External Nose Anatomy

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Questions and Answers

Damage to the phrenic nerve would directly impair the function of which muscle critical for quiet breathing?

  • Scalene muscles
  • Diaphragm (correct)
  • Sternocleidomastoid
  • External intercostals

A patient presents with restricted airflow due to inflammation in the nasal cavity. Which histological component is MOST likely contributing to this condition?

  • Engorgement and leakiness of vessels in the lamina propria (correct)
  • Thickening of the stratified squamous epithelium
  • Increased activity of vibrissae entrapping air
  • Decreased numbers of goblet cells reducing mucus production

A surgeon mistakenly severs the nerve supply to the serous glands within the nasal mucosa during a rhinoplasty. Which cranial nerve was MOST likely damaged?

  • Facial nerve (CN VII) (correct)
  • Trigeminal nerve (CN V)
  • Olfactory nerve (CN I)
  • Vagus nerve (CN X)

Following a traumatic injury, a patient experiences a disruption in the normal mucociliary clearance mechanism. Which of the following cellular changes would MOST directly contribute to this disruption?

<p>Impaired ciliary movement of ciliated columnar cells (A)</p> Signup and view all the answers

Which structure is a component of the external nose that forms the apex?

<p>Major alar cartilage (C)</p> Signup and view all the answers

A patient has difficulty with the initial stages of inspiration, even when using accessory muscles. Which center is MOST likely impaired?

<p>Dorsal respiratory group (B)</p> Signup and view all the answers

Damage to the tensor veli palatini muscle would MOST directly affect which function?

<p>Elevation of the soft palate (C)</p> Signup and view all the answers

A lesion in the medulla oblongata affects the ventral respiratory group (VRG). What specific breathing pattern change would be MOST expected in this patient?

<p>Difficulty with forced expiration (C)</p> Signup and view all the answers

If the pressure in the alveoli is higher than the pressure in the atmosphere, which of the following scenarios is MOST likely to occur?

<p>Air will flow out of the alveoli into the atmosphere. (D)</p> Signup and view all the answers

A patient with a deviated septum experiences significant airflow obstruction in one nasal cavity. Which region of the nasal cavity is MOST directly affected by this condition?

<p>Respiratory region (D)</p> Signup and view all the answers

A patient is diagnosed with damage to the anterior ethmoidal artery. Which area may be affected?

<p>olfactory region (A)</p> Signup and view all the answers

A patient has a condition that impairs the function of the goblet cells in their respiratory epithelium. Which function is MOST likely compromised as a direct result?

<p>Maintenance of epithelial moisture (C)</p> Signup and view all the answers

Which of the following structures is located within the laryngopharynx?

<p>Piriform recess (D)</p> Signup and view all the answers

During a pulmonary function test, a patient exhibits a significantly reduced vital capacity (VC). Which combination of lung volumes is MOST directly affected to cause this reduction?

<p>Inspiratory reserve volume (IRV) and expiratory reserve volume (ERV) (C)</p> Signup and view all the answers

A patient has a tumor that is compressing their thoracic cavity, leading to an increase in intrapleural pressure. Which of the following is MOST likely to occur as a direct result of this increased pressure?

<p>Decreased transmural pressure, potentially leading to airway collapse (B)</p> Signup and view all the answers

Which histological feature is UNIQUE to the true vocal folds compared to other regions of the larynx lined by respiratory epithelium?

<p>Nonkeratinized stratified squamous epithelium (D)</p> Signup and view all the answers

A disease process causes a thickening of the alveolar-capillary membrane. What effect will this MOST directly have on gas exchange?

<p>Reduce gas exchange (A)</p> Signup and view all the answers

Pulmonary capillaries constrict serving alveoli that have low PO2 and high PCO2. Why is this process important?

<p>Allows blood to go to other alveoli that may have more O2. (A)</p> Signup and view all the answers

During internal respiration, the partial pressure of oxygen in tissues is low (40 mm Hg), and the partial pressure of oxygen in the blood is high (100 mm Hg). Which of the following BEST describes the diffusion of oxygen?

<p>Promotes the diffusion of oxygen out of the blood and enter the tissue. (D)</p> Signup and view all the answers

What is the expected volume of air remaining in the lungs after maximum exhalation?

<p>1.2 liters (D)</p> Signup and view all the answers

What part of the pharynx is located between the nasopharynx and the laryngopharynx?

<p>Oropharynx (A)</p> Signup and view all the answers

What is the function of the epiglottis?

<p>Close off the laryngeal inlet during swallowing and prevent food from entering the airways (D)</p> Signup and view all the answers

A histological sample from the nasal cavity shows pseudostratified tall columnar epithelium without goblet cells and without motile cilia. Which area of the nasal cavity was this sample MOST likely taken from?

<p>Olfactory region (D)</p> Signup and view all the answers

A patient has a condition that specifically affects the function of the conchae (turbinates) in the nasal cavity. Which of the following processes is MOST likely impaired in this patient?

<p>Warming of inhaled air (A)</p> Signup and view all the answers

During an allergic reaction, a patient experiences significant swelling of the mucous membrane in the nasal cavity, leading to difficulty breathing. Which cellular component within the lamina propria is MOST directly contributing to this swelling?

<p>Vascular network (A)</p> Signup and view all the answers

A researcher is studying the function of basal cells in the respiratory epithelium. Which of the following BEST describes the primary role of these cells?

<p>Serving as stem cells for continual replacement of other epithelial cells (C)</p> Signup and view all the answers

A patient is found to have a lesion affecting the superior laryngeal nerve. Which specific function of the larynx is MOST likely to be impaired?

<p>Phonation (C)</p> Signup and view all the answers

What is the origin of the blood supply for the external apex and dorsum of the nose?

<p>External carotid artery branches (D)</p> Signup and view all the answers

What is tidal volume?

<p>Air volume moving in and out with each breath (B)</p> Signup and view all the answers

Which of the following epithelium types would be found lining the lingual mucosa of the epiglottis?

