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Flashcards in Kyle's Questions for Microscopic and Gross Deck (59)
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1
Q

What are the outer and inner layers of the pleura called? Name all four subspaces of the outer pleura. What space lies between them?

A

Outer- Parietal; Inner- visceral. Parietal is made of the costal (lateral), cervical (superior), mediastinal (medial), and diaphragmatic (inferior). Space between is called the pleura cavity.

2
Q

What connects the heart to the diaphragm? What hole is present in the structure and what runs through it?

A

The central tendon. The caval opening is a hole through it. The inferior vena cava and phrenic nerve run through it.

3
Q

How far does the pleural cavity extend on the lateral and medial portions of the lung?

A

Medially, lung extend to 6th rib but pleural space extends to 8th. Laterally, lung extends to 10th rib but pleura extends to 12th rib

4
Q

What sensory nerves innervate the parietal pleura? When do patients feel pain and how is pain felt?

A

Intercostal nerves. Patients feel pain when parietal and visceral adhere to one another as can happen during inflammation of the pleura (known as pleuritic). Pain feels stabbing. Diaphragmatic pleura is innervated by sensory fibers from phrenic nerve (C3-C5). If patient has inflammation of the diaphragmatic pleura, pain can be felt as radiating over the shoulder due to cervical origins of the phrenic nerve. Phrenic nerve also contains the motor fibers for the diaphragm.

5
Q

What is the branching pattern of the respiratory tree?

A

Trachea -> principle bronchi -> secondary (lobar) bronchi (three on right, two on left) -> tertiary (segmental) bronchi -> terminal bronchiole -> respiratory bronchiole -> alveolar duct -> alveolar saccules

6
Q

Which side is aspirated objects more likely to be found on and why?

A

Right side of the pulmonary tree because the primary bronchi is shorter and more vertical on the right side as compared to the left

7
Q

How do adjacent alveoli communicated?

A

Pores of Kohn – provide avenues for collateral air flow

8
Q

What is the pattern and location of the respiratory blood flow?

A

Pulmonary artery -> pulmonary arteries (follow branching pattern of bronchial tree) -> capillary plexus (surround each alveolus) -> intersegmental pulmonary veins (run on the outside of bronchioles – in connective tissue septa between bronchopulmonary segments) -> come together at hilum and form superior and inferior pulmonary veins.

9
Q

What are symptoms of enlarged lymph nodes in the bronchial tree? What diseases are associated with each of these symptoms?

A

Enlargement can lead to occlusion of a part of the bronchial tree leading to dyspnea. This can occur as a result of lung cancer (sometimes otherwise clinically silent). Increase in bronchopulmonary or tracheobronchial nodes can cause deviation of the trachea. Localized on the left side may lead to compression of the left recurrent laryngeal nerve (aka inferior laryngeal nerve) (X) causing hoarseness – may be first clinical sign of lung cancer.

10
Q

What types of nerves innervate the lungs? What are their branching patterns? Where do each originate? What information do they carry?

A

Generally, all visceral plexi contain postganglionic sympathetic fibers, preganglionic parasympathetic fibers, and visceral afferent fibers (2 types). Fibers of the anterior and posterior pulmonary plexi follow the pulmonary arteries/ branching pattern of the bronchiole tree.
Sympatheric fibers – originate from T1-T5. Bronchodilation and control blood flow through pulmonary vessels.
Preganglionic parasympathetic fibers – part of vagus nerve (Cn. X) synapse on ganglion near or within lung. Lead to bronchoconstriction and initiate glandular secretions.
Visceral afferent (monitoring) fibers – part of vagus nerve
Mucosa of bronchi – initiate cough
Muscle of the bronchi – respond to stretch
Connective tissue of interalveolar septae – control inspiration/ respiratory excursions
Pulmonary arteries – pressorreceptors (blood pressure)
Pulmonary veins – chemoreceptors (blood gas levels)
Visceral Afferent (pain) fibers follow the sympathetics. Pain is referred over dermatomes T1-T5. However, very limited number.
Somatic Afferent (pain) – fibers from the parietal pleura is transmitted by intercostal and phrenic nerves. Source of most pain

11
Q

What arteries supply the external nose? What part of the nose does the maxillary artery supply? What are the branches off the maxillary that supplies the nose? What foramen does they enter through?

