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SRNAanatomy > Pulmonary System I > Flashcards

Pulmonary System I Flashcards

1
Q

Define respiration

A

Exchange of gases between the atmosphere, blood and cells

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2
Q

What are the 3 processes required for respiration

A

ventilation (breathing)
External (pulmonary) respiration
Internal (Tissue) respiration

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3
Q

The CV assists the respiratory by

A

Transporting gases

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4
Q

What are the respiratory system STRUCTURAL DIVISION?

A

Upper Respiratory system

Lower respiratory system

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5
Q

What are the respiratory system FUNCTIONAL division

A

Conducting Zone

Respiratory Zone

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6
Q

What are the conduction zone

A

Dead space up to terminal bronchioles

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7
Q

What is the respiratory zone

A

Gas exchanges in alveoli

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8
Q

The UPPER respiratory consists of

A 
PANP
Paranasal sinuses
Associated Structures
Nose
Pharynx
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9
Q

The LOWER respiratory consists of :

A 
LLTB
Larynx
Lungs
Trachea
Bronchi
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10
Q

The upper respiratory tract : put in order nasopharynx ,oropharynx and laryngopharynx

A

NOL

Nasopharynx –>Oropharynx –>Laryngopharynx

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11
Q

Mallampati Score 1

A

Full visibility of Tonsils, Uvula, Soft palate (TUS)

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12
Q

Mallampati Score 2

A

Visibility of hard and soft palate, upper portion of tonsils and uvula

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13
Q

Mallampati Score 3

A

Soft and hard palate, and base of the uvula visible

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14
Q

Mallampati Score 4

A

Only hard palate visible

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15
Q

2 parts of the larynx

A

Thyroid Cartilages

Cricoid cartilages

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16
Q

True ribs are _______ and are _______to sternum via ______ cartilage

A

1-7 ; attached directly ; Costal

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17
Q

False ribs are ________ and are ________to sternum

A

8-10; indirectly attached

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18
Q

Floating ribs are ________ and are _______ to sternum

A

11-12; not attached to sternum.

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19
Q

Supernumary ribs are ____ribs and cervical ribs are

A

Extra; elongation of transverse process of 7th cervical vertebra

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20
Q

Supernumary ribs: Lumbar ribs

A

Elongation of transverse process of lumbar vertebra

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21
Q

Function of floating ribs?

What about the oblique orientation?

A

allow flexibility of movement that is needed for ventilation to occur
Oblique orientation allows for elevation of the rib cage involved with lung expansion

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22
Q

what is the upper most part of the sternum

A

Manubrium

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23
Q

Suprasternal notch is the

A

Jugular

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24
Q

Trachea lies where?

A

posterior to and in line with jugular notch

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25
Q

Suprasternal notch (jugular) signifies ? and is the ideal ___________

A

midpoint of trachea and ideal location for the distal tip of the endotracheal tube

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26
Q

Where does the manubrium joins the body of the sternum?

What occurs at this level ? Which is T__ - T___

A

Sternal angle of Louis

Bifurcation of the trachea (T4-T5)

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27
Q

What is the hinge-like joint between the manubrium and the body of the sternum?

A

Manubriosternal Joint

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28
Q

what is the function of the manubriosternal joint?

A

Allows hinge like forward movement of sternum during inspiration and backward movement during Expiration

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29
Q

***PART of the UPPER airway : nose function

A

***Warms, cleanses, and humidifies inhaled air

RESONATING CHAMBER THAT AMPLIFIED the voice

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30
Q

Bony and cartilaginous support: 3 parts

A

Superior
Inferior
Ala Nasi

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31
Q

Bony and cartilaginous support: Superior part –> _______bones medially and ______lateraly

A

Nasal bones; maxillae

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32
Q

Bony and cartilaginous support: Inferior part –>

A

Lateral and ALAR cartilages

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33
Q

What is the ALA NASI? What is shaped by ?

A

Flared portion shaped by dense CT , forms lateral wall of each nostril.

