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240 Cards in this Set
- Front
- Back
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what constitutes all structures above the trachea?
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upper respiratory system
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what begins the upper respiratory system?
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nose
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what seperates the two nostrils and nasal cavities?
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septum
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the roof of the nasal cavities is formed by what?
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the ethmoid bone
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what are the scroll shaped projections of the lateral walls of the nasal cavities called?
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Conchae (turbinates)
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the nostrils and nasal cavities are lined by what?
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epithelium
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what type of cells in epithelium produce mucous?
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goblet cells
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What are the functions of the nose?
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1-warming of inspired air
2-humidification of inspired air 3-filtering of inspired air |
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What is the nasal cavity also called?
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-fossae, posterior nares, choanae
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When breathing through the nose no particles larger than what enter the lungs?
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6 microns in diameter
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T or F when breathing at rest through the nose, total airway resistance to airflow is about twice that when breathing through the mouth
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True
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when is mouth breathing necessary?
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when high airflow rates are necessary (ex exercise)
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What does the palate form?
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floor of the nasal cavity and roof of mouth
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what is the anterior portion of the palate?
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hard palate
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where is the soft palate attached and what does it seperate?
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attached to posterior portion of hard palate, and seperates nasopharynx from oropharynx
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what projects from the midline posterior border of the soft palate?
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Uvula
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what is the uvula important for?
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-close nasopharynx
-phonation of constants -involved in snoring, sleep apnea, singing |
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what lies above the soft palate and behind the nasal cavities?
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nasopharynx
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what is lymphoid tissue that lie in the lateral walls of the nasopharynx?
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pharyngeal tonsils or adenoids
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what lies behind the oral cavity and below the soft palate?
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oropharynx
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where do the palatine tonsils lie?
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in the lateral walls of the oropharynx
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what do the palatine tonsils do?
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intercept materials that enter the lateral walls of oropharynx
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where does the hypopharynx lie and what is it also called?
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lies behind the opening of the larynx
aka: laryngeal pharynx |
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what does the hypopharynx become continuous with and where?
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esophagus at C6
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what are the functions of the larynx?
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1-phonation
2-protective sphincter at the opening of the lower resp system |
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what is the location of the larynx?
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1-lies below the tongue and hyoid bone
2-lies in front of vertebrae C3-C6 |
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how many cartilages make up the cartilagenous skeleton of larynx?
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9
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what are the 3 single cartilages that makes up skeleton?
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1-thyroid cartilage
2-cricoid cartilage 3-epiglottis |
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what seperates the thyroid cartilage from cricoid cartilage?
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cricothyroid ligament (membrane)
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what is the leaf-shaped cartilage that is attached to back of thryoid cartilage called?
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epiglottis
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what is epiglottis attached to base of tongue by?
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glossoepiglottic folds
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what are the glossoepiglottic folds are depression known as?
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valleculae
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where do the aryepiglottic folds attach to?
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sides of epiglottis to the arytenoid adn corniculate cartilages
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what is the function of the upper epiglottis?
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cover the glottis during swallowing to prevent aspiration
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what are the 3 pairs of cartilages of cartilagneous skeleton?
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1-arytenoid
2-corniculate 3-cuneiform |
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what are the pyramid shaped structures that lie at the back of the larynx?
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arytenoid cartilages
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T or F each arytenoid cartilage has a vocal process that is attached to a vocal fold.
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True
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What cartilages articulate w/ the arytenoid cartilages?
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corniculate cartilages
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where are the corniculate cartilages attached?
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to the aryepiglottic folds
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what are the rod shaped cartilages that lie in the aryepiglottic folds?
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cuneiform
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what do the cuneiform cartilages do/
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strengthen the aryepiglottic folds
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in the laryngeal cavity vestibular folds of fibrous tissue are known as what?
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false vocal cord
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where do the true vocal cords lie?
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inferior to the vestibular folds
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what muscle abduct the vocal cords?
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posterior cricoarytenoid muscles
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what muscles adduct the vocal cords?
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lateral criocarytenoid muscle
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what does the cricothryoid muscle do?
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tenses the vocal cords
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What does the thyroarytenoid muscle do?
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relaxes the vocal cords
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What does the transverse arytenoid muscle do?
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closes posterior portion of the glottis
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What is the triangluar opening btwn the vocal cords?
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glottis
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What is the narrowest portion of the larynx in adults?
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glottis
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what is the narrowest portion of larynx in children < 10?
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cricoid ring
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What is cranial nerve V?
