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AL- CRNA A & P > A&P Exam III - Pulmonary I > Flashcards

A&P Exam III - Pulmonary I Flashcards

1
Q

Respiration

A

Exchange of gases between the atmosphere, blood and cells

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2
Q

3 processes required for respiration

A

Ventilation (breathing)
External (pulmonary) respiration
Internal (tissue) respiration

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3
Q

How does the cardiovascular system assists the respiratory system?

A

By transporting gas

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4
Q

Structurally: respiratory system is divided into 2 parts:

A
  1. Upper resp. System

2. Lower resp. System

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5
Q

Functionally: resp system are divided into 2 zones:

A
  1. Conduction zone

2. Respiratory zone

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6
Q

Conduction zone :

A

Dead space up to terminal bronchioles

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7
Q

Resp. zone:

A

Gas exchange in alveoli

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8
Q

The upper respiratory system consist of:

A

The nose, paranasel sinuses, pharynx and associated structures

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9
Q

The lower respiratory system consist of:

A

The larynx, trachea, bronchi and lungs

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10
Q

The Mallampati score I, II, III, IV

A

Class I: Full visibility of tonsils, uvula and soft palate
Class II: Visibility of hard and soft palate, upper portion of tonsils and uvula
Class III: Soft and hard palate and base of the uvula are visible
Class IV: Only hard palate visible

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11
Q

Thorax

A

Bones and cartilage protect contents

12 pairs on ribs:
- True ribs (1-7) directly attached to sternum
via costal cartilage
- False ribs (8-10) indirectly attached
- Floating ribs (11-12) not attached to
sternum
-Supernumerary ribs (extra)
- Cevical ribs - elongation of transverse
process of 7th cervical vertebra (0.5%)
incidence)
- Lumber rib - elongation of transverse
process f lumbar vertebra, less
common
Allow flexibility for movement that is needed for ventilation to occur
- Oblique orientation of rib allows for
elevation of the rib cage involved with lung
expansion

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12
Q

Manubrium

A

Upper most part of the sternum

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13
Q

Suprasternal notch (jugular)

A
  • Trachea lies posterior to and in line with jugular notch.
  • Same horizontal plane as second thoracic vertebra, signifies midpoint of trachea and a ideal location for the distal tip of the endotracheal tube
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14
Q

Sternal angle (of Louis)

A

Where manubrium joins the body of the sternum.
- Bifurcation of the trachea (carina) occurs at
this level (T4-T5)

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15
Q

Manubriosternal joint

A

Hinge- like joint between manubrium and body of sternum.
- Allows hinge- like forward movements of
sternum during inspiration and backward
movements during expiration

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16
Q

Upper Airway - Nose

A

Functions:
Warms, cleans, humidifies inhaled air
-detects Oder
-resonating chamber that amplifies the
voice
Bony and cartilaginous support
-Superior half: nasal bones medially and
maxillae laterally
- inferior half: lateral and alar cartilages
- Ala nasi: flared portion shaped by dense
CT forms lateral walls of each nostril

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17
Q

Structure of the Respiratory System: Structurally

A

Respiratory system is divided into 2 parts:

1) . Upper respiratory system
2) . Lower respiratory system

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18
Q

Structure of the Respiratory System:

Functionally

A

Respiratory system are divided into 2 zones:

1) . Conducting zone (dead space up to terminal bronchioles)
2) . Respiratory zone (gas exchange in alveoli)

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19
Q

Nasal Cavity

A

*Extends from nostrils to posterior nares
*Vestibule : dilated chamber inside ala nasi
-stratified squamous epithelium, vibrissae
(guard hairs)
*Nasal septum divides cavity into right and left chambers called nasal fossae.

