Lecture 4/3 - Pulmonary Anatomy Flashcards
Test 3
1
Q
How much oxygen is in the lung, in between breaths, in a healthy adult, at rest, in the upright position? Please solve.
A
- Volume in between breaths is FRC = 3L
- PAO2 = 100 mmHg
- Solve for O2 concentration in lung:
- 100mmHg/760mmHg = 0.1316 - solve for total volume of gas:
3L x 0.1316 –> 0.395 L or 395 ml of O2 in the lung
2
Q
______mls of inhaled air in the lungs will reduce the PCO2 in the lungs by _____ mmHg
A
350 mls
4 mmHg
3
Q
We bring in _____ ml a fresh air into the lungs. How much is already there? What happens to the rest of the VT?
A
350
3L
150ml = anatomic dead space
4
Q
Blood leaves the lung via the pulmonary ________
A
Vein (right)
5
Q
Blood comes into the lung via the pulmonary _______
A
Artery (left)
6
Q
The oxygen tension is ________ in between breaths
A
100 mmHg
7
Q
PA = (after equilibration)
A
Pressure in pulmonary vein
8
Q
The O2 concentration in dry atmosphere is ____% and in humidified inspired air is _____%. Why is there a difference?
A
21%
19-20% (displaced by water vapors)
9
Q
The O2 concentration _______ as we go deeper into the system. What is that concentration value?
A
Decreases
13% (still correspondence to PO2 of 100mmHg)
10
Q
We have _____ ml of O2 in the lungs in between breaths, if we are healthy, resting, and upright
A
395 ml
11
Q
The body consumes ______ of O2 per minute
A
250 ml
12
Q
If we have 395ml of O2 in the lungs and our body consumes 250ml of O2 per minute, can we hold our breath for 2 minutes?
A
Yes.
Although uncomfortable, we can. We have less than two minutes of O2 in the lungs, but pulmonary blood can absorb more oxygen that’s tucked away in the lungs.
(we cannot do this for a very long time though)
13
Q
How does anesthesia affect oxygen in the lungs?
A
Pt is no longer upright, awake, at rest –> pt is supine, sedated, paralyzed
lung volumes drop below RV
Can drop under 1L
Decreased RV –> completely decreased O2 reserve
(remember has 395ml when at FRC and upright/healthy at FRC!!, now we are BELOW RV)
14
Q
Why is preoxygenating before intubating important? Give a few examples.
A
Decreased RV –> decreased O2 reserve –> decreased time to intubate
- Known difficult airway.
- Need more time to secure the airway (Student just learning like myself)
Giving 100% oxygen (pre-oxygenating) will help increase their O2 reserve to give me more time in case something goes wrong.
15
Q
Anesthetized patients RV can drop below ____ L
A
1L
16
Q
The ____ lung is bigger. Give a brief description.
A
Right
Heavier
More volume
17
Q
Why is the left lung smaller?
A
Piece carved out to fit the heart
18
Q
The _____ lung is taller
A
Left
19
Q
The R lung has ___ lobes and the L lung has ____ lobes. All the lobes are separated by _______.
A
3
2
Fissures
20
Q
How many lobes does the R lung have? What are they called?
A
3
Superior lobe
Middle lobe
Inferior lobe
21
Q
How many fissures does the R lung have? What are they called?
A
Horizontal fissure (top): separates superior & middle lobes
Oblique fissure (bottom): separates middle & inferior lobes
22
Q
Describe the oblique fissure
A
In the R lung
At an angle
Separates middle & inferior lobe
23
Q
What allows the lungs to slide around in the chest cavity? (2) Describe them.
A
- Visceral pleura: attached to lung.
- Parietal pleura: attached to chest cavity.
Both have thin layer of slippery fluid/ mucus to help decrease friction when the lungs are expanding/contracting during breathing
24
Q
Pain/inflammation between these two spaces is from _______. What symptoms would you see?
A
Infection
Pain when breathing –> lungs not being able to slide freely in chest from friction
25
Subdivisions w/i lung/lobe are called _________
Bronchopulmonary segments
26
There are ____ bronchopulmonary segments in the R lung and ______ in the L lung.
R = 10 (larger)
L = 8 (smaller)
27
What does visceral mean?
Organ
28
What is the pleural space? What is there?
"potential space" between visceral pleura & parietal pleura.
-Usually just fluid.
-sometimes a pocket of air
29
Is there is air located in the "potential space" where would it form? What is this?
