Spring A&P 2 (Galvin) Final Review

What is a normal expiratory reserve volume (ERV)?

1.1-1.5L

What is a normal residual volume (RV)?

1.5L

Primary muscles of inspiration - diaphragm: During eupnea, the diaphragm accounts for ? of tidal inhalation when upright and up to ? when supine

1/2; 2/3

How many tertiary/segmental bronchi are there?

10 per lung (supply 20 bronchopulmonary segments)

Primary muscles of inspiration - diaphragm: During deep inspiration, the dome moves down as much as ? cm into the ? cavity The limit of the abdominal wall compliance is reached around ? cm

10; abdominal 10

*Types of ribs*: Floating ribs are ribs ? through ? (also known as ?) How do they attach to sternum?

11; 12; vertebral No connection to sternum

The thorax is made up of: ? thoracic vertebrae ? *pairs* of ribs ?

12 12 Sternum

Old erythrocytes (? days) become fragile and can be destroyed by ? cells (macrophages) throughout the body; but esentially all in the ? by phagocytosis

120; reticuloendothelial; spleen

*Surface anatomy of parietal pleura*: Posterior view - crosses at ? rib Inferior regions of parietal pleura is ? ribs lower than the inferior border of a lung

12th 2

The viscerocranium (facial skeleton) is made of ? bones ? single bones - what are they? ? paired bones - what are they?

15 3; mandible (TMJ), ethmoid, vomer 6; maxilla (upper jaw), inferior nasal conchae, zygomatic, palatine

A patient weighing 150 lbs (ideal body weight) has a anatomic dead space of about ? In a physiological person, this is about how much of the tidal volume?

150 mL 1/3 (150/500)

The liver gets about ? mL/min of blood flow About ? mL of that is going through the sinusoids

1500 1350

The lungs eliminate approximately ? mEq/day of ? acid (in the form of ?) This is equlavent to ? L of concentrated HCl/day The kidneys eliminate approximately ? mEq/day of ? acids

16,000; *volatile*; carbonic acid-H2CO3 2.5 60-80; *fixed*

The trachea is a fibrocartilaginous tube supported by ? to ? incomplete tracheal cartilages

16; 20

Expired nitrogen percentage is measured during the 2nd breath: Phase 1 = ? Phase 2 = ? Phase 3 = ? Phase 4 = ?

1: gas from anatomic dead space 2: mixture of dead space and alveolar gas 3: mixed upper and lower alveolar gas 4: beginning of dependent airway closure

? to ? liters of gastric fluid is secreted from several cell types each day

1; 2

*Types of ribs*: True ribs are ribs ? through ? (also known as ?) They attach (directly or indirectly?) to ? via ?

1; 7; vertebrosternal Directly; sternum; costal cartilage

All salivary glands are bilateral and produce approximately ? L of mildly ? fluid daily What is the pH of saliva?

1; alkaline 6-7

*Attachment of ribs to sternum*: Which rib(s) attach to the only the manubrium? Which rib(s) attach to the manubrium and body?

1st 2nd

Blood flow in bronchial circulation is about ?% of the CO of LV

2

Type ? diabetes involves a resistance to the metabolic effects of insulin

2

? left bronchial artery/arteries usually arise from thoracic aorta ? right bronchial artery/arteries arise from aorta What is a common variation?

2 1 Right bronchial arises indirectly from an upper posterior intercostal artery or left bronchial

*Arytenoid cartilages*: ? pyramids in posterior larynx Sit atop the superior border of the ? 2 significant processes: ? - posterior/lateral cricoarytenoids attach ? - "true vocal cords" attach

2 Cricoid cartilage Muscular process Vocal process

Clear liquids leave the stomach within ? hours of ingestion/gastric acid continues Prolonged fasting may cause ? volume and acidity

2 Higher

Primary muscles of inspiration - external intercostals: Which ribs rotate upward and outward? This causes the ? dimensions of thoracic cavity to increase, which is termed the "? effect" Movement of upper ribs helps to rotate the sternum upward and forward, increasing the ? dimensions of the cavity - referred to as the "? effect"

2-10; Transverse; bucket handle Anterior-posterior; pump handle

Each respiratory bronchiole gives rise to (?-? number of) ? which are elongated airways

2-11; alveolar ducts

What is a normal inspiratory reserve volume (IRV)?

2.5-3L

Recoil due to surface tension: Accounts for ? of total elastic forces in the normal lung There is an air-liquid interface within the lungs that attempts to collapse lungs due to ? forces ? forces occur at any gas-liquid interface

2/3 Surface tension Surface tension

The pleural cavity is a thin cavity (about 20 micrometers) filled with about ? mL of serous fluid

20

Beyond the tertiary/segmental bronchi, there are ? generations of conducting bronchioles

20-25

Liver cells do not utilize all the acetylCoA formed, so ? acetyl units of ? acetylCoA molecules can be combined into ?

2; 2; acetoacetic acid

Hepatic cellular plates are ? hepatic layers thick that radiate from the ? to the ? (edge of the liver lobule like spokes on a wheel) ? separate cell layers of a cell plate; these drain bile from hepatic cells and deliver it to interlobular bile ductules

2; central vein; interlobular septum Bile canaliculi

The diaphragm is embryologically derived from ? separate ? that fuse during gestation

2; hemidiaphragms

The pharynx consists of ? layers of ? muscle What are the layers?

2; skeletal Outer circular; inner longitudinal

The left lung has ? lobes (what are they?) What separates the lobes?

2; superior and inferior Oblique fissure

Radiographically, where should the tip of the endotracheal tube be located?

2nd thoracic vertebra

Antral systole: Peristaltic waves occur every ? minutes rhythmically in distal stomach Food mixed with gastric juice to decrease particle size ? forces food back from pyloric sphincter into stomach Suspended particles are now called "?" Each waves pushes ? mL of ? through the pyloric sphincter (< 2 mm)

3-4 Retropulsion Chyme 1; chyme

Pores of Kohn: Present after which age? What happens in emphysema? In regards to emphysema, the pores of Kohn may also faciliate ?

3-4 years old Become enlarged Spread of infection

Renewal of alveolar air (assume 500 mL tidal volume and 3000 mL FRC) With each breath of fresh air, approximately ? mL of new air is delivered to the alveoli The proportion of the FRC being renewed with each breath is about ?% FRC resists sudden ? in alveolar air composition to help preserve arterial blood gas compensations

350 12% (350/3000) Changes

The right lung has ? lobes (what are they?) What separates the lobes? (Greater or lesser?) width, volume, weight and (more or less?) blood

3; superior, middle, inferior Two fissures (horizontal and oblique) Greater; more

*Attachment of ribs to sternum*: Which rib(s) attach to only the body? Which rib(s) attach to the body and xiphoid?

3rd - 6th 7th

In adults, the trachea is about 2.5 cm in diameter (smaller in children) and about ? to ? inches long

4; 6

The parathyroids are ? separate glands that are embedded in the two lobes of the ? found in the superior/inferior aspects of both left/right lobes (anterior or posterior?)

4; thyroid gland; posterior

How many secondary/lobar bronchi are there?

5 lobar bronchi 2 on left; 3 on right

Each alveolar duct gives rise to (?-? number of) ? which are clusters of alveoli that open into sacs

5-6; alveolar sacs

There is approximately ? of contact between alveoli and pulmonary capillaries for diffusion (BSA 1.7 meters squared)

50-100 meters squared

Bone is being constantly remodeled ? mg/day of calcium and phosphate are exchanged between bone and plasma Formation is by ? Resorption is by ?

500 Osteoblasts Osteoclasts

What is the average tidal volume?

500 mL or 10% of total lung capacity

A tidal volume of 500 mL and a respiratory rate of 12 breaths/min gives us a normal minute ventilation of ? L/min

6

Inferior borders at end expiration: Midclavicular line - rib ? Midaxillary line - rib ? Posteriorly - rib ?

6 8 10

When does alcohol withdrawal begin? What do delirium tremens (DTs) begin? ? is a condition involving neurological changes that occur with long-term thiamine deficiency

6-8 hours 2-4 days Wernicke's encephlopathy

During inspiration to the level of ?% TLC, volume of air upon inspiration is greater than tidal volume at rest The thorax has moved ? (muscle contraction of the ? muscles) to the point where its elasticity is neutralized - no outward elastic forces are exerted This is a beginning point where the thorax has an ? elastic recoil instead of an ? directed force At thoracic volumes less than ?% of TLC, thoracic elastic forces are directed ?

67% Outward; external intercostal Inward; outward 67%; outward

What is a normal total lung capacity (TLC)?

6L

Parasympathetic input for saliva (cranial nerve) ? to the submandibular and sublingual glands ? to the parotid gland

7 (facial) 9 (glossopharyngeal)

Food moves through the small intestine in ? hours Food is mixed with digestive enzymes

7-10

Protein binding provides a large reservoir of hormones with long half lives - T4 is ? day(s); T3 is ? day(s)

7; 1

New alveoli develop until around age ? Approximately how many alveoli are there?

8 300 million

The neurocranium (skull) is made of ? bones ? single bones - what are they? ? paired bones - what are they?

8 4 - frontal, ethmoid, sphenoid, occipital 2 - temporal, parietal

A major cause of cirrhosis is long term alcohol abuse - what is this defined as?

8-16 oz of hard liquor/day or its equivalent for 15+ years

*With the first breath*: Subject starts from RV, inspires single breath of 100% oxygen up to TLC, exhales back to RV At the end of forced expiration, gas left in the lungs is about ?% of ? Because of the IPP gradient from top to bottom of lungs... ? alveoli contain most of the RV and most of the N ? alveoli have smaller volumes and less N At the ? of the lung, airways are closed and trap a small volume of gas

80%; nitrogen Upper Lower Bottom

Blood glucose regulation is typically narrowly controlled ? to ? mg/dL fasting ? to ? mg/dL the first hour after a meal Glucose usually returns to baseline how long postprandially?

80; 90 120; 130 2 hours

*Types of ribs*: False ribs are ribs ? through ? (also known as ?) They attach (directly or indirectly?) to ? or ?

8; 10; vertebrochondral Indirectly; sternum; not at all

Portal circulation going to the liver is about ? mmHg Portal circulation, once it has left the liver, going to the IVC is about ? mmHg. Changes as low as ? mmHg can cause leaking of lymph

9 0; 3

Skeleton of the larynx is formed by ? cartilages: ? unpaired ? paired

9 3 3

The root of the tongue - posterior 1/3 (pharyngeal): Taste sensations are transmitted via CN ? Pain, touch, and temperature sensations are transmitted by both ? and ? CNs

9 9; 10

*Atelectasis* develops in ?% of anesthetized lungs Includes ?- localized or global A cause of ? The usual suspect in postoperative ? ? contributes to development

90% Bases Hypoxemia Fever Obesity

Oxygen cost of breathing: Oxygen requirement of inspiratory muscles at rest is ?% of total oxygen consumption During exercise, the oxygen cost of breathing ? with ventilation to as much as ?% Increased oxygen consumption is tolerated for normal subjects The increased oxygen consumption is poorly tolerated by individuals with ?, ?, or ?

<5% Increases; 30% Emphysema; obesity; CHF

Physical and emotional stress stimulate secretion of ? which increases glucocorticoid secretion by the adrenal cortex. The effects are widespread throughout the body.

ACTH

*CRH-ACTH-Cortisol Axis*: ? passes from the adrenal cortex to the adrenal medulla and participates in the synthesis of norepinephrine ? passes from the adrenal cortex to adrenal medulla and participates in the synthesis of epinephrine from norepinephrine Adrenal cortex supports the synthesis of norepinephrine and epinephrine in the adrenal medulla under ? conditions

ACTH Cortisol Stress

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Corticotrophic releasing hormone Stimulates ? secretion by ? in the anterior pituitary

ACTH; corticotrophs

? is the principle hormone for controlling water balance in the body It concentrates ? and causes free water retention Secretion controlled by changes in body fluid ? and blood ?

ADH Urine Osmolarity; volume

The posterior pituitary contains two peptide hormones - ? and ?

ADH (arginine vasopressin); oxytocin

What are the peptides/polypeptides? Where are they synthesized? Are they stored in vesicles? Generally ?-soluble Do they require a transport carrier? Mainly ? messengers

ADH, oxytocin, GH, insulin Rough ER Yes - released by exocytosis Water No, not typically Second

Phosphate is required by all cells and is needed for ? and ? (energy sources), and ? reactions

ATP, ADP, phosphorylation

Relaxation of smooth muscle requires ? - ? decreases by slow ? pump Myosin light chain phosphatase dephosphorylates and inactivates ?

ATP; calcium; calcium Myosin

What are the major muscles of active expiration?

Abdominal muscles

Static compliance is measured in the ? of gas flow It is based on ? pressure

Absence Plateau

Active expiration: Functional aspects of active expiration: (Accelerates or slows?) exhalation Allows for greater exhalation of volumes of air from which lung volume?

Accelerates ERV

Biochemistry - internal or cellular respiration: The utilization of oxygen at the cellular level as an electron ? Biochemical reactions that occur inside mitochondria include Krebs cycle, ETC, and reactions that generate ? from ? and ? Oxygen is used as an electron and hydrogen ? In the process (cellular respiration), ? is formed and ? is produced

Acceptor ATP; ADP; inorganic phosphate Acceptor Water; CO2

The ? branches off the main pancreatic duct (Wirsung) and delivers secretions to the duodenum; not the common bile duct

Accessory pancreatic duct (Santorini)

Any deficiency in blood glucose (starvation) in which large amounts of fat are metabolized for energy produce large amounts of ? This ? is highly soluble and gains access to the blood for distribution to other tissues; it is absorbed by cells, which convert it to ? and metabolize it for energy

Acetoacetic acid Acetoacetic acid; AcetylCoA

Kussmaul breathing during DKA is caused by high levels of ? and ? in the blood due to excessive ? metabolism It is excess ?, not excess ? Increased ? of blood results in deep breathing (Kussmaul breathing) that causes increased loss of ? from the body, which is equivalent to a loss of acid from the body This is an attempt to ? the blood pH and compensate for the acidity

Acetoacetic acid; B-hydroxybutyric acid; fat Acid; CO2 Acidity; CO2 Increase

Do the following stimulate depolarization or hyper polarization? Acetylcholine? Anticholinergic drugs? Distention? Epinephrine (from adrenal medulla)? Norepinephrine (from sympathetic NS or adrenal medulla)? Specific GI hormones?

Ach: depolarization Anticholinergics: hyperpolarization Distention: depolarization Epi: hyperpolarization Norepi: hyperpolarization Specific GI hormones: depolarization

? is the failure of smooth muscle motility and failure of the LES to relax; prevents transmission of food into stomach (idiopathic)

Achalasia

Secretin responds primarily to ? emptying into the duodenum from the pylorus of the stomach

Acid

*Secretin*: Stimuli for secretion? Site of secretion? ? pepsin secretion ? pancreatic bicarbonate secretion ? biliary bicarbonate secretion ? gastric acid secretion ? growth of exocrine pancreas

Acid, fat S cells of duodenum, jejunum, ileum Stimulates Stimulates Stimulates Inhibits Stimulates

The pancreas is made of which two major types of tissue?

Acini and islets of langerhans

After the terminal bronchioles, 10-12 respiratory bronchioles and branches (alveolar ducts/sacs) form an ? All parts of the above unit are involved in ?

Acinus Gas exchange

? is an excessive growth of bone and soft tissues after adolescence Caused by an anterior pituitary tumor of the ? that produce and secrete excessive amounts of ? after long bone closure Do these individuals grow in height?

Acromegaly Somatotrophs; growth hormone No

Individuals with ? display excessive growth of bone in face, cranium, regions of vertebrae, hands and feet but DO NOT grow in ? Growth or englargement occurs in soft tissues include nose and tongue

Acromegaly; height

*Contraction of smooth muscle*: Attractive forces between ? and ? myofilaments cause contraction Smooth muscle cells are ?, ?-shaped and have ? nucleus/nuclei ? are areas similar to Z-lines in skeletal muscle

Actin; myosin Elongated; spindle; one Dense bodies

? (or ?) is needed and there is production of transport carriers to absorb calcium ? requires sunlight for conversion or supplementation

Active Vitamin D3; Calcitriol Cholecalciferol

90% of bile salts are reabsorbed by ? into the blood in the ? and returned to the ? (Enterohepatic circulation) 10% of the remaining bile salts are lost in the ?

Active transport; ileum; liver Feces

If a patient on long-term treatment with oral glucocorticoids suddenly stops medication a ? can result Long-term use may cause atrophy of ? by negative feedback

Addison crisis Adrenal glands

Primary adrenal insufficiency is also called ? 80% (majority) of the causes is ?, while 20% of cases are due to ?

Addison's disease Autoimmune; infection

*Intrinsic muscles*: Oblique arytenoid?

Adducts arytenoid cartilages; closes posterior rima glottidis

*Intrinsic muscles*: Transverse arytenoid?

Adducts arytenoid cartilages; closes posterior rima glottidis

What are the pharyngeal tonsils called? Where are they located?

Adenoids; nasopharynx

The ? makes up 80% of the adrenal gland The ? makes up the remaining 20% of the adrenal gland

Adrenal cortex Adrenal medulla

Which portion of the adrenal gland (cortex or medulla) produces corticosteroids? How many different types of corticosteroids does it produce? What are corticosteroids produced from?

Adrenal cortex ~30 Cholesterol

The ? is located centrally inside the adrenal cortex It secretes ? - ? (80%), ? (20%), and ? (minor)

Adrenal medulla Catecholamines; epinephrine; norepinephrine; dopamine

*Type I alveolar cells* (AKA ?): Specialized for ? They are ?, ?, and ? cells (description/size) Consists of a ? fused to ? ? prevent leakage into alveolar space

Agranular pneumocytes Gas exchange Large; thin; flattened Basal lamina; pulmonary capillaries Tight junctions

Recoil due to surface tension: In alveoli, the inner alveolar surface lined by a fluid in contact with ? Surface tension of the fluid is attempting to contract and force air (out of the/into the?) lungs Net effect results in the overall surface tension recoil force of the alveoli or lungs

Air Contract; out of the

Conducting bronchioles transport ? What do conducting bronchioles lack?

Air Glands and cartilage

*Inspiration*: What happens when ambient pressure is greater than airway pressure?

Air enters the lungs

? resistance results from friction between gas molecules and walls of airways

Airway

*Larynx*: Guards the ? Located in the ? neck Bodies of ? to ? vertebrae Last segment of the ? airway; lower airway begins below ? What is another name for the laryngeal prominence?

Airway Anterior C3; C6 Upper; vocal folds Adam's apple

What are the two types of non-elastic resistance that oppose air flow? Both of them together are ? resistance

Airway and tissue resistance Pulmonary

*Inspiration*: Two means of air entry into the lungs: Making the ? less than ? Increasing the ? to greater than ? ? = ? = ?

Airway pressure; atmospheric pressure Ambient pressure; airway pressure Airway pressure; intrapulmonary pressure; alveolar pressure

All plasma proteins (?, ?, ?, and ?) are produced by the liver

Albumin; A1; A2; B-globulins

In chronic alcoholism, ? is the preferred nutrient Hepatic cells synthesize and store ? Fatty tissue compresses liver ?, which impedes blood flow through the liver, resulting in ?

Alcohol Fat Sinusoids; portal hypertension

? is required for the maintenance of ECF volume via sodium conservation

Aldosterone

*Biliary duct obstruction*: ? is a highly sensitive test for assessing the integrity of the biliary system but lacks specificity since it can also be found in the bone ? is the most specific test of biliary function

Alkaline phosphatase (AP) 5'Nucleotidase (5NT)

*Glucagon* Secreted from the ? cells of the pancreas It has the opposite effects of ? It is a ?-glycemic hormone - it ? glycogenolysis, ? gluconeogensis, and ? fatty acid availability

Alpha Insulin Hyperglycemic; increases; increases; promotes

What do each type of cell in the Islets of Langerhans secrete? Alpha? Beta? Delta?

Alpha - glucagon Beta - insulin Delta - somatostatin

Defense mechanisms of the respiratory system: ? inhibits proteases from digesting the proteins of the lungs

Alpha-1-antitrypsin

*Adrenal medulla receptors*: ? receptors are coupled to Gq proteins which cause an increase in intracellular ? in target cells ? receptors suppress cAMP responses via Gi ? receptors increase cAMP via Gs

Alpha-1; calcium Alpha-2 Beta-1, beta-2, beta-3

Digestive function of saliva: ? hydrolyzes 75% of starch before denaturing by Hcl Lingual ? hydrolyzes triglycerides (acidic)

Alpha-amylase Lipase

Two synthetic corticoids (medications) with mineralocorticoid activity: ? - the big one ? - slight mineralcorticoid activity

Alpha-fluorocortisol (fludrocortisone) Cortisone

*cAMP pathway*: The ? subunit hydrolyzes ? to ? to terminate adenylyl cyclase ? activates a protein kinase that phosphorylates a specific protein; this phosphorylated protein changes configuration and stimulates a cellular response

Alpha; GTP; GDP cAMP

? ventilation is the volume of fresh (new) air delivered to the alveoli per minute

Alveolar

At end-expiration, the anatomic dead space contains ? air

Alveolar

? dead space is the volume of alveolar air not equilibrating with pulmonary capillary blood Ventilation is wasted here - this is ventilation reaching unperfused ? There is ? alveolar dead space in healthy adults

Alveolar Alveoli Minimal

? ventilation excludes that portion of air not involved in gas exchange (The volume of air not involved in gas exchange is known as ?)

Alveolar Dead space

? are continuous with the third generation of respiratory bronchioles

Alveolar ducts

When IPP is positive and dynamic compression occurs, the effective driving pressure for airflow is the ? pressure

Alveolar elastic recoil

Defense mechanisms of the respiratory system - phagocytic cells: ? (AKA dust cells)*: Remove ? and ? Digest inhaled particles via ? Lifespan of ?, undigestibles are ?

Alveolar macrophages Debris; pathogens Lysozymes 1-5 weeks; re-deposited

The transmural pressure difference: Transmural pressure = ? - ?

Alveolar pressure - intrapleural pressure (IPP)

Dynamic compression - pressure gradient for airflow during expiration: Passive: ? minus ? Forced: ? minus ?

Alveolar pressure; atmospheric pressure Alveolar pressure; intrapleural pressure

The ? is the site of gas exchange in the lung

Alveolar-capillary unit

Respiratory airways - gas exchange airways: The respiratory bronchioles are characterized by the appearance of scattered ?, which are thin-walled outpocketings that extend from the lumen of bronchioles

Alveoli

*Alveolar ducts*: Walls are completely lined with ? Walls have small amounts of ? and ? tissue at alveolar junctions Each third generation of alveolar duct empties into a ?

Alveoli Smooth muscle; elastic Single (non-branching) alveolar sac

*Alveolar sacs*: Each alveolar sac is completely lined with ? Small amounts of ? and ? tissue, similar to ?

Alveoli Smooth muscle; elastic; alveolar ducts

At end-inspiration, the anatomic dead space contains ? air

Ambient

Defense mechanisms of the respiratory system - phagocytic cells: Alveolar macrophages/dust cells: Macrophages exit via: migration via ? to mucous sheet...or migration to the ? and removed via ? What are macrophages inhibited by? ? are prone to respiratory infections

Ameboid locomotion; terminal bronchioles; lymph vessels Cigarette smoke; low alveolar oxygen Emphysematics

*Small granule cells*: Basal cytoplasm is filled with dense-core granules such as ? and ? with ? function Found in ? and ? epithelium Derived from endodermal tissue of embryonic gut

Amines; peptides; paracrine Respiratory; gastrointestinal

The liver is capable of converting ? from proteins or ? from fat into glucose, a process called ?

Amino acids; ketoacids; gluconeogensis

When amine groups are removed from amino acids, they are converted to ?

Ammonia

? dead space is the volume of gas occupying the conducting airways Does gas exchange occur in these airways?

Anatomic No - there are no alveoli

What does the zona reticularis produce?

Androgens and glucocorticoids

Metabolic functions of the lung: Activation of vasoactive substances: ? - approximately 70% is converted to angiotensin II by ACE ? which breaks down ?

Angiotensin I ACE; bradykinin

What is aldosterone stimulated by? What does aldosterone do?

Angiotensin II and potassium (hyperkalemia) Maintains ECF volume by sodium conservation

Increased renin causes increased ? which causes increased secretion of ?

Angiotensin II; aldosterone

The body of the tongue is the ? portion of the tongue (?-sulcal) It is more anterior and is the oral cavity proper

Anterior 2/3; presulcal

What are the 3 compartments of the *inferior* mediastinum?

Anterior, middle, posterior

What are the 3 borders/margins related to the hilum and mediastinum?

Anterior, posterior, inferior borders

Boundaries of *posterior* mediastinum: Anterior: ? Posterior: ? Superior: ? Inferior: ?

Anterior: posterior pericardium and slope of diaphragm Posterior: 5th to 12th thoracic vertebrae Superior: sternal angle Inferior: diaphragm

Boundaries of *anterior* mediastinum: Anterior: ? Posterior: ? Superior: ? Inferior: ?

Anterior: sternum Posterior: parietal pericardium on anterior side of heart Superior: sternal angle Inferior: diaphragm

Mediastinal boundaries: Anterior: ? Posterior: ? Lateral: ? Inferior: ?

Anterior: sternum (posterior surface) Posterior: all thoracic vertebrae (centra) Lateral: mediastinal parietal pleurae Inferior: diaphragm

*Mechanisms of vomiting:* The main mechanism is ? which includes strong contractions of the stomach and duodenum and relaxation (but not complete relaxation) of ? A deep breath raises the ? bone and ? Closing of the ? Lifting the ? palate to close posterior nares ? muscles cause strong contractions "squeezing" the stomach which increases the intragastric pressure until vomitus expelled

Antiperistalsis; lower esophageal sphincter Hyoid; larynx Glottis Soft Abdominal

The uppermost portion of the lung is the ? It extends about ? above the clavicle through the ? along the medial 1/3 of the clavicle

Apex 1"; superior thoracic aperture

The ? region is also known as the gravity non-dependent region of the lung

Apical

Compliance: ? alveoli less compliant ? alveoli more compliant

Apical Basilar

? is absence of breathing

Apnea

? breathing involves prolonged period of inspiration followed by short abrupt expirations

Apneustic

After iron atoms are isolated from the heme group and combined with transferrin and transported to the liver, iron atoms enter hepatic cells and are combined with a cellular protein ? for storage

Apoferritin

Eicosanoids are second messengers derived from ?

