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KLowe Anesthesia Physiology 1: Respiratory > Lecture 1: Anatomy Of Respiratory System > Flashcards

Lecture 1: Anatomy Of Respiratory System Flashcards

1
Q

What are 8 anatomical structures of the respiratory system?

A
  • Nose/mouth
  • Pharynx
  • Larynx
  • Trachea
  • Bronchi
  • Terminal bronchi
  • Lungs and alveoli
  • Pulmonary vessels
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2
Q

What are 6 anatomical structures of the nose?

A
  • Nare
  • Meati
  • Conchae
  • Sinuses
  • Septum
  • Palate
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3
Q

What are 3 functions of the nose?

A
  • Warm inhaled air to body temperature (done by the conchae and septum)
  • Filter and obstruct foreign particles (via nasal hair/cilia)
  • Assists in phonation and sensation of smell (CN I)
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4
Q

What is the anatomical structure of the pharynx?

A
  • Posterior oral structure

- Connects the nose, mouth, larynx, and middle ear

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5
Q

What are the tonsils?

A

-Muscular mucosal lymph tissues

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6
Q

What are the 4 functions of the pharynx/tonsils?

A
  • Assists in phonation (forming speech)
  • Initiates deglutition (swallowing)
  • Defense against infectious pathogens
  • Enlarges with inflammation and tumor
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7
Q

What are the 5 parts of the ring of tonsils?

A

AKA Waldeyer’s Ring

  • Adenoid
  • Eustachian
  • Palatine
  • Lingual
  • Sublingual
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8
Q

How do we perform airway evaluation according to Mallampati classification?

A
  • Pt sitting with…
  • neck extended
  • mouth opened fully
  • tongue protruded
  • no phonation
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9
Q

MP Class 1

A

-Full view of uvula and tonsillar pillars, soft palate

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10
Q

MP Class 2

A

-Partial view of uvula or uvular base, partial view of tonsils, soft palate

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11
Q

MP Class 3

A

-Visualization of soft palate only

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12
Q

MP Class 4

A

-Visualization of hard palate only

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13
Q

Glossoptosis

A

-Collapse of oropharynx, tongue dropping posteriorly

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14
Q

Macroglossia

A

-Large tongue

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15
Q

Micrognathia

A

-Small jaw, mandible

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16
Q

Prognathism

A

-Protruding jaw, mandible

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17
Q

Microgenia

A

-Small chin

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18
Q

Microstomia

A

-Small mouth

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19
Q

Malocclusion

A

-Upper protrusion, “buck teeth,” overbite

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20
Q

What is the anatomical location of the larynx?

A
  • Adults: located anterior to C3-C6 vertebrae
  • At birth: C3-C4
  • Located between pharynx and trachea
  • A-O extension: normally 35 degrees
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21
Q

What are the 5 main functions of the larynx?

A
  • Functions as the airway protective sphincter
  • Closes off airway during swallowing
  • Supports vocal cords
  • Modulates speech
  • Provides auto PEEP
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22
Q

What are the 3 compartments of the larynx?

A
  • Supraglottis compartment
  • Glottis (ventricle)
  • Infraglottis compartment
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23
Q

What is in the supraglottis compartment?

A
  • Epiglottis

- False vocal cords

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24
Q

What is in the glottis (ventricle)?

A
  • True vocal cords
  • Rima glottidis–in adults, the narrowest portion of the upper airway
  • Arytenoids
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25
Q

What is in the Infraglottis compartment?

A
  • Below the vocal cords
  • Cricoid cartilage
  • Trachea
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26
Q

What are the 9 structures in the larynx (cartilaginous skeleton)?

A
  • 3 unpaired:
  • epiglottis
  • thyroid
  • cricoid
  • 3 paired:
  • Arytenoid
  • corniculate
  • cuneiform
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27
Q

What does the hyoid bone do?

A

-Suspends the larynx

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28
Q

What are the two types of muscles in the larynx?

A
  • Extrinsic muscles

- Intrinsic muscles

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29
Q

What are two functions of the extrinsic muscles of the larynx?

A
  • Attach the larynx to bone or the pharynx

- Move the larynx during swallowing

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30
Q

What are the functions of the intrinsic larynx muscle sets?