Costodiaphragmatic recess: opening between top of diaphragm & side of rib cage
This is found at the corner of the lung
30
The diaphragm is fastened into the base of the ______
Thorax
31
The muscle fibers of the diaphragm connect here; also the heart and lungs sit here ________
Central tendon
32
T/F: the heart moves up and down with the diaphragm during breathing
T
33
Why is the L lung taller?
Both the heart and lung sit on the central tendon depressing the L side of the diaphragm more than the R side
34
Where are the diaphragm anchoring points?
Muscle fibers of diaphragm: central tendon
Leaflets/cusps of diaphragm: vertebral bodies on L spine
35
Healthy, quiet breathing is primarily a result of the ________
Diaphragm
36
During healthy, quiet breathing getting air out of the lungs is a result of _________. Why does this occur?
Passive recoil
This pressure is generated when the diaphragm drops (contracts) during inspiration --> lung stretch --> air pulls in --> recoil is generated
37
What are scalene muscles? How many of them do we have? What do they do?
Muscles that assist when increased WOB is necessary
3 sets on each side of neck = **6 total**
Stabilize the top of the thorax as the diaphragm drops
38
Where are the scalene muscles located?
Anchored to base of skull/neck vertebrae = **C spine** & **rib 1/2**
39
What do the scalene muscles do/prevent?
-helps hold the thorax in place --> provides more effective inspiration
-thorax/ribcage from being pulled down when diaphragm contracts (drops) during inspiration
As this would prevent as much air from entering into the lungs
40
What and where is the mastoid process?
Bone behind the ear
41
What does the sternocleidomastoid muscle attached to?
-midline sternum (top of ribcage)
-mastoid process of skull (behind ear)
42
sternocleidomastoid muscle works similar to _______ muscle
Scalene
43
How does the sternocleidomastoid muscles work during inspiration?
Contracting this muscle at the same time as diaphragm contracts (drops) helps stabilize the thorax ribcage and prevents it from being pulled down
44
There are ____ sets of intercostal muscles. What are they called? Where are they located?
2
External intercostals: superficial/outer part of rib cage
Internal intercostals: inner side of rib cage
45
Where are intercostal muscles located in general?
Within the rib cage between the ribs
46
What does the term costal mean?
Rib
47
The external intercostals aid with _________. How?
Inspiration
They have two attachment points outside of rib cage --> when contract --> muscles pulled rib cage out --> thorax expands --> thorax move forward/anterior --> more area for air to enter in
48
With external intercostals aid the thorax moves _________
anteriorly/forward
49
The internal intercostals aid with _________. How?
Forced expiration
They have two attachment points inside of rib cage --> when contract --> muscles compress thorax --> thorax comes closer together --> air pushed out of lungs
50
When are the internal intercostals normally only used?
When breathing at a much faster rate and need to get air out of lungs, forcefully/quickly
51
How does contracting abdominal muscles assist with breathing?
Assists with **forced expiration** when needing to get air out faster than passive recoil allows
Contract abdomen muscles --> pushes abdomen contents upward towards diaphragm --> forces air out of lungs
52
Which abdominal muscles assist with forced expiration? Where are they located?
Rectus abdominis: front abdominal muscles
Oblique muscles: side abdominal muscles
53
The abdominal muscles aided in increasing the ______ of forced expiration
Speed
54
What are the pectoralis muscles that assist with breathing? Where are they located?
Pec major: big superficial muscle on top, upper part of chest (more superficial)
Pec minor: lies deep to the pec major
They attach to the shoulder blades & top of the rib cage
55
How do the pectoralis muscles assist with breathing?
Stabilize the position of the thorax
They attach to the shoulder blades & top of the rib cage
When **supporting your upper body with your arms** (like leaning on a table) --> stabilize the thorax during inspiration when under stress --> put diaphragm and a great position to pull down more effectively --> easier deep inspiration
56
Why does someone lean on a table when they are out of breath?
Stabilizing the arms --> stabilizing the shoulder blades --> allows, pectoralis muscles to stabilize the position of the thorax to assist with deep inspiration
57
The upper part of the airway is called the _______ and it has ____ parts
Pharynx
3
58
What are the 3 parts of the Pharynx called? Describe them.