A

External nose is supplied by the ophthalmic artery. The maxillary artery supplies the alar, lower portion of the nasal septum, and most of the naval cavities. The sphenopalatine artery is the branch that supplies most of the blood to the nose and enters via the sphenopalatine foramen (connects the pterygopalatine fossa with the nasal cavity). The nasopalatine artery breaks off the sphenopalatine and supplies the septum. The descending palatine artery is a branch off the maxillary artery originating in the pterygopalatine fossa, and runs through the ptergopalatine canal, divides into the greater and lesser palatine artery. The greater palatine artery runs the length of the hard palate and ends by passing through the incisive foramen to supply the anterior portion of the septum.

12
Q

What is Kiesselbach’s area?

A

Site of anastomosis (coming together) of branches of internal and external carotid arteries. The anterior and posterior ethmoid arteries (branches of IC), the nasopalatine, greater palatine, and superior labial arteries (all EC) all join. 90% of nose bleeds occur in the Kiesselbach’s area others more posterior in the sphenopalatine artery can be more serious.

13
Q

What nerves innervate the nose and what parts of the nose do they innervate?

A

Infratrochlear, supratrochlear, and external branch of anterior ethmoidal nerve (V1) supply superior aspects of the nose to the tip. Infraorbital nerve (V2) branches supply inferior and lateral aspects of nose, nares, up to lower eyelids. Nasopalatine supplies the septum. The anterior ethmoidal nerve (branch of V!) supplies general sensory anterosuperior aspects of lateral nasal wall and portions of nasal septum. Postganglionic parasympathetic and sympathetic fibers to nasal mucosa travel with branches of V2 (which enters cavity via foramen rotundum). Preganglionic parasympathetic arise from greater petrosal nerve (from CN VII) arrive at pterygopalatine ganglion – postganglionic travel with V2. Postganglionic sympathetic arise from cervical ganglion gain access to cranial cavity with internal carotid, and nerves destined for face join the deep petrosal nerve in the ptergoid canal and form the Vidian nerve goes to zygomatic nerve to communicating branches which vasoconstricts lacrimal.

14
Q

Name the bones and cartilage of the nose and their location.

A

Bones of the nose are the nasal bone (superior portion) and the frontal portion of the maxillary bone (lateral portion). Cartilage of the bone includes the alar (wing) of the nose.

15
Q

What are the boundaries to the naval cavity?

A

Superiorly: the cribiform plate; inferiorly: the palantine process of the maxilla and the horizontal plate of the palatine bone; laterally: superior and middle conchae (part of the ethmoid) and inferior concha (portion of the lacrimal); the bony septum makes up the medial extent

16
Q

What bones make up the nasal septum?

A

Superiorly, the vomer and inferiorly the perpendicular plate of the ethmoid bone

17
Q

What is the name of the strucutres that allow ventilation to the sinuses?

A

Ostia

18
Q

Name the structures that drain the sinuses

A

Frontonasal duct – Drains the frontal sinus into middle meatus
Ethmoidal bulla – drains the middle ethmoid air cells
Hiatus semilunar- drains the anterior ethmoid air cells and maxillary sinus to middle meatus
Posterior ethmoid cells drain into superior ethmoid air cells
Spenoethmoidal recess – Drains sphenoid sinus
Nasolacrimal drains into inferior meatus
Ostiomeatal complex – Drainage pathways going into middle meatus, has the tendency to blockage.

19
Q

What are the branches of the vagus nerve, where do they innervate, and what information do they carry?

A

Two branches, the superior and inferior laryngeal nerve
Superior broken into external and internal laryngeal nerve.
External has solely a motor function for cricothyroid muscles. Damage leads to monotone and deep voice.
Internal laryngeal nerve – General sensory fibers to mucosa above vocal cords, special sensory fibers to taste buds of the root of the tongue, preganglionic parasympathetic fibers that are secretory motor to mucosa above vocal cords. Internal laryngeal nerve enters inner larynx through piercing the thyrohyoid membrane traveling with the superior laryngeal artery. Severing cord leads to loss of cough reflex and objects may pass through trachea.
Inferior laryngeal nerve – motor fibers to all intrinsic muscles of the larynx. Sensory and preganglionic parasympathetic fibers that are secretomotor to the mucosa below the vocal cords. Severing cord leads to hoarseness and difficulty breathing/ swallowing.

