Respiratory A&P review (LAG)
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| What are the functions of the respiratory system? (GE, D, R, S, M, D) | gas exchange, Delivery of O2 to tissues, Removal of CO2, synthesis of surfactant and other chemicals, metabolism and detoxification of drugs and toxins, defense against infection
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| What are the major organs housed in the thorax? | Lungs, mediastinum – heart and major vessels
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| What’s unique to the first 7 ribs? | true ribs – attached to sternum and vertebral column
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| How do ribs 8-10 attach? | to the rib above
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| How do ribs 11&12 attach? | only at the vertebra, no anterior attachment
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| What is the name of the spaces between ribs? | intercostals spaces
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| What is the name of the angle between the xyphoid process of the sternum and the costal cartilages? | Costal angle
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| What muscle is the major muscle of respiration? | the diaphragm
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| What does contraction of the diaphragm do? | Contraction of the diaphragm promotes inhalation by flattening the dome shaped muscle downward toward the abdomen causing expansion in the lungs thus a decrease in pressure resulting the rushing in of air
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| What does contraction of the external intercostals muscles do? | expand the rib cage anterioposteriorly
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| What does contraction of the internal intercostals muscles do? | Accessory muscles for expiration
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| What does natural compliance mean when referring to the thorax? | Means it wants to spring outward and expand
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| Describe the features of the right lung. | thicker, wider, shorter (liver), 3 lobes- upper, middle, lower, 10 segments
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| Describe the features of the left lung. | narrower(mediastinum), longer, 2 lobes – upper, lower, 8 segments
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| What’s a lingula? | area between left upper and lower lobes
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| What’s an Apex? | the top pointy area of the lung
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| What makes up the pleural space? | The two layers of serous membrane surrounding the lungs- visceral pleura and parietal pleura and 5-15mL of fluid to facilitate smooth movement between the layers
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| Name the 3 sections of the pharynx. | nasopharynx, oropharynx, laryngopharynx (or hypopharynx)
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| Name two structures located in the nasopharynx. | adenoids and openings to Eustachian tubes
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| Name two structures in the laryngopharynx. | epiglottis and larynx (voice box)
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| Describe the cartilage of the trachea. | 16-20 C shaped with open side to back
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| About where do the right and left bronchi divide? | about the second or third intercostals space
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| What is the cartilage called where the left and right bronchi devide? | carina
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| Define the area included in the term airway. | from the nose to the terminal bronchioles
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| What structures make up the upper airway? | nasal cavity, sinuses, mouth, pharynx, and larynx
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| Describe the components of atmospheric air. | 21% Oxygen, 78% nitrogen, some other stuff
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| List the primary functions of the nasal cavity. | warm/cool, filter, humidify inspired air
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| Why is aspirated fluid more likely to go in the right lung? Why is it that ETT displacement more commonly happens in the right bronchus? | the right bronchus is shorter, wider, less bent – straight angle off main bronchus
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| Name the descending parts of the tracheobronchial tree. | trachea, main stem bronchi to lobar branches to segmental bronchi to subsegmental bronchi to bronchioles to terminal airways
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| What are airways less than 2mm in diameter? | bronchioles
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| Define anatomical deadspace. | normal passages for air (airways) where no gas exchange takes place – nose to conducting airways
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| Define alveolar deadspace. | Areas in aveoli where gas exchange does not occur
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| Define physiologic deadspace. | alveolar dead space + anatomical dead space
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| Define mucociliary escalator. | specialized mucous membrane lining the lower respiratory tract; composed of pseudostratified columnar epithelium; lined with cilia that work like an escalator to carry mucous trapped debris to the pharynx for expectoration or swallowing
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| Name several substances that inhibit/paralyze the cilia of the lower respiratory tract. | smoke, pollutants, alcohol, anesthesia, high O2, dehydration