Arachidonic acid

? is produced from membrane lipids when ? is activated via a G alpha subunit (Gq or G11) The ? expressed in the target cell determines the eicosanoid product (e.g. cyclooxygenase or lipoxygenase)

Arachidonic acid; phospholipase A2 Enzyme

Venous drainage of the nose Veins parallel ? What is the function of the submucosal venous plexus?

Arteries Thermoregulatory function - warms air before entering lungs

What separates piriform fossa from laryngeal inlet?

Ary-epiglottic folds

What are the 3 paired cartilages?

Arytenoid, corniculate, cuneiform

*Corniculate cartilages*: Sit atop and articulate with ? Located where?

Arytenoids Ary-epiglottic fold

Two important transaminases found in the liver are ? and ?. These enzymes are elevated in blood plasma when there is liver damage

Aspartate aminotransferase (AST); alanine aminotransferase (ALT)

? and ? are cytosolic enzymes released as a result of cell damage in the liver ? is located solely in the liver, but ? is present in many other tissues as well (heart, skeletal muscle, kidney, and brain)

Aspartate aminotransferase (AST); alanine aminotransferase (ALT) ALT; AST

? is the reversible constriction of airway smooth muscle

Asthma

What are the 2 obstructive lung disorders?

Asthma and emphysema

Mechanical effects: ? is collapse of alveolar units

Atelectasis

What is the usual suspect in postoperative fever?

Atelectasis

Conditions associated with a deficiency of surfactant: ? (lung condition) Failure of normal lung expansion in ? ? - caused by fluid transfer from pulmonary capillaries --> alveoli ? (lung condition)

Atelectasis Premature neonates Pulmonary edema Hyaline membrane disease/respiratory distress syndrome (RDS)

Structure of nasal cavity; chamber posterior to vestibule

Atrium

50% of diabetic patients with hypertension have ?

Autonomic neuropathy

Where must one auscultate to hear the inferior lobes?

Axilla or posteriorly

Regulation of smooth muscle tone - hormone signals, humoral: The following reactions result in *relaxation* of airway smooth muscle: ? receptors are widely distributed in smooth muscle ?/? combine with GPCRs in the plasma membrane of myocytes - ? binds to receptors in the ? and prevents ? release which causes relaxation/bronchodilation

B2 adrenergic Epinephrine; norepinephrine; cAMP; sarcoplasmic reticulum membrane; calcium

Protective functions of saliva: Reduces oral ? Alkalinity or acidity?

Bacteria Alkalinity

? is GI metaplasia (transformation of epithelium) of lower esophagus related to chronic GERD It is the main risk for ? of the lower esophagus ? of upper esophagus is typically related to smoking or alcohol

Barrett's esophagitis Adenocarcinoma Carcinoma

? is the difference between the pressure of the LES and gastric pressure

Barrier pressure

? (30%) are undifferentiated stem cells that can replace other cell types (i.e. metaplasia - these cells in a smoker may become goblet cells to increase mucus production)

Basal (short cells)

The lowermost portion of the lung is the ? It is broader in dimension as compared to the ? and is adjacent to the ?

Base; apex; diaphragm

The ? region is also known as the gravity dependent region of the lung

Basilar

Motor innervation to intrapulmonary airways (bronchi) - sympathetic (*weak effect*): Epinephrine to the ? receptors (greater effect) Epinephrine acts as an ? to bronchial muscle to cause broncho-? Motor to pulmonary vessels causes vaso-?

Beta-adrenergic Inhibitor; bronchodilation Vasoconstriction

What do the bronchi (in general) lie between? The primary bronchi contain ?-shaped pieces of cartilage that open ?

Between trachea and first generation of conducting bronchioles C; posteriorly

Where is the chemoreceptor trigger zone (CTZ) located? What is it associated with? What types of drugs may impact the CTZ?

Bilaterally in the floor of the 4th ventricle Medulla Morphine and narcotics

Functions of the liver: Produce ? to emulsify fats ? metabolism ? cycle Filtration of portal blood (phagocytosis by ? cells) ? mechanisms (such as CYP450) Production of ? Handles hemoglobin degradation products (such as ?) Stores vitamins and iron It is a ? reservoir - under conditions of expanded blood volume (high RA pressure), the liver can accomodate ? to ? L of blood

Bile Cholesterol Urea Kupffer Detoxification Protein Bilirubin Blood; 0.5; 1

? in lobules drain bile from hepatic tissue into interlobular bile ductules, which eventually coalesce and drain bile into ? and ? ducts that drain the left and right lobes of the liver

Bile canaliculi; left; right hepatic

? is released into the blood where it is combined with serum albumin for transport to the liver (Even though complexed with albumin it is designated as "?")

Bilirubin; free-bilirubin

The heme component (less the iron atoms) is metabolized into ? in macrophages and further metabolized into ? in the spleen

Biliverdin; bilirubin

? is a form of periodic or cluster breathing characterized by irregular periods of apnea alternating with periods in which four or five breaths of identical depth are taken What are some causes?

Biot's breathing Increased intracranial pressure; medulla or pons lesion

Metabolic functions of the lung may influence systemic ? Pulmonary disease may affect other body systems due to changes in ?

Blood pressure Metabolism

*Olfactory epithelium*: Contains ? of olfactory receptors (CN ?) CN ? passes through the ? Covers the ? nasal conchae

Bodies; 1 1; cribriform plate Superior

Non-uniform distribution of inspired air - variations are due to: ? - major cause of non-uniform distribution of inspired air normally; dependent areas of the lung receive a greater volume of fresh air per breath ? - ribs in lower thorax are more oblique allowing greater expansion of rib cage ? - compliance and/or resistance may be abnormally unequal throughout the lungs

Body position Mechanical advantage Pulmonary abnormalities

What is BTPS?

Body temperature and pressure saturated with water vapor

The ? is the largest portion of the sternum, formed by what?

Body; four sternabrae

Which equation measures physiologic dead space? What does this state?

Bohr equation Physiologic dead space = alveolar + anatomic dead space

Calcium distribution in the body 99% is located where? 1% is located wehre?

Bone Intracellular

Phosphate distribution in the body 85% is located where? 15% is located in other tissues - 14-15% in ?, and <1% in ? (alkaline phosphate and acid phosphate)

Bone Intracellular; extracellular

What happens to static/dynamic compliance curves with tension pneumothorax, atelectasis, pulmonary edema, pneumonia, and bronchial intubation?

Both curves shift to the right and flatten

Metabolic functions of the lung: Inactivation of vasoactive substances (what are they and do they constrict/dilate)?

Bradykinin (80%) is a vasodilator Serotonin (90%) may act as a vasodilator or vasoconstrictor Norepinephrine (30%) is a vasoconstrictor

? is abnormally slow breathing

Bradypnea

What is the blood supply to the larynx?

Branches of superior/inferior thyroid arteries Superior laryngeal artery, inferior laryngeal artery, cricothyroid artery

External respiration consists of: ? Regulation of ? Diffusion of ? across the alveolar/capillary unit Transportation of ? to and from body cells

Breathing (ventilation) Breathing Gases Gases

? circulation supplies conducting airways their tissues and visceral pleura

Bronchial

What are the two sources of blood supply to the lung?

Bronchial and pulmonary circulation

What is the blood supply of the main bronchi to the terminal bronchioles?

Bronchial arteries

What is the blood supply to the conducting bronchiole? What is the venous drainage?

Bronchial arteries Pulmonary veins

*Pleural blood supply*: Visceral pleura Receives blood from ? Blood drained by ? Blood vessels enter/leave by ?

Bronchial arteries that branch off aorta Pulmonary veins Hilum

What are the narrowest airways (diameters 4.5 mm down to 0.5 mm)?

Bronchioles

Defense mechanisms of the respiratory system - parasympathetic innervation: Parasympathetic innervation produces broncho-? Airways ? in response to harmful agents ? airway radius may minimize noxious material from penetrating the tracheobronchial tree

Bronchoconstriction Constrict Decreased

Motor innervation to intrapulmonary airways (bronchi) - parasympathetic: Smooth muscle of the bronchial tree - broncho-? ? to the pulmonary vessels which causes vaso-? ? to glands which is ?

Bronchoconstriction Inhibitory; vasodilation Secretory; secretomotor

What is the largest subdivision of a lung lobe?

Bronchopulmonary segments

? cells are tall columnar cells with a tuft of microvilli on surface

Brush

*Innervation of the diaphragm*: Phrenic nerves originate from which spinal cord segments?

C3, C4, C5 ("keep the diaphragm alive")

The cricoid cartilage corresponds with the ? vertebra Which processes are palpable?

C6 Transverse and spinous

The trachea extends from ? to ?

C6; sternal angle (T4-T5 intervertebral disc)

Between the follicles of the thyroid in the interstitium are ? cells known as ? cells that secrete the hormone ? ? has no relationship to T4 nor T3 follicles

C; parafollicular; calcitonin Calcitonin

Sensory innervation of nose: Upper portion only is innervated by ? Rest of nose and paranasal sinus are innervated by ?

CN 1 CN 5 (V1 - opthalmic, V2, maxillary)

*Cortisol release*: Stress and circadian rhythms cause the hypothalamus to release ? which goes to the anterior pituitary, causing the release of ? that goes to the adrenal glands to cause the release of cortisol

CRF; ACTH

What is the formula for static compliance?

CStat = Vt / (Pplat - PEEP)

? is a minor hormone involved in calcium and phosphate homeostasis

Calcitonin

? from the thyroid, while weak in humans, in animals it may ? bone resorption

Calcitonin; decrease

*ADH mechanism of secretion*: Nerve impulses cause ? influx into nerve ending which stimulates exocytosis of ? and ? into the blood

Calcium; ADH; neurophysin II

? and ? homeostasis are linked - both present in ? in the bone 99% of the body's calcium is where?

Calcium; phosphate; hydroxyapatite crystals Bone

Hypocalcemia causing laryngospasm: Lower ? near ? voltage-gated channels increases penetration of ? into laryngeal muscle cells Decreases internal negativity of cells and (does what to RP/threshold?) What are some possible causes of low calcium in ECF?

Calcium; sodium; sodium Raises resting potential closer to threshold Parathyroid hormone deficiency, Vitamin D deficiency, hypocaclemia due to cirrhosis of liver

Openings that allow collateral ventilation - communications between bronchioles/alveoli: Bronchiole-alveolar are called ?

Canals of Lambert

The septa of alveoli are almost entirely composed of ? ? and ? tissue fibers are between capillaries in septa

Capillaries Elastic; connective

*Blood supply to adrenal medulla*: Capsular blood vessels form blood ? that supply adrenal cortex tissues Capillaries merge into a ? and form capillaries in the adrenal medulla

Capillaries Venule portal system

The ? is the outer surface layer of the adrenal gland that is non-endocrine What does it contain?

Capsule Blood vessels

The ? of the stomach surrounds the gastroesophageal opening The ? of the stomach is the domed portion of the stomach superior to the corpus/body The ? is the opening at the end of the pyloric canal just before the duodenum

Cardia Fundus Pyloric sphincter

The ? glands of the stomach secrete mucus and bicarbonate

Cardiac

The trachea bifurcates into two main (primary) bronchi at the ?

Carina

The lowermost portion of the trachea is at ? (? to ? vertebra)

Carina; T4; T5

*Equal pressure point*: At and above this point where IPP = airway pressure, ? structures keep the airways open

Cartilaginous

What are the amines and amino acids? What are they synthesized from? Are they stored in vesicles? ? are water-soluble hormones that do not require carrier proteins ? are also derived from AA tyrosine but are poorly water soluble

Catecholamines, melatonin, thyroid hormones Synthesized from tyrosine Yes - await exocytosis Catecholamines Thyroid hormones

Sarcoplasmic tubules lie near ?, which are indentations

Caveolae

What is the formula for dynamic compliance?

Cdyn = Vt / (Ppeak - PEEP)

Both ADH and oxytocin are synthesized in neuron ? along with ? (which are carrier proteins) for transport to axon terminals

Cell bodies; neurophysins

*Abnormalities and ADH*: ? is from a lack of ADH which can be due to head injuries, surgery, infection, cysts, idopathic and familial What is the main symptom? How do we treat it?

Central DI Excretion of large volumes of dilute urine (polyuria) Treat with synthetic ADH via nasal spray

*Insertion of the diaphragm* Insertion of the diaphragm is the ? (this is the moveable portion of the diaphragm) Superior aspect - ? is connected to the ? that lies on the superior side of the diaphragm

Central tendon Central tendon; pericardial sac

In the middle of the liver lobule is the ? ? are found at the periphery

Central vein Hepatic triads

The area around the ? is most susceptible to ischemia This is termed "Zone ?" What is located in this zone?

Central vein Zone III CYP450 enzymes

*Oxytocin*: ? sends out nerve impulses (response to stretch receptors) to the hypothalamus Nerve cells send impulses to ? for the secretion of oxytocin Oxytocin stimulates incorporation of ? between uterine smooth muscle cells and increases secretion Stimulates ? ejection from the ?

Cervix Posterior pituitary Gap junctions Milk; lactating breast

Elastic tissue of the lungs follows Hooke's law using the following: Force is replaced with ? Distance of deformation is replaced with ?

Change in IPP Change in lung volume

In regards to work of breathing in respiratory physiology, force is replaced by ? and distance is replaced by ?

Change in transpulmonary pressure; change in lung volume Work = ΔP x ΔV

In the lungs, compliance = ? Compliance of the lung is reflected in both ? tissue recoil and ? recoil

Change in volume / change in IPP Elastic; surface tension

Openings that allow collateral ventilation - communications between bronchioles/alveoli: Interbronchiolar are called ?

Channels of Martin

The rupture with an open pneumothorax is where?

Chest wall and parietal pleura

? is a form of periodic breathing characterized by cycles of gradually increasing frequency and tidal volume followed by a gradual decrease in both ? and ? There are periods of ? What are some causes?

Cheyne-Stokes; frequency; depth Apnea Stroke, damage to respiratory centers

GI hormone secreted by "I" cells in the duodenum, jejunum, and ileum

Cholecystokinin (CCK)

During the digestive process of a meal containing sufficient fat, ? from the duodenum is released and stimulates smooth muscle contraction in the gallbladder and it stimulates the ? to relax, thus releasing concentrated bile into the duodenum

Cholecystokinin (CCK); sphincter of Oddi

*Liver functions related to fat metabolism*: Synthesizes large quantities of ? and ? for cell membranes of other cells Synthesis of most plasma ? (VLDL --> HDL and LDL) Liver can provide a high rate of ? oxidation to supply energy in lieu of glucose metabolism

Cholesterol; phospholipids Lipoproteins Fatty acid

Hepatic cells synthesize primary bile acids (cholic acid and chenodeoxycholic acid) from ?....and ? or ? are combined with the acids to form ?

Cholesterol; sodium; potassium; bile salts

The body of the tongue - anterior 2/3 (oral): Taste sensations are transmitted via ? branch of CN ? Pain, touch, and temperature sensations transmitted by ? branch of CN ?

Chorda tympani; 7 Lingual branch; 5

? cells make up the adrenal medulla Cells produce ? (80%) and ? (20%) Release of catecholamines by CNS input from ? axons Cells secrete hormones under stress circumstances via sympathetic stimulation to ? cells - ? is released/acts at nicotinic cholinergic receptors of these cells Describe the feedback mechanism to reduce secretions of norepinephrine and epinephrine

Chromaffin Epinephrine; norepinephrine Sympathetic preganglionic cholinergic Chromaffin; acetylcholine There is none :D

? cells (also known as ?) are cells located within the adrenal medulla They are innervated by ? neurons

Chromaffin; pheochromocytes Sympathetic preganglionic cholinergic

? is chronic inflammation of the liver Causes ? (scar tissue formation) - normal cells surrounded by bands of collagenous scar tissue with a "pebble" apperance What happens to plasma protein concentration with this condition? Edema is also present

Cirrhosis Fibrosis Decreases

An increasing number of nonciliated bronchiolar exocrine (secretory) cells known as ? occur as you descend the bronchial tree

Clara cells

A ? pneumothorax (or "?" pneumothorax) involves a rupture that occurs at the visceral pleura

Closed; spontaneous

? is the volume at which airway closure begins to occur

Closing volume

Non-gaseous exchange functions of respiratory system - filtration/removal processes: Examples of materials subject to filtration may be physiologic, pathophysiologic, or therapeutic: Fibrin ?, ? cells, bone marrow Cell debris produced by ? Small agglutinates of ? (sickle cell) Migrating ? cells ? bubbles - e.g. CO2

Clots; fat Trauma RBCs Cancer Gas

*Brush cells*: Tall ? cells with a tuft of ? on the surface ? can be found on basal surface May function as ? receptors Numbers ? in lower regions

Columnar; microvilli Afferent nerve endings Sensory Decrease

With obstructive jaundice, there is obstruction of the bile duct system Gallstones block the ? bile duct Obstruction leads to an overflow of bile that backs up to the ? and into the blood Tumors can also compress bile ducts Obstructive jaundice can also be caused by damage or destruction of ? cells

Common Spaces of Disse Hepatic

The main pancreatic duct (Wirsung) duct fuses with the ? This combined duct enters the duodenum at the ?. Here, the ? surrounds the duct and it regulates the entry of bile and pancreatic secretions

Common bile duct Hepatopancreatic ampulla; hepatopancreatic sphincter (Oddi)

The left and right hepatic ducts fuse and form the ? that emerges from the inferior right side of the liver This duct connects to the cystic duct and the form the ?

Common hepatic duct; common bile duct

Bile salts, bile pigments, and some cholesterol and lecithin are released from the liver by the bile duct system as follows - ? duct to the ? duct to the ? for storage

Common hepatic duct; cystic duct ; gallbladder

Hormone secretion may be under: ? - meaning a hormone secretion from a primary target gland is controlled by hormones that are controlled by other factors (i.e. anterior pituitary hormones are controlled by hypothalamic factors)

Complex negative feedback

? is a measure of the distensibility of lungs

Compliance

Specific compliance = ? divided by ? Lung compliance/unit of lung volume Units: L/cmH2O/L lung volume Measurement begins at ? since the compliance relationship is linear at this point

Compliance; FRC FRC

Non-uniform distribution of inspired air - variations are due to: Pulmonary abnormalities - ? and/or ? may be abnormally unequal throughout the lungs

Compliance; resistance

Significance of specific compliance: ? decreases with decreased lung volume, ? does not Standardizes for overall lung ? Analgous to comparing CO and CI

Compliance; specific compliance Size/volume

What is the secretory portion of the pancreas (that is composed of acini or sacs) called? What is it made of?

Compound alveolar (acinar) gland Layer of cuboidal cells

Structure of nasal cavity; 3 thin bony plates that project into the nasal cavity from lateral walls

Conchae/turbinates

Extrapulmonary and intrapulmonary airways are ? airways

Conducting

? airways are anatomical dead space; these airways also clean, warm, and moisten air What is included in this anatomical dead space?

Conducting Nose and mouth, pharynx, larynx, trachea, bronchi, to terminal bronchioles

The lungs are ? shaped structures located in the thorax They occupy most of the thoracic cavity except the ?

Cone Mediastinum

The thorax/thoracic cage is "?-shaped" It has a ? superior thoracic aperature (called the ?) and a ? inferior thoracic aperture (called the ?)

Cone Narrow; thoracic inlet; broad; thoracic outlet

? bilirubin is actively transported into the bile duct system (within the liver) and is drained into the gallbladder

Conjugated

*ADH mechanism of secretion*: After ADH is exocytosed, it circulates to the kidneys and combines with basolateral receptors of the ? and ? ADH stimulates a ? 2nd messenger system Phosphorylation of a protein kinase leads to the insertion of ? into the ? membranes Water is reabsorbed by diffusion from the tubules into the ? capillaries

Connecting tubule; collecting duct G-protein/cAMP Aquaporins; luminal Vasa recta

? separates bronchopulmonary segments and makes them independent units Each has its own ? Surgically resectable

Connective tissue Tertiary bronchus, arterial supply, nerve, and lymph vessels

Inhalation of chemical irritants, dust, smoke, or stimulation of the arterial chemoreceptors cause a reflex ? of the airways Decreased CO2 in the branches of the conducting airways causes local ? Increased CO2 or decreased O2 causes a local ? of smooth muscle

Constriction Bronchoconstriction Dilation

When is dynamic compliance measured?

Continuously during inspiration and exhalation

Volume, IPP, and alveolar pressure changes during a single, tidal respiratory cycle - *inspiration*: Inspiratory muscles ? IPP decreases by ? cm H2O Alveolar pressure decreases ? cm H2O below atmospheric Pressure change draws ? liters of air into lungs Lungs ?

Contract 3 1 0.5 Inflate

At *end inspiration* (inspiratory muscles ?) the thorax is positioned at ? tidal volume Muscle contractions (increase or decrease?) the ?-directed forces on the chest wall Lungs remain in contact with thorax, alveoli are stretched, which (increase or decrease?) their ? elastic recoil Transmural pressure = more ?

Contract; peak Increase; outward Increase; inward More positive

Calcium ions have widespread effects on many cellular reactions: ? in skeletal, cardiac, and smooth muscle ? (neuro) ? (vesicles) Remodeling of ? ? (blood)

Contraction Neurotransmission Exocytosis Bone Coagulation

What is the rate-limiting step in the synthesis of corticosteroids?

Conversion of cholesterol into pregnenolone by cholesterol desmolase

*Cuneiform cartilages*: Small cylinders Lie lateral to ? Located under the ? tubercle

Corniculate cartilage Cuneiform

The ? is the largest region of the stomach; contains most of greater and lesser curvatures

Corpus/body

The pylorus is below the ? of the stomach The antrum is designated by an imaginary line diagonally from ? to the ? The ? connects the pylorus to duodenum at the gastroduodenal junction

Corpus/body Angular notch; greater curvature Pyloric canal

? helps prevent hypoglycemia while fasting - it may take days to weeks to see the full expression of this effect

Cortisol

While the zona glomerulosa is mostly mineralocorticoid activity, some ? may be activated, but this effect is negligible

Cortisol

What are the steroids? What are they derived from? Are they stored in vesicles? Once synthesized, they rapidly diffuse out of the cell due to high ? solubility Why do they require carrier proteins in the blood? The mechanism of action is predominantly ? - ? onset with ? response

Cortisol, aldosterone, estrogen, progesterone, and testosterone Cholesterol No Lipid Low water solubility Altered gene expression; slow; sustained

? provides 95% of glucocorticoid activity while ? provides 4% of glucocorticoid activity ? is secreted in response to stress; it reduces ?

Cortisol; corticosterone Cortisol; inflammation

Most body cells have receptors for ? - small amounts of ? must be present for other hormones to exert their effects The complex may stimulate or inhibit the ? of m-RNA and the subsequent presence or absence of intracellular gene products required for activities under the influence of this hormone

Cortisol; cortisol Transcription

Synthetic corticoids with glucocorticoid activity ? - has the same potency of cortisol ? - 4x the potency of cortisol ? - 30x the potency of cortisol

Cortisone Prednisone Dexamethasone

Types of parietal pleura: ? pleura - attaches directly to the rib cage ? pleura - attaches directly to diaphragm ? pleura is not active in ventilation

Costal Diaphragmatic Mediastinal

What are the two pleural reflections?

Costal and sternal reflections

Division of parietal pleura; lines inside of rib cage and attaches to ribs

Costal pleura

Surface of the lung; portion next to rib cage

Costal surface

What are the 3 surfaces of the lungs?

Costal, mediastinal, diaphragmatic

What are the two major pleural sinuses/recesses?

Costomediastinal and costodiaphragmatic

Which two defense mechanisms of the respiratory system incorporate the valsalva maneuver?

Cough and sneeze reflexes

Defense mechanisms of the respiratory system: The ? reflex removes irritants from the airway and propels mucus toward the oropharynx; ? and ? are especially sensitive Incorporates the ? - it involves a deep ? followed by contraction of the expiratory muscles against a ? glottis

Cough; larynx; carina Valsalva maneuver; inspiration; closed

? is an irreversible intellectual disability due to hypothyroidism in childhood

Cretinism

What is the only cartilage that completely encircles the airway?

Cricoid

What is the only non-expandable portion of the upper airway?

Cricoid

Pharynx is a tube that extends from the cranial base to the inferior border of ? cartilage Widest (~5 cm) opposite the ? Narrowest (~1.5 cm) at its ? end (at the level of ?) - becomes continuous with esophagus

Cricoid Hyoid Inferior; C6

In infants, the ? is the narrowest *fixed* part of the upper airway

Cricoid cartilage

Motor innervation to intrinsic muscles of larynx?

Cricothyroid muscle is via the external laryngeal nerve All other muscles via the recurrent laryngeal nerve

Extrinsic ligament; joins cricoid to tracheal rings

Cricotracheal ligament

What are the 3 extrinsic ligaments?

Cricotracheal, thyrohyoid, hyoepiglottic

Which bones make up the ethmoid bone?

Crista galli, cribriform plate, perpendicular plate, superior and middle conchae

Spirometry curves: What happens to the shape with an obstruction?

Curve becomes concave

*Cushing's disease/syndrome*: ACTH dependent is called ? What is it caused by? This causes excess ?

Cushing's disease Adenoma of corticotrophs ACTH

Excessive glucocorticoids can result in hypercortisolism or ?

Cushing's syndrome

*Cushing's disease/syndrome*: ACTH independent is called ? What is it caused by? This causes excess ?

Cushing's syndrome Adenoma in zona fasciculata or excessive intake of prescribed glucocorticoids Cortisol

Blood gas terminology: ? is a bluish discoloration of skin due to deoxyhemoglobin concentration in excess of ? g/dL of blood or oxygen saturation decreased to ?% in a subject with normal hemoglobin blood concentration

Cyanosis; 5; 83%

In the presence of calcium, ? activates protein kinase C which phosphorylates target proteins to produce a cellular response ? causes the release of calcium from the endoplasmic reticulum and increased calcium alters the activity of many cellular proteins

DAG IP3

The liver can convert amino acid intermediates via enzymatic reactions utilizing ? (remove amine groups from amino acids) OR ? which transfer an amine from an amino acid to another chemical compound for the formation of intermediates in carbohydrate metabolism (gluconeogenesis)

Deaminases Transaminases

What do anticholinergics do to barrier pressure?