20
Q

What is the site in the trachea that can be used to insert a tube for airway?

A

The cricothyroid ligament/ membrane.

21
Q

What lies between true and false vocal cords

A

Ventricle

22
Q

Name and describe muscles that function to widen/ narrow larynx and their mechanism.

A

Cricothyroid muscles draws the thyroid cartilage forward and down lengthening and adducting the vocal cords. Lateral cricoarytenoid and arytenoid muscles aid in adducting vocal cords. Aryepiglottic muscles works with thyroarytenoid muscle to act as sphincter, protecting airway. Posterior cricoarrtenoid muscle is the only one that abducts vocal cords. If recurrent inferior laryngeal nerve is comporomised, breathing will be difficult.

23
Q

Name the two arteries that supply the blood to the larynx, their origin, and where they enter.

A

Superior laryngeal artery- branch of the superior thyroid artery (from EC), enters through the thyrohyaline membrane.
Inferior laryngeal artery – branch of the interior thyroid artery (from thyrocervical trunk/ subclavian artery). Enters larynx with inferior laryngeal nerve, in groove between the trachea and esophagus.

24
Q

What are the formed elements of blood? What percentage of the blood do they occupy? Where can you find each in centrifuged sample?

A

Erythrocyetes, Leukocytes, and Platelets. Together they occupy 45% of the blood. In a centrifuge, bottom layer of sediments are erythrocytes, which define the hematocrit of the blood (males = 45% females = 41%). Middle layer are leukocytes and platelets. Top layer is plasma including albumin, gamma globulins fibrinogen, complement proteins and other solutes.

25
Q

What is a Rouleaux?

A

A Rouleaux is an aggregate of RBC. Occurs in small blood vessels.

26
Q

What is the chemical name given to heme? What is the central ring structure? What side chains are attached to ring and in what orientation?

A

Protoporphyrin. Contains 4 pyrole rings and methy, propionic acid, and vinyl side chains. In hemoglobin the organization is MVMVMPPM (Protoporphyrin IX).

27
Q

What three proteins make up the erythrocyte’s membrane skeleton?

A

Spectrin, actin, and protein 4.1

28
Q

What are the different forms of hemoglobin and what differentiate them?

A

Hemoglobin (Hb) A1, HbA2, HbF, and HbS. HbA1 contains 2 alpha polypeptide chains and 2 beta polypeptide chains; it is the major form of hemoglobin in adults. HbA2 consists of 2 alpha and 2 delta polypeptide chains; it is a minor portion of hemoglobin in adults (5%). HbF consists of 2 alpha polypeptides and 2 gamma polypeptides; produced during intrauterine period. HbS is due to single nucleotide mutation switching a.a. from glutamic acid to valine; leads to RBC inflexibility and increased viscosity.

29
Q

What is the name of hemoglobin attached to a CO2 molecule?

A

Carbaminohemoglobin

30
Q

What is a young RBC called? How can you distinguish? What diagnostic information can be obtained from them?

A

Reticulocytes. Still have a little rRNA in their cytoplasm that stains brilliant cresyl blue (appears as a net-like structure). Generally make up ~1% of circulating erythrocytes. Can use to estimate the rate of erythropoiesis; useful in the diagnosis of some anemias. Also helpful in monitoring bone marrow regeneration / restoration of hemopoietin after erythropoietin therapy.

31
Q

What are two major classification of leukocytes, what distinguishes classes, and what cells fit in each category?

A

Granular have specific cytoplasmic granules; include neutrophils, eosinophils, and basophils. Agranular leukocytes lack specific cytoplasmic granules and include lymphocytes and monocytes.

32
Q

What is diapedesis? What are two types?

A

Means of leaving blood vessels. Crucucial because leukocytes function outside of the blood vessels. Cells can either leave between cells (paracellular) or through cells (transcellular)

33
Q

What are the relative frequencies of leukocytes in the blood?

