book- respiratory system Flashcards
(103 cards)
1
Q
epithelial lining and glands of respiratory system from what embryo?
what for CT, smooth muscle, cartilage?
A
endoderm
splanchnic mesenchyme
2
Q
what week in embryo does respiration become possible? via what chemicals and structures
A
week 24; alveoli + surfactant
3
Q
visceral and parietal pleural layers pleurae embryonic origin?
A
visceral (inner): splanchnic mesenchyme
parietal (outer): somatic mesenchyme
4
Q
when does bronchial lumen form and lungs vascularize in embryo?
A
canalicular stage wk 16-24
5
Q
what type of neuron in nasal cavity
A
olfactory cells; bipolar neurons
6
Q
larynx function and structure
A
voice + prevent entry of materials other than air into respiratory system
hyaline and elastic cartilage
cilia –> mucuciliary escalator
7
Q
trachea structure and cells
A
c rings of hyaline cartilage
goblet cells, brush cells, serous cells
8
Q
brachial tree (into left and right bronchi) birfucates at what level of trachea
A
T4
9
Q
type I vs type II alveolar cells
structure (epithelium) and function
A
type I: simple squamous; exchange CO2 and O2
type II: cuboidal cells; secrete surfactant
10
Q
nasal cavity anterior and posterior openings
A
anterior: nares
posterior: choanae
11
Q
4 paranasal sinuses
what are they?
what are they innervated by?
which is largest?
A
frontal sinus: supraorbital nerves (CNV1)
ethmoid sinus: nasociliary nerves (CNV1) and olfactory nerves(?)
sphenoidal sinus
maxillary sinus: largest
12
Q
what is the vertebral level of the larynx
A
C3-C6
13
Q
innervation of larynx
& exception
A
sensory: internal laryngeal nerve
motor: recurrent (inferior) laryngeal nerve [CNX branch]
exception
cricothyroid muscle innervated by external laryngeal nerve
14
Q
order of cartilages in the neck
A
hyoid
thyroid
cricoid
15
Q
glottis function
A
vocal apparatus in larynx
consists of vocal folds, vocal processes and rima glottidis
16
Q
3 muscles to move the larynx and hyoid
A
infrahyoid muscles (sternohyoid, sternothyroid, thyrohyoid, omohyoid) = depress hyoid and larynx
suprahyoid muscles (mylohyoid, digastric, geniohyoid, stylohyoid) = elevate hyoid and larynx
stylopharyngus muscle= elevate hyoid and larynx
17
Q
2 muscles that length or shorten the vocal cords to impact pitch of voice
A
cricothryoid muscle: lengthen (tenses) = higher pitch
thyroiarytenoid and vocalis muscles: shorten (relaxes) = lower pitch
18
Q
trachea; anatomically where in the vertebrae
A
C6-T4
19
Q
larynx
trachea
lung apex
lung extension (anterior)
lung extension (posterior)
surface landmarks
A
larynx= C3-C6
trachea= C6-T4
lung apex= above 1st rib and clavicle
anterior lung= 7th rib
posterior lung= 10th rib
20
Q
which lung is more likely to be infected
A
right main bronchus because straighter angle than left allows foreign bodies to enter
21
Q
right vs left lung structure
A
right: 3 lobes and 2 fissures
left: 2 lobes and one fissure, cardiac notch for heart and lingual
22
Q
arteries and veins going to lungs
which are the exception (artery carries deoxygenated blood and vein carries oxygenated blood)
A
pulmonary artery+ vein = exception (“pulmonary pairs are the rebels”)
- pulmonary arteries: carry deoxygenated blood to alveoli
-pulmonary veins: carry oxygenated blood to left atrium
bronchial arteries and veins are normal
- bronchial arteries: for nutrition and oxygenation of lung
-bronchial veins: drain to azygos vein and hemiaxygos vein
23
Q
bronchial veins from lungs drain into
A
azygos and access hemiazygos vein
24
Q
sympathetic and parasympathetic innervation of lungs and impact (constrict or dilate lungs)?