Decrease

*Anesthesia considerations for the liver failure patient*: General/regional anesthesia can ? liver blood flow by 30-50% Volatile agents and lower extremity blockade may ? hepatic blood flow by ? SVR What should one expect in terms of blood loss from this patient? Patient may have a relative (?-volemia)

Decrease Decrease; decreasing Higher than normal Hypovolemia

With autoimmune gastritis, what happens to acid levels? What happens to intrinsic factor levels? A lack of intrinsic factor causes ?

Decrease; decrease Pernicious anemia

Ascites leads to ? oncotic pressure and protein binding

Decreased

What happens to FVC... Obstructive: ? Restrictive: ?

Decreased Decreased

What happens to FEV1... Obstructive: ? Restrictive: ?

Decreased Decreased (lower than obstructive)

With *restrictive disease*, there is a ? inspired functional volume What are some examples of *restrictive* diseases?

Decreased Interstitial lung diseases - idiopathic pulmonary fibrosis, sarcoidosis, and asbestosis

What happens to FEV1/FVC... Obstructive: ? Restrictive: ?

Decreased Normal

What happens to FEF 25-75%... Obstructive: ? Restrictive: ?

Decreased Normal (maybe increased)

*Restrictive diseases*: Compliance ? Elastic recoil? FRC ? TLC ? Slope of pressure-volume relationship?

Decreased Increased Decreased Decreased Decreased

Active expiration: Muscular contractions ? the volume of the thorax, which ? lung volume ? lung volume ? pressure in the airways, causing air to flow which direction?

Decreased; decreased Decreased; increases; out of lungs

With obstructive disease (emphysema).... ? lung elasticity and recoil causes a ? FRC Chest wall exerts a ? outward force than normal to equalize forces

Decreased; increased Greater

*Renal hypoperfusion with liver failure*: ? GFR leads to ? RASS --> ? and ? retention ? syndrome: liver failure precipitates a ? GFR; liver transplant is needed

Decreased; increased; sodium; water Hepatorenal; decreased

A deeper inspiration increases lung volumes which ? airway resistance

Decreases

What does cricoid pressure do to barrier pressure?

Decreases

What does pregnancy do to barrier pressure?

Decreases

What happens to airway resistance as you descend the trachebronchial tree?

Decreases

*Hematologic issues with liver failure*: Anemia What happens to clotting factor production? Decreased ? levels causes decreased platelet production (resulting in thrombocytopenia) What happens to the spleen?

Decreases Thrombopoeitin Splenomegaly

*Atelectasis*: Respiratory changes during anesthesia: FRC ? (to about ? L) Compliance ? Resistance ?

Decreases; 1.5 Decreases Increases

Fibrosis: ? compliance due to ? fibrous tissue Results in ? change in volume with ? change in IPP

Decreases; excess Decreased; no

Following expiration, surface tension ? when alveoli deflate and surfactant concentration is ?

Decreases; increased

Exhalation, both passive and forced, ? lung volume or size, which ? resistance

Decreases; increases

Expiration from 67% TLC to FRC: Lung recoil ? until FRC is reached and elastic recoil of thorax ? as FRC is approached When FRC is reached elastic recoil forces of lungs and chest wall ?

Decreases; increases Become equal

Increasing the radius of the tube ? resistance to flow but ? the likelihood of turbulence in areas that are prone to turbulence, such as ? and ?, especially during exercise The decreased resistance due to an increased radius occurs mostly in ? True laminar flow with very low resistance occurs at the level of the ? where the velocity of air is extremely low

Decreases; increases Trachea; large airways Small airways Terminal/respiratory bronchioles

Descending the bronchial tree: Decreasing number of goblet cells (which end at the ?) ? cells are now present in the bronchioles

Decreasing; terminal bronchiole Clara cells/club cells/non-ciliated bronchiolar exocrine cells

What is the lymphatic drainage of the larynx?

Deep cervical lymph nodes

Lymphatic drainage of the pharynx is via the ? Nasopharynx also drains into the ?

Deep cervical lymph nodes Retropharyngeal lymph nodes

Lymphatics of nose: Posterior nose - lymph drains into ?, then ?, then ?

Deep parotid nodes; retropharyngeal nodes; deep cervical nodes

An insulin ? causes lipolysis and release of free fatty acids An insulin ? causes ketoacidosis

Deficiency Deficiency

What are the two androgen precursors? What are they stimulated by?

Dehydroepiandrosterone (DHEA) and androstenedione ACTH

Defense mechanisms of the respiratory system - phagocytic cells: ? cells phagocytize bacteria and antigens down to the acinus

Dendritic cells

Non-uniform distribution of inspired air - variations are due to: Body position - major cause of non-uniform distribution of inspired air normally; ? areas of the lung receive a greater volume of fresh air per breath

Dependent

Under normal circumstances... ? areas of the lung receive more airflow than ? areas In an upright position, ? alveoli receive more ventilation/unit volume than ? alveoli In a left lateral position, the ? lung receives more ventilation than the ?

Dependent; non-dependent Basilar (dependent); apical Left; right

Factors that stimulate (depolarization or hyper polarization?) will cause increased secretion and increased propulsive motility Factors that stimulate (depolarization or hyper polarization?) will cause decreased RMP

Depolarization Hyperpolarization

Factors affecting anatomic dead space (ADS): ? of inspiration stretches and expands conducting airways Gender: ? generally have increased ADS Age ? ADS due to loss of ? in conducting airways lacking cartilage

Depth Males Increases; elastic recoil

Diaphragmatic (abdominal breathing) uses only the ? ? are diaphragmatic breathers due to the ? orientation of their ribs Diaphragmatic breathing can occur during ? anesthesia Is the diaphragm essential for breathing at rest?

Diaphragm Infants; horizontal Spinal No

? allow for passage of structures from the thoracic cavity into the abdominal cavity What are the three?

Diaphragmatic openings Vena cava foramen, esophageal hiatus, aortic foramen

Division of parietal pleura; attached to superior surface of the diaphragm

Diaphragmatic pleura

Surface of the lung; right on top of diaphragm

Diaphragmatic surface

Where do lung structures distal to terminal bronchioles (respiratory bronchioles, ducts, sacs) receive their oxygen supply from?

Diffusion from the alveolar air

Defense mechanisms of the respiratory system - factors that can cause laryngospasm: ? with laryngoscope blade, ETT, food/liquid, trauma Describe lungs with drowning victims ?

Direct stimulation May have no water in lungs due to intense contraction

What are the 3 main factors that can cause larnygospasm?

Direct stimulation Reflex stimulation from a stimulus in another part of the body Hypocalcemia

Law of LaPlace states the pressure within a spherical bubble is ? proportional to the surface tension and ? proportional to the radius of the bubble at the liquid-air interface

Directly; inversely

The pressure difference is ? proportional to the flow (if laminar) x the ?

Directly; resistance

The pyloric gland area includes the antrum It is a major source of gastric hormones It is the ? 20% of the stomach It contains ?, ?, and ? cells

Distal Chief; mucous; endocrine

All areas of the lung (do or do not?) receive equal amounts of inspired air This is said to be (uniform or non-uniform?)

Do not Non-uniform

The diaphragm is ? shaped - this muscle separates the ? from the ? cavity

Dome; thoracic; abdominal

When the diaphragm contracts, which direction does it move?

Down

Muscles of expiration - contraction of abdominal muscles: Immobilizes the lower thorax and pulls ? on the rib cage during contraction ? the transverse and anteroposterior dimensions of the thorax Secondarily, contraction of the abdominals ? intra-abdominal pressure which pushes ? on the diaphragm, ? the vertical dimension of thorax

Down Reduces Increases; up; decreasing

Importance of pulmonary surfactant: Aids in keeping the alveoli ? A deficiency would ? surface tension Helps prevent pulling fluid out of the ? and into the alveoli

Dry Increase Pulmonary capillaries

? stimulates thirst (anti-cholinergic)

Dry mouth (xerostomia)

*Causative agents of vomiting*: Excessive irritation or distention of the upper GI tract, especially the ? Noxious stimuli in the gut lumen like with ? food CNS stimulation - effects of drugs like ?, rapidly changing motion, ? stimuli (disquieting scenes), or noxious odors

Duodenum Infected Narcotics; psychic

The pancreas is located in the "C" of the ? (portion referred to as the head) and extends laterally to the ? (tail)

Duodenum; spleen

80% of peptic ulcers occur in the ?, while 20% of peptic ulcers occur in the ? Gastric ulcers have a high rate of incidence in the ? and ? sections of the stomach Infection with ? bacterium leads to accomodation to acid in stomach; colonizes and destroys the antral ? barrier and exposes epithelium to acid, causing ulceration

Duodenum; stomach Antrum; pylorus Helicobacter pylori; mucosal

When can the intrapleural pressure (IPP) become positive?

During forced exhalation or positive pressure ventilation

? is the increased resistance during forced expiration

Dynamic compression

? is difficult or labored breathing; breathlessness

Dyspnea

What is the force of contraction of smooth muscle highly dependent on?

ECF calcium ion concentration

*Secretion of gastric acid by increased intracellular calcium*: Neural stimulation occurs to the ?, which causes the release of ? The binding of ? on M3 receptors of parietal cells release ? The binding of ? on M3 receptors of ECL cells release ? The vagus releases ? which activates a GPCR in the antrum, causing ? to be released in the blood, which goes to parietal cells to allow endocrine stimulation of ?

ENS; acetylcholine Acetylcholine; HCl Acetylcholine; histamine Gastrin-releasing peptide (GRP); gastrin; HCl

Functional residual capacity (FRC) = ? What is a normal FRC?

ERV + RV 3L

GI activity linked to behavior ? nerve fibers: emotions (e.g. anxiety produces diarrhea), salivation and gastric secretion occur with thought/smell of food ? nerve fibers: fullness/satiety, nausea/pain

Efferent Afferent

Functional residual capacity (FRC): At the end of inspiration... Contraction of inspiratory muscles have compressed the muscles of the thorax Inside those muscles - ? elements of the chest wall that are stretched to expand the lungs ? components of lung tissue have been stretched

Elastic Elastic

*Emphysema*: Decreased ? fibers in alveoli Decreased ? support tissue Destruction of ? and ? by proteolytic enzymes (?) Destruction of pulmonary ? occurs along with alveolar ? Accompanying increase in ? cells and decreased ? cells

Elastic Bronchiolar Alveoli; alveolar septa; macrophages Capillary beds; septa Goblet; ciliated

Recoil of the thorax involves only ?

Elastic recoil

Negative IPP: Results from the opposing ? of the lung and the chest wall The deeper the inspiration, the more ? the IPP

Elastic recoil Negative

? is the property of matter that causes it to return to it original position or configuration after having been displaced (stretched)

Elasticity

Compliance is the inverse of ?

Elasticity

*Myxedema coma*: Typically occurs in ? patients and is precipitated by ? Symptoms oppose those of ? ?-ventilation, ?-thermia, CHF ? ADH causes dilutional ? which leads to ? Prone to drug-induced respiratory ?

Elderly; infection Hyperthyroidism Hypoventilation; hypothermia Increased; hyponatremia; edema Depression

Primary muscles of inspiration - diaphragm: Further contraction of the central tendon causes ? of the lower ribs

Elevation

Insulin ? protein synthesis

Encourages

*Positions of diaphragm in relation to the thorax*: Highest position of the dome - left and right cupola - is at what point of the breathing cycle? Right side is at the level of the ? Left side is at the level of the ?

End expiration 5th rib 5th intercostal space

Methods of determining combined compliance of lung-thorax complex: From ? (part of breathing cycle), measure change in ? for a given change in ? Measurements use ? ? is used to take measurements periodically

End-expiration; volume; pressure Intrapulmonic (airway) pressure Plethysmography

*Glucagon* In high concentrations... ? inotropy ? bile secretion and ? gastric acid ? gut motility

Enhances Enhances; inhibits Decreases

Growth hormone: ? lean body mass ? fat stores Conserves ?

Enhances Reduces Carbohydrates

Laryngopharynx communicates with the larynx at the laryngeal intlet - boundaries: Anteriorly? Laterally? Posteriorly?

Epiglottis Ary-epiglottic folds Cuneiform and corniculate

What are the 3 unpaired cartilages of the larynx?

Epiglottis, thyroid, cricoid

The major endocrine product released by the adrenal medulla is ? The major sympathetic NT released by the adrenal medulla is ?

Epinephrine Norepinephrine

Sympathetic stimulation produces ? and ? from adrenal gland which causes broncho-? via ? receptors in airway smooth muscle with the resultant ? in resistance B2 agonists also stimulate ? receptors to stimulate broncho-? and ? resistance Histamine acts primarily on ? receptors causing broncho-? which ? resistance

Epinephrine; norepinephrine; bronchodilation; B2; decrease B2; bronchodilation; decrease H1; broncoconstriction; increases

During a forced expiration, the ? is the point along the airways where the pressure inside the airway is just equal to the pressure outside the ariway At this point, the *transmural/transpulmonary pressure gradient* is ?

Equal pressure point 0 mmHg

At end expiration airway pressure (equals, is greater than, or is less than?) ambient air pressure (barometric pressure) down to the level of the alveoli

Equals

? is due to incompetent LES which allows for reflux of gastric contents upward into the esophagus

Esophageal reflux

? is inflammation of esophagus caused by infection (bacterial or viral), or acid reflux from stomach

Esophagitis

What are the contents of the *superior* mediastinum?

Esophagus Trachea Aortic arch Brachiocephalic artery Left common cartoid artery R and L subclavian arteries R and L brachiocephalic veins Superior vena cava Nerves (vagus and phrenic) Thymus gland

What are the contents of the posterior mediastinum?

Esophagus Vagus nerves Descending thoracic aorta Carina Primary bronchi and portion of thoracic duct

What are the two methods of determining tidal volume?

Estimation: 6-10 mL/kg Direct spirometry

A single dose of ? can prevent 17 alpha hydroxylase (in cortex) from creating cortisol; can also prevent 11 beta hydroxylase (in medulla) - this can cause adrenal suppression

Etomidate

? is tidal breathing; normal quiet breathing

Eupnea

*Anesthetic concerns with hyperthyroidism* If the surgery is elective, the patient should be ? If the surgery is emergent, ? and ? are needed

Euthyroid Beta blockers; glucocorticoids

A typical western diet has a(n) ? of calcium and phosphorus - leading to a net ? matched by ?

Excess; intestinal absorption; urinary excretion

*cAMP pathway*: A hormone binds to a specific GPCR (this GPCR may be ? or ?) In the inactive state, the alpha, beta, and gamma subunits of the G protein form a complex that binds ? on the ? subunit When the receptor is activated, it undergoes a conformational change that causes the trimeric G protein to associate with the cytoplasmic part of the receptor to exchange ? for ?; this causes the alpha subunit to dissociate from the trimeric complex and associate with other intracellular signaling proteins ? converts an ATP to cAMP

Excitatory; inhibitory GDP; alpha GDP; GTP Adenylyl cyclase

Active expiration (requires muscular activity) - utilized during: Heavy ? Physiologic movements such as ? and ? Pathophysiologic states such as ? or ?

Exertion Coughing; valsalva maneuver Emphysema; COPD

The pancreas is both a ? and a ? gland

Exocrine; endocrine

ADH, oxytocin, and neurophysins are secreted by what mechanism ?

Exocytosis

Spirometry curves: The top part of the curve represents ?

Expiration

?: movement of air out of the lungs In normal physiology - results from a ? lung volume - ? airway pressure ? pressure = ? pressure = ? pressure

Expiration Decreased; increased Airway; intrapulmonary; alveolar

? is the maximum volume of air that can be forcibly exhaled

Expiratory reserve volume (ERV)

? is the volume of air that can be forcibly exhaled after a maximal inhalation - usually understood unless otherwise designated

Expiratory vital capacity

The ? nose is the visible portion of the nose It is composed of: Nasal part of ? ? nasal bones Frontal process of ? ? hyaline cartilages Sensory information sent via CN ?

External Fontal bone 2 Maxilla 5 5

*Blood supply of the pharynx*: Supplied by branches of the ? Venous drainage via ?

External carotid Internal jugular

*Blood supply of thyroid*: The superior thyroid artery is supplied from the ? The inferior thyroid artery is supplied from the ?

External carotid artery Thyrocervical trunk of the subclavian artery

What is the blood supply to the septum and lateral wall?

External carotid artery --> maxillary artery --> sphenopalatine artery

The outermost layer of intercostal muscles is the ? Fibers lie ?

External intercostal layer Obliquely downward/forward

Structure of nasal cavity; bound laterally by alae

External naris (nostrils or anterior nasal apertures)

Conducting airways can be considered ?, which lie outside of the lungs. Which structures are included?

Extrapulmonary Nose and mouth to bronchus

*Primary bronchi*: The primary bronchi are ?-pulmonary ? airways that pass into the hila Angles are more equal in ? than ? The ? main bronchi is wider, shorter, and runs more vertically than the ? The ? main bronchus is longer; passes inferiorly to the arch of the aorta

Extrapulmonary; conducting Children; adults Right; left Left

? ligaments attach laryngocartilages to hyoid bone or trachea

Extrinsic

The upper esophageal sphincter (UES) cricopharynxgeus muscle is controlled by ? The lower (inferior) esophageal sphincter (LES) is controlled by ?

Extrinsic cranial nerves ENS

What does Hooke's law state?

F = k * x (F = force, k = constant, x = distance of deformation)

Assessment of airway resistance: ? measures resistance in the large airways

FEV1/FVC

? is the lung volume at which the outward recoil of the thorax is equal to the inward recoil Lungs are always trying to recoil ? Elastic chest wall is always trying to recoil ?

FRC Inward Outward

Direction of recoil of lung/thorax complex: The volume of air in the lungs at the end of normal tidal expiration is ? Which respiratory muscles are contracting? At ?, there is equal and opposite forces

FRC None FRC

? and ? are primarily components of apical (non-dependent) alveoli

FRC; ERV

True or false: The negative IPP is responsible for lung expansion

False

*Vestibular/ventricular folds*: ? cords Superior to ? ? color

False True cords Pink

During ? the stomach is in a quiescent state Peristalsis waves known as ? interrupt at 90 minute intervals to move indigestible components through to the small intestine

Fasting Migrating motor complexes

The liver stores all ?-soluble vitamins (?, ?, ?, and ?) Vitamin ? is stored in the largest single quantity, followed by vitamin ?

Fat; A; D; E; K A; D

Triglycerides are digested in adipose tissue by lipolysis into ? and ? that are transported by ? to the liver Fatty acids are metabolized in hepatic cells by ? oxidation to ? groups that are combined with ? forming ? that is metabolized by the Krebs Cycle for production of ATP (immediate chemical source of energy in cells)

Fatty acids; glycerol; albumin Beta; acetyl; coenzyme A; acetyl coenzyme A

The oropharyngeal isthmus is known as the ?

Fauces

The palatine arches or pillars include the pillars of the ? that bound the ? tonsils

Fauces; palatine

Which two conditions produce abnormal compliance?

Fibrosis and emphysema

*Restrictive lung disorders*: ? - fibrotic scar tissue in lungs makes them "stiff"; recoil is ? Reduced surfactant results in ? surface tension recoil and ? of alveoli ? skeletal abnormalities such as kyphoscoliosis

Fibrosis; increased Increased; compression Thoracic

Non-gaseous exchange functions of respiratory system: ? of the pulmonary circulation - all mixed venous blood (blood in the pulmonary trunk that flowed there after entering the heart from the superior and inferior vena cava) --> pulmomary circulation carries out ? processes to protect systemic circulation

Filter; filtration/removal

Intracellular 2nd messenging: The binding of the hormone (the ? messenger) to its receptor causes the generation of intracellular signaling molecules (the ? messenger) The ? messengers amplify the hormonal signal within the target cell

First; second Second

A ? obstruction is an upper airway obstruction that interferes with both inspiration and expiration

Fixed

Accessory muscles of inspiration - sternocleidomastoid: Unilateral contraction ? Bilateral contraction ? With cervical vertebrae fixed, it elevates the ? and medial ends of the ? - assists pump-handle action of deep respiration

Flexes head laterally Pulls head forward Manubrium; clavicle

Airway obstructions: What is/are example(s) of a variable extrathoracic obstruction?

Floppy pharyngeal muscles and sleep apnea (OSA)

Flow = ? / ? Resistance = ? Pressure difference = ?

Flow = Pressure difference / resistance Resistance = Pressure difference / flow Pressure difference = Flow x resistance

What does Poiseuille's law state for flow? Increasing the pressure or radius will ? flow Flow rate is ? proportional to the constant (8), viscosity, and length

Flow is directly proprtional to the pressure of the gas x π x r⁴. Flow = πr⁴∆P/8nl Increase Inversely

The thyroid gland is composed of large numbers of closed ? that are filled with a secretory substance called ? and lined with ? cells that secrete into the interior of the follicles

Follicles; colloid; simple cuboidal epithelial

The ? is on the dorsum of the tongue and is a nonfunctional embryonic remnant of tissue that becomes the thyroid

Foramen cecum

What is work?

Force acting over a distance W = F x D

Assessment of airway resistance: ? measures resistance in the mid to smaller airways

Forced expiratory flow between 25-75% (FEF 25-75%)

Assessment of airway resistance: ? is the amount of air exhaled in 1 second

Forced expiratory volume in 1 second (FEV1)

Assessment of airway resistance: ? occurs from max inspiration when a patient exhales as rapidly as possible It is a *volume* of air

Forced vital capacity

Primary muscles of inspiration - external intercostals: Contraction moves ribs ? and ? (direction) This action ? dimensions of the thorax and ? the volume of the thoracic cavity

Forward; upward Increases; increases

The volume of *anatomic* dead space can be measured clinically by ? How is it estimated?

Fowler's method 1 lb of ideal body weight = 1 mL of anatomic dead space

? can be used to determine the anatomic dead space ? can be used to determine physiologic dead space (anatomic and alveolar dead space)

Fowler's method Bohr equation

What are the stromal tissues of the lungs?

Framework of fibroelastic connective tissue

In addition to Type I and Type II alveolar cells, there are ? which remove debris or microorganisms

Free-ranging phagocytic alveolar macrophages

Bones that are pneumatized have air cells or sinuses - which bones are pneumatized?

Frontal, ethmoid, sphenoid, temporal, maxilla

? is the volume of air continuing to exchange with pulmonary capillary blood between breaths

Functional residual capacity (FRC)

? is the volume of air remaining in alveoli after a normal, passive tidal expiration

Functional residual capacity (FRC)

At the resting position of the lung, the lung/thorax complex recoils following a passive exhalation --> the volume of air in the lungs corresponds to the ?

Functional residual capacity (FRC)

? is considered to be the balance point between opposing forces = ~?% of TLC

Functional residual capacity (FRC); 50%

cGMP is generated from ? via ?

GTP; guanylyl cyclase

The ? stores and concentrates the bile It actively transports ? into the plasma and ? follows passively as does ? by osmosis

Gallbladder Sodium; chloride; water

? are circulating antibodies produced by plasma cells of lymphoid tissues

Gamma-globulins

In the visceral smooth muscle of the GI tract, bundles of small cells are made of electrically coupled ? that allow movement of ions from one muscle cell to the next Once cell is stimulated, and a spike potential can be passed to the next

Gap junctions

GI hormone secreted by "K" cells of the duodenum and jejunum

Gastric inhibitory peptide

GI hormone secreted by the "G" cells of the antrum of the stomach in response to stimuli associated with ingestion of a meal, such as distention of the stomach, products of proteins, and nerves

Gastrin

? and ? have a greater effect on gastric emptying than migrating motor complexes (MMCs) of fasted state

Gastrin; CCK

The endocrine cells of the pyloric gland area secrete ? and ?

Gastrin; somatostatin

Autonomic neuropathy contributes to diabetic ? (can be asymptomatic) - this is one of the reasons why these patients need a protected airway (ET tube)

Gastroparesis

? is significantly delayed gastric emptying It is a common complication of poorly controlled ? Patients with this have early ?, ? emptying, and are a potential "?"

Gastroparesis Diabetes Satiety; delayed; full stomach

Mucus double layer: ? outer layer which is the ? mucus that lies adjacent to the lumen ? inner layer which is the ? mucus that lies next to the epithelia

Gel; thick Sol; thin

The ? muscle is the "protruder muscle" that prevents the tongue from occluding the oropharynx and causing an airway obstruction

Genioglossus

Angiotensin II stimulates zona ? cells via the ? system to produce and secrete ?

Glomerulosa; G-protein/phospholipase C; aldosterone

The ? is the vocal apparatus of the larynx - it is made of the ? and ?

Glottis; vocal folds; rima glottidis

The islets of langerhans are composed of: Alpha cells that secrete ? Beta cells that secrete ? Delta cells that secrete ? PP cells that secrete ?

Glucagon Insulin and amylin Somatostatin Pancreatic polypeptide

? of the zona fasciculata affect glucose metabolism ? the rate of glucose and glycogen formation by the liver Stimulate the release of ? from skeletal muscle and ? from adipose Promote ? catabolism Supplement the glucose-sparing effect of ?

Glucocorticoids Increase Amino acids; lipids Lipid Growth hormone

What does the zona fasciculata produce?

Glucocorticoids and androgens

*Cortisol and fasting*: Initial decline in blood glucose to a level of 60-70 mg/dL (1-2 days later) Cortisol stimulates ? in the liver (80%) and the kidneys (20%) several hours after the onset of fasting Blood glucose levels remain ? and stabilized because of the combination of glucose production and restriction of glucose use by tissues other than the brain

Gluconeogenesis Low

Free-bilirubin is absorbed into hepatic cells and 80% is conjugated with ? (called ?)

