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Respiratory Medicine > Week 2: Airway and Lung Anatomy, Histology and Development > Flashcards

Week 2: Airway and Lung Anatomy, Histology and Development Flashcards

1
Q

List 4 functions of the lung and airways, starting with its main function

A

-provide O2 and dispose of CO2 - warm and moisten air - provide immunological defence - provide ciliary defence

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2
Q

Fill the blanks

A
  1. superior concha 2. middle concha 3. opening of pharyngotympanic tube (eustachian tube) 4. nasopharynx 5. soft pallate 6. inferior concha
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3
Q

What are the spaces under the nasal conchae called?

A

Meatuses

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4
Q

What are the paranasal sinuses?

A

-frontal - sphenoidal - ethmoidal - maxillay

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5
Q

Fill the blanks

A
  1. frontal sinuses 2. cells of ethmoid sinuses 3. orbital plate of ethmoid bone 4. maxillary sinuses 5. roots of posterior upper molars
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6
Q

Fill the blanks

A
  1. frontal sinus 2. sphenoid sinus
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7
Q

What are the functions of the paranasal sinuses?

A

-weight reduction of skeleton - humidifying air - adding resonance to speech - crush zone: absorbing some shock from blows to the face

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8
Q

Name the sections of the pharynx from top to bottom

A

-nasopharynx - oropharynx - laryngopharynx

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9
Q

What are the functions of the larynx?

A

-provide an open airway for breathing - control coordination of food and air via epiglottis - phonation - can be closed for increased intrathoracic and intraabdominal pressure and provide protection to airways from foreign matter.

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10
Q

Fill the blanks

A
  1. hyoid bone 2. hyo-epiglottic ligament 3. later thyrohyoid ligaments 4. triticeal cartilage 5. aperture for internal branch of superior laryngeal nerve and artery 6. thyrohyoid membrane 7. median thyrohyoid ligament 8. cricotracheal ligament
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11
Q

Fill the blanks

A
  1. epiglottis 2. thyroid cartilage 3. cricoid cartilage 4. cuneiform cartilages 5. corniculate cartilages 6. arytenoid cartilages
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12
Q

Fill the blanks

A
  1. aryepiglottic muscle 2. superior thyroid notch 3. saccule 4. thyroarytenoid muscle
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13
Q

What is the innervation of the laryngeal muscles?

A

the crycothyroid muscle is innervated by the external laryngeal nerve, all others are innervated by the recurrent laryngeal

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14
Q

Fill the blanks

A
  1. normal relaxed state 2. forced respiration 3. phonation 4. whispering 5. conus elasticus 6. lamina or thyroid cartilage 7. vocal ligaments 8. rima glottidis 9. arytenoid cartilage 10. lamina of cricoid cartilage
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15
Q

how many cartilagenous tracheal rings are there?

A

16-20

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16
Q

Which tracheal muscle contracts during coughing and sneezing?

A

trachealis muscle

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17
Q

List the 3 branches in sequential order that arise from the trachea

A
  • primary bronchi (2) - secondary (lobar) bronchi (3 right, 2 left) - segmental bronchi
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18
Q

How do the right and left main bronchi differ?

A

The right is shorter and wider and has 3 secondary bronchi, while the left has 2

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19
Q

How many bronchopulmonary segments are there and how do these correlate with vascularisation?

A

10 per lung. each segment has its own bronchus, supplied by a pulmonary artery and vein

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20
Q

What is the diameter of bronchioles?

A

<1mm

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21
Q

Fill the blanks

A
  1. alveoli 2. alveolar duct 3. alveolar sac 4. respiratory bronchioles 5. terminal bronchiole
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22
Q

What is the root of the lung?

A

The root of the lung is located in a medial region named the hilum. It contains pulmonary arteries, veins, bronchi, lymphatics and nerves.

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23
Q

What are the pleurae?

A

These are the 2 serous membranes with surround the lungs, consisting of the parietal pleura, the visceral pleura and the serous fluid in between. These structures allow friction-free movement of the lungs

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24
Q

Fill the blanks

A
  1. horizontal (aka trnasverse) fissure 2. oblique fissure 3. superior lobe 4. middle lobe 5. inferior lobe 6. oblique fissure 7. superior lobe 8. inferior lobe
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25
Q

What is a pleural recess?

A

An area which is not occupied by lung during normal respiration but which will fill during deep respiration

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26
Q

What are pleural reflections?