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34
Q

Nasal Cartilage Caveat?

A

beware of nose rings and other jewelry (Bovie)

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35
Q

What is the vestibule? what kind of tissue is it made of?

A

It is a dilated chamber inside ALA NASI..Stratified Squamous epithelium , vibrissae (guard hairs)

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36
Q

Nasal cavity extends

A

from nostrils to posterior nares

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37
Q

Nasal septum divides cavity into

A

right and left chambers called Nasal fossae

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38
Q

Function of the Turbinates and Sinuses

A

Warm, clean and MOISTEN AIR for the lungs

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39
Q

What are the nasal conchae and how many are there?

A

3 folds of tissue on lateral and nasal fossa
mucous membranes supported by thing scrolllike turbinates bones
Superior, middle, inferior

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40
Q

What are the meatuses

A

Narrow air passage beneath each conchae

narrowness and TURBULENCE ENSURES AIR CONTACT MUCOUS MEMBRANES.

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41
Q

What are the paranasal sinuses? MENFS

A 
Maxillary
Ethnoid
Nasal cavity
Frontal 
Sphenoid
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42
Q

Nasal Cavity -Mucosa

A

Olfactory: lines roof of nasal fossa
Respiratory: Lines rest of nasal cavity with CILIATED PSEUDOSTRATIFIED EPITHELIUM

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43
Q

What kind of tissue line the rest of the nasal cavity?

A

Ciliated pseudostratified Epithelium

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44
Q

What is the defensive role of mucosa?

What are the bacteria destroyed by?

A

Mucous (from goblet cells) Traps inhaled particles - Bacteria destroyed by LYSOZYME & IgA

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45
Q

Function of the Cilia or respiratory epithelium?

A

sweep debris laden mucus into pharynx to be swallowed.

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46
Q

What is the function of the Erectile tissue of inferior conchae?

A

Venous plexus that rhythmically engorges with BLOOD and SHIFTS flow or air from on side of fossa to the other once or twice an hour to PREVENT DRYING.

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47
Q

Spontaneous EPISTAXIS most common site is

A

INFERIOR CONCHA

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48
Q

3 regions of pharynx in order from superior to inferior?

A

Nasopharynx
Oropharynx
Laryngopharynx

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49
Q

Nasopharynx is made of ______ ______ and is located posterior to _______, dorsal to ______ palate. It receives________ and contains what _______ ________

A

Pseudostratified epithelium

choanae ; soft; auditory tubes; PHARYNGEAL TONSIL

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50
Q

The pharynx ____degrees ______ turn does what?

A

Turn 90 degrees downward; Traps large particles

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51
Q

Oropharynx is made of _______ ______ and is the space between________location?
what does it contain?

A

stratified squamous epithelium; space between soft palate and root of tongue.
Inferior to hyoid bone
PALATINE and LINGUAL TONSILS

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52
Q

Lagyngopharynx is made up of ______ ____

Location ?

A

Stratified squamous

Hyoid bone to level of cricoid cartilage.

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53
Q

Glottis

A

Vocal cords and opening between

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54
Q

What is the epiglottis? guards what? and function?

A

Flap of tissue that guards glottis, direct foods, and drink to esophagus

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55
Q

Note on INFANT LARYNX

A

Higher in throat–> Forms a continuous airway from nasal cavity that allows breathing while swallowing

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56
Q

In infant larynx, by age 2,

A

more muscular tongue forces larynx down

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57
Q

Where are TRUE VOCAL CORDS?

A

True vocal folds are attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage.

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58
Q

Larynx located in adults ________

Larynx located in children_______

A

C3-C6

C3-C5 (superior)

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59
Q

Framework of the larynx is formed by ____total pieces of cartilages (____paired and _____ unpaired)

A

9; 3; 3

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60
Q

What are the 9 total pieces of cartilage?

