Respiratory S1 (done except sinusitis) Flashcards Preview

ESA 3 Callum's Cards > Respiratory S1 (done except sinusitis) > Flashcards

Flashcards in Respiratory S1 (done except sinusitis) Deck (105):
1

What are the basic concepts of the kinetic theory of gases?

Gases are a collection of molecules moving around in a space

Pressure is generated by collision of molecules with the walls

The more frequent and harder the collisions the higher the pressure

2

What is Boyle's law?

Describe the underlying physical basis

Presure is inversely proportional to volume

If a given amount of gas is compressed to a smaller volume molecules will hit the walls more often therefore raising pressure

3

What is Charle's law?

Describe the underlying physical basis

Pressure is proportional to absolute temperature (Kelvin scale)

As temperature increases molecules will have more kinetic energy and will therfore impact the walls of a container more often hence rainsing pressure

4

What is the universal gas law?

What does it allow us to calculate?

= n x R x T

Allows calculation of how volume will change with temperature and pressure changes

5

What is meant by 'STP'?

Standard temperature and pressure

Temp = 273K

Pressure = 101.0kPa

6

Describe what is meant by 'Partial pressure' of a gas in a mixture of gases

In a given mixture of gases molecules of each type behave independently

Therefore each gas will contribute a portion of overall pressure

The fraction of pressure is equal to the fraction of gas each molecule type makes up in a given mix

7

Describe the behaviour of gas mixtures in contact with water

Relate your answers to pressure

Water vapour:

Water moecules enter the gas via evaportation and exert vapour pressure

Gas dissolution:

Gases will enter water and exert 'tension' 

8

When water molecules enter and leave a gas at the same rate, what has been reached?

What does this equilibrium depend on?

Saturated vapour pressure

Equilibrium is temperature dependent

9

What is saturated vapour pressure at 37 deg C?

6.28kPa

10

Describe 'Tension'?

Hint: Not what your feeling now you've finally started revising

 

Tension is the 'pressure' exerted by gas molecules dissolved in water were the water not there

11

Describe Tension equilibrium

What is it equal to?

When there is no net movement of gas molecules in and out of a body of water

At equilibrium tension is the same as the partial pressure of a gas in gas mixture

12

How is tension relevant to gas exchange?

Tension in the pulmonary system drives oxygen out into tissues.

13

What is indicated by gas tension in a liquid?

How readily a gas will leave a liquid

NOT: How much gas is in a liquid

14

How is solubility relevant to gas tension?

Solubility determines how much gas will enter a liquid to establish a particular tension

Gas content of a liquid = Solubility Tension

15

How is our calculation of gas content of a liquid modified by chemical reaction of said gas and liquid?

Reaction must complete before tension is established

Equation:

Reacted gas Dissolved gas Total gas content

16

Per minute in the lungs what is the required minimum blood flow and O2 absorption rate?

Surface area needed for this is roughly equivalent to?

5L of blood in pulmonary circulation

12mmol of O2

Surface area:

Roughly one tennis court

17

How many alveoli does the averge human posess?

300 million

18

What are the divisions of the airway from trachea to bronchiole?

Trachea branches to form Main bronchi

Main bronchi branch to 3 right and 2 right lobar bronchi

Lobar bronchi divide into segmental bronchi

Then subsegmental

Then bronchioles

19

What are the layers (and hence the histological differences) between bronchi and bronchioles?

Bronchi:

Mucosa
Smooth muscle
Submucosa - contains glands
Crescent shaped cartilage (smaller than in trachea)

Bronchioles:

Epithelia
Smooth muscle (more than bronchi)

20

What are terminal bronchioles and what do they divide into?

How many are there?

Terminal bronchioles are analogous to 'twigs on a tree'

Not directly connected to alveoli but branch into a set of respiratory bronchioles, alveolar ducts and alveoli

~ 200,000 terminal bronchioles

21

Describe the blood supply of alveoli

Each alveoli surrounded by capillary supplied by branching blood vessels throughout the lungs

22

What are the 5 key features of the pulmonary circulation?

 

Low resistance (many parallel branches of short, wide vessels)

Low pressure

Recieves entire cardiac output

Forms practically no tissue fluid

Regional perfusion matched to ventilation

23

What are the external features of the nose?

