Respiratory Exam 1

Front 1

How many Cartilages does the Larynx have?

Back 1

Nine

Front 2

Name the 3 single cartilages in the larynx

Back 2

thyroid, cricoid, and epiglottis

Front 3

Name the 3 paired cartilages of the larynx

Back 3

arytenoid, corniculate, cuneiform

Front 4

What is at the base of the arytenoid cartilage?

Back 4

Vocal Process

Front 5

What are the 3 functions of the larynx?

Back 5

1 a [assageway of air b/t the pharynx and the trachea
2 protective mechanism against aspiration
3 generates sounds for speech

Front 6

What is the narrowest point of the larynx in the adult? in Infant?

Back 6

Adults-the Glottis (space b/t the true vocal cords)
Infant- Cricoid cartilage

Front 7

What are the 2 groups of extrinsic muscles

Back 7

Infrahyoid Group-- sternohyoid, sternothyroid, thyrohyoid, and omohyoid muscles
Suprahyoid Group--
stylohyoid, myohyoid, digastic, geniohyoid, and stylopharyngeus

Front 8

What is the function of the Infrahyoid Goup of extrinsic muscles?

Back 8

pull the larynx and hyoid bone down to a lower position in the neck

Front 9

What is the function of hte Suprahyoid Group of extrinsic muscles in the larynx?

Back 9

pull the hyoid bone forward, upward, and backward

Front 10

When is the best time to extubate patient; inspiration of expiration?

Back 10

The end of inspiration b/c the vocal cord are very wide apart

Front 11

What can cause massive adduction of vocal cords and the glottis become sealed

Back 11

Valsalvar Maneuver

Front 12

What are the groups of laryngeal intrinsic muscles?

Back 12

Posterior Cricoarytenoid Muscles
Lateral Cricoarytenoid Muscles
Transverse Arytenoid Muscles
Thyroarytenoid Muscles
Cricothyroid Muscles

Front 13

What are the Cartilaginous airways?

Back 13

Trachea
Main Stem Bronchi
Lobar Bronchi
Segmental Bronchi
Subsegmental Bronchi

Front 14

What are the Canals of Lambert?

Back 14

an opening b/t a terminal bronhiole and an alveoli

*it is thought that they may be secondary avenues for collateral ventilation in patient with respiratory disorders

Front 15

What are the parts of the Respiratory Zone in the lungs?

Back 15

respiratory Bronchioles
Alveolar Ducts
Alveolar Sacs
Alveoli

Front 16

What are the angles at which the right and left main stem branch off from the trachea?

Back 16

Right main stem--25 degree angle (most likely intubated)
Left main stem--40-60 degree angle

Front 17

What are the 3 functional units of gas exchange?

Back 17

1 resp. bronchioles
2 alveolar ducts
3 alveolar sacs

Front 18

What cells in the alveoli produce surfactant?

Back 18

Granular Pnuemocytes

Front 19

Does gas exchange take place in the tight space or the loose space?

Back 19

Tight space
b/t epithelium of cappilaries and epitheleum of alveoli

Front 20

What are the 2 types of cells that make up the alveolar epithelium?

Back 20

Squamous pneumocytes (95%)
Granular pneumocytes

* third type is macrophages is there is an imfection

Front 21

Name the ariways of the Conducting Zone

Back 21

Trachea
main stem bronchi
Lobar Bronchi
Segmaental Bronchi
Subsegmental Bronchi
?Terminal Bronchioles

Front 22

What are the Pores of Kohn?

Back 22

Normal holes in the alveoli that permit gas to move b/t adjacent alveoli

Front 23

What is the pressure in the pulmonary artery

Back 23

mean PA Pressure is 15-20

Front 24

What is the volume of the Respiratory Zone (where gas exchange occurs)?

Back 24

2-3 LIters

Front 25

what is the average thickness of the blood-gas barrier?

Back 25

0.3 um

Front 26

What is the Bronchiole circulation?

Back 26

The arteries that nourish the tracheobronchila tree (conducting zone)
onlly about 1% of CO
some of this de-oxygenated blood drains into the pulmonary veins (oxygentated blood)--this accounts for normal venous admixture

Front 27

Where do the pulmonary arteries and viens enter and leave the lungs?

Back 27

Hilum

Front 28

What does capacitance vessels mean?

Back 28

they are capable of collecting large abounts of blood without expereincing a pressure change (Veins)

Front 29

Which side of the lung has larger number of Lymph nodes?

Back 29

Left side--
Pleural effusion is more likely to occur on the right side b/c does not have as many lymphs to move bacteria, etc. out

Front 30

Name the 3 veins that bring the venous bronchiole circulation blood to the left heart

Back 30

1 azygous
2 hemiazygous
3 intercostal

Front 31

What law can be used to measure FRC?

