Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
-Which muscles tense and relax the vocal cords? - ANSWER-Cricothyroid: "Cords
ve ve ve ve ve ve ve ve ve ve
Tense"
ve
-Thyroarytenoid: "They Relax" ve ve
Which muscles abduct and adduct the vocal cords? - ANSWER-Posterior
ve ve ve ve ve ve ve ve ve
Cricoarytenoid: "Please Come Apart"
ve ve ve ve
-Lateral Cricoarytenoid: "Let's Close Airway"
ve ve ve ve
Describe the sensory innervation of the upper airway - ANSWERTrigeminal
ve ve ve ve ve ve ve ve ve
-V1 (Ophthalmic) = Nares and anterior 1/3 of septum
ve ve ve ve ve ve ve ve
-V2 (Maxillary) = Turbinates and septum
ve ve ve ve ve
-V3 (Mandibular) = Anterior 2/3 of tongue
ve ve ve ve ve ve
Glossopharyngeal
-Posterior 1/3 of tongue ve ve ve
-Soft palate
ve
-Oropharynx
-Vallecula
-Anterior side of epiglottis
ve ve ve
Superior laryngeal ve
-Internal branch = posterior side of epiglottis to the level of the vocal cords
ve ve ve ve ve ve ve ve ve ve ve ve ve
-External branch = 0 sensory function, motor innervation to the cricothyroid muscle
ve ve ve ve ve ve ve ve ve ve ve
Recurrent laryngeal ve
-All intrinsic muscles except the cricothyroid
ve ve ve ve ve
How does recurrent laryngeal nerve injury affect the integrity of the airway? -
ve ve ve ve ve ve ve ve ve ve ve ve
ANSWERBilateral
ve
-Acute = Respiratory distress (unopposed action of cricothyroid muscles)
ve ve ve ve ve ve ve ve
-Chronic = No respiratory distress
ve ve ve ve
How does superior laryngeal nerve injury affect the integrity of the airway? -
ve ve ve ve ve ve ve ve ve ve ve ve
ANSWER-Bilateral = Hoarseness/No respiratory distress
ve ve ve ve ve
-Unilateral = No respiratory distress
ve ve ve ve
Name 3 airway blocks and identify the key landmarks for each one - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve
Glossopharyngeal nerve block: Palatoglossal arch at the anterior tonsillar pillar
ve ve ve ve ve ve ve ve ve
-Superior laryngeal nerve block: Greater cornu of hyoid
ve ve ve ve ve ve ve
-Transtracheal nerve block: Cricothyroid membrane ve ve ve ve
,Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
What are the 3 paired and 3 unpaired cartilages of the larynx? - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve
Unpaired: Epiglottis, thyroid, cricoid
ve ve ve
-Paired: Corniculate, arytenoid, cuneiform
ve ve ve
What is the treatment for laryngospasm? - ANSWER-100% FiO2
ve ve ve ve ve ve ve ve
-Remove noxious stimulation ve ve
-Deepen anesthesia ve
-CPAP 15-20 cmH2O
ve ve
-Open the airway (head extension, chin lift)
ve ve ve ve ve ve
-Larson's maneuver ve
-Succinylcholine
What should you keep in mind about infants and small children receiving
ve ve ve ve ve ve ve ve ve ve ve
succinylcholine?
