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A&P of Speech and Hearing > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

What are the boundaries of the thorax?

A
  • Superior boundary: 1st rib and clavicle
  • Inferior boundary: 12th rib
  • Lateral and anterior aspects: ribs and sternum
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2
Q

The thorax is suspended from what?

A

The vertebral column

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3
Q

How many vertebrae are there?

A

7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal = 33 vertebrae

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4
Q

What is C1?

A

Atlas

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5
Q

What is C2?

A

Axis

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6
Q

What are the parts of the vertebrae?

A
  • Spinous process
  • Corpus
  • Transverse process
  • Vertebral foramen
  • Superior and inferior articular facets (attachment points for muscles)
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7
Q

What are some unique characteristics of the thoracic vertebrae?

A
  • T1-T12 are the base of the respiratory framework and posterior point of attachment for the ribs
  • Have larger spinous and transverse processes
  • Superior and inferior costal facets: the points of attachment for the ribs
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8
Q

What are some unique characteristics of the lumbar vertebrae?

A
  • Are much larger than the cervical and thoracic vertebrae
  • They provide direct/indirect attachment for back and abdominal muscles and posterior fibers of the diaphragm
  • Spinous and transverse processes are smaller, while the corpus is much larger
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9
Q

What forms the pelvic girdle?

A

Ilium, sacrum, pubic bone, and ischium

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10
Q

What forms the shoulder/pectoral girdle?

A

Scapula and clavicle

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11
Q

Why is it important to protect the girdles?

A

The girdles allow the lower and upper extremities to attach to the vertebral column, and they have a lot of muscles that aid in respiration, allowing you to maintain full function

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12
Q

What bone is a significant structure in respiration?

A

The sternum

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13
Q

What are the different kind of ribs and their attachment points?

A
  • True ribs 1-7: have direct attachment to the sternum
  • False ribs 8-10: attach to the sternum via cartilage
  • Floating ribs 11-12: have no anterior attachment
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14
Q

What are the parts of the sternum?

A
  • Sternal notch/jugular notch
  • Manubrium sterni: attachment for the clavicle and first rib
  • Manubrosternal angle: attachment for rib 2
  • Corpus: attachment for ribs 3-10
  • Xiphoid process
  • Clavicular notch
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15
Q

When oxygen needs increase, the smooth muscles of the trachea:

A

Relax

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16
Q

What assists in cleaning the trachea?

A

Submucosal glands

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17
Q

When is the eustachian tube open?

A

It is always closed except when vomiting, swallowing, or yawning

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18
Q

What is the left main-stem bronchi’s degree angle relative to the trachea?

A

45-55 degree angle

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19
Q

What is the right main-stem bronchi’s degree angle relative to the trachea?

A

20-30 degree angle

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20
Q

How may lobes does the right lung have?

A

3

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21
Q

How many lobes does the left lung have?

A

2

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22
Q

How many generations of the brochial tree does the right lung have?

A

28 generations

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23
Q

How many generations of the brochial tree does the left lung have?

A

14 generations

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24
Q

What are the levels of the bronchial tree?

A
  • Primary: mainstem bronchi bifurcate from trachea
  • Secondary: brochi serves lobes of the lungs
  • Tertiary: serves the segments of each lobe, and divide repeatedly
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25
Q

How many alveoli are there in mature lungs?

A

300 million alveoli

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26
Q

Respiration is also known as:

A

Gas exchange

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27
Q

Inhalation vs. exhalation elements

A

Inhalation = oxygen fills the alveoli
- Oxygen moves through the membrane and oxygenates the red blood cells
- Carbon dioxide leaves the blood cells and moves into the alveoli
Exhalation = carbon dioxide moves out

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28
Q

What do pulmonary artery branches do?

A

Pulmonary artery branches serve the gas exchange process at the alveolar level

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29
Q

What are the protectants?

A
  • Nostril hairs are the first line of defense, catching most particulate matter greater than 10 microns
  • Moist mucous membrane of the upper respiratory system
  • Goblet cells within the mucosal lining secrete a lubricant into the respiratory tract to trap pollutants
  • The whole respiratory passageway is lined with epithelium covered by cilia that beat more than 1000 times per minute (this drives the pollutants upward and posteriorly)
  • Beating epithelia move material up to the vocal folds, which stimulates secretion at the vocal folds and we clear our throats, usually eradicating particles within the 2-10 micron range
  • Lymphatic system provides a final cleaning stage - pollutants that are not moved by the beating epithelia are suspended to mucus and migrate to bronchioles through coughing, where they can be eliminated by the lymphatic system
  • Respiratory passageway protects lungs by warming and humidifying the air as it enters the lungs
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30
Q

What movement enlarges the vertical dimension?