<p>Stratified Squamous Nonkeratinized Epithelium (C)</p> Signup and view all the answers

A patient experiences a sharp decrease in airflow due to increased airway resistance from the atmosphere to alveoli. Which response would MOST likely lead to this patient's condition??

<p>Parasympathetic stimulation, causing bronchoconstriction (B)</p> Signup and view all the answers

What is the total lung capacity?

<p>5.9 L (C)</p> Signup and view all the answers

What function is performed by the Dorsal Respiratory Group?

<p>Initiates respiration and Determines rhythm of breathing. (A)</p> Signup and view all the answers

A patient with damage to CNVII may also struggle with:

<p>Innervation of serous glands (C)</p> Signup and view all the answers

What is the function of the Pneumotaxic Center?

<p>Allows for expiration (A)</p> Signup and view all the answers

What is the function of the Ciliated columnar cells?

<p>Sweep the surface of the epithelium and protect the lungs by removing small, inhaled particles (C)</p> Signup and view all the answers

A baseball player prepares for a game. He requires more oxygen than normal. Which respiratory center is activated?

<p>Apneustic center (A)</p> Signup and view all the answers

The amount of a gas that dissolves in a liquid is directly proportional to what?

<p>Partial pressure of that gas in the air above it (B)</p> Signup and view all the answers

A patient presents with damage to the superior free edge of the conus elasticus. Which of the following functions would be MOST directly affected?

<p>Aiding in phonation through vibration of the vocal folds. (C)</p> Signup and view all the answers

A patient has a condition that impairs the function of the seromucous glands in the lamina propria of the larynx. Which specific epithelial function is MOST likely compromised?

<p>Humidifying and cleansing inspired air. (D)</p> Signup and view all the answers

What specific characteristic of the hyaline cartilage in the thyroid and cricoid cartilages contributes MOST to its ability to provide flexible support in the larynx?

<p>Large amount of water in the extracellular matrix providing a smooth surface. (C)</p> Signup and view all the answers

Following a surgery involving the nasal cavity, a patient reports a diminished ability to detect odors. If the surgery inadvertently affected the nerve supply to a specific region, where was the MOST likely site of damage?

<p>Olfactory region at the dome of the nasal cavity. (D)</p> Signup and view all the answers

A patient presents with significant inflammation of the mucous membrane in the respiratory region of the nasal cavity due to an allergic reaction. Which cellular event within the lamina propria is MOST directly responsible for the patient's symptoms?

<p>Engorgement and leakiness of blood vessels causing fluid distension. (E)</p> Signup and view all the answers

During a diagnostic procedure, a clinician needs to access the piriform recess of the laryngopharynx. Which anatomical structure is MOST crucial for the clinician to identify to locate this recess accurately?

<p>Aryepiglottic fold. (B)</p> Signup and view all the answers

A patient who has undergone a partial laryngectomy involving removal of tissue superior to the true vocal folds is MOST likely to experience which of the following complications?

<p>Increased risk of aspiration during swallowing. (B)</p> Signup and view all the answers

A researcher is investigating the effects of a novel drug on mucociliary clearance in the respiratory epithelium. If the drug specifically targets and impairs the function of transmembrane proteins essential for chloride ion transport, which cell type would be MOST directly affected?

<p>Goblet cell. (C)</p> Signup and view all the answers

A forensic scientist is examining a tissue sample from the nasal cavity. The sample is pseudostratified columnar epithelium without goblet cells and without motile cilia. This sample MOST likely originated from which location?

<p>The olfactory region of the nasal cavity. (B)</p> Signup and view all the answers

A patient with a deviated septum experiences significant airflow obstruction and requires surgical intervention to improve nasal ventilation. Which anatomical alteration will MOST directly improve airflow after the surgery?

<p>Straightening the nasal septum to equalize the air passage bilaterally. (B)</p> Signup and view all the answers

A patient with a history of chronic sinusitis undergoes endoscopic sinus surgery. Postoperatively, the patient reports a noticeable decrease in the humidification of inspired air. Which of the following structures was MOST likely affected during the procedure?

<p>Pseudostratified ciliated columnar epithelium with goblet cells. (A)</p> Signup and view all the answers

During an experiment, the concentration of a specific gas in the alveolus is artificially maintained at a level higher than that in the incoming blood. This scenario BEST illustrates the physical principle underlying:

<p>Henry's law governing gas solubility in liquids. (B)</p> Signup and view all the answers

A hypothetical scenario involves a drug that selectively impairs the function of type II alveolar cells. This pharmacological intervention would MOST directly disrupt:

<p>Surface tension reduction within the alveoli. (B)</p> Signup and view all the answers

In a clinical study, researchers are investigating the impact of varying alveolar ventilation rates on pulmonary capillary blood flow. Assuming total cardiac output remains constant, which compensatory mechanism is MOST likely to occur in response to decreased alveolar ventilation?

<p>Pulmonary vasoconstriction to redirect blood flow to better ventilated areas. (B)</p> Signup and view all the answers

A patient presents with a rare genetic disorder that causes a significant reduction in the number of elastic fibers within the lung parenchyma. This condition will MOST directly affect which aspect of normal respiration?

<p>Elastic recoil during passive expiration. (A)</p> Signup and view all the answers

Following a traumatic injury to the neck, a patient exhibits paradoxical vocal cord movement, where the vocal cords adduct during inspiration. Which neural pathway is MOST likely affected in this patient?

<p>Recurrent laryngeal nerve causing bilateral adductor paralysis. (D)</p> Signup and view all the answers

A patient with a history of smoking develops emphysema, characterized by destruction of alveolar walls and a decrease in lung elasticity. Which blood gas change would be MOST expected in this patient?

<p>Decreased PaO2 and increased PaCO2. (B)</p> Signup and view all the answers

A patient is diagnosed with a condition that selectively impairs the ability of the pneumotaxic center to function. Which specific aspect of the breathing cycle would be MOST affected?

<p>Termination of inspiration. (D)</p> Signup and view all the answers

A mountain climber ascends to a high altitude where the partial pressure of oxygen in the atmosphere is significantly reduced. Which immediate physiological response is MOST critical for maintaining adequate tissue oxygenation?