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| What structure of the respiratory tract marks the transition to the respiratory zone? | the bronchioles
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| Name the structures that make up the respiratory zone. | terminal bronchioles, alveolar ducts, alveolar sacs, and alveoi
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| Where does gas exchange take place? | in the alveoli
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| How many alveoli are there in the adult lung? | about 300 million
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| What structures surround the alveoli? | pulmonary capillaries
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| What kinds of cells make up the epithelium of the alveoli? | Type I – pneumocytes line most of the alveolar surface, type II pneumocytes produce surfactant, Alveolar macrophages phagocytize bacteria and foreign particles
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| What is the function of surfactant? | reduces surface tension and prevents collapse
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| Where is the interstitium of the alveoli and what is it made of? | lies between alveoli – made up of capillaries, lymphatic channels, nerves and elastic tissue which gives the lungs their elastic recoil
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| What are two properties of the lungs that contribute to their function? | recoil and compliance
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| Define recoil. | Ability to return to resting position after stretching
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| Define compliance. | Ability to expand
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| Explain the connection between recoil and the pathophysiology of emphysema. | Ephysema results in loss of recoil due to alveolar wall breakdown resulting in hyperinflation
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| Describe the relationship between compliance and pulmonary fibrosis. | In pulmonary fibrosis connective tissue is replaced with scar tissue resulting in stiff, noncompliant lungs
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| Define ventilation. | movement of air in and out of the respiratory tract
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| What is required to achieve effective ventilation? | air reaches the alveoli so that gas exchange can take place; requires patent airway; working parts of respiration, thoracic cage, lungs, and muscles must be intact and functioning
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| Define respiration, internal and external. | respiration is the exchange of gases; internal - tissue level; external – lungs
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| What is required to have effective respiration? | adequate ventilation
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| Explain Boyles law. | The pressure gas exerts is inversely related to volume so that when volume goes up (as in expanding thoracic cavity) pressure goes down; When volume goes down (such as in smaller area in the thoracic cavity during expiration) pressure goes up
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| How many mmHg is atmospheric pressure? | 760 mmHg
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| Discuss the relationship of atmospheric pressure to intrathoracic/intraplueral pressure. | intrathoracic/intrapleural pressure is always slightly below atmospheric pressure
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| Describe how the receptors that regulate ventilation in the Medulla work. | Medulla/respiratory center has receptors sensitive to CO2 and H+ ions with arterial CO2 being the main stimulus for increased ventilation/decreased O2 is a lesser stimulus for increased ventilation
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| Describe how the peripheral chemoreceptors located in the carotid and aortic bodies work to control ventilation. | they are sensitive to decreased O2 mainly but also increased CO2 and decreased PH.
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| What pressure activates the carotid and aortic bodies? | PO2 below the normal of 100mmHg, but maximal response to PO2 below 50-60mmHg
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| Name the receptors in the lung that help regulate ventilation. | Pulmonary stretch receptors, Irritant receptors, J receptors
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| What is the function of Pulmonary stretch receptors? | prevent overinflation -say we’ve just had a nice stretch, that’s enough now,make more surfactant – Hering-Breuer Reflex
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| What is the function of Irritant receptors. | Create urge to cough
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| What do J receptors do? | increase respiratory rate (and possibly involved in the subjective feeling of dyspnea) in response to barotrauma like pneumonia, pulmonary embolism, pulmonary edema
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| What type of movement facilitates the exchange of O2 for Co2 in the alveoli? | Diffusion
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| Define diffusion. | the movement of substances from a place of higher concentration to lower concentration
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| Explain why O2 moves from the alveoli to the pulmonary capillary bed and why CO2 moves out. | Alveolar pressure of O2 is about 100mmHg, Venous pressure is about 40mmHg
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| Define ventilation/perfusion matching. | ventilation is the air being carried to the aveoli and perfusion adequate flow of blood to pick up oxygen; matching means That the amount of oxygen delivered is the amount that the body needs and the blood is able to pick it up and deliver it.
