Lecture 4/8 - Pulmonary Anatomy Flashcards by Shirica Shaw

The upper airway includes 3 ______ cavities. What are they?

Pharynx

Oropharynx.
Nasopharynx.
Laryngopharynx.

How well did you know this?

Not at all

Perfectly

The larynx is a _______ structure that floats in the ________ of the ______

Cartilagenous

middle

neck

How well did you know this?

Not at all

Perfectly

What is the hyoid connected to? How is it secured?

Top of larynx/superior horns of thyroid cartilage

-Ligaments = Thyrohyoid membrane/ligament
-Skeletal muscle = pharyngeal muscles

How well did you know this?

Not at all

Perfectly

The Hyoid bone is _______ to the Thyrohyoid membrane

Superior

How well did you know this?

Not at all

Perfectly

The trachea is connected to the ______ of the larynx

Base

How well did you know this?

Not at all

Perfectly

Describe the size of the trachea

10 - 13 cm

inner diameter = thumb width

How well did you know this?

Not at all

Perfectly

The majority of the trachea is _________. About how much is not? What is that called? Where can we access this at?

intrathoracic (9cm)

4cm

Extrathoracic

Accessible in the neck (top of the chest

How well did you know this?

Not at all

Perfectly

What is the trachea made out of? (2)

Annular ligaments
cartilages pieces

How well did you know this?

Not at all

Perfectly

What are annular ligaments?

Connective tissue between the tracheal cartilage pieces

How well did you know this?

Not at all

Perfectly

T/F: annular ligaments keep the trachea open

the pieces of cartilage do

How well did you know this?

Not at all

Perfectly

There are approximately _____ cartilagenous rings in the trachea. What properties does this give the trachea?

20 rings

Attributes to the trachea being flexible, bendable, resilient –> not easy to break under pressure

How well did you know this?

Not at all

Perfectly

Cartilagenous rings in the trachea are ____________. What shape are they? What does this create? What does this help with?

Not continuous –> C-shaped

Opening in posterior of trachea (made with connective tissue)

Helps with:
1) Swallowing: allows for easier movement of food through esophagus
2) Coughing up expectorant by increasing allowing increased expired airflow

How well did you know this?

Not at all

Perfectly

The trachea is _____ to the esophagus

How well did you know this?

Not at all

Perfectly

What happens in the trachea when we cough?

Increased pressure generated w/i resp system –> posterior connective tissue creates an infolding –> 1 big area becomes 2 smaller areas –> higher velocity/speed = easier to clear expectorant

How well did you know this?

Not at all

Perfectly

_____ cells produce mucous and are normally positioned around cells that have what? What purpose does this have?

Goblet cells

Normally positioned around cells that have cilia on them

combo of goblet cells + cells that have cilia = helps clear irritants out of the lungs/upper airway

How well did you know this?

Not at all

Perfectly

The R lung has ____ brochopulmonary segments & the L has ____. Why?

R = 10

L = 8

L: 4 segments fuse into 2 pair –> reducing number to 8

How well did you know this?

Not at all

Perfectly

Describe the differences between the R & L main stem. (If there are reasons for these differences, please state them)

R main stem (larger lung):
-wider
-shorter –> branches almost immediately to smaller airways
-more vertical: 25 degree

L main stem (smaller lung):
-narrower
-longer (4-6cm) – longer dt routing air past position of heart
-more horizontal: 45 degree – to go around heart

How well did you know this?

Not at all

Perfectly

The total bifurcation angle of the 2 main stems is ______

70 degrees

R = 25 degrees from verticle
L = 45 degrees from verticle

How well did you know this?

Not at all

Perfectly

The last piece of cartilage in the trachea is called the ______. What is the significance of this?

Carina

It is the start of the bifurcation of the 2 mainstems

How well did you know this?

Not at all

Perfectly

What are the 2 invasive airway locations? Briefly describe them

1) Tracheostomy:
-Top 4 cm of trachea (extrathoracic)

2) Median cricothyroid ligament/membrane:
-connective tissue
-connects & separates the front/inside of cricoid & thyroid cartilage

You can put an opening in the trachea or an incision in the median cricothyroid membrane

How well did you know this?

Not at all

Perfectly

What are considerations we should have w/ invasive airways/ETT?

Bypassing nose & mouth = bypassing natural humidification & warming of respiratory system –> Dries out respiratory system

Long procedures/bypassing = USE HUMIDIFICATION/WARMTH ON THE ANESTHESIA MACHINE

How well did you know this?

Not at all

Perfectly

The internal trachea is made of _______. What properties does this give it?

Soft tissue (connective tissue)

Allows it to stretch if needed

How well did you know this?

Not at all

Perfectly

How does extending the pts head backwards affect the trachea? What does this affect?

-Longer length
-Narrower diameter

Stretches it out –> Increases airway resistance

How does flexing the pts head forward affect the trachea? What does this affect?

Wider diameter

-Harder to intubate
-Decreased airway –> Easier to breathe
-Easier to swallow

What is the biggest ligament in the larynx? What does it do?

Thyrohyoid membrane Connects top of thyroid cartilage to hyoid bone at front of larynx

What is the most narrow point in the upper airway in an adult? <10yo?

Adult: Transglottic space (space between & around the vocal cords) <10yo: cricoid cartilage

Where can you palpate the inflated ETT cuff?

**Sternal Angle** Ridge at the top of the sternum (sternum notch)

The only closed, continuous, circle ring is the ______ cartilage. What significance does this have?

Cricoid Able to apply criocid pressure --> push the front --> pushes the entire piece --> helps prevent aspiration

What are the 6 laryngeal muscles?