A

Contraction of the diaphragm

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31
Q

What movement enlarges the transverse dimension?

A

Elevating the ribcage

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32
Q

Characteristics of pleural membranes

A
  • Composed of elastic and fibrous tissue
  • Airtight seal
  • Cuboidal cells within the lining produce a mucous solution, which creates an easy, low friction gliding of the lungs within the thorax
  • Negative pressure is maintained within the thorax because there is no contact with the outside atmosphere
  • Due to the movement of the pleural lining, the lungs are able to follow the action of the muscles without actually being attached to them
  • Because the surfaces of the two linings are infused with a serous secretion, there is low friction, making respiration more efficient
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33
Q

When the diaphragm contracts…

A

Air flows in, there’s increased volume and negative pressure

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34
Q

When the diaphragm stops contracting…

A

Air flows out of the lungs, there’s decreased volume and positive pressure

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35
Q

Alveolar pressure

A
  • Pressure that is present within the individual alveolus
  • Inhalation: air flows into the alveoli and the volume increases… when volume increases, pressure decreases (negative alveolar pressure)
  • Exhalation: air flows out of the alveoli and the volume decreases… when volume decreases, pressure increases (positive alveolar pressure)
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36
Q

Intrapleural pressure

A
  • Always negative throughout respiration (because:)
  • Lungs are in a state of continual expansion because the thorax is larger than the lungs
    The lungs are never completely deflated because of the residual volume
  • Lungs, inner thorax, and diaphragm are wrapped in this continuous sheet of plural lining
  • Keep the lungs from collapsing
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37
Q

Connection between alveolar and intrapleural pressure

A

Diaphragm contracts
- Air flows in
- Alveolar pressure drops
- Intrapleural pressure becomes more negative as the diaphragm pulls the diaphragmatic pleura

Diaphragm relaxes
- Air flows out
- Alveolar pressure increases
- Intrapleural pressure becomes less negative

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38
Q

Subglottal pressure

A
  • The pressure measured beneath the level of the vocal folds
  • Directly related to what is happening in the lungs as long as the vocal folds are open
  • Air flows into the lungs (negative pressure)
  • Air flows out of the lungs (positive pressure)

What happens when the vocal folds are closed?
- Blocks the air flow
- Immediate increase in the subglottal air pressure
- When the pressure exceeds 3-5cm H2O, the vocal folds will be blown open and voicing will begin

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39
Q

Intraoral pressure

A
  • Respiratory pressure measured above the vocal folds within the oral cavity
  • When vocal folds are open, intraoral, subglottal, and alveolar pressure are the same
  • Closing the vocal folds causes the intraoral pressure to drop as the subglottal pressure increases
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40
Q

Atmospheric pressure

A

Treated as a constant “0” against which to compare respiratory pressures

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41
Q

What are the four stages for gas exchange?

A
  • Ventilation: air comes into the respiratory pathway
  • Distribution: air is distributed to the 300 million alveoli
  • Perfusion: oxygen poor blood migrates through to the 6 billion capillaries
  • Diffusion: actual gas exchange across the alveolar capillary membrane
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42
Q

Turbulence as it relates to respiration

A
  • Lungs expand
  • Air courses through the bronchi
  • Some slight turbulence at the bifurcation of the bronchi but the air generally flows unimpeded
  • A small irregularity such as mucus or muscle spasm can greatly increase resistance to airflow
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43
Q

Alveoli at birth vs 8 years old

A

25 million increased to more than 300 million

44
Q

Breathing cycle amounts per age

A
  • Adults breath cycles 12-18 per minute
  • Newborns average 40-70 cycles per minute
  • 5 year old: 25 cycles per minute
45
Q

What is respiratory flow?

A

The rate of airflow in/out

46
Q

What is quiet respiration?

