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