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CRNA Boards--Respiratory
Respiratory
87
Nursing
Graduate
09/08/2009

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Cards

Term
The stellate ganglion is made up of what two ganglia?
Definition
Inferior cervical and superior thoracic
Term
All sympathetic nerve fibers pass through which rami communicans?
Definition
White Rami communicans
Term
From the white rami communicans, what are the 3 possible routes sympathetic fibers can take?
Definition
1. Go through the gray rami into the paravertebral ganglion
2. Ascend/descend into the paravertebral ganglia
3. Pass through the PVG without synapsing
Term
Sequence of norepi synthesis (precursors)
Definition
Tyrosine-->L-Dopa-->Dopamine-->Norepi-->Epi
Term
How is norepi's action terminated?
Definition
1. Reuptake (majority)
2. Metabolized by MAO in cleft
3. Metabolized by COMT away from cleft
in bloodstream
Term
What are two drugs to avoid with patients taking MAOI's?
Definition
Demerol and Ephedrine (Demerol especially)
Term
What does stimulation of presynaptic Alpha-2 receptors do? Is this is the central or peripheral nervous system?
Definition
Decreases the synthesis/release of norepi. This is found in the peripheral nervous system
Term
Where are post-synaptic Alpha-2 receptors found? What do they do?
Definition
In the CNS, when stimulated they decrease sympathetic outflow
Term
Where does Precedex (dexmedetomidine) work?
Definition
Pre-synaptic alpha-2 receptors in the PNS
Term
Where is renin released from?
Definition
Juxtaglomerular cells of the afferent arteriole
Term
What pathway does SSEP's monitor?
Definition
The dorsal lemniscal system, which includes the cuneatis and gracilis
Term
What sensations do SSEP's monitor?
Definition
Pressure, Touch, and Vibration
Term
SSEP-monitored pathways: are they ipsilateral or contralateral? (if contra, when do they cross?)
Definition
The pathways measured by SSEP's (cuneatis and gracilis) monitor Pressure, Touch, and Vibration. They are ipsilateral until crossing at the brain stem
Term
Which nerve is usually monitored when measuring SSEP's? Where is the electrode placed?
Definition
Tibial nerve; electrode on the midline scalp
Term
What does the Lateral Spinothalmic tract serve (senses and side)
Definition
Pain and Temp; contralateral
Term
What does the Dorsolateral Fasciculus serve? (sense and tract)
Definition
Modulates pain; descending tract
Term
What is the excitatory neurotransmitter in the Substantia Gelatinosa?
Definition
Substance P
Term
What is the inhibitory transmitter in the Substantia Gelatinosa?
Definition
Enkephalin
Term
Which lamina make up the Substantia Gelatinosa?
Definition
Rexed's Lamina II (some say III also)
Term
What are the effects of Mu-1 receptors?
Definition
Supraspinal analgesia
Euphora
Itching
Term
What are the effects of Mu-2 receptors?
Definition
Spinal analgesia
Respiratory Depression
Dependence
Term
Describe platelet plug formation
Definition
1. Adhesion (vW binds platelets to endothelium
2. Activation (platelets are activated by thrombin, which causes release of ADP and Thromboxane A2)
3. Aggregation (ADP and A2 uncover GPIIa/IIIb fibrinogen receptors, allowing fibrinogen to link platelets
4. Fibrin production (Factor 13 cross links the fibrin)
Term
Which clotting factors are not made in the liver?
Definition
--III (tissue factor/thromboplastin)
--IV (calcium)
--VIII (vW)
Term
Which factors are contained in cryoprecipitate?
Definition
1, 8, 13
Term
How does Heparin work?
Definition
Potentiates Anti-thrombin 3 (which then binds thrombin and factor Xa)
Term
Where is anti-thrombin 3 made?
Definition
Liver
Term
What is plasminogen and what does it do?