A
SNS: dilate bronchioles; sympathetic chain ganglia
PNS: construct bronchioles via vagus nerve
25
parietal pleura vs visceral pleura innervation
which doesnt have a nerve? which is sensitive to pain?
parietal (outer): intercostal and phrenic nerves; sensitive to pain
visceral (inner): no nerves; insensitive to pain
26
mediastinum (central compartment of thoracic cavity) contains
heart, great vessels, trachea, esophagus, thymus
theres a superior, middle and inferior mediastinum
also a anterior and posterior mediastinum
posterior (behind heart and esophagus); contains DATES- descending aorta, azygous and hemizygos veins, thoracic duct, esophagus, sympathetic trunk/ganglia
27
true ribs vs false ribs vs floating ribs
true: 1-7 (attach to sternum directly)
false: 8, 9, 10 (sternum via cartilage)
floating: 11 & 12
28
typical ribs vs atypical ribs
typical: 3-9
atypical: 1, 2, 10, 12
29
example of how ribs articulate with the vertebrae
Example: Rib 6
Head of Rib 6:
Articulates with the inferior costal facet of T5 and the superior costal facet of T6
Also contacts the intervertebral disc between T5–T6
Tubercle of Rib 6:
Articulates with the transverse process of T6
30
level of manubrium and sternal body and diploid
manubirum= T3+T4
angel of Louis= T4 and T5
body= T5-T9
xiphoid= T10
31
typical vs atypical thoracic vertebrae
typical: T2-T9
atypical: T1, T10-T12
32
facets on thoracic vertebrae to articulate with ribs
superior costal facet to articulate with head of rib of same #
inferior costal facet to articulate with head of rib one # higher
transverse costal facet to articulate with tubercle of rib
--> lumbar and cervical spine don't have costal facets to articulate with ribs
33
spinal cord terminates at which lumbar level
L1
34
abnormal lumbar vertebrae
L5
-forms lumbrosacral angle with sacrum
35
movements are lumbar spine
flex, extend, lateral bend
rotation is inhibited
36
venous drainage for back and thoracoabdominal wall
left side of vertebral column: accessory hemiazygous vein
right side of vertebral column: azygous vein
--> go into SVC
37
ventilation vs respiration
ventilation: move air in and out of lungs
respiration: exchange O2 and CO2 between blood and alveoli
38
lung distention at low vs high volumes
low volume: lung distend easily
high volume: elastic components of alveolar walls already stretched so only small increases in volume
39
innveration of diaphgram
C3,4,5
40
muscles of inspiration, forced inspiration, expiration, and forced expiration
inspiration: digraphs contracts (flattens), external intercostals (elevate ribs and pull stream forward)
forced inspiration: accessory muscles; scalenes, SCM, pec minor
expiration: passive recoil
forced expiration: ab wall (rectus abdominis, obliques, transverses abs), internal intercostals (depress ribs), quadrates lumborum
41
respiratory pressure is described relative to
atmospheric pressure
(high to low pressure flow)
42
2 factors of lung compliance/ recoil
elastin and collagen in alveolar walls causing stretchability
surface tension at air-water interface within alveoli
43
surfactant components and cells
phospholipid and protein secrete by type II alveolar cells
--> lowers surface tension
44
epinephrine and leukotrienes impact on airway resistnace
epi causes bronchodilation
leukotrienes cause bronchoconstriction
45
tidal volume
amount of air entering lungs during single inspiration under resting conditions; ~500mL
46
impact of restrictive and obstructive lung diseases on FEV1 and FVC
FVC is low in restrictive pulmonary disease (lungs cant expand as much)
FEV1 is low in obstructive pulmonary disease (cant get air out)
47
anatomic vs physiologic dead space
anatomic: air in conducting airways (nose to terminal bronchioles; always present)
physiologic: air in lungs that doesn't participate in gas exhange. is the anatomic dead space + alveoli dead space. impacted by lung disease. measure via Bohr equation
---------------------------
Anatomic = where gas exchange can't happen (by design)
Physiologic = where gas exchange should happen but doesn't
In a healthy lung, anatomic and physiologic dead space are nearly equal.
