Respiratory anatomy and histology

Question 1

what are the three lines used to demarcate the topography of the lungs?

Answer 1

midclavicular
midaxillary
paravertebral

Question 2

what are the locations of adhesion for the lung and visceral pleura?

Answer 2

midclavicular - rib 6
midaxillary - rib 8
paravertebral - rib 10

Question 3

what are the locations of adhesion for the parietal pleura?

Answer 3

midclavicular - rib 8
midaxillary - rib 10
paravertebral - rib 12

Question 4

what is the best access for removal of pleural effusion fluid?

Answer 4

posterior 7th / 8th / 9th intercostal spaces

Question 5

what is the superior pulmonary sulcus? what is the clinical relevance?

Answer 5

posterior concave curvature / region of thoracic wall

pancoast tumor can migrate superiorly to this sulcus

Question 6

which type of tumor can migrate superiorly to the superior pulmonary sulcus?

Answer 6

pancoast tumor

Question 7

what are the involved structures in a pancoast tumor?

Answer 7

sympathetics
brachial plexus
subclavian vessels

Question 8

what is the brachial plexus manifestation of a pancoast tumor?

Answer 8

intrinsic hand muscle deficits due to C8/T1 involvement

Question 9

what are the stellate ganglion manifestations of a pancoast tumor?

Answer 9

horner syndrome (ptosis, myosis, anhydrosis)

Question 10

the lingula is associated with which lobe / region?

Answer 10

superior lobe of left lung

Question 11

how many bronchopulmonary segments does the right lung have?

Answer 11

10

Question 12

how many bronchopulmonary segments does the left lung have?

Answer 12

8-10

Question 13

what is the relationship of the pulmonary artery to the bronchi in the right lung?

Answer 13

anterior

Question 14

what is the relationship of the pulmonary artery to the bronchi in the left lung?

Answer 14

superior

Question 15

at which thoracic level does the trachea bifurcate?

Answer 15

T4 / T5

Question 16

the trachea begins at what vertebral level?

Answer 16

C6

Question 17

what do segmental (tertiary) bronchi supply on the right and left sides?

Answer 17

right - 10 bronchopulmonary segments

left - 8 bronchopulmonary segments

Question 18

what are the four components of the respiratory airways?

Answer 18

respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

Question 19

the lamina propria of the vocal contains what structures?

Answer 19

vocal ligament

Reinke’s space

Question 20

what is Reinke’s space?

Answer 20

histological space contained in the lamina propria of the vocal fold adjacent to the vocal ligament

Question 21

what is the purpose of Reinke’s space?

Answer 21

fluid accumulation above and below (Reinke’s edema)

Question 22

what constitutes the epithelium on the inner aspect of the larynx?

Answer 22

ciliated, pseudostratified columnar with goblet cells

Question 23

what constitutes the epithelium on vocal folds, anterior surface of epiglottis, and external laryngeal surfaces?

Answer 23

non-keratinized stratified squamous

Question 24

what cell types are the drivers of mucociliary clearance?

Answer 24

ciliated columnar cells

Question 25

goblet cells span what regions of the respiratory tract?

Answer 25

trachea to primary bronchioles

Question 26

what are the neuroendocrine cells of Kulchitsky?

Answer 26

numerous in fetal lung - proliferate in certain diseases of pulmonary system

Question 27

where are smooth muscle bundles found in the respiratory tract?

Answer 27

interface of lamina propria and submucosa of intrapulmonary bronchi

Question 28

the glands in the submucosa of the intrapulmonary bronchus secrete what substances?

Answer 28

``` mucins lactoferrin lysozyme IgA a1-antitrypsin and other protease inhibitors ```

Question 29

75% of lung cancers originate in what bronchi?

Answer 29

1st, 2nd, and 3rd order bronchi

Question 30

what are the histologic changes seen in asthma?

Answer 30

``` increased mucus increased thickness of basal lamina increased thickness of lamina propria due to edema and emigration of inflammatory cells increased thickness of muscularis increased glands in submucosa ```

Question 31

what are the histological features of bronchioles?

Answer 31

lack cartilage lack submucosa goblet cells normally in large bronchiole prominent muscle layer

Question 32

where are club cells seen?

Answer 32

terminal and respiratory bronchioles

Question 33

what is the function of club cells?

Answer 33

represent stem cell population | secrete surfactant

Question 34

which pneumocyte makes up over 90% of the surface area?

Answer 34

type I

Question 35

what are the functions of type I pneumocytes?

Answer 35

facilitate gas diffusion between blood and alveoli

Question 36

which pneumocyte secretes surfactant?

Answer 36

type II

Question 37

what are the functions of type II pneumocytes?

Answer 37

secrete surfactant | cell division

Question 38

where are alveolar macrophages seen?

Answer 38

alveolar lumen

Question 39

what forms the blood gas barrier?

Answer 39

type I pneumocytes with adluminal surfactant | fused basal laminae of type I pneumocyte and continuous capillary