Root to Septum:

Root (Radix) at most posterior point on face between eyebrows

Bridge (Dorsum) running between tip and root

Tip

Septum forming the medial wall of the nasal cavities 

Laterally:

Wings (Alars) form lateral walls of nasal cavity in the nose

 

24

Describe the Internal structure of the nasal cavities

Extends from nostrils to posterior nares

Divides in two medially by nasal septum (cartilage and bone)

Lateral wall has 3 bony projections

Lined by pseudostratified columnar ciliated epithelium

Superior, middle and inferior Turbinate bones on the lateral walls each shaped like a stretched out seashell

Superior, middle and inferior meatus sit below each turbinate

 

 

25

Label the back boxes

What are represented by arrows labelled 1 to 4?

Boxes, top left clockwise:

Frontal sinus

Ethmoid sinus

Orbit

Masal cavity

Orbit

Numbers:

1 - 3 = Bony projections of the lateral wall (Turbinates)

4 = Nasal septum

26

Label the black boxes

What are represented by Arrows labelled 1 to 3 and 1a to 3a?

Boxes, top left clockwise:

Frontal bone and frontal sinus

Body of sphenoid and sphenoid sinus

Oral cavity

Hard Palate

Numbers:

1 to 3  = Superior, middle and inferior turbinates

1a to 3a = Superior, middle and inferior meatus

27

What are the functions of the nose?

Respiration:

Filters air

Humidifies and warms air

Organ of smell

Recieves local secretions:

Sinuses

Nasolacrimal duct

(Fun fact: Tears travel through this duct while crying, hence the runny nose, you're essentially crying out your nose)

28

What are the functions of nasal mucosa?

Pseudostratified columnar ciliated:

Hairs filter large particles

Epithelium moistened by mucus to trap particles

Cilia help transport trapped particles

Watery secretions humidify air

 

29

Apart from the epithelium what other features of the nose have a respiratory function and what are the specific functions of each feature?

Vessels beneath epithelium:

Warms air

Turbinates:

Slows airflow and helps mix air

30

What are the names of the paranasla sinuses and how many are there?

Frontal

Ethmoid

Maxillary

Sphenoid

8 in total (4 pairs)

31

Label these structures

Boxes, top to bottom:

Frontal

Ethmoid

Maxillary

32

Label the black box

Sphenoid Sinus

33

Describe the lining of the sinuses

Pseudostratified columnar ciliated epithelium with goblet cells and glands

34

What might be the function(s) of the paranasal sinuses?

Many theories:

Extension of nasal cavity for humidification and warming of air

Secretion of mucus that drains into the nasal cavities to moisten them

Lightening weight of the skull

Buffer for trauma (protect cranial cavity)

Insultation fo sensitive structures from temperature variation (Dental roots, eyes)

35

Label lines 1 to 4

1 = Frontal sinus

2 = Ethmoid sinus

3 = Maxillary sinus

4 = Sphenoid sinus

36

Label the black boxes

The labelled structures are collectively called what?

Boxes, top to bottom:

Nasopharynx

Oropharynx

Larynopharynx

Collectively:

Pharynx

37

what is the Pharynx?

Common passage for food, water and air

38

What are the Eustachian tubes?

Tubes connecting nasopharynx to middle ear

39

What are the structures of the/within the larynx with relevance to the respiratory system?

Epiglottis

Glottis and false vocal cords

40

Define glottis

The 2 vocal cords and the aperture between them

(Apeature technically called rima glottidis)

41

What is the function of the epiglottis?

Closes during swallowing and therefore protects against aspiration of food

42

What are the functions of the vocal cords?

Act as a valve guarding trachea

Phonation

43

What are the positions of the vocal cords while performing different functions?

Abducted (away from midline/open) during respiration

Adducted (towards midline/closed) during swallowing

Partially abducted during phonation

Initially adducted then rapidly abducted during cough reflex

44

What is the difference between the two diagrams?

Label the boxes

Left - Adducted vocal cords

Right - Abducted vocal cords

Boxes, top to bottom:

Base of tongue

Epiglottis

False vocal cord

True vocal cord

Glottis

Inner lining of trachea (accept 'trachea')

Corniculate cartilage

 

45

Label the boxes

Boxes, top right clockwise:

Epiglottis

Vocal cords

Cricoid cartilage

Eosophagus

Trachea

Thyroid cartilage

Hyoid bone

46

From where does the reccurent laryngeal nerve arise and what does it innervate?

