ACP Respiratory Flashcards
What are the 3 components of the UPPER conducting pathway?
Nasal cavity/nasopharynx
Oral cavity/ oroPharynx
Laryngeopharynx/ Larynx
What separates nasal cavities right and left?
The nasal septum
What is the term for the posterior nares that enter into the nasopharynx?
Choanae
What is the difference between the anterior and posterior septum structure?
The anterior is made of cartilage, the posterior is made of bone.
What region of the nares are common for epistaxis in pediatrics?
Anterior
What region of the nares are common for epistaxis in geriatric patients?
The posterior region.
Where are the turbinates found in the nasal cavity? And how many are there?
Found on the lateral wall of each nare.
There are 3
The superior, middle and inferior.
Where is the cribiform plate located? And what nerve passes through it?
Located in the nasal cavity and the base of the skull. Cranial nerve I (olfactory) passes through. Ethmoidal bone
What are the 4 sinuses?
Ethmoidal, sphenoid, frontal, maxillary
What are the 3 areas of the throat?
Nasal pharynx, oral pharynx, laryngeal pharynx (hypopharynx)
Where does the larynx begin and end anatomically?
The larynx extends from the hyoid bone to the lower border of the cricoid cartilage. It lies anterior to the 3rd and 6th cervical vertebrae.
What are the 4 major cartilages in the laryngeal region?
Epiglottis, thyroid, arytenoids, cricoid
What is the epiglottis, and what is its function?
The epiglottis is a semi rigid structure made of cartilage.
It is found immediately posterior to the base of the tongue, directly behind the hyoid bone.
Covers the top of the larynx to prevent aspiration.
How long is the trachea?
10cm
What is the bifurcation of the trachea called?
The carina.
What is the shape of the trachea? And why is it that way?
Horseshoe shaped. To allow expansion of the esophagus during swallowing.
How does the trachea remove foreign material?
Ciliated columnar epithelium sweep foreign matter out. As well as mucus and coughing
What is the overall purpose of the upper respiratory tract? (Pharynx, larynx)
Conduct, warm, moisten and filter the air.
What are the structures and order of the lower respiratory tract?
Right and left main stem bronchi
Secondary bronchi
Tertiary bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sac
Alveoli
Where do the right and left bronchi enter into the lung?
The hilum
What type of tissue are the bronchioles made up of?
What happens as subdivision ensues?
Similar in structure to the trachea with cartilage rings and lines with ciliated columnar epithelium.
As subdivision ensues cartilage gradually becomes replaced with SMOOTH muscle.
Which bronchus is shorter?
How long is it?
The right main stem bronchus is shorter at approx 5cm in length.
Has an approx 25* angle from the trachea.
As well as a larger diameter.
How many bronchopulmanary segments are in the right lung? And the left lung?
10 in the right
9 in the left
What is the respiratory membrane purpose?
What is the respiratory membrane made up of?
The purpose is to separate the alveolar air and the blood.
It consists of alveolar endothelium, surfactant, capillary basement membrane, capillary endothelial wall
What is the total surface area of the average healthy lung?
70m2
Which lung is larger? And why does that make sense?
The right lung. Because the left lung has to accommodate space for the heart.
How many segments are in the right lung and how is it divided?
3 segments.
Superior, middle, inferior.
divided by horizontal fissure and oblique fissure.
How many segments are in the left lung?
2
What is the flap of lung between the oblique fissure and the cardiac notch?
The lingula
What 3 locations do you auscultate to confirm ETT placement?
Right and left lung, as well as above the xiphoid process to rule out breath sounds in the stomach
What are the plurae?
The sacs the enclose the lungs
What is the term for the pleura that adhere directly to the lung tissue?
Visceral pleura
What is the term for the pleura that adhere to the chest wall?
The parietal pleura.
What are the 3 regions of the parietal pleura?
Mediastinal, diaphragmatic, costal
What is the pressure of the pleural space?
-4mmhg
What area of the pleural cavity to the lungs not completely fill?
The left and right costal diaphragmatic recess
What is a common complication in the pleural recesses?
Pleural effusion (fluid in the pleural space)
What are the major structures located in the mediastinum?
Trachea, esophagus, blood vessels, heart.
How’s does the pressure in the lungs become lower during respiration?
Contraction of respiratory muscles results in enlargement of the thoracic cage and expansion of the lungs. Expansion reduces the pressure and creates a pressure gradient of approx 3mmhg between the mouth and alveoli.
