Pulmonary System I Flashcards
1
Q
Define respiration
A
Exchange of gases between the atmosphere, blood and cells
2
Q
What are the 3 processes required for respiration
A
ventilation (breathing)
External (pulmonary) respiration
Internal (Tissue) respiration
3
Q
The CV assists the respiratory by
A
Transporting gases
4
Q
What are the respiratory system STRUCTURAL DIVISION?
A
Upper Respiratory system
Lower respiratory system
5
Q
What are the respiratory system FUNCTIONAL division
A
Conducting Zone
Respiratory Zone
6
Q
What are the conduction zone
A
Dead space up to terminal bronchioles
7
Q
What is the respiratory zone
A
Gas exchanges in alveoli
8
Q
The UPPER respiratory consists of
A
PANP Paranasal sinuses Associated Structures Nose Pharynx
9
Q
The LOWER respiratory consists of :
A
LLTB Larynx Lungs Trachea Bronchi
10
Q
The upper respiratory tract : put in order nasopharynx ,oropharynx and laryngopharynx
A
NOL
Nasopharynx –>Oropharynx –>Laryngopharynx
11
Q
Mallampati Score 1
A
Full visibility of Tonsils, Uvula, Soft palate (TUS)
12
Q
Mallampati Score 2
A
Visibility of hard and soft palate, upper portion of tonsils and uvula
13
Q
Mallampati Score 3
A
Soft and hard palate, and base of the uvula visible
14
Q
Mallampati Score 4
A
Only hard palate visible
15
Q
2 parts of the larynx
A
Thyroid Cartilages
Cricoid cartilages
16
Q
True ribs are _______ and are _______to sternum via ______ cartilage
A
1-7 ; attached directly ; Costal
17
Q
False ribs are ________ and are ________to sternum
A
8-10; indirectly attached
18
Q
Floating ribs are ________ and are _______ to sternum
A
11-12; not attached to sternum.
19
Q
Supernumary ribs are ____ribs and cervical ribs are
A
Extra; elongation of transverse process of 7th cervical vertebra
20
Q
Supernumary ribs: Lumbar ribs
A
Elongation of transverse process of lumbar vertebra
21
Q
Function of floating ribs?
What about the oblique orientation?
A
allow flexibility of movement that is needed for ventilation to occur
Oblique orientation allows for elevation of the rib cage involved with lung expansion
22
Q
what is the upper most part of the sternum
A
Manubrium
23
Q
Suprasternal notch is the
A
Jugular
24
Q
Trachea lies where?
A
posterior to and in line with jugular notch
25
Suprasternal notch (jugular) signifies ? and is the ideal ___________
midpoint of trachea and ideal location for the distal tip of the endotracheal tube
26
Where does the manubrium joins the body of the sternum?
| What occurs at this level ? Which is T__ - T___
Sternal angle of Louis
| Bifurcation of the trachea (T4-T5)
27
What is the hinge-like joint between the manubrium and the body of the sternum?
Manubriosternal Joint
28
what is the function of the manubriosternal joint?
Allows hinge like forward movement of sternum during inspiration and backward movement during Expiration
29
***PART of the UPPER airway : nose function
***Warms, cleanses, and humidifies inhaled air
| RESONATING CHAMBER THAT AMPLIFIED the voice
30
Bony and cartilaginous support: 3 parts
Superior
Inferior
Ala Nasi
31
Bony and cartilaginous support: Superior part --> _______bones medially and ______lateraly
Nasal bones; maxillae
32
Bony and cartilaginous support: Inferior part -->
Lateral and ALAR cartilages
33
What is the ALA NASI? What is shaped by ?
Flared portion shaped by dense CT , forms lateral wall of each nostril.
34
Nasal Cartilage Caveat?
beware of nose rings and other jewelry (Bovie)
35
What is the vestibule? what kind of tissue is it made of?
It is a dilated chamber inside ALA NASI..Stratified Squamous epithelium , vibrissae (guard hairs)
36
Nasal cavity extends
from nostrils to posterior nares
37
Nasal septum divides cavity into
right and left chambers called Nasal fossae
38
Function of the Turbinates and Sinuses
Warm, clean and MOISTEN AIR for the lungs
39
What are the nasal conchae and how many are there?