ve
-What site produced the fastest onset (excluding IV)? - ANSWER-Infants and small
ve ve ve ve ve ve ve ve ve ve ve
children should receive atropine 0.02 mg/kg (20 mcg/kg) with succinylcholine
ve ve ve ve ve ve ve ve ve ve
-If no IV access, submittal administration will produce the fastest onset
ve ve ve ve ve ve ve ve ve ve
Describe how the respiratory muscles function during the breathing cycle -
ve ve ve ve ve ve ve ve ve ve
ANSWERInspiration
ve
-Diaphragm and external intercostals contract
ve ve ve ve
-Accessory muscles include the sternocleidomastoid and scalene muscles
ve ve ve ve ve ve ve
Expiration
-Exhalation is usually passive ve ve ve
-Active exhalation is carried out by the abdominal musculature (rectus abdominis,
ve ve ve ve ve ve ve ve ve ve
transverse abdominis, internal obliques, external obliques)
ve ve ve ve ve ve
-Internal intercostals serve secondary role in active exhalation
ve ve ve ve ve ve ve
What is the difference between minute ventilation and alveolar ventilation? -
ve ve ve ve ve ve ve ve ve ve
ANSWERAlveolar ventilation removes the anatomic dead space gas from the
ve ve ve ve ve ve ve ve ve ve
minute ventilation equation
ve ve ve
Define the 4 types of dead space - ANSWER-Anatomic Vd: Air confined to the
ve ve ve ve ve ve ve ve ve ve ve ve ve
conducting airways
ve ve
-Alveolar Vd: Alveoli that are ventilated but not perfused
ve ve ve ve ve ve ve ve
-Physiologic Vd: Anatomic Vd + Alveolar Vd ve ve ve ve ve ve
-Apparatus Vd: Vd added by equipment ve ve ve ve ve
What does the alveolar compliance curve tell you? - ANSWER-Best ventilated
ve ve ve ve ve ve ve ve ve ve
alveoli are the most compliant (steep portion of the curve)
ve ve ve ve ve ve ve ve ve ve
,Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
-Poorest ventilated alveoli are the least compliant (flat portion of the curve)
ve ve ve ve ve ve ve ve ve ve ve
What does the V/Q ratio represent?
ve ve ve ve ve
-What is the normal V/Q ratio? What do the abnormal values tell us? - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve ve
Ratio of perfusion to ventilation (minute ventilation/cardiac output)
ve ve ve ve ve ve ve
-Normal V/Q ratio is 0.8 ve ve ve ve
-V/Q ratio > 0.8 = dead space
ve ve ve ve ve ve
-V/Q ratio of < 0.8 = shunt
ve ve ve ve ve ve
Define the West zones of the lung - ANSWERZone I
ve ve ve ve ve ve ve ve ve
-PA > Pa > Pv
ve ve ve ve
-Dead space - ventilation without perfusion
ve ve ve ve ve
Zone II ve
-Pa > PA > Pv
ve ve ve ve
-Waterfall - normal physiology ve ve ve
Zone III ve
-Pa > Pv > PA
ve ve ve ve
-Shunt - perfusion without ventilation
ve ve ve ve
Zone IV ve
-Pa > Pist > Pv > PA
ve ve ve ve ve ve
-Pressure in the interstitial space impairs ventilation and perfusion
ve ve ve ve ve ve ve ve
Define the alveolar gas equation - ANSWERPAO2 = FiO2 x (Pb - PH2O) -
ve ve ve ve ve ve ve ve ve ve ve ve ve
(PaCO2/RQ)
ve
-Pb = Atmospheric pressure (760 mmHg at sea level)
ve ve ve ve ve ve ve ve
-PH2O = 47 mmHg ve ve ve
-RQ = Respiratory quotient = 0.8
ve ve ve ve ve
Normal = 105.98 mmHg ve ve ve
What is the A-a gradient, and what factors affect it? - ANSWERDifference between
ve ve ve ve ve ve ve ve ve ve ve ve
alveolar oxygen and arterial oxygen.
ve ve ve ve ve
-It helps us diagnose the cause of hypoxemia by quantifying the amount of venous
ve ve ve ve ve ve ve ve ve ve ve ve ve
admixture
ve
-Normally 5-15 mmHg ve ve
, Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
-Increased by high FiO2, aging, vasodilators, right-to-left shunting, and diffusion
ve ve ve ve ve ve ve ve ve
limitation
ve
List the 5 causes of hypoxemia. Which ones are reversed with supplemental
ve ve ve ve ve ve ve ve ve ve ve
oxygen? - ANSWER
ve ve ve
Define the 5 lung volumes, and give reference values for each - ANSWER
ve ve ve ve ve ve ve ve ve ve ve ve
Describe the Lung Volume/Lung Capacity Chart - ANSWER
ve ve ve ve ve ve ve
What factors influence FRC? - ANSWER-Positioning
ve ve ve ve ve
-Anesthetic induction ve
-NMB's
-Surgical displacement ve
-Obesity/Pregnancy
Why can't spirometry measure FRC? - ANSWERBecause the FRC contains the RV
ve ve ve ve ve ve ve ve ve ve ve
What tests can measure FRC? - ANSWERFRC is measured indirectly by nitrogen
ve ve ve ve ve ve ve ve ve ve ve
washout, helium wash in, or body plethysmography
ve ve ve ve ve ve ve
What is closing volume and what increases it? - ANSWER-Closing volume is the
ve ve ve ve ve ve ve ve ve ve ve ve
point at which dynamic compression of the airways begins.
