19

13 cm and 1.5 - 2.5 cm in diameter

Front 20

the cartilaginous airway consists of

Back 20

the trachea, main stem bronchi, lobar bronchi, segmental bronchi, and subsegmental bronchi

Front 21

the cartilaginous airways are aka

Back 21

the conducting zone

Front 22

the trachea extends from

Back 22

the cricoid cartilage to the second costal cartilage

Front 23

the trachea divides at

Back 23

the carina

Front 24

the carina is located at ??? which correlates with what?

Back 24

T4 - T5 - the angle of louis at the articulation of the second rib with the sternum

Front 25

flexion of the neck causes

Back 25

the trachea to rise making an ETT sink deeper

Front 26

extension of the neck causes the trachea

Back 26

to move downward causing the ETT to move upward and inadvertant extubation at times

Front 27

movement of the head from side to side causes the trachea to

Back 27

move upward

Front 28

the tracheal C rings

Back 28

are incomplete posteriorly where they share a fibroelastic membrane with the esophagus

Front 29

proper placement of the ETT is

Back 29

2 cm above the carina

Front 30

right main stem branch is

Back 30

25 degrees

Front 31

left main stem branches at

Back 31

40 - 60 degrees

Front 32

the right main stem is

Back 32

shorter and wider than the left in an adult - in an infant both branches are the same and branch at a 55 degree angle

Front 33

the right main bronchus divides into

Back 33

the upper and middle lobe bronchi, and then segmental, and subsegmental bronchi

Front 34

size of bronchi range from

Back 34

1-4mm in diameter

Front 35

the left main bronchi divides into

Back 35

the upper and lower lobal bronchi, then segmental bronchi, then subsegmental bronchi

Front 36

as cross sectional area increases, air velocity

Back 36

decreases

Front 37

the larger airways cross sectional area is

Back 37

smaller

Front 38

noncartilaginous airways are composed of

Back 38

bronchioles and the terminal bronchioles

Front 39

what generation of branches are the bronchioles

Back 39

between 10th and 15th branching

Front 40

the bronchioles are surrounded by

Back 40

spiral muscle fibers

Front 41

because bronchioles have no cartilage, they

Back 41

are susceptible to collapse based on intrapleural and intraalveolar pressures

Front 42

the conducting portion of the airway ends

Back 42

with the terminal bronchioles (16th - 19th generation)

Front 43

what are the channels that connect the terminal bronchioles to adjacent alveoli

Back 43

canals of Lambert (1955)

Front 44

the canals of lambert provide

Back 44

for collateral flow for ventilation distal to an obstruction

Front 45

anything distal to the terminal broncioles is the

Back 45

respiratory zone (where air exchange occurs)

Front 46

the velocity of air flow in relation to branchings

Back 46

further down the tree you go, the greater the cross sectional area, the slower the velocity and increasing airway resistance

Front 47

canals of lambert are not

Back 47

affected by smooth muscle contraction (bronchial constriction)

Front 48

the respiratory zone consists of

Back 48

the respiratory bronchioles, alveolar ducts, and alveoli (air exchange occurs in any of these places)

Front 49

two cell types of alveoli

Back 49

type I cells (epithelial primarily) and type II cells (more granular with high metabolic rates)

Front 50

the alveolar macrophages

Back 50

cruise around the alveoli engulfing debris

Front 51

the openings that connect two alveoli are called

Back 51

the pores of kohn

Front 52

Pores of Kohn are absent

Back 52

at birth but increase with size and age and certain diseases

Front 53

the number of alveoli increase

Back 53

from 10 to 25 million at birth up to 300 million when the lungs are fully mature

Front 54

in adults the number of alveoli vary with

Back 54

the body length and the size of individual alveoli increases with age

Front 55

total alveolar surface area is approximately equal to

Back 55

the size of a tennis court

Front 56

the pulmonary artery divides into

Back 56

the right and left main branches about 5 cm past the right ventricle - these supply the right and left lungs respectively

Front 57

the pulmonary arterial tree is

Back 57

very compliant and distensible because of thin walls and larger diameters

Front 58

the blood in the pulmonary arteries is

Back 58

partially unoxygenated

Front 59

the pulmonary veins are

Back 59

short, return blood back to the left atria and are similar to the systemic veins

Front 60

the bronchial vessels feed

Back 60

the tracheobronchial tree

Front 61

the bronchial vessels come from

Back 61

the aorta

Front 62

the bronchial vessels follow the

Back 62

tracheobronchial tree until the terminal bronchioles where they merge into the pulmonary arteries and capillaries

Front 63

the normal bronchial arterial flow is about

Back 63

1 - 2% of the cardiac output

Front 64

the bronchial arteries feed

Back 64

the mediastinal lymph nodes, the pulmonary nerves, and a portion of the esophagus

Front 65

1/3rd of the bronchial arterial blood

Back 65

joins the intercostal veins and returns to the right atrium

Front 66

2/3rds of the bronchial arterial blood

Back 66

drains into the pulmonary circulation after it has left the alveolar capillaries therefore some deoxygenated blood is added to oxygen rich blood before it returns to the left atria

Front 67

the addition of the bronchial arterial deoxygenated blood to the pulmonary vein is called

Back 67

the venous admixture

Front 68

the venous admixture explains

Back 68

the discrepancy between right and left atrial volume (1 - 2%)

Front 69

there are more lymph vessels

Back 69

on the lower lobes than the upper and more lymph vessels on the left than the right

Front 70

the role of the lymph in the pulmonary system?