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Trigeminal nerve
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What nerve innervates anterior septum and lateral walls of the nose?
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opthalmic division (ant. ethmoidal nerve)
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What innervates the post. portion of the nose?
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maxillary division (sphenopalatine nerve)
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what nerve provides general sensation to the tongue?
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mandibular division (lingual nerve)
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What nerve innervates the hard and soft palate?
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trigeminal nerve
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what cranial nerve is the facial nerve and what structures does it innervate?
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-cranial nerve VII
-hard and soft palate |
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what cranial nerve is the glossopharyngeal nerve and what does it innervate?
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1-cranial nerve IX
2-roof of pharynx, tonsils, tongue (sensation of taste) |
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What cranial nerve is vagus nerve?
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cranial nerve X
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what nerve provides sensory innervation of the airway below the epiglottis?
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vagus nerve
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what are the two branches of vagus nerve?
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1-Superior laryngeal nerve
2-Recurrent laryngeal nerve |
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WHat are the two branches of the superior laryngeal nerve?
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1-internal laryngeal nerve
2-external laryngeal nerve |
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what provides sensory innervation of the larynx btwn epiglottis and vocal cords?
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internal laryngeal nerve
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what provides sensory innervation of the larynx below the vocal cords and trachea?
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recurrent laryngeal nerve
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why is the recurrent laryngeal nerve called recurrent?
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b/c the branches of the nerve innervate the laryngeal muscles in the neck through a circuitous route; it descends into the thorax before rising up btwn trachea and esophagus to reach the neck
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All laryngeal muscles except cricothyroid muscle are innervated by what nerve?
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recurrent laryngeal nerve
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injury to recurrent laryngeal nerve is a potential consequence of what surgeries?
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1-thyroidectomy
2-parathyroidectomy 3-cervical disc surgery |
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what can result from a unilateral injury to RLN?
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paralysis of ipsilateral vocal cord, hoarseness
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What can result from bilateral injury to RLN?
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acute-stridor, resp distress
chronic-aphonia, less resp probs |
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cricothyroid muscle is innervated by what nerve?
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external laryngeal nerve; tenes the vocal cords
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what can happen w/ unilateral nerve injury to external laryngeal muscle?
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minimal effects on voice
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What can happen w/ bilateral nerve injury external laryngeal nerve?
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hoarseness, tiring of voice, breathing not affected
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Where does the lower respiratory system begin?
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trachea
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how many divisions does the lower resp system have?
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23 divisions or generations of respiratory passageways
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the conducting airways or conducting zone is what generations?
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first 16
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the conducting airway begins w/ what?
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trachea
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the adult trachea is how long and what diameter?
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10-15cm in length
2.5cm in diameter |
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where does the blood supply to trachea come from?
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inferior thryoid artery
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Where does the trachea begin and bifurcate?
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begins at C6 and bifurcates at carina (sternomanubrial joint, T5).
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what anchors the trachea to cricoid cartilage?
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cricotracheal membrane
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how many cartilagenous rings make up the trachea?
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16-20
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the post wall of trachea contains what kind of receptors and what role do they play?
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slowly adapting stretch receptors, play a role in regulation of breathing
-activation can decrease vagal efferent activity |
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what receptors lie around the tracheal wall and what can they trigger?
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rapidly acting irritant receptors, trigger the cough reflec and bronchoconstriction
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what angle does the right bronchus diverge from trachea?
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25 degrees
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the left bronchus diverges at what angle from trachea?
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45degrees
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how many lobes to Right lung?
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3
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how many lobes to left lung?
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2
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orfice of RUL bronchus is how many cm from carina?
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2.5
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LUL orfice is how many cm from carina?
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5
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what maintains patency in bronchi?
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cartilage in walls
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the first how many generations of bronchi have cartilagenous rings?
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7
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bronchi give rise to what?
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bronchioles
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where do the bronchioles begin?
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at the 11th generation
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where do the bronchioles end?
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terminal bronchioles (generation 16)
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What are in the walls of bronchioles?
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smooth muscle, no cartilage
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what does patency of bronchioles depend on ?
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traction exerted by surrounding tissue
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what is function of conducting airways?
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to conduct inspired air to regions of gas exchange in the lung
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Do conducting airways participate in gas exchange?>
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NO, they constitute the anatomic dead space of resp. system
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what is volume of conducting airways dead space?
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150ml (2.0-2.2ml/kg)
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alveolar ducts are lined w/ what?
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alveoli
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alveolar sacs contain approx how many alveoli?
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15-20 alveoli
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what is avg number of alveoli in lungs?