ve ve ve ve ve ve ve ve ve ve
-The volume above residual volume where the small airways being to close during
ve ve ve ve ve ve ve ve ve ve ve ve
expiration.
ve
Increased - pneumonic CLOSE-P ve ve ve
-COPD
-Left ventricular failure
ve ve
-Obesity
-Smoking
-Extreme age ve
-Pregnancy
State the equation and normal value for oxygen carrying capacity. - ANSWER-O2
ve ve ve ve ve ve ve ve ve ve ve
Carrying Capacity (CaO2) - How much O2 is carried in the blood
ve ve ve ve ve ve ve ve ve ve ve ve
-CaO2 = (1.34 x Hgb x SaO2) + (PaO2 x .003)
ve ve ve ve ve ve ve ve ve ve
-Normal = 20 mL O2/dL ve ve ve ve
State the equation and normal value for oxygen delivery. - ANSWER-Oxygen
ve ve ve ve ve ve ve ve ve ve
Delivery (DO2) - How much O2 is delivered to the tissues
ve ve ve ve ve ve ve ve ve ve ve
-DO2 = CaO2 x Cardiac output x 10
ve ve ve ve ve ve ve
-Normal = 1000 mL O2/min ve ve ve ve
Discuss the factors that alter the oxyhemoglobin dissociation curve. - ANSWER
ve ve ve ve ve ve ve ve ve ve
How is carbon dioxide transported in the blood? - ANSWER-Venous blood
ve ve ve ve ve ve ve ve ve ve
transports it to the lungs, where it's excreted into the atmosphere
ve ve ve ve ve ve ve ve ve ve ve
ve ve ve ve ve ve
-Which muscles tense and relax the vocal cords? - ANSWER-Cricothyroid: "Cords
ve ve ve ve ve ve ve ve ve ve
Tense"
ve
-Thyroarytenoid: "They Relax" ve ve
Which muscles abduct and adduct the vocal cords? - ANSWER-Posterior
ve ve ve ve ve ve ve ve ve
Cricoarytenoid: "Please Come Apart"
ve ve ve ve
-Lateral Cricoarytenoid: "Let's Close Airway"
ve ve ve ve
Describe the sensory innervation of the upper airway - ANSWERTrigeminal
ve ve ve ve ve ve ve ve ve
-V1 (Ophthalmic) = Nares and anterior 1/3 of septum
ve ve ve ve ve ve ve ve
-V2 (Maxillary) = Turbinates and septum
ve ve ve ve ve
-V3 (Mandibular) = Anterior 2/3 of tongue
ve ve ve ve ve ve
Glossopharyngeal
-Posterior 1/3 of tongue ve ve ve
-Soft palate
ve
-Oropharynx
-Vallecula
-Anterior side of epiglottis
ve ve ve
Superior laryngeal ve
-Internal branch = posterior side of epiglottis to the level of the vocal cords
ve ve ve ve ve ve ve ve ve ve ve ve ve
-External branch = 0 sensory function, motor innervation to the cricothyroid muscle
ve ve ve ve ve ve ve ve ve ve ve
Recurrent laryngeal ve
-All intrinsic muscles except the cricothyroid
ve ve ve ve ve
How does recurrent laryngeal nerve injury affect the integrity of the airway? -
ve ve ve ve ve ve ve ve ve ve ve ve
ANSWERBilateral
ve
-Acute = Respiratory distress (unopposed action of cricothyroid muscles)
ve ve ve ve ve ve ve ve
-Chronic = No respiratory distress
ve ve ve ve
How does superior laryngeal nerve injury affect the integrity of the airway? -
ve ve ve ve ve ve ve ve ve ve ve ve
ANSWER-Bilateral = Hoarseness/No respiratory distress
ve ve ve ve ve
-Unilateral = No respiratory distress
ve ve ve ve
Name 3 airway blocks and identify the key landmarks for each one - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve
Glossopharyngeal nerve block: Palatoglossal arch at the anterior tonsillar pillar
ve ve ve ve ve ve ve ve ve
-Superior laryngeal nerve block: Greater cornu of hyoid
ve ve ve ve ve ve ve
-Transtracheal nerve block: Cricothyroid membrane ve ve ve ve
,Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
What are the 3 paired and 3 unpaired cartilages of the larynx? - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve
Unpaired: Epiglottis, thyroid, cricoid
ve ve ve
-Paired: Corniculate, arytenoid, cuneiform
ve ve ve
What is the treatment for laryngospasm? - ANSWER-100% FiO2
ve ve ve ve ve ve ve ve
-Remove noxious stimulation ve ve
-Deepen anesthesia ve
-CPAP 15-20 cmH2O
ve ve
-Open the airway (head extension, chin lift)
ve ve ve ve ve ve
-Larson's maneuver ve
-Succinylcholine
What should you keep in mind about infants and small children receiving
ve ve ve ve ve ve ve ve ve ve ve
succinylcholine?