3 folds of tissue on lateral and nasal fossa
mucous membranes supported by thing scrolllike turbinates bones
Superior, middle, inferior
40
What are the meatuses
Narrow air passage beneath each conchae
| narrowness and TURBULENCE ENSURES AIR CONTACT MUCOUS MEMBRANES.
41
What are the paranasal sinuses? MENFS
```
Maxillary
Ethnoid
Nasal cavity
Frontal
Sphenoid
```
42
Nasal Cavity -Mucosa
Olfactory: lines roof of nasal fossa
Respiratory: Lines rest of nasal cavity with CILIATED PSEUDOSTRATIFIED EPITHELIUM
43
What kind of tissue line the rest of the nasal cavity?
Ciliated pseudostratified Epithelium
44
What is the defensive role of mucosa?
| What are the bacteria destroyed by?
Mucous (from goblet cells) Traps inhaled particles - Bacteria destroyed by LYSOZYME & IgA
45
Function of the Cilia or respiratory epithelium?
sweep debris laden mucus into pharynx to be swallowed.
46
What is the function of the Erectile tissue of inferior conchae?
Venous plexus that rhythmically engorges with BLOOD and SHIFTS flow or air from on side of fossa to the other once or twice an hour to PREVENT DRYING.
47
Spontaneous EPISTAXIS most common site is
INFERIOR CONCHA
48
3 regions of pharynx in order from superior to inferior?
Nasopharynx
Oropharynx
Laryngopharynx
49
Nasopharynx is made of ______ ______ and is located posterior to _______, dorsal to ______ palate. It receives________ and contains what _______ ________
Pseudostratified epithelium
| choanae ; soft; auditory tubes; PHARYNGEAL TONSIL
50
The pharynx ____degrees ______ turn does what?
Turn 90 degrees downward; Traps large particles
51
Oropharynx is made of _______ ______ and is the space between________location?
what does it contain?
stratified squamous epithelium; space between soft palate and root of tongue.
Inferior to hyoid bone
PALATINE and LINGUAL TONSILS
52
Lagyngopharynx is made up of ______ ____
| Location ?
Stratified squamous
| Hyoid bone to level of cricoid cartilage.
53
Glottis
Vocal cords and opening between
54
What is the epiglottis? guards what? and function?
Flap of tissue that guards glottis, direct foods, and drink to esophagus
55
Note on INFANT LARYNX
Higher in throat--> Forms a continuous airway from nasal cavity that allows breathing while swallowing
56
In infant larynx, by age 2,
more muscular tongue forces larynx down
57
Where are TRUE VOCAL CORDS?
True vocal folds are attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage.
58
Larynx located in adults ________
| Larynx located in children_______
C3-C6
| C3-C5 (superior)
59
Framework of the larynx is formed by ____total pieces of cartilages (____paired and _____ unpaired)
9; 3; 3
60
What are the 9 total pieces of cartilage?
| CETACC
```
Crycoid
Epiglottis
Thyroid
Arytenoid (paired)
Corniculate (paired)
Cuneiform (paired)
```
61
Vertebral levels in the larynx
Hyoid (C2/C3)
Thyrohoid membrane (C4)
Laryngeal prominence (C5)
Cricoid cartilage and start of trachea (C6)
62
Which is the most superior of the 9 cartilages of the larynx?
Epiglottic Cartilage
63
Which is the largest of the 9 cartilages of the larynx? what does it form?
Thyroid Cartilage
| Forms laryngeal prominence
64
Which is the cartilage of the 9 cartilages of the larynx, that connects LARYNX to TRACHEA
Cricoid Cartilage.
65
Which is the one out of the 9 cartilages of the larynx that is posterior to the thyroid cartilage?
ARYTENOID CARTILAGE
66
Arytenoid cartilage is composed of ______ and are located?
2; posterior to thyroid cartilage
67
Corniculate cartilage is composed of ____ and do what ?
Attached arytenoid cartilages like a PAIR OF HORNS
68
Which cartilage is attached like a PAIR OF HORNS?
CORNICULATE cartilage.
69
Which structures support soft tissue between arytenoids and EPIGLOTTIS?
Cuneiform Cartilages.
70
What is the narrowest portion of the airway in pediatric patients?
Cricoid
71
In pediatric patients newer studies suggest ?
