respiratory 1-4 Flashcards
What does the upper respiratory tract consist of?
Hint - NNPP; all different including posh way of saying nostrils
- nose
- nasal cavity
- pharynx
- paranasal sinuses
What does the lower respiratory tract consist of?
- larynx (voice box)
- trachea
- bronchi
What are the following composed of: a) septal cartilage? (Hint - glass) b) greater alar cartilage? (Hint - not as thick)
a) hyaline cartilage
b) thin, flexible plate
Which 2 components make up the nose?
- the external nose
- the internal nasal cavity
What can be found in the internal nasal cavity?
Hint - VIPEr
- external nares (nostrils)
- vestibule (anterior part of nasal cavity)
- internal nares (choanae)
- posterior region of nasal cavity
What is the nasal septum?
- divides L & R nasal cavity
What is the anterior portion of the nasal septum made of?
hyaline cartilage
What is the posterior portion of the nasal septum made of?
Hint - two bones
fusion of vomer and ethmoid bone
What is the nasal cavity floor made of?
made of hard palate
Which structure does the nasal cavity floor form?
Hint - trace down from that area
forms roof of mouth
Where can the 3 conchae and meatuses be found?
lateral wall of nasal cavity
What is a concha?
Hint - O
openings of nasal cavity
What is a meatus?
passageways betw/ conchea
Where can the openings of paranasal sinuses be found?
Hint - M+S
within superior & median meatuses
Where can the openings of the nasolacrimal duct be found?
Hint - naslacrImal duct
within inferior meatus
Which epithelia and cells line the: a) vestibule (Hint - quite far in, no hairs, lots of layers) b) posterior nasal cavity (Hint - the full shebang + balgam) c) superior nasal cavity (Hint - for smelling)
a) stratified squamous epithelium
b) pseudostratified ciliated columnar epithelium and goblet cells
c) olfactory epithelium
What is the pharynx?
Hint - a place where two systems meet
chamber shared by digestive and respiratory tracts
What are the 3 regions of the pharynx going downwards?
Hint - Nas-Oro-La
- nasopharynx
- oropharynx
- laryngopharynx
What can be found in the nasopharynx?
hint - ears and a mass of lymphoid tissue
- eustachian tube openings
- pharyngeal tonsils (posterior)
What is the oropharynx the junction between?
Hint - two systems again
GI and respiratory tract
Where does the oropharynx run and what can be found within it?
(hint - flap to voicebox; epithelia and remaining PL tonsils)
- uvula to epiglottis
- stratified squamous epithelium
- two sets of tonsils: palatine and lingual
Which region is classed as the laryngopharynx?
hint - EOL
epiglottis to openings of oesophagus and larynx
What are the 3 unpaired cartilages of the larynx?
Hint - thy-epi-cri
- thyroid (largest, superiorly-positioned, forms laryngeal prominence/adam’s apple)
- epiglottis (elastic and forms free flap)
- cricoid (forms base of larynx)
What are the 3 paired cartilages of the larynx?
Hint - ary-cor-cune
- arytenoid
- corniculate
- cuneiform
Describe the arytenoid cartilage.
Hint - people you know with an A are usually loud
- two ligament pairs extend from anterior surface
- extend to posterior of thyroid to form vestibular/false vocal cords
- skeletal muscles here can modify sound by changing the length of vocal folds
What is the glottis?
Hint - rima glottidis etc…
two types of vocal cords and associated opening betw/ them
Structure of the trachea.
- long membranous tube
- made of 15 - 20 C-shaped cartilages
How can the diameter of the trachea be modified?
by posterior wall (SM and ligamentous membrane)
What are the lungs?
conical-shaped organs; extend from diaphragm to 2.5cm superior to clavicle
Describe the right lung shape, lobes lobules and the reasons for this.
- broader
- as the heart and great vessels project into left thoracic cavity
- 3 lobes
- 10 lobules
Describe the left lung shape, lobes lobules and the reasons for this.
- longer
- as diaphragm rises on right side for liver
- 2 lobes
- 9 lobules
What is the pleura of the lungs and what is each lung contained within?
- pleura; two serous membranes (with parietal and visceral parts)
- a separate pleural cavity
What is thoracentsis?
sampling pleural fluid
What is the mediastinum of the lungs?
membranous partition between lungs
State the 2 functions of pleural fluid.
LA
1) lubrication
2) attachment
What is the major and minor blood supply of the respiratory tract?
- major route; pulmonary artery supplies deoxygenated blood
- minor route; bronchial artery (branched off thoracic aorta) supplies oxygenated blood to respiratory bronchioles
What are the muscles of respiration?
- diaphragm; arises from lateral and posterior walls of body cavity which lungs rest upon
- muscles that elevate ribs
- muscles that depress ribs
What must air flow in/out of lungs be associated with?
pressure difference between the internal/external environment of lungs
What is atmospheric pressure?
760 mmHg
State two reasons for collapse of the lungs.
- elastic recoil
2. surface tension - formation of droplets in alveoli cause alveolar membranes to draw together; alveolar collapse
Which two factors normally prevent lung collapse?