1. Nasopharynx: top
Opening in nose
2. Oropharynx: middle.
Oral cavity
3. Laryngopharynx: lower.
Everything below oral cavity in through larynx
59
The Laryngopharynx travels from the _______ to the _______
Pharynx
Larynx
60
The _______ is the portion attaches the pharynx to the trachea
Larynx
61
What type of muscle is the tongue and the floor of the mouth? What consideration should we have with this?
Striad = **skeletal muscles**
These muscles are affected by paralytics!!!
When supine and paralyzed --> tongue is flaccid & falls back --> blocks larynx --> need to manipulate to get an ETT in
THIS IS WHY WE USE MAC AND MILLER BLADES
62
Why are the boney projections in the nose porous?
Where blood vessels sit
63
What are 2 roles of the upper airway? What is required for these two things to happen?
1. Filter: mucus in nose make sure things don't down into the lung
2. Heat/humidifier: rapidly brings inhaled air up to body temperature, almost immediately and adds water papers
Rich blood flow is required for these two things to happen (porous boney projections in nose)
64
Where is the ethmoid bone located?
Middle of the face
Behind opening of nose
65
T/F: the ethmoid bone is sturdy
F
It is small, fragile, & easy to Fx
66
What are the bony projections in the nose called? How many do we have? Where are they located?
Conchae (singular = concha)
6 total
3 sets; 1 on each side of the nose
-Superior concha: Top of nose
-Middle concha: Middle of nose
-Inferior concha: Bottom of nose
67
The _______ bone is the main bone connecting the nasal ______
ethmoid
nasal sinuses
68
_______ is another name for concha (conchae)
Turbinate(s)
69
What is the shape on concha? Which is more or less prominent? What is the purpose of this shape?
They are curved
Most curved = inferior concha
Fairly curved = superior concha
Curved shape from the concha in the nose generates turbulence during inspiration
70
Turbulence is generated by ________ in the nose during ________. What is the purpose of this?
concha
inspiration
Turbulence = increased particles getting stuck in mucous in nose wall --> helps with filtration in the upper airway
71
Turbulence helps with _______ in the upper airway. This is caused by ______. What does this prevent?
filtration
concha
This prevents particles going into the lower airway (lungs)
72
The turbulence in the upper airway filters what types of particles? What are some examples?
Large particles: dust, pollen
(does not work well for small particles, such as smoke)
73
At rest, in a healthy adult about ______ of the air that we inspire comes through the nose. What happens to the remainder
1/2
nose
other half is inspired thru mouth
74
What is turbulence?
Spinning air
75
T/F: the turbulence in the upper airways can filter smoke
F
Only large particles. Smoke is too small.
76
A Coronal section view is looking from ________
Front (separating front from back)
77
The superior & middle conchae are projections off of the _________ bone
Ethmoid
78
The inferior concha is continuous with the __________
Roof of the mouth/ hard palate
79
The inferior concha are projections off of ________ bone
Maxillary
80
What is the Maxillary bone?
Top part of the jaw/ upper mouth
Teeth are anchored in here
81
Teeth are anchored into the _______ bone
Maxillary
82
Porous conchae = increased risk of ________ --> increased risk of ________
Fracture
Bleeding
83
Porous bones increases the risk of ______
fx
84
Which conchae are the strongest?
inferior conchae
85
During nasal intubation, where would you want to insert the tube? Why?
Along the floor of the nose
-Should be flat
-can go underneath and to the side of inferior conchae
-avoids more fragile conchae
**This helps to prevent breaking a conchae which can cause extensive bleeding into the lungs**
86
Pressure can build up in the _________ with bad allergies. What symptoms might you see?
Maxillary sinus
HA
Uncomfortable breathing
**worse with infection**
87
What are sinuses surrounded by?
Fleshy material
88
The Crista Galli is an ______ projection off of the _____ bone and runs ______
Upward
Ethmoid
midline
89
The ______ is ________ that separates the L & R brain hemisphere
Falx Cerebri
connective tissue/membrane
90
The Crista Galli is projected into the _______ and is the connection point for the ________
cranium
falx cerebri
91
Cranial nerve V =
Trigeminal nerve
92
What is the main nerve that covers sensory in most areas of the face?
Cranial nerve V (trigeminal nerve)
93
What are the divisions of cranial nerve V? What areas of the face do they cover?
1. Ophthalmic: forehead
2. Maxillary: a proportion of mouth.
3. Mandibular: jaw.
94
What causes a brain freeze? What is the Tx?
