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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
What is in the Infraglottis compartment?
- Below the vocal cords - Cricoid cartilage - Trachea
26
What are the 9 structures in the larynx (cartilaginous skeleton)?
- 3 unpaired: - epiglottis - thyroid - cricoid - 3 paired: - Arytenoid - corniculate - cuneiform
27
What does the hyoid bone do?
-Suspends the larynx
28
What are the two types of muscles in the larynx?
- Extrinsic muscles | - Intrinsic muscles
29
What are two functions of the extrinsic muscles of the larynx?
- Attach the larynx to bone or the pharynx | - Move the larynx during swallowing
30
What are the functions of the intrinsic larynx muscle sets?
- 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
31
What are the 3 specific intrinsic muscles that alter the size and shape of the larynx, and what are they Innervated by?
- Aryepiglottic - Thyroepiglottic - Oblique Arytenoid - Innervated by the recurrent laryngeal nerve
32
Aryepiglottic-function and innervation
- Pulls epiglottis down over larynx | - Innervated by the recurrent laryngeal nerve
33
Thyroepiglottic-function/innervation
- Assists pulling epiglottis down | - Innervated by the recurrent laryngeal nerve
34
Oblique Arytenoid-function/innervation
- Pulls arytenoids together, adductor | - Innervated by the recurrent laryngeal nerve
35
What are the 6 intrinsic muscles that move the true vocal cords?
- Cricothyroid - Thyroarytenoid - Lateral Cricoarytenoid - Posterior Cricoarytenoid - Traverse Arytenoid - Vocalis
36
Cricothyroid-function/innervation
- Tensor of the vocal cords | - Innervated by the external superior laryngeal nerve
37
Thyroarytenoid-function/innervation
- Relaxor of the vocal cords | - Innervated by the recurrent laryngeal nerve
38
Lateral Cricoarytenoid-function/innervation
- adductor | - Innervated by the recurrent laryngeal nerve
39
Posterior Cricoarytenoid-function/innervation
- Abductor | - Innervated by the recurrent laryngeal nerve
40
Traverse Arytenoid-function/innervation
- Adductor | - Innervated by the recurrent laryngeal nerve
41
Vocalis-function/innervation
- Abductor (weak) | - Innervated by the recurrent laryngeal nerve
42
-How does the larynx move during swallowing?
- Upward | - Hyoid bone elevates the larynx, suprahyoid bone indirectly moves the larynx
43
What 5 muscles directly attach to the larynx?
- Thyrohyoid - Salpingopharyngeus - Stylopharyngeus - Inferior constrictor - Palatopharyngeus
44
What are three important membranes of the larynx?
- Thyrohyoid membrane - Quadrangular membrane - Cricothyroid membrane
45
What is the Quadrangular membrane?
- Epiglottis to Arytenoid | - Lateral wall of larynx
46
What is the Cricothyroid membrane?
- Inferior to the true vocal cords | - Emergency airway--cricothyroidotomy or jet ventilation***
47
What does the recurrent laryngeal nerve do?
- 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
The left recurrent laryngeal nerve passes at the ___
-Aortic arch
49
The recurrent laryngeal nerve provides sensory innervation to ___
-the infraglottis
50
The recurrent laryngeal nerve provides motor innervation to ___
-All of the larynx except the Cricothyroid muscle
51
Stimulation of the recurrent laryngeal nerve causes...
-abduction (move apart, opening) of the vocal cords
52
Damage of the recurrent laryngeal nerve causes...
-vocal cord adduction (come together, close)
53
What is the superior laryngeal nerve?
- Part of the vagus nerve (CN X) branch | - Divides into two nerves: internal superior laryngeal nerve; external superior laryngeal nerve
54
What does the INTERNAL superior laryngeal nerve do?
- Provides sensation to the supraglottic and ventricle compartment - Stimulation of the internal SLN causes LARYNGOSPASM***
55
What does the EXTERNAL SLN do?
-Provides motor innervation of the Cricothyroid muscle
56
What does the sphenopalatine ganglion innervate?
- Part of the middle division of CN V (trigeminal nerve) | - Innervates nasal mucosa, superior pharynx, uvula, tonsils
57
What does the glossopharyngeal nerve (CN IX) innervate?
- back 1/3 of the tongue - oral pharynx - tonsillar nerves - supraglottic region
58
What does the internal branch of the SLN (CN X--vagus nerve) innervate?
- mucus membrane above the vocal cords | - glottis
59
What does the recurrent laryngeal nerve (CN X--vagus nerve) innervate?
-trachea below the vocal cords
60
What is the epiglottis?
- Flap-like structure | - Positioned upright to allow air passage during inspiration
61
What is the vallecula?
-Space anterior to the epiglottis at the root of the tongue
62
What does pressure on the hyoepiglottic ligament do?
-Lifts the epiglottis during laryngoscopy
63
What is the epiglottis position during swallowing?
- Epiglottis covers glottis to protect airway - Larynx raised upward by muscular contractions - Epiglottis is pressed downward by base of tongue
64
What are the vocal folds (glottis)?