<p>Stimulation of peripheral chemoreceptors leading to increased respiratory rate. (C)</p> Signup and view all the answers

A pathologist is examining a biopsy from the larynx of a patient with chronic laryngitis. The epithelium is described as nonkeratinized stratified squamous with no evidence of glands, lymphatic tissue, or blood vessels. From which specific laryngeal structure was this sample MOST likely taken?

<p>True vocal fold. (A)</p> Signup and view all the answers

A researcher is studying the effects of a drug that selectively inhibits the function of the dorsal respiratory group (DRG) in the medulla oblongata. Which direct effect on respiratory mechanics would be MOST likely observed?

<p>Apnea or severely reduced respiratory rhythm. (D)</p> Signup and view all the answers

A patient reports difficulty elevating the soft palate during swallowing, leading to nasal regurgitation of food. Dysfunction of which muscle is MOST likely contributing to this condition?

<p>Levator veli palatini muscle. (C)</p> Signup and view all the answers

During a bronchoscopy, a small lesion is identified near the carina, the point where the trachea divides into the main bronchi. If this lesion disrupts the normal function of local airway receptors, which physiological response would be MOST likely compromised?

<p>Cough reflex in response to irritants. (B)</p> Signup and view all the answers

A patient who has undergone a tracheostomy requires assistance to expectorate thick mucus secretions. Which intervention is MOST likely to improve the patient's ability to clear these secretions?

<p>Increasing the humidity of inspired air to liquefy secretions. (A)</p> Signup and view all the answers

In a patient with severe kyphoscoliosis (curvature of the spine), which alteration in lung volumes and capacities is MOST likely to be observed?

<p>Decreased functional residual capacity and inspiratory reserve volume. (C)</p> Signup and view all the answers

A researcher is comparing the blood gas composition in the pulmonary artery and the pulmonary vein of a healthy individual at rest. Which difference is MOST consistent with normal physiology?

<p>Lower PO2 and higher PCO2 in the pulmonary artery compared to the pulmonary vein. (B)</p> Signup and view all the answers

A patient with a tumor compressing the trachea experiences a progressive increase in airway resistance. Which compensatory mechanism will MOST effectively maintain adequate alveolar ventilation in the short term?

<p>Increased tidal volume to enhance air flow. (C)</p> Signup and view all the answers

A patient is diagnosed with a condition that causes selective degeneration of the elastic cartilage in the epiglottis. Which functional impairment would MOST likely result from this condition?

<p>Increased risk of aspiration during swallowing. (D)</p> Signup and view all the answers

A patient undergoes a surgical procedure involving the removal of the pharyngeal tonsil (adenoids). Which potential long-term complication is MOST directly associated with this procedure?

<p>Increased susceptibility to upper respiratory infections. (C)</p> Signup and view all the answers

A researcher is investigating the factors affecting airway resistance. If the goal is to assess the bronchodilatory response to sympathetic stimulation, which physiological parameter should be PRIMARILY monitored?

<p>Diameter of the bronchioles. (D)</p> Signup and view all the answers

A patient has a condition that selectively impairs the function of the vibrissae in the nasal vestibule. Which specific consequence is MOST likely to occur as a direct result of this impairment?

<p>Increased deposition of large particulate matter in the lower airways. (C)</p> Signup and view all the answers

A patient experiences significant swelling of the torus tubarius following an upper respiratory infection. Which Eustachian tube function is MOST likely to be impaired due to this inflammation?

<p>Equalization of pressure between the middle ear and the atmosphere. (B)</p> Signup and view all the answers

A patient who has undergone a uvulectomy (removal of the uvula) as part of sleep apnea treatment is MOST likely to experience which postoperative complication?

<p>Changes in voice resonance due to altered pharyngeal space. (C)</p> Signup and view all the answers

Which of the following mechanisms is MOST responsible for the increase in alveolar pressure during exhalation?

<p>Relaxation of inspiratory muscles, causing the lungs to recoil. (B)</p> Signup and view all the answers

A patient presents with a lesion affecting the T1 level of the spinal cord. Which specific nasal function is MOST likely to be impaired as a result?

<p>Regulation of blood flow through the nasal mucosa. (D)</p> Signup and view all the answers

A patient has a rare condition in which the ciliated columnar cells of their respiratory epithelium are non-motile. Which compensatory mechanism would MOST effectively mitigate the functional deficit caused by this condition?

<p>Forced exhalation techniques to clear airway secretions. (B)</p> Signup and view all the answers

A patient presents with impaired function of the lingual mucosa of the epiglottis following a localized infection. Which specific function is MOST likely compromised due to the characteristics of this mucosa?

<p>Protecting the laryngeal inlet by initiating the swallowing reflex. (C)</p> Signup and view all the answers

A researcher is studying the effects of targeted gene therapy on the respiratory epithelium lining the nasal cavity. If the therapy selectively enhances the expression of genes responsible for producing odorant-binding proteins, which specific region of the nasal cavity would benefit MOST directly from this treatment?

<p>The olfactory region located on the dome of the nasal cavity. (C)</p> Signup and view all the answers

A patient exhibits significantly reduced oxygen saturation during exercise but normal values at rest. Pulmonary function tests reveal a normal FEV1/FVC ratio, but diffusion capacity is markedly decreased. Which alteration in the alveolar-capillary membrane is MOST likely responsible for these findings?

<p>Thickening of the interstitial space between the alveolar and capillary walls. (A)</p> Signup and view all the answers

During a physiological experiment, the partial pressure of carbon dioxide (PCO2) in the alveoli is selectively manipulated. If the PCO2 in a specific group of alveoli is experimentally decreased while systemic arterial PO2 remains constant at 100 mm Hg, what compensatory change would MOST likely occur in the adjacent pulmonary capillaries serving those alveoli?

<p>Vasoconstriction to increase blood flow to better-ventilated alveoli. (C)</p> Signup and view all the answers

A patient with a rare genetic mutation exhibits a complete absence of seromucous glands in the lamina propria of the larynx. Which of the following functional impairments would be MOST directly attributable to this specific deficiency?