What is the main muscle in respiration?
Diaphragm
What are the accessory muscles of respiration?
SCM, Scalenes, intercostal muscles
What are the muscles of expiration?
What patient commonly uses these muscles?
Abdominal muscles, oblique muscles.
Commonly used by COPD patients.
What is pulmonary compliance?
The amount of pressure required to inflate the lung.
What is pulmonary surfactant?
Surfactant is a protein substance that is found around alveolar cells and it helps reduce surface tension. Decreasing the muscular effort required to expand the alveoli.
What is the fluid found in the pleural space known as?
Pleural or serous fluid.
What is a normal persons oxygen cost of breathing?
<5%
What is normal adult tidal volume?
400-500ml
What is residual lung volume?
The volume of air remaining after expiration
What is functional residual capacity?
The volume of gas remaining in the lungs at the end of normal exhalation.
What is a P.E.E.P device and what does it affect in regards to functional residual capacity?
Positive end expiratory pressure device. Used to limit exhalation which increases the functional residual capacity preventing alveoli from collapsing.
What is force vital capacity?
The maximum amount of air that can be exhaled after maximal expiration.
What is CO2 effect on the respiratory system?
CO2 is the main chemical compound responsible for triggering increased respiratory rate or increased tidal volume.
What is the main chemical compound for stimulation of the respiratory drive?
CO2
Where does CO2 act to stimulate respiration?
The brain stem
What is the hypoxic drive?
Stimulation of respiration based on hypoxia rather than hypercarbia
Where does hypoxia trigger for increased respiration?
And generally what level of PAO2 causes this trigger?
Hypoxia is sensed in the aortic arch chemoreceptors, and the internal carotid chemoreceptors.
It is stimulated when PAO2 reaches 70mmhg.
What is metabolic acidosis effect on the respiratory center?
How would it be reflected in ETCO2?
Increases respiratory rate.
Lowers ETCO2 as the body try’s to compensate by blowing off volatile gases.
What is V/Q?
Ventilation/perfusion
What can cause a V/Q of less than 1?
Decreased ventilation due to obstruction, or anything that decreases the amount of oxygen reaching the alveoli.
Getting less oxygen than the amount of blood perfusing the lungs.
What is intrapulmonary shunting?
When blood is able to flow through the blood vessels in the lungs but is unable to oxygenate. This leads to oxygenated blood mixing with the deoxygenated blood, thus lowering the overall saturation of blood.
What is asthma?
Chronic inflammatory disease of the airway. Characterized by increased responsiveness of the trachea and bronchi
What causes narrowing of the airway in asthma?
Early phase: smooth muscle contraction
Later phase: mucosal tissue edema and mucus production.
What is the concern regarding a prolonged respiratory issue?
The patients ability to compensate is finite. And they will eventually deteriorate.
What is the definition criteria for COPD?
Chronic airway obstruction defined as occurring for at least 3 months of the year, for the previous 2 years.
What are the 3 pathologies of COPD?
Asthma, bronchitis, emphysema
What is emphysema?
A condition of abnormal permanent enlargement of the air spaces distal to the terminal bronchiole, accompanied by destruction of their walls.
Enlargement
Destruction of septal walls
What is bronchitis?
Chronic or recurrent excess mucus secretions in the bronchial tree.
What happens to the bronchioles of emphysema patients?
They collapse due to the destruction of alveolar septa which support bronchi and keep them open.
What is the risk of coughing in emphysemics?
Barotrauma leading to pneumos
What’s is the cause of V/Q mismatch in bronchitis?
Obstruction due to mucus
What is atelectasis?
Atelectasis is the collapse of part of the lung due to blockages in the bronchioles. Blockages result in decreased/block of airflow into areas of the lung. The air distal to the blockage is eventually absorbed by the alveoli and leaves that area deflated.
What’s are some common symptoms of pleuritic pain?
Stabbing
Knife like
Increased on inspiration, movement, cough
Commonly caused by pneumonia, pneumothorax
What are some key findings in pericardial pain?
Pain may be relieved while leaning forward, due to decreased pressure on the pericardium.
Pain is often described similar to pleuritic pain.
Often increased during inspiration due to squeezing of the mediastinum/pericardium.
What is 1 key factor of aortic dissection pain?
Pain beginning in the anterior of the chest and migrating to the interscapular region and/or down the back.
Migrating pain is highly specific to dissection.
Commonly described as ripping or tearing.
A difference in BP >15mmhg may indicate aortic dissection.
