Ch. 1 The Airways and Alveoli
When does laryngospasm occur?
When anything except air enters the trachea. This is why drowning victims often have little water in their lungs.
The airways beyond the terminal bronchioles are collectively called the ______________.
acinus
Attachment points for vocal ligaments that stretch across the lumen of the larynx and attach to the thyroid cartilage.
arytenoid cartilages
Mast cell breakdown, airway inflammation, and subsequent bronchospasm are features of ________________, a condition characterized by chronic airway inflammation and hypersensitivity.
asthma
The point of tracheal division is called the ___________________.
carina
The _______________________ airways connect the atmospheric air with the gas-exchange membrane of the lungs.
conducting
Inside the larynx, the vocal cords lie just above the ____________________ cartilage.
cricoid
Which cartilage forms the only complete ring around the trachea?
cricoid cartilage
Which cartilage limits the endotracheal tube size that can pass through the larynx?
cricoid cartilage
What is the narrowest portion of the upper airway in infants?
cricoid ring
Which ligament connects the thyroid and cricoid cartilages?
cricothyroid ligament
This structure is sometimes the puncture site for a tracheostomy when structures above it are occluded.
cricothyroid membrane
What is the membranous space between the thyroid and cricoid cartilages called?
cricothyroid membrane
Because the conducting airways do not participate in gas exchange, they are called the anatomical ________________ ______________.
dead space
Epiglottitis is a life-threatening emergency in _________________ and requires immediate placement of an artificial airway by skilled medical personnel.
infants
The vocal cords are wider apart during quiet _________________________ than _______________________.
inspiration expiration
The cartilage of the mainstem bronchi resembles the cartilage of the trachea initially, but as the bronchi continue to branch, the cartilage becomes more ______________________ and ______________________.
irregular and discontinuous
What is that mucus-secreting epithelium called?
respiratory mucosa
True or false: The conducting airways participate in gas exchange.
False. The conducting airways DO NOT participate in gas exchange; they simply provide the pathway by which inspired air reaches the gas-exchange surface.
True or false: Arteriovenous anastomoses and countercurrent blood flow are present in airways below the larynx (in the lower airways).
False. They are not present in lower airways.
Largest cartilage of the larynx.
thyroid cartilage
The main cartilage of the larynx; also sometimes called the Adam's apple.
thyroid cartilage
Cold air or mouth breathing moves the ISB ________________ into the airways, but never by more than a few generations.
deeper
Mast cells release their inflammatory agents when activated by a process called ____________________ ________________________.
immune sensitization
Approximately ________ mL of mucus is secreted per day in normal, healthy people. This volume greatly __________________ in individuals with acute and chronic airway inflammation.
100 mL increases
How long does the trachea extend in an adult?
11 cm
Internal diameter of trachea in adults
11-12 mm
In mechanical ventilation, inspired gas exits the tip of an ET tube about _____ cm above the carina.
2 cm
At the carina, the right mainstem bronchus angles only _______ to ________ degrees away from the midline, forming a more ____________ continuation of the trachea than the left mainstem bronchus.
20 to 30 direct
The left mainstem bronchus breaks away more sharply, forming a _______ to _______ degree angle with the vertical tracheal midline.
45 to 55
Particles that are larger than ______ um in diameter cannot enter the lower airways.
5 um
What is bronchiectasis?
A disease process that weakens and dilates bronchial walls. This disease causes permanent anatomical airway dilations that tend to collect secretions, which become infected, creating further airway damage.
What is the vallecula?
A small space between the epiglottis and tongue.
What is immotile cilia syndrome?
AKA ciliary dyskinesia. A genetic disorder that causes a lack of normal beating activity in the cilia lining the respiratory tract. People with this syndrome are predisposed to multiple chronic respiratory infections that may eventually cause bronchiectasis.
Bronchioles
Airways less than 1 mm in diameter that contain no cartilage in their walls.
mucokinesis
Mucous movement.
Do the lower airways have fenestrated capillaries like those in the upper airway that allow water transport to the epithelial surface?
No.
What kind of cells line the oropharynx and laryngopharynx?
Nonciliated, stratified squamous epithelium cells.
Where are mast cells located?
On the epithelial surface of the airways and in the airway walls near smooth muscle.
Besides speech, what is the other major function of the larynx?
Preventing the lower airway from aspirating solids and liquids during swallowing and breathing.
What kind of cells line the posterior two thirds of the nose (including the turbinates)?
Pseudostratified, ciliated columnar epithelial cells interspersed with many mucus-secreting glands.
What function of the nose is lost when the patient is intubated?
The air-conditioning function
What is the humidity deficit?
The difference between the water content of room air (
What are the names of the lympathic tissues in the nasopharynx and oropharynx?
The pharyngeal tonsil (called "adenoids" when inflamed); the palatine tonsil; and the lingual tonsil.
isothermic saturation boundary (ISB)
The point at which inspired gas becomes 100% saturated with water vapor and is warmed to body temperature (37 degrees C) after it passes below the carina.
Where do the digestive and respiratory tracts separate?
At the laryngopharynx (AKA hypopharynx).
Nasal secretions contain _________________________________ and ______________________ ____________, which act as the first defense against inspired microorganisms.
immunoglobulins inflammatory cells
lung parenchyma
Essential supportive tissue composing the lung.