A

Neutrophils: 60-70%, eosinophils 2-4%, basophils 0-1%, lymphocytes 20-30%, monocytes 3-8%

34
Q

Name 5 other functions of neutrophils

A

Production of superoxide anions, netosis (release of a mesh-like structure that is capable of trapping microbes), release of microvesicles that have antibacterial activity (contain myeloperoxidase and lactoferring), and synthesis of cytokines (tnf-alpha, Il-1beta, Il-8)

35
Q

What are the three size classes of lymphocytes? How can you distinguish

A

Small-medium have a more heterochromatic nucleus, have less organelles in cyctoplasm (smaller light blue area), and have yet to be activate by specific antigens. Large granulars have been activated and have larger cytoplasm. Large granulars have distinct granules present in cytoplasm. Large granular lymphocytes are neither B or T cells (are Natural Killer cells)

36
Q

What type of lymphocyte are natural killer cells? What are their functions?

A

Large granular lymphocytes. Function to kill virus infected cells, malignant cells (without prior sensitization), production of cytokines (INF-gamma)

37
Q

What are the two theories of blood cell development?

A

Monophyletic – all blood cells arise from a common progenitor cell
Polyphyletic – Each blood cells arose out of its own stem cell.. not widely held theory today.

38
Q

What is the sequence from beginning to the end of granular development (give both name, identifying features, and time table)?

A

The steps of development are from promyelocyte to myelocyte to metamyelocyte to band cell, to mature cell. The first three steps occurs in the bone marrow (in normal individuals) and takes 9-14 days. Bands and mature cells are usually the only cells seen in the blood. Generally, granulocytes are in the blood for 1 day before migrating into tissue where they can live 5 days. Therefore, the normal life span of a granulocyte is 15-20 days. Defining features of each stage include: promyelocytes have a round nucleus and still blue cytoplasm; azurophilic granules are present which help distinguish from myeloblast. At the myeloytes stage, the color of the cytoplasm has shifted from blue to salmon pink; azurophylic granules are no longer being synthesize and first appearance of specific granules occurs; the nucleus is still round which distinguishes from metamyelocytes. At the metamyelocyte stage, nucleus becomes kidney-shapes, chromosome continues to condense, specific granules are more numerous than azurophilic; finally, this is the first stage in which mitosis is no longer possible. Band cells have indentation in the nucleus that exceeds ½ the diameter; chromosome continues condensing; normally bands are 1-5% of wbc - % of bands can help provide a rough indication of the rate of neutrophil production. Finally, when segments between lobules are thin and heterochromatic, the band has differentiated into a mature neutrophil.

39
Q

What is a left-shift?

A

Shift in the percentage of bands in peripheral blood. Indicates stress is being applied to bone marrow to make more neutrophils.

40
Q

How to distinguish developing eosinophils and basophils?

A

Developing eosinophils have specific granules that are black in color when they first appear, later turn pink in development. Developing basophils have specific granules that stain purple in smears.

41
Q

What is marrow granulocytic reserve (MGR) and Total blood granulocyte pool (TBGP)? What is the relative percentage of each?

A

MGR is the number of cells in the bone marrow. TBGP is the total number of granulocytes in the peripheral circulation. MGR is 10X than TBGP.

42
Q

Where does hematopoiesis occur? Name specific areas!

A

Red bone marrow, which is found in flat bones – the sternum, vertebrae, ribs, clavicles, bones of the pelvis, and bones of the skull.

43
Q

What are hematopoietic stem cell niches (HSC)? What cells play a major role in developing hematopoietic stem cell niches? What cells play a minor role?

A

HSC niches are areas in the red bone marrow that a high proportion of hematopoietic precursor cells. These area are not randomly distributed. Rather, they are maintained by osteoclasts which provide the space for the cells, osteoblasts, that play a role in the localization of stem cells and support hematopoiesis, and other minor cells (endothelial cells, pericytes, bone marrow macrophages). Interaction of the stem cells with the elements of the stem cell niche is critical. Alteration can lead to myeloproliferative disease.

44
Q

What is yellow bone marrows role?

A

Not active in hematopoiesis. Found in the medulla of all other bones. Mainly made of adipose tissue. Role is to store reserve energy and act as storage reserve for hematopoietic tissue.

45
Q

What is a Blast? How to distinguish?