<p>Compromised humidification and protection of the laryngeal epithelium. (B)</p> Signup and view all the answers

Flashcards

External nose

Pyramidal structure with root superiorly and apex inferiorly.

Nares (nostrils)

Openings to the nasal cavity, separated by the nasal septum.

Nasal, Maxillae, & Frontal Bones

Form the bony nasal root, shaping the upper part of the nose.

Major alar cartilage

Forms the apex (tip) of the nose.

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Minor alar cartilages

Support the ala nasi (wings) of the nostrils.

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Lateral nasal cartilage

Form the dorsum (bridge) of the nose.

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Septal cartilage

Bounds the nares medially, forming part of the nasal septum.

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Nares (internal)

Anterior openings of the nasal cavity.

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Choanae

Posterior openings that communicate with the nasopharynx.

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Ethmoid bone

Forms the roof of the nasal cavity.

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Nasal conchae

Bony shelves projecting into the nasal cavities from lateral walls.

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Inferior nasal meatus

Channel between the floor and inferior concha.

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Middle nasal meatus

Channel between the inferior and middle concha.

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Superior nasal meatus

Channel between the middle and superior concha.

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Sphenoethmoidal recess

Between the superior concha and the nasal cavity roof.

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Common nasal meatus

Channel between the conchae and nasal septum.

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Vestibule

Located just inside the anterior external opening of the nose; contains hair follicles.

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Olfactory region

Small area located at the superior apex of the nasal cavity; lined by olfactory epithelium.

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Respiratory region

Remainder of the nasal cavity, lined with respiratory epithelium.

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Paranasal sinuses

Bony recesses communicating with the nasal cavities, located within specific bones.

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External carotid artery branches

Artery supply to vestibule/resp. portion of external nose.

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Internal artery branches

Artery to olfactory region and surrounding external nose.

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Olfactory nerve (CN I)

Provides olfactory function in nasal cavity.

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Trigeminal nerve (CN V)

Provides general sensation in nasal cavity.

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CN VII - parasympathetic fibers

Innervates serous glands in nasal mucosa.

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Sympathetic innervation (T1)

Regulates blood flow through nasal mucosa.

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Nasopharynx

Uppermost pharynx, behind nasal cavity.

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Torus tubarius

Folds that are elevations of the auditory tube.

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Torus levatorius

Elevation produced by the levator veli palatini muscle.

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Pharyngeal recesses

Located behind the Eustachian tube.

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Salpingopharyngeal folds

Ridges formed by the salpingopharyngeus muscle

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Soft Palate

Posterior to the hard palate, contains the tensor veli palatini muscle.

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Palatine uvula

Conical projection hanging down from the soft palate.

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Pharyngeal tonsil

Lymphatic tissue in the nasopharynx (adenoids).

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Oropharynx

Pharynx between nasopharynx and laryngopharynx, behind oral cavity.

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Vallecula epiglottica

Fossa between glossoepiglottic folds and epiglottis.

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Palatopharyngeal arches

Folds overlying the palatopharyngeal muscle.

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Root of the tongue

Posterior tongue anchoring to mandible and hyoid bone.

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Vallate papillae

Taste bud-containing papillae on the tongue root.

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Lingual tonsils

Lymphoid tissue at the base of the tongue.

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Palatine tonsils

Lymphoid tissue in the oropharynx (MALT).

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Laryngopharynx

Pharynx behind larynx, from oropharynx to esophagus.

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Piriform recess

Located on both sides of the laryngopharynx.

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Epiglottis

Closes during swallowing to seal trachea

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Laryngeal inlet

Opening from pharynx to larynx.

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Aryepiglottic folds

Mucosal folds at the opening of the larynx, aiding phonation.

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Interarytenoid notch

Indentation between arytenoid cartilages.

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Cuneiform tubercles

Prominence formed by cuneiform cartilage.

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Corniculate tubercles

Eminences formed by corniculate cartilage.

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Study Notes

  • The external nose is a pyramidal structure located on the anterior surface of the head
  • The root is the superior part and the apex is the inferior part
  • The dorsum is a section located between the root and the apex
  • The nares (nostrils) are inferior to the apex and are openings to the nasal cavity
  • The nasal septum separates the nares
  • The ala nasi (wings of the nostrils) laterally bound the nares

Bony Part of the External Nose

  • Bones shape the nose root
  • The bony nasal root is formed by the nasal, maxillae, and frontal bones

Cartilaginous Part of the External Nose

  • The cartilaginous part comprises several cartilages: alar, lateral nasal, and septal
  • Alar cartilages:
    • Major alar cartilage forms the apex of the nose
    • Minor alar cartilages support the ala nasi
  • Lateral nasal cartilage forms the dorsum of the nose
  • Septal cartilage bounds the nares medially

Nasal Cavity Anatomy

  • Two nasal cavities reside within the external nose and adjacent skull, structured by 12 cranial bones
  • Anterior openings: Nares
  • Posterior openings: Choanae, which communicate with the nasopharynx
  • Roof: Ethmoid bone

Lateral Walls of the Nasal Cavity

  • Nasal conchae (inferior, middle, and superior) are bony shelves attached to the lateral walls and project into the nasal cavities
  • Conchae divide the nasal cavities into four air channels

Air Channels of the Nasal Cavities

  • Inferior nasal meatus: Located between the floor and inferior concha
  • Middle nasal meatus: Located between the inferior and middle concha
  • Superior nasal meatus: Located between the middle and superior concha
  • Sphenoethmoidal recess: Located between the superior concha and the nasal cavity roof
  • Common nasal meatus: Located between the conchae and nasal septum

Regions of the Nasal Cavity

  • Vestibule:
    • Located just inside the anterior external opening of the nose
    • Contains hair follicles
  • Olfactory region:
    • Small area
    • Located inside at the superior apex of the cavity
    • Lined by olfactory epithelium
  • Respiratory region:
    • Remainder of the nasal cavity
    • Largest region
    • Lined with respiratory epithelium