A

Abrupt lines of direction change of pleura

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27
Q

Describe the main innervation of the lung

A

Parasympathetic via vagus. Stimulation of cholinergic nerves causes bronchoconstriction, mucus secretion, and bronchial vasodilation. Sympathetic innervation is via cervical and thoracic ganglia. The trachea is equally innervated by both systems, but the lobes of the lung are mostly controlled by the vagus nerve

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28
Q

Describe the epithelium of the upper respiratory tract

A
  • stratified squamous epithelium: vestibule, oropharynx, vocal cords, epiglottis - pseudostratified cicliated columnar (respiratory) epithelium: rest of upper respiratory tract
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29
Q

Fill the blanks

A
  1. cartilage 2. trachea 3. fibroelastic membrane and trachealis muscle 4. oesophagus
30
Q

Briefly describe the relationship of structure and function of the trachea

A

The anterior C-shaped rings of cartilage allow the airway to be permanently opened. The trachealis muscle posteriorly is flexible and can allow for movement of food through the oesophagus directly posterior to the trachea and also change in the diameter of the trachea during coughing and sneezing

31
Q

At which point in the respiratory tract is there major change in the structural components?

A

The trachea has a similar makeup to the following branches up until the terminal bronchi, from the bronchioles onward, cartilage is replaced with smooth muscle.

32
Q

Describe the layers of this section

A
  1. hyaline cartilage with chondrocytes in lacunae, producing and maintaining cartilage 2. submucosa with seromucous glands (none on section) which secrete a watery mucus. This mucus moistens air and contains lysozymes for immune function 3. the highly vascularised lamina propria is a loose areolar connective tissue layer supporting the epithelium. The blood supply also warms the airways 4. Pseudostratified ciliated columnar epithelium with goblet cells. It lies upon the basement membrane and creates a boundary between the lumen and other tissue. The cilia sweep foreign objects trapped in mucus back up the respiratory tract. Mucus is produced by goblet cells. Once in the pharynx, mucus can be swallowed or eliminated
33
Q

Which type of epithelium lines the bronchioles?

A

Ciliated simple columnar epithelium.

34
Q

What tissues underlie the epithelium in the bronchioles?

A

There are no longer seromucous glands and there is no cartilage. Instead, there is smooth muscle which maintains patency of the bronchioles

35
Q

Describe type 1 alveolar cells

A

PPType 1 cells are simple squamous epithelia cells, which make up approximately 90% of the cell surface area of the alveolus, but only 50% of the epithelial cell number. The air exchange happens across their membranes.

36
Q

Describe type 2 alveolar cells

A

PPType 2 cells are cuboidal epithelial cells, scattered throughout the type 1 cells. These make up the other 50% of the epithelial cells. These cells secrete alveolar fluid called surfactant which helps maintain patency by having a low surface tension.

37
Q

What are pores of Kohn?

A

These are small pores in the layer of type 1 alveolar cells which allow for air communication between adjacent alveoli and equalise pressure throughout the lungs

38
Q

Describe how the budding of the respiratory tract and its separation

A

During week 4 of development the respiratory tract begins to bud from the endodermal foregut. The tracheoesophageal ridge (folds) begin to fold in and pinch off the respiratory tract from the foregut by first forming a septum and then completely separating. From the primitive trachea, two lung buds form caudally

39
Q

What is a fusion of the trachea and oesophagus during development called and how common are they?

A

Tracheooesophageal fistulae. 1 in 4500

40
Q

Briefly describe how the lung buds develop to form all of branches of the lungs

A

The first lung buds divide into 3 further buds on the right and two buds on the left. At this stage the initial lung buds become the primary bronchi. From there the lung buds undergo a sequence of dichotomous divisions to give rise to the 10 bronchopulmonary segments per side and their substructures. During this development the branches begin to fill the pleura

41
Q

Name the periods of lung development and their timeline (considering there is overlap between them)

A
  1. pseudoglandular (5-16 weeks) 2. canalicular (16-26) 3. terminal sacular (26-birth) 4. alveolar (after birth)
42
Q

Describe the structures formed by the end of the pseudoglandular period.

A

PPMajor structures of the lung have developed down to terminal bronchioles, but structures for gas exchange are not yet present

43
Q

Can preterm babies born from week 16 and before survive?

A

Since the facilities for exchange have not yet developed, babies can’t survive.

44
Q

Describe the canalicular period

A

PPCanaliculi branch out from terminal bronchioles. Lumina of bronchioles and bronchi begin to enlarge. Lungs become vascularised. In later stages, cuboidal epithelial cells lining alveoli differentiate into type I and type II cells.

45
Q

How does the canalicular period affect preterm baby survival?

A

AFTER completion of the canalicular period, type I and type II cells have differentiated and surfactant is produced. Babies born at this stage can survive.

46
Q

Describe the sacular period?

A

PPAlveolar sacts begin to form and lung tissue begins to resemble adult lung more. Blood-air barrier forms with continuation of epithelial cell and endothelial cell maturation.

