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Respiratory System Flashcards

1
Q

What are the features of the upper and lower respiratory tracts?

A

Upper respiratory tract:
Nose
Paranasal sinuses
Nasopharynx

The upper respiratory tract filters, humidifies and adjusts the temperature of the inspired air.

Lower respiratory tract:
Larynx
Trachea
Bronchi/bronchioles
Alveoli

The lower respiratory tract conducts the air to the sites of gaseous exchange.

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2
Q

What lines the respiratory tract?

A

Respiratory mucosa, composed of epithelium (‘respiratory epithelium’) and supporting connective tissue (‘lamina propria’).

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3
Q

What feature of the immune system is present in the lamina propria?

A

Lymphoid aggregates

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4
Q

What type of respiratory epithelium lines the upper tract?

A

The upper tract, larynx and trachea are lined by tall, pseudostratified columnar ciliated epithelium with many goblet cells

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5
Q

What is the role of cilia in the upper respiratory tract?

A

cilia are small finger-like processes on the luminal surfaces of the cells

the cilia move synchronously to waft particles entrapped in mucus towards the pharynx.

the goblet cells produce mucus

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6
Q

What respiratory epithelium lines the vocal cords?

A

Stratified squamous epithelium

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7
Q

What supports the trachea and bronchi from collapse?

A

Rings of hyaline cartilage >1mm diameter

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8
Q

Do both bronchi and bronchioles have rings of cartilage?

A

No, bronchioles lack cartilaginous support

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9
Q

What comprises the terminal portion of the respiratory tree?

A 
Terminal bronchiole
Respiratory bronchiole
Alveolar duct
Alveolar sacs
Alveoli
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10
Q

What are alveoli composed of?

A
  1. Epithelium:
    The alveoli are lined by 2 types of epithelial cells:

Type I pneumocytes: large, flat cells across which gas exchange occurs
Type II pneumocytes: cuboidal cells which produce surfactant and which proliferate following injury to the lung

  1. Capillaries
  2. Connective tissue
  3. Alveolar macrophages
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11
Q

Describe the nose and nasal cavity

A

The nose looks fairly solid but in fact contains large air-filled cavities, the paranasal sinuses (black areas on the X-ray)

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12
Q

Where are the paranasal sinuses located?

A

Frontal, maxillary, ethmoid and sphenoid sinuses

The nasal passages extend laterally into the paranasal sinuses (cavities within the frontal, ethmoid sphenoid bones and the maxillae that are lined by respiratory epithelium)

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13
Q

What is the pharynx and where is it located?

A

The throat (pharynx and larynx) is a ring-like muscular tube that acts as the passageway for air, food and liquid.

The pharynx joins the skull to the alimentary and respiratory tracts. It has three divisions (nasopharynx, oropharynx and laryngopharynx)

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14
Q

What are the functions of the larynx?

A

Allow the crossing over of the digestive and respiratory passageways
Prevent food from entering the trachea
Contribute to voice production
Permit coughing by ‘fixing’ the thorax

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15
Q

Where do the hyoid and cricoid bones lie?

A

The hyoid bone lies at the CIII to CIV level

The cricoid at the CV to CVI level

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16
Q

Where does the trachea bifurcate?

A

At the carina T4

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17
Q

How does the heart affect the structure of the main bronchi?

A

The position of the heart means that the left bronchus branches off at an angle so that inhaled foreign bodies (eg Lego) tend to go down the right bronchus.

Foreign objects are more likely to get stuck in the R bronchus as it is shorter, wider and more vertical

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18
Q

Identify the muscles of the thorax

A 
Pectoralis major
Pectoralis minor
Subclavius
Serratus anterior
(Latissimus dorsi)
Diaphragm
External intercostals
Internal intercostals
Innermost intercostals
Scalenes
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19
Q

What type of expansion is:
Pump handle
Bucket handle?

A

Pump handle: Anterior-posterior expansion

Bucket handle: Lateral expansion

The dome of the diaphragm moves down to allow Supero-inferior expansion

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20
Q

What is alongside the ciliated respiratory epithelium lining the trachea?

A

Goblet cells secreting mucus

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21
Q

What obstructs airways in asthma?

A

Spasm of bronchial musculature

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22
Q

Describe the overall structure of the lungs

A

cone-shaped -> apex + base + 3 surfaces + 3 borders

apex: above 1st rib, base: diaphragm, surfaces: costal, mediastinal, and diaphragmatic, borders: anterior (sharp), inferior (sharp), and posterior (smooth)

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23
Q

What are the lobes and fissures of both lungs?

A

right lung has 3 lobes, left lung has 2 lobes

formed by:
oblique fissure – separates inferior from superior + middle lobes; begins T3(L)/T(R); around thorax to level of 6th rib

horizontal fissure – separate superior from middle lobe; follows 4th rib, from inferior border to posterior border

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24
Q

What is the blood supply of the lungs?