Glucoronic acid; bilirubin glucuronide or conjugated bilirubin

? is the only nutrient that is normally used by the brain, retina, and germinal epithelium of the gonads

Glucose

Liver serves as a ? buffer for the body and helps to maintain these levels in the blood

Glucose

*Physiology of diagnosis of diabetes*: ? in the urine (one of the first signs) Fasting blood glucose > ? mg/dL Glycated hemoglobin (A1c) >= ? Fasting ? (not seen often) ? test - usually to test for gestational diabetes

Glucose 126 6.5 Insulin Glucose tolerance

*Action of insulin on target cell*: The uptake of glucose by insulin requires the use of ? transporters (which are translocated intracellular vesicles) When insulin is no longer available, these vesicles separate from the ? and return to the ? of the cell (? to ? minutes) Cell membrane permeability increases for ?, ?, and ? Slower enzymatic effects lead to very slow changes in ? expression

Glucose Cell membrane; interior; 3; 5 AA, potassium, and phosphate Gene

*Type 1 diabetes - tissue injury*: Predisposition to autoimmune destruction of ? ? proteins ? viscosity impedes blood flow Derangement of ? of CNS blood flow, myocardium, kidney ? disease - neuropathy, retinopathy, nephropathy ? disease - CAD, PVD, cerebrovascular disease

Glucose transporters Glycoslated Increase Autoregulation Microvascular Macrovascular

The liver converts excess glucose intermediates into ? that can be metabolized into fat or converts glucose intermediates into ? for protein synthesis

Glycerol; amino acids

The liver takes up glucose to store as glycogen (process is called ?) when necessary, typically ? meals Liver converts glycogen back to glucose (process is called ?) by the phosphorylase/phosphatase enzyme system that includes epinephrine in the process (likely ? meals)

Glycogenesis; after Glygenolysis; between

*Example of ANS-Epinephrine axis and integrated control during the simple stress of exercise*: ? in skeletal muscle (early effect) provides glucose for myocytes If needed, mobilization of fatty acids from adipose tissue by way of ? stimulation of lipase activity in adipose tissue

Glycogenolysis Epinephrine

Epinephrine causes ? in the liver and ? lipolysis for fatty acid utilization

Glycogenolysis; increases

*Anesthetic concerns with diabetes*: ? of the joints - reduced range of motion of atlantooccipital joint "? sign" - possible difficult intubation

Glycosylation Prayer

Mucus originates from ? and ? Exists as a ? layer

Goblet cells; mucous glands Double

Phospholipase C is activated by which G protein?

Gq

Passive expiration: Muscles of inspiration relax ? Expiration is approximately ? as long as inspiration

Gradually Twice

*Type II alveolar cells* (AKA ?): Secrete ? into alveoli Cover 10% of the alveolar surface (compared to 90% of type I cells) - however...? Function as ? - about 1% alveolar epithelium replaced daily

Granular pneumocytes Surfactant There are as many (or more) Type II cells Stem cells

? (exophthalmic goiter) is the most common cause of hyperthroidism; females:males 8:1

Graves disease

? is the major cause for regional differences in ventilation/unit volume ? produces unequal stretching, which causes unequal ?

Gravity Gravity; expansion

With stage 2 of swallowing, ? impacts the movement of food to the stomach A stroke impacts the ? and ? phase of swallowing

Gravity Oral; pharyngeal

Explanation for differences in regional ventilation during eupnea at FRC: During a normal respiratory cycle, there is a greater change in volume in ? alveoli IPP ? by about 0.5 cmH2O for each cm from apical to basilar regions

Gravity-dependent/basilar Increases

*Airway resistance decreasing as you descend the tracheobronchial tree*: Total radii of summed bronchioles is ? than the total radii of the trachea and bronchi The larger the summed radii, the ? airway resistance, and the ? the air flow Small airways are arranged in ? - resistances add as ?

Greater Less; slower Parallel; reciprocals

The volume of air entering/leaving the nose or mouth per minute is (greater or less than?) the volume of air entering/leaving the alveoli per minute

Greater than

Gigantism results from excessive secretion of ? before closure of epiphyses It can also be due to a pituitary ? of the ? pituitary (somatotrophs) which cause an excessive secretion of ? and increased production of ? causing excessive growth of all body tissues Giants may grow 8 to 9 feet tall and usually display ? (10% have ?) - these people may have constantly high ? levels that cause degeneration of ?

Growth hormone Tumor; anterior; growth hormone; IGF-1 Hyperglycemia; diabetes mellitus; blood glucose levels; pancreatic beta cells

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Growth hormone releasing hormone (GHRH) Stimulates ? secretion by ? in the anterior pituitary

Growth hormone Somatorophs

Somatostatin, also known as ?, is released by ? cells of the pancreas It ? insulin it ? glucagon It ? gall bladder contraction It ? gastric motility

Growth hormone inhibiting hormone; delta Inhibits Inhibits Inhibits Inhibts

Which four hormones increase insulin release?

Growth hormone, cortisol, epinephrine, glucagon

Which class of drugs effectively reduce gastric acid production? Which class of drugs block the final common pathway and are more effective? What is that final common pathway?

H2 receptor antagonists Proton pump inhibitors; H/K ATPase pump

What do oxyntic (parietal) cells secrete?

HCl and intrinsic factor

The most common form of hypothyroidism (and predominant in females) is ? With this type, autoimmune antibodies are made against thyroid gland tissues. Tissues converted to non-functional ? tissues, therefore, little or no ? nor ? are produced

Hashimoto's disease (thyroiditis) Fibrotic; T3; T4

What are the contents of the *middle* mediastinum?

Heart and pericardium 8 major blood vessels - ascending aorta, SVC, IVC, pulmonary veins, pulmonary trunk Vagus and phrenic nerves

What makes up the thoracic cavity?

Heart, lungs, and viscera inside

The boundaries of the *middle* mediastinum is the space occupied by ? and ?

Heart; major blood vessels

What is the negative IPP (intrapleural pressure) responsible for?

Helps to keep lungs expanded *Not* responsible for lung expansion

Hemoglobin is metabolized and broken down into ? and ? components ? is transported to the liver and broken down into amino acids Iron atoms are isolated from the ? and combined with ?, a plasma protein that transports iron to the liver

Heme; globin Globin Heme; transferrin

? jaundice is associated with increased destruction of RBCs It is coupled with a rapid release of ? into the plasma, which accumulates in the plasma

Hemolytic Bilirubin

A ? is blood in the pleural cavity Can be ? related or from ? surgery

Hemothorax Trauma; cardiovascular

The ? supplies hepatic cells with nutrients

Hepatic artery

*Hepatic arterial buffer response*: If there is a decrease in portal vein supply, the ? will compensate - this is mediated by ? which causes ?

Hepatic artery; adenosine; vasodilation

Spaces of disse are located between ? and ?

Hepatic cells; sinusoid endothelium

The ? drains mesenteric veins from the small and large intestines

Hepatic portal vein

A ? (medical condition) may interfere with maintenance of barrier pressure, causing reflux

Hiatal hernia

Does the hepatic artery have a high or low PO2?

High

*Inspiration*: Air moves from a ? pressure area to a ? pressure area

High; low

*Anesthesia considerations for the liver failure patient*: Assess for a ? cardiac output and ? peripheral vascular resistance Anticipate a ? response to inotropes and vasopressors Suspect portal hypertension and esophageal ? May have ? sensitivity to highly protein bound drugs (sedatives)

High; low Depressed Varicies Increased

Symptoms of hyperthyroidism: ? body temperature and BMR with excessive ? ?-tension, ?-sympathetic state ? minute ventilation Weight ? ? intolerance, ? (temperature) skin Hand ? (mild as compared to parkinson's) ? (eyes) Goiter

High; sweating Hypertension; hypersympathetic Increased Loss Heat; warm Tremor Exopthalmos

P = 2T/r - implies the inherent instability of alveoli Example: two nearby alveoli are connected to each other have the same common airway (alveolar duct), and the same external pressure If each of the alveoli has a different radius and both have the same surface tension... According to La Place's law the alveolus with the smaller radius (r=1 unit) should generate a ? internal pressure forcing air into the larger alveolus (with r= 5 units) Surface tension is 50 dynes/ unit

Higher

*During forced exhalation*: Net alveolar pressure is +35 cmH2O This establishes a ? pressure gradient from alveoli to the outside as compared to a normal passive exhalation There is a drop in pressure to the outside due to ? of gas molecules encountering ? diameter of the lower airway walls (increased airway resistance)

Higher Friction; decreased

A deeper inspiration increases lung volumes which decrease airway resistance This occurs even in emphysema, although the resistance is ? ? airways are distensible/compressible

Higher Small

*Major factors affecting position of diaphragm*: Recoil of lungs after expiration causes diaphragm to move ? into the ? cavity Force exerted on ? surface of diaphragm can be due to fluid in lungs (i.e. CHF); diaphragm does not return to normal ? position

Higher; thoracic Superior; resting

Where do superficial (sub pleural) plexes drain their lymph into?

Hilar lymph

The ? is the root of the lung - a slightly depressed region located toward the middle of mediastinal surface It is the point where structures enter or exit the lungs

Hilum

? is a congenital absence of the myenteric plexus; alters motility

Hirschprung's

What do enterochromaffin-like cells (ECL) secrete? What does this chemical cause?

Histamine Nausea/vomiting

Metabolic functions of the lung: Some vasoactive substances not affected by lungs and whether they constrict/dilate?

Histamine: pulmonary vasconstrictor (bronchoconstrictor) and systemic vasodilator Vasopressin: vasoconstrictor Epinephrine: vasoconstrictor or vasodilator depending on the vascular bed and dose

*Secretion of gastric acid by increased cAMP*: Paracrine stimulation by ? (? produced locally antagonizes histamine at oxyntic cell and inhibits cAMP) When histamine occupies the receptor, there is an increased secretion of hydrogen ions by ? and ?

Histamine; prostaglandin E2 Gastrin; acetylcholine

Epithelium of bronchi: Mast cells contain membrane-bound secretory granules --> inflammatory mediators include ?, ?, ?, and ? These mediators cause broncho-?, ? secretion, and ? edema

Histamine; proteoglycans; lysosomal enzymes; metabolites of arachidonic acid Broncoconstriction; mucous secretion; mucosal edema

*Ligaments of the larynx*: Function? What are the two types of ligaments/membranes?

Hold the laryngeal cartilages together Extrinsic and intrinsic

Which law applies to elastance?

Hooke's law

The major mechanism of regulation of pancreatic secretion is by ? control (80%) ? is produced by S-cells in duodenum ? is produced by I-cells of duodenum and proximal jejunum which stimulates acini

Hormonal Secretin Cholecystokinin (CCK)

Mucus: Functions to ? and trap particles suspended in inhaled air ? removes particles larger than ? micrometers; primarily in ? and ? pharynx - the trachea contains few particles that are greater than ? micrometers

Humidify Impaction; 5; oro and nasopharynx; 10

Regulation of smooth muscle tone - hormone signals: ? mechanisms are related to the release of epinephrine and norepinephrine during "fight or flight" circumstances

Humoral

What does ghrelin (body) regulate?

Hunger and satiety

In the parietal cell, water dissociates into ? and ? ? ions go into the lumen of canaliculus. They go across by a ? pump which is primary active transport On the basolateral membrane, ? is being exchanged for ?. ? exits via the luminal side through leak channels and is returned through the ? pump ? leaks from the ECF/interstitial fluid to the luminal side

Hydrogen; OH Hydrogen; H/K ATPase Na; K (Na/K ATPase pump); potassium; H/K ATPase Chloride

Extrinsic ligament; joins hyoid bone to epiglottis

Hyoepiglottic ligament

What is the only bone in the body that doesn't articulate with another bone (not part of larynx)?

Hyoid bone

Blood gas terminology: ? is an excess of CO2 in arterial blood

Hypercapnia/hypercarbia

In advanced liver disease, circulation is said to be ? What happens to: SVR? BP? CO? RAAS? Blood volume?

Hyperdynamic Low Low Increased Increased Increased

*Physiologic factors that decrease secretion of GH*: ?-glycemia ? plasma free fatty acids

Hyperglycemia Elevated

Mechanical effects: ? is increased air in lungs; examples include ? (air trapping) or severe ? (FRC increased)

Hyperinflation; emphysema; asthma

? is increased ventilation to meet metabolic needs; occurs during exercise

Hypernea

Blood gas terminology: ? is an oxygen concentration exceeding ?% in blood

Hyperoxia; 21

*Clinical signs of diabetic autonomic neuropathy*: ?-tension ? MI Orthostatic ? Lack of ? variability (typically seen intraoperatively) Resting ? (HR issue - seen preoperatively) Reduced heart rate response to ? or ? Early ? (related to gastoparesis) Neurogenic ? Lack of ? These patients should have ? monitoring, with 5 leads preferred

Hypertension Painless Hypotension Heart rate Tachycardia Atropine; beta blockers Satiety Bladder Sweating ST

With ?, the thyroid gland becomes hyper plastic/hypertrophic

Hyperthyroidism

Slow stomach emptying: Tonicity? Food character? Consistency?

Hypertonic Fats Solids

? is when ventilation increases beyond metabolic needs What happens to CO2? What happens to O2? What are some causes?

Hyperventilation Decrease Increased; stress, anxiety, metabolic acidosis

Defense mechanisms of the respiratory system - factors that can cause laryngospasm: ?-calcemia

Hypocalcemia

Blood gas terminology: ? is a lack of Co2 in arterial blood

Hypocapnia/hypocarbia

Primary adrenal insufficiency (Addison's disease): Coritsol deficiency causes ?, ?, and ? Aldosterone loss causes ?, ?, ?, and ? (acid-base disorder) A lack of negative feedback results in increased ? levels, which causes an increased deposition of ? giving the skin a bronzing coloration

Hypoglycemia; hypotension; weakness/fatigue Hypovolemia; hyponatremia; hyperkalemia; metabolic acidosis ACTH; melanin

*Physiologic factors that increase secretion of GH*: ? (acute) and ? (chronic) ? plasma concentration of amino acids ? in the form of trauma or exercise 70% in the first two hours of deep ?

Hypoglycemia; starvation Increased Stress Sleep

? hormones control secretion of anterior pituitary hormones

Hypothalamic

Chronic systemic glucocorticoids can suppress the ? axis if treatment is stopped abruptly - dose should be ?

Hypothalamic-pituitary-adrenal; tapered

The ? controls secretion of pituitary hormones by releasing factors

Hypothalamus

*Anesthetic concerns with hyperthyroidism* A thyroidectomy may be done to treat hyperthyroidism; risks include: ?-thyroidism ? (large blood supply) Recurrent ? nerve injury ?-calcemia

Hypothyroidism Hemorrhage Laryngeal Hypocalcemia

Fast stomach emptying: Tonicity? Food character? Consistency?

Hypotonic Sugars/starch Liquid

? is when ventilation does not meet metabolic needs What happens to CO2? What happens to O2? What are some causes?

Hypoventilation Increased Decreased; sleep apnea, drugs

*Diabetic ketoacidosis (DKA) treatment*: Correct ?-volemia with what ? What can rapid correction cause? Correct ?-glycemia Correct total body ? depletion Goal is to decrease by ? to ? mg/dL per hour or ?% per hour

Hypovolemia; normal saline or D5W Cerebral edema Hyperglycemia Potassium 75; 100; 10%

Blood gas terminology: ? is a decreased amount of oxygen in arterial blood

Hypoxemia

Blood gas terminology: ? is a decreased amount of oxygen at the tissue

Hypoxia

Causes of surfactant deficiency: ? - lack of ? reduces cellular metabolic activities Interrupted ? supply - loss of pulmonary blood - embolism - can reduce O2 ? with the insufficient production of surfactant Breathing at the same ? for prolonged periods of time

Hypoxia; oxygen Blood Locally Tidal volume

*Blood supply of thyroid*: The superior thyroid vein drain into the ? The middle thyroid vein drains into the ? The inferior thyroid vein drains into the ?

IJ vein IJ vein Brachiocephalic vein

What are the two routes of calcium release from the sarcoplasmic reticulum?

IP3 and ryanodine channel pathway

At end expiration (rest), what is the intrapleural pressure (IPP) in relation to atmospheric pressure?

IPP is slightly subatmospheric (< 760 mmHg); about 756 mmHg (-4 mmHg or -5 cmH2O)

Vital capacity = ?

IRV + TV + ERV

? and ? are primarily components of basilar (gravity dependent) alveoli

IRV; IC

With obstructive airway disorders, ? will be greater than the ? (inspiratory vital capacity or expiratory vital capacity)

IVC; EVC

Surfactant deficiency: Can be caused by ? lung Surfactant is not normally secreted until between the ? and ? month gestation Premature neonates can be given synthetic ? surfactant May give the mom ? which may increase the maturation of ? cells

Immature 6th; 7th Aerosol Steroids; Type II

Defense mechanisms of the respiratory system - factors that can cause laryngospasm: Reflex stimulation from a stimulus ?

In another part of the body

Defense mechanisms of the respiratory system - *alpha-1 antitrypsin*: ? or ? proteolytic enzymes released by bacteria, leukocytes, macrophages Produced in ? - normally found in ? and in ? secretions Abnormal alpha-1 antitrypsin accumulates in ? and can cause ? A1AT may be absent or reduced in patients with ?

Inactivates; digests Liver; plasma; lung Liver; cirrhosis Emphysema

What do beta agonists do to serum glucose?

Increase

*Action of insulin on target cell*: Membranes (80%) markedly ? the uptake of glucose, especially ? and ? - this does not occur in neurons in the ?

Increase; muscle; adipose; brain

An increased respiratory rate will ? airway resistance due to ?

Increase; turbulent flow

Following inspiration, surface tension will ? due to the higher ? concentration at the surface in conjunction with the ? concentration of surfactant The greater the inspiration, the ? the recoil due to increased surface tension

Increase; water; decreased Greater

*Autonomic issues with liver failure*: ? SNS and RAAS responses ANS reflex dysfunction

Increased

Portal hypertension leads to ? hepatic vascular resistance

Increased

In liver failure, what happens to prothrombin time (PT)? Only ?% of clotting factors are required for normal coagulation If a patient has a prolonged prothrombin time (PT) especially after ? administration, this may mean severe disease ? has a half-life of 21 days so it is not as useful for acute liver failure

Increased 25% Vitamin K Albumin

*Example of ANS-Epinephrine axis and integrated control during the simple stress of exercise*: ? glycogenolysis in liver to maintain blood glucose ? insulin secretion - Under normal circumstances, epinephrine ? secretion of insulin; but under exercise conditions, local sympathetic input to pancreas ? the epinephrine effect Net effect: normal blood glucose levels required by the ? are maintained

Increased Decreased; stimulates; inhibits Brain

During CPR, applying firm pressure to the thorax over the inferior sternum moves the sternum approximately 4-5 cm posteriorly The ? intrathoracic pressure forces blood out of the heart and into the great arteries When external pressure is released and intrathoracic pressure ?, the heart again fills with blood

Increased Decreases

*Type 2 diabetes* Plasma insulin levels are ? Most patients are of what body type? Treatment may be conservative or with ? agents

Increased Obese Hypoglycemic

*Obstructive diseases*: Compliance ? Elastic recoil? FRC ? Tidal volume & TLC ? Slope of pressure-volume relationship?

Increased Decreased (loss of elasticity and compromised alveolar structure) Increased Increased Increased

If frequency is increased... Work of breathing is ? due to ? An individual with *emphysema* works to overcome ? and ? To maintain minute ventilation, they will ? their tidal volume and ? their respiratory rate

Increased; airway resistance and tissue resistance forces Tissue and airway resistance Increase; decrease

With fibrotic disease... ? lung recoil ? FRC because the chest wall is moved inward more than normal to equalize expressed forces

Increased; decreases

*Hepatic encephalopathy*: Decreased hepatic clearance leads to ? ammonia which causes cerebral ? and ? ICP

Increased; edema; increased

If tidal volume is increased... Work of breathing is ? due to ? An individual with *restrictive disease* works to overcome ? To maintain minute ventilation, they will ? their tidal volume and ? their respiratory rate

Increased; elastic recoil of lungs Increased recoil of lungs Decrease; increase

In advanced liver disease, there is ? peripheral shunting which causes a ? SVO2 There may also be anatomic shunting to abnormal vessels such as spider ?

Increased; increased Angiomas

*During forced exhalation*: Airway resistance ? to a greater extent compared to passive IPP increases up to ? cmH2O due to contraction of expiratory muscles. This is reflected throughout the lungs outside of the airways IPP is ? cmH2O and alveolar recoil pressure is ? cmH2O This gives a net alveolar pressure of ? cmH2O

Increases +25 +25; 10 +35

Insulin ? transport of amino acids into cells Insulin ? the translation of mRNA into new proteins Insulin ? catabolism of proteins Insulin ? the rate of gluconeogenesis

Increases Increases Inhibits Decreases

Insulin ? glucose utilization by most tissues Insulin ? fatty acid synthesis Insulin ? fat storage in adipocytes Insulin ? hormone-sensitive lipase Insulin ? glucose transport into fat (and muscle cells)

Increases Promotes Promotes Inhibits Promotes

Motor innervation of nose: Parasympathetic - ? mucous gland production ? fibers innervate blood vessels ? are not innervated - they respond intrinsically to irritants

Increases Sympathetic Goblet cells

Metoclopramide: ? barrier pressure ? LES tone

Increases Increases

Decreasing lung volume ? the airway pressure ? atmospheric pressure Pressure gradient is created that allows airflow from ? to the ?

Increases; above Lungs; external environment

PTH ? free plasma calcium and ? plasma phosphate PTH stimulates bone ?, ? renal calcium excretion, and ? renal phosphate excretion

Increases; decreases Resorption; decreases; increases

Emphysema: ? compliance due to destruction of ? Results in ? change in volume ? change in IPP

Increases; elastic septa Increased; no

When stimulated, the thyroid ? basal metabolic rate, which ? oxygen consumption, which ? CO2 production

Increases; increases; increases

Small airways traveling through the lung are attached to alveolar walls As alveoli expand during deep inspiration, elastic recoil ? and pulls open airways - this is related to ? on the small airways

Increases; traction (radial traction)

*ADH mechanism of secretion*: Vasopressin ? fluid retention at kidney and causes vaso-? ? receptors are in vascular smooth muscle ? receptors mediate ADH effects on kidney

Increases; vasoconstriction V1 V2

During expiration, a ? IPP ? venous return IPP ?, which ? blood vessels, which ? resistance to blood flow Venous ? in lower regions of body (legs) prevent backward flow of blood

Increasing; decreases Increases; compresses; increases Valves

Spirometry curves: After peak expiratory flow, expiration becomes effort ? Prior to peak expiratory flow, expiration is effort ?

Independent Dependent

Growth hormone stimulates growth from ? through age ?

Infancy; 50s-60s

What is the blood supply to the trachea? Venous drainage?

Inferior thyroid arteries, bronchial arteries, intercostal arteries Corresponding veins

Tissue injuries cause a complex set of reactions referred to as ? that precedes tissue repair Reactions are stimulated by release of chemical ? - prostaglandins, leukotrienes, histamine, serotonin, kinins, and lymphokines Direct or indirect actions of the above include: Local vaso-? ? capillary permeability and ?

Inflammation Mediators Vasodilation Increased; edema

Glucocorticoids have anti-? actions Best understood are those related to the formation of prostaglandins and leukotrienes Glucocorticoids stimulate the synthesis of proteins called ? (membrane stabilizers) which inhibit ?, thus decreasing ?

Inflammatory Lipocortins; phospholipase A2; arachidonic acid

Area within laryngeal cavity; lies between the vocal folds and inferior border of cricoid

Infraglottic (subglottic) cavity

Extrinsic muscles move the larynx as a unit ? muscles are depressors ? muscles are elevators

Infrahyoid Suprahyoid

Functional residual capacity (FRC): FRC can be greater than relaxation volume if...? Examples include ?

Inhalation occurs before relaxation volume is reached Rapid shallow breathing, partial obstruction of exhalation (asthma/emphysema)

Defense mechanisms of the respiratory system: Provide protection for body against damaging agents that may be ? from enviornment (microorganisms, particulates, noxious gases and pollutants) Air conditioning - ? and ?; mucosa, turbinates, and oropharynx and nasopharynx; rich blood supply and large surface area ? - rapid shallow inhalation for sensation without inhalation Filtration/removal of inspired particles: more defenses in breathing through the (nose or mouth?)

Inhaled Temperature; humidity Olfaction Nose

Sleep, dehydration, fatigue, and fear all ? salivation

Inhibit

PTH can ? phosphate reabsorption in the proximal tubule causing ? urinary loss of phosphate and ? plasma phosphate

Inhibit; increased; decreased

In the duodenum, Feedback ? of hydrogen ion secretion occurs in response to hydrogen ions, fatty acids, and hypertonicity This stimulates ?, which is the primary hormone released in response to low pH in the ?

Inhibition Secretin; duodenum

Cortisol mobilizes stored fat for energy Insulin has a ? effect to ? production of cyclic AMP in fat cells (adipocytes); ? is required to activate hormone sensitive lipase (HSL) During fasting, this ? effect of insulin is diminished and cyclic AMP levels are ?

Inhibitory; reduce; cyclic AMP Inhibitory; increased

Pancreatic polypeptide ? pancreatic secretion and ? gastric motility

Inhibits; inhibits

Defense mechanisms of the respiratory system - protective structures: Mucus contains ? immunity - contains substances that destroys pathogens: Immunoglobulins are produced by ? and are anti-? and anti? ? is the primary immunoglobulin in mucus Also: lysozymes, lactoferrin, a1-antitrypsin, interferon

Innate Plasma cells; antibacterial; antiviral IgA

The most innermost layer of intercostal muscles is the? It is a ? layer found primarily in ?

Innermost intercostal layer Thin; lower intercostal spaces

? is the movement of air into lungs

Inspiration

Spirometry curves: The bottom part of the curve represents ?

Inspiration

Effect of IPP on soft tissue: Soft tissues of the upper airway are subject to collapse during ? Obstruction occurs at the following sites and is worsened by ? soft tissue: ?, ?, and ?

Inspiration Increased Tongue; soft palate; pharynx

The dynamic compliance curve: Has ? and ? limbs The difference between the curves is ? Difference is attributable to ?

Inspiration; expiration Hysteresis Alveolar surface tension

? is the maximal volume of air that can be inhaled after a maximal forced inspiration

Inspiratory reserve volume (IRV)

What volumes does total lung capacity consist of?

