1
, 2
NURS 629 – Nurse Anesthesia Breathing tract Handling Study Guide | University of Pennsylvania | Spring–
July 2025 Exams | For CRNA, AIIMS, UST, and MAHSA Candidates
Breathing tract Evaluation and Handling Study Guide
Breathing tract Defined
- Definition: Consisting of nasal cavity, oral cavity, pharynx, voice box, trachea, and principal bronchi
(Left and right main stems) (Barash)
- Anatomically complex
o Grown changes of size and shape
o Genetic, nutritional, and hormonal factors
▪ Congenital malformations of breathing tract (ex. cleft lip and palates)
▪ Nutritional → malnutrition → very friable breathing tract soft and compression)
▪ Obese - thick necks a lot of compression of breathing tract and obstruct
▪ Hormonal – OB PT could be breathing tract which in 3rd trimester → nasal cavity and
oral cavity is edematous
- Handling is paramount to safe perioperative care
o Have TWO plans → back up plan
Two (2) Divisions of Breathing tract (divided at the cricoid
cartilage) Upper (above cricoid cartilage)
Nose- nasal cavity
Mouth- oral cavity
Pharynx (throat)- carries food/air/water to the esophagus
Hypopharynx
Voice box- (voice box) opening to trachea
o Epiglottis (leaf shaped flap, entrance of voice box)→ protects trachea against food aspiration
o Glottis (narrowest part of voice box) – opens to the breathing tract, vocal cords make the lateral borde
of it.
Responsible for phonation
o When we swallow, upward movement of glottis and downwards movement of epiglottis (close to
prevent food into trachea)
Lower (below cricoid cartilage)
Trachea
Bronchi
Bronchioles
Alveoli
, 3
Upper Breathing tract Development (mesenchyme progression to cranial bones)
Pharyngeal Arches (eventually becoming part of upper breathing tract)
- 6 arches that develop from 5 structures
o Arches 1-4 and 6 become breathing tract structures, and arch 5 disappears with fetal development
- Arches expand into additional cartilage. beginning at early stage in life
- Fetal development/lack of development
- Beginning at first sign of life
- Above people goes through different arches and how it expands over life
- Different arteries that supply it
, 4
Illustration of Upper Breathing tract
From lecture
- Turbinates tend to become inflamed and can cause obstruction
o Tend to be source of issue with obstruction
- Nasal separated by hard palate for oral cavity
- Uvula – one big connection with soft palate
- Tongue → biggest offender, muscular muscle tends to flop back and obstruction
o Jaw thrust/lift to effectively get tongue to force anterior to open up pharynx and oral breathing tract
- For children, adenoids and tonsil source of obstruction
for pediatrics
o Chronic respiratory problems
Upper Breathing tract Anatomy
Pharynx
- Divided into three compartments- nasopharynx,
oropharynx, and hypopharynx
Nose (nasopharynx)
- Humidifies air/filtration (but provides 2/3 resistance to
breathing)
- Provide resistance to bleeding
- Turbinates
, 2
NURS 629 – Nurse Anesthesia Breathing tract Handling Study Guide | University of Pennsylvania | Spring–
July 2025 Exams | For CRNA, AIIMS, UST, and MAHSA Candidates
Breathing tract Evaluation and Handling Study Guide
Breathing tract Defined
- Definition: Consisting of nasal cavity, oral cavity, pharynx, voice box, trachea, and principal bronchi
(Left and right main stems) (Barash)
- Anatomically complex
o Grown changes of size and shape
o Genetic, nutritional, and hormonal factors
▪ Congenital malformations of breathing tract (ex. cleft lip and palates)
▪ Nutritional → malnutrition → very friable breathing tract soft and compression)
▪ Obese - thick necks a lot of compression of breathing tract and obstruct
▪ Hormonal – OB PT could be breathing tract which in 3rd trimester → nasal cavity and
oral cavity is edematous
- Handling is paramount to safe perioperative care
o Have TWO plans → back up plan
Two (2) Divisions of Breathing tract (divided at the cricoid
cartilage) Upper (above cricoid cartilage)
Nose- nasal cavity
Mouth- oral cavity
Pharynx (throat)- carries food/air/water to the esophagus
Hypopharynx
Voice box- (voice box) opening to trachea
o Epiglottis (leaf shaped flap, entrance of voice box)→ protects trachea against food aspiration
o Glottis (narrowest part of voice box) – opens to the breathing tract, vocal cords make the lateral borde
of it.
Responsible for phonation
o When we swallow, upward movement of glottis and downwards movement of epiglottis (close to
prevent food into trachea)
Lower (below cricoid cartilage)
Trachea
Bronchi
Bronchioles
Alveoli
, 3
Upper Breathing tract Development (mesenchyme progression to cranial bones)
Pharyngeal Arches (eventually becoming part of upper breathing tract)
- 6 arches that develop from 5 structures
o Arches 1-4 and 6 become breathing tract structures, and arch 5 disappears with fetal development
- Arches expand into additional cartilage. beginning at early stage in life
- Fetal development/lack of development
- Beginning at first sign of life
- Above people goes through different arches and how it expands over life
- Different arteries that supply it
, 4
Illustration of Upper Breathing tract
From lecture
- Turbinates tend to become inflamed and can cause obstruction
o Tend to be source of issue with obstruction
- Nasal separated by hard palate for oral cavity
- Uvula – one big connection with soft palate
- Tongue → biggest offender, muscular muscle tends to flop back and obstruction
o Jaw thrust/lift to effectively get tongue to force anterior to open up pharynx and oral breathing tract
- For children, adenoids and tonsil source of obstruction
for pediatrics
o Chronic respiratory problems
Upper Breathing tract Anatomy
Pharynx
- Divided into three compartments- nasopharynx,
oropharynx, and hypopharynx
Nose (nasopharynx)
- Humidifies air/filtration (but provides 2/3 resistance to
breathing)
- Provide resistance to bleeding
- Turbinates
