Chapter 1: Conducting Airways/ Respiratory System

Question 1

State the three primary functions of the nose

Answer 1

• Heating
• humidification
• filtering

Question 2

Describe the functions of turbinates

Answer 2

To increase the surface area of the nasal passage to facilitate heating, humidifying, and filtering of inspired air

Question 3

Describe the impact of intubation on inspired air

Answer 3

Intubation by-passes the upper airway including the nose so all the functions of the nose and upper airway are lost. When using an artificial airway we need to be prepared to assist in carrying out the functions of the upper airways

Question 4

Name the structure that is the narrowest part of the upper airway (adults / babies).

Answer 4

• Adults - the glottis (space between the true vocal cords)
• neonates- cricoid cartilage

Question 5

Label the structures of the upper airway

Answer 5

May be one on the exam

Question 6

Describe the changes in the epithelium of the lower airway as it progresses down toward the bronchioles

Answer 6

The epithelial layer thins, moving from pseudo stratified columnar epithelial later to cuboidal, and finally savamous by the terminal bronchioles
In addition the cartilage disappears as do the submucosal glands

Question 7

Name the alveolar cell types and functions

Answer 7

• Type l alveolar cells : these are very thin very simple cells whose purpose is to facilitate gas exchange

• Type 2 alveolar cells: produce surfactant (dppc) which helps stabilize the alveoli and serves as a source for new type I and type 2 cells following injury

• Type 3 alveolar cells: alveolar macrophages. They attack any foreign substance that makes it to the alveoli. They phagocytize it

Question 8

Name the structure that covers the opening of the larynx to keep food from going into the lungs during swallowing

Answer 8

The epiglottis protects the entrance to the larynx and the lower airway

Question 9

Explain why an endotracheal tube is move likely to be inserted into the right mainstream as opposed to the left mainstream

Answer 9

The angle at which the right mainstream bronchus comes off the carina is not very acute at 25 degrees. This provides almost a straight shot for aspirates or endotracheal tubes to enter the right mainstream bronchus

Question 10

Differentiate between bronchi and bronchioles

Answer 10

• Bronchi: large, cartilaginous airways with normal respiratory epithelium and lots of submucosal glands
• Bronchioles: small airways lacking in cartilage, with cuboidal to squamous epithelium and diminishing to absent submucosal glands

Question 11

Discuss what differentiates the conducting airways from the area of gas exchange

Answer 11

Alveoli. If alveoli are present then we are in the area of gas exchange

Question 12

Describe how cilia function and their role in mucociliary clearance

Answer 12

They continuously sweep towards the laryngopharynx . They whip forward contacting the ger layer of the mucus, moving it and anything stuck to it towards the laryngopharynx.

Question 13

Describe the interface at which gas exchange occurs.

Answer 13

• ACM
  -alveolar epithelium
  - alveolar basement membrane
  - interstitial space
  - capillary basement membrane
  - capillary endothelium
  - blood plasma
  - RBC’s

Question 14

Name the primary neurotransmitters in the sympathetic and parasympathetic nervous systems

Answer 14

SNS: catecholamines - epinephrine and norepinephrine
PNS: acetylcholine (ach)

Question 15

Describe the typical effects of the sympathetic and parasympathetic nervous system stimulation

Answer 15

•SNS
Alpha 1 - vasoconstriction primarily of arterial smooth muscle
Beta 1 - increased heart rate and force of myocardial contraction
Beta 2 - causes bronchial smooth muscle relaxation leading to bronchodilation

• PNS
-relaxation of the arterial blood vessels
- slowing heart rate and force of constriction
- bronchoconstriction

Question 16

Describe the effects of Beta 1 receptor stimulation

Answer 16

Increased heart rate and force of myocardial contraction

Question 17

Describe the effects of Beta 2 receptor stimulation

Answer 17

Cause bronchial smooth muscle relaxation leading to bronchodilation

Question 18

Define cAMP and describe its effect on bronchial smooth muscle

Answer 18

cAMP is a secondary messenger within cells. When the sympathetic nervous system is activated by epinephrine other catecholamine it binds at the receptors on the surface the cell and camp mediates the response.in the pulmonary system this results in brochodilation

Question 19

Describe the effect a drug that inhibits phosphodiesterase would have on bronchial smooth muscle

Answer 19

By blocking the breakdown of camp there is a week bronchodialtory effect

Question 20

Describe how atropine exerts its parasympathetic (anticholinergic) effect, as well as the effect it has on heart rate

Answer 20

-Atropine blocks parasympathetic receptors. As the parasympathetic system slows everything down and causes bronchoconstriction, blocking the parasympathetic nervous system results in bronchodilation, increased heart rate, and drying of secretions

-Atrovent (ipratropium bromide) is a pulmonary specific variant of atropine that minimizes the impact on heart rate but results in bronchodilation. Continues to cause reduced production of secretions

Question 21

Be able to label structures of the thoracic cage

Answer 21

Anterior and posterior view

Question 22

The primary muscle of inspiration/ventilation

Answer 22

Diaphragm

Question 23

Name the accessory muscles of inspiration

Answer 23

-scalene muscles
-sternocleidomastoid
-pectoralis major muscles
- trapezius muscles
- external intercostal muscles

Question 24

Name the primary accessory muscles of expiration

Answer 24

-rectus abdominis
-external abdominis
-internal abdominis
-transversus abdominis
-internal intercostal muscles

Question 25

Name substances that are released when mast cells degranulate

Answer 25

Histamine Heparin Slow release substances of anaphylaxis Platelet activating factor Eosinophil chemotactic factor of anaphylaxis