1
Q
Rhinitis needs one or more of the following to qualify as such…
A
- Sneezing
- Rhinorrhea
- Nasal congestion
- Nasal itching
2
Q
Commonly associated symptoms with rhinitis
A
- Fatigue
- Headache
- Cognitive impairment
- Sleep disturbance
3
Q
What are the functions of the lungs?
A
- Gas exchange
- Metabolism
- Regulation of blood pH
- Defense against microbes
4
Q
Oxygen consumed at rest
A
250 mL/min
5
Q
Carbon dioxide produced at rest
A
200 mL/min
6
Q
Ventilation at rest
A
7,000 mL/min
7
Q
Cardiac output at rest
A
5,000 mL/min
8
Q
Two stages of respiration
A
- Gas exchange
2. Cell respiration
9
Q
3 processes of respiration
A
- Ventilation
- Diffusion
- Perfusion
10
Q
What is ventilation?
A
Air intake and output
11
Q
What is diffusion?
A
Gas exchange
12
Q
What is perfusion?
A
Movement of gas within the blood
13
Q
What is the conduction zone of the airways?
A
Trachea»bronchi»bronchioles»terminal bronchioles
14
Q
What is the respiratory zone of the airways?
A
Respiratory bronchioles»alveolar ducts»alveolar sacs
15
Q
Where do you lose cartilage down the respiratory tract?
A
Bronchioles
16
Q
Type II epithelial cells
A
Release surfactant
17
Q
Type I epithelial cells
A
Structure
18
Q
What is the function of the cartilage in the upper respiratory tract?
A
Prevent collapse of smooth muscle in trachea and bronchus
19
Q
Why is a thin blood-gas interface very important?
A
Diffusion
20
Q
Why is a large blood-gas interface very important?
A
A larger surface area allows for more diffusion
21
Q
Fick’s law of diffusion
A
Vgas = A/T * D * (P1-P2)
22
Q
Diffusion constant for any given gas is dependent on…
A
- Solubility of the gas in the membrane
2. Inverse of the square root of the molecular weight
23
Q
Body’s supply of oxygen depends on…
A
- Concentration of gases in ambient air
2. Partial pressure
24
Q
Pb (barometric pressure) @ sea level
A
760 mmHg
25
Po2 @ sea level
159 mmHg
26
Pco2 @ sea level
0.3 mmHg
27
Pn2 @ sea level
600 mmHg
28
Dalton's law
Pb = Po2 + Pco2 + Pn2
29
What happens to the trachea air in relation to partial pressures?
Partial pressure of nitrogen goes down
30
What happens to the alveoli in terms of partial pressures?
Carbon dioxide partial pressure goes up
31
Partial pressure of H2O @ 37 C
47 mmHg
32
Henry's Law
Mass of a gas that dissolves in a fluid at a given temperature varies in direct proportion to pressure of the gas over the liquid
33
Two factors that govern the rate of diffusion into a fluid...
1. Pressure gradient between gas above the fluid and gas dissolved in the fluid
2. solubility of gas in the fluid
34
Joints of the thorax
1. Costovertebral
2. Costotransverse
3. Sternocostal
4. Costochondral
5. Sternoclavicular
6. Manubriosternal
7. Xiphisternal
35
Regions of parietal pleura
1. Cervical
2. Costal
3. Diaphragmatic
4. Mediastinal
36
What innervates the visceral pleura and what does this mean?
Viscerosensory innervation; leaves lungs relatively insensitive to painful stimuli (dull, non-localized pain)
37
What innervates parietal pleura and what does this mean?
Somatosensory nerves, making the parietal pleura sensitive to pain (sharp and well-localized pain)
38
What nerve innervates the pericardium, mediastinal parietal pleura, and diaphragmatic parietal pleura?
Phrenic n.
39
What dermatomes do pain inputs from phrenic n. refer to?
C3-5
40
What primary muscles are involved during quiet and forceful inspiration and what are their innervations?
- Diaphragm (phrenic n.)
| - External intercostals (intercostal nn.)
41
What secondary muscles are involved during forceful inspiration and what are their innervations?
- Scalene mm. (cervical spinal nn.)
- Sternocleidomastoid (CN XI - accessory n.)
- Internal intercostals (intercostal nn.)
42
Where does the diaphragm go when it contracts during inspiration?
Down
43
Where does the diaphragm go when it relaxes during exhalation?
Up
44
Which ribs move along the A-P axis?
2-6
45
Which ribs move along the transverse axis?
7-10
46
What is expiration mostly due to?
Elastic recoil of the lungs
47
Relaxation of the inspiratory muscles ________ the volume of the thoracic cavity
Decreases
48
What are the muscles involved during forced expiration?
- Abdominal muscles (rectus abdominus, external and internal obliques, transversus abdominus) - increases intra-abdominal pressure, forcing organs up and thereby forcing the diaphragm up
- internal intercostals
- innermost intercostals
- transversus thoracis
49
What innervates the muscles involved during forced expiration?