A
  • There are two sets of intrinsic larynx muscles–each set performs a different function:
  • One set alters the size and shape of the larynx
  • Other set of muscles move the true vocal cords
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31
Q

What are the 3 specific intrinsic muscles that alter the size and shape of the larynx, and what are they Innervated by?

A
  • Aryepiglottic
  • Thyroepiglottic
  • Oblique Arytenoid
  • Innervated by the recurrent laryngeal nerve
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32
Q

Aryepiglottic-function and innervation

A
  • Pulls epiglottis down over larynx

- Innervated by the recurrent laryngeal nerve

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33
Q

Thyroepiglottic-function/innervation

A
  • Assists pulling epiglottis down

- Innervated by the recurrent laryngeal nerve

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34
Q

Oblique Arytenoid-function/innervation

A
  • Pulls arytenoids together, adductor

- Innervated by the recurrent laryngeal nerve

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35
Q

What are the 6 intrinsic muscles that move the true vocal cords?

A
  • Cricothyroid
  • Thyroarytenoid
  • Lateral Cricoarytenoid
  • Posterior Cricoarytenoid
  • Traverse Arytenoid
  • Vocalis
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36
Q

Cricothyroid-function/innervation

A
  • Tensor of the vocal cords

- Innervated by the external superior laryngeal nerve

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37
Q

Thyroarytenoid-function/innervation

A
  • Relaxor of the vocal cords

- Innervated by the recurrent laryngeal nerve

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38
Q

Lateral Cricoarytenoid-function/innervation

A
  • adductor

- Innervated by the recurrent laryngeal nerve

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39
Q

Posterior Cricoarytenoid-function/innervation

A
  • Abductor

- Innervated by the recurrent laryngeal nerve

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40
Q

Traverse Arytenoid-function/innervation

A
  • Adductor

- Innervated by the recurrent laryngeal nerve

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41
Q

Vocalis-function/innervation

A
  • Abductor (weak)

- Innervated by the recurrent laryngeal nerve

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42
Q

-How does the larynx move during swallowing?

A
  • Upward

- Hyoid bone elevates the larynx, suprahyoid bone indirectly moves the larynx

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43
Q

What 5 muscles directly attach to the larynx?

A
  • Thyrohyoid
  • Salpingopharyngeus
  • Stylopharyngeus
  • Inferior constrictor
  • Palatopharyngeus
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44
Q

What are three important membranes of the larynx?

A
  • Thyrohyoid membrane
  • Quadrangular membrane
  • Cricothyroid membrane
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45
Q

What is the Quadrangular membrane?

A
  • Epiglottis to Arytenoid

- Lateral wall of larynx

46
Q

What is the Cricothyroid membrane?

A
  • Inferior to the true vocal cords

- Emergency airway–cricothyroidotomy or jet ventilation***

47
Q

What does the recurrent laryngeal nerve do?

A
  • Part of the vagus nerve branch (CN X)
  • Left recurrent laryngeal nerve passes at the aortic arch
  • Provides sensory innervation to the infraglottis
  • Provides motor innervation to all of the larynx except for the Cricothyroid muscle
48
Q

The left recurrent laryngeal nerve passes at the ___

A

-Aortic arch

49
Q

The recurrent laryngeal nerve provides sensory innervation to ___

A

-the infraglottis

50
Q

The recurrent laryngeal nerve provides motor innervation to ___

A

-All of the larynx except the Cricothyroid muscle

51
Q

Stimulation of the recurrent laryngeal nerve causes…

A

-abduction (move apart, opening) of the vocal cords

52
Q

Damage of the recurrent laryngeal nerve causes…

A

-vocal cord adduction (come together, close)

53
Q

What is the superior laryngeal nerve?

A
  • Part of the vagus nerve (CN X) branch

- Divides into two nerves: internal superior laryngeal nerve; external superior laryngeal nerve

54
Q

What does the INTERNAL superior laryngeal nerve do?

A
  • Provides sensation to the supraglottic and ventricle compartment
  • Stimulation of the internal SLN causes LARYNGOSPASM***
55
Q

What does the EXTERNAL SLN do?

A

-Provides motor innervation of the Cricothyroid muscle

56
Q

What does the sphenopalatine ganglion innervate?

A
  • Part of the middle division of CN V (trigeminal nerve)

- Innervates nasal mucosa, superior pharynx, uvula, tonsils

57
Q

What does the glossopharyngeal nerve (CN IX) innervate?