Arises from vagus

Supplies all intrinsic laryngeal muscles except cricothyroid

 

47

Describe the course of the reccurent laryngeal nerves

Right:

Branches from vagus in nech, curves under subclavian artery and back up the neck in the groove between the trachea and eosophagus to supply intrinsic muscles of larynx

Left:

Branches from vagus in neck, curves around the arch of the aorta and comes back up neck in groove between trachea and eosophagus to supply the intrinsic muscles of the larynx

48

What s the clinical relevance of the reccurent laryngeal nerves?

Can be involved in disorders of the chest

Lesions may cause hoarseness of voice

49

What nerve supplies the cricothyroid muscle?

From where does it arise?

Superior laryngeal nerve

Vagus nerve

50

If you were to contract an upper respiratory tract infection (URTI) then when in the body might it commonly spread?

Sinuses via openings into nasal cavities resulting in sinusitis

To the middle ear via Eustachian tubes

51

What disorders of the Larynx may cause repiratory difficulty?

Oedema (anaphylaxis/severe infection)

Tumour

Aspiration of foreign body

Bilateral cord paralysis (cords adducted)

52

What disorders of the Pharynx can cause repiratory difficulty?

Tongue falling into airway while unconscious can obstruct airway

Sleep apnoea (decrease pharyngeal uscle tone during sleep obstructs airway during sleep)

53

What disorders of the nose might cause significant respiratory difficulty?

Nasal polyps may lead to mouth breathing (not ideal, less humidification)

54

In an unconscious patient what may be obstructing the pharynx?

Vomit (may be aspirated to lung)

Tongue

Foreign body

55

The respiratory system contains two types of membrane, what are they and where are they found?

Mucous membranes:

Lines the conducting portion of respiratory tract, secretes mucous

Serous membranes:

Lines the pleural sacs which envelope each lung

56

Label this diagram

Boxes from top picture, top to bottom:

Visceral pleura

Rib

Parietal pleura

Boxes from lower picture, top center clockwise:

Left lung

Moist pleura (makes lung shiny)

Impression of heart (Cardiac notch)

Impression of aorta

 

57

What is the conducting portion of the respiratory tract?

Include each structure in descending order

Nose

Pharynx

Larynx

Trachea

Primary bronchi

Secondary bronchi (lobar)

Tertiary bronchi (segmental)

Bronchioles

Terminal bronchioles

58

What is the respiratory portion of the respiratory system?

Include each structure in descending order

Respiratory bronchioles

Alveolar ducts

Alveoli

59

What structures of the lung are intrapulmonary and which are extrapulmonary?

Intra:

Secondary bronchi to Alveoli

Extra:

Nose to Primary bronchi (enter the lung at the hilum)

60

Label this picture

Boxes from top right clockwise:

Trachea

Superior left lung lobe

Primary bronchus

Secondary (lobar) bronchus

Tertiary (Segmental) bronchus

Inferior lobe of left lung

Inferior lobe of right lung

Middle lobe of right lung

Superior lobe of right lung

61

How does diameter of passageways change from nose to alveoli?

Diameter decreases as you travel towards alveoli

Passage walls also get thinner

62

What epithelia are present in the conducting portion of the respiratory system?

Nasal cavity to large bronchioles:

Pseudostratified columnar ciliated epithelium w/goblet cells

Smaller bronchioles and terminal bronchioles:

Simple columnar ciliated epithelia with clara cells

63

What epithelia are present in the respiratory portion of the respiratory system?

Respiratory bronchioles and alveolar ducts:

Simple cuboidal with clara cells and sparse cilia

Alveoli:

Type 1 - Simple squamous epithelia

Type 2 - Cuboidal epithelia

64

Label the box

Olfactory Mucosa

65

Epithelia in the nose can be split into two broad regions, what are these regions?

Non-olfactory regions

Olfactory regions

66

Describe in detail the mucosa of the non-olfactory regions of the nasal cavities

Pseudostratified columnar ciliated epithelium w/mucous glands and venous sinuses in lamina propria

67

What is the function of the venous sinuses in the nasal cavity mucosa?