Intercostal nn. T7-11
50
What accessory muscles are involved during expiration and what are their functions?
- Scalenes - elevate 1/2 ribs
- Pec minor and major - elevate ribcage if arms abducted and scapula fixed
- Serratus anterior - elevates lateral ribcage if scapula fixed
- Trapezius, levator scapulae, rhomboids - stabilize the scapula so the other muscles can work on the ribcage
51
What diseases are associated with abnormal hypertrophy of accessory muscles of expiration?
COPD, emphysema
52
Boyle's Law
If temp is constant, pressure and volume are inversely related
53
What is the basis for atelectasis?
If the alveoli collapse, the lung cavity cannot maintain the negative pressure required for normal conditions so air leaves the lung and enters the space between the viscera and the parietal pleura compressing the lung causing it to collapse
54
What is the sequence of inspiration?
1. Inspiratory muscles contract
2. Thoracic cavity expands
3. Pleural pressure becomes more negative
4. Transpulmonary pressure increases
5. Lungs inflate
6. Alveolar pressure becomes subatmospheric
7. Air flows into the lungs until alveolar pressure equals atmospheric pressure (@ max volume here)
55
Two major determinants of lung compliance
1. Elasticity of lung tissues due to collagen and elastin
| 2. Surface tension
56
How are compliance and elastic recoil related?
Inversely
57
Compliance can be related to volume and pressure how?
Compliance = change in volume / change in pressure
58
How does emphysema alter lung compliance?
- Increased lung volume
- Easy to inflate
- Less elastic recoil
59
How does fibrosis or alveolar edema alter lung compliance?
- Decreased lung volume
- Hard to inflate
- More elastic recoil
60
Which area of the lung generally has high compliance?
Base of the lung
61
Which area of the lung has higher compliance @ residual volume?
Apex of the lung
62
Where does surface tension act?
ONLY at the gas-liquid interface
63
Law of Laplace
P = 2T / r
| -At higher radii, the alveoli will have lower pressure
64
Surfactant
Lipoprotein mix of phospholipids, proteins, and calcium produced by Type II alveolar epithelial cells
65
What does surfactant do?
Disrupts and lowers surface tension
66
Where is surfactant's greatest effect and why?
Its effect is greater in smaller alveoli because the molecules start to stack in layers; thereby reducing surface tension below that of larger alveoli
67
How does surfactant stabilize the alveoli?
It reduces the pressure in smaller alveoli by acting to lower surface tension, thereby lowering pressure
68
How does surfactant affect lung compliance?
Increases
69
Why is respiratory distress a concern for premature babies?
- Normally surfactant isn't made until the last 2 months in utero
- When premature babies are born, the type II cells aren't mature enough to produce surfactant
- Without surfactant, the alveoli collapse and have to be re-inflated every time the baby inspires which is a huge energy drain
- They're usually put on ventilators to help them breathe
70
What could be a reasonable explanation for decreased lung compliance?
- Decreased functional pulmonary surfactant
- Fibrosis of the lungs
- Surgical removal of one lobe
- Pulmonary vascular congestion
71
What do the choanae do?
Connet nasal cavities to the nasopharynx
72
Where does the auditory tube drain?
Naspharynx
73
Where does the sphenoid sinus drain?
Sphenoethmoidal recess
74
Where do the posterior ethmoid air cells drain?
Superior meatus
75
Where do the anterior and middle ethmoid air cells drain?
Ethmoid bulla>>middle meatus
76
Where do frontal and maxillary sinus drain?
Semilunar hiatus>>middle meatus
77
Where does the nasolacrimal duct drain?
Inferior meatus
78
What is the blood flow through the nose from internal carotid a.?
Opthalmic a.>>anterior and posterior ethmoidal aa.>>anterior and posterior septum or nasal wall, respectively
79
What is the blood flow through the nose from external carotid a.?
- Maxillary a.>>sphenopalatine>>posterior septum or nasal wall
- Maxillary a.>>descending palatine>>greater palatine>>incisive >>anterior septum or nasal wall
- branches from facial a.>>anterior septum or nasal wall
80
What do vibrissae do?
Trap large particles in the nasal vestibule
81
What do conchae do?
Create turbulence
82
What does the mucous coating in the respiratory epithelium do?
Catch smaller particles
83
What does the lamina propria between respiratory epithelium and bone contain?
Arteries, distended veins (swell bodies), and mucoserous glands
84
What do ciliated cells in respiratory epithelium do?
Move mucous
85
What do goblet cells in respiratory epithelium do?
Create mucin
86
What are basal cells?
Stem cell population
87
What are brush cells?
Sensory cells
88
What are small granule cells?
Endocrine cells
89
What do olfactory ducts and glands in olfactory epithelium do?
Release serous fluid
90
What type of epithelium is in the respiratory and olfactory epithelium?
Ciliated pseudostratified columnar epithelium
91
Where does the pharynx attach to the skull?
Medial pterygoid plate and pharyngeal tubercle
92
What ligament connect the styloid process on the skull to the hyoid bone?