- surfactant (a mixture of lipoproteins which produce attractive force by surface tension)
- intrapleural pressure (drops to balance w/ negative intrapleural pressure to stop elastic recoil)
What is compliance?
ability of lungs and thorax to expand (increased lung volume per unit of intrapulmonary pressure change; L/cm of water)
What is the normal value compliance value for lungs & thorax?
0.13L/cm
so every cm increase in intrap. pressure + 0.13L lung volume
What are a spirometer and spirometery?
- measures flow of air in/out of lungs
- examination of pulmonary air-flow
What is a pulmonary capacity?
- measure of two or more pulmonary volumes combined
What is dead air space?
regions of respiratory system where gas exchange does not occur
What is dead air space divided into and what is the healthy value?
- anatomical and physiological spaces
- volume taken up by nasal cavities to terminal bronchioles (normally 150ml)
What is the alveolar ventilation rate (AVR)?
hint - the volume that is single
volume of air available for gas exchange (V/min)
What is respiration mostly controlled by?
neurones in medulla oblongata
Medullary neurones set basic respiration rhythm but what else can it can be influenced by inputs from?
- other parts of brain
- peripheral sensory receptors
What is the respiratory centre and what does it control?
hint - literally parts a cell in a certain place
- three pairs of nuclei in a reticular formation
- located in medulla oblongata and pons
- controls respiratory minute volume by adjusting the frequency and depth of pulmonary ventilation
What are the two regions of the respiratory centre?
1) inspiratory centre
2) expiratory centre
What is the inspiratory centre and when does it function?
hint - 2D, in the brain
- two dorsal (upper) regions of medulla oblongata
- functions in every respiratory cycle (quiet/forced)
Describe the activity of neurones within the inspiratory centre?
- show spontaneous rhythmicity
2. cyclic form of activity (every few seconds)
Which nerves and muscles do APs in the inspiratory centre pass along?
- intercostal nerves and phrenic nerve
- to muscles of inspiration
What is the expiratory centre and when does it function?
hint - 2V, in the brain
- two groups of ventral neurones (under) either side of medulla oblongata
- mostly inactive; functions only during heavy breathing
Which muscles do APs of the expiratory centre pass to?
muscles associated w/ expiration i.e. diaphragm and rib muscles
Complete the following diagram with green arrows for stimulates and red arrows for inhibits.
see document
What is the apneustic centre and what does it do?
hint - neurone arrangement. 2 sec rule
- scattered neurones in pons
- sends APs to inspiratory centre
- increases inhalation intensity for 2 seconds under normal conditions
What do both inspiratory and apneustic centres function together to regulate?
- regulate rate/depth of respiration
- ensure rhythmical breathing
What is the Herring Breuer reflex ?
- control mechanism to prevent over-inflation of lung
- to do w/ stretch receptors in SM in alveolar wall
- during inspiration (inflation)
- during expiration (deflation)
Name the two chemoreceptors which achieve control of respiration, their location and the nerves they are connected to.
(hint - c for central)
1) central chemoreceptors
- located in medulla oblongata in chemosensitive area
- influence respiratory centres
2) peripheral chemoreceptors
- located in carotid & aortic bodies
- connect to respiratory centres by glossopharyngeal & vagus nerve respectively
What do chemoreceptors in the body respond to?
Whanges in conc. of:
- [H+]/pH
- Oxygen
What effect does changes in [CO2] have?
hint - hypo/hyper and arterial Px
- hypercapnia - excessive PCO2 in arterial blood (note Px means partial pressure of)
- hypocapnia - a lower than average PCO2 in arterial blood
How is the [CO2] of blood detected and by which type of receptors?
(hint - direct/indirect)
- indirectly by chemoreceptors as changes in blood pH
- by peripheral and sensory chemoreceptors
What detects [O2] of blood?
chemoreceptors in carotid and aortic bodies
If PCO2 remains constant how much must PO2 drop before blood [O2] has large stimulatory effect on respiration? Why?
- 50% of normal value in aorta and carotid arteries
- because Hb is still filled w/ O2 at 80mm
What are the three normal defence mechanisms of the respiratory system?
(Hint - MIF)
- filtration
- mucociliary transport -
cilia beat rhythmically and carry trapped particles towards digestive tract to be broken down by low pH and pepsin - immunological response - tonsils and adenoids (rich in lymphatic tissue), macrophages in IS
Which two factors allow inhaled particles to become trapped in mucus lining mucosa?
1) upper respiratory tract turbulence
2) large surface
- smaller particles trapped by mucus further down respiratory tract
- macrophages clear particles that may reach alveoli
What can filtration in the respiratory tract affect?
hint - think pharmacology
drug delivery
State 4 signs of respiratory disease.
- cough
- sneeze
- dyspnoea - difficult/laboured breathings (air hunger)
- cyanosis - abnormal bluish skin associated with low blood PO2 in capillary beds
What does a cough involve and what is it caused by?
- inspiration + closure of epiglottis and vocal cords
- forceful abdominal contraction opening glottis and vocal cords
- expulsion of air under pressure
- cause: irritation of lower respiratory tract
What may result in sneezing and what may cause it?