Inspiratory reserve volume (IRV) Tidal volume (VT) Expiratory reserve volume (ERV) Residual volume (RV)

? is the maximal volume of air that can be inhaled following a forced exhalation

Inspiratory vital capacity

? is an anabolic hormone associated with energy abundance

Insulin

Increased blood glucose stimulates ? secretion - there is a feedback between the two

Insulin

*Ketoacidosis* Caused by ? deficiency Large amounts of ? are formed in the liver cells The ? deficiency leads to increased ? which leads to increased ? (B-hydroxybutyric acid and acetone) ? means large amounts of ketones present, which can lead to ? (acid-base disorder), coma, and death

Insulin Acetoacetic acid Insulin; acetoacetic; ketone bodies Ketosis; acidosis

Post carbohydrate ingestion, glucose causes a rapid secretion of ? ? causes rapid uptake, storage, and use of glucose by most tissues - muscles, adipose, liver; normal resting muscle is ? permeable

Insulin Insulin; not

Which two hormones decrease serum glucose?

Insulin and somatostatin

? is primarily responsible for the effects of growth hormone on linear growth

Insulin-like growth factor 1

African pygmies do not have the ability to synthesize ?

Insulin-like growth factor 1 (IGF-1)

*Hyperosmolar nonketotic coma*: These patients typically have enough ? present to prevent ? formation There is a hyperglycemia-induced ?, which leads to ? and ? ? induces dehydration of neurons Severe hyperglycemia leads to factitious ?-natremia. Each ? mg/dL increase in plasma glucose ? plasma sodium concentration by ? mEq/L

Insulin; ketone Diuresis; dehydration; hyperosmolality Hyperosmolality Hyponatremia; 100; lowers; 1.6

*Lymphatic drainage of pleura*: Parietal pleura lymph is drained from 3 divisions: Costal pleura into ? Diaphragmatic pleura into ? Mediastinal pleura into ?

Intercostal lymph nodes Diaphragmatic lymph nodes Mediastinal lymph nodes

*Innervation of pleura - parietal pleura*: Costal pleura supplied by ? Mediastinal pleura supplied by ? Diaphragmatic pleura supplied by ?

Intercostal nerves Phrenic nerve Phrenic nerve and lower intercostal nerves

Intercostal muscles lie in ? spaces (? pairs) between adjacent ribs They occur in ? layers and promote ? and ? of rib cage

Intercostal; 11 3; expansion; reduction

The ? nose includes the nasal cavities The nasal septum is composed of: ? ? plate of the ? bone ? cartilage A deviated septum can...?

Internal Vomer Perpendicular; ethmoid Septal Obstruct airflow

Sensory innervation to larynx: Upper vocal cords and above? Lower vocal cords and below?

Internal branch of superior laryngeal nerve Inferior laryngeal nerve which branches off the recurrent laryngeal nerve

What is the blood supply to the superior nasal cavity?

Internal carotid artery --> opthalmic artery --> anterior and posterior ethmoid artery

The middle layer of intercostal muscles is the ? Fibers lie?

Internal intercostal layer Obliquely downward/backward

Following a *maximal forced exhalation*, lung recoil is less than normal due to: ? and ? muscles contracting, bringing the FRC down to 25% of TLC The size of the thorax has ?; the AP dimension has ? The lung elastic tissue is not ? as much as it is at end-expiration Elastic recoil of lungs is ? as compared to end-expiration; outward recoil of thorax is ?

Internal intercostals; abdominal muscles Decreased; decreased Stretched Decreased; increased

What is venous drainage of larynx?

Internal jugular

Structure of nasal cavity; connect the nasal cavities to the nasopharynx

Internal naris (choanae or posterior nasal apertures)

Hormones usually activate target cell activity via ? and ?

Intracellular 2nd messenging; gene transcription/translation

Secretion of gastric acid can be stimulated by increased ? or increased ?

Intracellular calcium; cAMP

? is the pressure within the pleural cavity

Intrapleural pressure (IPP)

Secondary/lobar bronchi and tertiary/segmental bronchi are ? airways

Intrapulmonary

Conducting airways can be considered ?, which are located within the lung structure. Which structures are included?

Intrapulmonary Secondary bronchi to alveoli

Measurement of IPP: A balloon is swallowed into the ? portion of the ? During inspiration the intrathoracic pressure ? and the balloon ? A ? is used to record the pressure change

Intrathoracic; esophagus Decreases; inflates Manometer

? ligaments connect laryngocartilages

Intrinsic

In addition to HCl, oxyntic (parietal cells) secrete ? which is required for absorption of ? in ileum

Intrinsic factor; Vitamin B12

Stage 2 of swallowing is pharyngeal and is ? The bolus stimulates proprioceptors in oropharynx to send impulses by CNs ? and ? to the deglutition center in the pons

Involuntary 5; 9

Effects of IPP changes on paralyzed muscles: Intercostal muscles - pressure gradient would cause ? during inspiration Hemi-diaphragm - inspiration would cause ? movement during inspiration

Inward bulging Upward

Upon expiration from 100% TLC to 67% TLC, expiratory movement is due to ? and ? From 67% TLC to 50% TLC, expiratory movement is due only to ? since at 67% TLC, elastic elements of ? begin to be stretched and oppose lung recoil

Inward elastic recoil of lungs; inward directed recoil of chest wall Elastic recoil of lungs; chest wall

Which two *lung* factors decrease lung volume during passive expiration?

Inward recoil of elastic tissue of lung to resting state Surface tension recoil in alveoli - more important than elastic tissue recoil

FRC balance point: What are the inward forces? What are the outward forces?

Inward: elastic recoil of lungs and alveolar-associated surface tension Outward: elastic recoil of chest wall musculature

Functional residual capacity (FRC): During passive expiration... ? directed forces Stretched elastic tissues ? toward their resting position ? at inner lining of alveolar epithelium assists the return to resting position

Inwardly Recoil Surface tension

The formation of thyroid hormone requires ?

Iodine

Three forms of calcium in blood plasma: ? (50%) - which is tightly regulated by parathyroid Protein bound to ? - diffusible through capillaries? - 45% Complexed with low-molecular weight anions (?, ?, and ?) - diffusible through capillaries? - 5%

Ionized (free calcium) Albumin; not diffusible through capillaries Citrate; oxalate; bicarbonate; diffusible through capillaries

Primary muscles of inspiration - external intercostals: Contraction of external intercostals (is or is not?) sufficient for ventilation at rest in the event of diaphragmatic paralysis Does the loss of external intercostal muscle contraction have a major impact on ventilation during exercise?

Is No

IPP is reflected throughout the entire lung from outside of the airways: The pressure surrounding the alveoli and intrapulmonary airways (is or is not?) the pressure across the walls of the airways Pressure is found throughout the thorax and mediastinum during breathing ? pressure = intrapleural pressure

Is not Intrathoracic

Scattered among the acini of the pancreas are endocrine tissues called ? which secrete insulin, glucagon, and somatostatin

Islets of Langerhans

Intermediate stomach emptying: Tonicity? Food character? Consistency?

Isotonic Protein Semi-solids

The thyroid is "H" shaped, with the left and right lobes interconnected by a narrow ? (covers rings ? through ? of the trachea) The ? glands are embedded in the four lobes of thyroid tissue

Isthmus; 2; 4 Parathyroid

? is a yellow-brown tint of body tissues, particularly in the skin, mucous membranes, and sclera, and is usually the first thing the patient sees This is caused by large quantities of ? in the ECF (normally ?)

Jaundice Bilirubin; free

What are the 2 locations of dense bodies?

Just under plasma membrane and throughout the sarcoplasm

*Stratified squamous epithelium*: Initial 1.5 cm of the vestibule is ? Then transitions to ? Lines the ? of internal nose

Keratinized Non-keratinized Anterior 1/3

*Diabetic ketoacidosis (DKA)*: DKA is an accumulation of ? (which are weak ?) - this may cause a ? (acid-base disorder) ? is a common precipitating cause and may be the initial presenting etiology Clinical manifestations include ? (respiratory compensation), ? pain, ? and ?, and ? (neurological)

Ketone bodies; acids; metabolic acidosis Infection Tachypnea; abdominal; nausea; vomiting; altered mental status

The adrenal glands lies at the superior poles of both ?

Kidneys

*Second messengers* Second messengers use ? (enzymes) to phosphorylate target proteins For peptides and catecholamines, 2nd messenger generation usually begins with the hormone-receptor complex with intracellular heterotrimeric ? ? are highly variable (related to cell type found) and have many actions; i.e. stimulate opening of ion channels or insertion of water channels (aquaporins)

Kinases G proteins Kinases

Factors related to alveolar stability: Communication (especailly ? and ?) ? ? - most important From interwoven nature of ? tissue

Kohn; Lambert Surfactant Interdependence Connective

? cells are macrophages of the reticuloendothelial system that line the sinusoid endothelium of the liver These destroy bacteria, tissue debris, and aged ? by phagocytosis

Kupffer Red blood cells

? is rapid deep breathing observed in diabetic ketoacidosis

Kussmaul breathing

Factors leading to a *decreased compliance* of thoracic wall: Skeletal abnormalities such as ? ? - makes it more difficult to move thoracic cage by muscular contractions ? - as with tumors and pregnancy

Kyphoscoliosis Extreme obesity Increased abdominal mass

Barrier pressure = ? pressure minus ? pressure

LES; intragastric

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Gonadotrophic releasing hormone Stimulates ? secretion by ? in the anterior pituitary

LH and FSH; gonadotrophs

*Anesthetic concerns with diabetes*: ? in lactated ringers can be converted to hyperglycemia Hyperglycemia worses neurologic outcomes after ? Autonomic ? Osmotic ? Schedule ? due to hypoglycemic therapy Check ? perioperatively Intraoperative hypoglycemia may be masked by ?, ? and ? (which blunt the SNS response)

Lactate Ischemia Neuropathy Diuresis Early (first thing in AM) Glucose General anesthesia; diabetic autonomic neuropathy; beta blockers

The hepatic portal vein contains all of the absorbed substances from the intestines except contents that entered the ? (such as ?)

Lacteals; chylomicrons

? airflow is smooth, streamlined flow with low resistance Air flows in concentric cylinders More ? located cylinders flow faster Air molecules flowing next to the wall of a tube encounter ? resistance due to ?

Laminar Centrally More; friction

The ? (part of the GI tract) transports fluids and electrolytes and ferments undigested carbohydrates over the next 12-24 hours

Large intestine

The patient with emphysema has: A ? lung volume due to ? A (compliant or non-compliant?) chest wall When assisting ventilations by hand, you are ventilating them at the ? of the compliance curve (making it ? to hand-ventilate the patient)

Large; air trapping Non-compliant Top; difficult

Law of LaPlace... The smaller alveolus generates a ? internal pressure... Forces air into the ? alveolus and - collapse of ? alveolus It should be easier to keep the larger alveolus open *This does not normally occur* because as the radius of the smaller alveolus decreases, ? molecules ? in concentration at the air-liquid interface

Larger Larger; smaller Surfactant; increase

Defense mechanisms of the respiratory system: ? muscles promote constriction of the airway in response to irritating stimuli Irritation can ? cords and obstruct the ?

Laryngeal Adduct; airway

Laryngeal cavity extends from the ? to the inferior border of ?

Laryngeal inlet; cricoid cartilage

Area within laryngeal cavity; recesses extending laterally between vestibular and vocal folds

Laryngeal ventricle

Area within laryngeal cavity; cavity between the laryngeal inlet and vestibular folds

Laryngeal vestibule

The ? is posterior to the larynx

Laryngopharynx

What is the organ of voice production?

Larynx

The thyroid gland is located in the neck below the ? It is palplable in the anterior neck in front of the ?

Larynx Trachea

*Inner longitudinal layer*: Function: Elevates (shortens/widens) ? and ? during swallowing and speaking Lifts ? against the base of the tongue Is the epiglottis essential to close inlet?

Larynx; pharynx Larynx No

Cricoid cartilage indicates the junction of the ? and ? Also indicates the joining of the ? and ? It is also where the ? enters the larynx

Larynx; trachea Pharynx; esophagus Recurrent laryngeal nerve

Lower lobes of lungs can be easily visualized ?

Laterally

? states the pressure within a spherical bubble is directly proportional to the surface tension and inversely proportional to the radius of the bubble at the liquid-air interface

Law of LaPlace

*Major factors affecting position of diaphragm*: Force exerted on abdominal surface of diaphragm by abdominal viscera when ? or during ? Intra-abdominal tension caused by abdominal muscle contractions - ? can cause abdominal muscle contractions that push abdominal contents upward on abdominal surface of diaphragm

Laying down; pregnancy Standing

*Work of breathing related to obstructive disease*: In emphysema... The static compliance curve is shifted ? due to the decreased recoil of the lung Dynamic compliance curve of expiration is shifted to the ? of AC to a greater degree than normal because of lack of lung ? Expiration is ? in the person with emphysema

Left Left; recoil Active

Primary muscles of inspiration - diaphragm: What innervates the diaphragm?

Left and right phrenic nerves

Which lung contains the cardiac notch?

Left lung

Which lung is slightly greater in height?

Left lung

*Innervation of the diaphragm*: The ? and ? nerves supply left and right hemidiaphragms If one of the nerves is incapacitated, can adequate function occur?

Left phrenic; right phrenic Yes

Following a maximal forced exhalation, lung recoil is ? than normal

Less

The smaller alveolus has ? surface tension This decreases alveolar surface tension proportional to the size of the ? The end result is that the force of air pressure needed to inflate both sizes of alveoli ? so from the standpoint of surface tension all alveoli are ?

Less Alveolus Remains the same; equal

In emphysema: There is ? elastic connective tissue present in the walls of the bronchioles and alveoli The loss of septa ? alveolar elastic forces: moves it from ? cmH2O to ? cmH20 This decreases the net alveolar pressure to ? cmH2O for a forced expiration as compared to ? cmH2O and lowers the equal pressure to ? cmH2O - which causes closure of non-cartilaginous airways Intrapulmonic pressure gradient ?, IPP more easily narrows airways, causing ? Individuals respond by ? breathing - restriction at mouth maintains airway pressure higher for longer to promote exhalation before narrowing of airways occurs

Less Decreases; 10; 4 29; 35; +20 Decreases; air trapping Pursed lip

*Basilar/gravity dependent region*: ? distended than apical region Basilar IPP is ? negative

Less Less

What is the blood supply to the tongue?

Lingual artery of external carotid

The inferior surface of the tongue is connected to the floor of mouth by ?

Lingual frenulum

The ? tonsils are lymphoid nodules

Lingual tonsils

What is the anterior/inferior part of the tonsilar ring?

Lingual tonsils

GH causes the following acute diabetogenic effects (oppose insulin) ? in adipose ? glucose uptake in muscle ? in liver

Lipolysis Reduced Gluconeogensis

*Hormone receptors and signaling*: Hormones that are ? do not require a carrier and can diffuse into the cell to a cytoplasmic receptor When the hormone binds with a receptor, a hormone-receptor complex is created that leads to a hormone response element which is the promotor to help further develop the hormone/signal

Lipophilic

The oral cavity is from the ? to ?

Lips; palatoglossal folds or arch

*Surfactants*: Surfactants have ? attraction for other surfactant molecules or water molecules A surfactant placed in a volume of water in a beaker uniformly disperses itself throughout the water, and displaces ? molecules - ? their concentration ? concentration of water molecules at the surface ? the surface tension

Little Water; reducing Reduced; reduces

What type of effect do factors that increase secretion or hypertrophy of the zona glomerulosa have on the other two zones?

Little effect

Smooth muscle of airways (trachea to alveolar ducts) are controlled by efferent fibers of ANS Sympathetic innervation effect on airway resistance? Parasympathetic stimulation on airway resistance occurs via ? nerve. NT is ?. Result is ? and secretion of ? by ? airway resistance

Little effect Vagus; acetylcholine; bronchoconstriction; mucus; increasing

*Cortisol and the immune system*: How do glucocorticoids affect the immune system? When glucocorticoids are given in large doses over prolonged periods: They suppress ? formation They interfere with cell-mediated ? - which is why they are used to suppress ? of transplanted organs and tissues

Little influence normally Antibody Immunity; rejection

The body requires the ? for synthesis of critical proteins

Liver

What is the most important storage site for iron in the body?

Liver

Where are all protein blood clotting factors synthesized?

Liver

Where is most of the vitamin B12 stored in the body?

Liver

? is the major source of insulin-like growth factor 1 (IGF-1) Why is IGF-1 an unusual peptide?

Liver 90% protein bound

*Summary*: ? buffers blood glucose ? and ? feedback to maintain a normal blood glucose concentration Severe hypoglycemia directly effects the ? to stimulate the ? which causes the release of ? (causing glycogenolysis) Prolonged hypoglycemia cause ? and ? to be secreted which increase ? utilization over glucose

Liver Insulin; glucagon Hypothalamus; SNS; epinephrine Growth hormone; cortisol; fat

Most coagulation factors and proteins are produced by the ? ? directly determines the amount of clotting factors available

Liver Prothrombin

The liver ? is the basic unit of structure and function of the liver There are about ? to ? per liver and they are in a ? arrangement

Lobule 50,000; 100,000; hexagonal

*Hormonal reactions (regulation of plasma calcium and phosphate)*: ? term - takes several minutes to hours to become effective; involves three hormones; primary means for regulation of plasma calcium and phosphate Decreased plasma calcium causes increased ? secretion, which, in turn, causes calcium to be mobilized and added to the plasma

Long PTH

While nonalcoholic fatty liver disease (and NASH) is a major cause of liver cirrhosis, what are the two major causes?

Long term alcohol abuse and hepatitis (commonly hepatitis C)

Free cortisol controls ACTH secretion by a ? loop (inhibition of CRF secretion) and a ? loop (inhibition of ACTH secretion) from the anterior pituitary gland

Long; short

*Contraction of smooth muscle* - dense bodies: Throughout the sarcoplasm... Dense bodies are scattered ? and connected by ? filaments and thick and thin myofilaments Clusters of ? filaments (thin) extend away from dense bodies into sarcoplasm ? (thick) filaments are mixed with ? (thin) clustered filaments Phosphorylation of light chain myosin filaments by ? activates myosin to allow the ? filament to slide past the ? filaments to cause shortening

Longitudinally; intermediate protein Actin Myosin; actin ATP; thin actin; thick

Aging causes: ? of alveolar elastic recoil ? chest wall recoil ? muscle strength ? of alveolar surface area ? of pulmonary capillary blood volume What does all of the above do to FRC and closing volume?

Loss Increased Decreased Loss Loss Increased both FRC and closing volume

Does the hepatic portal vein have a high or low PO2?

Low

Resistance is ? with laminar flow Resistance is ? with turbulent flow

Low High

Cilia can be inhibited by: ? humidity Cold or heat? ? smoke ? (anesthesia-related) ? (anesthesia-related)

Low Cold Cigarette Anesthesia gases Endotracheal tube

With primary adrenal insufficiency (Addison's disease), what happens to: Cortisol levels? Aldosterone levels? ACTH levels?

Low Low High

Non-linear aspects of compliance: Lungs are not compliant at very ? and very ? lung volumes At high lung volumes, lungs are already highly stretched so much that an increased change in IPP only yields a small ? in change in volume At approximately FRC of ? mL the compliance curve becomes linear

Low; high Increase 3000

For normal, laminar flow: Resistance in the airways is ? - ? driving pressure is needed Greatest resistance is in the ? (summed)

Low; low Large and medium bronchi

During inspiration, alveolar ventilation is ? than minute ventilation due to dead space The last part of each inspiration remains in the conducting airways

Lower

A higher barrier pressure means a ? risk of reflux/aspiration To prevent aspiration, a ? gradient maintains LES tone

Lower Positive

During starvation, the enzyme that converts T4 to T3 shows a different expression which ? basal metabolic rate

Lowers

Increasing lung volume (increases or decreases?) airway pressure (above or below?) atmospheric pressure Pressure gradient is created that allows airflow from ? to ?

Lowers; below External environment; lungs

High hepatic pressures cause an increase in ? and you can get backup causing edema, ascites, or anasarca Half of all ? is formed in the liver

Lymph Lymph

Enzymes of saliva reduce bacterial growth: ? attacks bacterial cell walls ? chelates iron which interrupts replication ?-binding protein required for immune activity of this immunoglobulin Saliva also contains ? ions that are bactericidal

Lysozyme Lactoferrin IgA Thiocyanate

*Motilin*: Stimuli for secretion? Site of secretion? ? gastric motility ? intestinal motility

M cells of duodenum and jejunum Fat, acid, nerve Stimulates Stimulates

Parasympathetic regulation of smooth muscle tone: Acetylcholine can combine with ? receptors on the plasma membranes of myocytes *or* with ? receptors on the surface membrane of the same axon ("presynaptic")

M3 muscarinic; M2 muscarinic

Parasympathetic regulation of smooth muscle tone: ? receptors stimulate smooth muscle contractions (bronchoconstriction), whereas ? receptors stimulate "presynaptic inhibition" The combined actions initiated by M3 and M2 muscarinic receptors assist in maintaining ? baseline tone

M3; M2 Bronchoconstrictor

Small radicle ducts coalesce to form the ?

Main pancreatic duct (Wirsung)

Which duct releases inactive enzymes and sodium bicarbonate from the pancreatic gland and associated internal ducts

Main pancreatic duct (Wirsung)

*Intrinsic muscles*: Thyroarytenoid? ? muscles - promotes relaxation of cords (superior fibers --> epiglottis)

Main relaxers of vocal cords Vocalis

*Intrinsic muscles*: Cricothyroid?

Main tensors of vocal cords

The uppermost portion of the sternum is the ? Where is the suprasternal/jugular notch located? The ? thoracic vertebra corresponds to the mid-portion of the trachea

Manubrium Superior concave area 2nd

*Anesthesia considerations with patients with acromegaly*: Diffcult ? and ? What size tubes should we use? Why?

Mask ventilation; laryngoscopy Smaller tubes due to subglottic narrowing and vocal cord enlargement

? of food creates a bolus that can be swallowed ? lubricates and provides enzymes for digestion How long does it take for food to travel through the esophagus?

Mastication Saliva 10 seconds

When is static compliance measured (in terms of absence/presence of gas flow?) What pressure is it based on?

Measured in the absence of gas flow Based on plateau pressure

When is dynamic compliance measured (in terms of absence/presence of gas flow?) What pressure is it based on?

Measured in the presence of gas flow Based on peak pressure

Structure of nasal cavity; narrow passages beneath the concha Each one is associated with an opening for drainage from (?) paranasal sinuses. Paranasal sinuses are easily infected - communciations and swollen mucosa

Meatuses 4

What two things stabilize the alveoli?

Mechanical interpendence Pulmonary surfactant

The intrinsic ligament, ?, is used for emergency airway access

Median cricothyroid ligament

Where are the cell bodies of the posterior pituitary (neurohypophysis) located? What are the two cell bodies?

Median eminence of hypothalamus Supraoptic nucleus and paraventricular nucleus

Surface of the lung; concave shaped

Mediastinal

Division of parietal pleura; forms lateral walls of mediastinum

Mediastinal pleura

? is a procedure that enables visualization of the contents of the mediastinum, usually for biopsies. There are several areas that can be ? during the procedure, so monitoring with arterial lines and several pulse oximeters are warranted during the procedure Typically, ? sedation is required because we are trying to avoid ? by the patient

Mediastinoscopy Compressed Deep; coughing

Parietal pleura... Forms the walls of the ? Continuous with visceral pleura at ? Forms a ? around the structures at the hilum

Mediastinum Root of the lung Collar

Where is the vomiting center located? Does the vomiting center require noxious gut stimuli?

Medulla oblongata No - can come from smell, motion sickness, emotions

*Type 1 diabetes*: Which acid-base disorder is present? There is a ? of the body's proteins Difficult intubations are possible in 30% of type 1 DM patients due to ? - the ? and ? mobility is decreased

Metabolic acidosis Depletion Stiff joints; temperomandibular joint; cervical spine

In both types of diabetes... ? is altered, which prevents the efficient uptake and utilization of glucose by cells (except the ?) When blood glucose concentration increases, cell utilization of glucose ?, and utilization of fats and protein ?

Metabolism; brain Falls lower; increases

On the dorsum of the tongue, there is a ? that divides the tongue into left and right halves

Midline groove (median sulcus)

What does the zona glomerulosa produce?

Mineralcorticoids

? is the volume of air remaining in the lungs after a complete collapse What is the amount?

Minimal air 500 mL

? is the volume of air inhaled or exhaled per minute

Minute ventilation

Pulmonary ventilation = ?

Minute volume/ventilation

? is the volume of air inhaled or exhaled per minute Formula? Normal value?

Minute volume/ventilation Tidal volume x frequency of breaths 6L/min

While manipulating respiratory rate and tidal volume may not change your ? ventilation, significant changes in ? ventilation may occur

Minute; alveolar

*Apical/gravity non-dependent region*: ? distended than basilar region ? difficult to stretch further Apical IPP is ? negative

More More More

Explanation for differences in regional ventilation during eupnea at FRC: IPP is ? negative in the upper regions of the lung compared to the lower regions Alveoli in ? regions are subjected to a greater distending pressure and greater volume This difference in ? causes a difference in ventilation between upper and lower areas

More Upper Volume

*Airway resistance decreasing as you descend the tracheobronchial tree*: While a single small airway provides ? resistance than a single large airway, resistance to air flow depends on the number of ? pathways present The total cross-sectional area of bronchioles is very ? compared to the total cross-sectional area of the trachea and bronchi Total radii of summed bronchioles is ? than the total radii of the trachea and bronchi

More; parallel Large Greater

Which hormone increases gastrointestinal motility by stimulating migrating motor complexes (MMCs)?

Motilin

Airway resistance occurs only when there is ? - during ? and ?

Movement of air; inspiration; expiration

Defense mechanisms of the respiratory system: The ? involves ciliated cells transporting mucus toward the oropharynx

Mucociliary escalator

What do mucous neck cells secrete?

Mucous and bicarbonate

All pharyngeal epithelial contain ?

Mucous glands

? secrete mucus onto luminal surface

Mucous goblet cells

The mucosa of the esophagus only secretes ? Does it secrete digestive enzymes? The function of the esophagus is that it is a conduit through the ?

Mucus No Pharynx

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - has its fibers innervated by single nerve endings and can contract independently?

Multi-unit

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - includes ciliary and iris muscles of the eye and piloerector muscles?

Multi-unit

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - is composed of discrete fibers without gap junctions?

Multi-unit

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - is mainly under nervous control?

Multi-unit

What are the 2 major types/arrangements of smooth muscle?

Multi-unit smooth muscle and unitary smooth muscle (syncytial or visceral)

Most important element related to flow/Poiseuille's law: If the radius is reduced by half, the resistance is ? by ? If the radius is doubled, the resistance is ? by a factor of ?