Paranasal Sinuses

  • Four bony recesses communicate with the nasal cavities
  • Named according to the bones they are located within
  • All sinuses are covered by respiratory mucosa and innervated by the trigeminal nerve (Cranial Nerve V)
    • Sphenoidal sinus
    • Maxillary sinus
    • Frontal sinus
    • Ethmoidal cells

Blood Supply to the Nasal Cavity

  • Blood supply to the vestibule and respiratory portion (external nose – apex and dorsum) comes from external carotid artery branches
    • Sphenopalatine artery
    • Greater palatine artery
    • Superior labial artery
    • Lateral nasal artery
  • Blood supply to the olfactory region and surrounding external nose comes from internal artery branches
    • Anterior and posterior ethmoidal arteries

Nerve Supply of the Nasal Cavity

  • Three cranial nerves innervate the nasal cavity
    • Olfactory nerve (CN I): Olfactory function
    • Trigeminal nerve (CN V): General sensation
    • CN VII (parasympathetic fibers): Innervates serous glands in the nasal mucosa
  • Sympathetic innervation
    • T1 level of spinal cord
    • Regulates blood flow through nasal mucosa

The Pharynx

  • Muscular column posterior to the oral cavity, nasal cavity, and larynx, lined by mucosa
  • It is important for voice production and serves as a passageway for food and air

Nasopharynx

  • Uppermost portion of the pharynx
  • Located on the posterior part of the nasal cavity behind the conchae
  • Communicates with the nasal cavity via the nasal conchae
  • Torus tubarius: Folds that are elevations of the auditory tube (Eustachian tube)
  • Torus levatorius:
    • Located just below the torus tubarius
    • Elevation produced by the levator veli palatini muscle
    • Muscle of the soft palate that elevates the soft palate during swallowing and aids in stopping food from entering the nasopharynx
  • Pharyngeal recesses: Located behind the Eustachian tube
  • Salpingopharyngeal folds: Ridges formed by the salpingopharyngeus muscle
  • Soft palate:
    • Located posterior to the hard palate
    • Comprised of the tensor veli palatini muscle
  • Palatine uvula:
    • Conical projection of the posterior free edge of the soft palate
    • Hangs down into the oropharynx
  • Pharyngeal tonsil
    • Also known as the adenoids comprised of lymphatic tissue located in the nasopharyngeal portion of the pharynx

Oropharynx

  • Portion of the pharynx located between the nasopharynx and the laryngopharynx
  • Just behind the oral cavity
  • Extends from the soft palate to the hyoid bone
  • Vallecula epiglottica: Fossa located between the lateral and median glossoepiglottic folds and the epiglottis
  • Palatopharyngeal arches:
    • Two folds of mucous membrane that overlie the palatopharyngeal muscle
    • Palatopharyngeal muscle depresses the palate
  • Root of the tongue:
    • Posterior part of the tongue
    • Anchors tongue to mandible and the hyoid bone
  • Structures on root of tongue:
    • Vallate papillae containing taste buds
    • Lingual tonsils
  • Palatine tonsils:
    • Comprised of lymphoid tissue
    • Mucosa-associated lymphoid tissue (MALT)

Laryngopharynx

  • Located behind the larynx
  • Extends from the oropharynx to the esophagus
  • Piriform recess: Located on both sides of the laryngopharynx
  • Epiglottis:
    • Covered by mucous membrane
    • Made up of elastic cartilage
    • Closes during swallowing to close off the larynx from the food bolus
    • Is otherwise open when you’re breathing
  • Laryngeal inlet:
    • Opening that opens from the pharynx to the larynx, connecting the pharynx and the larynx
    • Closed by the epiglottis to prevent food and liquid from entering the respiratory tract
  • Aryepiglottic folds:
    • Located at the opening of the larynx
    • Mucosal folds overlying the aryepiglottic muscle to aid in phonation
  • Interarytenoid notch:
    • Depression or indentation found between the two apices of the arytenoid cartilages
    • Covered by mucosa
  • Cuneiform tubercles:
    • Mucosa-covered prominence
    • Formed by the underlying cuneiform cartilage, located on the posterior part of the aryepiglottic folds
  • Corniculate tubercles:
    • Eminences formed by the underlying corniculate cartilage
    • Covered by mucosa
  • Piriform fossa/piriform recess:
    • Located between the aryepiglottic folds and the thyroid cartilage on either side of the laryngeal inlet
    • Mucosa houses a branch of the superior laryngeal nerve

Overview of the Larynx

  • Located in the anterior neck, anterior to the cervical part of the esophagus
  • It connects the pharynx and the trachea, allowing air to pass through
  • Sits at the level of the third to sixth cervical vertebrae
  • Sits slightly higher in females and children

Functions of the Larynx

  • Protects the airways from large, swallowed matter
  • Involved in the production of sound (phonation)

General Anatomy of Larynx

  • Laryngeal inlet: Entrance from the pharynx into the larynx

Main Spaces of the Larynx

  • Vestibule:
    • Most superior space
    • Extends from the laryngeal inlet to the vestibular folds
  • Ventricle:
    • Middle and smallest space of the larynx
    • Space between the vestibular folds and the vocal folds
  • Infraglottic cavity:
    • Most inferior space of the larynx
    • Extends between the inferior aspect of the vocal folds and the first tracheal ring
  • Rima Glottidis: Opening between the vocal folds and the arytenoid cartilages

Cartilages of the Larynx

  • Three unpaired cartilages: Epiglottis, thyroid, and cricoid cartilages
  • Paired cartilages: Arytenoid, corniculate, and cuneiform cartilages

Epiglottis

  • Leaf-shaped piece of elastic cartilage
  • Sits posterior to the hyoid bone and anterior to the laryngeal inlet
  • Main function: closes off the inlet during swallowing to prevent food from entering the airways
  • Two parts:
    • Free superior part
      • Broad and rounded, may have a notch in the midline
    • Attached inferior stem-like part
      • Connected to the posterior surface of the thyroid cartilage by the thyroepiglottic ligament

