Pulmonary System

Question 1

Lungs

Answer 1

Right = 3 lobes
Left = 2 lobes (left lingular lobe = right middle lobe)
The apex of lung extends 4 cm above rib #1
Medial (hilar) surface:
1. pulmonary arteries veins
2. Bronchi
Pleura:
1. Visceral - adheres to lung
2. Parietal - adheres to thoracic cage
Pneumothorax is the loss of vacuum between the two.

Question 2

Mediastinum

Answer 2

Anterior - Thymus gland
Middle - Heart and pericardium
Posterior - Esophagus, descending aorta, azygous veins, thoracic duct, sympathetic trunk
Superior - Aortic arch, brachiocephalic veins

Question 3

How do we drain mucous out of the head?

Answer 3

CN1 - Olfactory - sensation
CN5 - Sensation

Sphenoid drains into ethmoid.
Both Frontal and ethmoid drain into the maxillary which then drains into the nasal cavity.

Question 4

Tidal volume

Answer 4

Breathing in and out

Amount of air that moves in or out of the lungs with each respiratory cycle.

Question 5

Inspiratory reserve volume

Answer 5

It is the amount of air that can be forcibly inhaled after a normal tidal volume.
Used during exercise.

Question 6

Expiratory reserve volume

Answer 6

Your expiratory reserve volume is the amount of extra air — above-normal volume — exhaled during a forceful breath out

Question 7

Residual volume

Answer 7

It is the volume that remains in the lungs after a maximal expiration

Question 8

FEV 1

Answer 8

It is the volume that can be expired in 1 second after a maximal inspiration.
It is normally 80% of the forced vital capacity.
Good for checking COPDs

Question 9

What does the phrenic nerve innervate?

Answer 9

The diaphragm

Question 10

Medulla

respiration

Answer 10

Dorsal respiratory group
-Associated with inspiration

Ventral respiratory group

• Associated with expiration
• Only operates during active respiration as normal expiration is known to be passive.

Question 11

Pons

respiration

Answer 11

Apneustic Center (lower pons)
- Stimulates inspiration (gasp / Apneusis)

Pneumotaxic Center (upper pons)
- Inhibits inspiration (regulates rate and volume)

Question 12

Remember

Answer 12

Carbon dioxide CO2 creates an acidic environment.

Bicarbonate creates a base environment.

Question 13

Remember

Answer 13

Most of carbon dioxide is put away in bicarbonate buffer.

Question 14

Rhinitis

Answer 14

Rhin = nasal
-itis = inflammation
Inflammation of the nose
runny nose (rhinorrhea), nasal itching, nasal congestion, and sneezing

Question 15

Allergic rhinitis

Answer 15

Allergic rhinitis is inflammation of the nose caused by allergens such as hay, pollen, dust, animal hair, or mold spores.
Type 1 hypersensitivity reaction.
IgE mediated.
There are lots of mast cells that were activated by B-cells (which were activated by T cells) around the nose and mouth because both are portals of entry for infections
Symptoms:
- red itchy swollen eyes.
- nasal congestion.
- frequent bouts of sneezing
Treatment:
- antihistamine 
- nasal irrigation

Question 16

Upper respiratory tract infection

Answer 16

An upper respiratory tract infection is any infection that involves the nasal cavity, paranasal sinuses, pharynx, or larynx, and it’s most often caused by an invading pathogen like a virus.

Question 17

What is the larynx?

Answer 17

Below the pharynx
Commonly called voice box or glottis.
Passage for air between the pharynx above and the trachea below.

Question 18

Tonsils

Answer 18

Lymphoid tissue
Acts as q first line of defense
Main function is to trap germs (bacteria and viruses)

Question 19

What produces mucus?

Answer 19

Goblet cells and submucosal gland

Question 20

Pus

Answer 20

Can form in the area where pathogens have invaded
Pathogens + immune cells + dead tissue + cytokines.
These cytokines get to the brain making the body increase temperature

Question 21

Rhinitis

Answer 21

Rhin = nose
-itis = inflammation
Infection of the nasal cavity
Bacterial or viral
Usually caused by viruses
Common Cold
Flu

VIRAL:
Rhinovirus (common cold)
Influenza virus
Respiratory syncytial virus (RSV)
Parainfluenza virus
Adenovirus

BACTERIAL:
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrahalis (causes otitis media in children)
Staphylococcus aureus

Question 22

Chronic rhinitis

Answer 22

Post-nasal drip

Question 23

Laryngitis

Answer 23

Laryng = larynx 
-itis = inflammation
Inflammation of the larynx
Most common
Especially affects children
Chronic if it lasts more than 3 weeks

Question 24

What does the pharynx split into?

