RESPIRATORY pp

Question 1

Respiratory track parts

Answer 1

Nose
Pharynx = Naso P. / Oro P. / Laryngo P.
Larynx = voice-box
Trachea = windpipe
Bronchi = airways
Lungs
Alveoli - site of gas exchange
Locations of infections
upper respiratory tract is above vocal cords
lower respiratory tract is below vocal cords

Question 2

Nasal structure external

Answer 2

Skin, nasal bones, & cartilage lined with mucous membrane
Openings called external nares or nostrils

Question 3

Nasal structure internal

Answer 3

Large chamber within the skull
Roof is made up of ethmoid and floor is hard palate / Maxilla
Internal nares (choanae) are openings to pharynx
Nasal septum is composed of bone & cartilage
Conchae on lateral walls turbinate, moisten & warm air

Question 4

Pharynx

Answer 4

Muscular tube (5 inch long) hanging from skull skeletal muscle & mucous membrane
Extends from internal nares to cricoid cartilage
passageway for food and air
resonating chamber for speech production
tonsil (lymphatic tissue) in the walls protects entry-way into body

anatomical regions

1. Nasopharynx
2. Oropharynx
3. Laryngopharynx

Question 5

Nasopharynx

Answer 5

From choanae to soft palate openings of auditory (Eustachian) tubes from middle ear cavity adenoids or pharyngeal tonsil in roof

Passageway for air only

Question 6

Oropharynx

Answer 6

From soft palate to epiglottis
fauces is opening from mouth into oropharynx
palatine tonsils found in side walls, lingual tonsil in tongue

Common passageway for food & air

Question 7

Laryngopharynx

Answer 7

Extends from epiglottis to cricoid cartilage / post. to larynx
Epiglottis folds down to cover opening to trachea when swallowing
Common passageway for food & air & ends as esophagus inferiorly

Question 8

Larynx

Answer 8

Cartilage & connective tissue tube
Anterior to C4 to C6
Constructed of 3 single & 3 paired cartilages

Question 9

cartilages of larynx

Answer 9

Thyroid cartilage forms “Adam’s Apple”

Epiglottis—leaf-shaped piece of elastic cartilage during swallowing, larynx moves upward

epiglottis folds down to cover glottis when swallowing to divert food into esophagus and keep food out of trachea (wind pipe)

Question 10

vocal cords

Answer 10

False vocal cords (ventricular folds) found above vocal folds (true vocal cords)
True vocal cords attach to arytenoid cartilages

Question 11

airway epithelium

Answer 11

Ciliated pseudostratified columnar epithelium with goblet cells produce a moving mass of mucus / smoking destroys cilia

Question 12

trachea

Answer 12

Size is 5 in. long & 1in. diameter
Extends from larynx to T5 anterior to the esophagus and then splits into bronchi at Carina
Layers:
mucosa = pseudostratified columnar with cilia & goblet
submucosa = loose connective tissue & seromucous glands
hyaline cartilage of 16 to 20 incomplete “C” rings
open side facing esophagus to accommodate swallowing
opening of “C” ring to the posterior

Question 13

tracheostomy vs intubation

Answer 13

Re-establishing airflow past an airway obstruction

• crushing injury to larynx or chest
• swelling that closes airway
• vomit or foreign object

Tracheostomy is incision in trachea below cricoid cartilage of the larynx if larynx is obstructed

Intubation is passing a tube from mouth or nose through larynx and into the trachea

Question 14

bronchi and bronchioles

Answer 14

Primary bronchi supply each lung / branch forming secondary br.
Secondary bronchi supply each lobe of the lungs (3 right + 2 left)
Tertiary bronchi supply each bronchopulmonary segment
Repeated branchings called bronchioles form a bronchial tree

Question 15

Histology of Bronchial Tree

Answer 15

Epithelium changes from pseudostratified ciliated columnar to nonciliated simple cuboidal as pass deeper into lungs / smoking destroys cilia