Thyroid Cartilage

  • Largest cartilage of the larynx formed of two hyaline cartilage laminae which fuse in the midline
  • Laryngeal prominence:
    • Inferior two-thirds, i.e., Adam’s apple
    • Epiglottis cartilage attaches to the posterior aspect of this eminence
  • Superior thyroid notch: Above the prominence which is V-shaped
  • Superior and inferior horns (cornua): Posterolateral extensions

Cricoid Cartilage

  • Complete ring of hyaline cartilage between the thyroid cartilage and the trachea
  • Two parts:
    • Anterior arch (curved)
    • Posterior lamina (flattened)

Arytenoid Cartilages

  • Sit on the cricoid cartilage; hyaline cartilages in a pyramidal shape tapering into an apex
    • Articulate with the corniculate cartilage above it
  • Two projections on the arytenoid cartilage are attachment sites
    • Vocal process: Elongated sharp projection of the anterior surface
    • Muscular process: Rounded and projects posterolaterally

Corniculate Cartilages

  • Sit on top of the arytenoid cartilages are conical shaped and are considered minor cartilages

Intrinsic Structures of the Larynx

  • Quadrangular membrane
    • Layer of submucosa and broad thin sheets of connective tissue extending from the lateral edges of the epiglottis to the arytenoid cartilages, covered in mucosa
    • Superior free border forms the aryepiglottic fold, which forms the lateral border of the laryngeal inlet
    • Cuneiform tubercle (at the inferior end of each aryepiglottic fold) contains the cuneiform cartilages
  • Vestibular fold: Inferior free edge of the quadrangular membrane and is commonly known as the false vocal cord
  • Conus elasticus
    • Connective tissue between the superior rim of the cricoid and the thyroid cartilage where the superior free edge forms the vocal ligament
  • Vocal Ligaments
    • Superior free edges of the conus elasticus that extend from the arytenoid cartilages to the inner surface of the thyroid cartilage
    • Covered in a mucous membrane to form the vocal folds, commonly known as the vocal cords which are essential for producing sound

Nasal Cavity Histology

  • Most of the upper respiratory tract is lined with pseudostratified ciliated columnar epithelium, known as respiratory epithelium with parts of the pharynx and larynx as exceptions
  • All cells contact the basement membrane with nuclei not aligned in the same plane and appear to have multiple layers

Respiratory Epithelium Cell Types

  • Ciliated columnar cells:
    • Most abundant cells that extend the entire thickness of the epithelium
    • Cilia sweep the surface to protect the lungs by removing inhaled particles
  • Goblet cells:
    • Columnar epithelial cells shaped like a wine goblet, secrete mucus glycoproteins
    • Mucus forms a protective layer on the epithelial surface to maintain moisture and trap particulate material and pathogens
    • Numerous in the proximal airways and decrease in number towards the distal parts
  • Basal cells:
    • Small, nearly cuboidal cells located close to the basal lamina with apices that do not reach the lumen of the epithelium
    • Act as stem cells for continual replacement of other epithelial cells

Function of the Respiratory Epithelium

  • Moistens and protects the airways by acting as a physical barrier to pathogens and their removal (mucociliary clearance)
  • Ciliated cells are the primary components in the mucociliary clearance mechanism possessing two hundred cilia that beat constantly (10-20 times/sec) towards the pharynx, either upwards from the lower respiratory tract or downwards from the nasal structures

Vestibule of the Nasal Cavity

  • Forms a part of the external nose, communicates with the external environment, and is lined with stratified squamous epithelium
  • Contains vibrissae that entrap large particulate matter
  • Sebaceous glands are present, and their secretions assist in the entrapment
  • Transition to pseudostratified epithelium occurs posteriorly along with the absence of sebaceous glands

Respiratory Region of the Nasal Cavity

  • Constitutes most of the volume of the nasal cavities and is lined by respiratory epithelium (pseudostratified ciliated columnar epithelium with goblet cells)
  • Lamina propria has a rich, vascular network that warms inhaled air with vessels that may become engorged during allergic reactions or viral infections resulting in marked swelling of the mucous membrane with consequent restriction of the air passage
  • Lamina propria also contains mucous glands that supplement the goblet cells in the respiratory epithelium
  • Conchae (turbinates) increase the efficiency with which the inspired air is warmed
  • Particles suspended in the air stream adhere to the mucus-covered wall
  • Particles trapped in this layer of mucus are transported to the pharynx by means of coordinated sweeping movements of cilia and are then swallowed or forcefully removed from the nasal cavity by sneezing

Olfactory Region of the Nasal Cavity

  • Located on part of the dome of each nasal cavity and is lined with specialized olfactory mucosa
  • Surface area is 10 cm2 in humans, more extensive in animals with an acute sense of smell
  • Lamina propria of the olfactory mucosa is directly contiguous with the periosteum of the underlying bone
  • Contains numerous blood and lymphatic vessels, unmyelinated olfactory nerves, myelinated nerves, and olfactory glands, no goblet cells and motile cilia are present
  • Olfactory receptor cells:
    • Neurons that span the thickness of the epithelium and enter the central nervous system
  • Supporting cells:
    • Columnar cells that provide mechanical and metabolic support to the olfactory receptor cells, synthesizing and secreting odorant-binding proteins
  • Basal cells:
    • Stem cells from which new olfactory receptor cells and supporting cells differentiate

Transitional Area

  • Area transitions between the olfactory epithelium (above) and the respiratory epithelium abruptly
  • The mucosal surface of the sinuses is a thin, ciliated, pseudostratified columnar epithelium with numerous goblet cells where the lamina propria is thin and continuous with the underlying periosteum containing only a few small glands
  • Mucus produced in the sinuses is swept into the nasal cavities by coordinated ciliary movements

Pharynx Histology

  • The epithelium of the nasopharynx is continuous with that of the nasal cavity
  • In the oropharynx, the epithelium transitions to non-keratinized stratified squamous epithelium which is more durable and better suited to accommodate friction associated with swallowing food
    • Lymphatic aggregates (distributed throughout the mucosa) act as a first contact point for the immune system to sort through particles entering the body