The GLOTTIC OPENING may be the narrowest in the pediatric patient.
72
What is the RIMA GLOTTIDIS?
Opening between true vocal cords and the ARYTENOID cartilages.
-Narrowest portion of the upper airway in the adult
73
Glottis in the laryngeal cavity =
true vocal cords and the rima glottidis
74
If the laryngoscope blade is too deep?
looking down the esophagus and hiding the larynx
75
What is the function of the EXTRINSIC MUSCLES
Connect larynx to HYOID bone, elevate larynx during swallowing UP and FORWARD
76
What are the parts of the SUPRAHYOID muscles? (MDS)
Mylohoid
Stylohoid
Diagstric
77
What are the parts of the INFRAHYOID muscles? (SOTS)
Sternothyroid
Omohyoid
Thyrohyoid
Sternohyoid
78
What are the muscles of the LARYNGEAL INLETS? (ATO)
Aryepiglottic
Oblique aretynoid
Thryroepiglottic
79
What does the Aryepiglottic do?
Narrows inlet, closes glottis
80
What does the OBLIQUE ARETYNOID do?
narrows inlet, closes glottis
| Together , the aryepiglottic and oblique aretynoid act as a PURSE-STRING sphincter during swallowing.
81
Which act as a purse string sphincter during swallowing?
Aryepiglottic
| Oblique aretynoid
82
What is the role of THYROEPIGLOTTIC?
Widens inlet
83
Intrinsic Muscles function
Rotate corniculate and arytenoid cartilages.
84
The intrinsic muscle ADDUCTS (which sound)
tightens : HIGH PITCH SOUND
85
The Intrinsic muscle ABDUCTS (which sound)
Loosens: LOW PITCH SOUND
86
What are the muscles involved with movement of true cords?
```
Cricothyroids
Lateral cricoarytenoids
Oblique arytenoids
Thyroarytenoids
Transverse arytenoids
```
87
3 intrinsic muscles that ADDUCTS CORDS and closes ? (LOT)
Lateral cricoarytenoids
Transverse arytenoids
Oblique arytenoids
88
What is the ONLY INTRINSIC MUSCLE to lie outside the CARTILAGINOUS framework of the larynx?
CRICOTHYROIDS
89
Which intrinsic muscle TENSE VOCAL CORDS?
CRICOTHYROIDS
90
Which intrinsic muscle RELAX VOCAL FOLDS
THYROARYTENOIDS
91
________is part of the THYROARYTENOIDS
Vocalis m.
92
Which structure ADJUST TENSION of CORDS
Vocalis m.
93
Which structure adjust vocal cords and FOLDS , OPENS
Posterior cricoarytenoids
94
WHICH is the ONLY ABDUCTOR muscle of vocal cords?
Posterior Cricoarytenoids .
95
Blood Supply to the larynx
supplied via EXTERNAL CAROTIDS and SUBCLAVIAN ARTERIES and INTERNAL JUGULAR VEIN
96
Larynx innervated by
CN X Vagus
97
Motor: All intrinsic muscles EXCEPT the _____ are innervated by the _______
Cricothyroid; RECURRENT LARYNGEAL NERVE
98
Motor : The cricothyroid muscle is the only muscle not innervated by the laryngeal nerve , and is innervated by?
SUPERIOR LARYNGEAL NERVE.
99
Sensory : larynx innervation
INFERIOR BRANCH of SUPERIOR LARYNGEAL NERVE
100
What is the function of the inferior branch of superior laryngeal nerve?
Provides sensation for upper portion of the larynx down to and including upper half of the vocal cords.
101
What is the function of the RECURRENT LARYNGEAL NERVE?
Transmits sensation below that TRUE CORDS and half of the LOWER CORDS
102
Trachea is a ________tube, approx. _____long and ______ in diameter?
Fibrocartilaginous, 10-20cm and 12mm in diameter
103
Where does the trachea begins?
AT end of larynx (C6) and extends to T5-T6
104
What is the trachea supported by ?
16-20 C-Shaped rings of cartilage with smooth muscle posteriorly.
105
What is the lowest most portion of the trachea where it divides into PRIMARY bronchi?
CARINA
106
what is the trachea lined with? which function as?