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300million
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what is avg diameter of alveoli?
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0.2-0.3mm (200-300 microns)
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what is total surface area of alveoli?
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50-100m^2
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what are type I epithelial cells?
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flat thin cells for gas exchange
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what do type II epithelial cells do?
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produce pulm surfactant
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what are some other cell types in alveoli?
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-alveolar macrophages
-mast cells |
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what does the muscous coating from nose to terminal bronchioles do?
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-keeps surface moist
-traps small inhaled particles |
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cilia in nose beat which direction?
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downward
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cilia in bronchi and bronchioles beat which direction?
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upward
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cilia do what?
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move mucous and entrapped particles to pharynx to be swallowed or expectorated
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what do pulm. arteries do?
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direct deoxygenated blood to pulmonary capillaries
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what is avg diameter of pulm capillaries?
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10microns
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what are lg diameters and thin walls, distensible and more compliant?
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pulmonary arteries
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what is the consequence of having the pulm interstitium be rich in albumin?
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minimal change in pulm capillary pressure will cause edema in interstitium
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what do pulmonary veins do?
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deliver oxygenated blood to the left side of the heart
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does bronchiole circulation supply blood to alveoli?
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no
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what do bronchiole arteries do?
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direct oxygenated blood to lung tissue, connective tissue, lg and sm bronchi
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where does venous blood drain?
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into pulm veins and is delivered to the left atrium
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where do pulm capillaries originate?
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in interstitial space surrounding the terminal bronchioles
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where do lg lymphatic vessels travel and empty?
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travel upward next to airways, empty into right thoracic duct
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what do pulmonary lymphatics do?
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remove particulate matter that crosses the alveoli into interstitium
-also returns albumin present in interstitum back to circulation |
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the lungs are located where?
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in thoracic cavity
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the _______ is the central compartment of the thoracic cavity?
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mediastinum
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the mediastinum has how many subdisvisions?
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4-superior
anterior posterior middle |
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what are the surgical procedures that involve the mediastinum?
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CABG, thymectomy, medstinoscopy
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each lung is surrounded by a double membrane layer known as what?
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pleura
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what layer lines the inner chest wall, diaphragm, and mediastinum?
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parietal pleura
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what layer covers the outer surface of the lung?
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visceral
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what kind of receptors are located in the parietal pleura?
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nociceptors (pain receptors)
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what is the narrow space btwn the pleura known as?
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the pleural space (intrapleural space)
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what does the pleural space do?
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contains several ml of pleural fluid which acts to hold the lungs against the inner chest wall
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the apex of the thoracic cavity allows passage of what?
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trachea
esophagus nerves blood vessels lymphatics |
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what are the nerves that are allowed passage through the apex of the thoracic cavity?
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phrenic
vagus recurrent laryngeal sympathetic trunk |
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what blood vessels run through the apex of the thoracic cavity?
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carotid
subclavian arteries internal jugular and subclavian veins |
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the base of the thoracic cavity is formed by what?
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the diaphragm
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what is the pleural space?
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narrow space btwn the visceral and parietal plurae; contains several ml of pleural fluid
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the pleural pressure is normally subatmospheric (negative) due to what?
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elastic recoil of the lung and chest wall
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at end-expiration the avg pleural pressure is approx what?
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-5cmH20
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during normal inspiration avg pleural pressure decreases to what?
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-7.5cmH20
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what is alveolar pressure?
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pressure w/in the lung alveoli
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when glottis is open and no air is moving into or out of the lung, alveolar pressure is equal to what?
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atmospheric pressure (0cmH20)
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during normal inspiration, PA falls to__________-, causing mvt of a volume of air (___) into lungs over a period of __seconds?
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-1cmH20
500ml 2 |
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during normal expiration PA increases to ____cmH20, causing expiration of same volume of gas over period of ______seconds?
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+1cmH20
2-3 |
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transpulmonary pressure=?
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difference btwn alveolar pressure and pleural pressure
(value is normally positive) |
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The transpulmonary pressure is?
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-a distending pressure that tends to keep the alveoli expanded
-a measure of the elastic forces that tend to collapse the lung at any of its expansion |
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what is the most important muscle of inspiration?
|
diaphragm
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where does the diaphragm insert?
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into the lower ribs-arranged as two domes (hemidiaphragms), form the base of thoracic cavity and can function independently
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what do the slow twitch endurance muscle fibers do?
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used for continual breathing w/o fatigue
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fast twitch muscle fibers of diaphragm used for?
|
useful for short bursts of maximal ventilatory effort
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the hemidiaphragms are innervated by what?
|
phrenic nerves
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where do the phrenic nerves originate from?