Larynx Histology

  • Epiglottis:
    • Lingual surface is on the anterior side and the laryngeal surface is on the posterior surface
    • Central elastic cartilage forms the framework containing elastin fibers in its extracellular matrix that allows it to snap back into its original form, providing strength, elasticity, and more flexibility than other cartilage types
    • It's lingual mucosa is lined with a stratified squamous nonkeratinized epithelium whose lamina propria merges with the connective tissue perichondrium of the elastic cartilage
    • Towards the base on the laryngeal surface, the lining changes to pseudostratified ciliated columnar epithelium
    • Taste buds and lymphatic nodules may be observed in the both the lingual and laryngeal epithelium
  • Lining of the larynx from the epiglottis to the true vocal fold is lined by respiratory epithelium (pseudostratified ciliated columnar epithelium with goblet cells) where the lamina propria contains mixed seromucous glands whose ducts open onto the epithelial surface
  • True vocal fold:
    • The mucosa is lined with a nonkeratinized stratified squamous epithelium and a thin, dense lamina propria devoid of glands, lymphatic tissue, or blood vessels
  • Inferior to true vocal fold:
    • The epithelium in the lower larynx changes back to respiratory epithelium (pseudostratified ciliated columnar epithelium with goblet cells) where the lamina propria contains mixed seromucous glands
    • The hyaline cricoid cartilage is the lowermost cartilage of the larynx composed of sparse cells (chondrocytes) surrounded by water based extracellular matrix, providing a flexible yet firm support

Factors Affecting Airflow

  • Airflow is the movement of air into and out of the lungs
  • Two factors that affect airflow: pressure differences and airway resistance

Pressure Difference

  • Airflow is measured in liters per minute (L/min), marked as “Q" and moves between the atmosphere and the alveoli inside the lungs
  • Air movement is driven by the pressure difference between the atmosphere and alveoli from an area of higher pressure towards an area of lower pressure where "Q" is proportional to the pressure difference
    • Increase in pressure difference increases Airflow
    • Decrease in pressure difference decreases Airflow
    • Air flows into alveoli if atmosphere pressure is higher than alveoli pressure
    • Air flows out of alveoli if atmosphere pressure is lower than alveoli pressure

Volume and Pressure

  • The pressure difference between the atmosphere and the alveoli can be created by changing the volume of the lungs during inspiration and expiration
  • Changing the volume of the lungs creates volume changes in the alveoli causing a pressure drop with volume increase and a pressure rise with volume decrease
  • Inhalation:
    • Contraction of the diaphragm and chest muscles causes the lungs expand thus raising the volume of alveoli which reduces the pressures inside
    • Pressure in alveoli is lower than the atmospheric pressure, causing a large pressure difference which means air flows from the atmosphere into the alveolus
    • At the end of inhalation the alveolus is filled with air where the pressure inside alveolus = atmosphere pressure causing no pressure difference or air movement
  • Exhalation:
    • Muscles relax and lungs spring back to their normal size causing lung and alveolus volume decrease which increases alveolar pressure
    • Alveolus pressure higher than the atmospheric pressure causing air to flow out of the lungs to the atmosphere

Airway Resistance

  • Airflow and airway resistance are inversely proportional where Q is proportional to 1 divided by resistance
  • Changes in airway radius causes changes to airway resistance
    • Airway radius decrease increases airway resistance decreasing airflow
    • Airway radius increase decreases airway resistance increasing airflow
  • Airway resistance is under autonomic control
    • Parasympathetic stimulation decreases airway radius causing Bronchoconstriction
    • Sympathetic stimulation increases airway radius causing Bronchodilation

Components of Breathing

  • Ventilation: how the air moves into and out of the lungs
  • Inspiration : air flows into the lungs
  • Expiration: air leaves the lungs
  • Rest period: brief pause between inspiration and expiration

Pressures

  • The direction of air flow is determined by the difference between the atmospheric pressure and alveolar pressure
  • Atmospheric pressure:
    • Pressure of the air in the environment
  • Alveolar pressure:
    • Pressure of the air inside the alveoli
  • Intrapleural pressure (intrathoracic pressure):
    • Pressure of the fluid inside the pleural cavity that surrounds the lungs which is usually negative compared to alveolar/atmospheric pressures
    • Transmural pressure = alveolar pressure – intrapleural pressure (airways remain open with positive transmural pressure)
  • Lungs and the chest wall act as opposing forces which means lungs have a tendency to collapse during rest, while the chest wall has a tendency to expand

Tidal Volume

  • Volume of air that fills the alveoli with an inspiration combined with the volume of air that fills the airways

Respiratory Center

  • Groups of neurons that control ventilation
  • Medulla Oblongata:
    • Dorsal Respiratory Group (DRG): Initiates respiration and determines rhythm of breathing
    • Ventral Respiratory Group: Facilitates forced expiration and sends inhibitory impulses to the apneustic center in pons to decrease the duration of inspiration which leaves more time for a longer expiration
  • Pons:
    • Pontine Respiratory Group
      • Pneumotaxic center: Allows for expiration to happen by limiting activation by the DRG to decreases action potentials of phrenic nerve in order to stop inspiration
      • Apneustic center: Is activated when the body requires more oxygen than normal by exciting the dorsal respiratory group (DRG) prolonging prolonging action potentials in the phrenic nerve in order to prolong the contraction of the diaphragm

Chemoreceptors

  • Monitor concentration of CO2 and O2 in the blood and send signals to the respiratory center neurons if concentrations are abnormal
  • Normal values:
    • PaO2: partial pressure of oxygen in the arteries (100 mmHg)
    • PaCO2: partial pressure of carbon dioxide in the arteries (40 mmHg)
    • Arterial pH: 7.4

Muscles

  • Quiet Breathing :
    • Diaphragm increases length of thoracic cavity
    • External Intercostal muscles pull ribs up and out, increasing width of thoracic cavity
  • Accessory Muscles:
    • Contract during vigorous inspiration increasing volume of thoracic cavity beyond tidal volume by moving the ribs up and out to increase thoracic volume with use of the sternocleidomastoid and scalene muscles

Nerves

  • Phrenic nerve: innervates the diaphragm
  • Intercostal nerves: innervate the external intercostal muscles