A

Also known as tidal inspiration, it is normal breathing without any extra inspiration or expiration
- 12-28 cycles of respiration per minute
- One cycle is ½ liter of air
- We process approximately 6-8 liters of air every minute

47
Q

What does volume do?

A

It estimates the amount of air each compartment can hold

48
Q

Tidal volume

A

The volume of air we breathe in during a respiratory cycle

Quiet tidal volume has an average
- Adult males: 600 cc
- Adult females: 450 cc
- Fill up three 2-liter bottles in one minute

49
Q

Inspiratory reserve volume

A
  • Volume that can be inhaled after a tidal inspiration
  • Average volume: 2.475 liters
50
Q

Expiratory reserve volume

A
  • Volume that can be expired following passive tidal expiration
  • Average volume: 1.0 liters
  • Also referred to as resting lung volume: volume present in the resting lungs after a passive exhalation
51
Q

Residual volume

A
  • The volume remaining in the lungs after a maximum exhalation
  • No matter how forcefully you exhale, there is a volume of air that cannot be eliminated: approximately 1.1 liters worth
  • Does not exist in the newborn
52
Q

Dead air

A
  • Air in conducting passageways
  • Air that cannot undergo gas exchange
  • An adult has approximately 1/10 of a liter
  • Associated with residual volume (RV) because it is air that cannot be expelled
53
Q

What is a capacity?

A

A combination of volumes that express a physiological limit

54
Q

Vital capacity

A
  • Capacity available for speech
  • Combination of the inspiratory reserve volume (IRV), expiratory reserve volume (ERV), and tidal volume (TV)
  • Represents the total volume of air that can be inspired after a maximal expiration
  • Approximately 4 liters for the average adult
55
Q

Functional residual capacity

A
  • Volume of air remaining in the body after a passive exhalation
  • Expiratory reserve volume + residual volume
  • Approximately 2.1 liters
56
Q

Inspiratory capacity

A
  • Maximum inspiratory volume possible after tidal expiration
  • Capacity of the lungs for inspiration (tidal volume + inspiratory reserve volume)
  • Approximately 3 liters for adults
57
Q

Total lung capacity

A
  • Sum of all the volumes
  • Totals approximately 5.1 liters
  • Different from the vital capacity because it includes residual volume (RV), which serves as a buffer in respiration in providing constant oxygenation when needed
58
Q

Effects of age on vital capacity

A
  • Vital capacity decreases by about 0.1 liter per year in adulthood
  • Vital capacity steadily increases with body growth up to about age 20, holds steady through about 25, and then begins a steady decline
  • Females have a smaller vital capacity throughout the lifespan
59
Q

Effects of age on residual capacity

A
  • Residual capacity increases with age
  • Individuals retain their functional total lung capacity (that doesn’t decrease), however, they have a reduction in function
  • As we age, compliance of the lungs decrease which results in reduced ability to inflate the lungs
  • Lung volume is constant but there is growth in the volume that is unavailable for direct gas exchange… residual volume = dead space air
60
Q

What muscle is involved in quiet inspiration?

A

The diaphragm

61
Q

What happens when the diaphragm contracts muscle-wise?

A

Muscle fivers shorten and the diaphragm pulls the central tendon down and forward

62
Q

What muscle completely separates the abdominal and thoracic cavities?

A

The diaphragm

63
Q

What are the attachment points of the diaphragm?

A
  • Sternal attachment at the xiphoid process
  • Costal attachment is to the inner border of ribs 7-12
  • Vertebral diaphragmatic attachment: attaches with the corpus of L1-L4 and transverse processes at L1
64
Q

What are the characteristics of the central tendon?

A
  • Crescent-shaped, white and translucent
  • Conforms to the prominence of the vertebral column
  • Flexible, but depends on the radiating fibers of the diaphragm for movement
  • Provides a strong and secure floor for the heart/lungs
65
Q

What are the three openings in the diaphragm?

A
  • Aortic hiatus: descending abdominal aorta passes through
  • Esophageal hiatus: esophagus passes through
  • Foramen vena cava: inferior vena cava passes through
66
Q

Which muscles are the accessory muscles of inspiration?