Lots of nerves on roof of mouth/**hard palate** --> cold sensed in mouth by trigeminal nerve --> brain feel pain, but is confused about location dt trigeminal nerve having multiple divisions --> feels HA on forehead
Tx: push tongue on roof of mouth --> warms roof of mouth
95
96
The external acoustic meatus is directly ________ to the mastoid process
anterior
97
What is the opening for the inner ear called?
External acoustic meatus
98
The boney top of the mouth is the _______
Hard palate
99
The ethmoid bone is in the ______ of the cranium
Front
100
Smell sensors route through the __________ plate of the ________ bone
Cribriform plate
Ethmoid bone
101
Where are Olfactory neurons located? What is the significant of this?
Cribriform plate of the ethmoid bone
This area is a portion of the top of the nose where olfactory neurons work their way into the nose so we can smell what we are taking in
102
Smell sensors are located on the ______ of the ethmoid bone, cribriform plate
Top
103
T/F: pores in the ethmoid bone allows route for smell sensors to route smell back to brain
T
104
Why is the nose a great place to absorb drugs?
-has neurons
-highly vascular
-very porous
All of these things combined = direct connection to the brain
105
CN V covers sensory functions to what areas in the pharynx?
1. Oropharynx
2. Back of nose
106
CN X covers sensory functions to what areas in the pharynx? What other areas?
Larynx to trachea (back of oropharynx thru larynx & trachea)
Vallcula
Epiglottis
Posterior/inferior throat
107
CN IX covers sensory functions to what areas in the pharynx? What other areas?
Small portion of back of mouth
Anterior to the epiglottis (small part of the very back 1/3 of the tongue-where it looks bumpy)
108
CN IX =
Glossopharyngeal nerve
109
CN X =
Vagus nerve
110
Where/what is the epiglottis? What does it do?
Big piece of cartilage
Sits at back of tongue
Opens/closes airway when we need to swallow; prevent prevents food from going into larynx/trachea by closing off and allows food to go into the esophagus
111
T/F: somatic sensations include taste
F
Touch, pressure, pain, tickle, itch
112
Somatic sensation: The posterior ____ of the tongue is innerated by _______
1/3
CN9
113
Somatic sensation: The anterior ____ of the tongue is innerated by _______.
2/3
CN5 --> mandilubar division (V3)
114
What does CN5 - V3 mean?
Trigeminal nerve mandilubar division
115
T/F: the taste sensations are the same throughout the tongue and epiglottis
F
epiglottis doesnt have many taste sensations
116
What nerves innovate certain areas of the tongue for taste sensation?
Epiglottis: CNX
Posterior 1/3: CN9
Anterior 2/3: CN7
117
CN VII =
Facial nerve
118
The soft palate is _____ and ______ to the hard palate. Where is it located?
Posterior
Inferior
The soft palate hangs off the back of the hard palate
119
How could the soft palate create a difficult airway?
It is made out of soft tissue and is dangling at the back of your airway
If too much is hanging off of the back of the hard palate --> obstruction
120
What what typically causes people to snore?
Too much of the soft palate hanging off the back of the hard palate causing an obstruction in the airway
121
The uvula projects off the _______
Soft palate
122
How many types of tonsils do we have? Where are they located?
3 types
1. 2 palatine tonsils: back of the mouth
2. 1 pharyngeal tonsil: nasopharynx (back of nose); behind soft palate
3. 1 lingual tonsil: hangs on at the base of the tongue
123
How many total tonsils do we have?
5
124
What happens if the Pharyngeal tonsils be becoming enlarged?
Situated behind soft palate --> push against soft palate --> make airway more difficult to access
125
Palantine tonsil is ______ to lingual tonsil
superior
126
We have ______ salivary glands. Where are they located? What is the purpose of them?
2 sets (4 total)
-Sublingual glands: under the front of the tongue
-Submandibular glands: under mandible; rear and off to the side (base of jaw)
Produces saliva to help start processing food
127
Sublingual glands are more ________ to the Submandibular glands
anterior
128
Describe the parotid gland
Inside the side of face
Can swell very very big if injured
129
All glands are highly ______ which make them easy to _______ if injured
Vascular
Swell
130
The _______ protrude from the back of the tongue
Epiglottis
131
The __________ is between the tongue and the epiglottis
Lingual tonsils
132
The ________ is immediately in front of the Epiglottis.
