Lung 1 Flashcards
(108 cards)
1
Q
right lung bud develops into
A
3 branches of lobar bronchi
2
Q
respiratory system is an outgrowth from
A
ventral wall of the foregut
3
Q
left lung bud develops into
A
2 lobar branches
4
Q
conducting airways
A
nasal, mouth, pharynx, larynx, trachea, bronchi, bronchioles
5
Q
respiratory tissues
A
terminal respiratory bronchiole, alveolar ducts and sacs
6
Q
lobar bronchi are lined by
A
columnar ciliated epithelium
7
Q
distal to terminal bronchioles
A
pulmonary acinus (7mm)
8
Q
A cluster of three to five terminal bronchioles with its
appended acinus is referred to as
A
pulmonary lobule
9
Q
distinguished by lack of cartilage and submucosa glands
A
bronchioles
10
Q
alveolar tissue total weight and surface
A
250g, 75 sqm
11
Q
true vocal cords are lined by
A
stratified squamous epithelium
12
Q
entire respiratory tree (larynx, trachea, bronchioles)
A
pseudostratified tall columnar ciliated epithelium
13
Q
express high levels of the cystic fibrosis transmembrane conductance regulator (CFTR) and
appear to modulate the ion content and viscosity of bronchial secretions
A
ionocytes
14
Q
bronchial mucosa contains neuroendocrine cells
A
serotonin, calcitonin, bombesin
15
Q
are the ones also
producing mucus, it usually traps inhaled
foreign body like dust or inhaled microbes
and so they stick there, so it’s also a sort of
protection, preventing these smaller particles
from going directly to the pulmonary alveoli
A
goblet cells
16
Q
an intertwining network of anastomosing capillaries lined with endothelial cells
A
alveolar walls
17
Q
These pores allow gas exchange from one alveolus to another alveolus.
A
pore of Kahn
18
Q
carbon particles in the lungs
A
anthracosis
19
Q
amount of air inhaled and exhaled with each resting breath
A
tidal volume (70kg: 350-400ml)
20
Q
amount of air remaining in the lungs at the end of a maximal exhalation
A
residual volume
21
Q
total amount of air that can be exhaled following maximal inhalation
A
vital capacity
22
Q
total lung capacity
A
vital capacity + residual volume
23
Q
amount of gas in the lungs at the end of a resting tidal breath
A
functional residual capacity
24
Q
lesser pleural pressure on the apex causes __________ expansion of the apical alveoli
A
greater
25
PaO2 falls below 60mmHg
respiratory failure
26
normal PaO2
80-100mmHg (10.7-13.3kPa)
27
normal PaCO2
35-45mmHg (4.7-6.0)
28
PaO2 is low but PaCO2 is within normal range
type 1
29
Type 2 resp failure
PaO2 is low but PaCO2 is raised
30
the only direct clinical sign of resp failure
central cyanosis (PaO2 is 50mmHg or lower)
31
less than 30mmHg PaO2
loss of consciousness
32
hypercapnia when severe causes
```
tremor
bounding pulse
vasodilation
increased CO
confusion leading to coma
```
33
2 main causes of chronic hypoxemia
pulmonary hypertension
| polycythemia
34
Due
to
pulmonary
vasoconstriction. This occurs when the PaO2 falls below 60mmHg
Pulmonary hypertension
35
Due to stimulation of
| erythropoietin release from the kidney when there is low oxygen
polycythemia
36
Provide anatomic assistance in reducing the
| surface tension of alveoli
surfactant (type 2 pneumocytes)
37
phospholipids and proteins in a surfactant
Dipalmitoylphosphatidylcholine
Surfactant apoproteins
Calcium ions
38
what is the surface tension of water
72 dynes/cm
39
surface tension of alveolar fluid without surfactant
50 dynes/cm
40
surface tension of alveolar fluid with surfactant
5-30 dynes/cm
41
steroids which increase the prod of surfactant
thyroxin and cortisol
42
biochemical defenses
```
proteinase inh (alpha 1 protease inh)
Antioxidants (transferrin, lactoferrin, glutathione)
```
43
main disease of the airways and the lungs
infection
inflammation
obstruction
44
incomplete expansion of the lungs
atelectasis (neonatal) (-) surfactant
45
collapse of previously inflated lungs
atelectasis (acquired)
46
3 main types of atelectasis
resorption
compression
contraction
47
complete obstruction of an airway
resorption atelectasis
48
Mediastinum shifted towards the atelectatic lung
resorption atelectasis
49
Significant amount of fluid (transudates,
exudate- infection: pneumonia, or blood),
tumor or air (pneumothorax) accumulate
within the pleural cavity
compression atelectasis
50
mediastinum is shifted away from the affected lung
compression atelectasis
51
type of atelectasis whch is more common in traumatic patients like stabbed wounds
compression atelectasis
52
Focal or generalized pulmonary or pleural
| fibrosis prevents full lung expansion.
