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230 Cards in this Set

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two different categories of ligaments of the larynx
extrinsic and intrinsic
what do the extrinsic ligaments do?
connect the larynx either inferiorly to trachea or to the hyoid bone above the larynx
name 3 extrinsic ligaments of the larynx
a. hyoepiglottic
b. cricotracheal
c. thyrohyoid
origin and insertion of the cricotracheal mm
origin:cricoid
insertion: 1st tracheal ring
name of the type of ligaments that connect the laryngocartilages together
instrinsic ligaments of the larynx
name the two intrinsic ligaments of the larynx
cricothyroid
thyroepigottic
origin and insertion of the thyroepiglottic ligament
origin: thryoid
insertion: tapered inferior end of the epiglottis
shape and orientation of the laryngeal inlet
oval and oblique
how does the laryngeal inlet project?
projects backward and upward into the laryngopharynx
what is lateral to laryngeal inlet?
piriform fossa/recess/sinus on both sides
folds of tissue projecting into the lumen of the larynx from the lateral walls of the larynx
laryngeal folds
two types of laryngeal folds
vestibular and vocal folds
vestibular/ventricular folds are also called?
false vocal cords
where are the false vocal cords located?
superior and lateral to the true vocal cords
appearance of the vestibular folds?
pinkish in color due to their vascularity
what lies under vestibular folds and helps to form them?
vestibular ligament
attachment of the vestibular ligament?
anteriorly: attaches to the inner surface of the angle of the thyroid cartilage
posteriorly: attaches to the upper anterior lateral aspect of the arytenoid cartilage
another name for vocal folds
true vocal cords
location of vocal folds in comparision to the vestibular folds
more inferior and medial
appearance of the vocal folds?
whitish due to poor vascularity, which makes it less likely to become infected w/ a URI
lies under vocal folds, helps form them
vocal ligament
attachment of vocal ligament
anterior: tip of the vocal process of the arytenoid cartilage
posterior: inner surface of the angle of the thyroid
what is reinke's space?
potential space lying b/t the epithelium that covers the vocal fold and the underlying vocal ligament
what do you have when there is swelling over the true vocal cords?
reinke's edema: caused by an accumulation of fluid in reinke's space
what is the first thing that occurs pathologically in response to irritation of the true cords?
reinke's edema
how do you resolve reinke's edema?
remove the irritant
does reinke's edema resolve quickly?
no, b/c there are no lymph vessels in the true vocal cords
what could reinke's edema lead to?
difficult intubation
reinke's edema is common in what pt's?
GERD, it causes irritation of the cords
opening b/t the true vocal cords and arytenoid cartilages
rima glottidis
narrowest portion of upper airway in adults
rima glottidis
rima glottidis and true vocal cords
glottis
3 laryngeal cavities
vestibule
ventricle
infraglottic (subglottic)
part of laryngeal cavity b/t laryngeal inlet and vestibular folds
vestibule
small part of laryngeal cavity b/t the vestibular folds and vocal folds
ventricle
portion of laryngeal cavity below vocal cords to the end of the larynx
infraglottic (subglottic) cavity
which muscles move the entire larynx as a whole? lifts it up?
extrinsic muscles/longitudinal mm's
where are all of the extrinsic mm's inserted and what happens when they contract?
they are all inserted into the posterior border of the thyroid cartilage, upon contraction, they elevate the entire larynx during swallowing, helping to close laryngeal inlet and prevent aspiration
names of the extrinsic mm's of the larynx?
stylopharyngeus
palatopharyngeus
salpingopharyngeus
which mm's are involved w/ the movement of a part of the larynx?
intrinsic mm's of the larynx
contraction of the intrinsic mm's of the larynx can result in which two things:
modifying the laryngeal inlet
movement of the true vocal cords
which intrinsic mm's of the larynx are involved w/ modifying the laryngeal inlet?
aryepiglottic
oblique arytenoideus
thyroepiglottic
which two intrinsic mm's of the larynx are involved in narrowing the laryngeal inlet?