Back 31

Boyle's Law

P1V1=P2V2

Front 32

What is FRC

Back 32

Functional Residual Capacity
The volume of gas in the lung after a normal expiration
cannot be measured by a spirometer
FRC = Expiratory Reserve Volume (left in lung after normal expiration) + Residual Volume (left in lung after maximial expiration)

Front 33

What is Residual Volume

Back 33

volume of gas that remains in the lung after max expiration
Prevents lung from collapse
(cannot be breathed out)
cannot be measured with spirometer.

Front 34

How is alveolaer ventilation calculated

Back 34

(TV-150) X RR= alv. ventilation
*if trying to increase this, it is more effective to increase TV

Front 35

What is Vital Capacity?

Back 35

Max. volume exhaled after maximum inspiration

Front 36

List the different types of lung volumes measured with spirometry

Back 36

volumes measured by spirometry:
tidal volume
Inspiratory Reserve Volume
Expiratory Reserve Volume
All = Vital Capacity

Front 37

What is Vital capacity?

Back 37

the maximal exhaled volume
VC= Inspiratory Reserve volume+ Tidal Volume + Expiratory Reserve Volume

Front 38

What is Fowler's Method?

Back 38

Measure's Anatomical Dead Space by measuring expiratory voluem that does not contain Nitrogen

Front 39

Name the 3 Mechanisms that can affect Pulmonary Diffusion

Back 39

1 # of alveoli available for gas exchange
2 Hb concentrations (uptake of gases by RBC)
3 Changes in the physical properties of the membrane

Front 40

What does Diffusion Limited mean?

Back 40

If the gas in the blood and alveoli are unable reach steady state, it is called diffusion limited.

Front 41

Is the movement of Carbon Monoxide across the blood-gas barrier diffusion limited or perfusion limited?

Back 41

It is Diffusion Limited b/c it binds to the RBC right away and does not build up a Partial Pressure so never reaches a steady state (equilibrium of pressures)

Front 42

Is the movement of Nitroud Oxide across the blood-gas barrier diffusion of perfusion limited?

Back 42

It is perfusion limited b/c N20 is not very soluble and builds up a partial pressure quickly, so the amount of gas taken up by the blood depends entirely on the amount of available blood flow

Front 43

What are 3 things that can challenge the diffusion process?

Back 43

1 Excercise (RBC has less time to equibrilate with alveolar PO2)
2 Alveolar Hypoxia
(The pressure gradient is smaller so O2 moves into blood slower)
3 Thickening of the blood-gas barrier
(ex Pulmonary Fibrosis--diffusion pathway is longer)

Front 44

What does Bohr's Method Measure?

Back 44

Measure all dead space--both anatomical and physiological
Method: measure the CO2 exhaled bec it will be lower in diseased lung
Equation: Vd/Vt=PACO2-(PECO2/PACO2)
Vd= vol. of dead space
Vt= tidal volume

Front 45

What is the diffusion capacity of CO?

Back 45

25 ml/min/mmHg

Front 46

What are the 3 pressures within the pulmonary circulation?

Back 46

1 Intravascular Pressure
2 Transmural Pressure
3 Driving Pressure (the downstream pressure)

Front 47

What is transmural pressure?

Back 47

the pressure diference b/t the inside and the outside of the capillaries

Front 48

What is PVR?

Back 48

Pulmonary Vascular Resistance
PVR= Pulmonary driving pressure/Cardac Output

*total PVR is lowest at FCR*

Front 49

What is Recruitment?

Back 49

One way the lung reduces its PVR when pulmonary pressures are increased.
recruitment of previously unperfused pulmonary vessels; may occur in response to increased pulmonary blood flow

Front 50

What is Distention

Back 50

Second way for lungs to reduce its PVR by widening of individual capillary segments;occurs at high vascualr pressures, (flattend cappilaries are now round)

Front 51

What causes increased PVR when lung volume is high (lungs are expanded)?

Back 51

cappilaries --they get squashed, so resistance increases

Front 52

What causes increased PVR at low lung volumes?

Back 52

The extra-alveolar vessels have increase resistance at low lung volumes

Front 53

What affects the blood flow pattern within the the lung

Back 53

changes in posture and excercise
*in exercise all blood flow increases and there are less regional differences

Front 54

Describe the pressure gradient in Zone 1 of the lung

Back 54

PA > Pa > Pv
*does not occur under normal conditions
could occur if alveolar pressure is greater than arterial pressure (ie pos. pressure ventilation)
or if arterial pressure drops to make PA > Pa (ie hemmorhage)

Front 55

What is the pressure difference b/t the top and bottom of the lung

Back 55

about 23 mmHg

Front 56

What is the "Waterfall Zone"

Back 56

Zone 2 :
Pa> PA > Pv
Difference b/t arterial press and alveolar press determines
the flow
Since arterial pressure increases down the lungbut alveolar pressure remains the same the pressure difference responsible for flow increases

Front 57

Describe Zone 3

Back 57

Pa > Pv > PA
Difference b/t arterial press and venous pressure determine the flow

Front 58

What is Hypoxic Pulmonary vasoconstriction and when is it Critical?