contraction atelectasis
53
presence of
fibrous tissue in between the alveolar
spaces, so in the alveolar septa, that will
prevent the lungs from expanding fully
interstitial fibrosis
54
also called non cardiogenic pulmonary edema
acute lung injury
55
Characterized by abrupt onset of significant hypoxemia and bilateral
pulmonary infiltrates in the absence of cardiac failure
Acute lung injury
56
histologic manifestation of ALI and ARDS
diffuse alveolar damage
57
made up of alveolar fluid rich in proteins that has precipitated.
Hyaline membrane
58
lining hyaline membrane surrounds the alveolar spaces which makes it difficult for gas exchange to happen
hyaline membrane disease
59
increase resistance to airflow due to partial or complete obstruction at any level from trachea and larger bronchi to the terminal and respiratory bronchioles
Obstructive diseases
60
reduced expansion of lung parenchyma and decreased total lung capacity
restrictive disease
61
Obstructive and Restrictive lung dse types
emphysema
Chronic bronchitis
asthma
bronchiectasis
62
irreversible enlargement of the airspaces distal to terminal bronchiole accompanied by destruction of their walls without obvious fibrosis
emphysema
63
Central or Proximal parts of the acini formed by
| respiratory bronchioles are affected
CENTRIACINAR (CENTRILOBULAR) EMPHYSEMA
64
Both emphysematous and normal airspaces exist within the same acinus and lobule.
CENTRIACINAR (CENTRILOBULAR) EMPHYSEMA
65
more common and severe (CENTRIACINAR (CENTRILOBULAR) EMPHYSEMA)
upper lobes
66
Acini are uniformly enlarged from the level of the
respiratory bronchiole to the terminal blind
alveoli
Panacinar emphysema
67
Panacinar emphysema tend to occur more in the _______________
lower zones
68
Panacinar emphysema is associated with ______________ deficiency
alpha 1 antitrypsin
69
Proximal portion of the acinus is normal and the
| distal part is predominantly involved
Paraseptal/ DIstal acinar emphysema
70
Distal Emphysema is more striking adjacent to the pleura,
| more on the
upper half of the lung
| can sometimes form cyst-like structures
71
Usually in small foci and is clinically significant
irregular emphysema
72
most common cause of emphysema
Inhaled cigarette smoke
73
Factors (emphysema)
o Inflammatory mediators and leukocytes
– released from resident epithelial cells
and macrophages.
o Protease-antiproteases imbalance
o Oxidative stress
o Infection
74
Symptoms of emphysema do not appear until atleast __
1/3 of the functioning lung parenchyma is damaged.