A

External and internal intercostal muscles, levatores costarum, serratus posterior superior, serratus anterior, sternocleidomastoid, the scalenes, pectoralis major and minor, subclavius, levator scapulae, trapezius, and rhomboideus major and minor

67
Q

External intercostal muscles

A
  • When contracted, the entire rib cage elevates, mostly distance moved is the front part
  • Most significant respiratory muscles for speech
  • Reside between the 12 ribs: originate in the lower surface of each rib and course downward to insert into the upper surface of the rib immediately below
68
Q

Internal intercostal muscles

A
  • The muscles near the sternum is the part that assists with forced inspiration
  • Originates from the superior margin of each rib and runs up and medially to the inferior surface of the rib above
69
Q

Levatores costarum

A
  • Elevates the ribcage
  • Longis originates on the transverse processes of T7-T10, skips the rib below and inserts into the next rib, and courses obliquely out
  • Brevis originates on the transverse processes of C7-T11 for a total of 12 levator costarum brevis muscles, which course obliquely down and out to insert into the tubercle of the rib below
70
Q

Serratus posterior superior

A
  • Elevation of the ribcage
  • Originate from on the spinous processes of C7 and T1-T3
  • Course down and laterally to insert just beyond the angles of ribs 2-5
71
Q

Sternocleidomastoid

A

Elevates the anterior ribcage and sternum

72
Q

Scalenes

A
  • Anterior, middle, and posterior muscles
  • Elevate the first and second ribs, increase vertical dimension of the thorax
73
Q

Pectoralis major

A
  • Originates at the sternum and fans out to the humerus
  • Elevates the sternum
74
Q

Pectoralis minor

A
  • Originates on the anterior surface of ribs 2-5 and inserts into the scapula
  • Increases transverse dimension of the ribcage
75
Q

Serratus anterior

A
  • Originates from ribs 1-9 and runs upward to the scapula
  • Elevates ribs 1-9
76
Q

Subclavius

A
  • Originates from the inferior surface of the clavicle and inserts into the superior surface of rib 1
  • Elevates rib 1
77
Q

Levator scapulae

A
  • Originates from the transverse processes of C1-C4 and inserts into the scapula
  • Elevates scapula and supports the neck
78
Q

Trapezius

A
  • Originates from the spinous processes of C2-T12 and inserts into the scapula
  • Elongates the neck and controls the head
79
Q

Rhomboideus major

A
  • Originates from the spinous processes of T2-T5 and runs down and laterally to the scapula
  • Stabilizes the shoulder girdle
80
Q

Rhomboideus minor

A
  • Originates from the spinous processes of C7 and T1 and runs down and laterally to the scapula
  • Stabilizes the shoulder girdle
81
Q

What do the muscles of forced expiration do?

A

They indirectly act on the lungs to “squeeze” the air out of them

82
Q

What are the muscles of forced expiration?

A

Interal intercostal, innermost intercostal, transverse thoracis, serratus posterior inferior, and the subcostals

83
Q

Internal intercostal (interosseous portion)

A
  • Lateral portion is a significant contributor for forced expiration
  • Originate on the superior margin of each rib and runs up and medially to insert into the inferior surface of the rib above
  • Depresses the ribcage
84
Q

Innermost intercostal (intercostales intimi)

A
  • Deepest of the intercostal muscles
  • Originate on the surface of the lower rib and course obliquely up to the rib above
  • Lateral aspect of the inner rib cage
  • Depress ribs 1-11
85
Q

Transverse thoracis

A
  • Inner surface of the ribcage
  • Originates on the sternum coursing to the inner chondral surface of ribs 2-6
  • Resists elevation of the rib cage (depresses it)
  • Decreases the volume of the thoracic cavity
86
Q

Serratus posterior inferior

A
  • Originate on the spinous processes of T11, 12, and L1-L3, and course upward into the lower margin of the lower five ribs
  • Pull the rib cage down
87
Q

Subcostals

A
  • Found on the inner posterior wall of the thorax (may span more than one rib)
  • Inner surface of the rib near the angle, and runs down and lateral to the inner surface of the second or third rib below
  • Depresses thorax
88
Q

What are the abdominal muscles of expiration?