Stylohyoid ligament
93
What ligaments connect the cricoid to the thyroid cartilage?
Cricothyroid ligaments
94
Function of superior, middle, and inferior pharyngeal constrictors
Constrict pharynx to move bolus of food inferiorly
95
Function of stylopharyngeus and salpingopharyngeus
Elevate and shorten pharynx
96
Function of muscles of soft palate and uvula, and levator and tensor veli palatini muscles
Separate the nasopharynx and oropharynx
97
Function of palatopharyngeus
Depress palate and elevate pharynx
98
Function of palatoglossus
Depress palate
99
CN IX and X send axons to the pharynx as the __________ __________.
Pharyngeal plexus
100
Motor innervation of pharynx
CN X (Vagus n.) is motor to all except stylopharyngeus (CN IX - glossopharyngeal n.)
101
Sensory innervation of pharynx
- CN IX is sensory to part of nasopharynx, posterior tongue, and oropharynx
- CN X is sensory to the spiglottic region, laryngopharynx, larynx, trachea, and esophagus
102
Function and innervation of cricothyroid muscle
Tense vocal fold to raise pitch; external branch of superior laryngeal n. (branch of vagus)
103
Function and innervation of thyroarytenoid muscle
Relax vocal fold to lower pitch; inferior laryngeal n. (branch of vagus)
104
Function and innervation of vocalis muscle
Relax vocal fold to lower pitch; inferior laryngeal n.
105
Function and innervation of lateral cricoarytenoid muscle
Adduct vocal fold to lower volume; inferior laryngeal n.
106
Function and innervation of arytenoids (oblique and transverse)
Adduct vocal fold to lower volume; inferior laryngeal n.
107
Function and innervation of posterior cricoarytenoid muscle
Abduct vocal fold to raise volume; inferior laryngeal n.
108
Deinnervation of what muscle results in hoarseness?
Posterior cricoarytenoid muscle
109
Muscles that close the laryngeal opening
- Aryepiglottic muscles - elevate larynx towards epiglottis; innervated by inferior laryngeal
- Oblique arytenoids - elevate larynx towards epiglottis; innervated by inferior laryngeal
- Suprahyoid muscles - elevate hyoid and larynx to close laryngeal opening
110
False (vestibular) fold
Mucosal fold that does not move toward midline
111
True vocal fold
Mucosal fold over the vocal ligament that adducts and abducts from midline
112
Ventricle
Space between false and true vocal folds
113
Rima glottidis
Space between left and right vocal folds
114
What types of areas can respiratory epithelium be found in?
Parts of the airway that do not regularly experience friction or impact
115
Where can stratified squamous epithelium be found?
Lines areas that experience friction
116
What does the epiglottis separate?
Oral cavity and laryngopharynx
117
What type of epithelium do false folds have?
Respiratory epithelium (do not make contact)
118
What type of epithelium do true vocal folds have?
Stratified squamous epithelium over DCT and skeletal muscle (make actual contact)
119
Asthma
Excessive constriction of bronchiolar smooth muscle, causing difficult air expiration, mucus accumulation
120
Cystic fibrosis
Mutation in ion pump (CFTR) results in deficiency of Cl- ions, and therefore water, to reach the airway; airway and ducts in other organs become blocked by this thickened mucous
121
Obstructive lung diseases
Affect the parenchyma (airways involved in gas exchange)
- COPD
- Asthma
- Emphysema
- Bronchitis
- Cystic fibrosis
122
Interstitial diseases (restrictive)
Affect the space between parenchymal cells, the interstitium (space between 2 adjacent alveoli's basal laminae)
- asbestosis
- idiopathic pulmonary fibrosis
- sarcoidosis
- connective tissue related ILD
123
Emphysema
- type of COPD
- smoking leading cause
- damage to alveolar walls results in reduced surface area and reduced gas exchange
124
What nerves innervate cervical and costal pleurae?
Intercostal nn.
125
Pneumothorax
Air in pleural space
126
Pleural effusion
Fluid in pleural space
127
Hemothorax
Blood in pleural space
128
Hydrothorax
Excess serous fluid
129
Chylothorax
Lymph from adbomen in pleural space
130
Pyothorax
Pus in pleural space
131
What can cause fluid to leak from lymphatics into the pleural space?
Heart failure, pulmonary emboli, tumors, infections
132
Where are lymphatics found in visceral pleura?
Deep to mesothelium among DICT
133
Inferior borders of lungs
Anterior - 6th costal cartilage
Lateral - 8th rib
Posterior - 10th rib
134
Where is the line of pleural reflection?
```
Anterior = 8th costal cartilage
Lateral = 10th rib
Posterior = 12th rib
```
135
Where should a thoarcocentesis be performed?
Lateral = 8th-10th rib
136
What is the relationship between flow and pressure gradient, radius, and length of tube?
Increase pressure gradient, increase radius, and decreased length all increase flow
137
Why is the airway resistance not highest in the smallest regions of the airways?
Turbulence greatly increases airway resistance so larger radii have higher resistance because their turbulence is very high
Respiratory
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