75
Manifestations of emphysema
Dyspnea, cough and expectoration, wheezing, weight loss
76
Generally, in patients with smoking-related
disease, the _________ are
more severely affected
upper 2/3 of the lungs
77
apical blebs or bullae are characteristics of
irregular emphysema
78
Persistent cough with sputum production for at
least 3 months in at least 2 consecutive
years
chronic bronchitis
79
most important risk factor of chronic bronchitis
cigarette smoking
80
Dominant pathology features of chronic bronchitis
mucous hypersecretion
| persistent inflammation
81
– ratio of thickness of the mucous
| gland layer to the thickness of the wall between the epithelium and the cartilage
reid index
82
normal measure in reid index
not more than 0.4
83
reid index: chronic bronchitis
>0.4
84
Is a heterogeneous disease, usually
characterized by chronic airway inflammation
and variable expiratory airflow obstruction that
produces symptoms such as wheezing,
shortness of breath, chest tightness, and cough,
which vary over time and in intensity
asthma
85
Episodic bronchoconstriction due to increased
| airway sensitivity to a variety of stimuli.
asthma
86
2 types of asthma
atopic and non atopic
87
Evidence of allergen
| sensitization and immune activation
atopic (more common)
88
No evidence of allergen
| sensitization
non- atopic
89
▪ IgE – mediated (type 1 hypersensitivity reaction)
▪ Usually begins in childhood and is triggered by
environmental allergens (dust, pollen, cockroach
or animal dander and food)
atopic asthma
90
▪ Usual triggers are respiratory infections (viral),
air pollutants (smoking, sulfur dioxide, ozone,
exposure to cold and exercise).
non-atopic asthma
91
```
▪ Inhibits cyclooxygenase pathway of arachidonic
acid metabolism leading to a rapid decrease in
Prostaglandin E2 (aspirin)
```
Drug-induced asthma
92
▪ Fumes in workplace (epoxy resins, plastics)
▪ Organic and chemical dusts (wood, cotton,
platinum)
▪ Gases (Toluene)
▪ Others: formaldehyde, penicillin products
occupational asthma
93
Bronchoconstriction is triggered by direct
| stimulation of
subepithelial vagal
| (parasympathetic) receptors
94
asthma-pharmacologic mediators
leukotrienes c4, d4, e4
| acetylcholine
95
asthma suspects
ILF3/IL4
| IL13
96
One susceptibility locus for asthma is
| located on
chromosome 5q
97
are linked to
| production of IgE antibodies
Particular class II HLA
98
may be linked to increased
proliferation of bronchial smooth muscle and
fibroblasts
Polymorphisms in the gene encoding
| ADAM33
99
IL-4 receptor gene variants are associated
| with
atopy, elevated serum IgE, and asthma
100
morphology of asthma
lungs are distended
Occlusion of bronchi and bronchioles by thick, tenacious mucus plugs
Charcot-Leyden crystals
101
asthma-airway remodelling
```
▪ Thickening of airway wall
▪ Sub Basement membrane fibrosis
▪ Increased in the size of submucosal glands
and number of airway goblet cells
▪ Hypertrophy and/or hyperplasia of the
branchial wall muscle
```
102
severe form of asthma
status asthmaticus
103
▪ Destruction of smooth muscle and elastic tissue
by chronic necrotizing infections
▪ Permanent dilation of bronchi and bronchioles
bronchiectasis
104
bronchiectasis is associated with
```
o Congenital or inherited conditions, e.g
cystic fibrosis
o Infections- necrotizing pneumonia
o Bronchial obstruction- tumor, foreign
bodies
o Others: rheumatoid arthritis, SLE
,inflammatory bowel disease, COPD and
post transplantation
```
105
smaller bronchioles are
| progressively obliterated as a result of fibrosis
bronchiolitis obliterans
106
is an autosomal
recessive disease. The disease causing
mutations result in ciliary dysfunction due to
defects in ciliary motor proteins
Primary ciliary dyskinesia
107
Approximately half of patients with primary ciliary
| dyskinesia have
Kartagener syndrome
108
occurs
in patients with asthma or cystic fibrosis and
frequently leads to the development of
bronchiectasis. It is a hyperimmune response to
the fungus Aspergillus fumigatus.
Allergic bronchopulmonary aspergillosis