48
bohr equation
The Bohr equation is a physiological formula used to calculate the proportion of each breath (tidal volume) that is dead space—that is, the portion of air that does not participate in gas exchange.
The Bohr equation determines the physiologic dead space in the lungs by comparing how much carbon dioxide is in arterial blood (where gas exchange occurs) versus in expired air (which includes both gas-exchanging and non-gas-exchanging regions).
49
dead space volume
volume of air that does not participate in gas exhange
50
alveoli in which part of the lung receive more ventilation per unit volume and why?
lower regions/ base because of gravity (less Palv pressure)
more dead space at the apex because Palv is greater than pulmonary arterial pressure
51
pulmonary edema; 2 causes
intra alveolar accumulation of fluid i.e. from increased capillary permeability (sepsis, shock, pneumonia etc)
or from increased capillary hydrostatic pressure (i.e. LV failure, mitral stenosis)
52
unconscious vs conscious (voluntary) neural control respiration centers
unconscious: reticular formation of medulla; influenced by centers in the pons
conscious: cerebral cortex --> motor cortex --> stimulate muscles ; bypass the medullary centers
53
peripheral vs central chemoreceptors
and what stimulates it?
peripheral: common carotid arteries (carotid bodies) and arch of aorta (aortic body) --> excitatory centers in medullary inspiratory centers
stimulated by decrease in arterial PO2 and increase in arterial [H+]
central: ventral surface of medulla --> excitatory input to inspiratory centers
stimulated by increase in H+ in CSF (CO2 in CSF turns into carbonic acid causing liberation of H+)
54
if an alveoli gets too little air relative to the blood supply what happens to the PO2
PO2 falls and causes local vasoconstriction --> send blood to better ventilated areas in the lungs
55
physiological; shunts and dead space
in lung where there is blood perfusion but no ventilation (and therefore no gas exhange)
56
hemoglobin as intracellular buffer
deoxyhemoglobin has negative charge; Hgb unloads O2 into tissues and its binds H+ to minimize pH changes
57
a decrease in the following factors will cause an increase in hemoglobins affinity for O2; causing a left shift to the curve (meaning less offloading of O2 in the tissue)
1. 2,3 BPG
2. temperature
3. PCO2 and H+
58
2,3 BPG impact on oxygen and hemoglobin association
it binds reversibly to Hbg; made by RBCs in breakdown of glucose in glycolysis.
increases in exercise or with hormones (NE, Epi, testosterone, thyroxine) to enhance oxygen delivery to tissue
59
carbon dioxide transport
8% dissolved in plasma
32% bound to hemoglobin in RBC (carbaminohemoglobin) (doesnt compete with oxyhemoglobin; but tends to make O2 unload)
65% of CO2 is converted by carbonic anhydrase to bicarbonate
60
adult respiratory distress syndrome (ARDS)
pH? alkalosis or acidosis?
multiple pulmonary insults (diffuse bilateral alveolar infiltrates) --> respiratory failure
respiratory alkalosis; low PaO2, normal or low PaCO2, elevated pH (because of initial compensatory hyperventilation)
respiratory distress, hypoxemia, pulmonary edema
----------------------------
Why ARDS Can Cause Respiratory Alkalosis (Initially)
🔹 Key Mechanism: Hyperventilation
In early ARDS, inflammation and hypoxemia (low oxygen in blood) trigger:
Increased respiratory drive via chemoreceptors (especially peripheral ones sensing hypoxemia)
Tachypnea (rapid breathing) and hyperventilation
This leads to excessive CO₂ being exhaled → ↓ PaCO₂ (hypocapnia)
61
idiopathic pulmonary fibrosis
excessive collagen in lung tissue matrix
i.e. from silicosis, sarcoidosis, TB, coal worker pneumoconiosis, ankylosing spondylitis
sx: dyspnea, cough, cyanosis, weight loss
62
pneumoconiosis
interstitial fibrosis from inhaling inorganic dusts
i.e. coal worker pneumoconiosis, silicosis, asbestosis
63
sarcoidosis
noncaseating epithelioid granulomas
in lungs (most common), lymphs, eyes, skin, liver, bone, CNS etc.