Breathing Cycle

  • Rest Phase:
    • Diaphragm is at its balanced position
    • Alveolar pressure equals atmospheric pressure (no pressure gradient = no air is moving)
    • Transmural pressure is + 5cm causing airways to be open during rest
  • Inspiration:
    • Increased PaCO2 detected by chemoreceptors causes the DRG to send command via phrenic nerve to diaphragm and intercostal nerves to external intercostal muscles causing muscles contract and thorax to increase
    • Lung volume increases and alveolar pressure decreases below atmospheric pressure causing a pressure gradient from higher pressure to lower pressure so air moves into alveoli
    • Pressure in alveoli = pressure in atmosphere causes flow of air to stop
  • Expiration:
    • Diaphragm relaxes causing the lungs return to their initial size, increasing alveolar pressure and exceeding atmospheric pressure causing gradient from high pressure to lower pressure so air leaves the lungs
    • All volumes and pressures return to their values at rest as a new breathing cycle begins

Definitions

  • Gas exchange: passive movement of gases across membranes
  • External respiration: flow of air into lungs AND transfer of oxygen and carbon dioxide through diffusion
  • Internal respiration : capillary gas exchange in body tissues

Mechanisms of Alveolar Gas Exchange

  • Three components of gas exchange:
    1. Surface area of the alveolo-capillary membrane
    2. Partial pressure gradients of the gasses
    3. Matching of ventilation and perfusion

Gas Exchange

Gas Exchange Across Alveolo-Capillary Membrane

  • Partial Pressure Gradients:
    • Difference between the partial pressure of gas in the alveolar sac and the partial pressure of gas in the blood
    • Is the driving force of gas diffusion across the membrane (not the concentration difference)
    • Partial pressure of a gas in the alveolar sac shown as PA where Partial pressure of a gas in the blood is Pa
  • Movement of Oxygen:
    • PAO2 > PaO2 (Pressure gradient = 60mmHg) means oxygen diffuses from area of high partial pressure to an area of low partial pressure into the blood from the alveoli
  • Movement of Carbon Dioxide:
    • PACO2 < PaCO2 (Pressure gradient is 5 mmHg) means carbon dioxide diffuses from an area of high partial pressure to an area of low partial pressure from capillary into alveoli

Gas Exchange (Internal and External Respiration)

  • Movement of a Gas Between Air and a Liquid (Blood):
    • This mechanism facilitates the exchange of carbon dioxide from the blood into the alveoli during inspiration
    • The amount of a gas that dissolves in a liquid is directly proportional to the partial pressure of that gas in the air above it which means amount of dissolved gas depends on partial pressure
    • High gas pressure above the liquid means a high amount of the gas is dissolved
    • Low gas pressure above the liquid means a low amount of the gas is dissolved
    • To force gases to dissolve into a liquid enough pressure must be applied which also permits gas to leave a liquid if the pressure outside the liquid is low (or if pressure is released)
  • Inspiration:
    • Alveolar pressure decreases to cause carbon dioxide dissolved in the blood to leave the blood and returns to its gaseous state

Matching of Ventilation and Perfusion

  • Definitions:
  1. Ventilation: gas reaching alveoli
  2. Perfusion: blood flow in pulmonary capillaries servicing those alveoli
  • Factors that affect diameters of airways and blood vessels:
    • Airways: diameter of bronchioles controlled by PACO2
    • Blood: diameter of capillaries controlled by PAO2

Gas Exchange (Internal and External Respiration)

  • Alveoli with high PAO2 and low PACO2 means the:
    • bronchioles serving the alveoli constrict
    • Pulmonary capillaries dilate
  • Alveoli with low PAO2 and high PACO2 means the:
    • Bronchioles serving the alveoli dilate
    • Pulmonary capillaries constrict (allows blood to go to other alveoli that may have more O2)

External Respiration Summary

  • Mixed venous blood returns from the tissues to the right heart
  • Blood is pumped from the right ventricle into the pulmonary artery and delivered to the pulmonary capillaries
  • Blood composition at this point reflects tissue metabolic activity where the PCO2 level in the blood is 45 mm Hg and is cellular activity (cells produce CO2 and take O2 out of blood causing them to reflect cellular activity)
  • PCO2 > PO2 because is cellular activity (cells produce CO2 and take O2 out of blood)
  • Exchange of O2 and CO2 between alveolar air and pulmonary capillary blood causes the Blood leaving the pulmonary capillaries normally has the same PO2 and PCO2 as alveolar air with PaO2 at 100 mm Hg and PaCO2 at 40 mm Hg where PAO2 is 100 mm Hg and PACO2 is 40 mm Hg
    • This oxygenated blood returns to the left heart and is pumped out from the left ventricle

Internal Respiration

  • Partial pressure gradient:
    • Partial pressure of oxygen in tissues is low (40 mm Hg)
    • Partial pressure of oxygen in the blood is high (100 mm Hg)
  • Oxygen diffusion:
    • The gradient causes oxygen to diffuse out of the blood and enter the tissues
  • Carbon dioxide diffusion:
    • Partial pressure of carbon dioxide is lower in the blood than it is in the tissues so partial pressure of carbon dioxide diffuses out of the tissue and enters the blood

Lung Volumes

  • Tidal volume:
    • Volume of air moving in and out with each breath during normal, quiet breathing (500 ml)
  • Inspiratory reserve volume:
    • Volume of air that is inhaled above the tidal volume
    • 3 liters
  • Expiratory reserve volume:
    • Volume of air that can be exhaled below the tidal volume
    • 1.2 liters
  • Residual volume:
    • Air remaining in the lungs after maximum exhalation
    • 1.2 liters

Lung Capacities

  • Functional residual capacity:
    • Expiratory reserve volume + residual volume
    • 2.4 liters
  • Inspiratory capacity:
    • Tidal volume + inspiratory reserve volume
    • 3.5 liters
  • Vital capacity:
    • Tidal volume + inspiratory reserve volume + expiratory reserve volume
    • 4.7 L
  • Total lung capacity:
    • Vital capacity + residual volume
    • Total volume of air that the lungs can hold
    • 5.9 L

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