aryepiglottic and oblique arytenoideus
origin and insertion of the oblique arytenoideus mm
origin: muscular process of arytenoid cartilage
insertion: apex of the other arytenoid cartilage unless it continues on to join with the ariepiglottic mm
which mm is involved in widening the larygneal inlet?
thryoepiglottic
3 mm's involved in changing the tension and length of the vocal cords
cricothyroid
thyroarytenoideus
--vocalis
mm that increases tension and length of true vocal cords
cricothyroid
mm's that decrease tension and length of the true vocal cords
thyroarytenoideus and vocalis mm
origin and insertion of the thyroarytenoideus mm
origin: angle of the thyroid
insertion: anterolateral aspect of the arytenoid cartilage
which mm contracts and pulls/tilts the thyroid cartilage forward?
cricothyroid
which mm contracts and pulls the arytenoid cartilage forward towards the thyroid cartilage?
thyroarytenoideus
what lies immediately lateral to the vocal ligaments and is involved in relaxation of true vocal cords?
vocalis mm
adductor mm of the larynx
lateral cricoarytenoideus
oblique arytenoid
transverse arytenoid
origin/insertion of the lateral cricoarytenoideus mm
origin: lateral aspect of the cricoid
insertion:muscular process of the arytenoid cartilage
which mm helps close the rima glottidis by pulling the muscular processes forward and vocal processes more medially
lateral cricoarytenoideus
what adductor mm closes the rima glottidis by pulling the muscular processes forward and moves the vocal processes medially bringing the vocal cords together
lateral cricoarytenoideus mm
which adductor mm just brings the vocal cords together and helps to close the rima glottidis?
lateral cricoarytenoideus
which adductor mm contracts and pulls the arytenoids closer and helps to close the rima glottidis?
transverse arytenoid mm
which adductor mm brings 2 arytenoid cartilages and vocal cords together to close the rima glottidis
oblique arytenoid
only abductor mm of the vocal cords
posterior cricoarytenoid
origin and insertion of the posterior cricoarytenoid
origin:posterior aspect of the cricoid
insertion: muscular process of the arytenoid
what happens when the posterior cricoarytenoid mm contracts?
it pulls the muscular processes medially and the vocal processes laterally, opening the rima glottidis
epithelial lining of the larynx
respiratory epithelium, except for true vocal cords which are stratified squamous
epithelial lining of the true vocal cords
stratified squamous epithelium
why are the true vocal cords lined w/ stratified squamous?
need a more durable epithelium d/t the vibration they are exposed to
mucous glands of the larynx are innervated by?
PSNF from vagus
what arteries provide blood supply to the larynx?
superior and inferior thyroid artery
superior thyroid artery branches into the?
superior laryngeal artery
venous drainage of the larynx
internal jugular vein
lymphatic drainage from the larynx will drain into the?
deep cervical lymph nodes
sensory innervation from laryngeal inlet to the upper 1/2 of true vocal cords
internal laryngeal nn
(branch of superior laryngeal, which is branch of vagus)
carries sensory info from lower 1/2 of true vocal cords to bottom of larynx
recurrent laryngeal
in the area of the larynx, what happens to the recurrent laryngeal nn?
it terminates, becoming the inferior laryngeal nerve
2 branches of the recurrent laryngeal nn?
right recurrent laryngeal:branch given off of vagus that turns around after passing over brachiocephalic artery and ascends back up to the neck area to innervate the larynx
left recurrent laryngeal:branch off of vagus that turns around and ascends after passing over aortic arch
motor innervation of the extrinsic mm's of the larynx
stylo: CN IX
palato:CN X (XI)
salpingo: CN X (XI)
motor innervation of the intrinsic mm's of the larynx, except the cricothyroid mm? what is the innervation of the cricothyroid?
recurrent laryngeal; external laryngeal
unilateral cutting of the recurrent laryngeal nn results in?
flaccid paralysis of corresponding vocal fold, hoarseness (can happen during thyroid sx)
bilateral cutting of the recurrent laryngeal nn results in?
paralysis of both vocal folds, loss of voice. during inspiration, could lead to occlusion of the airway due to neg pressure pulling the two cords together and closing the airway
external laryngeal nn is a branch off of the?
superior laryngeal nn, which is a branch of the vagus
what innervates the mucus glands of the larynx?