Multiplied/increased; 16 Reduced/decreased; 16

? is a childhood disease that is usually caused by a viral infection of the ? gland (gland swells) ? (benign or malignant) of the salivary glands may occur due to genetic tendency/predisposition

Mumps; parotid Tumors

Glycogen is stored in ? Insulin can increase rate of transport of glucose into resting muscle by ? times Insulin promotes ? (organ) uptake, storage, and glucose utilization ? is released from the liver between meals Insulin promotes conversion of excess glucose into ? and inhibits ? in the liver

Muscle 15 Liver Glucose Fatty acids; gluconeogenesis

*Insulin receptor* Located on which 3 target tissues? How many subunits? What are these subunits? Insulin attaches to the ? subunit, which then activates the ? subunit which then acts as an enzyme - a ? to phosphorylate additonal enzymes

Muscle, adipose, liver 4 subunits; 2 alphas, 2 betas Alpha; beta; tyrosine kinase

*Work of breathing related to active expiration*: Requires expiratory ? contraction and therefore uses ? A dynamic curve of expiration extends to the left of ? (segment) It represents additional ? expended during active expiration in the normal individual

Muscle; energy CA Energy

*Anesthesia concerns of hypothyroidism* The hypothyroid patient is typically okay for elective surgery - cancel if ? Airway ? may occur due to swollen vocal cords, large tongue, goiter ? gastric emptying More susceptible to ? due to anesthetic agents - ? cardiac output, ? baroreceptor reflexes

Myxedema Obstruction Delayed Hypotension; decreased; blunted

The extreme of hypothyroidism is ? which is impaired mentation resulting from severe hypothyroidism; high mortality rate

Myxedema coma

? is also a dermatologic condition seen with ?-thyroidism that involves edematous skin (facial and under eyes) It is caused by a deposition of ? in interstitium of skin; deposition attracts fluid (edema) resulting in what type of edema?

Myxedema; hypothyroidism Glycosaminoglycans; non-pitting

Iodide trapping by follicular cells from the ECF occurs by a ? cotransporter ? is synthesized in follicular cells (then on to the Golgi) and is secreted into ? by exocytosis Conjugation of two iodinated ? groups on ? produce T4 and T3 Endocytosis of thyroid colloid into ? cells occurs. Hydrolysis of ? occurs when endocytic vesicles enter the lysosomal pathway. This produces free ? and ? and an iodinated residue. MIT and DIT returns ? into intracellular pool within follicular cells ? (90%) and ? (10%) secreted by exocytosis into the ECF

Na/I Thyroglobulin; colloid Tyrosyl; thyroglobulin Follicular cells; thryoglobulin; T4; T3; iodide T4; T3

Intrinsic muscles that modify the laryngeal inlet (do they widen or narrow the inlet?): Aryepiglottic? Oblique arytenoid? Thyroepiglottic?

Narrow Narrow Widen

Defense mechanisms of the respiratory system: The sneeze reflex removes irritants primarily through which passages? What does it incorporate?

Nasal passages (nose and nasopharynx) Valsava maneuver

The ? is the posterior extension of nasal cavity

Nasopharynx

Where is the pharnygotympanic (eustachian) tube located?

Nasopharynx

Pharyngeal (involuntary) phase (stage 2) of swallowing: Uvula (soft palate) elevates to close ? Vocal cords are ? Larynx is pulled ? and anteriorly; ? covers the laryngeal inlet ? relaxes, all pharyngeal constrictor muscles contract in a peristaltic wave Bolus passes through the ? and stimulates a peristaltic wave (smooth muscle)

Nasopharynx Approximated Upward; epiglottis UES UES

Subdivisions of pharynx ? - respiratory ? - respiratory; digestive-muscular ? - respiratory; digestive-muscular

Nasopharynx Oropharynx Laryngopharynx

? pressure breathing: Air moves into lungs as a result of airway pressure decreasing below atmospheric pressure

Negative

Normal physiologic breathing is ? pressure breathing

Negative

The iron lung is an example of a ? pressure mechanical ventilator

Negative

During inspiration, a ? IPP ? venous return IPP in the thoracic region ? the external pressure on blood vessels (inferior vena cava) in the thoracic cavity which causes ? of blood vessels, and ? resistance to blood flow and conditions favor ? blood flow to the heart The diaphragm ?, causing an ? intra-abdominal pressure exerted on the IVC below the diaphragm which forces blood flow toward the heart

Negative; aids Decreases; dilation; less; increased Descends; increased

*Abnormalities and ADH*: ? diabetes insipidus is when ADH is normal to high What are the causes?

Nephrogenic Chronic renal disease (chronic pyelonephritis, polycystic kidney)

*Modes of intercellular communication* ? - release of neurotransmitters at synapses ? - cells release hormones into the blood to act at a distant site ? - neurohormone released from an axon into blood ? - hormone diffuses locally (ISF) to act on a different cell type ? - cell regulates itself by the release of a chemical messenger

Neural Endocrine Neuroendocrine Paracrine Autocrine

*Hypothalamic hormones and the anterior pituitary*: A releasing hormone is secreted from ? in a hypothalamic nucleus into the hypothalamo-hypophyseal portal system The releasing hormone is delivered to the ? and binds to specific receptors on the plasma membrane Initiates a ? response The releasing hormone can stimulate an increased rate of ? synthesis by specific anterior pituitary cells and stimulate secretion of the cells by ?-induced exocytosis

Neurons Anterior pituitary G-protein/cAMP Hormone Calcium

Does passive expiration require muscular activity?

No

During expiration, air from the last part of a previous inspiration is added back to the ADS Is the 150 mL in ADS fresh air?

No

Is there lymphatic drainage in the alveoli?

No

*Inspiration*: Are lungs capable of self-inflation? What is required?

No Pressure gradient

Does esophageal muscle display slow waves? Normally, UES and esophageal body are ? and the LES is tonically ? yielding an intraluminal pressure of ? mmHg

No Relaxed; constricted; 30

Is the diaphragm a single muscle?

No - embryologically derived from two separate hemidiaphragms that fuse during gestation

In addition to parasympathetic, the ? system is a possible means for bronchodilation Efferent fibers are present in the ? nerve and they pass to airway smooth muscle Known neurotransmitter is ? + ? which creates ?

Non-adrenergic non-cholinergic (NANC) system Vagus Vasoactive intestinal peptide (VIP); substance P; nitric oxide

AST and ALT are ? in isolation but if elevated together, this may mean ? Which is more sensitive? Which is more specific for the liver? An AST/ALT ratio > ? means cirrhosis or alcoholic liver disease

Non-specific; hepatitis AST; ALT 2

Glucocorticoids are required for the normal response of vascular smooth muscle to the vasoconstrictor action of ? by regulating the expression of adrenergic ? In the absence of glucocorticoids, the ? response of vascular smooth muscle is reduced

Norepinephrine; receptors Norepinephrine

*Work of breathing related to restrictive disease*: Work to overcome airway resistance is ? Work required to overcome elastic forces is ? The static compliance line (ABC) shifts to the ? due to extra work to overcome recoil The work to acheive 1L volume requires much more work Dynamic compliance curves of inspiration and expiration are both shifted to the ?

Normal Increased Right Right

What happens to static/dynamic compliance curves with a pulmonary embolus?

Nothing - no effect on compliance

Pulmonary veins course through adjacent bronchopulmonary segments and carry ? blood back to ?

O2 rich; left atrium

*Restrictive lung disorders*: ? (such as ? syndrome) - excess adipose in thoracic region ? diseases such as myasthenia gravis and ALS

Obesity; Pickwickian Neuromuscular

Rib orientation is ? at sternal attachment The sternal attachment is at a ? level than the vertebral articulation Orientation allows for ? and ? movement of rib cage, which contributes to the ? in volume of thoracic cavity during inspiration In infants, rib orientation is ?, meaning the ribs are not ?, and the ribs have a less important role in breathing. How do infants breathe?

Oblique Lower Superior; anterior; increase Horizontal; expandable; diaphragmatic

Non-uniform distribution of inspired air - variations are due to: Mechanical advantage - ribs in lower thorax are more ? allowing ? expansion of rib cage

Oblique; greater

? jaundice is caused by obstruction of bile ducts or damage to hepatocytes

Obstructive

? lung disorders include disorders where the airways are obstructed which limits the ability to exhale

Obstructive

Risk factors for reflex dysfunction of the ANS? ? age DM > ? years ? (heart disorder) ? blockade

Old 10 CAD Beta-adrenergic

What are the 3 types of epithelium that line the internal nose?

Olfactory, stratified squamous, and pseudo stratified ciliated columnar epithelium

A ? pneumothorax is an opening in the chest wall and parietal pleura

Open

Tension pneumothorax: Flap of damaged tissue acts as a one-way valve Inspiration: flap is ? and air ? Expiration: flap is ? and air ? IPP is ?, which ? venous return, which ? cardiac output ? the mediastinum and the heart

Open; enters pleural cavity Closed; is prevented from leaving Increased; decreases; decreases Compresses

*Functional characteristics of the thorax*: Strength - protection of ? Flexibility - allows for ? Severe ? can decrease flexibility, which can compromise ?

Organs Ventilation Kyphoscoliosis; ventilation

Origin, insertion, and action of anterior scalene muscle?

Origin: Transverse processes of C3-C6 vertebrae Insertion: 1st and 2nd ribs Action: Flexes head

Origin, insertion, and action of middle scalene muscle?

Origin: Transverse processes of C5-C7 vertebrae Insertion: 1st and 2nd ribs Action: Flexes neck laterally and elevates 1st rib

Origin, insertion, and action of posterior scalene muscle?

Origin: Transverse processes of C5-C7 vertebrae Insertion: 1st and 2nd ribs Action: Flexes neck laterally and elevates 2nd rib

Where do deep lymphatic plexes originate? Where do they drain their lymph into?

Originate deep in respiratory tissue at the level of terminal bronchioles Drain into pulmonary lymph nodes

The ? is posterior to the oral cavity

Oropharynx

? is dyspnea only while in supine position May be related to ?

Orthopnea CHF, lung failure, severe asthma, anxiety

*ADH mechanism of secretion*: ? in the hypothalamus sense changes When there is an increased osmolality of the blood, there is ? of fluid from ?

Osmoreceptors Osmosis; osmoreceptors

*Hyperglycemia*: Glucose exerts ? in the ECF which causes ? Glucose appears in the ? (called ?) There is an osmotic ? Long-term hyperglycemia damages ? and ? ? and ? stimulation Hormones

Osmotic pressure; dehydration Urine; glucosuria Diuresis Blood vessels; nerves PNS; SNS

? is lack of mineralization of bone in adults; it is not much of a problem in U.S. because of additive to food supply The symptom is severe ? The cause is ? a dietary deficiency - it is a lack of ? activity Lack of absorption from ? A primary disease of the liver or kidneys (CKD) that cause an impairment to the production of calcitriol via cellular enzymatic reactions (conversion reactions)

Osteomalacia Bone pain NOT; Vitamin D3 (calcitriol) Small intestine

? involves a net reduction of bone mass; loss is from both mineral and organic matrices Ocurrence is mainly in ? with a greater occurence in ?

Osteoporosis Older adults; women

The ? layer of the pharynx consists of fibers that extend laterally and circle the pharyngeal wall Function - constrict walls of pharynx during ? (known as the ? muscles)

Outer circular Swallowing; pharyngeal constrictor

Closed pneumothorax: Air from lung enters the pleural cavity region; occurs where? ? of the lung can seal the defect Mechanical ventilation can ? the size of the pneumothorax

Outer lung surface Recoil Increase

Transmural pressure: Conventionally calculated by subtracting the ? pressure from the ? pressure (Since alveolar pressure = atmospheric pressure)

Outside; inside

After *forced maximal inspiration* where 100% TLC is reached... Inspiratory muscle contraction causes maximum ? movement of thorax TLC is reached, elastic recoil of lungs is at its maximum, surface tension forces of alveoli are directed ? Inspiratory muscles have caused excessive ? movement of thorax And now stretched elastic components of the thorax at this point now have an ? directed force - mirrors direction of ? recoil forces

Outward Inward Outward Inward; lung

Gaseous exchange functions of respiratory system: Delivery of ? to cells Elimination of ? from body Regulation of ? balance - can control blood pH by varying the level of ?

Oxygen Carbon dioxide Acid-base; carbon dioxide

Functions of *conducting airways*: Transport ? and ? to and from gas exchange airways ? inhaled air via ? plexus of nasal septum and turbinates - especially the ? and ? conchae ? the inhaled air - water vapor originates from a sheet of mucus - mucous glands and cells ? of inhaled air - bacteria proliferate in a ?, moist (humid) enviornment - mucus is sticky and traps particles; ? airflow in the nasal cavity causes collision of particles with mucus; the ? involves cilia removing phlegm that could cause infection

Oxygen; carbon dioxide Warm; venous; middle; inferior Humidify Filtration; warm; turbulent; mucociliary escalator

? is a maternal hormone for parturition (pregnancy), lactation, and maternal behavior. What two reasons is this hormone used exogenously for?

Oxytocin Induce uterine contractions and to stop postpartum hemorrhage

What breaks down cAMP? What breaks down cGMP?

PDE-3 PDE-5

NSAIDs inhibit ? synthesis and subsequently ? synthesis

PGH2; PGE2

Conducting bronchioles: Bronchial venous drainage decreases the ? of ? blood The remainder of the blood is drained by ?: Blood returning from viscera pleura Peripheral lung regions Distal portions of lung root

PO2; arterial Pulmonary veins

What are the two primary hormones that regulate calcium and phosphate homeostasis?

PTH and Vitamin D

*Anesthetic concerns with hyperthyroidism* Patients may need to be treated for 6-8 weeks with ? and ? Goiter may cause ? Exopthalmos increases the risk of ?

PTU; beta blocker Tracheal deviation Corneal abrasion

The ? separates the nasal and oral cavities

Palate

What makes up the hard palate?

Palatine process of maxilla (anterior 2/3) and palatine bone (posterior 1/3)

When someone has a tonsillectomy, which tonsils are usually removed?

Palatine tonsils

What is the lateral part of the tonsilar ring?

Palatine tonsils and tubal tonsils (if present)

In the oral cavity, the fold is the ? muscle Its origin is ? Its insertion is ?

Palatoglossal Palate Glossus

The anterior pillar is known as the ? Where is it located?

Palatoglossal folds/arch Oral cavity

What are the skeletal muscles that make up the soft palate?

Palatoglossal, palatopharyngeal, levator veli palatini, uvular muscles, tensor palatine

The posterior fold is the ? muscle

Palatopharyngeal

The posterior pillar is known as the ? Where is it located?

Palatopharyngeal arch Oral pharynx

Layer of inner longitudinal layer; blends with stylopharyngeus and inserts into thyroid cartilage

Palatopharyngeus

*Superior pharyngeal constrictor*: Originates from ? sphincter of the ? palate Rounded ridge of tissue is the ? ridge - what is its function?

Palatopharyngeus; soft Palatopharyngeal; closes nasopharynx

Entry of food into the small intestine is coordinated with exocrine secretions from the biliary system and what other organ? The above organ is essential for digestive enzymes - it secretes ? to neutralize stomach acid The ? delivers stored bile to the intestine

Pancreas HCO3 Gallbladder

? is decreased secretion of all anterior pituitary hormones It is a ? absence or destruction of anterior pituitary

Panhypopituitarism Congenital

Pituitary dwarfism usually results from ? in childhood Growth stops due to lack of ? secretion before closure of ? in long bones during adolescence ? are the first hormones affected - this causes a lack of secondary sex characteristics

Panhypopituitarism Growth hormone; epiphyses Gonadotropins

Regulation of smooth muscle tone - hormone signals: ? secretions from cells present in respiratory epithelium (e.g. histamine and bradykinin)

Paracrine

? is a temporary cessation of gut motility S/S include nausea/vomiting, abdominal ?, and ? bowel sounds Usually related to ? and which electrolyte imbalance (?)

Paralytic ileus Distention; hypoactive Surgery; hypokalemia

Mucous glands are innervated by ? nerves in the larynx

Parasympathetic

Generalization of stomach innervation: ? nervous system stimulates smooth muscle activity and gland secretion ? nervous system input has the opposite effects

Parasympathetic Sympathetic

What is the motor innervation for the intrapulmonary airways (bronchi)?

Parasympathetic fibers of pulmonary plexus Sympathetic fibers of pulmonary plexus (weak effect)

Where is oxytocin formed?

Paraventricular nucleus

Oxytocin is primarily produced in the ? nucleus with small amounts synthesized in the ? nucleus *Physiological effects include*: Potentiates smooth muscle contraction ? labor Plasma levels are not appreciably high ? labor

Paraventricular; supraoptic During Before

? pleura lines the pulmonary cavity

Parietal

? pleura lines the walls of the thoracic cavity

Parietal

Which pleura - parietal or visceral - contains pain receptors?

Parietal

The ? glands of the stomach provide most exocrine secretions

Parietal (oxyntic)

HCl, secreted by ? cells, is made of what?

Parietal (oxyntic); hydrogen, chloride, potassium, water

? covers the abdominal (inferior) surface of the diaphragm It contains pain receptors... Pain sensations are transmitted over ? and the ? that innervate the most peripheral areas of the diaphragm

Parietal peritoneum Phrenic nerve and lower intercostal nerves

Open pneumothorax: Ambient air enters and causes the ? and ? to separate During inspiration the volume of the pleural cavity ? and the pressure ?

Parietal; visceral pleura Increases; decreases *Remember: volume of the pleural cavity increases, not the lung volume!*

The largest salivary gland is the ? gland which secretes 25% of daily saliva via ?

Parotid; Stensen's duct

*Mucous goblet cells*: Mucus traps inhaled ? ? inspired air Goblet cells are ?-cell mucous glands of epithelium Mucus glands lie in the ?

Particles Moisturizes Single Submucosa

Alveoli expand (actively or passively?) in response to an increased distending pressure across the alveolar wall

Passively

What do peptic (chief) cells secrete?

Pepsinogen and lipase

The largest group of hormones are ?

Peptides (and polypeptides)

Lymphatic vessels are found at the ? of the lobule

Periphery

Hepatic triads are found at the ? of the liver lobule and include which 3 components?

Periphery Branches of the hepatic portal vein Branches of the hepatic artery Interlobular bile ductules

*Lack of effect of insulin on glucose uptake and usage by the brain* The brain cells are ? to glucose without insulin intermediation Brain cells use only ? for energy (efficiently) When blood glucose falls too low (20-50 mg/dL), ? ensues

Permeable Glucose Hypoglycemic shock

*Innervation of pharynx*: The ? supplies the motor and most sensory to pharynx Motor? Sensory?

Pharyngeal plexus Motor - derived from CN 10 (except stylopharyngeus, which is CN 9) Sensory - CN 9 to nasopharynx and oropharynx; CN 10 to laryngopharynx

What is the posterior/superior part of the tonsilar ring?

Pharyngeal tonsils

The cGMP signal is terminated when cGMP is broken down by ?

Phosphodiesterase (PDE)

? breaks down cGMP in pulmonary vascular smooth muscle and erectile tissue

Phosphodiesterase-5

IP3 and DAG are produced by membrane-bound ?

Phospholipase C

? cleaves the membrane lipid PIP2 into ? and ?

Phospholipase C; IP3 and DAG

Composition of pulmonary surfactant: ? (80%), ? (10%) & ? proteins (10%) Major phospholipid - ? ? - a phospholipid found in lesser quantity Phospholipids have a ? end and a ? end

Phospholipids; cholesterol; surfactant Dipalmitoylphosphatidyl choline Sphingomyelin Polar; non-polar

The ? nerve is the only motor innervation of the diaphragm

Phrenic

Parietal pleura pain sensations are transmitted over which nerves?

Phrenic nerve and lower intercostal nerves

Sensory innervation of the diaphragm comes from the ? nerve, except the peripheral edges, which is provided by the ? nerve(s)

Phrenic; lower intercostal

In addition to hormone signals, regulation of smooth muscle tone can be by ? stimulation of stretch receptors located in smooth muscle: ? (think anesthesia) Can also be caused by ? trapped in the trachea or bronchi

Physical Laryngoscopy Foreign objects

? dead space is the volume of inhaled air not exchanged with pulmonary capillary blood This volume of air is inhaled for ? use - is it involved in gas exchange? Since there is minimal alveolar dead space in a healthy individual, an increase in ? dead space is usually due to an increase in ? dead space

Physiologic Physiologic; no Physiologic; alveolar

What is the anesthesia landmark to block the internal laryngeal nerve (a branch of the superior laryngeal nerve)?

Piriform fossa/recess

Bones/food may be lodged in the ? of the ?

Piriform fossa/recess; laryngopharynx

The "master gland" is the ? gland It is divided into two parts - the ? (adenohypophysis or pars distalis) and the ? (neurohypophysis or pars nervosa)

Pituitary (hypophysis) Anterior pituitary; posterior pituitary

Non-gaseous exchange functions of respiratory system - fluid exchange and drug absorption: Colloid osmotic pressure of blood due to ? is normally ? than the hydrostatic pressure of pulmonary capillaries Pulls fluid from alveoli into the pulmonary capillaries, which means water in the lungs is absorbed into the ? Drugs/chemicals can readily pass through ? and enter into systemic circulation - inhaled drugs may have ? effects (i.e. albuterol, nitrous oxide, volatile aneshetics)

Plasma proteins; greater Blood Alveolar/capillary barrier; systemic

A pleural fluid layer is between ? Pleural fluid lubricates the pleural surfaces to facilitate movement during ? Surface tension of the pleural fluid provides cohesion that maintains the connection of the ? surface with the ? Contraction of inspiratory muscles causes ? of the thoracic cavity which causes the lungs to ? because of the contact maintained between the pleurae and pleural fluid

Pleurae Respiration Lung; thoracic wall Expansion; expand

? fluid maintains connection between visceral and parietal pleurae ? pleura attached to inner surface of rib cage and to thoracic (superior) surface of diaphragm As long as only ? fluid is located in the pleural cavity, the lung connection to the wall of the thoracic cavity is maintained

Pleural Parietal Pleural

The pleural cavity contains ? fluid that is secreted by ? What other anatomical structures are located in the pleural cavity?

Pleural (serous); pleurae None

A pneumothorax is the presence of air in the ? - results in collapse of the lung

Pleural cavity

A ? (or ?) is excess serous fluid in the pleural cavity Commonly caused by ? and ? disease

Pleural effusion; hydrothorax CHF; kidney

The ? is a potential space within the pleural reflections

Pleural sinus/pleural recess

? is inflammation of pleural membranes Most commonly related to ?

Pleurisy Infection

A ? is air in the pleural cavity General effect of this is decreased ? and decreased ?

Pneumothorax Ventilation; venous return

Physical factors affecting airway resistance: The size of the airway utilizes ? (law/number) - changes in airway radius change airway resistance Types of airflow utilize ? (law/number) - changes in airflow change airway resistance

Poiseuille's law Reynolds number

*Pulmonary surfactant*: (Polar or non-polar?) molecule due to ? component ? and ? regions at opposite ends of the molecule ? end faces inward toward the alveolar lining ? end points outward toward the fluid-air interface Pulmonary surfactant is found only (where?)

Polar; phospholipid Hydrophilic; hydrophobic Hydrophilic Hydrophobic At the surface of the alveoli air-liquid interface

What is the shape of the alveoli? Why? What shape is it not?

Polygonal shaped (more surface area) Not spherical

In stage 2 of swallowing, the deglutition center (located where?) sends motor impulses over which CNs?

Pons; 5, 9, 10, 12

Openings that allow collateral ventilation - communications between bronchioles/alveoli: Interalveolar are called ?

Pores of Kohn

Since there is no lymphatic drainage in the alveoli, macrophages migrate through ? to the mucocilary escalator

Pores of Kohn

75% of liver blood flow comes from the ? 25% of liver blood flow comes from the ? Each deliver approximately ?% of oxygen

Portal vein Hepatic artery 50%

The ? eventually subdivides to yield branches at the periphery of a liver lobule Central veins coalesce into hepatic veins which lead to the ?

Portal vein IVC

Severe portal hypertension can lead to ? shunts --> esophageal, umbilical, internal hemorrhoids

Portosystemic

Functional residual capacity (FRC): FRC can be less than relaxation volume (at rest) if...? ? contents abut against diaphragm due to changes in force vector of gravity --> reduction in the expression of ? elastic forces of the thorax, which will ? FRC

Position shifts from standing to supine Abdominal; outward; decrease

? pressure breathing: Air moves into the lungs as a result of atmospheric pressure exceeding airway pressure

Positive

Mechanical ventilation is an example of ? pressure ventilation

Positive

Prevention of *atelectasis* during anesthesia: Utilizing ? ? maneuvers Minimizing gas ? Maintenance of ?

Positive end-expiratory pressure Recruitment Resorption Muscle tone

The ? mediastinum has a unique shape due to the slope of the diaphragm

Posterior

*Epiglottis*: Leaf-shaped elastic cartilage ? to root of tongue Lower end attached to ? cartilage by ? ligament Attached to ? by ? fold

Posterior Thyroid; thyroepiglottic Tongue; Median glossoepiglottic

The root of the tongue is the ? portion of the tongue (?-sulcal) It is more posterior and is near the anterior wall of the oropharynx

Posterior 1/3; postsulcal

*Congenital defects of the diaphragm* The most common defect is a patent foramen of the ? diaphragm (also known as a ? hernia) Another defect of the diaphragm involves the ? (also known as a ? hernia)

Posterior diaphragm; Bochdalek Lateral sternal border; Morgagni

*Pleural blood supply*: Parietal pleura - from several arteries Major arteries are ? arteries (there are several off of aorta) and ? arteries that lead to ? arteries Drainage is by ? and ? veins

Posterior intercostal Internal thoracic; anterior intercostal Intercostal; internal thoracic

*ADH mechanism of secretion*: Osmoreceptors send impluses over the hypothalamo-hypophyseal nerve tract to the ?

Posterior pituitary

*Ribs (costae) and costal cartilages*: Attach ? to vertebrae Head of ribs ? through ? articulate with centrum (body) of their associated vertebra (1 or 2) Tubercle of rib articulates with ? of vertebra

Posteriorly 2; 9 Transverse process

Rings are absent ? where trachea is adjacent to ? ? gaps filled by flat wall of involuntary (smooth) muscle called ?