Back 70

it courses around the lungs, removing debris, returning proteins and extra fluid to the systemic circulation

Front 71

what determines your AP diameter

Back 71

rib cage

Front 72

what two ways do the lungs expand or contract

Back 72

moving the diaphragm up or down, elevating or depressing the ribcage and therefore changing the AP diameter of the chest

Front 73

normal breathing uses only the

Back 73

diaphragm

Front 74

as the diaphragm contracts it

Back 74

flattens and pushes the abdominal contents down and pulls the lungs down

Front 75

pressure changes as the diaphragm contracts

Back 75

the intra abdominal pressure increases and the intrathoracic pressure decreases

Front 76

the diaphragm is made of

Back 76

2 dome shaped muscles

Front 77

when the diaphragm relaxes it

Back 77

allows the lungs and chest to recoil and the abdominal contents to push up, expelling air.

Front 78

exhalation is usually

Back 78

passive but can be active with heavy breathing

Front 79

the abdominal muscles used in active breathing are

Back 79

the rectus abdominus, external abdominis oblique, internal abdominis oblique, and transverse abdominis

Front 80

a paralyzed diaphragm functions

Back 80

opposite the normal - during inspiration it moves up and during exhalation it moves downward

Front 81

the abdominal diaphragm is what type of muscle

Back 81

skeletal and therefore will be paralyzed with drugs

Front 82

the diaphragm is innervated by

Back 82

the phrenic nerve

Front 83

the phrenic nerve arises from the

Back 83

3, 4, 5th cervical spinal nerves (C3 - C5)

Front 84

the phrenic nerve is made mostly of

Back 84

motor nerve fibers that produce the contractions of the diaphragm

Front 85

"C3,4,5 keeps

Back 85

the diaphragm alive"

Front 86

supraclavicular blocks risk

Back 86

knocking out the phrenic nerve leading to hemi paralysis of the diaphragm - so may not be worth the risk in a severe COPD pt

Front 87

instead of using the diaphragm to ventilate, some people use

Back 87

the external intercostal muscles to lift the rib cage up and out which can increase the chest wall AP diameter by as much as 20%

Front 88

to actively exhale and relax

Back 88

the internal intercostals relax and pull the chest down and in and assist in exhalation

Front 89

internal intercostals pull

Back 89

down and in and exhale

Front 90

external intercostals pull

Back 90

out and up and inhale

Front 91

COPD patients favor their

Back 91

internal intercostals

Front 92

accessory muscles useds for inspiration

Back 92

external intercostals, sternocleidomastoid, anterior serrati, scaleni

Front 93

accessory muscles for forced expiration

Back 93

internal intercostals, abdominal recti

Front 94

the sternocleidomastoid works by

Back 94

lifting the sternum

Front 95

the anterior serrati work by

Back 95

lifting many of the ribs

Front 96

the scaleni work by

Back 96

lifting the first two ribs

Front 97

with normal breathing, expiration is

Back 97

passive

Front 98

signs of struggling to inhale

Back 98

retractions - often seen in children

Front 99

retractions most often occur with

Back 99

upper airway obstruction

Front 100

retractions occur where

Back 100

the sternum, subxiphoid process, between ribs

Front 101

the mediastinum contains

Back 101

all chest structures except the lungs (the pleural cavity contains the lungs)

Front 102

what is the hilum

Back 102

the only area in the chest where the lungs are in a fixed position

Front 103

the lungs are surrounded by

Back 103

a thin layer of pleural fluid that lubricates movement of the lungs within the cavity

Front 104

the -8 pressure of the thoracic cavity is created by

Back 104

the pull of the lymph

Front 105

what keeps the lungs inflated

Back 105

the pleura

Front 106

what are the pleura

Back 106

two thin linings or membranes that protect and cushion the lungs

Front 107

the lining that covers the lungs is called the

Back 107

visceral pleura

Front 108

the lining that covers the chest wall

Back 108

parietal pleura

Front 109

what is between the two linings surrounding the lungs

Back 109

pleural fluid

Front 110

ventilation is

Back 110

the process that exchanges gases between the external environment and the alveoli

Front 111

what is the driving pressure

Back 111

the pressure difference between two points in a tube (P1 - P2) = driving pressure - the amount of force required to move a gas or fluid through a tube

Front 112

transairway pressure is

Back 112

the barometric pressure difference between the mouth and the alveoli

Front 113

air moves into and out of the lungs because of

Back 113

pressure difference

Front 114

alveolar pressure is

Back 114

the pressure of the air inside the alveoli

Front 115

when the pressure in the alveoli is the same as the atmosphere it is called the

Back 115

zero reference point

Front 116

the zero reference point occurs when

Back 116

the glottis is open and no air is flowing in or out

Front 117

a fall in alveolar pressure of 1 mmHg will exchange

Back 117

.5 liters of air over about 2 seconds

Front 118

normal I:E ratio

Back 118

1:2

Front 119

if patients don't exhale fully they will

Back 119

breath stack

Front 120

alveolar pressures typically vary from

Back 120

-1 to +1

Front 121

Pleural pressure is

Back 121

the pressure in the fluid in the pleural space

Front 122

the pleural pressure is the same as

Back 122

the intrathoracic pressure

Front 123

normal pleural pressure

Back 123

-5 to -8 (-7.5 mmHg) between exhalation and inhalation

Front 124

chest wall expansion makes intrathoracic pressure

Back 124

more negative

Front 125

transpulmonary pressure is aka

Back 125

recoil pressure

Front 126

the transpulmonary pressure is

Back 126

the pressure difference between the alveolar pressure and the pleural pressure

Front 127

transpulmonary pressure describes

Back 127

the elastic forces in the lungs that tend to collapse the lungs

Front 128

when we paralyze a patient we PPV because

Back 128

the only pressure working for ventilation is the driving pressure

Front 129

lung pressures are dependent on

Back 129

movement of the diaphragm and the chest wall