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20
Q

Nasal Conchae and Paranasal sinuses

A
  • turbinates and sinuses warm, clean and moisten air for the lungs
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21
Q

Nasal Conchae

A

3 folds of tissue on lateral wall of nasal fossa-mucous membrane supported by thin scroll-like turbinate bones

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22
Q

3 types of Conchae

A

Superior, Middle, and Inferior nasal conchae

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23
Q

Meatuses

A
  • Narrow air passage beneath each conchae

- Narrowness and turbulence ensure air contacts mucous membranes

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24
Q

2 Type of nasal cavity mucosa

A
  • olfactory mucosa (lines roof of nasal fossa)

- respiratory mucosa (lines rest of nasal cavity with ciliated pseudostratified epithelium

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25
Q

Defensive role of mucosa

A
  • mucus traps inhaled particles

- bacteria destroyed by lysozyme and IgA

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26
Q

Mucus is from

A

Goblet cells

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27
Q

Cilia Function

A

Sweep debris - laden mucus into pharynx to be swallowed

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28
Q

Cilia Location

A

respiratory epithelium

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29
Q

Erectile tissue

A

Venous plexus that rhythmically engorges with blood and shifts flow of air from one side of fossa to the other once or twice an hours to prevent drying

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30
Q

Erectile tissue location

A

Inferior concha

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31
Q

Spontaneous epistaxis

A

Most common site is inferior concha

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32
Q

3 part of pharynx

A
  1. ) Nasopharynx
  2. ) Oropharynx
    3) . Laryngopharynx
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33
Q

Nasopharyngeal (pseudostratified epithelium)

A

-posterior to choanae, dorsal to soft palate
- receives auditory tubes and contains
pharyngeal tonsil
-90 degree downward turn traps large particles (>10nm)

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34
Q

Oropharynx (stratified squamous epithelium)

A

-space between soft palate and root of tongue, inferiorly down to hyoid bone, contains palatine and lingual tonsils

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35
Q

Laryngopharynx (stratified squamous)

A

-hyoid bone to level of cricoid cartilage

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36
Q

Lower airways

A

Glottis

Epiglottis

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37
Q

Glottis

A
  • Part of Larynx

- Vocal cords and opening between

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38
Q

Epiglottis

A
  • Part of Larynx

- Flap of tissue that guards glottis, directs food and drink to esophagus

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39
Q

Infant Larynx

A
  • higher in throat, forms a continuous airway from nasal cavity that allows breathing while swallowing
  • by age 2, more muscular tongue forces larynx down
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40
Q

Larynx located : adults and children

A
  • Adults C3-C6

- Children C3-C5 (superior)

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41
Q

Nine Cartilage of Larynx

A
  • Epiglottic cartilage - most superior
  • Thyroid cartilage - largest ; forms laryngeal prominence
  • Cricoid cartilage - connects larynx to trachea
  • Arytenoid cartilages (2)- posterior to thyroid cartilage
  • Corniculate cartilages (2)- attached t o arytenoid cartilages like a pair of little horns
  • Cuneiform cartilages (2) - support soft tissue between arytenoid and epiglottis
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42
Q

Narrowest portion of pediatric Larynx

A
  • newer studies say glottis opening

- older studies say cricoid

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43
Q

Extrinsic muscles (suprahyoid muscles)

A
  1. ) stylohyoid
  2. ) mylohyoid
  3. ) diagstric
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44
Q

Extrinsic muscles of the larynx

A

•Connect larynx to hyoid bone, elevate larynx during swallowing up and forward

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45
Q

Extrinsic muscles (infrahyoid muscles)

A

1) omohyoid
2) sternothyroid
3) thyrohyoid
4) sternohyoid

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46
Q

Muscles of the laryngeal inlet

A

-Aryepiglottic: narrows inlet, closes glottis

  • Oblique aretynoid: narrows inlet, closes glottis
  • Together, the aryepiglottic and oblique arterynoid act as a purse-string sphincter during swallowing

-Thyroepiglottic: widens inlet

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47
Q

Intrinsic Mucles

A

rotate corniculate and arytenoid cartilages adducts (tightens: high pitch sound) or abducts (loosens: low pitch sound) vocal cords

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48
Q

Intrinsic Muscles involved with movement of true cords

A
  • Cricothyroid
  • Thyroarytenoids
  • Lateral cricoarytenoids
  • Transverse aryternoids
  • Oblique arytenoids
  • Posterior cricoarytenoids
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49
Q