- Two pairs of horizontal membrane folds: - False vocal cords - True vocal cords
65
What are the false vocal cords?
- Upper vestibular folds | - Close during swallowing
66
What are the true vocal cords?
- Responsible for vocal sounds - Mobile elastic fibers - Vocal ligament within
67
What is the mucous membrane of the vocal folds?
- Loosely attached, except at the vocal cords | - Susceptible to edema***
68
What are the grades of view via direct laryngoscopy (DL)?
-Grades 1-4
69
Grade 1 DL
-full view of vocal cords, glottis
70
Grade 2 DL
-partial view of vocal cords, Arytenoid, and corniculate cartilages
71
Grade 3 DL
-only epiglottis visualized
72
Grade 4 DL
-only soft palate visualized
73
Abduction of vocal cords
- Abduction = move apart, open - Passive resting position - Vocal cords abduct during inspiration
74
What is the only abductor muscle of the vocal cords?
-Posterior Cricoarytenoid = only abductor muscle
75
Stimulation of what nerve abducts (or opens) the vocal folds?
-Stimulation of the recurrent laryngeal nerve
76
Adduction of the vocal cords
- Adduction = move together, close | - Intrinsic muscles close and tense the vocal folds
77
What two nerves are responsible for adduction (closure) of the vocal folds?
- Recurrent laryngeal nerve responsible for adduction of vocal folds - Superior laryngeal nerve tenses the vocal folds via the Cricothyroid muscle
78
How is sound produced via the vocal cords?
- Air is forced between CLOSED cords, which causes vibration | - Vibratory sound waves are formed into words by upper airway movement
79
What upper airway structures are involved in sound modification?
- Pharynx/oral cavity | - Tongue/lips
80
How is pitch controlled by the vocal cords?
- Control of vocal cord tension... - Increased tension = higher-pitched sound - Decreased tension = lower tone
81
How is intensity of sound controlled by the vocal cords?
- 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
What is the cricoid ring?
-A complete ring of cartilage shaped like a signet ring
83
What is the cricoid?
- Cricoid is a cartilage ring located below the larynx and thyroid cartilage (Adam's apple) - Found between the Cricothyroid membrane and trachea
84
What is Sellick's maneuver and when is it used?
- 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
Cricoid in children
- The cricoid is the narrowest part of the upper airway in children - It is cone shaped, narrowing inferiorly - Until age 8 years
86
What is the trachea?
- Flexible cylindrical tube supported by 20-25 C-shaped cartilages - 18-20 mm diameter - 12.5-18 cm length - Extends from C6-T5
87
Where does the trachea divide?
- At the carina--level T5-T7 - Divides into 2 bronchi - @ 25 cm from teeth
88
What prevents tracheal collapse?
-Incomplete C-shaped cartilage--there is connective tissue/smooth muscle posteriorly
89
What is trachealis?
- Posterior smooth muscle of the trachea | - Allows for esophageal expansion
90
What filters air that enters the trachea?
-Ciliated epithelium filters air and conducts particles upward to pharynx on mucus carpet
91
What is the bronchial tree?
- Branched conducting airways | - Multiple divisions into smaller, shorter tubes
92
What are functions of the bronchial tree?
- Distributes air to alveoli - Warms and humidifies air - Filters and transports particles from lungs, ciliated
93
What is special about the right primary bronchus?
-It is slightly straighter and wider
94
What happens to airway diameter/area with branching?
- Airway diameter decreases with branching | - Overall cross-sectional area increases, so resistance decreases tremendously
95
Conducting airways do not participate in...
- 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
What is acinus?
- Includes all respiratory structures--respiratory bronchiole, alveolar ducts/sacs, alveoli - Site of gas exchange
97
Where does the conducting airway end?
-It ends at the respiratory bronchiole
98
What are the alveolar sacs/alveoli?
- Terminal respiratory unit - Simple diffusion allows gaseous exchange between airspace and pulmonary capillaries - Multiple cell types present in alveolar wall
99
The lower respiratory tract is lined by...
-mucosa and contain variable amounts of muscle and/or cartilage
100
Airways become progressively...
-smaller and increasingly involved in gas exchange
101
Pseudostratified ciliated columnar epithelium (PS-CC)
- PSCC found from larynx to bronchi - Cilia remove trapped particles - Disabled by smoke
102
What are goblet cells?
- 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
Clara cells
- 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
What are 6 cell types found in the alveolar wall?
- Type I pneumocyte - Type II pneumocyte - Endothelial capillaries - Macrophages - Septal cells (fibroblasts) - Mast cells
105
Type I pneumocyte
- 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
Functions of type I pneumocyte
- Controls fluid movement between interstitium and airspace - Susceptible to injury and unable to regenerate self - Held together by tight junctions - Simple diffusion
107
Type II pneumocyte
- 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
What is surfactant and what does it do?
- 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
Macrophages
-Found throughout interstitium and alveolar spaces
110
Septal cells
- AKA fibroblasts | - Maintain connective tissue of lung
111
Mast cells
-produce histamine

KLowe Anesthesia Physiology 1: Respiratory (13 decks)

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