A

pulmonary artery brings deoxygenated blood from R ventricle

pulmonary vein brings oxygenated blood to L atrium

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25
What is the lung root?
suspends lungs from mediastinum. covered by mediastinum pleura phrenic nerves pass anterior to lung root vagus nerves pass posterior to lung root
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Which nerves pass too lung root and what is posterior/anterior?
P comes before V so phrenic nerve is anterior + vagus nerve is posterior
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What is the hilum?
the hilum is the entry/exit point between the root and the lungs each root and hilum has: ``` 1 pulmonary artery (superior) 2 pulmonary veins (inferior) main bronchus bronchial vessels nerves + lymphatics ```
28
What is the carina and where is it?
Carina is a full ring circle (cough reflex) composed of: pseudostratified ciliated columnar epithelium + goblet cells -> mucociliary escalator innervation: recurrent laryngeal inferior thyroid artery
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At what levels does the trachea begin and end?
C6-T4
30
How many segment bronchi are there in each lung with only smooth muscle?
10
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What supplies each bronchopulmonary segment?
Its own pulmonary artery
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What is the main secretory cell in the bronchioles?
Clara cell, secretes component of surfactant | no goblet cells
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Type 1 vs Type 2 alveolar cells
Type 1 alveolar cells = alveoli, wall, large, flat, very big surface area, fewer in number Type 2 alveolar cells = surfactant, proliferate in injury, take up less space but many more in number
34
What muscles are used in inspiration and what do they do
Diaphragm: Costal fibres attach to ribs, crura fibres attach around oesophagus and tether. contraction downward and raises chest wall External Intercostals: Forced inspiration. connect adjacent rib and are angled forward so that contraction causes the chest to rise. There are 11 pairs that run inferoanteriorly (from rib above to below) Accessory Muscles: Forced inspiration and exercise. Scalene – elevates first 2 ribs Sternomastoid – lift sternum
35
What muscles are used in expiration and what do they do
Elastic Recoil: ``` Abdominal Muscles: Muscles of the abdominal wall. Active during forced expiration, vomiting, coughing, and defecating. Rectus abdominis Transverse abdominis Internal oblique muscle External oblique muscles ``` Internal Intercostals: Forced expiration. Run inferoposteriorly (from rib above to below)
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What are bronchopulmonary segments?
* An area of lung supplied by a segmental (tertiary) bronchus and accompanying pulmonary artery branch * Each is shaped like an irregular cone with an apex facing the lung root and a base at the pleural surface • Smallest, functionally independent unit of a lung and smallest area that can be isolated and removed without affecting adjacent regions • 10 in each lung (8-10 in left) as some of them fuse in the left lung
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What is the hilum?
HILUM: Root of each lung is a short, tubular collection of structures attaching the lung to the mediastinum Covered by a sleeve of mediastinal pleura that reflects onto the surface of the lungs ``` Within each root is: • Pulmonary artery • Pulmonary veins (2) • Main bronchus • Bronchial vessels • Nerves and lymphatics ```
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What is the pulmonary ligament?
``` Pulmonary ligament: fold of pleura that projects inferiorly from root of lung • Stabilise inferior lobe • Permit movement during respiration ``` Vagus nerves pass immediately posterior to lung root and phrenic nerves immediately anterior
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Describe the trachea
Enters superior thoracic aperture, connecting the root of the neck with the thorax • Lies in an oblique plane, tilted anterosuperiorly • The superior aspects of the pleural cavities, which surround the lungs, lie on either side of the entrance to the mediastinum • Structures entering the thorax from head and neck enter more vertically than those entering from the upper limb
49
Trachea structure
``` The trachea consists of 4 layers • Mucosa - Goblet cells (mucin) • Submucosa • Fibrocartilage • Adventitia - Binds trachea to adjacent structures in the next and mediastinum ``` Secretions of mucous and serous glands moisten the air, which protects the alveoli from desiccation
50
Mobile cartilaginous and membranous tube • Divides into left and right principle (main) bronchi at the level of the sternal angle (T4-T5) • 11cm long, 2.5cm diameter • Fibroelastic tube kept patent by U-shaped bars (rings) of hyaline cartilage • Posterior free ends connected by smooth muscle: trachealis
51
Where is the trachea's position in the neck?
``` • Commences at lower border of larynx - cricoid cartilage (C6) ``` • Anterior to oesophagus • Lies within a visceral compartment of the neck, surrounded by a pre-tracheal layer of fascia * Extend medially in front of carotid sheath * 11cm in length * Bifurcates at T5 – carina
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Features of the bronchi and the differences between right and left
• Right main bronchus is wider and shorter (2.5cm length) • Left main bronchus is narrower, longer and more horizontal (5cm length) • Inhalation of foreign bodies – more likely to enter right bronchus, passing into middle or lower lobe bronchi
54
What is a bronchoscopy?