Incomplete rings of cartilage replaced by rings of smooth muscle & then connective tissue
Sympathetic NS & adrenal gland release epinephrine that relaxes smooth muscle & dilates airways
asthma attack or allergic reactions constrict distal bronchiole smooth muscle
nebulization therapy = inhale mist with chemicals that relax muscle & reduce thickness of mucus

Question 16

Lobue of lung structure

Answer 16

A lobule is formed by a compartment wrapped by elastic connective tissue

Terminal bronchiole branches to a Respiratory Bronchiole

Arteriole, venule & lymphatic vessel wrap around a Respiratory Bronchiole
Arterioles form alveolar capillaries and surround alveolar sacs / alveoli

Question 17

Alveolar cell types

Answer 17

Type I alveolar cells
simple squamous cells where gas exchange occurs

Type II alveolar cells (septal cells)
secretes alveolar fluid containing surfactant
surfactant reduces the surface tension of the alveoli allowing them to open and receive air for gas exchange
reduced production of surfactant in premature baby causes Respiratory Distress Syndrome

Alveolar macrophages - lie Outside in air space

Question 18

alveolar-capillary membrane

Answer 18

Respiratory membrane = 1/2 micron thick

Exchange of gas from alveoli to blood and from blood to alveoli

Membranes for gases to diffuse across type I & type II alveolar epithelial cells endothelial cells forming capillary wall the membrane of the RBC / oxygen inside RBC

Vast surface area provided by branching of alveolar capillaries = handball court

Question 19

pleural membrane and cavity

Answer 19

Visceral pleura covers lungs — parietal pleura lines ribcage & covers upper surface of diaphragm
Pleural cavity is potential space between ribs & lungs

Question 20

quiet inspiration

Answer 20

Diaphragm moves 1 cm & ribs lifted by muscles
Diaphragm innervated by Phrenic Nerve
Intrathoracic pressure falls and 2-3 liters inhaled

Question 21

quiet expiration

Answer 21

Passive process with no muscle action
Elastic recoil of abdominal organs & lungs compresses the size of the lungs increasing the pressure by making volume smaller
Alveolar pressure increases & air is “pushed” out

Question 22

Labored Breathing

Answer 22

Forced expiration
abdominal m. force diaphragm up
internal intercostals depress ribs
lung volume is decreased
emphysema “builds “up m.

Forced inspiration
sternocleidomastoid, scalenes & pectoralis minor lift chest upwards as you gasp for air

Question 23

alveolar pressure changes

Answer 23

When alveolar pressure decreases air “rushes in

When alveolar pressure increases air “rushes out

Question 24

pneumothorax

Answer 24

The pleural cavities are sealed cavities not open to the outside / lined with serous membrane

Injuries to the chest wall may let air enter the intrapleural space

collapsed lung on same side as injury
surface tension and recoil of elastic fibers within lung causes the lung to collapse / “pull” away from thoracic wall
the lung cannot inflate if it is not adhered to the thoracic cavity
pressure equalization causes a pneumothorax

Question 25

compliance of lungs

Answer 25

Ease with which lungs & chest wall expand and recoil depends upon the elasticity of lungs & surface tension

Question 26

airway resistance

Answer 26

Resistance to airflow depends upon airway Size increase size of chest airways Increase in diameter / Pressure decreases contract or relax smooth muscles in airways (particularly the bronchioles) asthma causes smooth muscle to contract adrenalin / epinephrine like medicine opens airway by dilating bronchiole

Question 27

lung volumes and capacities ADULT

Answer 27

Tidal volume = amount air moved during 1 breath ~ 500 cc MVR= minute ventilation is amount of air moved in a minute Reserve volumes ---- amount you can breathe either in or out above that amount of tidal volume Residual volume = 1200 mL permanently trapped air in system Vital capacity & total lung capacity are sums of the other volumes

Question 28

Hyperbaric Oxygenation

Answer 28

Use of pressure to dissolve more O2 into the blood treatment for patients with anaerobic bacterial infections (tetanus and gangrene) anaerobic bacteria die in the presence of O2 Hyperbaric chamber pressure raised to 3 to 4 atmospheres so that tissues absorb more O2 Used to treat heart disorders, carbon monoxide poisoning, cerebral edema, bone infections, gas embolisms & crush injuries