Ciliated pseudostratified Epithelium which functions as MUCOCILIARY ESCALATOR.
107
The lungs produce ____Ml of mucous per day
100ml
108
What help trap precipitate?
Turbulent flow
109
Additional way to remove inhaled particles?
Cough Reflex
110
Explain the mucociliary Escalator Mechanism
Impaired by endotracheal intubation & Volatile anesthetics
Ciliary epithelial cells beat particles up the airway to be swallowed in the OROPHARYNX
Cilia remove "contaminated mucous"
111
Branching of Tracheobronchial Tree: Conducting ? does exchange occur here?
Dead zone TMLSBT
Trachea --> L and R main bronchi -->Lobar bronchi -->Segmental bronchi -->Bronchioles -->Terminale Bronchioles.
NO
112
Branching of Tracheobronchial Tree: RESPIRATORY?
| Does exchange occur here?
Respiratory Bronchioles -->Alveolar ducts -->Alveolar Sacs --> Alveoli.
Yes
113
Conducting zone: Secondary LOBAR BRONCHI? what occurs ? how many on the right and left?
Bronchospasm occurs here
| 3 on the right, 2 on the left.
114
Segmental Bronchi? does bronchospasm occur here? Treat how?
Bronchospasm occurs here, it Can be treated by increasing positive pressure, deepening the anesthetic, increasing the inspiratory time of ventilators and directly spraying lidocaine into the trachea.
115
Segmental Bronchi how many on R and left?
TEN on the right, EIGHT on the LEFT
116
TERMINAL BRONCHIOLES
Diameter of and _____ mm contain_________
Relatively thick smooth muscle wall compared to lumen
• Can during asthma attack
• No ________ cells
1 mm; NO cartilage
contract
goblet
117
Parasympathetic --> Ach--> broncho________
constriction
118
Sympathetic --> Epi/NE --> Broncho_______
Dilation
119
Alveoli are formed from birth to age _____ they
| continue to maximally expand until age______
4; 8
120
The respiratory Zone composed of: (4) which is the terminal respiratory unit?
Acinus (terminal respiratory unit)
• Respiratory bronchioles
• Alveolar ducts
• Alveoli
121
Where is the first segment of airway where gas exchange occurs?
Respiratory Bronchioles (Transitional zone)
122
What are the alveolar ducts?
Walls completely lined with alveoli
123
What are the alveolar sacs?
located at end of each 3rd generation of alveolar ducts
124
What is the main mechanism for gas transfer from the alveoli INTO BLOOD? Which dissolve easier?
Diffusion; lipid soluble
125
What is the formula for diffusion?
Area/thickness
126
In a normal lung zone the area of the blood gas interface is about
the size of a tennis court.
127
Alveoli _______million in the adult
300 million
128
What maximize surface area?
Polygon shape.
129
Surrounded by
1000 pulmonary capillaries each
130
Types of Alveoli
Type I alveolar cells - Squamous
| Type II alveolar cells - Cuboital
131
Which type of alveoli involved in gas exchange?
Type I Form walls of alveoli, involved with gas exchange
132
which type of alveoli produce surfactant ? what can they do ?
Type II --> can differential into Type I cells if needed.
133
What happens in chronically injured lung?
Alveolar epithelium is lined entirely by Type II cells, limiting gas exchange.
134
What are pores of Kohn? Function?
opening in the wall between adjacent alveoli.
| Allow for collateral ventilation.
135
What eliminates foreign debris?
Alveolar macrophages.
136
Perfusion Adjustments: Response to reduced ventilation
Decreased airflow => Reduced pO2 in blood vessels =>Vasoconstriction of pulmonary vessels =>Decreased blood flow => blood flow matches airflow.
137
Perfusion Adjustments: Response to increased ventilation
Increased airflow =>Elevated pO2 =>Vasodilation of pulmonary vessels =>increased blood flow => blood flow matches airflow
138
Ventilation Adjustments: Response to reduced perfusion
Decreased blood flow => Reduced PCO2 in alveoli =>Constriction of bronchioles =>Decreased airflow => airflow matches blood flow.
139
Ventilation Adjustments: Response to increased perfusion
Increased blood flow => Elevated PCO2 in alveoli =>Dilation of bronchioles =>Increased airflow =>Airflow matches blood flow.