Definition
Its a factor incorporated in to clots as they're formed. If activated, it becomes plasmin and breaks down clots
Term
Describe the chloride shift
Definition
when CO2 enters the RBC, it reacts with H20 and is converted to carbonic acid (H2CO3), which is then broken down into HCO3 and H. HCO3 then diffuses out of the cell; as the HCO3 diffuses out, Cl- diffuses inside in order to keep neutrality
Term
What nerve innervates the carotid bodies?
Definition
Glossopharyngeal (CN 9)
Term
What innervates aortic bodies and lung stretch receptors?
Definition
The Vagus
Term
What is the primary inspiratory pacemaker?
Definition
Dorsal Respiratory Group
Term
What is the major control center for expiration?
Definition
Ventral respiratory group
Term
What does the pneumotaxic center do?
Definition
Shuts off inspiration (antagonizes the apneustic center)
Term
What does the apneustic center do?
Definition
Promotes deep/prolonged inspiration
Term
What is normal O2 usage?
Definition
250 mL/min
Term
What is the best pulmonary test for assessing small airway disease?
Definition
FEF 25-75
Term
What FEV1 and FEV1/FVC should postpone elective surgeries?
Definition
FEV1 < 2L
FEV1/FVC < 0.50
Term
What is normal serum osmolality?
Definition
300 mOsm/kg
Term
What are some endocrine functions of the kidney?
Definition
RAAS system
Vitamin D production
Erythropoeitin
Term
Where in the kidney are proteins reabsorbed?
Definition
Proximal tubule via pinocytosis
Term
What are the most common 2nd messengers?
Definition
cAMP, cGMP, IP3, calcium, and calmodulin
Term
What is the most common inherited bleeding disorder?
Definition
Von Willebrand's Disease
Term
Hemophilia A is a deficiency of what factor?
Definition
Factor 8C
Term
How does ASA inhibit clotting?
Definition
ASA inhibits COX, which converts arachidonic acid into prostaglandins, which eventually become thromboxane A2
Term
What are some characteristics of DIC?
Definition
Oozing from sites and increased fibrin split products (d-dimer)
Term
What are the common anti-cholinesterases?
Definition
Neostigmine, edrophonium, pyridostigmine, and physostigmine
Term
Which anti-cholinesterases inhibit both true and pseudo (plasma) cholinesterase?
Definition
Neostigmine and Pyridostigmine (Edrophonium does not inhibit pseudo)
Term
What effects can echothiopate drops have?
Definition
Lowers cholinesterase activity levels, taking longer to metabolize Sux
Term
What are the common antimuscarinics (anti-cholinergics)and where do they work?
Definition
Atropine, Scopolamine, glycopyrrolate---they work at post-ganglionic, parasympathetic nerves
Term
What 2nd messengers promote bronchodilation?
Definition
cAMP and cGMP
Term
What 2nd messengers promote bronchoconstriction?
Definition
Ca and IP3
Term
What do PDE inhibitors do in the lungs? What is an example?
Definition
They prevent the breakdown of cGMP and cAMP by PDE, allowing more to build up and leading to bronchodilation. Milrinone is an example
Term
What do xanthines do? Example?
Definition
Inhibit all PDE's, leading to bronchodilation. Ex: aminophyline
Term
What do mast cell inhibitors do? Example?
Definition
Prevents the release of histamine from mast cells, preventing bronchoconstriction. Ex: cromolyn
Term
Describe the motor/sensory innervation of the larynx
Definition
All motor is provided by the RLN, except the cricothryoids (external SLN). All sensory above the cords is the internal SLN, while all sensory below the cords is RLN
Term
What happens with unilateral RLN damage? BIlateral?
Definition
Unilateral RLN damage causes one cord to me intermediately placed and hoarseness. Bilateral RLN damage will cause both cords to be intermediate and will cause aphonia and airway obstruction
Term
What happens with external SLN damage?
Definition
Cords are floppy and a weak/husky voice ensues
Term
What PO2 correlates with an SpO2 of 50%?