Question 29

external respiration

Answer 29

Exchange of gas(O2&CO2) between Air & Blood Gases diffuse from areas of high partial pressure to areas of lower partial pressure Deoxygenated blood becomes saturated Compare gas movements in pulmonary capillaries to tissue capillaries

Question 30

internal respiration

Answer 30

Exchange of gases between blood & tissues Conversion of oxygenated blood into deoxygenated blood Note: diffusion of O2 inward at rest 25% of available O2 enters cells during exercise more O2 is absorbed Note: diffusion of CO2 outward

Question 31

gas transport

Answer 31

Oxyhemoglobin contains 98.5% chemically combined oxygen and hemoglobin inside red blood cells Hgb + O2 = oxyhemoglobin is “bright red” Deoxyhemoglobin is “blue” only 1.5% of oxygen transported dissolved in blood There are several factors affecting dissociation of O2 from hemoglobin / pH, CO2 levels, temperature Remember - the Hbg has a lot of O2 to dissociate from and it must dissociate at the right time and place in body

Question 32

carbon dioxide transport

Answer 32

1. Is carried by the blood in 3 ways 1. 7% dissolved in plasma 2. 23% combined with the Globin part of Hb molecule forming Carbamino-hemoglobin 3. 70% as part of a Bicarbonate Ion CO2 + H2O combine to form carbonic acid that dissociates into H+ and bicarbonate ion CO2 + H2O H2CO3 H + HCO3(bicarbonate) bicarbonate dissociates to CO2 in lungs

Question 33

Acidity & Oxygen Affinity for Hb

Answer 33

As acidity increases, O2 affinity for Hb decreases H+ binds to hemoglobin & alters it / O2 “falls” off Hb O2 left behind in needy tissues

Question 34

CO2 and acidosis

Answer 34

increaseCO2 = increaseacidosis CO2 + H2O = H2CO3 = H + HCO3 carbonic bicarbonate acid ion HgbO2 + H causes O2 to be more “easily released” from the Hgb and the Hgb now binds to the H acting as a buffer forming HgbH Buffers are compounds that combine to H ions

Question 35

pCO2 & Oxygen Release

Answer 35

As pCO2 rises with exercise, O2 is released more easily CO2 converts to carbonic acid & becomes H+ and bicarbonate ions & lowers pH.

Question 36

Temperature & Oxygen Release

Answer 36

As temperature increases, more O2 is released Metabolic activity & heat increases the release of O2 from the Hgb

Question 37

hypoxia types

Answer 37

Hypoxia - A deficiency of Oxygen at the tissue level 4 Types 1. Hypoxic hypoxia - low oxygen in the blood from high altitude / airway obstruction / fluid in lungs 2. Anemic hypoxia - reduced hemoglobin in blood from blood loss / anemia / Hgb combined to CO 3. Ischemic hypoxia - blood flow to tissue is reduced from infart or cut vessel to organ 4. Histotoxic hypoxia - blood delivers adequate oxygen but cells can not use it as from cyanide poisioning

Question 38

CNS respiratory center

Answer 38

Involuntary respiration controlled by neurons in Pons and Medulla of the Brain Stem

Question 39

regulation of respiratory center

Answer 39

Influences from Cortex of Cerebrum voluntarily alter breathing patterns limitations are buildup of CO2 & H+ in blood this will stimulate the respiratory center in the pons and medulla of the brain stem fever and pain increase respiratory rate if you hold your breath until you faint----breathing will resume

Question 40

chemical regulation of respiration

Answer 40

Central chemoreceptors in medulla respond to changes in H ions(acid) or pCO2 hypercapnia = slight increase in pCO2 is noticed Peripheral chemoreceptors respond to changes in H ions(acid) , pO2 or PCO2 aortic body---in wall of aorta nerves join vagus nerve carotid bodies--in walls of common carotid arteries nerves join glossopharyngeal nerve