A

Transversus abdominis, internal ablique abdominis, external oblique abdominis, rectus abdominis, quadratus lumborum, latissimus dorsi

89
Q

Transversus abdominis

A
  • Runs laterally, it’s the deepest anterior abdominal muscle
  • Originates in the posterior aspect of the vertebral column
  • Inserts into the abdominis aponeurosis and inner surface of ribs 6-12
  • Inferior attachment is the pubis
  • Reduces the volume of the abdomen
90
Q

Internal oblique abdominis

A
  • Originates from the inguinal ligament and the iliac crest
  • Inserts into the cartilaginous portion of the lower ribs, abdominal aponeurosis, and linea alba
  • Compresses the abdomen
91
Q

External oblique abdominis

A
  • Most superficial of the abdominal muscles
  • Originate along the osseous portion of the lower seven ribs
  • Fan downward to insert into the iliac crest
  • Compresses abdomen
92
Q

Rectus abdominis

A
  • Midline muscles of the abdomen
  • Originate at the pubis and insert into the xiphoid process of the sternum and cartilage of ribs 7-10
  • Use this muscle when youre doing sit-ups
93
Q

Quadratus lumborum

A
  • Originates along the iliac crest
  • Fans up and inward to insert into the lumbar vertebrae and inferior border of the 12th rib
  • Lateral movement of the trunk and fixing the abdominal wall to support abdominal compression
94
Q

Latissimus dorsi

A
  • Originates from the lumbar, sacral, and lower thoracic vertebrae
  • Fanlike fibers insert into the humerus
  • Chest stability, expiration, and assists with movement of the upper extremity
95
Q

Muscles vs. gravity in respiration

A

Inspiration
- Use of muscular action to exert force and overcome gravity
- Stretch tissue and distend the abdomen

Exhalation
- Uses elasticity and gravity to save energy
- Muscles relax and return to their original state due to elasticity and gravity

96
Q

Do lungs completely fill up the thoracic cavity?

A

No

97
Q

What happens when the lungs are stretched?

A
  • When stretched, they are stretched beyond their resting position
  • The result of stretching is increased capacity and reserve
98
Q

Can lungs ever be completely compressed?

A

No, there is always a reserve of air left (residual volume)

99
Q

What happens when the lungs expand?

A

Muscles are expanding the rib cage and then they relax, and the lungs return to their original shape and size

100
Q

What do the abdominal muscles do?

A

Abdominal muscles stretch when you inhale and then they relax and return to their original length: they push the abdominal viscera back in and force the diaphragm up

101
Q

What does respiration for speech require?

A
  • Must maintain a steady flow of air at a relatively steady pressure
  • Vocal folds require a minimum subglottal pressure of 3-5cm H20
102
Q

How much of our vital capacity is used up during conversational speech?

A

35-60% of our vital capacity - loud speech can use lung volumes up towards 80%

103
Q

How do we maintain the continuous flow of air upon expiration to use it for speech?

A
  • The muscles of inspiration must intervene
  • They check the outflow of air
  • They impede the outflow of air to maintain a constant subglottal pressure
  • This gives us control of phonation
  • Abdominal muscles remain in a state of graded tonic contraction during exhalation
104
Q

How is the respiratory cycle for speech different?

A
  • Long drawn out expiration to produce long utterances
  • Short inspiration to maintain the smooth flow
  • 10% of the respiratory cycle on inspiration, 90% on exhalation
  • Does not change the amount of air we breathe in//out, it just alters how long we spend in each stage
105
Q

What do we use when we exhale during speech?

A
  • We use a “checking action” when we exhale during speech
  • This restrains the flow of air out of your inflated lungs by using the inspiratory muscles that got it there in the first place
  • Creates respiratory control for speech
  • Maintains a constant flow of air through the vocal tract
  • Helps to maintain the constant subglottal pressure to maintain phonation
106
Q

Describe the pressures of speech

A

Two levels of pressure simultaneously

Constant supply of subglottal pressure required to drive the vocal folds
- 3-5cm H20 vocal folds move
- 7-10cm H20 conversational speech

Micro-control of that constant pressure
- Adding stress, intensity, and pitch changes
- Increase the subglottal pressure by 2cm H20 to add stress

107
Q

What should you know about speaking on expiratory reserve?

A
  • When we get down to the resting lung volume and we have more to say, we have to enlist the muscles of expiration to push beyond (start using expiratory reserve volume)
  • We continue talking beyond the point where we would normally take another breath
  • The deeper our inhalation or the farther we go below RLV, the greater the force we have to overcome

A&P of Speech and Hearing (5 decks)

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