47
Q

Describe the alveolar period

A

32weeks - 8years old: many more alveoli arise. At birth roughly, 50 million alveoli increase to roughly 300 million at 8 years of age. Alveoli at birth are immature and grow and mature from there. The number of respiratory bronchioles and alveolar sacs increases also. Type I cells become thinner and vascularisation spreads further through lungs

48
Q

Fill the blanks

A
  1. tracheoesophageal ridge 2. foregut 3. esophagus 4. trachea 5. lung buds 6. respiratory diverticulum
49
Q

Name each muscle of the larynx and describe how it functions

A
  1. cricothyroid muscle: this muscle tilts the thyroid cartilage anteriorly and increases tension on the vocal cords to heighten pitch (when acting with transverse and oblique arytenoid) 2. thyro-arytenoid or vocalis muscles: pull the arytenoid cartilage anteriorly and relaxes the vocal cords to lower pitch (when acting with transverse and oblique arytenoid) 3. posterior cricoarytenoid: widen aperture to allow heavy breathing 4. lateral cricoarytenoid: narrow aperture, used when whispering 5. transverse arytenoid: bring arytenoid and cords together for phonation 6. oblique arytenoid: bring arytenoid and cords together for phonation
50
Q

What are the 3 pair cartilages which make up the larynx?

A

Arytenoid, corniculate and cuneiform

51
Q

What are the 3 unpaired cartilage which make up the larynx?

A

Thyroid cartilage, cricoid and epiglottis

52
Q

Which laryngeal muscle increases tension in the larynx and what is its innervation?

A

Cricothyroid muscle which is innervated by the external laryngeal nerve.

53
Q

Which laryngeal muscle/s reduce tension and what are they innervated by?

A

Thyroartyenoid is innervated by the recurrent laryngeal nerve.

54
Q

Which laryngeal muscle is responsible for abduction and what’s it innervated by?

A

Posterior cricoarytenoid which is innervated by the recurrent laryngeal nerve

55
Q

Which laryngeal muscle is responsible for adduction and what’s it innervated by?

A

Lateral cricoarytenoid (innervated by recurrent laryngeal nerve) and transverse and oblique arytenoids (innervated by the recurrent laryngeal nerve)

56
Q

What are the 5 regions of the conducting system?

A

Trachea, primary bronchi, secondary bronchi, segmental bronchi and bronchioles.PP

57
Q

What are 4 differences between the bronchi and bronchioles?

A

PP

58
Q

What are the main characteristics of the right lung?

A

The right lung is slightly higher due to the location of the liver. It is bigger as it is further away from the heart and has 2 fissures (an oblique and transverse) which separates it into the superior, middle and inferior lobes.

59
Q

What are the main characteristics of the left lung?

A

Not as thick as heart is located close. Has a chunk missing known as the cardiac notch. Has 1 fissure (oblique) which separates it into he superior and inferior lobe.

60
Q

Describe the blood supply to and from the lungs

A

PPPulmonary arteries – carry de-oxygenated blood to the lungs. Pulmonary veins – carry oxygenated blood from the lungs to the heart. Bronchial arteries- bring oxygenated blood to the lungs, gives the lungs its nutrients so it can function. Bronchial veins- drains the lung tissue.

61
Q

What is the function of the pseudostratified ciliated columnar epithelium in the airways of the lung?

A

The mucous will trap the foreign particles and the clilia will slowly push it out of the lungs.

62
Q

What would happen to the epithelia in a smokers lungs?

A

PPWould undergo metaplasia (adaption of cell to a different type of cell). Would change to stratified squamous to protect the tissue from further smoke damage.

63
Q

What is emphysema and what does it result in?

A

Loss of alveoli tissue over time. This significantly reduces the surface area where gas exchange can occur. It also results in increased elasticity (increase compliance of lung).

64
Q

What is the importance of the foetus drawing amniotic fluid into lung?

A

Extremely important for lung development and muscular strengthen.

65
Q

Why are the elderly, newborns and lung transplant recipients more susceptible to pneumonia (hint: cough)?

A

Have a poorly developed cough reflex

66
Q

Which part of the upper airways can be typically affected by bacterial or viral infection and why?

A

Paranasal sinuses, typically the maxiallary sinus as it drains superiorly.

67
Q

If there is injury to the recurrent laryngeal nerve and the patient is unable to adduct the vocal cords, what impact will this have on the patient and why?

A

Can’t sneeze or cough properly as cannot create intraabdominal pressures and therefore, cannot create a strong expulsion.

68
Q

Why do you need to blow your nose when you cry?

A

The lacrimal duct (tear duct) opens into the inferior meatus which is next to (posteriorly) the nasal cavity.

69
Q

What is the layer of serous membrane that covers the thoracic wall?

A

PPParietal pleura

70
Q

What is the layer of serous membrane that covers the lung?

A

PPVisceral pleura

71
Q
A

Respiratory Medicine (15 decks)

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