Connect the middle ear with the nasopharynx. Allow pressure equalization between the middle ear and atmosphere.
Eustachian tubes; AKA auditory tubes
A tracheostomy is generally located ______ to ______ cm below the cricoid cartilage.
1 to 3 cm
Why is any mucous membrane swelling in the airway (i.e. epiglottitis) more life threatening in children compared with the same amount of swelling in an adult?
Because the airway diameter of a small child is approximately half the diameter of an adult. In an adult, this swelling merely causes hoarseness and perhaps a sore throat. The same degree of swelling nearly closes the smaller airway of a child.
Why are newborns preferential nose breathers?
Because their epiglottis is located much higher than an adult's.
What are the conducting airways?
Beginning with the trachea, all airways down to the level just before alveoli first appear.
How is the stridor sound created?
By high-velocity air flowing through a narrowed glottis.
What do pores of Kohn do?
Connect adjacent alveoli with one another.
What do canals of Lambert do?
Connect terminal bronchioles and nearby alveoli.
arteriovenous anastomoses
Countercurrent blood flow and connections between arterial and venous vessels.
Which cartilage is the only one to form a complete ring around the trachea, and marks the entrance to the trachea?
Cricoid cartilage
During inspiration, this causes a characteristic high-pitched crowning sound called stridor.
Croup
Alveoli
Gas exchange membranes that separate air from pulmonary capillary blood.
What is croup?
Glottic and subglottic edema secondary to viral infections. A common cause of upper airway obstruction in infants and young children.
What do arteriovenous anastomoses do?
Improve the ability of the nasal mucosa to adjust the temperature and water content of inspired air. Countercurrent blood flow lessens the mucosa's heat and water vapor loss.
Where are the 4 sinuses located?
In the frontal, sphenoid, ethmoid, and maxillary bones.
Why is it important for the vocal cords to be able to open and close?
It is essential for generating and releasing high pressure in the lung during a cough, which is an extremely important lung defense mechanism.
Where is the cricoid cartilage?
Just below the thyroid cartilage.
Where does the lower epiglottis attach?
Just below the thyroid notch on its upper anterior surface.
What happens if supplemental humidity is not added to the inspired air when an ET tube is in place?
Lower airway mucus thickens as water evaporates.
If an ET tube is inserted too far during the process of intubation, its tip is more likely to enter which bronchus?
Right bronchus, because it is more in line with the trachea than the left bronchus.
bronchospasm
Smooth muscle contraction.
What kind of cells line the anterior third of the nose?
Squamous, nonciliated epithelium cells
Which two layers make up the respiratory mucosa?
The epithelium and lamina propria
Acinus
The functional respiratory unit of the lung that consists of the respiratory bronchioles, alveolar ducts, alveolar sacs, and the alveoli.
What are the 3 main functions of the nose?
The humidification, heating, and filtering of inspired air.
What parts of the airway does the upper airway consist of?
The nose, oral cavity, pharynx, and larynx.
respiration
The process of moving O2 and CO2 between air and blood.
ventilation
The process of moving gas in and out of the lungs.
Which layer contains the most mucous glands?
The submucosa
During childhood, these tissues sometimes become inflamed and swollen and may interfere with nasal breathing because of the child's small airway diameter; chronic inflammation may necessitate their surgical removal.
The tonsils.
Why do artificial airways such as ET tubes render a cough ineffective?
They prevent the vocal cords from sealing the airway.
What is the main function of the lungs?
To bring atmospheric gases into contact with the blood.
True or false: Gas exchange only occurs in the alveoli.
True.
Drooling and muffled speech are more serious signs of __________________ in a child.
epiglottitis
Inflammation of the epiglottis.
epiglottitis
What is the narrowest part of the adult larynx?
glottis
What is the opening to the trachea called?
glottis
Resistance to airflow through the nose is _______________ than resistance through the mouth.
greater
The larynx is located _______________ in women and children than in men.
higher
When the vocal cords suddenly seize up or close when taking in a breath, blocking the flow of air into the lungs.
laryngospasm
This structure is sometimes called the voice box because it contains the vocal cords that control the size of the opening into the trachea.
larynx
Which part of the airway marks the transition between the upper and lower airways?
larynx
The nasal septum is often deflected to one side or the other, more often to the ____________ than the _____________, possibly making the passage of a catheter or artificial airway through this side difficult.
left right
These cells have granules in their cytoplasm that contain preformed inflammatory agents. These agents include histamine, various prostaglandins, leukotrienes, thromboxane, and platelet-activating factor.
mast cells
What reflex arc is responsible for the gag and swallowing reflexes that protect the lower airway?
pharyngeal and laryngeal reflexes
The space behind the nasal cavities that extends down behind the tongue to the larynx.
pharynx
The left bronchus is _________________ in diameter than the right but twice as ________________.
smaller long
The convoluted design of the turbinates greatly increases the _________________ ____________ of the nasal cavity.
surface area
It is the lung's main method for removing microbes and inhaled particles that have gained access to the bronchial tree.
the mucociliary escalator
An important landmark used during intubation.
the vallecula
Only the _____________ vocal cords play a part in vocalization.
true
Because they create air flow turbulence, the conchae are also called _____________________.
turbinates