1. Cricothyroid 2. Vocalis 3. Thyroartenoid 4. Transverse Arytenoid 5. Posterior Cricoarytenoid 6. Lateral Cricoarytenoid

Laryngeal muscles Muscle #; Location; function; effects: Cricoidthyoid Muscle

Muscle # 1 Location: Connects front of cricoid cartilage to rear thyroid cartilage Function: Contracts --> pulls larynx down (has vocal cords tethered to laryngeal prominence & arytenoid cartilage) --> **tightens vocal cords** Effects: Difficult intubation -higher pitch

Laryngeal muscles Muscle #; Location; function; effects: Vocalis Muscle

Muscle # 2 Location: Parallel to vocal cords Function: contract --> tighten vocal cords Effects: Difficult intubation -higher pitch -no effects on rima glottis

Laryngeal muscles Muscle #; Location; function: Thyroarytenoid Muscle

Muscle #3 Location: attached to thyroid cartilage along sides of vocal fold & back/bottom of arytenoid cartilage (process) (attaches them together) Function: Contracts --> arytenoid swivels --> **closes the vocal cords** = **closes Rima Glottis**

Laryngeal muscles Muscle #; Location; function: Transverse Arytenoid Muscle

Muscle # 4 Location: Between L & R arytenoid cartilage (FYI transverse means in-between) Function: Contracts --> pulls arytenoid cartilage closer together (bendable dt being cartilage) --> **pulls vocal cords closer = closes rima glottis** **This functions depends on arytenoids being flexible dt them being cartilage**

Laryngeal muscles Muscle #; Location; function: Posterior Cricoarytenoid Muscle

Muscle #5 Location: attached to back of arytenoid cartilage triangle and cricoid cartilage Function: contracts --> pulls inwards on back processes of arytenoid cartilage --> **Opens vocal cords = opens rima glottis**

Laryngeal muscles Muscle #; Location; function: Lateral Cricoarytenoid Muscle

Muscle #6 Location: Lateral corner of arytenoid cartilage & cricoid cartilage Function: contracts --> arytenoid swivels --> **closes vocal cords = closes rima glottis**

Where are the vocal cords? What are they attached to?

Larynx Laryngeal Prominence & arytenoid cartilage

T/F: When the Cricoidthyoid Muscle contracts & relaxes, it closes & opens the rima glottis

F Only tighten the vocal cords -Has absolutely no affect on opening

The opening between the vocal cords is the ________. What is the difference between this and the transglottic space?

Rima Glottis Transglottic space includes the Rima glottis and the area around it. The rima glottis is ONLY the space between the vocal cords.

When the Thyroarytenoid Muscle contracts the L arytenoid cartilage spins ______ and the R spins ________. What does this do? Where exactly is the muscle attached to the arytenoid cartilage?

L = clockwise R = counterclockwise (**Collectively pulls inwards** on back processes of arytenoid cartilages) **Closes the vocal cords** = **Closes the Rima Glottis** This muscle is attached to the bottom of the artenoid cartilage --> process

Closing the vocal cords is __________ & Opening the vocal cords is __________

Adducting Abducting

When the Posterior Cricoarytenoid Muscle contracts the L arytenoid cartilage spins ______ and the R spins ________. What does this do? Where exactly is the muscle attached to the arytenoid cartilage?

L = counterclockwise R = clockwise **Opens the vocal cords** **Opens the Rima Glottis** This muscle is attached to the bottom of the arytenoid cartilage triangle and the cricoid cartilage

The ___________ muscle is the only laryngeal muscle that opens the rima glottis.

Posterior cricoarytenoid muscle

What are the muscles that **close** the Rima Glottis?

Thyroarytenoid (3) Transverse arytenoid (4) Lateral cricoarytenoid (6)

What will happen if you have dysfunctional set of cricoarytenoid muscles?

Posterior + lateral Will have a breathing problem

What muscles cause a laryngeal spasm?

**Pharyngeal constrictors**: -skeletal muscles around the neck area

When the Lateral Cricoarytenoid Muscle contracts the L arytenoid cartilage spins ______ and the R spins ________. What does this do? Where exactly is the muscle attached to the arytenoid cartilage?

L = clockwise R = counterclockwise **closes vocal cords/rima glottis** lateral side of arytenoid cartilage

Trigeminal Nerve =

CN V (5)

What CN is the majority of sensory in the face innervated by? Where is it located? What are its divisions?

Trigeminal nerve (CN V) Location: Side of the face Divisions: V1: Ophthalmic = forhead V2: Maxillary = uppermouth V3: Mandibular = Madible/Jaw

What position are the vocal cords normally in? What is this associated with?

Gentle abduction Associated with normal breathing

Describe the vocal cords during whispering

Stage Whisper Vocal cords are far apart & open enough for air **Vocal cords are NOT phonating bc too far apart** **No vibrations of vocal cords**

Describe the vocal cords during regular speaking

Vocal cords very **close to being closed** Tight closure gives ability to vibrate --> generates sound

The vocal cords are fully open during _______. What muscle group achieves this?

Full abduction Laryngeal muscle #5: Posterior cricoarytenoid

Why is it hard to breath while talking?

The vocal cords are almost closed when talking = hard to breath when rima glottis is closed

The _________ inervate most of the muscles in the larynx to control the vocal cords

Inferior Laryngeal nerves

What happens when we damage 1 recurrent laryngeal nerve? What happens if you damage both?

Damage 1: Raspy speech (still able to speak) Damage both: Serious medical condition -airway is compromised -maybe able to speak very weak

Increasing altitude = ______ pressure

Lower

Decreasing altitude = ______ pressure

Higher

Lecture 4/8 - Pulmonary Anatomy Flashcards

Final