``` • Bronchoscopy: enables examination of trachea to carina: • Experience permits view of lobar and even segmental bronchi • Can be used for biopsy of mucous membrane and removal of inhaled foreign bodies • Tracheostomy may be required in severe cases to re-establish an airway ```
55
Bronchial tree
Bifurcation of the trachea behind the arch of the aorta into left and right principle bronchi • Bronchi divide dichotomously, giving rise to several million terminal bronchioles that terminate in one or more respiratory bronchioles • Each respiratory bronchiole divides into 2- 11 alveolar ducts that enter alveolar sacs
56
Pleura of lungs
Smooth membrane which secretes serous fluid Two membranes of epithelial cells Line and enclose body cavities One continuous layer in each cavity Parietal (lines body walls) and Visceral (lines organs or ‘viscera’) layers Reflections of serous membranes form ‘potential spaces’ Pleural, pericardial, and peritoneal membranes and cavities (spaces)
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How does pleura develop?
Laryngotracheal tube with lung buds and coelomic cavity Then parietal and visceral pleura Then pleural cavity between them with fully formed lungs
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What is occupied by the lungs during inspiration?
Costodiaphragmatic recess (between costal and diaphragmatic parietal pleura)
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What is occupied by the anterior border of the lungs during inspiration?
Costomediastinal recess: Between costal and | mediastinal parietal pleura
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Pleural effusion
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Pneumothorax
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Innervation of parietal pleura
Parietal pleura has a somatic nerve supply: * Costal pleura by intercostal nerves * Mediastinal pleura by phrenic nerve (C3 C4 C5) * Central diaphragmatic pleura by phrenic nerve • Peripheral diaphragmatic pleura by lower 6 intercostal nerves • Response to touch, temperature and pressure (PAIN)
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Innervation of visceral pleura
Autonomic nervous system (ANS) • Pulmonary plexus • From the sympathetic trunk and the Vagus nerve • Response to distention
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Blood supply to pleura
• Blood supply via the anterior and posterior intercostal arteries • Originate from the internal thoracic artery (branch of the subclavian) and descending thoracic aorta respectively • Form a basket-like pattern of vascular supply around the thoracic wall • Each intercostal artery gives off branches to the muscles, skin and parietal pleura and in the region of the breast in the female the branches to the superficial structures are particularly large
71
What are the blood vessels of the bronchial circulation system and what do they do?
Bronchial arteries carry oxygenated blood to the lungs • Pulmonary capillaries – exchange of water, oxygen, carbon dioxide and nutrients between blood and tissue • Bronchial veins Because of the dual blood supply to the lungs via the bronchial and pulmonary systems, the lungs are more resistant to infarction
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Bronchial arteries
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Bronchial veins
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What do bronchial veins do?
• Return blood from larger bronchi and structures of the lung root • Carrying waste products away from cells that constitute lung tissue • Actually carry only 13% blood flow – rest is returned to the heart via the pulmonary veins • Right side drains into azygous veins • Left side drains into accessory hemiazygous vein
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Lymphatic drainage of the lungs: name the lymph nodes and their locations
• Pre-tracheal and paratracheal nodes are located anterior to, and along the sides of the trachea (respectively); • Superior tracheobronchial nodes, are seen at the superior border of the bifurcation of the trachea; • Bronchopulmonary or hilar nodes, are located in the hilum of the lungs where the main-stem bronchi enter the lungs, • Pulmonary or intrapulmonary nodes, are just deep to the hilum and surround the bronchi; • Inferior tracheobronchial or subcarinal nodes are inferior to the carina of the trachea.
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The sternal angle transects the intervertebral disc between which two vertebrae?
T4/T5
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Sternal angle marks the transition between what?
Superior and inferior mediastinum
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What is the anterior boundary of the superior mediastinum?
Manubrium of sternum
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Pericardium
80
Which surfaces are separated by the inferior border?
Base from costal and mediastinal surfaces
81
Lingula means...
tongue like
82
Where does apex of lung project?
Above level of 1st rib and into root of neck
83
Stab wound to the neck can cause what problem with lungs and pleura?
Pneumothorax
84
Bronchopulmonary segments in right lung?
10
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Blood in bronchial arteries vs pulmonary arteries
1% in bronchial arteries
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Clinical significance of bronchopulmonary segments
Independent units- COPD patients can utilise other segments instead of damaged one bc they're BUILT DIFFERENT Can be surgically excised without entire lung being lobbed off Limits infection spread bc connective tissue between the segments

Anatomy (13 decks)

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