fever, weight loss, arthralgia
64
asthma
constriction of bronchioles
sx: dyspnea, wheeze, cough
65
intrinsic vs extrinsic asthma
intrinsic: adult; no allergy, neural reflex to chronic insult causing inflammation, mucus and bronchoconstriction
extrinsic: kids; type I hypersensitivity to allergens, IgE and mast cells
66
bronchiectasis
obstructive disease; often secondary to infectious process
leads to abnormal dilation in proximal and medium sized bronchioles
from ie. infection, cystic fibrosis, allergy, aspiration, reflux
sx: purulento sputum, cough
67
chronic bronchitis
obstruction in terminal airway (not alveoli) from excess tracheobronchial mucus production
i.e. initial insult damages airway and then get bacterial colonization
for 3 consecutive months over 2 consecutive years
sx: productive cough, barrel chest, clubbing, edema, obesity cyanosis = BLUE BLOATER
68
emphysema vs chronic boronchitis
emphysema: dyspnea, thin, hyperifnlated, slightly low PaO2 and normal PaCO2
chronic bronchitis: productive cough, obese, wheeze, cor pulmonale, redueced PaO2, increased PaCO2
69
emphysema
enlarged alveolar air spaces with destruction of alveolar walls
increase residual volume
types: centrilobular, panacinar, paraseptal, irregular
sx: pink puffers= thin, dyspnea, cough, SOB, smokers
70
diphtheria
main finding
corynebacterium diphtheria (gram +) causes grey pseudomembranes on mucosal epithelial cells (tissue destruction and necrosis)
risks: substandard living, immunocompromised
pseudomembrane can hemorrhage --> toxin enters blood stream i.e. myocarditis
71
epiglottis
main cause
h. influenza type B
kids 2-7yo
sx: dysphagia, drooling, fever, cervical adenopathy, respiratory distress, muffled voice, minimal cough
72
laryngitis
from viruses, bacteria, irritants, or overuse of voice
sx: edema, hoarseness, throat pain
73
pertussis (whooping cough)
cause
esp infants
pertussis toxin stimulates G protein --> cAMP
lymphocytosis by inhibiting chemokine receptors
bordetella pertussis or B. parapertussis (gram negative)
whooping cough and vomit
74
rhinitis
most common cause
adenovirus
sx: runny nose, sneeze, nasal congestion, mild sore throat
75
allergic rhinitis
Type X, Ig_
type I immune rxn; IgE
sx: nasal discahrge
76
streptococcal pharyngitis
streptococcus pyogenese (group A, beta hemolytic, gram positive cocci)
produces exotoxin that cross reacts with antibodies
sx: throat pain, pustular exudate, tonsils inflamed, fever, leukocytosis, headache
complications: sepsis, TSS, post strep glomerulonephritis , scarlet fever (erythrogenic toxin)
77
scarlet fever
cause and sx
from pharyngitis (from strep pyogenes)
strawberry tongue, fever, red rash on face, and maculopapular rash on trunk
78
tonsilitis
strep or viral infection (mostly bacteria)
sore throat, pain on swallowing,
membrane on tonsils that dont bleed when removed
fever, malaise, headache, vomit, erythema
79
croup (laryngotracheobronchitis)
main cause and who it impacts
kids <3yo; barking cough and dyspnea and inspiratory stridor
viral; parainfluenza (RNA virus)
80
chylothroax
milky lipid rich fluid in pleural cavity from lymph obstruction
81
most common lung cancer
adenocarcinoma
82
tension pneumothorax
mediastinum shift to other side and compress opposite lung (from pneumothorax)
83
pulmonary infarction
reduced compliance from pulmonary embolism
sx: tachypnea, crackles, dyspnea, cyanosis, pleural rub
84
85
where is the most common type of lung cancer found and whats it called
adenocarcinoma; peripheral;
86
squamous cell carcinoma of lung
central + smoking
87
large cell carcinoma of the lung
neuroendorceine
local mass syndrome (cough, hemoptysis, cough, emphysema)
carcinoid dysndrome (cyanosis, tachycardia,, diarrhea)
compress nerves (pancoast and Horners sydrnome)
88
paraneoplastic syndromes
i.e. hyponatremia from ADH (SIADH- syndrome of inappropriate ADH)
cushing (ectopic ACTH)
hypercalcemia from PTH
89
pancost and Horners syndrome
horners:
1. Ptosis (droopy eyelid)
2. Miosis (constricted pupil)
3. Anhidrosis (lack of sweating)
pancoast= Horners plus muscle waisting in hand and arm pain
90
mesothelioma
where? from?