PSNF from CN X
the trachea is described as what type of tube?
fibrocartilaginous
trachea begins and ends where?
begins at inferior end of larynx and passes down to imaginary line at the sternal angle anteriorly, and the IVD b/t T4 & T5 posteriorly
midline structure passing down the neck from superior mediastinum down to the level of the sternal angle at the carina
trachea
midpoint of trachea
horizontal level corresponding posteriorly to T2 and anteriorly to the jugular notch, ideal for distall end of ETT
what makes of the walls of the trachea
anterolateral walls are made up of 16-20 C shaped cartilages that are open ended posteriorly
open ends of the trachea become closed by what?
trachealis mm
what type of mm is the trachealis?
sm mm
what do you sometimes see happen with the cartilages of the trachea?
they bifurcate
what is the fxn of the C-shaped cartilage of the trachea?
to keep the airway open
what is the appearance of the trachea posteriorly?
flattened, lies anterior to esophagus, which is flat
where does the trachea divide into the right and left mainstem bronchi?
carina, lowermost portion of trachea
along w/ the trachealis mm, what else will you see inthe musculature of the trachea?
increasing amts of collagen and elastin fibers
epithelial lining of the trachea
resp epi along w/ mucous glands in submucosa
arterial blood supply to trachea
branches of:
inferior thyroid
intercostal
bronchial
venous drainage of the trachea
veins of the:
inferior thyroid
intercostal
bronchial
lymphatic drainage of the trachea
a. tracheal (paratracheal)
b. tracheobronchial: superior and inferior
c. inferior deep cervical
inferior tracheobronchial lymph nodes are also called:
carinal nodes
sensory innervation to the trachea
recurrent laryngeal nn, which is a branch off of vagus
what part of the trachea is very sensitive?
carina
motor innervation of trachea
mucus glands innervated by PSNF of Vagus
portion of conducting airways located b/t the trachea and bronchioles
bronchi
3 types of bronchi
primary, secondary, tertiary
2 reasons that the right mainstem bronchi is easily intubated
a. it is more directly aligned w/ trachea
b. it is larger in diameter
what composes the walls of the primary bronchi?
C shaped cartilages closed off by sm mm
the primary bronchi are the last of the ________ ?
extrapulmonary airways
mainstem that is longer & narrower?
left
alignment of left mainstem bronchi?
horizontal
mainstem bronchi that is shorter and wider
right
alignment of right mainstem bronchi?
more vertical, more directly aligned w/ trachea
angle of the left mainstem off of the trachea
45
angle of right mainstem off of trachea in adults
25
angle of both mainstems off of the trachea in babies/children
55
another name for mainstem bronchi
primary bronchi
what surrounds the walls of the intrapulmonary airways?
irregular pieces of cartilage surrounding the entire circumference
1st part of the intrapulmonary airway
secondary (lobar) bronchi
what makes up the walls of the secondary and tertiary bronchi?
irregular shaped pieces of cartilage
how many secondary bronchi do we have?
5, one for each lobe
another name for secondary bronchi?
lobar
another name for tertiary bronchi
segmental
what is last segment of conducting airway that contains cartilage?
bronchi
musculature of the bronchi contains?
sm mm and significant amts of collagen and elastic fibers
epithelial lining of the bronchi
respiratory epi, with some mucous glands present in mucosa
the bronchi is the last segment that you will find what?
mucus glands and cartilage
arterial blood supply to bronchi?
bronchial aa's that can be a direct branch off of the aorta and intercostal aa's
venous return of the bronchi?