Posteriorly; esophagus Posterior; trachealis

Parasympathetic regulation of smooth muscle tone: Airway smooth muscle contracts by responding to ? innervation, which is the major source for stimulating muscle contraction for bronchoconstriction Axon terminals contain several varicosities that contain ? vesicles ? is released among several smooth cells; stimulating receptors on the cell membranes (*no* ? are present)

Postganglionic parasympathetic Acetylcholine Acetylcholine; NMJs

*Work of breathing related to normal, passive expiration*: Inspiration creates ? energy as a result of expansion of the lungs This energy is used to overcome ? during expiration Recoil of lungs and surface tension recoil of alveoli cause ? expiration The only impediment to breathing during expiration is ? and ? The area represented by ? (segment) is energy dissipated as heat during expiration Does work of breathing occur during normal passive expiration?

Potential Tissue and airway resistance Passive Tissue and airway resistance ABCA No

The pleural cavity is a ? space located between the ? and ?

Potential; visceral pleura; parietal pleura

The "?" correlates well with issues regarding difficult intubation and unable to perform may be suspecious of issues with the temperomandibular joint

Prayer sign

Dynamic compliance is measured in the ? of gas flow It is based on ? pressure

Presence Peak

? of a gas is the force exerted per unit area on the walls of its container ? of gas is the enclosed space of its container When volume increases, pressure ? When volume decreases, pressure ?

Pressure Volume Decreases Increases

Boyle's law states that ? is ? proportional to ? at a constant temperature

Pressure; inversely; volume

Endocrine disorders can be classified as: ? - an excess or deficiency of secretion by target gland

Primary

*Intrinsic muscles*: Lateral cricoarytenoid?

Primary adductors of vocal folds

Which structures enter or exit the lungs via the hilum?

Primary bronchi Pulmonary arteries and veins Bronchial arteries and veins Lymph vessels and nodes (bronchopulmonary or hilar lymph nodes) Pulmonary plexus

? is a disorder caused by excess mineralcorticoids

Primary hyperaldosteronism (Conn's syndrome)

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Dopamine (AKA ?) Inhibits secretion of ? by ? in the anterior pituitary

Prolactin inhibiting hormone Prolactin; lactotrophs

Elasticity: With Hooke's law, the stretch placed on an elastic body is ? to the force applied to it

Proportional

At the superficial or surface mucous cells (at the surface of the lumen), ? stimulate secretion of mucus and bicarbonate This mucous forms a protective layer rich in ? to buffer ? ions What class of drug inhibits prostaglandin synthesis leaving the mucous susceptible to low pH?

Prostaglandins Bicarbonate; hydrogen NSAIDs

What are the eicosanoids? Are eicosanoids hormones or intracellular signals?

Prostaglandins, prostacyclins, leukotrienes, thromboxanes Hormones

Cortisol and insulin have opposing effects on ? breakdown

Protein

99% of both T4 and T3 are ? ? is more protein bound than ?

Protein bound T4; T3

*Gastrin*: Stimuli for secretion? Site of secretion? What does it do to gastric acid secretion? Mucosal growth?

Protein, distention, nerve (acid inhibits release) G cells of antrum, duodenum, jejunum Stimulates; stimulates

*Cholecystokinin*: Stimuli for secretion? Site of secretion? ? pancreatic enzyme secretion ? gallbladder contraction ? gastric emptying ? pancreatic bicarbonate secretion ? growth of exocrine pancreas

Protein, fat, acid I cells of duodenum, jejunum, ileum Stimulates Stimulates Inhibits Stimulates Stimulates

*Gastric inhibitory peptide*: Stimuli for secretion? Site of secretion? ? insulin release ? gastric acid secretion

Protein, fat, carbohydrate K cells of dudoenum and jejunum Stimulates Inhibits

Clara cells: Secrete ? - include ? Secrete ?, ?, and modulators of ? Act as progenitors for ? cells and ? cells Protect lungs with ? and by ?

Proteins; surfactant apoproteins Lipids; glycoproteins; inflammation Clara; ciliated epithelial Mucus; metabolizing foreign material

Venous drainage of areas supplied by bronchial arteries - what do bronchial veins drain?

Proximal part of the root of the lung

Where is the pterygopalatine ganglion (sphenopalatine ganglion) located? Why would local anesthetic be put on a Q-tip to block the pterygopalatine ganglion?

Pterygopalatine fossa Post-dural puncture headache or migraine

Saliva contains two major types of protein secretions - a serous secretion which contains ? (an ?) and a mucus secretion that contains ? for lubricating and protective purposes

Ptyalin; alpha amylase Mucin

Salivary glands have an acinar portion for primary secretion which consists of ? or ? ? is actively absorbed ? is passively absorbed ? is actively secreted ? is secreted as well

Ptyalin; mucus Na Cl K HCO3

? circulation supplies pulmonary epithelial tissues; respiratory bronchioles to alveoli

Pulmonary

Most distal branches of the bronchial arteries anastamose with branches of the ? in the walls of the bronchioles

Pulmonary arteries

Blood supply to alveoli: Lung parenchyma supply is ?

Pulmonary arteries and veins

Roots enter and leave the hilum and include which structures?

Pulmonary artery Superior and inferior pulmonary veins Main bronchus Pulmonary plexuses Lymphatics

Alveoli are predominately (70%) covered by ?

Pulmonary capillaries There are 500-1000 capillaries per alveolus; 280 billion pulmonary capillaries

Innervation of the lungs come from ?, which is a network of ANS nerves Parasympathetic via ? Sympathetic via ?

Pulmonary plexes Vagus nerve Spinal nerves T2-T6

? is surface active agent at the fluid surface of the inner lining of the alveoli

Pulmonary surfactant

What is the lymph drainage of the bronchi?

Pulmonary, bronchopulmonary, and tracheobronchial lymph nodes

*Cortisol release*: Diurnal (daily) rhythm: ? secretion during the course of a 24-hour period Most of the synthesized cortisol is secreted at a basal level according to the ?, but peaks and valleys occur When are the highest levels of cortisol released? When are the lowest levels released?

Pulsatile Time of day Early morning 3-5 hours after the onset of sleep

? is the most important stimulus for aldosterone secretion

RAAS

Upon relaxation of expiratory muscles, internal intercostals and abdominal muscles... Inspiration is passive from ? to ? (50% TLC) ? elastic recoil of the thorax is returning the thorax to end-expiration position At this point (?) passive inspiration stops due to ? and opposite lung/thoracic forces

RV; FRC Increased FRC; equal

What opposes dynamic compression?

Radial traction

The duct system of the pancreas (called ? ducts) secrete a watery fluid that is high in ? content with a pH of about ?

Radicle; sodium bicarbonate; 8

99% of calcium filtered through the kidney is ?

Reabsorbed

The insulin receptor is an example of ?

Receptor tyrosine kinase

? are intracellular second messengers that directly initiate cascades of phosphorylation reactions within the cell when occupied by their hormone (i.e. the insulin receptor)

Receptor tyrosine kinases

A response to a particular hormone is seen only in cells with specific ? for that hormone

Receptors

Importance of pulmonary surfactant: Reduces surface tension ? forces and the ? efforts needed to ventilate Surfactant stabilizes the alveoli and prevents them from ?

Recoil; muscular Collapsing

All cells in the body have the capability to derive energy from fat except ? This process is especially prominent and fast in liver cells

Red blood cells

With *obstructive disease*, there is ? expiratory flow rate What are some examples of *obstructive* diseases?

Reduced COPD and asthma

Renin is released via: ? distention of renal afferent arteriole ? signaling low GFR Stimulation of the renal ? nerves by ? reflex

Reduced Tubuloglomerular feedback Sympathetic; baroreceptor

Pleural ? are regions where parietal pleura membrane turns back and folds on itself (a ? layer of parietal pleura)

Reflection; double

Volume, IPP, and alveolar pressure changes during a single, tidal respiratory cycle - *expiration*: Inspiratory muscles ? IPP increases by ? cm H2O Increases Alveolar pressure ? cm H2O above atmospheric Pressure change forces ? liters of air out of lungs Lungs ?

Relax 3 1 0.5 Deflate

At *end expiration* (inspiratory muscles ?) the thorax is positioned at ? tidal volume Elastic elements of alveoli exert an ? elastic recoil force, which ? volume of alveoli Elastic elements of chest wall exert an ? elastic recoil force, which keeps alveoli ? Transmural pressure = (positive or negative?)

Relaxed; base Inward; decreases Outward; patent Positive

*RAAS system summary*: ? is produced by the kidney - it uses ? from the liver and is converted to ? ? uses ACE from the lungs (and other areas) and ? is converted to ? via ACE ? binds with AT1 receptor on the adrenal gland and ? is released so it can affect principal cells of the kidney

Renin; angiotensinogen; angiotensin I Angiotensin I; angiotensin I; angiotensin II Angiotensin II; aldosterone

What do stem cells do? Where are they located?

Repair damage of gastritis (e.g. H. pylori, smoking, ETOH, NSAIDS, and chronic stress) In the neck of gastric glands

Non-gaseous exchange functions of respiratory system: Blood ? for the left ventricle - average adult male pulmonary blood volume is about ? mL If the left ventricular output is greater than systemic venous return to right atrium, the ? circulation can return an increased volume of blood to the heart and transiently compensate the greater increased ventricular output for a few heart beats

Reservoir; 500 Pulmonary

Stomach can be considered two parts - the proximal ? portion which includes the cardia, fundus, and upper 1/3 of corpus AND the ? portion which is the lower 2/3 of the corpus through the pylorus

Reservoir; pump/antral

? is the volume of air remaining in the lungs following a maximal, forced exhalation

Residual volume (RV)

What does Poiseuille's law state for resistance?

Resistance is directly proportional to the viscosity of a fluid and length of the tube through which it flows and is inversely proportional to the 4th power of the radius of the tube R = 8nl/πr⁴

*Pseudostratified ciliated columnar epithelium*: AKA ? epithelium Found throughout respiratory system A ? layer of cells Nuclei occur at different ?

Respiratory Single Heights

Diffusion of gases across the alveolar/capillary unit (pulmonary or respiratory membrane) Membranes associated with alveoli begin at the ?

Respiratory bronchioles

Each terminal bronchiole gives rise to several generations of ?

Respiratory bronchioles

? are the first segment of airways that participate in gas exchange/have alveoli Includes ? generations of successive branching with increasing number of alveoli

Respiratory bronchioles 3

Respiratory airways are from ? to ?

Respiratory bronchioles; alveoli

Epithelium of most of the larynx is ? What is the exception?

Respiratory epithelium True vocal cords are stratified squamous epithelium

Describe the epithelium of the bronchi

Respiratory epithelium with mucous glands

What kind of epithelium is present in the trachea?

Respiratory epithelium with mucous glands in submucosa

Defense mechanisms of the respiratory system - lymph: ? - filter degenerating cells and other particulate from lymph ? (which are lymphatic tissue) are involved in detoxification and destruction of microorganisms

Respiratory lymph nodes Tonsils

Which airways facilitate gas exchange - conducting, respiratory, or both?

Respiratory only

The ? is the segment of airways completely lined with alveoli

Respiratory zone

Passive expiration: Used at ? and during ? activity

Rest; moderate

Functional residual capacity (FRC): At end expiration... Respiratory muscles are what position? Respiratory muscles exert an ?-directed muscular force on thorax (and alveoli) Lung volume referred to as the relaxation or resting volume = ?

Resting position Outwardly FRC

*Hepatopulmonary syndrome*: Hepatopulmonary syndrome is caused by ? secondary to decreased compliance and atelectasis from additional fluid ABG may show ? because of the compensatory ? related to hypoxia Abnormal intrapulmonary vaso-? may cause congestion ?-sided heart failure if PVR increases

Restriction Respiratory alkalosis; hyperventilation Vasodilation Right

? lung disorders include lungs and/or thorax movement are limited which limits inhalation

Restrictive

*Type 2 diabetes - long term complications*: ? (microvascular issue of the eye) ? disease ?-tension ? (heart issue) ? and ? vascular disease Peripheral and autonomic ?

Retinopathy Kidney Hypertension CAD Peripheral; cerebral Neuropathies

? causes most of the antral contents (chyme) to be forced back into the stomach

Retropulsion

? is a dimensionless/theoretical number used to describe airflow Flow changes from laminar to turbulent when this number exceeds ?

Reynold's number 2000

Muscles of expiration - abdominal muscles Attached to lower ? and upper portion of ? including pubic symphysis Contraction of the abdominal muscles decreases which dimensions of the thorax?

Rib cage; pelvic girdle All three

Accessory muscles of inspiration - pectoralis major, pectoralis minor, serratus anterior: Not true thoracic wall muscles, but extend from thoracic cage (axial skeleton) Help elevate the ? to expand the thoracic cavity Typically used when respiration is ? (as in ?)

Ribs Deep and forceful; exercise

? is a lack of mineralization of bone in young children The lack of mineralization of bone is associated with ? deficiency If untreated, the child presents with ? (symptom) Is it reversible if treated?

Rickets Vitamin D Bowing in legs Yes

? and ? are disorders due to lack of mineralization of new bone

Rickets; osteomalacia

Which lung has greater width, volume, weight, and more blood BUT NOT greater height?

Right lung

What is the path of the right bronchial vein? What is the path of the left bronchial vein?

Right: Drains into azygos vein, then into SVC Left: Drains into accessory hemi-azygous, then azygos vein on right, then SVC

The ? hemidiaphragm is slightly *higher* than the ? hemidiaphragm...why?

Right; left Heart pushes downward on left side; liver pushes up on right

The ? is the narrowest part of the adult upper airway

Rima glottidis

The ? is the opening between true cords and arytenoid cartilages

Rima glottidis

*Oropharynx*: ? and ? form the anterior wall ? arch in lateral walls ? between pillars

Root of tongue; lingual tonsils Palatopharyngeal Palatine tonsils

Lungs attach to the mediastinum by their ?

Roots

*Abnormalities and ADH*: With ?, ADH is high What are the causes?

SIADH Ectopic production of vasopressin (R/T SAH or TBI)

Functions of ? include lubrication, protection, and digestion

Saliva

Layer of inner longitudinal layer; contraction dilates the auditory tube

Salpingopharyngeus

cAMP, DAG and IP3, and receptor tyrosine kinases are all ?

Second messengers

Endocrine disorders can be classified as: ? - an excess or deficiency of secretion by pituitary

Secondary

More common than primary hyperaldosteronism (Conn's syndrome) is ? which is related to which 3 conditions?

Secondary hyperaldosteronism; renal artery stenosis, cirrhosis, CHF

Esophageal phase (stage 3) of swallowing: If all contents in esophagus are not delivered to the stomach by primary peristalsis, then ? is induced The ? initiates a secondary peristaltic wave Supported by a reflex in which sensory impulses pass over CN ? to the ?; motor impulses sent back via CN ? and ? to the ? of the esophagus, causing peristalsis

Secondary peristalsis Myenteric plexus 10; medulla; 9; 10; myenteric plexus

The first segment of intrapulmonary airways is ? Scattered cartilage plates

Secondary/lobar bronchi

? is released from the duodenum and stimulates the secretion of a serous bicarbonate-rich fluid from the epithelium of the biliary duct system

Secretin

GI hormone secreted by "S" cells of the duodenum, jejunum, and ileum

Secretin

Composition of gastric fluid is determined by rate of ? *Nonoxyntic contribution*: ? secretion rates This fluid resembles ? - it is mildly ?, ? volume, ? composition *Oxyntic contribution*: Exocrine fluid - primarily ? When the stomach is stimulated, oxyntic component dominates

Secretion Low ISF; alkaline; low; constant HCl

Mucus: ? (gravity) removes particles between ? to ? micrometers ? removes particles smaller than ? micrometers 80% of particles between 0.1 and 1.0 micrometers are ?

Sedimentation; 2; 5 Diffusion/brownian motion; 0.1 Exhaled

Innervation to both pleura (visceral/parietal) is sensory, motor, or both?

Sensory only

Serous, mucus, or both? Parotid? Submandibular? Sublingual? Buccal?

Serous Both Both Mucus

Spirometry curves: What happens to the shape with a restrictive disorder?

Shifted to the right

*Non-hormonal reactions (regulation of plasma calcium and phosphate)*: ? term, simple chemical equilibrium exchange between ? and ? plasma calcium Exchangeable pools are in the ? and at the newly formed surface of bony matrix that has not completely solidified

Short; protein bound; free ionized ECF

? are stones in the salivary gland ducts 85% occur in the ? 15% occur in the ?

Sialothiasis Submandibular Parotid

The drug ? inhibits PDE-5 (thus increasing ? levels) and potentiates ? to treat pulmonary HTN or ED

Sildenafil; cGMP; vasodilation

Hormone secretion may be under: ? - meaning a hormone or response inhibits further secretion of that hormone

Simple negative feedback

Liver ? serve as blood capillaries

Sinusoids

The ? (which are permeable) are the liver capillaries

Sinusoids

Two general effects of GH: Determines final body ? GH causes acute ? effects (effects that oppose ?)

Size Diabetogenic; insulin

? is the inability to produce the moisture needed for eyes and mouth

Sjogren's syndrome

The diaphragm is ? muscle (which is voluntary or involuntary?)

Skeletal; voluntary

Are classic steroid hormone effects fast or slow? Why is this? ? hormone receptors are widely expressed in body tissues and function similarly to steroid receptors

Slow - related to altered gene expression Thyroid

? cells are part of the diffuse neruoendocrine system

Small granule

Where does calcium and phosphate absorption occur?

Small intestine

Where does significant absorption of nutrients occur in the GI tract?

Small intestine

Virtually all phosphate is absorbed in the ? 85% of phosphate is reabsorbed in the ? of the kidney 15% is ?

Small intestine Proximal tubules Excreted into urine

Insulin is a ? (size) protein - two ? chains linked by ? bonds

Small; amino acid; disulfide

Explanation for differences in regional ventilation after forced expiration to the RV: After a forced expiration down to RV, dynamic compression occurs in the ? airways of the ? region

Smaller; basilar

Liver cells contain enzyme systems (in the ?) that chemically inactivate or change drugs, hormones, and toxic subtances to more soluble compounds that will be excreted by the kidneys Most chemicals are inactivated by the enzyme system that includes ? Many hormones are inactivated in the liver except ? hormones that regulate gut secretion and gut motility - these are inactivated in ? or tissues other than the liver

Smooth endoplasmic reticulum Cytochrome P450 Peptide; plasma

Which is smaller - smooth muscle or skeletal muscle? The internal ? of fibers for smooth muscle is different than skeletal muscle

Smooth muscle Arrangement

Describe the musculature of the bronchi

Smooth muscle with significant amounts of elastic and collagen

? muscle can maintain contraction for much longer than ? muscle due to a ? state

Smooth; skeletal; latch-bridge

Mineralcorticoids affect ? and ? 90% of mineralcorticoid activity is ?

Sodium; potassium Aldosterone

Aldosterone stimulates ? reabsorption and ? secretion (absence of aldosterone is fatal) from ? cells in the connecting tubule and collecting duct

Sodium; potassium; principal

During deglutition, the ? palate can be raised to close passageway between the oral and nasal pharynx

Soft

How is compliance altered with fibrosis (related to soft tissues and distensibility)?

Soft tissues become less distensible

*Intrinsic muscles*: Posterior cricoarytenoid?

Sole abductors of vocal cords

What do D cells secrete?

Somatostatin

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Growth hormone inhibiting hormone (GHIH) (AKA ?) Inhibits ? secretion by ? in the anterior pituitary

Somatostatin (SS) Growth hormone; somatotrophs

What are the contents of the *anterior* mediastinum?

Some lymph nodes Adipose tissue

The ? are connected to lymphatic vessels to drain the liver of excessive fluid They can receive plasma proteins synthesized in hepatic cells for distribution into blood

Spaces of disse

? is a measure of distensibility of a lung as it relates to lung volume

Specific compliance

*Paranasal sinuses*: ? drain into the superior meatus ? drain into the middle meatus ? drain into the inferior meatus

Sphenoidal sinus and ethmoid sinus/cells Frontal, maxillary, and portion of the ethmoid sinus/cells Nasolacrimal duct

Kiesselbach's area is an anteroinferior nasal septum anastomases of which arteries? This is a popular area for ?

Sphenopalatine, ethmoidal, palatine, facial Nose bleeds

One of our strongest reflexes: Combined action of most muscles of laryngeal inlet result in a protective ? action. ? occurs reflexively when liquid or particles approach the laryngeal vestibule

Sphincteric; adduction

The ? is the true action potential in the GI tract that stimulates smooth muscle contraction; they occur when the slow wave is less negative Occurs when voltage gated ? and ? channels open Result is large amount of ? and lesser quantities of ? to enter smooth muscle cells to cause contraction Intracellular ? release may also trigger contraction

Spike potential Calcium; sodium Calcium; sodium Calcium

Pulmonary lung volumes are measured by ? or ?

Spirometry; plethysmograph

*Ciliated cells (30%)*: Sweep ? toward the oral cavity ? is mucus + trapped material (pathogens) The ? escalator includes ciliated cells sweeping things out

Sputum Sputum (phlegm) Mucociliary

The alveolar surface is a thin layer of ? cells

Squamous epithelial

What is STPD?

Standard temperature and pressure, dry (0 degrees celsius, 760 mmHg)

What happens to static/dynamic compliance curves with mucous plugging or bronchospasm?

Static compliance remains same, but dynamic compliance curve shifts to right and flattens

Some urobilinogen is oxidized in the lower colon into ? and then into ? which is a feces pigment 5% of urobilinogen is sent to the kidney and upon urination it is oxidized into ? which is a urine pigment

Stercobilinogen; stercobilin Urobilin

The superior and inferior mediastinum are divided by an imaginary horizontal line drawn from the ? to the intervertebral disc between ? and ? This separates the two divisions and defines the ?

Sternal angle T4; T5 Carina

The ? (or ?) is the articulation of the manubrium and body Corresponds with the ? of the trachea

Sternal angle; angle of Louis Carina

The *inferior* mediastinum extends from imaginary horizontal line (at the ?) down to the ?

Sternal angle; inferior thoracic aperture

The *superior* mediastinum extends from imaginary horizontal line (at the ?) up to the ?

Sternal angle; superior thoracic aperature

Primary muscles of inspiration - interchondral part of internal intercostal muscles: These muscles are attached to the ? and run between the ? Contraction of the internal intercostal muscles does what?

Sternum; rib cartilages Elevates the ribs

? hormones (estrogens, progesterone, testosterone, etc.) are inactivated where?

Steroid; liver

Cholecystokinin ? pancreatic enzyme secretion ? pancreatic bicarbonate secretion ? gallbladder contraction ? gastric emptying

Stimulates Stimulates Stimulates Inhibits

Smooth muscle of organs is unique by: Physical dimensions/arrangement Response to different types of ? Characteristics of ? Function

Stimuli Innervation

*Epithelial lining of the pharynx*: Oropharynx is made of ? Nasopharynx is made of ? Laryngopharynx is made of ?

Stratified squamous epithelium Respiratory epithelium Stratified squamous epithelium

There is a low overall incidence of stress ulcers, but they are related to major physiologic ? Where do they mostly occur? Causes include stomach ?, large skin surface area ?, physical trauma, major ? procedures, major physiologic ?

Stress Fundus Ischemia; burns; surgical; stress

Esophageal phase (stage 3) of swallowing: Primary peristalsis is caused by ? of muscular wall Some cells release ? in the area where smooth muscle is stretched in front of the bolus; this is an ? NT so region in front of the bolus ? Behind the bolus, the myenteric plexus releases ? and ? which cause a region of contraction

Stretching VIP; inhibitory; relaxes Acetylcholine; substance P

Layer of inner longitudinal layer; insertion is the pharyngus muscle and thyroid cartilage

Stylopharyngeus

The ? gland secretes 5% of daily saliva via ? located under the tongue in the floor of the oral cavity

Sublingual; ducts of Rivnius

Lymphatics of nose: Anterior nose - lymph drains into ?

Submandibular (submaxillary) nodes

The ? gland secretes 70% of daily saliva via ?

Submandibular (submaxillary); Wharton's duct

*Lymphatic drainage of pleura*: Visceral pleura - lymph is drained from visceral pleura into ? and then into ?

Superficial lymphatic plexus; hilar lymph nodes

What are the two divisions of the mediastinum?

Superior and inferior

Conchae/turbinates: The ? are part of the ethmoid bone The ? is a separate bone

Superior and middle conchae Inferior concha

Cricopharyngeus muscle (corresponds to what other structure?) is located at ? - it is tonically ? Which layer of the outer circular layer is it?

Superior esophageal sphincter; C6; contracted Inferior pharyngeal constrictor

*Middle pharyngeal constrictor*: Overlaps the ? What is it overlapped by?

Superior pharyngeus Inferior pharyngeus

What are the 3 pharyngeal constrictors (outer circular layers)?

Superior, middle, inferior constrictors

Insulin has a ? effect on protein breakdown in skeletal muscle During fasting, insulin secretion is ? and its ? of protein breakdown is lost Cortisol ? the reincorporation of amino acids into proteins; cortisol ? the enzymes needed for AA to convert to glucose

Suppressing Reduced; suppression Inhibits Stimulates

Where is ADH (arginine vasopressin) formed?

Supraoptic nucleus

? are substances that decrease surface tension

Surface active agents (surfactants)

Signals that cause increased angiotensin II formation and aldosterone secretion: Increase in renal ? nerve activity ? in BP in afferent arterioles associated with glomeruli Reduction in NaCl content in renal tubular fluid at the ? Increase in plasma ? is a secondary stimulus (through depolarization of glomerulosa cell membrane potential)

Sympathetic Reduction Macula densa Potassium

Sensory innervation to intrapulmonary airways (bronchi) - vagus: Nociceptive afferents of visceral pleura --> ? nerves

Sympathetic spinal

The liver is supplied by ? and ? nerves Any increase in SNS outflow will produce hepatic arterial ? The liver is a blood ? and enough sympathetic activity will "squeeze" out the extra 500 mL of blood for immediate needs (this is termed ?)

Sympathetic; parasympathetic Vasoconstriction Reservoir; autotransfusion

What is the treatment for hypothyroidism? Initial response to therapy is decreased ?

Synthetic T4 TSH

Rearranging La Place's law shows the relationship between the pressure inside a distensible sphere and the tension of its walls = ? Surface tension has a resolved ? direction of force Whereas the air pressure inside the sphere is directed ?

