Resp 283 - Week 1

Front 1

What structures are responsible for substantially increasing the surface area of the nasal cavity?

Back 1

Conchae or turbinate's

Front 2

What type of epithelium covers the posterior 2/3 of the nasal mucosa?

Back 2

Respiratory Mucosa = pseudostratified ciliated columnar epithelium with mucus secreting glands

Front 3

What are the main functions of the nose?

Back 3

humidification

heating

filtering

Front 4

What size particles do not gain entry into the lower airways due to the filtering of the nose?

Back 4

Particles >5 microns

Front 5

When an ET tube is in place and a patient is mechanically ventilated, what function of the nose is lost?

Back 5

Air condition function of the nose is lost, and unmodified cool, dry gas directly enters the trachea

Front 6

What lymphoid tissues are present in the pharynx?

Back 6

Pharyngeal (adenoid) tonsils

Palatine tonsils

Lingual tonsils

Front 7

There are no water droplets condensed on the inner surface of a ventilator's inspiratory tube, secretions are thick and difficult to suction, what is the best therapy t resolve this situation?

Back 7

Add heated humidification to the ventilator circuit

Front 8

What are the goals of humidification in mechanical ventilation regarding temp and relative humidity?

Back 8

-Duplicate heat and humidity in nonintubated trachea

-32-34 degrees Celsius

-100% relative humidity

Front 9

What pairs of reflexes is responsible for preventing aspiration of foreign materials into the lungs?

Back 9

Pharyngeal and laryngeal reflexes

Front 10

How is a seal formed between the ET tube and tracheal wall to minimize aspiration of pharyngeal contents?

Back 10

Inflation of the endotracheal tube cuff

Front 11

Aspiration of pharyngeal contents makes mechanically ventilated patients susceptible to?

Back 11

Ventilator associated pneumonia (VAP)

Front 12

In deeply unconscious patients what is the most common threat to upper airway patency?

Back 12

Soft tissue obstruction

Front 13

What signs are most suggestive of complete airway obstruction?

Back 13

-Strong inspiratory efforts without sound or air movement

-Soft tissue between ribs and sternum sucked inward

-Intercostal and suprasternal retractions

Front 14

What describes the sniffing position?

Back 14

-Extended neck with chin pulled anteriorly

-Pulls tongue forward out of airway

-Aligns oral and nasal cavities with pharynx-larynx axis

-Opens airway for facilitation of intubation

Front 15

What structure us an important landmark for insertion of an ET tube into the trachea?

Back 15

Vallecula

Front 16

Characteristics of individuals with sleep apnea

Back 16

-Short necks

-Receding lower jaws (retrognathia)

-Large tongues (macroglossia)

-Obese

-Snore

-Daytime sleepiness and fatigue

Front 17

What is the most efficacious treatment for patients with OSA?

Back 17

CPAP

Front 18

Inflammation of what anatomic structure is considered a life-threatening condition?

Back 18

Epiglottis

Front 19

What is the narrowest portion of the airway in an infant?

Back 19

Cricoid ring

Front 20

Where should the incision be made for an emergency airway?

Back 20

Tracheostomies are located 1-3cm below the cricoid cartilage in the cricothyroid membrane

Front 21

What is the narrowest space that an ETT will go through in an adult?

Back 21

Glottis

Front 22

What sound is associated with high velocity air flowing through a narrowed glottis?

Back 22

Stridor

Front 23

What is the diagnosis of the classic thumb sign on a lateral soft tissue x-ray?

Back 23

Epigglotitis

Front 24

What mechanism explains why drowning victims have little water in their lungs?

Back 24

Laryngospasm

Front 25

Characteristics of the trachea

Back 25

-Begins at 6th cervical vertebrae

-In adults extends 11cm

-Ends 5th thoracic vertebrae

-Divides left and right mainstem bronchi at Carina

Front 26

What happens if the ETT is inserted too far?

Back 26

If the endotracheal tube is inserted to far it enters the right mainstem bronchus, diminished breath sounds will be heard on the left side of the lungs

Front 27

What term describes a volume of gas that is approximately 150ml in the average adult that does not participate in gas exchange?

Back 27

Anatomical dead space

Front 28

If water content and humidity is affected what will happen to the mucous sheet?

Back 28

-Dehydrated

-Thick

-Immobile

Front 29

If during normal breathing inspired air only reaches 50% relative humidity at 37C, what will be the humidity deficit as air passes through the trachea?

Back 29

22mg deficit

Front 30

What conditions are associated with neutrophilic infiltration of the airways?

Back 30

Chronic inflammation (CF, chronic bronchitis, asthma, emphysema, cigarette smokers) causes neutrophils to invade the airways

Front 31

What group of cells accounts for most of the alveolar surface?