bronchial vv's
lymph drainage of your primary bronchi
a. tracheobronchial
(superior & inferior)
b. bronchopulmonary/hilar
lymph drainage of 2ndary and tertiary bronchi
pulmonary(intrapulmonary)
sensory innervation of bronchi
PSNF from vagus
motor innervation of bronchi
mucus glands via pSNF of vagus
another name for bronchioles of conducting airways?
conducting bronchioles
2 definitions of the bronchioles
-airways that are 1mm in diameter
-airways that do not have cartilage in their walls
what is the first part of the conducting airways that has no cartilage in the walls?
conducting bronchioles
there may be as many as ____ generations of branching in the conducting bronchioles
13
branching of the bronchioles can be described as usually ____?
dichotomous
what keeps the walls of the bronchioles from collapsing?
support tissue: collagen and elasic fibers
what happens to the conducting bronchioles in emphysema?
lose support tissue that keeps airways open, leads to airway collapse and air trapping
describe the musculature of conducting bronchioles
lg amt of sm mm in walls relative to lumen size
lots of elastic tissue and some collage
epithelial lining of the conducting bronchioles
modified resp epithelium:
-cells are ciliated cuboidal
-decreasing number of goblet cells as you go down the bronchiolar tree
-increasing number of clara (bronchiolar) cells
why are cells no longer columnar in the conducting bronchioles?
b/c if they were, it would obstruct the narrow lumen
are there goblet cells present in terminal bronchioles?
no
what replaces goblet cells as you descend the bronchiolar tree?
clara/bronchiolar cells
fxn of clara cells
secretory, increase as you go down bronchiolar tree
what is in the submucosa of the conducting bronchioles?
nothing, no mucus cells here
arterial supply to conducting bronchioles
bronchial arteries
venous flow from conducting bronchioles?
pulmonary veins, causing shunting
describe shunt-like condition in conducting bronchioles
blood coming from bronchial artery, gives oxygen and nutrients to the conducting bronchiole, leaves deoxygenated and mixes w/ the pulmonary vein, which is well oxygenated.
in normal, healthy person there is a 1-3% shunt
lymphatic drainage of conducting bronchioles
lymph vv originate as lymph capillaries at terminal bronchioles...forming the deep pulmonary lymphatic plexus. that drains into pulmonary lymph nodes, then bronchopulmonary/hilar
sensory innervation of conducting bronchioles
PSNF of vagus
motor innervation of the bronchioles
PSNF of X---bronchiolar constriction via M3 receptor
SNS: T2-T6 little innervation
Circulating catecholamines: bronchodilation via B2
mechanism of bronchiolar constriction
1. Ach from PSNF binds w/ M3 receptor
2. M3 activates a Gq protein
3. Gq will cause alpha subunit to release GDP
4. GTP comes to bind to alpha subunit, then alpha subunit unit will separate from Gq
5. alpha subunit and GTP will go and bind to PLC, this activates PLC
6. PLC causes GTP to split to GDP and Pi, and PLC acts on PIP2
7. PIP2-->IP3 + DAG (2nd mess)
8. IP3 binds to IP3 receptor on SR, opens CA release channels, moves CA out of SR into cytosol
9.Ca binds to calmodulin, activates myosin light chain kinase
10. MLCK phosphorylates to light chain of the myosin crossbridge
11. head immediately binds to acting binding site, conformation change, powerstroke
12. release of ADP and Pi from myosin head
13. ATP binding site exposed
14. ATP binds, uncouples
15. ATP split, myosin crossbridge head is re-energized
16. cycle continues as long as there is ATP, CA and MLChain is phosphorylated
explain the mechanism of bronchodilation of the conducting bronchioles
circulating catecholamines produce bronchodilation by:
1. Epi binds to B2 receptor, activates a Gs protein
2. Activation causes the alpha subunit to release GDP
3. GTP then binds to alpha, then alpha/GTP are released from Gs protein
4. alpha/GTP attaches to adenylate cyclase and activates it
5. Adenylate cyclase splits ATP to cyclic AMP, which is the second messenger
6. cAMP converts inactive protein kinase, to active protein kinase
7. active protein kinase causes bronchodilation

cAMP will eventually be broken down by phosodiesterase to 5'AMP
the narrowing of airways in COPD is r/t what?