ve
-What site produced the fastest onset (excluding IV)? - ANSWER-Infants and small
ve ve ve ve ve ve ve ve ve ve ve
children should receive atropine 0.02 mg/kg (20 mcg/kg) with succinylcholine
ve ve ve ve ve ve ve ve ve ve
-If no IV access, submittal administration will produce the fastest onset
ve ve ve ve ve ve ve ve ve ve
Describe how the respiratory muscles function during the breathing cycle -
ve ve ve ve ve ve ve ve ve ve
ANSWERInspiration
ve
-Diaphragm and external intercostals contract
ve ve ve ve
-Accessory muscles include the sternocleidomastoid and scalene muscles
ve ve ve ve ve ve ve
Expiration
-Exhalation is usually passive ve ve ve
-Active exhalation is carried out by the abdominal musculature (rectus abdominis,
ve ve ve ve ve ve ve ve ve ve
transverse abdominis, internal obliques, external obliques)
ve ve ve ve ve ve
-Internal intercostals serve secondary role in active exhalation
ve ve ve ve ve ve ve
What is the difference between minute ventilation and alveolar ventilation? -
ve ve ve ve ve ve ve ve ve ve
ANSWERAlveolar ventilation removes the anatomic dead space gas from the
ve ve ve ve ve ve ve ve ve ve
minute ventilation equation
ve ve ve
Define the 4 types of dead space - ANSWER-Anatomic Vd: Air confined to the
ve ve ve ve ve ve ve ve ve ve ve ve ve
conducting airways
ve ve
-Alveolar Vd: Alveoli that are ventilated but not perfused
ve ve ve ve ve ve ve ve
-Physiologic Vd: Anatomic Vd + Alveolar Vd ve ve ve ve ve ve
-Apparatus Vd: Vd added by equipment ve ve ve ve ve
What does the alveolar compliance curve tell you? - ANSWER-Best ventilated
ve ve ve ve ve ve ve ve ve ve
alveoli are the most compliant (steep portion of the curve)
ve ve ve ve ve ve ve ve ve ve
,Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
-Poorest ventilated alveoli are the least compliant (flat portion of the curve)
ve ve ve ve ve ve ve ve ve ve ve
What does the V/Q ratio represent?