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| What happens if we have ventilation but lack perfusion? | No gas exchange
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| What is dead space? | where no gas exchange takes place
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| Give some examples of condition that increase the amount of dead space. | Emphysema and pulmonary embolism
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| Give some examples of conditions in which the blood flow to the aveoli is adequate but ventilation is inadequate. | pneumonia, atelectasis, ARDs
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| Give 2 ways that O2 is delivered by the blood. | 3% is dissolved and 97% is bound to Hgb
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| What does pulse oximetry tell us about? | O2 bound to Hgb
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| How is CO2 carried in the blood? | 70% in bicarbonate, 20% in doxygenated Hgb- carbaminohemoglobin, 10% dissolved – this value is what PCO2 measures in ABGs
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| What percentage of energy is used by a healthy person for breathing at rest? With exercise? | 5%; up to 30% with exercise
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| Name two factors that affect the work of breathing. | airway resistance (narrowed airways) and compliance (stretchiness)
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| Give 5 local manifestation of respiratory dysfunction. | cough- lasting longer than 2-3 wks may = pulmonary disease; excessive nasal secretions; expectoration of sputum; Pain – pleuritic, intercostals, generalized; Dyspnea
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| What are some outward signs of dyspnea? (raLB, AM, FN, T, AE, G, C) | rapid, audible, labored breathing; accessory muscles; flared nostrils; tachycardia; anxious expression; gasping; cyanosis
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| What’s the difference between hypoxia and hypoxemia? | hypoxemia means decreased PaO2; Hypoxia means inadequate tissue oxygenation
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| Give 6 possible causes of hypoxemia/hypoxia. (VP, HA, IO, A, AH, CI) | ventilation/perfusion mismatch (most common); High altitude; not enough O2 in inspired air; anemia; abnormal Hgb; Circulatory impairment like hypotension or low cardiac output
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| What values provide the most reliable indication of hypoxemia? | ABGs
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| What are the early signs of hypoxia? | (think Sympathetic nervous system) tachycardia, dilated pupils, tachypnea, irritability, unexplained apprehension
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| What are the later signs of hypoxia? | combativeness, retractions, cyanosis, hypotension, HA and decreased LOC
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| When does hypoxemia become the main respiratory stimulus? | in situations where CO2 retention and resulting acidosis are long standing such as in COPD
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| How does lack of oxygen result in acidosis? | anaerobic metabolism results in lactic acid
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| Define hypercapnia/hypercarbia. | increased CO2 in arterial blood
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| What causes hypercapnia/hypercarbia? | Inadequate alveolar ventilation such as occurs in respiratory depressioin, pneumonia, pulmonary edema, and obstructive lung disease
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| Describe how excess CO2 leads to excess hydrogen or acidosis. | CO2 and Water combine in the blood to form H2CO3 in greater than normal amounts(carbonic acid – weak acid) which dissociates into Hydrogen and bicarbonate
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| What is the normal balance/ratio between bicarbonate HCO3 and carbonic acid H2CO3? | bicarbonate 20: carbonic acid 1
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| What signs are associated with acidosis resulting from increased CO2? | tachycardia, hypertension, dizziness, HA, Mental cloudiness, LOC if severe
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| Define respiratory failure. | Oxygenation and/or ventilation not working adequately
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| Briefly define the pathophysiology of respiratory failure. | inability to supply the body with adequate oxygen (Oxygenation failure) and rid it of CO2 (ventilatory failure)
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| What PaO2 and PaCO2 levels define respiratory failure? | PaO2 < 50 mmHg; PaCO2 > 50mmHg and pH < 7.25
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| What are the two classifications of respiratory failure? | acute or chronic
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| Name some causes of Ventilatory failure (alveolar hypoventilation). | upper airway obstruction, Depression of respiratory center (medulla); Problem with transmission of nerve impulse from respiratory center to muscles of respiration; Mechanical abnormailities of the chest wall or lung; Smokers (COPD)
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| What are some potential causes of depression of the respiratory center (medulla)? (O A H C) | O.D., anesthesia, Head trauma, CVA
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| Give some examples of conditions that would interfere with impulse transmission from the respiratory center to the muscles of respiration. | Lesion at the cervical level of the spinal cord; nerve or neuromuscular disorders like polio, Guillain-Barre, Myasthenia Gravis
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| Define Guillain-Barre. | serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness; often starts with a minor infection like a lung/GI infection.
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| Define Myasthenia Gravis. | chronic progressive disease characterized by chronic fatigue and muscular weakness (especially in the face and neck); caused by a deficiency of acetylcholine at the neuromuscular junctions.
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| Give some examples of mechanical abnormalities of the chest wall or lung. | Pleural effusion, pneumothorax, hemothorax, flail chest
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| What are some causes of oxygenation failure? | ventilation perfusion mismatch
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| Name some conditions that would lead to ventilation/perfusion mismatch. | Pneumonia, ARDS, atelectasis, Severe Pulmonary edema, pulmonary embolism
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| What should be done in the case of respiratory failure? | Provide O2, Ventilation or both; diagnose the underlying disorder
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