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C3-C5
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injury to or local anesthetic block of phrenic nerve will cause what?
|
paralysis of the ipsilateral hemidiaphragm
|
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contraction of the diaphragm forces abd contents where?
|
downward, increasing the superior-inferior(vertical) dimension of the thorax
|
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during normal tidal breathing the diaphragm moves how many cm?
|
1-2
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what are the external intercostal muscles?
|
skeletal muscles that connect adjacent ribs; slope downward and forward
|
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contraction of external intercostal muscles pulls ribs which direction?
|
upward and forward
-increases the anterior and posterior diameter of the thorax |
|
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the external intercostal muscles are innervated by what?
|
somatic intercostal nerves that originate from spinal cord segments at the same level
|
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when do external intercostal muscles become important?
|
during forceful inspiration
|
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what are the most important accessory muscles?
|
cervical strap muscles
|
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what do the cervical strap muscles do?
|
assist elevation of the sternum and upper chest wall
|
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what muscles become the primary inspiratory muscles when diaphragm function is impaired?
|
cervical strap muscles
|
|
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what muscles raise the sternum and scalene muscles?
|
sternocleidomastoid muscles
|
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when does the sternocleidomastoid muscles become important?
|
during forceful inspiration (exercise)
|
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what is normal breathing?
|
eupnea
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during normal breathing expiration is _________- and results from what?
|
passive, elastic recoil of the lung and chest wall
|
|
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internal intercostal muscles pull ribs which direction?
|
downward and inward
|
|
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what are the muscles of the abd wall?
|
-rectus abdominus
-transversus abdominus -internal and external oblique |
|
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what does contraction of abd muscles cause?
|
increase intra-abd pressure, raising the diaphragm
|
|
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what is hysteresis?
|
inspiratory curve is different from expiratory curve
|
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in the pressure volume curve the compliance of the lung is represented as what?
|
the slope at any point
|
|
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an increase in volume of the thoracic cavity does what to pleural and alveolar pressure?
|
decreases
|
|
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what is normal range of transpulmonary pressures?
|
5-10cmH20
|
|
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compliance is less when?
|
at low and high lung volumes
|
|
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what are some factors that reduce compliance?
|
1-interstitial edema
2-fibrosis 3-obesity 4-external compression of lung tissue |
|
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what are some factors that increase lung compliance?
|
1-aging
2-emphysema |
|
|
what are the elastic forces of the lung?
|
-elastic recoil of interwoven elastic fibers
-surface tension |
|
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what are the SI units for surface tension?
|
N/M (force/distance)
|
|
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what does surface tension do?
|
cause collapse of alveoli
|
|
|
surface tension accounts for how much of total elastic forces in the lungs?
|
66%
|
|
|
what does pulmonary surfactant do?
|
reduces surface tension in the alveoli
|
|
|
surface active agent is produced by what?
|
type II epithelial cells in alveoli
|
|
|
what is one component of surfactant?
|
dipalmitoyl lecithin
|
|
|
what is the physiological significance of pulmonary surfactant?
|
-reduced surface tension
-increases lung compliance -reduces work of breathing |
|
|
production of surfactant begins when?
|
28-32 weeks gestation
|
|
|
babies born w/o adequate amts of surfactant may develop infant RDS and lungs will be?
|
-stiff lungs (low compliance)
-areas of atelectasis -fluid in alveoli |
|
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what is L/S ratio?
|
-lecithin/spingomyelin ratio
(indicates amt of mature surfactant present in fetus |
|
|
compliance of the lung-thorax combination is approx how much of lung alone?
|
one half
|
|
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what kind of pressure is necessary to expand the lung-thorax combination?
|
transpulmonary pressure
|
|
|
what is parabolic velocity profile?
|
molecules in center of stream have highest velocity
|
|
|
according to Poiseuille's law pressure drop is proportional to what?
|
flow rate
|
|
|
resistance is inversely related to?
|
the fourth power of the radius
|
|
|
resistance is directly related to?
|
the gas viscosity
|
|
|
what is the most important in determining pressure drop for a given flow rate?
|
gas density is much more important than viscosity
|
|
|
laminar flow occurs where in respiratory tree?
|
in very small airways
|
|
|
where might turbulent flow occur?
|
trachea
|
|
|
what is gas flow like in tracheobronchial tree?
|
transitional-some turbulence occuring at branch points in resp passageways
|
|
|
what is total airway resistance?
