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