CETACC

A 
Crycoid
Epiglottis
Thyroid 
Arytenoid (paired)
Corniculate (paired)
Cuneiform (paired)
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61
Q

Vertebral levels in the larynx

A

Hyoid (C2/C3)
Thyrohoid membrane (C4)
Laryngeal prominence (C5)
Cricoid cartilage and start of trachea (C6)

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62
Q

Which is the most superior of the 9 cartilages of the larynx?

A

Epiglottic Cartilage

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63
Q

Which is the largest of the 9 cartilages of the larynx? what does it form?

A

Thyroid Cartilage

Forms laryngeal prominence

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64
Q

Which is the cartilage of the 9 cartilages of the larynx, that connects LARYNX to TRACHEA

A

Cricoid Cartilage.

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65
Q

Which is the one out of the 9 cartilages of the larynx that is posterior to the thyroid cartilage?

A

ARYTENOID CARTILAGE

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66
Q

Arytenoid cartilage is composed of ______ and are located?

A

2; posterior to thyroid cartilage

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67
Q

Corniculate cartilage is composed of ____ and do what ?

A

Attached arytenoid cartilages like a PAIR OF HORNS

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68
Q

Which cartilage is attached like a PAIR OF HORNS?

A

CORNICULATE cartilage.

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69
Q

Which structures support soft tissue between arytenoids and EPIGLOTTIS?

A

Cuneiform Cartilages.

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70
Q

What is the narrowest portion of the airway in pediatric patients?

A

Cricoid

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71
Q

In pediatric patients newer studies suggest ?

A

The GLOTTIC OPENING may be the narrowest in the pediatric patient.

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72
Q

What is the RIMA GLOTTIDIS?

A

Opening between true vocal cords and the ARYTENOID cartilages.
-Narrowest portion of the upper airway in the adult

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73
Q

Glottis in the laryngeal cavity =

A

true vocal cords and the rima glottidis

74
Q

If the laryngoscope blade is too deep?

A

looking down the esophagus and hiding the larynx

75
Q

What is the function of the EXTRINSIC MUSCLES

A

Connect larynx to HYOID bone, elevate larynx during swallowing UP and FORWARD

76
Q

What are the parts of the SUPRAHYOID muscles? (MDS)

A

Mylohoid
Stylohoid
Diagstric

77
Q

What are the parts of the INFRAHYOID muscles? (SOTS)

A

Sternothyroid
Omohyoid
Thyrohyoid
Sternohyoid

78
Q

What are the muscles of the LARYNGEAL INLETS? (ATO)

A

Aryepiglottic
Oblique aretynoid
Thryroepiglottic

79
Q

What does the Aryepiglottic do?

A

Narrows inlet, closes glottis

80
Q

What does the OBLIQUE ARETYNOID do?

A

narrows inlet, closes glottis

Together , the aryepiglottic and oblique aretynoid act as a PURSE-STRING sphincter during swallowing.

81
Q

Which act as a purse string sphincter during swallowing?

A

Aryepiglottic

Oblique aretynoid

82
Q

What is the role of THYROEPIGLOTTIC?

A

Widens inlet

83
Q

Intrinsic Muscles function

A

Rotate corniculate and arytenoid cartilages.

84
Q

The intrinsic muscle ADDUCTS (which sound)

A

tightens : HIGH PITCH SOUND

85
Q

The Intrinsic muscle ABDUCTS (which sound)

A

Loosens: LOW PITCH SOUND

86
Q

What are the muscles involved with movement of true cords?

A 
Cricothyroids
Lateral cricoarytenoids
Oblique arytenoids 
Thyroarytenoids 
Transverse arytenoids
87
Q

3 intrinsic muscles that ADDUCTS CORDS and closes ? (LOT)

A

Lateral cricoarytenoids
Transverse arytenoids
Oblique arytenoids

88
Q

What is the ONLY INTRINSIC MUSCLE to lie outside the CARTILAGINOUS framework of the larynx?

A

CRICOTHYROIDS

89
Q

Which intrinsic muscle TENSE VOCAL CORDS?