parasymphathetic tone
best way to produce bronchodilation in COPD'ers?
anticholinergic: atrovent/atropine
4 function of conducting airways
a. transport O2 and CO2
b. warming inhaled air
c. humidify inhaled air
d. filtration of inhailed air
how is inhaled air humidifed?
water vapor from mucus membrane: mucus glands, goblets, serous
4 aspects of filtration of inhaled air
mucous
turbulent air flow
beating of cilia
mucociliary escalator
when mucous traps matter/bacteria in conducting airways, and cilia moves it up and out...we call this the?
mucociliary escalator
how does turbulent air flow aid in filtration of inhaled air?
in nasal passages, air can suddenly change direction but the larger inhaled particles can't, so they get stuck in mucus
what depresses your mucociliary escalator?
inhaled agents
explain the total cross-sectional area of the bronchioles
relatively large total cross-sectional area, airflow becomes very slow, so there is very little resistance to airflow despite their very small size
what could potentially connect a preterminal bronchiole to the gas exchange airway?
canal of lambert
when does a canal of lambert form?
only if there is a blockage in terminal bronchiole that prevents ventilation of gaseous exchange airway distal to that terminal bronchiole, it is collateral ventilation
do you see canal's of lambert in healthy peeps?
no
what is the end of the conducting airway and the last of the bronchioles?
terminal bronchiole
(13th if there are 13)
(16th gen in tracheobronchial tree)
those segments of airways that contain alveoli in their walls
gaseous exchange airways
area after the terminal bronchioles
resp bronchioles
how many gen's of resp bronchioles?
3
what happens has you move from 1-3rd generation and descend deeper into resp bronchiole branches?
increased # of alveoli
collective term for the 3 generations of resp bronchioles
transitional zone: b/c these are situatied b/t airways w/ no alveoli and those w/ alveoli completely lining the walls
morphology of resp bronchioles?
a. sm mm & elastic tissue in walls ( decreasing amts)
b. ciliated cuboidal
c. bronchiolar/clara cells

NO goblet,mucus,cartilage
what branches off 3rd generation of resp bronchioles?
alveolar ducts
how many generations of alveolar ducts?
3
straight tube-like structures completely lined w/ alveoli
alveolar ducts
structural features of alveolar ducts
walls of small amt of sm mm and elastic fibers, same types of cells as alveoli b/c the walls are completely lined w/ alveoli
3rd generation of alveolar ducts empty into ?
a single alveoli sac
shape of alveolar sac
round-sac like
structural features of alveolar sacs
walls have small amt of sm mm and elastic fibers, same type of cells as alveoli
how many generations of alveolar sacs?
1
alveolar ducts and alveolar sacs make up the ?
respiratory zone, the portion that is completely lined w/ alveoli
portion of lung distal to a single terminal bronchiole
pulmonary acinus
pulmonary acinus consists of?
respiratory bronchioles
alveolar ducts
alveolar sacs
portion of lung distal to a single terminal bronchiole
pulmonary acinus
single terminal bronchiole and gaseous exchange airways it serves
pulmonary/primary lobule
# of alveoli in an adult lung
300 mil
shape of alveoli
polygonal
why is polygonal shape of alveoli highly desirable
greater SA, highest SA/volume ratio, greater SA for gas exchange to occur
what shape has the smallest SA/volume ratio?
sphere
total SA available for gas exchange in the alveoli?