Back 58

An active response that occurs when PO2 of alveolar gas < 70. Mechanism of action is not known.
Cause vasoconstriction and directs blood flow away from poorly ventilated area.
Critical at Birth in transition from placental to air breathing (the pulmonary veins stop constricting and allow blood flow to the lungs)

Front 59

Does low blood pH cause vasoconstriction or vasodilation?

Back 59

Vasoconstriction

Front 60

What does Starling's Law state about Fluid Balance in the lung?

Back 60

Explains how fluid stays in capillaries and does not go into alveli.
Net Fluid Out= K (Pc - Pi)

Pc= capillary hydrostatic pressure (if high pushes fluid into the alveoli)

Pi= Press. in interstium (if increased pushes fluid into capillary)

Front 61

Does O2 diffusion become perfusion limited or diffusion limited in pulmonary edema?

Back 61

Diffusion Limited b/c the pathway for diffusion is lengthened

Front 62

What pressures are increased and cause pulmonary edema?

Back 62

Left Atrium--there is back flow, so the pressure goes up b/c contractility is decreased
compensation by distention and recruitment only last so long, eventually the Pulmonary artery pressure increases--causing increased capillary pressure--and the capillary leaks

Front 63

Cause of Pulmonary Edema

Back 63

1 Increased Cap. Hydrostatic pressure

2 Increaed Cap permeability

3 Decreased Lymph drainage

4 Decrease colloid pressure (malnutrition--low albumin)

5 Uncertain Etiology
(High altitude, Heroine)

6 Decreased Interstitial pressure
(ie rapid removal of Pneumothorax)

Front 64

What are the Stages of Pulmonary Edema?

Back 64

1 Interstitial--Asymptomatic
2 Interstital with crescent filling of alveoli
Pt may have dyspnea
3 Alveolar Flooding
"All or Nothing"--No gas exchange in alveoli that are flooded; becomes a shunt unit
4 Extreme Alveolar Flooding
Frothy air passageways
3

Front 65

What are some causes of Negative Pressure Pulmonary Edema?

Back 65

1 Laryngospasm
2 Rapid reinflation of lung
3 Vigorous spontaneous ventilation against an obstructed airway

Front 66

Name some drugs that increase PVR

Back 66

Serotonin
Histamine
Norepinephrine

Front 67

Name some drugs that decrease PVR

Back 67

Acetycholine
Isoproterenol

Front 68

What ALWAYS cause increased PCO2?

Back 68

Hypoventilation

Front 69

What are the 2 things that determine alveolar PO2

Back 69

1 Rate of removal of O2 by the blood (metabolic demands of the body)
2 Rate of replenishment of Os by alveolar ventilation

Front 70

What is the Alveolar Gas Equation?

Back 70

there is an indirect relationship b/t alveolar ventilation and PCO2 that can be calculated.
Calculate the fall in PAO2 and rise in PCO2 in hypoventilation
PAO2 = PiO2 - (PACO2/ R) + F
R=0.8
PAO2 is aveolar O2

Front 71

What does a low V/Q Ratio mean?

Back 71

That the ventilation is low and perfusion is high or normal. The blood remains venous blood b/c cannot become oxygenated

Front 72

What does a high V/Q ratio mean?

Back 72

the perfusion is low and the ventilation is high or normal
PO2 and PCO2 values will be the same as inspired gas

Front 73

If the arterial O2 going to tissues is decreased, does the venous O2 go down or up?

Back 73

It goes down b/c the tissues still extract O2 at the same rate

Front 74

Why do ALL Post-op Patients need supplemental O2?

Back 74

They will become hybercarbic (from hypoventilation) and hypoxemic from increased PCO2

Front 75

What is the nomral alveolar O2 - arterial O2 Gradient?

Back 75

young adults 100-97=3 (<15)
older adult < 37

Front 76

what is the reason for the normal increased alveolar to arterial gradient in the older adult

Back 76

there is a decrease in effective surface area which causes a decrase in diffusion

Front 77

What are the 4 causes of Hypoxemia?

Back 77

1 Hypoventilation
2 Diffusion
3 Shunt
4 Ventilation-perfusion Mismatch

Front 78

What is Shunt?

Back 78

Blood that enters the arterial system without going through a ventilated area of the lung
Causes
1 Age (Normal)
2 Bronchial Circualtion (Normal)
3 Venous Admixture

*cannot be fixed with increased FiO2 intake*

Front 79

Why doesn't shunt bring PaCO2 down?