A

CRICOTHYROIDS

90
Q

Which intrinsic muscle RELAX VOCAL FOLDS

A

THYROARYTENOIDS

91
Q

________is part of the THYROARYTENOIDS

A

Vocalis m.

92
Q

Which structure ADJUST TENSION of CORDS

A

Vocalis m.

93
Q

Which structure adjust vocal cords and FOLDS , OPENS

A

Posterior cricoarytenoids

94
Q

WHICH is the ONLY ABDUCTOR muscle of vocal cords?

A

Posterior Cricoarytenoids .

95
Q

Blood Supply to the larynx

A

supplied via EXTERNAL CAROTIDS and SUBCLAVIAN ARTERIES and INTERNAL JUGULAR VEIN

96
Q

Larynx innervated by

A

CN X Vagus

97
Q

Motor: All intrinsic muscles EXCEPT the _____ are innervated by the _______

A

Cricothyroid; RECURRENT LARYNGEAL NERVE

98
Q

Motor : The cricothyroid muscle is the only muscle not innervated by the laryngeal nerve , and is innervated by?

A

SUPERIOR LARYNGEAL NERVE.

99
Q

Sensory : larynx innervation

A

INFERIOR BRANCH of SUPERIOR LARYNGEAL NERVE

100
Q

What is the function of the inferior branch of superior laryngeal nerve?

A

Provides sensation for upper portion of the larynx down to and including upper half of the vocal cords.

101
Q

What is the function of the RECURRENT LARYNGEAL NERVE?

A

Transmits sensation below that TRUE CORDS and half of the LOWER CORDS

102
Q

Trachea is a ________tube, approx. _____long and ______ in diameter?

A

Fibrocartilaginous, 10-20cm and 12mm in diameter

103
Q

Where does the trachea begins?

A

AT end of larynx (C6) and extends to T5-T6

104
Q

What is the trachea supported by ?

A

16-20 C-Shaped rings of cartilage with smooth muscle posteriorly.

105
Q

What is the lowest most portion of the trachea where it divides into PRIMARY bronchi?

A

CARINA

106
Q

what is the trachea lined with? which function as?

A

Ciliated pseudostratified Epithelium which functions as MUCOCILIARY ESCALATOR.

107
Q

The lungs produce ____Ml of mucous per day

A

100ml

108
Q

What help trap precipitate?

A

Turbulent flow

109
Q

Additional way to remove inhaled particles?

A

Cough Reflex

110
Q

Explain the mucociliary Escalator Mechanism

A

Impaired by endotracheal intubation & Volatile anesthetics
Ciliary epithelial cells beat particles up the airway to be swallowed in the OROPHARYNX
Cilia remove “contaminated mucous”

111
Q

Branching of Tracheobronchial Tree: Conducting ? does exchange occur here?

A

Dead zone TMLSBT
Trachea –> L and R main bronchi –>Lobar bronchi –>Segmental bronchi –>Bronchioles –>Terminale Bronchioles.
NO

112
Q

Branching of Tracheobronchial Tree: RESPIRATORY?

Does exchange occur here?

A

Respiratory Bronchioles –>Alveolar ducts –>Alveolar Sacs –> Alveoli.
Yes

113
Q

Conducting zone: Secondary LOBAR BRONCHI? what occurs ? how many on the right and left?

A

Bronchospasm occurs here

3 on the right, 2 on the left.

114
Q

Segmental Bronchi? does bronchospasm occur here? Treat how?

A

Bronchospasm occurs here, it Can be treated by increasing positive pressure, deepening the anesthetic, increasing the inspiratory time of ventilators and directly spraying lidocaine into the trachea.

115
Q

Segmental Bronchi how many on R and left?

