resp anatomy Flashcards by J C

anatomical functions of nose

inhaled air warmed by conchae and septum,
filtration & obstruction of foreign particles,
assists phonation& sensation of smell (CNI)

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function of pharynx and tonsils

assists phonation,
initiates deglutition,
defense against pathogens,
enlarges with inflammation and tumor

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ring of tonsils

adenoid,
eustachian,
palatine,
lingual,
sublingual

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Mallampati class 1

full view of uvula and tonsillar pillars, soft palate

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mallampati class 2

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

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Mallampati class3

soft palate only

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Mallampati class 4

hard palate only

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glossoptosis

collapse of oropharynx, tongue dropping posteriorly

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Macroglossia

large tongue, (common in Down syndrome)

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Micrognathia

small jaw, mandible

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Microgenia

small chin

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Microstomia

small mouth

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Malocclusion

upper protrusion “buck teeth,” overbite

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Location Adult Larynx

Anterior to 3rd-6th cervical vertebre

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Location of Larynx at birth

level at C3-4

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A-O extension

normally 35 degrees

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Larynx function

functions as airway protective sphincter,
closes off airway during swallowing,
supports vocal cords,
modulates speech,
provides autoPEEP

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Compartments of Larynx

Supraglottis,
Glottis(Ventricles),
Infraglottis

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Supraglottis Compartment anatomy

Epiglottis,

False vocal cords

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Glottis (ventricles) anatomy

True vocal cords,
Rima glottis- in adults the narrowest portion of upper airway,
Arytenoids

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Infraglottis Compartment anatomy

Below vocal cords,
Cricoid Cartilage,
Trachea

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Unpaired Cartilage Larynx

Epiglottis
Thyroid
Cricoid

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Paired Cartilage Larynx

Arytenoid
Corniculate
Cuneiform

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Attach larynx to bone or pharynx,

move larynx during swallowing

Extrinsic muscles of larynx

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One set alters the size and shape of larynx, | other move the true vocal cords

intrinsic larynx muscle set (two sets)

pulls epiglottis down over larynx

Aryepliglottic (first set intrinsic muscle) (RLN)

Assist pulling epiglottis down

Thyroepiglottic (first set intrinsic muscle) (RLN)

Pulls arytenoids together, Adducter 1st set

Oblique Arytenoid (first set intrinsic muscle) (RLN)

Tensor of Vocal Cords

Cricothyroid (2nd set intrinsic muscles) (*External SLN)

Thyroarytenoid

Relaxor of VC (2nd set)

Adductors 2nd set

Lateral Cricoarytenoid Transverse Arytenoid 2nd set

Abductors

Posterior Cricoarytenoid Vocalis (weak) 2nd set

Direction larynx moves during swallowing

upwards

hyoid bone elevators

suprahyoid (indirectly move larynx)

Muscles directly attach to larynx

``` Thyrohyoid, Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus, Inferior constrictor ```

Laryngeal membranes

Thyrohoid membrane, Quadrangular Membrane, Cricothyroid membrane

Left Recurrent laryngeal nerve provides sensory innervation to

infraglottis sensory innervation?

Damage to RLN

vocal cord adduction cause

Vagus nerve branch

CN X, Recurrent laryngeal nerve, Superior laryngeal nerve

Superior laryngeal nerves divides into two nerves

Internal SLN, | External SLN,

Internal SLN provides

Sensation to supraglottic and ventricle compartment, | STIMULATION CAUSES LARYNGOSPASM

Stimulation causes laryngeal spasm

Internal SLN

External SLN provides

motor innervation of cricothyroid muscle

Sphenopalatine ganglion innervation

(middle division of CN V), nasal mucosa, superior pharynx, uvula, tonsils

Glossopharyngeal nerve innervation

(CN IX), (lingual back 1/3, pharyngeal, tonsillar nerves), oral pharynx, supraglottic region

Internal branch superior laryngeal nerve innervation

(CN X), mucous membrane above the VCs, glottis

Recurrent Laryngeal nerve

(CN X), | trachea below VC's

Epiglottis

positioned UPRIGHT to allow air passage during inspiration

Vallecula

space anterior to the epiglottis at root of tongue (mac laryngoscope end placed here)

Pressure on the hyoepiglottic ligament

LIFTS epiglottis during laryngoscopy

what pushes epiglottis downward during swallowing

base of tongue

Direct Laryngoscopy Grade 1

full view of vocal cords, glottis

Grade 2 laryngoscopy

partial view of vocal cords, arytenoid and corniculate cartilages

Grade 3

Only epiglottis visualized

Grade 4

Only soft palate visualized

Posterior Cricoarytenoid muscles only

Abductor muscles

Recurrent laryngeal nerve stimulation

opens vocal cords (think phlegm in trachea, open to cough out)

Recurrent laryngeal nerve responsible for

adduction of vf

SLN tenses VF via

cricothyroid muscle

air is forced between closed cords causes

vibration

Increased tension of VC creates

higher-pitched

Intensity

stronger blasts of air cause VC to vibrate more and louder sounds

Sellick Maneuver

Pressure on the cricoid applied posteriorly closes the esophagus, prevent gastric regurg, aligns glottic opening, prevents vent of air into stomach

Narrowest portion of upper airway in children

Cricoid ring until age 8yrs, reason uncuffed ETT

Carina level

T5-7

Carina distance from teeth

25cm

Lenght and diameter of trachea

12.5-18cm, | 18-20mm diameter

Shape of trachea cartilage and number

C-shaped (allow expansion of esophagus), | 20-25

placement of ETT depth

3x tube size. | ex 7.0=21cm

primary bronchus is slightly straighter and wider, aspiration more likely

right

conducting airways

ventilation but no perfusion

amount of breath that remains in airway

30%, (150cc/700cc breath), | 2cc/kg or pts wt. in lbs.

Acinus

gas exchange segment, | resp bronchiole, alveolar ducts and sacs, alveoli

What allows gas exchange between airspace and pulmonary cap

simple diffusion

Found from larynx to bronchi and removes trapped particles

pseudostratified ciliated columnar epithilium (cilia beat 1000-1500 cycles/min) disabled by smoke

Release mucous granules into airway lumen

Goblet cells, | increase with injury and infection

located in smaller bronchiole which lack goblet cells

clara cells-produce mucus- poor, watery proteinaceous material

Cell types of alveolar wall

``` Type I pneumocyte Type II pneumocyte, macrophages, septal cells (fibroblasts)(maintenance of conn. tissue of lung), mast cells(produce histamine) ```

Type I pneumocyte increase

alveolar surface area

Secretes surfactant

Type II Pneumocyte

Surfactant

mix of proteins, phopholipids (phosphatidylcholine) and ions. Diminishes surface tension, prevent alveolar collapse during expiration(important in neonates) Maturation occur 24weeks.

Thin bone at top of nasal passage

Cribiform plate of ethmoid bone