Vallecula
133
Which blade slides into the Vallecula notch? Which blade covers it?
notch: Mac
covers it: Miller
134
What is the purpose of the Epiglottis? How does it work? (2)
Protects the airway by blocking food from entering into the larynx/trachea --> routing it to the esophagus
1. swallow --> epiglottis pulls back --> airway blocked
2. swallow --> larynx/voice box moves up --> airway blocked
135
The most narrow point of upper airway in a <10yo in the larynx is _________
cricoid cartilage
136
The most narrow point of upper airway in an adult in the larynx is _________. What is this space?
transglottic space (vocal fold)
This is the space between the vocal cords
137
The area that you clear your throat is called the ____________. What happens to the mucus?
Cricoid cartilage
Mucus is propelled out of the larynx --> into esophagus
138
Describe the Hyoid bone
Floating bone
Located: middle of throat; under the mouth; above larynx
Can break with force, but is a CARTILAGE (bendable)
139
______ bone prevents fractures from happening in the larynx. Where is the attachment points of this bone?
Hyoid
Muscles in the floor of the mouth; and some other cartilage in the larynx
140
What are the cartilage structures in the larynx? (5)
1. Epiglottis
2. Hyoid bone
3. Thyroid cartilage
4. Cricoid cartilage
5. Cricoid joint
141
What is the largest cartilage in the larynx? What are the attachment points?
Thyroid cartilage
hyoid bone, trachea & everything above it
142
Describe the Cricoid cartilage (3xC)
C-ring
Circle shaped
Continuous cartilage
143
The _________ allows thyroid cartilage to pivot down inferiorly. What are the attachment points?
Cricothyroid joint
Cricoid cartilage & thyroid cartilage
144
We have ____ **inferior horns** and they are projections off of the _________. The __________ projects off of the inferior horns.
2
Thyroid cartilage
Cricothyroid joint
145
The thyroid gland sits on ___________ and we have ___ of them. Where is this?
Laminae (singular: lamina)
2
Laminae are the sides of the thyroid cartilage
146
We have ____ **superior horns** and they are projections off of the _________. They are connected to the ______ bone.
2
Thyroid cartilage
hyoid
147
What is the real name of the Adams apple?
Laryngeal prominence
148
Where is the Laryngeal prominence located? What is the attachment point?
Front/medial projection of thyroid cartilage
**vocal cords**
149
Describe how differences in the Laryngeal prominence affect voice in women vs men
Women: **shorter vocal cords**
higher pitches voces
Men: more anterior/prominent --> **longer vocal cords**
Lower/deeper voice
150
T/F: thyroid cartilage connects to the circular shaped cricoid cartilage that contains pivot point to allow thyroid cartilage to swivel forward
T
151
The __________ on the cricoid cartilage is a groove that serves as a pivot point between the thyroid and cricoid cartilage
Articular facet for the thyroid cartilage
152
The Arytenoid cartilage is ______ shaped and attach to what? How many do we have?
diamond
cricoid cartilage & vocal cords
153
What is the joint for the arytenoid cartilage to be able to pivot so that we can speak and controlled sound? How many are there?
Articular facet for arytenoid cartilage
2
154
What is the Corniculate cartilage?
small appendage bound to arytnoid cartilage
155
What are the unpaired cartilages that make up the larynx? (3) Describe them
1. Thyroid cartilage: largest.
-forms anterior wall
2. Cricoid cartilage: **only complete ring**
-bottom of larynx
-inferior to thyroid cartilage
3. Epiglottis: covers laryngeal inlet during swallowing
156
The only complete ring is the ______ cartilage
Cricoid
157
What are the paired cartilages that make up the larynx? (2) Describe them
1. Arytenoid cartilage (x2): diamond shaped
-vocal cord movement
2. Corniculate cartilage (x2): small horn shaped
-top of arytenoid cartilage
158
What muscle helps the larynx pivot forward when it contracts?
Cricothyroid muscle
159
There are ____ sets of _______ arytenoids muscle/cartilage that tighten/pull om vocal cords
6
swivel
160
What is cricoid pressure? What are the pros and cons?
Continuous manual pressure on front of cricoid cartilage --> obstructs esophagus --> prevents aspiration during intubation
con: muscle spasms --> increase stomach pressure --> Blow out esophageal sphnicter --> ** this causes permanent damage**
161
Where is the esophageal sphnicter? What does it do?
Base of esophagus
Separates the stomach and the esophagus
162
Pec minor is connected to the ______ & ribs _____. When the arms are stabilzed it secures the _______ making deep inspiration easier
coracoid process
ribs 3-5
Scapula