A

TEN on the right, EIGHT on the LEFT

116
Q

TERMINAL BRONCHIOLES
Diameter of and _____ mm contain_________
Relatively thick smooth muscle wall compared to lumen
• Can during asthma attack
• No ________ cells

A

1 mm; NO cartilage
contract
goblet

117
Q

Parasympathetic –> Ach–> broncho________

A

constriction

118
Q

Sympathetic –> Epi/NE –> Broncho_______

A

Dilation

119
Q

Alveoli are formed from birth to age _____ they

continue to maximally expand until age______

A

4; 8

120
Q

The respiratory Zone composed of: (4) which is the terminal respiratory unit?

A

Acinus (terminal respiratory unit)
• Respiratory bronchioles
• Alveolar ducts
• Alveoli

121
Q

Where is the first segment of airway where gas exchange occurs?

A

Respiratory Bronchioles (Transitional zone)

122
Q

What are the alveolar ducts?

A

Walls completely lined with alveoli

123
Q

What are the alveolar sacs?

A

located at end of each 3rd generation of alveolar ducts

124
Q

What is the main mechanism for gas transfer from the alveoli INTO BLOOD? Which dissolve easier?

A

Diffusion; lipid soluble

125
Q

What is the formula for diffusion?

A

Area/thickness

126
Q

In a normal lung zone the area of the blood gas interface is about

A

the size of a tennis court.

127
Q

Alveoli _______million in the adult

A

300 million

128
Q

What maximize surface area?

A

Polygon shape.

129
Q

Surrounded by

A

1000 pulmonary capillaries each

130
Q

Types of Alveoli

A

Type I alveolar cells - Squamous

Type II alveolar cells - Cuboital

131
Q

Which type of alveoli involved in gas exchange?

A

Type I Form walls of alveoli, involved with gas exchange

132
Q

which type of alveoli produce surfactant ? what can they do ?

A

Type II –> can differential into Type I cells if needed.

133
Q

What happens in chronically injured lung?

A

Alveolar epithelium is lined entirely by Type II cells, limiting gas exchange.

134
Q

What are pores of Kohn? Function?

A

opening in the wall between adjacent alveoli.

Allow for collateral ventilation.

135
Q

What eliminates foreign debris?

A

Alveolar macrophages.

136
Q

Perfusion Adjustments: Response to reduced ventilation

A

Decreased airflow => Reduced pO2 in blood vessels =>Vasoconstriction of pulmonary vessels =>Decreased blood flow => blood flow matches airflow.

137
Q

Perfusion Adjustments: Response to increased ventilation

A

Increased airflow =>Elevated pO2 =>Vasodilation of pulmonary vessels =>increased blood flow => blood flow matches airflow

138
Q

Ventilation Adjustments: Response to reduced perfusion

A

Decreased blood flow => Reduced PCO2 in alveoli =>Constriction of bronchioles =>Decreased airflow => airflow matches blood flow.

139
Q

Ventilation Adjustments: Response to increased perfusion

A

Increased blood flow => Elevated PCO2 in alveoli =>Dilation of bronchioles =>Increased airflow =>Airflow matches blood flow.

140
Q

Alveoli have a tendency to

A

collapse

141
Q

What is alveolar collapse prevented by ?

A

a. Surfactant
b. Alveolar pores
c. Interdependence

142
Q

What happens when an alveolus start to collapse?

A

The surrounding alveoli are stretched and then recoil exerting expanding forces in the collapsing alveolus to open it.

143
Q

Lungs located in the __________ occupy all of thoracic cavity except________

A

Thorax; mediastinum

144
Q

Right lung has how many lobes______and receives ______ of cardiac output

A

3; 60%

145
Q

Left lung has how many lobes?

A

2

146
Q

Which lung lobe is more narrow?

A

left

147
Q

The lungs are innervated by the __________. _______Fibers T2-T6 and ________ from the vagus.

A

pulmonary plexus;
Sympathetic fibers
Parasympathetic fibers.

148
Q

Why is there normal perfusion and ventilation (V/Q)?