Back 31

Type I cells constitute most of the alveolar surface

Front 32

What group of cells contain the lamellar bodies?

Back 32

Type II cells contain the Lamellar Bodies

Front 33

What group of cells engulf microorganisms and foreign material in the alveolus?

Back 33

Alveolar macrophages

Front 34

IN the presence of high inspired O2 concentrations, which substances produce alveolar injury?

Back 34

Oxygen toxicity = overproduction of toxic oxygen radicals in the presence of high inspired oxygen concentrations

Front 35

Why is the left hemidiaphragm slightly lower than the right?

Back 35

Heart pushes down the left half of the diaphragm

Liver props up the right half of the diaphragm

Front 36

Term that describes the presence of fluid in the pleural space as a result of inflammation?

Back 36

Pleural effusion

Front 37

What is an anatomic shunt?

Back 37

Refers to the mixing of unoxygenated venous blood from the bronchial circulation mixing with oxygenated blood in the pulmonary veins, which is then pumped into the aorta and systemic arterie

Front 38

What is the impact of an anatomic shunt?

Back 38

Systemic arterial blood can never have the same partial pressure of oxygen as alveolar gas, giving rise to the P(A-a)O2 (alveolar to arterial O2 pressure difference

Front 39

Which nervous system innervates the lungs?

Back 39

Autonomic nervous system sensory and motor nerves

Front 40

What is true of phrenic nerves?

1. Norepinephrine

2. Acetylcholine

3. Dopamine

4. Adrenalin

Back 40

acetylcholine and norepinephrine

Front 41

What respiratory muscles will be compromised by C2 and C3 vertebrae injury?

Back 41

diaphragm, external and internal intercostals, and abdominals

Front 42

3/4ths of all parasympathetic fibers are in which cranial nerve?

Back 42

Vagus nerve (cranial nerve X)

Front 43

What is the only natural mechanism for sympathetic bronchodilation?

Back 43

Epinephrine

Front 44

What structures are innervated by parasympathetic postganglionic fibers?

Back 44

airway muscle, mucous glands, and pulmonary blood vessels

Front 45

What is the effect of parasympathetic stimulation on airway secretions?

Back 45

Increases the viscosity of airway secretions

Front 46

Why are anticholinergics less useful than adrenergic bronchodilators in treating small airway constriction?

Back 46

Because cholinergic innervation is the greatest in large airways, while adrenergic bronchodilators are equally effective in large and small airways

Front 47

What are the typical locations of pulmonary B2 receptors?

Back 47

-airway smooth muscle,

-airway epithelium,

-vascular smooth muscle, and

-submucosal glands

Front 48

What agents should be considered for asthmatics admitted to the ER?

Back 48

B2 agonists

Anticholinergics

Sympathomimetics

Alpha adrenergics

Front 49

What type of agent is racemic epinephrine?

Back 49

Alpha 1 adrenergic drug

Front 50

What forms of NO2 are useful identifying the early forms of asthma?

Back 50

eNOS

Front 51

What reflex causes smooth muscle relaxation and bronchodilation after a deep inspiration?

Back 51

Hering Breuer Reflex

Front 52

Bronchoconstriction caused by irritants is produced by the stimulation of what structures?

Back 52

Rapidly adapting (irritant) receptors

Front 53

Sequence of events for generating a cough:

Back 53

-Diaphragm contracts, causing deep inspiration

-Slight inspiratory pause

-Muscles in larynx close glottis, sealing upper airway

-Abdominal expiratory muscles contract forcefully

-Glottis suddenly opens, explosively releasing gas

Front 54

How many ribs articulate with the thoracic vertebrae?

Back 54

The 12 thoracic vertebrae articulate with all 12 ribs (but not all ribs connect with the sternum anteriorly)

Front 55

What is the name of the landmark for the carina that is the junction of the manubrium, body of the sternum, and second rib?

Back 55

Angle of Louis

Front 56

During CPR, care must be taken not to compress what part of the sternum?

Back 56

Xiphoid process

Front 57

What is the primary muscle of respiration during quiet breathing?

Back 57

Diaphragm

Front 58

What are the accessory muscles of respiration?

Back 58

-sternomastoids,

-pectoralis major, and

-abdominals

Front 59

What are the only accessory muscles of expiration?

Back 59

Abdominals

Front 60

What mechanism causes the most significant thoracic cavity enlargement during inspiration?

Back 60

Downward movement of the diaphragm

Front 61

If the lungs fail to empty due to weakened elastic recoil or high Raw, what will change on the chest radiograph?

Back 61

Flattening of the diaphragm

Front 62

What are strong inspiratory efforts that create enough subatmospheric pressure in the thoracic cavity that suck the intercostals inward called?

Back 62

Intercostal retractions