Swell every 20-30 minutes alternating airflow from nostril to nostril to prevent overdrying

68

Describe the location and structure of the olfactory mucosa

Posterior, superior region of each nasal fossa

Thick pseudostratified columnar epithelium without goblet cells and with non-motile cilia

Contain olfactory cells (bipolar neurons)

Serous glands in the lamina propria (Bowman's glands) flush odourants from epithelial surface

69

Label the boxes

Boxes from top left clockwise:

Duct

Olfactory epithelium

Duct

Olfactory glands (Bowman's glands)

Olfactory nerves

70

Label the boxes

Boxes from center top clockwise:

Junctional complex

Cilia

Pseudostratified columnar ciliated epithelia

Axon

Basal cell

Olfactory (Bowman's) Gland

Olfactory cell

Basal lamina

Microvilli

Olfactory vesicle

71

Label the boxes

Boxes left to right, top to bottom:

Mucous glands

Vestibule of larynx

Ventricular folds of the false vocal cords (x2)

Ventricles

Vocal fold (x2)

Vocalis muscle (x2)

Intraglottic cavity

72

What is the function of the ventricles and ventricular folds?

What lines the ventricular folds?

Ventricles along with ventricular folds contribute to resonance of the voice

Ventricular folds lined by pseudostratified epithelium and contains mucous glands and numerous lymph nodes

73

Describe the structure of the true vocal cords

Lined by stratified squamous epithelium

Contains a vocal ligament (large bundle of elastic fibres running anteroposterior)

Also a vocalis muscle (bundle of skeletal muscle under somatic control)

74

What is the clinical relevance of the paths of the primary bronchi?

Path of right bronchi more vertical than left therefore foreign objects more likely to lodge in right bronchus

75

What structure(s) are shown?

Use this image to estimate age of specimen, what features are important to your evalutation?

Label the boxes

Trachea and Oesophagus

Age:

Elderly, as indicated by calcified bone tissue present in cartilage

Boxes from top left clockwise:

Cartilage (C-shaped)

Bone tissue

Fibroelastic membrane containing trachealis muscle

Trachea

Bone tissue

Cartilage

Oesophagus

76

What strucutre is shown?

Label the boxes

Wall of trachea

Boxes left to right:

C shaped cartilage

Submucosa with seromucous glands

Lamina propria

Epithelium

77

What is shown?

Label boxes

A section throught the mucosa of the trachea or bronchi

Boxes, top 2:

Epithelium

Boxes, bottom 6:

Seromucous glands

78

What is secreted by submucosal seromucous glands in the trachea and larger bronchi?

Mucins

Water

Serum proteins

Lysozyme

Antiprotease

Lymphocytes contribute Immunoglobulins (Especially IgA)

79

Identify the salient histological features the tracheal mucosa

Ciliated

Thick basement membrane

Lamina Propria rich in immune cells

Lamina propria includes a layer of elastic fibres

80

Label the boxes and identify the cell type/location

Boxes from top to bottom

Goblet cells

Ciliated epithelial cells

Basal cells

Connective tissue

Epithelium type:

Tracheal pseudostratified ciliated eipthelium/respiratory epithelium

81

Describe the effect of cystic fibrosis on epithelia and the respiratory tract

Sufferers lack the cystic fibrosis transmembrane regulator (CFTR) ion channel on the apical membranes of epithelial cells

Chloride ion transport across the membrane compromised

In the respiratory tract water does not adequately leave the epithelium and hydrate the secreted mucous

Viscous mucus is less readily moved by the oropharynx for swallowing

Serious pulmonary infection can occur

82

What is the blood capacity of the pulmonary vasculature

500ml of blood

83

Label the boxes and identify the tissue

Box at the very top:

Cresent shaped cartilage

Remaining boxes from bottom clockwise:

Submucosal glands

Artery

Epithelium

Smooth muscle

Vein

Tissue:

Secondary or tertiary bronchi

84

Label the boxes and identify the tissue

Boxes from top to bottom:

Pulmonary artery

Bronchial artery

Island of cartilage

Same as above

Bronchus

Island of cartilage

Pulmonary artery

Bronchial artery

Glands in submucosa

Bronchiole

Pulmonary artery

85

What differentiates a bronchiole from a bronchus?

Less than 1mm diameter

No cartilage

Epithelium is pseudostratified at first however progresses to simple ciliated columnar then simple cuboidal as diameter decreases

 

86

Describe how asthma affects bronchioles

Excessive constriction can occur due to lack of cartilage

During expiration bronchioles can collapse/severely constrict

(During inspiration bronchioles held patent by alveoli)

87

Where are clara cells found?

What are the functions of a clara cell?