A

Because of different surface areas

149
Q

Parasympathetic Fibers produces _______Of the airways and ______Mucus secretion by the mucus glands

A

Bronchoconstriction

Increased

150
Q

Sympathetic hormones produce _______of the airways( __ response)

A

Bronchodilation; B2

151
Q

Serous membranes that line the thoracic cavity and cover the lungs

A

Pleural membranes.

152
Q

How much pleural fluid produced by lungs? ____cc; and prevents______________________

A

10; friction in the pleural cavity; creates pressure gradient

153
Q

Attached to outer surface of the lungs

A

Visceral Pleura

154
Q

Line the wall of the thoracic cavity which pleura?

A

Parietal

155
Q

One breathing cycle

A

one cycle of inspiration and one cycle of expiration

156
Q

At rest :

During exercise:

A

Quiet respiration

forced respiration.

157
Q

Flow of air in and out of lung requires a_____

A

pressure difference between air pressure within lungs and outside body.

158
Q

Muscles of Respiration: INhalation (SEDS)

A

Sternocleidomastoid
External Intercostals
Diaphragm
Scalene

159
Q

Muscles of Respiration: EXhalation (TRIEDI)

A 
Internal Intercostals
Diaphragm
External oblique
Internal oblique 
Transversus abdominis
Rectus abdominis
160
Q

What account for most of TIDAL VOLUME?

A

Diaphragm

161
Q

Dome shaped muscle that forms the floor of the thorax and separates the thoracic cavity and the abdominal cavity?

A

Diaphragm

162
Q

The diaphragm into 2 halves:

A

Hemidiaphragms

163
Q

Right hemidiaphragm is ________ than the left because _____Pushes left side down and ______ raises right side

A

HIGHER
Heart
LIVER

164
Q

Major: diaphragmatic foramina

A
  • Vena cava foramen
  • Esophageal hiatus (esophagus and vagus nerve pass through; SITE OF HIATAL HERNIA
  • Aortic Hiatus
165
Q

Diaphragm is supplied by paired

A

Phrenic nerves

C3-C5

166
Q

Which C provides 70% contribution of phrenic

A

C4

167
Q

The innervation allows for

A

half of the diaphragm to continue working if one side is damaged.

168
Q

Where does sensory diaphragmatic pain referred to?

A

shoulder areas.

169
Q

Major factors affecting the position of the diaphragm

A

Recoil of lungs
Thoracic viscera pressure (CHF)
Abdominal viscera pressure (pregnancy)
Abdominal muscle activity (contraction pushes diaphragm upward)

170
Q

Movement during normal breathing?

A

1-2 cm normal tidal breathing

7-13 cm with deep breathing

171
Q

The diaphragm accounts for

A

60-75% of normal Tidal volume respiration.

172
Q

_______Is a skeletal muscle and you can PARALIZE it ?

A

Diaphragm

Yes

173
Q

External intercostal muscles oriented

Orientation? responsible for what percentage of TV? what happens to the ribs during inspiration?

A

obliquely forward and downward
responsible for up to 25% of tidal volume that enters lungs during normal breathing at rest
Lift up the ribs during inspiration

174
Q

Internal intercostals muscles oriented?

A

backward and downward
assist in expiration by pulling the ribcage down
Aids in forced expiration.

175
Q

Pressure changes in ventilation

A

At rest, diaphragm is relaxed , alveolar pressure is equal to atmospheric pressure and there is no air flow.

176
Q

Inwardly directed force in the alveoli which must be overcome to expand the lungs during inspiration?

A

Surface tension

177
Q

Decreases the size of the alveoli during expiration

A

Elastic recoil

178
Q

Ease with which the lungs and thoracic wall can be expanded?

A

Compliance

179
Q

Surface tension

A

Inwardly directed force in the alveoli which must be overcome to expand the lungs during each inspiration

180
Q

Elastic recoil

A

Decreases the size of the alveoli during expiration

181
Q

Compliance

A

Ease with which the lungs and thoracic wall can be expanded

SRNAanatomy (25 decks)

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