A

A blast is a precursor cell to many different blood cells (including lymphocytes, RBC, and megakaryocytes) A blast is a relatively large cell, which contains a large euchromatic nucleus, with numerous ribosomes in cytoplasm (will appear pale blue), and has no cytoplasmic granules. Each blast develops into one type of blood cell (monopotential) either erythrocyte, lymphocyte, or megakaryocyte.

46
Q

What are general trends in erythrocyte differentiation?

A

Decrease in volume, nuclear diameter, increase in heterochromatin, disappearance of nucleoli, loss of nucleus, becomes more eosinophilic.

47
Q

What are the steps in erythrocyte differentiation?

A

Basophilic erythroblast to polychromatophilic erythroblast to normoblast. Basophilic erythroblast has a navy blue cytoplasm due to high level of ribosomes. Polychromatopilic erythroblast has an increase in cytoplasmic eosinophilia (due to accumulating hemoglobin), normoblast has a very small heterocromatic nucles; is a terminal cell (can no longer undergo mitosis).

48
Q

What is the difference between reticulocyte and orthochromatic erythroblast?

A

About 80% of normoblast develop into reticulocyte, 20% develop into orthochromatic erythroblasts. Orthochromatic erythroblasts lose their residual RNA before nuclease extrusion and are not present in normal peripheral blood. They have bright eosinophilic cytoplasm from RNA.

49
Q

What are the kinetics of RBC maturation?

A

1-2 days as a basophilic erythroblast, 3 days as a polychromatophil, 3 days for normoblast to reticulocyte transition, 1 day for reticulocyte to RBC transition.

50
Q

What is the role of erythropoietin?

A

Increase rate of mitosis, RNA synthesis in developing RBC, attenuates degree of brain damage after stroke

51
Q

What is a erythroblastic island?

A

Is a developing RBC cluster around reticular cells in bone marrow. Reticular cells phagocytose extruded nuclei.

52
Q

What are the steps of Megakaryocyte differentiation?

A

Cell enlargests, nucleus becomes lobulated, ploidy increases, cytoplasmic shifts from basophilia to eosinophilic, accumulates azurophilic granules

53
Q

What is the proplatelet model of platelet production?

A

Extension of thick pseudopods forms a long extension called the proplatelet, where platelets are released from megakaryocyte.

54
Q

Where do megakaryocytes lie?

A

Just outside of the discontinuous sinusoid

55
Q

What make up the respiratory system components?

A

Conduits for air passage, muscle and CT for movement of gases, and gas exchange tissues.

56
Q

What are the five types of respiratory epithelium and what are their respective functions?

A

Ciliated Pseudostratisfied Columnar Epithelium- Must abundant. Each cell contains approximately 250 cilia on the apical side. Basal bodies lie just beneath the cilia
Mucous goblet cells – Most abundant in larynx and trachea, diminish through bronchi. Secrete polysaccharide-rich mucous droplets
Brush cells – Have microvilli on apical surface which function as sensory receptors/ afferent receptors
Basal cells – lie on basement membrane but do not extend to apical side. Round and short cells. Believed to generate cells that undergo mitosis and give rise to other cell types when necessary.
Granule cells- Also do not make it to apical side. Contain dese granules that may function in neuroendocrine system that regulates mucous and serous secretory processes.

57
Q

What is the coordinated beating of cilia called? What is the name of the condition in which this process does not work? What is the mechanism? What occurs in these individuals more often?

A

Mucociliary elevator. Kartagener syndrome is due to dynein dysfunction leading to no ciliary beating. These individuals have respiratory infections more often.

58
Q

What cells make up the olfactory epithelium?

A

Supporting cells with microvillie (no cilia) – type of pseduostratisfied columnar epithelium. Olfactory cells (bipolar neurons), basal cells (small, round, at base of epithelium, are regenerative). Olfactory (Bowman’s) Capsule produce proteinaceous serous secretions to clear cilia and facilitate access to new odorants

59
Q

What is the pharynx? Which epithelium can you find dorsally/ ventrally within?

A

Passage in which the oral and nasal cavities are connected. Dorsoally lined with respiratory epithelium, ventrally lined with stratisifed squamouse epithelium.

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