50-100 sq meters, quitle large
body SA of physiologic person
1.7 sq meter, wayyy less than the SA for gas exchange
alveoli are surrounded by?
a very dense capillary bed, they are bathed in pulmonary capillary blood
what does the inner lining of the alveoli consist of?
a thin layer of fluid
3 types of cells comprising alveolar wall
type1/agranular pneumocyte
type2/granular pneumocyte
alveolar macrophage
which cell comprises most of alveolar wall?
type 1/agranular pneumocyte
characteristics of type1/agranular cell
squamous/flattened cell, making it advantageous for gas exchange
-no granules in cytoplasm
characteristics of type2/granular pneumocyte
-granules in cytoplasm
-cuboidal shape
-secretory fxn
fxn of type 2/granular pneumocyte
-secretes surfactant
-secretes fluid that lines the alveoli
3 types of cells comprising alveolar wall
type1/agranular pneumocyte
type2/granular pneumocyte
alveolar macrophage
which cell comprises most of alveolar wall?
type 1/agranular pneumocyte
characteristics of type1/agranular cell
squamous/flattened cell, making it advantageous for gas exchange
-no granules in cytoplasm
characteristics of type2/granular pneumocyte
-granules in cytoplasm
-cuboidal shape
-secretory fxn
fxn of type 2/granular pneumocyte
-secretes surfactant
-secretes fluid that lines the alveoli
special fxn of type 2/granular pneumocytes
progenetor of Type I cells. When type I cells are destroyed, Type 2 cells can differentiate into Type 1 cells.
what lung conditions cause type 1 cells to be replaced w/ type 2 cells?
pulmonary fibrosis, the replacement w/ type 2 cells causes an associated diffusion problem that leads to impaired gas exchange and hypoxemia
originates from monocytes
alveolar macrophages
most phagocytic WBC
monocyte
fxns of alveolar macrophage
a. filter debris that wasn't filtered by conducting airways and made it down to alveoli
b. destroy bacteria that has moved down
opens b/t adjacent alveoli
pores of kohn, not present at birth, fxn unknown
advantages of pores of kohn
supplies collateral ventilation, supplies the sacs of blocked ducts w/ air for gas exchange
disadvantages of pores of kohn
permits spread of pulmonary infection from one alveolar sac to another
in emphysema, what happens to the pores of kohn
they can enlarge and result in obliteration of alveoli septa
are alveoli stable?
no, always trying to collapse
4 factors preventing collapse of alveoli?
a. canals of lambert
b. pores of kohn
c. interdependence
d. pulmonary surfactant
what 2 things provide collateral circulation to gas exchange airway?
pores of kohn, canals of lambert
reduces surface tension of alveoli, decreases tendency to collapse
pulmonary surfactant
most important factor that helps prevent collapse of alveoli?
interdependence
explain interdependence
collagen & elastin fibers have interwoven type of arrangement that keeps alveoli open, when one attempts to collapse, it puts pressure on surrounding connective tissue fibers, they attempt to resist this inward stress
blood supply to gas exchange airways
pulmonary arteries: contain poorly oxygenated blood
pulmonary veins: carrying oxygenated blood
venous supply to gas exchange airway
pulmonary veins: contain well oxygenated blood and deoxygenated blood from bronchioles
typically there are ____ pulmonary veins?
4
how do you have 4 pulmonary veins?
2 from left, upper and middle of right lung fuse, lower right lobe
may have as many as __ or as few as ___ pulmonary veins?
5, 3
are there valves in pulmonary veins?
no
lymph drainage of gas exchange airways?
no lymph drainage, foreign substances are removed from alveolar area b/c the fluid produced eventually migrates up the mucociliary escalator to terminal bronchiole
innervation of gas exchange airways
we don't know
# of alveoli at birth
30 millioon-10 fold increase
lung development completes at age ?
8
what has detrimental effects on lung development?
early childhood resp diseases, whooping cough & measles
fxn of gas exchange airways
a. passage of oxygen from alveoli to pulm cap blood
b. passage of CO2 from pulmonary cap blood into alveoli
# of branches in our tracheobronchial tree
23
23 generations: list
Bronchi: 3
Conducting bronchioles: 13
Respiratory bronchioles: 3
Alveolar ducts: 3
alveolar sacs: 1