Location:

Small bronchioles between ciliated cuboidal cells

Function 1:

Secrete surface lipoprotein to prevent walls of bronchioles sticking together during expiration

Function 2:

Secrete Clara cell protein (CC16)

A marker of alveolar damage (if lowered)

A marker in serum (if present then leakage across air/blood barrier)

88

What are terminal bronchioles and how do their structures differ from othe bronchioles? Why is this important?

Terminal bronchioles are <0.5mm

Absence of goblet cells to prevent individuals drowning in their own mucus

89

Label the boxes and identify the location

Boxes from top to bottom:

Terminal pronchiole

Respiratory bronchiole

Alveolar duct

Alveolar sacs

90

Individual alveoli can open into what structures?

An alveolar sac

An alveolar duct

A respiratory bronchiole

Another alveolus (via alveolar pore)

 

91

What are the functions of cells in the alveoli?

Type 1 (90%):

Simple squamous cells permit gas exchange

Type 2 (10%):

Produce surfactant

Macrophages:

Line alveolar surface and phagoctose particles

92

Label the boxes

Top to bottom left to right:

Basal lamina

Type 2 alveolar cell

Surfactant

Fibroblast

Alveolar lumen

O2

CO2

Macrophage

Endothelial cells

Erythrocyte

Capillary lumen

93

What is the cause of emphysema?

What are the structural changes to lung tissue?

Cause:

Alpha-1-antitrypsin deficiency

Smoking

Structural changes:

Destruction of alveolar walls and permanent enlargement of air spaces

94

How does emphysema affect lung function and what is the hallmark sign?

Function changes:

Damage to alveolar walls cause bronchioles to collapse on expiration making it difficult to empty the lungs

Hallmark:

Pursed lip breathing

95

What condition would this be?

What allows you to form your answer?

Emphysema

Enlarged alveolar spaces

96

What is seen here?

What disease might this be?

What are the common causes?

Seen:

Lung tissue, alveolar spaces filled with inflammatory cells

Disease:

Pneumonia

Common causes:

Streptococus pneumoniae

Haemophilus influenzae

Staphylococcus aureus

Legionella pneumophilia

Mycoplasma pneumoniae

97

What structures are lined by the pleura?

Visceral:

Lungs

Parietal:

Throacic cage

Diaphragm

Mediastinal surface

98

What are pleural reflections?

Sharp angles in the pleura where it changes direction from the costal surface to the mediastinal or diaphramatic surfaces

99

Where is the apex of the lung/pleural cavity found?

3cm above the medial 1/3 of the clavicle

100

Describe the route of the pleaural reflections/surface markings of the pleura starting at the apex and travelling anteriorly

Describe the entire course, all the way back to the apex

Course inferiorly and medially behing the sternoclavicular joints to meet at the midline behind the sternal angle (2nd rib)

Course down to the 4th rib

At 4th rib/costal cartilage the left pleura deviates laterally and continues inferio-laterally

At 6th rib/costal cartilage the right pleura deviates laterally and continues infero-laterally

Each pleural reflection meet the 8th rib at the mid clavicular line

Meet the 10th rib at the mid axillary line

Meet the 12th rib at the scapular line

The medial border of the pleural cavity ascends vertically long the lateral border of the paravertebral muscles up to the apex

101

Describe the surface markings of the lungs starting at the apex and travelling anteriorly

Feel free to relate this to the pleural markings to save time

Lungs fill the pleura except at lower margins, therefore they follow the pleural markings at apex, 2nd, 4th and 6th ribs (except cardiac notch, which is more pronounced in the lung compared to pleura

The lower margins of the lung cross the:

- 6th rib at the mid clavicular line

- 8th rib at the mid axillary line

- 10th rib at the scapular line

Thereafter medial border of the lung ascends along with the pleura vertically along the paravertebral muscles up to the apex

102

Why are surface markings of the lungs and pleura clinically important?

Procedures such as:

Cannulation of subclavian

Liver biopsy

Exposure of the kidney

May produce a pneumothorax (possibly unnoticed) which will causing rapid deterioration

103

What are the fissures of the lungs?

Oblique fissure:

Separates the upper and lower lobe of the left lung

Separates the upper and middle lobe of the right lung

Horizontal fissure:

Separates the middle and lower lobe of the right lung

104

Describe the courses of the lung fissures

Oblique fissures:

Extends from spinous process of T2 posteriorly to the 6th costal cartilage anteriorly

Horizontal fissure:

Extends from Oblique fissure of the right lung at the mid axillary line aalong the 4th rib to the anterior edge of the lung (follows the 4th rib all the way)

105