ve ve ve ve ve
-What is the normal V/Q ratio? What do the abnormal values tell us? - ANSWER-
ve ve ve ve ve ve ve ve ve ve ve ve ve ve
Ratio of perfusion to ventilation (minute ventilation/cardiac output)
ve ve ve ve ve ve ve
-Normal V/Q ratio is 0.8 ve ve ve ve
-V/Q ratio > 0.8 = dead space
ve ve ve ve ve ve
-V/Q ratio of < 0.8 = shunt
ve ve ve ve ve ve
Define the West zones of the lung - ANSWERZone I
ve ve ve ve ve ve ve ve ve
-PA > Pa > Pv
ve ve ve ve
-Dead space - ventilation without perfusion
ve ve ve ve ve
Zone II ve
-Pa > PA > Pv
ve ve ve ve
-Waterfall - normal physiology ve ve ve
Zone III ve
-Pa > Pv > PA
ve ve ve ve
-Shunt - perfusion without ventilation
ve ve ve ve
Zone IV ve
-Pa > Pist > Pv > PA
ve ve ve ve ve ve
-Pressure in the interstitial space impairs ventilation and perfusion
ve ve ve ve ve ve ve ve
Define the alveolar gas equation - ANSWERPAO2 = FiO2 x (Pb - PH2O) -
ve ve ve ve ve ve ve ve ve ve ve ve ve
(PaCO2/RQ)
ve
-Pb = Atmospheric pressure (760 mmHg at sea level)
ve ve ve ve ve ve ve ve
-PH2O = 47 mmHg ve ve ve
-RQ = Respiratory quotient = 0.8
ve ve ve ve ve
Normal = 105.98 mmHg ve ve ve
What is the A-a gradient, and what factors affect it? - ANSWERDifference between
ve ve ve ve ve ve ve ve ve ve ve ve
alveolar oxygen and arterial oxygen.
ve ve ve ve ve
-It helps us diagnose the cause of hypoxemia by quantifying the amount of venous
ve ve ve ve ve ve ve ve ve ve ve ve ve
admixture
ve
-Normally 5-15 mmHg ve ve
, Unit 13 - APEX Complete Board Review
ve ve ve ve ve ve
-Increased by high FiO2, aging, vasodilators, right-to-left shunting, and diffusion
ve ve ve ve ve ve ve ve ve
limitation
ve
List the 5 causes of hypoxemia. Which ones are reversed with supplemental
ve ve ve ve ve ve ve ve ve ve ve
oxygen? - ANSWER
ve ve ve
Define the 5 lung volumes, and give reference values for each - ANSWER
ve ve ve ve ve ve ve ve ve ve ve ve
Describe the Lung Volume/Lung Capacity Chart - ANSWER
ve ve ve ve ve ve ve
What factors influence FRC? - ANSWER-Positioning
ve ve ve ve ve
-Anesthetic induction ve
-NMB's
-Surgical displacement ve
-Obesity/Pregnancy
Why can't spirometry measure FRC? - ANSWERBecause the FRC contains the RV
ve ve ve ve ve ve ve ve ve ve ve
What tests can measure FRC? - ANSWERFRC is measured indirectly by nitrogen
ve ve ve ve ve ve ve ve ve ve ve
washout, helium wash in, or body plethysmography
ve ve ve ve ve ve ve
What is closing volume and what increases it? - ANSWER-Closing volume is the
ve ve ve ve ve ve ve ve ve ve ve ve
point at which dynamic compression of the airways begins.
ve ve ve ve ve ve ve ve ve ve
-The volume above residual volume where the small airways being to close during
ve ve ve ve ve ve ve ve ve ve ve ve
expiration.
ve
Increased - pneumonic CLOSE-P ve ve ve
-COPD
-Left ventricular failure
ve ve
-Obesity
-Smoking
-Extreme age ve
-Pregnancy
State the equation and normal value for oxygen carrying capacity. - ANSWER-O2
ve ve ve ve ve ve ve ve ve ve ve
Carrying Capacity (CaO2) - How much O2 is carried in the blood
ve ve ve ve ve ve ve ve ve ve ve ve
-CaO2 = (1.34 x Hgb x SaO2) + (PaO2 x .003)
ve ve ve ve ve ve ve ve ve ve
-Normal = 20 mL O2/dL ve ve ve ve
State the equation and normal value for oxygen delivery. - ANSWER-Oxygen
ve ve ve ve ve ve ve ve ve ve
Delivery (DO2) - How much O2 is delivered to the tissues
ve ve ve ve ve ve ve ve ve ve ve
-DO2 = CaO2 x Cardiac output x 10
ve ve ve ve ve ve ve
-Normal = 1000 mL O2/min ve ve ve ve
Discuss the factors that alter the oxyhemoglobin dissociation curve. - ANSWER
ve ve ve ve ve ve ve ve ve ve
How is carbon dioxide transported in the blood? - ANSWER-Venous blood
ve ve ve ve ve ve ve ve ve ve
transports it to the lungs, where it's excreted into the atmosphere
ve ve ve ve ve ve ve ve ve ve ve