Cricothyroid

A

-tense vocal cords

•ONLY intrinsic muscle to lie outside the cartilaginous framework of the larynx

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50
Q

Thyroarytenoids

A

-relax vocal folds

•Vocalis m.: part of the thyroarytenoids, adjusts tension of cords

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51
Q

Lateral cricoarytenoids muscles

A

: adducts cords, closes (slide 24)

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52
Q

Transverse arytenoids

A

adducts cords, closes

53
Q

Oblique arytenoids

A

-adducts cords, closes

54
Q

Posterior cricoarytenoids

A

-abducts vocal cords & folds, opens

•ONLY ABDUCTOR muscle of vocal cords

55
Q

Larynx blood supply

A

•supplied via the external carotids & subclavian arteries and internal jugular vein

56
Q

Innervation of the larynx

A

by cranial nerve X (Vagus nerve)

57
Q

Interior Branch of Superior laryngeal nerve

A

-provides sensation for upper portion of the larynx down to and including upper half of the vocal cords

58
Q

Recurrent laryngeal nerve (sensory)

A

transmits sensation below the true cords and half of the lower cords

59
Q

Motor

A

Fibrocartilaginous tube, approximately 10-20cm long and 12mm in diameter

60
Q

Trachea

A

Begins at the end of the larynx (C6) and extends to T5-T6

61
Q

Trachea

begins /extends

A

Begins at the end of the larynx (C6) and extends to T5-T6

62
Q

Trachea supported by

A

16-20 C-shaped rings of cartilage with smooth muscle posteriorly

63
Q

Carina

A

the lower most portion of the trachea where it divides into primary bronchi

64
Q

Trachea lined with

A

ciliated pseudo stratified epithelium

65
Q

ciliated pseudostratified epithelium function

A

functions as mucociliary escalator

66
Q

lungs produce how much mucous per day

A

100ml

67
Q

Turbulent flow helps

A

trap precipitate

68
Q

Mucociliary escalator mechanism impaired by

A

endotracheal intubation and volatile anesthetics

69
Q

Cilia remove______ mucus

A

contaminated

70
Q

Conduct Zone

A
  • Secondary (labor) bronchi
  • Segmental Bronchi
  • Terminal Bronchioles
71
Q

secondary (labor) bronchi

A
  • Bronchospasm occurs here

- Three on the right, two on the left (related lobes)

72
Q

Terminal bronchioles

A
  • Diameter of 1mm and contain NO cartilage
  • Relatively thick smooth muscle wall compared to lumen
  • Can contract during asthma attack no goblet cells
73
Q

Broncial circulation suppled by

A

systemic circulation

74
Q

Anatomic shunting due to bronchial circulation

A

area of the lung where there is perfusion but no ventilation

75
Q

Bronchial Innervation (sensory and motor)

A

via Vagus

76
Q

Bronchial Innervation (sympathetic)

A

Epi/NE&raquo_space;> bronchodilation

77
Q

Respiratory Zone composed of:

A

Acinus (terminal respiratory unit)

78
Q

Bronchial Innervation (parasympathetic)

A

Ach»>bronchodilation

79
Q

Acinus composed of

A
  • respiratory bronchioles
  • alveolar ducts
  • alveoli
80
Q

Alveoli are formed

A

-birth to age 4, they continue to maximally expand until age 8

81
Q

Alveoli # in adult

A

300 million

82
Q

Alveoli shape

A

polygon shape

-maximizes surface area

83
Q

Alveoli surrounded by

A

1000 pulmonary capillaries each

84
Q

Type 1 alveolar cells type

A

squamous

85
Q

Type 1 alveolar cell form/involved

A

from wall of alveoli and involved with gas exchange

86
Q

Type II alveolar cells type

A

cuboidal

87
Q

Type II alveolar cells secrete ____

A

surfactant

88
Q

Type II alveolar cells can differentiate

A

into type I cell when needed

89
Q

What happens to alveolar cells in pulmonary fibrosis?