Definition
PaO2 26-27
Term
What factors cause a leftward shift of the O2 curve (p50 less than 26, sats higher than normal)
Definition
Decreased Temp
Increased pH (low CO2)
Decreased 2-3 DPG
Fetal/Carboxy/Met Hemoglobin
Term
What factors cause a rightward shift of the O2 curve? (p50 >26, sats lower than normal)
Definition
Increased Temp
Decreased pH (increased CO2)
Increased 2-3 DPG
Sicle Cell
Term
What happens with methemoglobin?
Definition
Methemoglobin causes Ferric (Fe3+) instead of the usual Ferrous (Fe2+) iron
Term
How is CO2 transported in the body? (breakdown)
Definition
90% as HCO3 (70% in plasma, 20% in RBCs)
5% protein bound
5% dissolved
Term
Where are most peripheral chemoreceptors found and what do they respond to?
Definition
Mostly in the carotid bodies (glossopharyngeal nerve); they respond to low PO2
Term
What do central chemoreceptors mostly respond to?
Definition
Hydrogen ions; however H ion concentration is dependent on pH
Term
What is normal FRC?
Definition
2.3-2.5 L
Term
During normal inspiration, when does intrapleural pressure become positive?
Definition
Never
Term
What is the normal PAO2-PaO2 gradient?
Definition
5-15
Term
What is the normal PaCO2-PACO2 gradient?
Definition
2-10
Term
What value is the average of PACO2?
Definition
ETCO2
Term
What is the normal PaO2/PAO2 ratio?
Definition
>0.75
Term
What are the 3 possible reasons for hypoxemia?
Definition
Low FiO2, hypoventilation, and V/Q mismatch
Term
During one-lung ventilation, which is more effective: CPAP of the non-dependent lung or PEEP of the dependent lung?
Definition
CPAP of the non-dependent lung is more effective during OLV
Term
What is more affected in a patient in whom V/Q mismatch suddenly develops (O2 or CO2)?
Definition
O2
Term
Describe the blood flow in each of the 4 zones of the lung
Definition
Zone 1 = no blood flow
Zone 2 = flow during systole
Zone 3 = flow during systole/diastole
Zone 4 = flow during systole (intersitial pressure becomes greater than venous)
Term
In which zone should the tip of a PA catheter be placed?
Definition
Zone 3
Term
Why do we pre-oxygenate?
Definition
Breathing 100% O2 for a few minutes replaces all of the Nitrogen in the FRC with O2, effectively increasing the amount of O2 in the FRC 5-6 times
Term
In theory, how long can the average adult who is adequately pre-oxygenated be apneic without desaturation?
Definition
About 9 minutes (FRC of 2500 mL full of O2, using 250 mL/min)
Term
What are some drugs that can inhibit hypoxic vasoconstriction?
Definition
HPV can be inhibited by direct acting vasodilators (SNP, hydralazine, etc) and volatiles at > 1 MAC
Term
What are the main types of obstructive disease?
Definition
Asthma and COPD (chronic bronchitis and emphysema)
Term
What spirometry results require split lung function tests prior to pneumonectomy?
Definition
FEV1/FVC < 50% and FEV1 < 2L
Term
If a patient has a V:Q ratio of zero, are they: deadspacing, having R-->L shunt, normal, or having L--R shunt?
Definition
They would be having R-->L shunt
Term
Is PAO2 higher in the dependent or non-dependent lung? Why?
Definition
PAO2 is higher in the non-dependent lung because the blood flow is lower and therefore less blood is carried away from the alveoli
Term
When a patient is given narcotics, what happens to the O2 curve? CO2 curve?
Definition
O2 curve shifts right (low sats), while CO2 curve shifts left
Term
What is the best test for assessing small airway disease?
Definition
FEF 25-75
Term
When should split lung function tests be ordered?
Definition
If the FEV1 < 2L and FEV1/FVC < 50%
Term
Expiration/inspiration is impaired with variable extrathoracic/intrathoracic obstruction
Definition
Expiration is impaired with an intrathoracic

Inspiration is impaired with an extrathoracic
Term
what % of the normal healthy adult vital capacity is closing volume? geriatric?
Definition
young healthy = 10% of VC
geriatric = 40% of VC
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