A
  • back 1/3 of the tongue
  • oral pharynx
  • tonsillar nerves
  • supraglottic region
58
Q

What does the internal branch of the SLN (CN X–vagus nerve) innervate?

A
  • mucus membrane above the vocal cords

- glottis

59
Q

What does the recurrent laryngeal nerve (CN X–vagus nerve) innervate?

A

-trachea below the vocal cords

60
Q

What is the epiglottis?

A
  • Flap-like structure

- Positioned upright to allow air passage during inspiration

61
Q

What is the vallecula?

A

-Space anterior to the epiglottis at the root of the tongue

62
Q

What does pressure on the hyoepiglottic ligament do?

A

-Lifts the epiglottis during laryngoscopy

63
Q

What is the epiglottis position during swallowing?

A
  • Epiglottis covers glottis to protect airway
  • Larynx raised upward by muscular contractions
  • Epiglottis is pressed downward by base of tongue
64
Q

What are the vocal folds (glottis)?

A
  • Two pairs of horizontal membrane folds:
  • False vocal cords
  • True vocal cords
65
Q

What are the false vocal cords?

A
  • Upper vestibular folds

- Close during swallowing

66
Q

What are the true vocal cords?

A
  • Responsible for vocal sounds
  • Mobile elastic fibers
  • Vocal ligament within
67
Q

What is the mucous membrane of the vocal folds?

A
  • Loosely attached, except at the vocal cords

- Susceptible to edema***

68
Q

What are the grades of view via direct laryngoscopy (DL)?

A

-Grades 1-4

69
Q

Grade 1 DL

A

-full view of vocal cords, glottis

70
Q

Grade 2 DL

A

-partial view of vocal cords, Arytenoid, and corniculate cartilages

71
Q

Grade 3 DL

A

-only epiglottis visualized

72
Q

Grade 4 DL

A

-only soft palate visualized

73
Q

Abduction of vocal cords

A
  • Abduction = move apart, open
  • Passive resting position
  • Vocal cords abduct during inspiration
74
Q

What is the only abductor muscle of the vocal cords?

A

-Posterior Cricoarytenoid = only abductor muscle

75
Q

Stimulation of what nerve abducts (or opens) the vocal folds?

A

-Stimulation of the recurrent laryngeal nerve

76
Q

Adduction of the vocal cords

A
  • Adduction = move together, close

- Intrinsic muscles close and tense the vocal folds

77
Q

What two nerves are responsible for adduction (closure) of the vocal folds?

A
  • Recurrent laryngeal nerve responsible for adduction of vocal folds
  • Superior laryngeal nerve tenses the vocal folds via the Cricothyroid muscle
78
Q

How is sound produced via the vocal cords?

A
  • Air is forced between CLOSED cords, which causes vibration

- Vibratory sound waves are formed into words by upper airway movement

79
Q

What upper airway structures are involved in sound modification?

A
  • Pharynx/oral cavity

- Tongue/lips

80
Q

How is pitch controlled by the vocal cords?

A
  • Control of vocal cord tension…
  • Increased tension = higher-pitched sound
  • Decreased tension = lower tone
81
Q

How is intensity of sound controlled by the vocal cords?

A
  • Loudness is related to the force of air passing between the vocal cords
  • Stronger blasts of air cause vocal cords to vibrate more and produce louder sounds
82
Q

What is the cricoid ring?

A

-A complete ring of cartilage shaped like a signet ring

83
Q

What is the cricoid?

A
  • Cricoid is a cartilage ring located below the larynx and thyroid cartilage (Adam’s apple)
  • Found between the Cricothyroid membrane and trachea
84
Q

What is Sellick’s maneuver and when is it used?

A
  • Pressure on the cricoid applied posteriorly to close the esophagus
  • Prevents gastric regurgitation into the trachea, used during…
  • rapid sequence intubation, trauma, full stomach, GERD, obesity, pregnancy, gastroparesis, SBO, pyloric stenosis, etc.
  • Aligns glottic opening during intubation
  • Prevents air into the stomach
85
Q

Cricoid in children

A
  • The cricoid is the narrowest part of the upper airway in children
  • It is cone shaped, narrowing inferiorly
  • Until age 8 years
86
Q

What is the trachea?