A

-In a chronically injured lung (e.g. pulmonary fibrosis), alveolar epithelium is lined entirely by type II cells, limiting gas exchange

90
Q

Alveolar macrophages

A

eliminate foreign debris

91
Q

Alveolar pores

A
  • pores of Kohn

- are openings in the walls between adjacent alveoli

92
Q

Alveolar Pores (Pores of Kohn) function

A

allow for collateral ventilation

93
Q

Alveoli collapse primarily prevented by:

A
  • surfactant
  • alveolar pores
  • interdependence
94
Q

If an alveolus start to collapse …

A

the surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it

95
Q

Lungs shape

A

cone shape

96
Q

Lungs occupy all of thoracic cavity except

A

Mediastinum

97
Q

Right lung # of lobes

A

3

98
Q

Left lungs # of lobes

A

2

99
Q

Which lung of more narrow? R or L?

A

Left is more narrow than the right

100
Q

Lungs innervation

A
  • innervated by the pulmonary plexus
  • sympathetic fibers T2-T6
  • parasympathetic fibers from the Vagus
101
Q

Lung pain receptors

A

few to no pain receptors in lung

102
Q

T/F- There is a normal perfusion and ventilation (V/Q) difference between the two lungs b/c of the different surface areas

A

True

103
Q

The right lungs has 3 lobes and receives ____% of the CO

A

60%

104
Q

Parasympathetic fibers produce _____ of the airways and increase _____

A

_ construction

-mucus

105
Q

serous membranes that line the thoracic cavity and cover the lungs

A

pleural membranes

106
Q

pleural fluid: amount/function

A

10cc produced per lung prevents function in pleural cavity

107
Q

attached to outer surface of the lungs, parietal pleura line the wall of the thoracic cavity

A

Visceral pleura

108
Q

Breathing (pulmonary ventilation)

A
  • one cycle of inspiration and expiration
  • quiet respiration- at rest
  • forced respiration- during exercise
109
Q

Flow of air in and opt of lungs requires

A

a pressure difference between air pressure within lungs and outdoes body

110
Q

Diaphragm

A

Dome-shaped muscle that forms the floor of the thorax and separates the thoracic cavity and the abdominal
cavity

111
Q

Diaphragm accounts for _____ tidal volume

A

most

112
Q

Diaphragm separated into

A

2 halves = hemidaphragms

-Right hemidiaphragm is higher than the left (heart pushes left side down; liver raises rightsize)

113
Q

Major diaphragmatic foramina

A
  • Vena cava foramen

- esophageal hiatus (esophagus and vagus nerve pass through; site of hiatal hernia)

114
Q

Diaphragm Innervation

A

-supplied by paired phrenic nerves
-C3-5 (C4 provides 70% of contribution)
-Allows for half of the diaphragm to continue working if one side is damaged
-Motor AND sensory nerves.
•Sensory diaphragmatic pain referred to the shoulder areas

115
Q

Major factors affecting the position of the diaphragm:

A
  • Recoil of lungs
  • Thoracic viscera pressure (e.g. CHF)
  • Abdominal viscera pressure (e. g. pregnancy)
  • Abdominal muscle activity (contraction pushes diaphragm upward)
116
Q

Diaphragm movement during normal breathing

A
  • 1-2cm normal tidal breathing

- 7-13cm with deep breathing

117
Q

The diaphragm accounts for _____% of normal tidal volume respiration

A

60-75%

118
Q

External intercostal muscles oriented

A

obliquely forward and downward

119
Q

External intercostal muscles responsible for up to of tidal volume that enters lungs during normal breathing at reat

A

25%

120
Q

External intercostal muscles during inspiration

A

left up the ribs

121
Q

Internal intercostal muscles oriented

A

backward and downward

122
Q

internal intercostal muscles oriented

A

backward and downward

123
Q

internal intercostal muscle assist in

A

expiration by pulling the ribcage down

124
Q

At rest, when the diaphragm is relaxed, alveolar pressure is ___ to atmospheric pressure, and there is ____ air flow.

A
  • equal

- no air flow

125
Q

Factors affecting Ventilation

A
  • surface tension
  • elastic recoil
  • compliance
126
Q

Surface tension

A

inwardly directed force in the alveoli which must be overcome to expand the lungs during each inspiration

127
Q

Elastic recoil

A

decrease the size of the alveoli during expiration

128
Q

compliance

A

ease with which the lungs and thoracic wall can be expanded

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