140
Alveoli have a tendency to
collapse
141
What is alveolar collapse prevented by ?
a. Surfactant
b. Alveolar pores
c. Interdependence
142
What happens when an alveolus start to collapse?
The surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it.
143
Lungs located in the __________ occupy all of thoracic cavity except________
Thorax; mediastinum
144
Right lung has how many lobes______and receives ______ of cardiac output
3; 60%
145
Left lung has how many lobes?
2
146
Which lung lobe is more narrow?
left
147
The lungs are innervated by the __________. _______Fibers T2-T6 and ________ from the vagus.
pulmonary plexus;
Sympathetic fibers
Parasympathetic fibers.
148
Why is there normal perfusion and ventilation (V/Q)?
Because of different surface areas
149
Parasympathetic Fibers produces _______Of the airways and ______Mucus secretion by the mucus glands
Bronchoconstriction
| Increased
150
Sympathetic hormones produce _______of the airways( __ response)
Bronchodilation; B2
151
Serous membranes that line the thoracic cavity and cover the lungs
Pleural membranes.
152
How much pleural fluid produced by lungs? ____cc; and prevents______________________
10; friction in the pleural cavity; creates pressure gradient
153
Attached to outer surface of the lungs
Visceral Pleura
154
Line the wall of the thoracic cavity which pleura?
Parietal
155
One breathing cycle
one cycle of inspiration and one cycle of expiration
156
At rest :
| During exercise:
Quiet respiration
| forced respiration.
157
Flow of air in and out of lung requires a_____
pressure difference between air pressure within lungs and outside body.
158
Muscles of Respiration: INhalation (SEDS)
Sternocleidomastoid
External Intercostals
Diaphragm
Scalene
159
Muscles of Respiration: EXhalation (TRIEDI)
```
Internal Intercostals
Diaphragm
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
```
160
What account for most of TIDAL VOLUME?
Diaphragm
161
Dome shaped muscle that forms the floor of the thorax and separates the thoracic cavity and the abdominal cavity?
Diaphragm
162
The diaphragm into 2 halves:
Hemidiaphragms
163
Right hemidiaphragm is ________ than the left because _____Pushes left side down and ______ raises right side
HIGHER
Heart
LIVER
164
Major: diaphragmatic foramina
- Vena cava foramen
- Esophageal hiatus (esophagus and vagus nerve pass through; SITE OF HIATAL HERNIA
- Aortic Hiatus
165
Diaphragm is supplied by paired
Phrenic nerves
| C3-C5
166
Which C provides 70% contribution of phrenic
C4
167
The innervation allows for
half of the diaphragm to continue working if one side is damaged.
168
Where does sensory diaphragmatic pain referred to?
shoulder areas.
169
Major factors affecting the position of the diaphragm
Recoil of lungs
Thoracic viscera pressure (CHF)
Abdominal viscera pressure (pregnancy)
Abdominal muscle activity (contraction pushes diaphragm upward)
170
Movement during normal breathing?
1-2 cm normal tidal breathing
| 7-13 cm with deep breathing
171
The diaphragm accounts for
60-75% of normal Tidal volume respiration.
172
_______Is a skeletal muscle and you can PARALIZE it ?
Diaphragm
| Yes
173
External intercostal muscles oriented
| Orientation? responsible for what percentage of TV? what happens to the ribs during inspiration?
obliquely forward and downward
responsible for up to 25% of tidal volume that enters lungs during normal breathing at rest
Lift up the ribs during inspiration
174
Internal intercostals muscles oriented?
backward and downward
assist in expiration by pulling the ribcage down
Aids in forced expiration.
175
Pressure changes in ventilation
At rest, diaphragm is relaxed , alveolar pressure is equal to atmospheric pressure and there is no air flow.
176
Inwardly directed force in the alveoli which must be overcome to expand the lungs during inspiration?
Surface tension
177
Decreases the size of the alveoli during expiration
Elastic recoil
178
Ease with which the lungs and thoracic wall can be expanded?
Compliance
179
Surface tension
Inwardly directed force in the alveoli which must be overcome to expand the lungs during each inspiration
180
Elastic recoil
Decreases the size of the alveoli during expiration
181
Compliance
Ease with which the lungs and thoracic wall can be expanded