Back 79

Two Reasons:
1 Hypoxemia causes increased RR to blow off PCO2
2 CO2 diffuses more easily than O2

Front 80

HOw do you distiguish a shunt vs Hypoventilation?

Back 80

Look at PAO2- PaO2 gradient
Should be less than 15

if given bl gas levels (PaO2 and PCO2) can calculate PAO2 using the alveolar gas equation:
PAO2= PiO2- (PCO2/R 0.8)

Front 81

At what point is a shunt life-threatening?

Back 81

When it is > 30%
Based on Isoshunt Diagram

Front 82

What is the normal V/Q ratio at apex of lung?

Back 82

3.3--High VQ because ventilation and perfusion are both low (but ventilation is a little bit better)

Front 83

Which has greater increase as you go from top to bottom of lung ventilation or perfusion

Back 83

Perfusion .07 at apex and 1.29 at base

Front 84

What is the normal V/Q ratio at the bottom of the lung?

Back 84

0.63--Low VQ b/c Q has increaed tremendously (V has increased too, but not as much)

Front 85

what is the composition of Alveolar gas in a low V/Q

Back 85

High perfusion
low ventilation
alveolar gas composition is similiar to venous blood composition PO2 40
PCO2 45

Front 86

What is the compostition of Alveolar gas in High V/Q?

Back 86

hig ventilation and low perfusion
Alveolar gas composition is similar to air
PO2 150
PCO2 0

Front 87

What is Oxygen Capacity?

Back 87

the max. amount of oxygen is combined with Hemoglobin
(all bind sites are occupied)
amt of Hb patient has X 1.39 = O2 Capacity

Front 88

How do you calculate Oxygen saturation of Hb

Back 88

SaO2= O2 combined with Hb/Oxygen capacity X 100

Front 89

what are the 2 causes of CO2 Retention?

Back 89

Hypoventilation and V/Q Ratio Inequality

Front 90

What is the Bohr Effect?

Back 90

describes the effect of CO2 on the oxygen dissociation curve
Increase CO2 causes a right shift--lower affinity of Hb for oxygen

Front 91

What can cause a right shift in the O2 dissociation curve?

Back 91

increased CO2
increased temperature
increased Hydrogen ions
and increased 2,3-DPG

Front 92

What is the normal value for p50?

Back 92

27 mmHg
this is the PO2 for a sat of 50%

Front 93

What does a right shift in the O2 dissociation curve mean?

Back 93

the affinity of Hb to O2 is reduced so the O2 unloading to peripheral tissues is assisted (O2 concentration is lower)

Front 94

What is the most common way CO2 is carried in the blood?

Back 94

As Bicarbonate

Front 95

What is the Haldane Effect?

Back 95

Describes the effect of O2 on the CO2 dissociation curve

deoxynation of blood increases its ability to carry CO2

Front 96

What are the 3 forms that CO2 is carried in the blood as?

Back 96

1 dissolved CO2
2 Bicarbonate
3 Cabamino Compounds

Front 97

What is meant by the Chloride Shift?

Back 97

Cl moves into the cell to maintain electrical nuetrality
(b/c HCO3- moved out)

Front 98

What does an increase in O2 Saturation do to the CO2 dissociation curve?

Back 98

causes a right shift
(oxygenated blood carries less CO2)

Front 99

What is the Henderson-Hasselbalch equation

Back 99

calculates the pH resulting from the solution of CO2 in blood and the consequent dissociation of carbonic acid
Has do with the ratio b/t the bicarbonate and CO2
(normally = 20 for pH of 7.4)

Front 100

What is alveolar dead space?

Back 100

lung units with high V/Q ratios. there is no gas exchange at these sites (or gas exchange is severely compromised)

Front 101

Will increased ventilation help to increase the PO2 in high V/Q or low V/Q?

Back 101

moderately low V/Q ratio will benefit from increased ventilation

Front 102

What is the most important muscle of inspirations?

Back 102

The Diaphragm
it is supplied by the phrenic nerves that originate from C 3, 4, & 5

Front 103

What is paradoxycal movement?

Back 103

when the diaphragm is paralyzed, it moves up rather than down

Front 104

What are the most important muscles of Expiration?

Back 104

muscles of the abdominal wall

Front 105

Is breathing active or pasive during rest?

Back 105

inspiration is active, expiration is passive

Front 106

What is the equation for calculating PVR?

Back 106

PVR= pulmonary driving pressure / cardiac output

PVR= 15-5 / 6 = 1.7 mmhg/min
Or 100 dynes/sec/cm-5

Front 107

What are the 2 passive changes that occur in response ot increaed PVR?

Back 107

Distention
Recruitment

Front 108

when is PVR lowest

Back 108

at FRC