|
difference btwn atmospheric pressure of mouth and alveolar pressure/ flow rate
|
|
|
where is the chief site of airway resistance?
|
medium sized bronchi
|
|
|
what is one determinant of airway resistance?
|
lung volume
|
|
|
as lung volumes during expiration decrease the diameters of smaller bronchi does what?
|
decrease-causing their resistance to increase
|
|
|
what are some causes of bronchodilation?
|
-epinephrine
-exogenous beta-2 agonists -nitric oxide |
|
|
total work of inspiration=?
|
avg pressure of inspiration x tidal volume
|
|
|
what is compliance work?
|
work required to expand the lungs against the forces of the lungs and thoracic wall
|
|
|
what is tissue resistance work?
|
work required to overcome viscous forces in the lungs and thoracic wall
|
|
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what is airway resistance work?
|
work required to overcome resistance to air flow through the airways
|
|
|
during normal breathing most of work of inspiration is what?
|
compliance work
|
|
|
at rest how much of total body oxygen consumption is used for breathing?
|
3%
|
|
|
what is tidal volume?
|
volume of air inspired or volume of gas expired with each breath
|
|
|
what is IRV?
|
inspiratory reserve volume
-amt of air that can be inspired over and above the resting tidal volume |
|
|
what is ERV?
|
expiratory reserve volume
-amt of gas that can be expired beyond a normal tidal expiration by forceful expiration |
|
|
what is ERV volume?
|
1100ml
|
|
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what is IRV volume?
|
3000ml
|
|
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what is normal Tidal volume at rest?
|
500ml
|
|
|
what is RV?
|
residual volume
-volume of gas remaining in the lungs after maximal expiration |
|
|
what is RV volume?
|
1200ml
|
|
|
what is pulmonary capacities?
|
combination of two or more pulmonary volumes
|
|
|
what is IC?
|
inspiratory capacity
-amt of air that a person can inspire beginning at normal end-expiration and maximally expanding the lungs |
|
|
what is FRC?
|
functional residual capacity
=expiratory reserve volume + residual volume |
|
|
FRC means?
|
amt of gas remaining in the lungs at the end of a normal expiration
|
|
|
what are the factors affecting FRC?
|
1-body habitus
2-gender 3-restrictive pulmonary diseases 4-posture 5-anesthesia reduces FRC |
|
|
what is VC and its definition?
|
vital capacity= IRV + Vt+ERV
-amt of gas expelled from the lungs during a maximal expiration that follows a maximal inspiration |
|
|
what is total lung capacity?
|
TLC=FRC+IC
-maximal volume to which the lungs can be expanded w/ a maximal inspiratory effort |
|
|
what can spirotmetry not measure?
|
cannot measure FRC, RV, and TLC
|
|
|
how can u measure FRC?
|
helium dilution method
-measures only the ventilated lung volume and not the volume of air trapped behind collapsed airways |
|
|
what does body plethysmograph measure?
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the total volume of gas in the lung; including that trapped behind collapsed airways
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when is boyle's law applied?
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body plethysmograph-when total volume of gas in lung is measured
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what is total ventilation?
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product of tidal volume and respiratory rate
-approx 6L/min at rest |
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what is alveolar ventilation?
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not all of the tidal volume reaches the sites of gas exchange in the respiratory zone, some is held within the conducting airways (anatomic dead space) of the resp system
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what is volume of anatomic dead space?
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approx 150ml
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what is FACo2?
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fractional concentration of CO2 in alveolar gas
-normally about 5.3% |
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what is primary determinant of the partial pressures of oxygen and CO2 in alveolar gas?
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alveolar ventilation
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what is alveolar dead space?
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volume of air contained in alveoli that are ventilated but are poorly or not at all perfused
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what is Bohr's method used for?
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measures volume of the lung that does not eliminate CO2
-gives ratio of dead space volume to tidal volume |
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in indiv w/ normal respiratory fxn, VD/VT is what?
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0.20-0.35
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where is pleural pressure more negative in the lung?
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at the apex of the upright lung is more negative than at the base
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what is the equal pressure point?
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when the transmural pressure difference will become zero
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what does the flow volume curve demonstrate?
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-the phenomenon of dynamic airway compression
-maximal inspriration followed by maximal expiration |
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what is the lung volume at which airways in the dependent regions of the lung begin to close during expiration called?
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closing capacity
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what is the vital capacity measured w/ an exhalation that is as forceful and rapid as possible?
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forced vital capacity
-commonly performed PFT's -provides info regarding airway resistance |