- airway obstruction
- reduced lung compliance
Which 2 things can cause cyanosis?
1) peripheral vasoconstriction - extreme cold
2) respiratory disorders where blood supply exceeds ventilation rate so increased Hb, thus increased physiological shunt
What are infections?
diseases due to pathogenic microorganisms
What does poor ventilation of lungs increase?
incidence of respiratory infections
What can infections lead to?
inflammation – term ending in ‘itis’ indicates inflammation, i.e., rhinitis (inside of nose), pharyngitis (throat), bronchitis (bronchus), etc.
What has greatly reduced respiratory infection-related mortality?
antibiotic and vaccine use
Name an upper respiratory tract infection.
hint - the most common thing we all get in winter
- common cold; viral, affects nose, throat, sinuses
(symptoms: cough, runny nose, sneezing - different forms; sinusitis, tonsillitis, otitis media, pharyngitis)
Name two lower respiratory tract infections.
hint - PT
- pneumonia; inflammatory, affects alveoli, usually caused by streptococcus pneumoniae
- tuberculosis; affects lungs; caused by mycobacterium tuberculosis
What are obstructive lung diseases? give three examples.
Hint - ABE
group of diseases associated with narrowing of air passages
- i.e. asthma, bronchitis, emphysema
What is asthma, its symptoms and how can it be treated?
- recurrent, reversible airway obstruction, caused by bronchial hyper-responsiveness
- allergic component
- symptoms: wheeze, shortness of breath, nocturnal cough; bronchospasm
- treated w/ bronchodilators or anti-inflammatory drugs
What is status asthmaticus?
severe acute asthma; a medical emergency
What is emphysema?
Hint - form of something caused by sootay
COPD caused by elastin loss (smoking)
What is elastase and how is it affected by smoking?
- serine protease
- breaks down elastin (which decreases lung elasticity)
- smoking = inhalation of nicotine
- nicotine accumulates in pulm. epithelial cells causing elastin loss
- can act directly on alveolar macrophages and neutrophils
- increasing elastase secretion and oxygen radicals (DNA/RNA damage)
What produces elastase and how are they deactivated?
- neutrophils and macrophages
- by serine-protease inhibitor 1-antitrypsin
How is serine-protease inhibitor 1-antitrypsin activity inhibited?
- by oxygen radicals
How is susceptibility to faulty 1-antitrypsin controlled?
- genetic; 1-antitrypsin gene is polymorphic w/ 3 major alleles: M, S and Z (see table)
What are restrictive lung diseases?
Hint - what it says on the tin w/ lungs
- diseasesthat restrictlung expansion
- resulting in decreasedlungvolume, increased work of breathing and inadequate ventilation
What are the effects of restrictive lung diseases and what are they caused by?
- pulmonary fibrosis, reduced lung compliance and VC
- caused by inelastic replacing elastic tissue, typically by materials, i.e. asbestos, silica, coal dust
Diseases of the respiratory tract.
- invasive cancer cells
- pleural cavity diseases/effusion (fluid in pleural cavity)
- pneumothorax (hole in pleura)
- pulmonary vascular disease, embolism, arterial hypertension, oedema, haemorrhage, inflammation, capillary damage,
commonly-used tests to assess pulmonary function.
- spirometry
- respiratory rates
- vitalograph
- peak flow meters
- FEV1/
- FEV1/FVC ratios
- blood gas and pH measurements
Effects of ageing on the respiratory system.
EAE
- elastic tissues deteriorate
- arthritic changes
- emphysema (SOB)
Define the respiratory minute volume (VE).
total volume of air that passes through respiratory system per minute
What is the respiratory minute volume in healthy individuals?
6L
What is anatomical dead space?
region where gas exchange does not occur
What is alveolar ventilation?
amount of air reaching alveoli each minute
What is a vitalograph?
used to measure forced expiratory volumein one second (FEVI) and forcedvital capacity(FVC)
What is a peak flow meter?
small handheld device that measures peak flow by the patient blowing into it as hard as possible
State the % predicted for FEV1 and FEV1/FVC values that are:
a) normal
b) mild
c) moderate
d) severe
a) > 80%
b) 65-80%
c) 50-65%
d) <50%
What type of respiratory disease is it if FVC is normal but FEV is low?
obstructive lung disease
What type of respiratory disease is it if FEV1/FVC ratio and the % predicted FEV1/FVC ratio is high?
restrictive lung disease
What are the pros of taking blood gas and pH measurements?
Hint - not bottles of blood and straight away
- simple
- quick
- may only need small amounts of blood
tidal volume
volume of air that passes in and out of lungs during normal inspiration/expiration
inspiratory reserve volume
volume of air can be inspired on top of tidal volume
expiratory reserve volume
volume of air can be forcefully exhaled
residual volume
volume of air remains in lungs after maximal exhalation
inspiratory capacity
air inspired after 1 cycle of respiration
functional residual capacity (FRC)
total air left in lungs after a normal expiration
vital capacity
total amount of air that can be exhaled after maximal inspiration
total lung capacity
total volume of your lungs