T = P x R/2 Inward Outward

Primary muscles of inspiration - external intercostals: Most of the innervation comes from which spinal nerves?

T1-T11

*Diaphragmatic openings*: Esophageal hiatus... Located at ? level Passage of ?

T10 Esophagus and vagus nerve

*Diaphragmatic openings*: Aortic foramen... Located at ? level Passage of ? While it is a considered a hiatus, it is a ? opening - meaning the aorta passes between the edge of the diaphragm and the body wall

T12 Abdominal aorta Retro-diaphragmatic

? corresponds to the subcostal nerve - supplies ? and ? below the diaphragm

T12; skin; muscle

Intercostal muscles are innervated from ? to ? segments of the spinal cord These nerves come off via ?

T1; T11 Anterior rami

Sympathetic innervation of the stomach - preganglionic neurons originate in spinal cord segments ? through ? and pass to the ? ganglion (not chain) Postganglionic fibers from the ? ganglion terminate on parasympathetic cholinergic AXONS in the ? plexes to inhibit ? stimulation of smooth muscle contraction/gland secretion Some SNS fibers terminate on (inhibit) ? muscle cells

T7; T9; celiac Celiac; ENS; acetylcholine Smooth

*Diaphragmatic openings*: Vena cava foramen (caval opening)... Located at ? level Passage of ?

T8 Inferior vena cava

Hyperthyroidism diagnosis: TSH? T3? T4?

TSH - Low T3 - High T4 - High

How is hypothyroidism diagnosed? TSH? T3? T4?

TSH - high T3 - low T4 - low

*Hypothalamic hormone and the anterior pituitary cells it affects*: Hypothalamic hormone: Thyrotrophic releasing hormone Stimulates ? secretion by ? in the anterior pituitary

TSH; thyrotrophs

Autonomic neuropathy limits the ability to compensate for intravascular volume changes: May not be able to have ? in response to hypotension ? peripheral resistance Postinduction ?-tension Sudden ?

Tachycardia Increased Hypotension Cardiac death

? is very rapid breathing

Tachypnea

A ? pneumothorax involves air entering the pleura cavity during inspiration but cannot leave during expiration

Tension

What are the smallest and last generation of conducting airways?

Terminal bronchioles

Special features of *bronchioles*: ? are the last segment of the conducting airway There is no ? - walls of conducting bronchioles are almost entirely ? Contain relatively thick ? walls in relation to lumen size (issues with allergic reactions) Contain a "modified" respiratory epithelium of ? As you descend the tracheobronchial tree, the ? and ? of epithelium decreases

Terminal bronchioles Cartilage; smooth muscle Smooth muscle Ciliated cuboidal cells Height; complexity

The ? is a V-shaped groove on tongue dorsum

Terminal sulcus

Endocrine disorders can be classified as: ? - excess or deficiency of secretion by hypothalamus

Tertiary

What are the last portion of conducting airways with mucous glands or cartilage?

Tertiary bronchi

? is synthesized from DHEA (an androgen precursor), but this a small amount compared to ? synthesis of these hormones This is more important in children, as children do not secrete ? androgens until post-pubescent

Testosterone; gonadal Gonadal

Why is a single blood sample less useful than stimulation tests like with cortisol?

There are rhythmic patterns of secretion - cyclic (circadian) and pulsatile

What are the components of the alveolar-capillary unit?

Thin layer of fluid adjacent to the inner lining of alveoli Alveolar epithelium and its basement membrane (Extracellular matrix/collagen) Capillary endothelium and its fused basement membrane

Sympathetic neurons of the upper ? region go to the sympathetic chain ganglia then to all salivary glands

Thoracic

What is the diaphragm attached to (origin)? When the diaphragm contracts, it moves to about the ? intercostal space

Thoracic outlet 4th

The major protein in colloid is ? which contains ? and ?

Thyroglobulin; T3; T4

Extrinsic ligament; joins thyroid cartilage to hyoid bone

Thyrohyoid ligament

The ? cartilage has a "V" shaped opening that projects posteriorly

Thyroid

The ? is the largest cartilage of the larynx

Thyroid

The cricoid lies immediately below the ? It can be described as a "?" with broad portion facing ? Inferior border is at ? - lowermost part of ? airway

Thyroid cartlage Signet ring; posteriorly C6; upper

? from the anterior pituitary acts on the thyroid gland (to stimulate ? and ? production) and follicular tissue (to secrete ? production)

Thyroid stimulating hormone (TSH); T3; T4; thyroglobulin

? is an acute increase in thyroid activity - may be euthyroid (normal) or hyperthyroid patient

Thyroid storm

The hypothalamus neurons secrete ? into portal blood ? stimulates the anterior pituitary to produce and increase the secretion of ? ? is released into the general circulation and exerts its effects on the thyroid gland - thyroid hormone synthesis and secretion by thyroid follicular cells

Thyrotropin-releasing hormone (TRH) TRH; TSH TSH

? is the volume of air inhaled or exhaled with each breath at rest

Tidal volume (VT)

Inspiratory capacity = ?

Tidal volume + inspiratory reserve volume (IRV)

Calculate the minute ventilation *and* alveolar ventilation of a patient with a tidal volume of 500 mL with an ideal body weight of 150 lbs, breathing at a RR of 12 breaths/min

Tidal volume = 500 mL ADS volume = 150 mL RR = 12 breaths/min Minute ventilation: 6 L/min Alveolar ventilation: 4.2 L/min

What is the minute ventilation formula? (Inspiratory or expiratory?) minute ventilation is often measured

Tidal volume x frequency (respiratory rate) Expiratory

To blow off CO2, the body will naturally/normally increase ? first, then ?

Tidal volume; frequency

Methods of determining combined compliance of lung-thorax complex: Another means is measuring the ? and ? Clinical changes are due to ? compliance, not ? compliance The lungs and thoracic wall are in ? with each other - their compliances can be added as ?

Tidal volume; plateau pressure (tidal volume / plateau pressure) Lung; thoracic Series; reciprocals

? resistance is from friction encountered as the lung and thoracic wall tissues move against each other The ? must push abdominal contents away (?) during inhalation

Tissue Diaphragm; downward

Work of breathing related to the thorax is concerned primarily with ? Affected most by ? and ? abnormalities that make it difficult to expand thorax (i.e. patients with kyphoscoliosis and obesity compensate by ? their tidal volume and ? frequency/rate)

Tissue resistance Skeletal; abdominal; decreasing; increasing

? accounts for 20% of non-elastic resistance, while ? accounts for 80% of non-elastic resistance

Tissue resistance; airway resistance

What are the parenchymal tissues of the lungs?

Tissues with specific respiratory functions

? of the proximal stomach determines intragastric pressure ? is the main determinant of emptying liquids

Tonic contraction Tonic contraction

Lymphoid tissue forms an incomplete ? around the superior part of the pharynx

Tonsillar ring (Waldeyer's ring)

? is the volume of air present in the lungs following a maximal inspiratory effort

Total lung capacity (TLC)

The bronchi contain the same type of cells as in the ? although lower height

Trachea

What is the tracheobronchial tree made of?

Trachea + 3 generations of bronchi: Primary/main stem bronchi Secondary/ lobar bronchi Tertiary/segmental bronchi

Lymphatic drainage of trachea?

Tracheal and tracheobronchial nodes

Airway obstructions: What is/are example(s) of a fixed obstruction?

Tracheal stenosis

? airflow is combined laminar and turbulent flow Where is it seen?

Transitional Bifurcations (i.e. carina)

? pressure difference determines the radius of small airways Resistance is ? proportional to r^4 and can dramatically affect resistance

Transmural Inversely

? is the distending pressure of the alveoli

Transmural pressure

Transmural pressure = ? pressure

Transpulmonary

Muscles of expiration - *interosseous* part of the internal intercostals Contraction causes a decrease in the ? and ? dimensions of thorax Contraction gives rigidity to the intercostal spaces and prevents ? breathing

Transverse; anteroposterior Paradoxical

The ? position (post-exercise, COPD, epiglotitis) describes the position someone takes when they are experiencing respiratory distress and may use their ? respiratory muscles to assist the expansion of their thoracic cavities Leaning on a table or putting their hands on their knees fixes their scapulae and clavicles so these muscles can act on their rib attachments and ? the thorax

Tripod; accessory Expand

TSH has a ? effect on the thyroid gland; sustained excess causes ? When thyroid hormone levels reach ?-times normal, negative feedback mechanisms exerted by ? and ? occur which inhibit ? and ?

Trophic; hyperplasia 1.75; T4; T3; TRH; TSH

Smooth muscle myofilaments do not contain ? - involves ? phosporylation Contraction begins with ? (spontaneous or by NTs or hormones) There is a ? increase, ? binds to ?, and a ? complex is formed Activated ? stimulates myosin light chain kinase to phosphorylate and activate ?

Troponins; myosin Depolarization Calcium; calcium; calmodulin; calcium-calmodulin Calmodulin; myosin

*Vocal cords*: ? cords Lack ? ? color ? vascularity - ? swelling in adults

True vocal Submucosa White Poor; less

The compound alveolar (acinar) gland of the pancreas secretes INACTIVE proteolytic enzymes such as ?, ?, and ? ACTIVE enzymes: Pancreatic ? (an ?) Pancreatic ? Elastases and nucleases

Trypsinogen; chymotrypsinogen; procarboxypeptidase Amylase; alpha amylase Lipase

*Primary hyperaldosteronism (Conn's syndrome)*: What is the cause? Resulting conditions include: ?-tension ?-kalemia What acid-base disorder? ? blood volume (? of water) ? cramps (probably due to the above electrolyte issue)

Tumor (adenoma) of zona glomerulosa cells that secrete aldosterone Hypertension Hypokalemia Metabolic alkalosis Increased; retention Muscle

Airway obstructions: What is/are example(s) of a variable intrathoracic obstruction?

Tumors

? airflow is irregular flow with high resistance Gas molecules encounter friction against airway walls Occurs largely in the ? airways from ? to ? Resistance is higher when breathing through the ?

Turbulent Upper; nose; larynx Nose

Law of LaPlace works with bubbles, which have ? air-liquid interface(s) Alveoli have ? air-liquid interface(s) and are assumed ? What is the Law of LaPlace formula for alveoli (P) ?

Two One; spherical P = 2T/r P = pressure T = tension r = radius

*Anesthesia considerations for the liver failure patient*: What are some examples of hepatotoxic drugs? What happens to pseduocholinesterase levels? ? hepatic clearance of medications May affect volume of distribution

Tylenol, sulfonamides, tetracycline, penicillin, amiodarone Decrease Decreased

With ? diabetes, there is a lack of insulin production by beta cells There is an ? destruction of beta cells Hyperglycemia causes glyco-?, which leads to an osmotic ?, -volemia, and then polyuria, dehydration, and polydipsia

Type 1 Autoimmune Glycosuria; diuresis; hypovolemia

Which type of diabetes is insulin-dependent? Which type of diabetes is non-insulin dependent?

Type 1 Type 2

Which alveolar cells cover 90% of the alveolar surface and are specialized for gas exchange?

Type 1 alveolar cells (agranular pneumoycytes)

Which alveolar cells secrete surfactant?

Type II (granular pneumocytes)

Where is pulmonary surfactant derived from?

Type II alveolar epithelial cells (type II pneumocytes)

Insulin circulates in its ? form What is insulin's half-life? How long does it take to clear insulin? Insulin is degraded by ? (enzyme) mainly in the ?

Unbound 6 minutes 10-15 minutes Insulinase; liver

*Contraction of smooth muscle*: Just ? the plasma membrane, ? of the plasma membrane are connected to adjacent cells via intermediate protein filaments --> mechanical junction

Under; dense bodies

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - has cell membranes that adhere in multiple points for force generation and gap junctions allow ion flow?

Unitary (syncytial/visceral)

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - has fibers arranged in sheets or bundles with syncytial interconnections?

Unitary (syncytial/visceral)

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - includes hundreds to thousands of fibers that contract together as a single unit?

Unitary (syncytial/visceral)

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - includes most viscera, including GI tract, bile ducts, uterus, ureters, and blood vessels Smooth muscle is distributed from trachea to terminal bronchioles

Unitary (syncytial/visceral)

Which type of smooth muscle - multi-unit or unitary (syncytial or visceral) - is mainly under non-nervous control?

Unitary (syncytial/visceral)

Explanation for differences in regional ventilation after forced expiration to the RV: With inspiration from low lung volumes... The initial part of the breath goes to the ? alveoli The later part of the breath goes to the ? alveoli As the inspiration approaches FRC from the RV, the airways of the ? alveoli begin to open and these alveoli fill later in the inspiration

Upper Dependent Basilar dependent

Accessory muscles of inspiration - scalene muscles: A strong contraction of the scalenes lifts the ?

Upper thorax

Light to moderate contraction of scalenes fixes/immobilizes the ? - this allows the ? to raise the lower ribs to a greater degree

Upper thorax; external intercostals

*With the second breath*: Subject starts from RV, inspires single breath of 100% oxygen up to TLC, exhales back to RV The initial part of the breath enters the ? alveoli, most oxygen enters the ? alveoli

Upper; lower

Two phases of movement/beating of cilia with the mucociliary escalator: Forward stroke - propels mucus toward the oropharynx; occurs with the cilia (in which position?) and with tips in contact with the ? layer Recovery phase - cilia return to (which position?) by bending; cilia move only through the ? layer

Upright; gel Original positioning; sol

Individuals with liver disease who are incapable of forming ? can develop increased plasma levels of ? that can lead to hepatic coma and death

Urea; ammonia

Hepatic cells metabolize ammonia into ? and ? ? is released into the blood and is excreted by the kidneys

Urea; glutamate Urea

After bile is secreted into the small intestine, 50% of the conjugated bilirubin is converted by bacterial action into ? in the terminal ileum and colon ? may be reabsorbed from the small intestine back into the blood and sent to the liver

Urobilinogen Urobilinogen

What makes up the soft palate?

Uvula and skeletal muscles (palatoglossal, palatopharyngeal, levator veli palatini, uvular muscles, tensor palatine)

In addition to the CTZ and vomiting center, major anatomical elements of vomiting include sensory pathways such as ? pathways, motor pathways such as ? pathways It also includes the diaphragm and abdominal muscles

Vagal and sympathetic; cranial and spinal

When food is ingested, ? reflexes allow food accommodation without increasing intragastric pressure Food causes slow, sustained tonic contractions

Vagovagal

What is the sensory innervation for the intrapulmonary airways (bronchi)?

Vagus

Regulation of smooth muscle tone: Parasympathetic neural stimulation achieved by unitary stimulation via ?

Vagus nerve

While the major mechanism of regulating pancreatic secretion is hormonal control (80%), ? impulses stimulate 20% of both types of secretions (enzyme and sodium bicarbonate) early in the digestive process

Vagus nerve

Sensory impulses of the lungs come from the ? Motor impulses of the lungs...parasympathetic motor stimuli cause ? and mucus gland ?

Vagus nerve Bronchconstriction; secretion

Parasympathetic innervation of stomach is the ? Preganglionic nerve fibers innervate postganglionic cholinergic neurons in the ? Neurons in the ? cause muscle contraction Neurons in the ? cause secretion of glands

Vagus nerve ENS Myenteric plexus Submucosal plexus

Sensory innervation of trachea? Motor innervation of trachea?

Vagus nerve; carina and true vocal cords are very sensitive Mucous glands via parasympathetic fibers

*Epiglottis*: ? - depressions on each side of median glossoepiglottic fold ? - folds form lateral walls of epiglottis During swallowing, tips posteriorly

Vallecula Ary-epiglottic

A ? obstruction affects inspiration

Variable extrathoracic

A ? obstruction affects expiration

Variable intrathoracic

Non-gaseous exchange functions of respiratory system - filtration/removal processes: Lytic enzymes are derived from ? Ingestion by ? ? migration/penetration into airways

Vascular endothelium Macrophages Macrophage

? is a stimuli that causes a mixed response on the electrical activity of the GI tract It ? electrolyte secretion but ? propulsive movement

Vasoactive intestinal peptide (VIP) Increases; decreases

Symptoms of hypothyroidism: Peripheral vaso-? ? heart rate/contractility ? minute ventilation/reduced response to low oxygen/high CO2 ? in the lung and heart are common Weight ? ? intolerance Dry hair and skin ? (GI issue) ? (psych issue)

Vasoconstriction Decreased Decreased Effusions Gain Cold Constipation Depression

*Example of ANS-Epinephrine axis and integrated control during the simple stress of exercise*: Vaso-? of skeletal muscle arterioles ? blood flow ? of bronchial smooth muscle - assists in increasing ventilation The above two provide increased ? delivery to muscle

Vasodilation; increases Relaxation Oxygen

Changes in the IPP and "thoracic pump" Alternating inspirations and expirations of the "thoracic pump" supports ? return

Venous

Non-gaseous exchange functions of respiratory system: "Thoracic pump" aids in ? Pressure in the thoracic region is ? with each breath. This ? pressure favors blood flow from inferior body regions to the right atrium

Venous return Reduced; reduced

Primary muscles of inspiration - diaphragm: Contraction of the diaphragm increases which dimension of the thoracic cavity? Contraction of the diaphragm helps to ? volume

Vertical Increase

What are the 2 sets of laryngeal folds/cords?

Vestibular/ventricular folds and vocal cords

Structure of nasal cavity - the ? is the hairy (the hairs are called ?) entrance of nasal canal It contains ? skin with many ? glands

Vestibule; vibrissae; thick; sebaceous

Defense mechanisms of the respiratory system - protective structures: ? located in the vestibule which act as a course filter ? - turbulence of air facilitates impaction ? - which warms the air; necessary for normal cellular function; a cold environment ? metabolism in goblet cells; cold ? the activity of the cilia

Vibrissae Conchae/turbinates Venous plexus; decreases; decreases

Hepatitis is from a ? etiology - includes types A, B, C, D (with B); E is uncommon in US

Viral

? pleura is attached directly to the lung

Visceral

? pleura is attached to/covers the outer surface of the lungs

Visceral

The rupture with a closed (spontaneous) pneumothorax is where?

Visceral pleura

*Innervation of pleura - visceral pleura*: Nerve fibers lie between the ? and ? Nerve fibers send impulses to the ? and ? No ? receptors in *visceral* pleura, so no ? sensations transmitted

Visceral pleura; lung surface Pulmonary plexes; vagus nerves Pain; pain

The ? pleura covers the outer surface of the lung and folds back onto itself to form the ? pleura that eventually covers the walls of the thoracic cavity

Visceral; parietal

*Causes related to osteoporosis*: ? deficiency causing low plasma calcium ? deficiency causing reduced collagen production in organic matrix Reduction of mechanical ? applied to bone, disuse, or a limb that is ?

Vitamin D Vitamin C Stress; immobilized

What divides the upper and lower airway?

Vocal folds/cords

The ? lies under the vocal cords It connects the ? to the angle of the ?

Vocal ligament Vocal process of arytenoid; thyroid

The function of the muscles of inspiration is to increase the ? of the thorax for the purpose of expanding the ?

Volume; lungs

Stage 1 of swallowing is ? - food bolus is squeezed or rolled into oropharynx by elevation of the tongue against the hard palate

Voluntary

What is another name for the tonsilar ring?

Waldeyer's

Defense mechanisms of the respiratory system - lymph: ? is a circular band of lymphatic tissue "Guards" the entryway into the ? and ? tracts Tonsils include ?

Waldeyer's tonsillar ring Digestive; respiratory Pharyngeal, palatine, lingual, and tubal (if present)

*Signs/symptoms of excess glucocorticoids*: Muscular and skeletal ? Increased lipolysis leads to free ? - redistribution of body fat - increased ? adipose, "?" and "?" features What happens to blood sugar? This is called ? There is ? utilization of glucose and ? gluconeogenesis

Wasting Fatty acids; abdominal; buffalo hump; moon face Increases (hyperglycemia); adrenal diabetes; decreased; increased

Recoil due to surface tension: Generated by cohesive forces between ? molecules and ? bonding when unopposed at the surface of a liquid ? is what causes water to bead - causes water molecules to form the ? surface area possible

Water; hydrogen Surface tension; smallest

T4 and T3 are poorly soluble in ?. Are they bound to plasma proteins? Most of the secreted hormone directly secreted from the thyroid is ? Most activity is from ? 75% of T3 comes from ? of T4 in peripheral tissues

Water; yes T4 T3 Deiodination

Pleural membranes secrete a ? fluid They create ? layers of pleural membranes

Watery Two

What does line AB'CBA represent?

What does line AB'CBA represent?

What does line ABC represent?

What does line ABC represent?

What does line EABCD represent?

What does line EABCD represent?

When is static compliance measured? Exhalation in ? with measurements

While no airflow is occurring Stages

The ? is the lowermost and smallest portion of the sternum It begins as ? Ossifies into bone around ? years of age It is often a site of injury for ? and ?

Xiphoid process Hyaline cartilage 40 Blunt trauma; CPR

*Origins of the diaphragm*: Internal surface of ? Internal sufaces of costal cartilages r/t ribs ? through ? Internal surfaces of ? and ? ribs Transverse processes of ? and ? vertebrae Centra of ? through ?

Xiphoid process 7; 10 11th; 12th T12; L1 L1; L3

Does active expiration require muscular activity?

Yes

Under abnormal conditions, is it possible for one hemidiaphragm and not the other to be incapacitated? Fluoroscopy shows the non-functional hemidiaphragm to ? during the "?" test (paradoxical movement on inspiration)

Yes Rise; sniff

Can the enteric nervous system function alone? The enteric nervous system is linked with the CNS: the ? increases stimulation/vagovagal reflex; the ? decreases motility and increases sphincter tone

Yes Vagus; SNS

Explain measuring residual volume (RV) with a spirometer

You cannot measure RV with a spirometer - it cannot be exhaled; spirometers can only measure the lung volumes a subject can exchange with it

*Layers of the adrenal cortex*: The ? (75%) is the middle layer

Zona fasciculata

*Layers of the adrenal cortex*: The ? (15%) lies under the capsule

Zona glomerulosa

*Layers of the adrenal cortex*: The ? (10%) is the inner layer adjacent to the adrenal medulla

Zona reticularis

What is the formula for Reynold's number? What is Reynold's number directly proportional to? What is it inversely proportional to?

vpd / n v = velocity (of air) p = density (of air) d = diameter (of tube) n = viscosity (of air - minimal) Directly: velocity, density, diameter Inversely: viscosity

What does effect do the following conditions have on static compliance, dynamic compliance, or both? Atelectasis? Bronchospasm? Bronchial intubation? Mucous plugging? Pneumonia? Pulmonary edema? Pulmonary emboli? Tension pneumothorax?

*Atelectasis*: Static compliance and dynamic curves are similar, but decrease *Bronchospasm*: Static compliance normal; dynamic compliance decreases *Bronchial intubation*: Static compliance and dynamic curves are similar, but decrease *Mucous plugging*: Static compliance normal; dynamic compliance decreases *Pneumonia*: Static compliance and dynamic curves are similar, but decrease *Pulmonary edema*: Static compliance and dynamic curves are similar, but decrease *Pulmonary emboli*: Neither change *Tension pneumothorax*: Static compliance and dynamic curves are similar, but decrease

*During passive exhalation*: During normal passive exhalation, recoil force is ? cmH2O and includes elastic and surface tension forces of alveoli Net difference of opposing forces is: ? minus ? There is a drop in pressure to the outside due to ? of gas molecules encountering lower airway walls

+10 cmH20 Recoil forces; IPP (+10 cmH2O - 8 cmH2O = 2 cmH2O (alveolar pressure) Friction

*End inspiration*: Transmural pressure = ? Alveoli are distended - alveolar pressure is decreased to ? cm H2O A ? pressure gradient has been created between ambient air and alveoli, which leads to ?

+7 cmH20 (-1 cmH20 - -8 cmH20) -1 Negative; inhalation

*During passive exhalation*: Normal end-expiration IPP is ? cmH2O After tidal inhalation (tidal volume = ? mL), IPP is ? cmH2O - this IPP is reflected throughout the lungs/outside airways Once produced, this ? IPP helps to keep alveoli distended by opposing inward alveolar elastic recoil forces and surface tension forces

-5 cmH2O 500 mL; -8 cmH2O Negative

Resting potential of smooth muscle cells is between ? and ? mV Slow waves are stimulated by ?, which are part of the myenteric plexus

-50; -60 Interstitial cells of Cajal (ICC)

End inspiration: Muscular contraction of chest wall causes IPP to change from ? cm H2O to ? cm H2O Alveolar pressure changes from ? cm H2O to ? cm H2O At this point, elastic elements of lungs/alveoli are stretched, which leads to an ? inward elastic recoil

-5; -8 0; -1 Increased

At *end inspiration* of a normal tidal volume, the IPP is about ?

-8 cmH20

*End expiration*: The respiratory tract is open to the outside Alveolar pressure = ? cmH2O = ambient or barometric pressure IPP = ? cm H2O Transmural pressure (formula) = ? - ? Transmural pressure (actual number) = ? cmH20

0 -5 Alveolar pressure; IPP +5

What is a normal total compliance?

0.1 L/cmH2O

Combined compliance of both the thoracic wall and the lungs together: Thoracic wall compliance = ? L/cm H2O Lung compliance = ? L/cm H20 Normal total compliance for lung-thorax complex = ? L/cm H2O The two factors are working aginst each other

0.2 0.2 0.1

What is a normal compliance?

0.2 L/cmH2O

Normal plasma level (mostly free form) of bilirubin is ? mg/dL Skin is pigmented at ? mg/dL -- can measure ? mg/dL (conjugated)

0.5 1.5; 40

Gastric acid secretion is maximal at ? hours postprandial (meal) What inhibits gastrin secretion? Direct inhibition of antral ? cells (endocrine) stimulates indirect somatostatin secretion by antral ? cells

1-2 Decreased pH G; D

Primary muscles of inspiration - diaphragm: During eupnea, dome moves downward ? cm into the ? cavity The abdominal wall is ?

1-2; abdominal Compliant

Elimination of fecal waste occurs ? days after ingestion

1-3

Food stays in the stomach for ? hours while it mixes and grinds food Smaller particles pass through the ? sphincter out of the stomach ? stomach secretions (mucosa) dilute food ? dissolves food

1-4 hours Pyloric Exocrine Gastric acid