Answer 24

Esophagus and larynx (and or trachea)

Question 25

Acute laryngitis

Answer 25

``` Most common (usually due to upper respiratory tract infection) Usually due to viruses: - Rhinovirus - Coronavirus - Influenza virus - Respiratory syncytial (RSV) - Parainfluenza ``` ``` Bacterial - Group A streptococcus - Streptococcus pneumonae - Haemophilus influenzae Super infection - bacterial infection with viral infection. ``` Goblet cells produce lots of mucus, immune cells migrate to the area (neutrophils and macrophages), they release chemicals that cause swelling and pain, vocal cords don't vibrate smoothly, dysphonia occurs (hoarseness) Symptoms: 3 D's = Dysphonia, dyspnea, and dysphagia Hoarse voice, cough, difficulty swallowing (dysphagia as the epiglottis may compress against the esophagus), SOB (in children due to smaller airways).

Question 26

Epiglottis

Answer 26

Sits on top of the larynx (voice box) | Keeps food and liquid going towards the esophagus and not going into the trachea

Question 27

Bacterial Epiglottitis

Answer 27

Inflammation of the epiglottis Can be life-threatening as it can block the trachea not allowing for breathing Mostly caused by Haemophilus influenzae Group a streptococcus. Pathogens get into the mouth or nose, deposit in the mucosa of the epiglottis, goblet cells produce mucus, immune cells migrate to that area and release cytokines which makes blood vessels more permeable to fluid, inflammation and swelling occurs, obstruction of airflow happens. symptoms: Fever, difficulty breathing, stridor Lab: Endoscope and x-ray

Question 28

Nasal Polyp

Answer 28

Nasal polyps develop when epithelial cells that line the respiratory region simply overgrow - a process called hyperplasia. Non-cancerous Blocks airflow and mucus drainage making pathogens lingering which cause infection causing swelling.

Question 29

Remember

Answer 29

Between the pulmonary and systemic circuit, if I am pumping into the aorta or systemic circuit I am pumping at 100 mmHg. I can not do this in the pulmonary circuit. We are going to have the same volume but lower pressure.

Question 30

Ventilation

Answer 30

The mass movement of air in and out of the lungs

Question 31

Perfusion

Answer 31

Movement of O2 and CO2 across the alveolar membrane

Question 32

Remember

Answer 32

Cartilaginous rings in the trachea and bronchi are C rings because, in the back of the C ring, there is smooth muscle that connects the two ends together. Beta 1 goes to the heart and Beta 2 goes to the lungs

Question 33

Pulmonary Edema

Answer 33

Any factor that causes the pulmonary interstitial fluid pressure to rise from negative to positive Causes: Left heart disease Pulmonary capillary membrane damage

Question 34

Emphysema

Answer 34

Pink puffers Normal pCO2 - due to compensatory mechanism/response PCO is normal because, unlike chronic bronchitis patients, they are never having a break from their emphysema. Chronic stimulation of erythropoietin (which comes from kidneys), then goes to bone marrow saying we need more red blood cells. Permanent dilation of part or all the acinus with eventual destruction of alveolar walls Cigarette smoking or def. serum alpha 1 protease inhibitor in non-smokers. Barre-chest, pursed lips, slow forced expiration

Question 35

Chronic bronchitis

Answer 35

Increased pCO2 Persistent cough with sputum for at least 3 months in at least two consecutive years Obese, corp pumonale, cyanotic Do not retain hypercapnic drive to breathe

Question 36

How much erythrocyte is in total blood volume?

Answer 36

45% of total blood volume is made up of erythrocytes.

Question 37

What are erythrocytes? | What is the function of erythrocytes?

Answer 37

Red blood cells | Carry oxygen to tissues and carbon dioxide to lungs

Question 38

What is hematocrit?

Answer 38

The hematocrit is the proportion, by volume, of the blood that consists of red blood cells. The hematocrit (hct) is expressed as a percentage.

Question 39

What does hematopoietic stem rise give rise to?

Answer 39

It gives rise to red blood cells, white blood cells, and platelets.

Question 40

Polycythemia vera

Answer 40

refers to an increase in the number of red blood cells in the body. The extra blood cells in the blood cause the blood to be thicker, increasing the risk of other health issues, such as blood clots. 90% of individuals with polycythemia have a mutation of the Janus Kinase 2 (JAK2) gene found in the hematopoietic stem cell which is responsible for making red blood cells. ``` Symptoms: Fatigue Dizziness Increased sweating Redness in the face Blurred vision Itchiness ``` complications: Stroke, heart attack, DVT, Budd-Chiari syndrome (which is when liver veins are blocked by blood clot).