tumor in pleural lining esp from asbestos
91
cystic fibrosis
which channel impacted
disease of exocrine glands
causes dysfunction in chloride channels
lead to excess pulmonary mucous and recurrent infections and digestive enzyme secretions causing steatorrhea
autosomal recessive
sx: respiratory impacts, infertility, nasal polyps, large appetite
92
tracheoesopahgeal fistula
inappropriate connection between trachea and esophagus
congenital defect
hyper salivation, choking, cough, cyanosis
93
atypical/ walking/ interstitial pneumonia
causes and manifestations
virus (influenza or adenovirus) or non viral (mycoplasma)
lymphocytes --> thicken alveolar septa, hyaline membrane, type II alveolar cell proliferation, thicken blood air barrier, dyspnea
(not neutrophils and consolidation**)
94
acute bronchitis cause
80% viral
inflamed medium size airways
cough, fever, myalgia, fatigue, dyspnea, wheeze
95
brocnhopneuminia
patchy consolidation in alveoli around bronchioles
full of neurtophils, exudate, bacteria
most often secondary to other conditions i.e. CHF
organisms: s pneumonia, h. influenza, klebseilla pneumonia, staph aureus...
sx: productive cough and rusty sputum
96
lobar pneumonia (entire lobe impacted) most often cause
strep pneumonia
97
lung abscess
suppuration (pus) from aspiration, infected emboli, bacterial pneumonia, or obstruction
98
fungal pneumonias
2 causes
mimics?
histoplasmosis: histoplasmosis capsulatum
mimics tuberculosis
pneumonia with cavitation, disseminated infection (multi organ)
-----------
coccidioidomycosis: coccidodides immitis
asymptomatic or fever, cough, erythema nodosum, goon complex like lesion; can spread to bone and SNS
--------
pneumocystitis jiroveci pneumonia: active if have HIV
--------
aspergillosis: septate hyphae get Into wound, cornea, ears then into lungs causing hemoptysis and granulomas , fungus balls and make aflatoxins
99
aspergillosis
fungal infection
septate hyphae get Into wound, cornea, ears then into lungs causing hemoptysis and granulomas , fungus balls and make aflatoxins
allergic; type I, III, IV hypersensitivity with eosinophilia
otitis externa, sinusitis, allergic bronchopulmonary aspergillosis, fungus ball, sepsis
test: wheal and flare via skin sensitivity test, anti-aspergillus IgE
100
respiratory syncytial virus (RSV)
what does it lack? how does it act?
RNA virus without neuramidase or hemagglutinin
F glycoprotein causes cells to fuse leading to syncytium formation
infants; pneumonia and bronchiolitis --> rhinitis, wheeze and respiratory distress
101
tuberculosis
cause and sx
primary vs secondary vs miliary
mycobacterium tuberculosis
asymptomatic
single granuloma with caseous necrosis near pleura of lung= Ghon focus
primary: type IV hypersensitivity
secondary: reinfection; numerous granulomas that can erode and spread
miliary: spread systemically
102
103
coronavirus
receptors
ssRNA
angiotensin converting enzyme 2 (ACE2) and amino peptidase N
URI: fever, aches, cough, fatigue, diarrhea
ARDS: alveolar deposition of fluid prevents gas exhange and cytokine storms
long covid: fatigue, brain fog, muscle pain
