Intro

Question 1

Parts of the upper respiratory tract

Answer 1

Nasal passage
Turbinates
Parasinal sinuses
Pharynx
- nasopharynx
- oropharynx
- laryngopharynx
Larynx

Question 2

Turbinates

Answer 2

Boney projections that warm, moisten and filter air/pathogens

Question 3

Parasinal sinuses

Answer 3

Small cavities/openings that add resonance to voice

Question 4

Larynx content and function

Answer 4

Consists of cartilage and muscle
- hyoid, thyroid and cricoid ligament
Contains epiglottis and vocal chords

Involved in breathing, producing voice and preventing aspiration

Question 5

Epiglottis during breathing, coughing and eating

Answer 5

Open during breathing so air goes into tranche
Closed during eating so food into esophagus
With coughing it closes to increase abdominal pressure then opens up to release cough

Question 6

Lower respiratory tract

Answer 6

Trachea
Right and left primary bronchi
Secondary and tertiary bronchi
Bronchioles
Alveoli

Question 7

Trachea anatomy and function

Answer 7

Connects larynx to bronchi
12cm long
From cricoid cartilage to carina at T5/sternal angle
Cartilage supports wall and prevents airway collapse

Question 8

Angle of left vs right bronchi

Answer 8

Left: 45-55
Right: 20-30

Question 9

How do Alveoli enable gas exchange

Answer 9

Create large SA
Coated with surfactant which reduces surface tension allowing inspiration and preventing collapse

Question 10

Collateral ventilation

Answer 10

Ventilation of alveolar structures through passages that bypass normal airways
- interbrincholar channel of martin
- bronchiole alveolar channel of lambert
- interalveolar pore of Kohn
- interlobar via fissures

Question 11

Right lung surface anatomy

Answer 11

3cm above clavicle at midclavicular line
Follows R parasternal line
Ends at 6th rib parasternal line at midclavicular line, 8th rib mid axillary line and 10th rib posteriorly

Question 12

Left lung surface Anatomy
Markings

Answer 12

3cm above clavicle in midclavicular line
Follows L parasternal line
Ends at 6th rib mid clavicular line, 8th rib mid axillary line and 10th rib posterior (lateral to vertebral line)

Question 13

Surface anatomy of fissures

Answer 13

Oblique: T2 Spinous process to 6th coastal cartilage anteriorly
Horizontal: extends from oblique fissure to 3rd or 4th rib

Question 14

Right upper lobe segments

Answer 14

Apical
Anterior
Posterior

Question 15

Right middle lobe segment

Answer 15

Medial
Lateral

Question 16

Right lower lobe segments

Answer 16

Superior
Medial
Lateral
Anterior
Posterior

Question 17

Left upper lobe segments

Answer 17

Apical
Anterior
Posterior
Lingula

Question 18

Left lower lobe segments

Answer 18

Superior
Anterior
Lateral
Posterior

Question 19

Pressure inside pleural cavity

Answer 19

Negative pleura holds the visceral and parietal pleura close together and promote lung expansion

Question 20

Diaphragm role

Answer 20

Primary inspiration muscle
Postural stability
Vascular and lymphatic system role
Supports gastroesohageal function

Question 21

3 openings of diaphragm

Answer 21

T8 - IVC, R phrenic N
T10 - esophagus, anterior and posterior vagal trunk
T12 - thoracic duct and aorta

Question 22

Respiratory defense mechanism

Answer 22

Respiratory mucosa
Mucociliary transport
Cough

Question 23

Airflow is ___ proportional to airway resistance and ___ related to pressure difference

Answer 23

Inversely, proportionally

Question 24

Inspiration mechanism

Answer 24

Contraction of diaphragm and external intercostal
Diaphragm flattens and descends while ribs rise
Decreased pressure in pleural cavity, alveoli and airway
Decreased thoracic pressure < atmospheric pressure leads to inspiration

Question 25

Expiration mechanism

Answer 25

Diaphragm and external intercostal relax causing thorax size to decrease Natural recoil of alveoli Increased intra alveolar pressure causes passive expiration

Question 26

Control to ventilation

Answer 26

1. Medullary respiratory center - ventral group: control rhythm and respiratory rate - dorsal: stimulates inspiration via phrenic nerve and intercostal nerve to diaphragm and intercostal (stimulates forced expiration when needed) 2. Potine respiratory center 3. Higher brain centers 4. Peripheral chemoreceptors (respond to 02) 5. Central chemoreceptors (respond to CO2) 6. Muscle joint receptors 7. Stretch and irritant receptors in lungs 8. External factors (e.g. drugs)

Question 27

Trigger of respiration

Answer 27

Elevated CO2 diffuses into CSF and Lowers pH —> stimulates respiratory center —> increased RR and depth O2 levels have a large reserve and need a large decrease for peripheral chemoreceptors to kick in

Question 28

Factors affecting diffusion

Answer 28

Pressure gradient Thickness of respiratory membrane Surface area

Question 29

Inspiration reserve volume

Answer 29

Maximal volume of air inspired in excess of normal tidal volume

Question 30

Expiratory reserve volume

Answer 30

Maximal volume of air expired following tidal expiration

Question 31

Vital capacity

Answer 31

Maximal amount of air expired following maximal inspiration

Question 32

Total lung capacity

Answer 32

Total volume of air in lungs after maximal inspiration

Question 33

What is the Dependent lung and how is it created

Answer 33

Pleural pressure is more negative as you go down due to weight of lung and pressure of mediastinal and abdominal content. This causes top of lung to have larger and inflated alveoli (not compliant) Dependent lung: When the alveoli are small and compressed creating a compliant portion in the lung of the volume-compliance curve and more alveolar ventilation l

Question 34

West zones

Answer 34

Difference in pressure across the lung result in distinct areas of lung perfusion Zone 1, where alveolar pressure is higher than arterial or venous pressure —> collapse of alveolar vessels —> no ventilation (lots of alveolar dead space) Zone 2, balance between alveolar and arterial pressure determines blood flow Zone 3, where both arterial and venous pressure is higher than alveolar —> capillaries distend and increases air exchange.Blood flow is highest here . Similar to dependent lung (zone 3 is healthy part of lung)

Question 35

V/Q ratio in west zones

Answer 35

>1 : zone 1 with excellent ventilation but poor blood flow <1: zone 3 with excellent blood flow but poor ventilation 1: zone 2 (~.8) well matched gas and blood flow 0: no airflow/obstruction

Question 36

Obstructive vs restrictive

Answer 36

Obstructive: reduction in airflow and difficulty exhaling Restriction: reduction in lung volume, difficulty inhaling