A
  • Flexible cylindrical tube supported by 20-25 C-shaped cartilages
  • 18-20 mm diameter
  • 12.5-18 cm length
  • Extends from C6-T5
87
Q

Where does the trachea divide?

A
  • At the carina–level T5-T7
  • Divides into 2 bronchi
  • @ 25 cm from teeth
88
Q

What prevents tracheal collapse?

A

-Incomplete C-shaped cartilage–there is connective tissue/smooth muscle posteriorly

89
Q

What is trachealis?

A
  • Posterior smooth muscle of the trachea

- Allows for esophageal expansion

90
Q

What filters air that enters the trachea?

A

-Ciliated epithelium filters air and conducts particles upward to pharynx on mucus carpet

91
Q

What is the bronchial tree?

A
  • Branched conducting airways

- Multiple divisions into smaller, shorter tubes

92
Q

What are functions of the bronchial tree?

A
  • Distributes air to alveoli
  • Warms and humidifies air
  • Filters and transports particles from lungs, ciliated
93
Q

What is special about the right primary bronchus?

A

-It is slightly straighter and wider

94
Q

What happens to airway diameter/area with branching?

A
  • Airway diameter decreases with branching

- Overall cross-sectional area increases, so resistance decreases tremendously

95
Q

Conducting airways do not participate in…

A
  • Gas exchange–ventilation occurs, but no perfusion

- Portion of each breath is wasted ventilation–30% of each normal breath remains in airway (150 ml/700 ml breath)

96
Q

What is acinus?

A
  • Includes all respiratory structures–respiratory bronchiole, alveolar ducts/sacs, alveoli
  • Site of gas exchange
97
Q

Where does the conducting airway end?

A

-It ends at the respiratory bronchiole

98
Q

What are the alveolar sacs/alveoli?

A
  • Terminal respiratory unit
  • Simple diffusion allows gaseous exchange between airspace and pulmonary capillaries
  • Multiple cell types present in alveolar wall
99
Q

The lower respiratory tract is lined by…

A

-mucosa and contain variable amounts of muscle and/or cartilage

100
Q

Airways become progressively…

A

-smaller and increasingly involved in gas exchange

101
Q

Pseudostratified ciliated columnar epithelium (PS-CC)

A
  • PSCC found from larynx to bronchi
  • Cilia remove trapped particles
  • Disabled by smoke
102
Q

What are goblet cells?

A
  • GC release mucous granules into airway lumen
  • Creates mucous blanket that moistens inspired air, prevents drying of airway, and traps particles
  • GC increase with injury and infection
103
Q

Clara cells

A
  • Located in smaller bronchiole which lack goblet cells
  • Produce mucus-poor, watery, proteinaceous material
  • This secretion combines with surfactant and mucus to assist cleaning small airways and reduce surface tension in bronchioles
104
Q

What are 6 cell types found in the alveolar wall?

A
  • Type I pneumocyte
  • Type II pneumocyte
  • Endothelial capillaries
  • Macrophages
  • Septal cells (fibroblasts)
  • Mast cells
105
Q

Type I pneumocyte

A
  • Covers 95% of alveolar wall
  • Squamous epithelial cell
  • Flat thin cells designed to increase alveolar surface area
  • Thin surface facilitates gas exchange
  • Less than 0.2 micrometers thick
106
Q

Functions of type I pneumocyte

A
  • Controls fluid movement between interstitium and airspace
  • Susceptible to injury and unable to regenerate self
  • Held together by tight junctions
  • Simple diffusion
107
Q

Type II pneumocyte

A
  • Cuboidal
  • Capable of mitosis
  • Repairs alveolar epithelium after injury
  • PC II regenerate PC I
  • PC II secretes surfactant
  • Maturation of PC II occurs at 24 weeks gestation***
108
Q

What is surfactant and what does it do?

A
  • Surface-active material
  • Mix of proteins, phospholipids, and ions
  • Mixes with water molecules and decreases the cohesiveness, thus diminishing the surface tension of alveolar fluid, which reduces the force necessary to inflate the alveoli and facilitates breathing
  • Prevents alveolar collapse during expiration, important in neonate
109
Q

Macrophages

A

-Found throughout interstitium and alveolar spaces

110
Q

Septal cells

A
  • AKA fibroblasts

- Maintain connective tissue of lung

111
Q

Mast cells

A

-produce histamine

KLowe Anesthesia Physiology 1: Respiratory (13 decks)

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