Question 41

What is erythropoietin?

Answer 41

It is a hormone that is produced predominantly by specialized cells in the kidney

Question 42

What normally makes erythropoietin (hormone) to be released?

Answer 42

Low oxygen

Question 43

Myelofibrosis

Answer 43

Secondary to polycythemia Hematopoietic cells die out causes fibrosis within the bone. Anemia, thrombocytopenia, and leukopenia are developed as the cells responsible for making RBCs, platelets, and WBCs die out.

Question 44

Reactive polycythemia

Answer 44

Caused by emphysema

Question 45

Pneumonia ``` Patchy area throughout the lung Working hard to breathe X-ray Dullness to percussion Tactile fremitus ```

Answer 45

Infection in the lungs is caused by microbes. This infection brings fluid to the lungs making it harder to breathe. It brings white blood cells, red blood cells, fluid, and proteins to the area of inflammation when microbes achieve colonization of an area(s) of the lung. Symptoms: Dyspnea, chest pain, productive cough Caused by viruses, bacteria, and fungi Most common viral cause: Influenza (flue) Most common bacterial cause: Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus

Question 46

Community-acquired pneumonia

Answer 46

Not in a hospital

Question 47

Hospital-acquired pneumonia

Answer 47

More serious because patients have weakened immune system

Question 48

Aspiration pneumonia

Answer 48

Occurs when something installs into the lungs from air tubes such as gastric juice, food, etc.

Question 49

Lobar pneumonia

Answer 49

A whole lobe is affected Streptoccocus pneumoniae Stages: 1. Congestion - days 1 and 2 Blood vessels and alveoli fill with excess fluid 2. Red hepatization - days 3 and 4 Exudate (RBCs, neutrophils and fibrin) fill airspaces making them more solid. Liver-like appearance 3. Gray hepatization - days 5 to 7. 4. Resolution - day 8 to 3 weeks Exudate is digested, ingested and coughed up

Question 50

Atypical or interstitial pneumonia

Answer 50

Patchy areas concentrated in the perihilar region

Question 51

Lung abscess

Answer 51

In bronchial segment | Aspired microbe that causes abscess

Question 52

Tuberculosis

Answer 52

Mycobacterium tuberculosis 90-95% aren't aware they are infected. Aerobe! Hard surface - survive on surfaces and inside of macrophages infecting them. Transmitted via inhalation infecting the lung. Upper lobes are affected the most It can be in any organ, but it usually starts in the lung. If not cured, it invades other organs

Question 53

Hypersensitivity pneumonitis

Answer 53

farmer's lung, pigeon breeders lung, air conditioner , interstitial pneumonia and fibrosis, non-caseating granulomas. Body mistakenly thinks its pneumoniae

Question 54

bronchiectasis

Answer 54

Bronchi = bronchus ectasis = dilation/expansion Chronic inflammation make the bronchi and bronchioles get dilated Obstructive lung disease - the infection makes mucus which obstructs airway. secondary to ciliary dyskinesia - cilia don't move normally. Bacteria starts to multiply. Overtime after being damaged and having the elastin damaged/destroyed from the chronic inflammation, the airways dilate.

Question 55

Goodpasture's syndrome

Answer 55

Autoimmune disorder Goodpasture syndrome is a rare disorder in which your body mistakenly makes antibodies that attack the lungs and kidneys. It most often occurs in people ages 20 to 30 or older than age 60. It is more common in men. It can be fatal if not quickly diagnosed and treated. Causes hemoptysis. In kidneys: Hematuria - blood in the urine Autoantibodies bind to specific of the alpha chain type 2 hypersensitivity reaction

Question 56

What is the most abundant protein in the human body?

Answer 56

Collagen - triple helix, each chain is 1 of6 types.

Question 57

Basement membrane

Answer 57

sheet-like, made of protein (various), found in every organ system

Question 58

Asthma

Answer 58

It is small bronchi airway disease. This causes two negative things: restriction or contraction of smooth muscle and over production of immune product - mucus People die

Question 59

Pleural effusion

Answer 59

Wetness outside the lungs | Increased hydrostatic pressure/heart failure