Week 5

Question 1

What does partial pressure of a gas mean?

Answer 1

* The pressure exerted by a single gas in a mixture

Question 2

Define

1. FIO2
2. PIO2
3. P_A
4. PAO2
5. Pa
6. PaO2
7. PACO₂
8. PaCO₂
9. P_ECO₂
10. P_B

Answer 2

Question 3

Define

1. P_V
2. P_PL
3. P_AW
4. P_TP
5. R_AW
6. R
7. V_T
8. V_D
9. V_A
10. V_E
11. n

Answer 3

Question 4

During exercise what happens to

1. Cardiac output
2. Arterial pressure
3. Skeletal muscle arteries
4. Sympathetic activity
5. Tidal volume
6. Breathing frequency
7. Oxygen demand
8. Production of CO₂

Answer 4

1. Increased cardiac output
2. increased
3. dilated skeletal muscle arteries - to allow for max blood flow to muscles
4. increased sympathetic activity
5. increased tidal volume
6. increased breathing frequency
7. increased oxygen demand
8. increased production of CO2

Question 5

with more external power output (more exercise) there is (BLANK) oxygen consumption?

Answer 5

1. more oxygen consumption
   * at a certain exercise intensity oxygen consumption levels out and there is a change to anaerobic metabolism

Question 6

How does oxygen consumption change between trained and untrained individuals?

Answer 6

1. Trained individuals have higher oxygen consumption with exercise before moving onto anaerobic metabolism

Question 7

1. What is VO₂ max?
2. What is the equation for this?

Answer 7

1. maximum oxygen consumption.
2. VO₂ = CO X rate of oxygen consumption of muscles

Question 8

With VO₂ equation → what are ways to increase VO₂

Answer 8

1. Increase SV (part of cardiac output) → no increase in HR because this is just due to age
   * CO increases with training (via SV)

Question 9

Why do trained athletes have bradycardia at rest?

Answer 9

• trained athletes have increased SV
• If athletes maintained “normal” HR then their cardiac output would be too large due to large SV
• To have normal cardiac output at rest → reduced HR paired with increased SV normalizes CO

Question 10

How is Stroke volume increased? (2)

Answer 10

1. Increased CVP which leads to increase in preload and therefore end diastolic volume
2. Increase in ventricular chamber size

Question 11

What is sports anemia?

Answer 11

1. athletes have increased plasma albumin production which leads to more fluid/plasma volume
2. This means concentration of hemoglobin falls → this is anemia (low hematocrit)

Question 12

What leads to muscle’s increased O2 extraction?

Answer 12

1. Increased capillary formation throughout muscles;; increased muscle blood flow and decreased diffusion distance for oxygen
2. increased expression of mitochondrial enzymes → leads to greater consumption of O₂

Question 13

1. What is static exercise?
2. what type of hypertrophy does this leads to?

Answer 13

1. exercise done for a short duration in one spot. Usually using weights.
2. concentric hypertrophy

Question 14

1. What is dynamic exercise?
2. what type of hypertrophy does this leads to?

Answer 14

1. repetitive and sustained movement of limbs like running or bicycling
2. Eccentric hypertrophy

Question 15

1. What is internal respiration?
2. What is external respiration?

Answer 15

1. When mitochondria use oxygen to make energy and CO2 within the cell
2. What the lungs do → deliver continuous amount of oxygen to tissues

Question 16

What 3 processes are involved in external respiration?

Answer 16

1. Ventilation - bulk flow of gas from atmosphere into the lungs
2. Perfusion - circulatory system job to deliver oxygen to tissues and pick up CO2 to bring back to lungs
3. Diffusion (molecular level) - diffusion occurring across membrane at the blood gas interface in lung where O2 diffuses in and CO2 diffuses out

Question 17

What is the partial pressure of oxygen in…

1. atmosphere
2. airway/bronchi (inspired air)
3. Alveoli
4. Systemic arterial blood
5. Pulmonary arterial blood

Answer 17

1. 159 mmHg
2. 149 mmHg
3. 100 mmHg
4. 97 mmHg
5. 40 mmHg

Question 18

What is the partial pressure of CO2 in…

1. atmosphere
2. Alveoli
3. Systemic arterial blood
4. Pulmonary arterial blood

Answer 18

1. 0 mmHg
2. 40 mmHg
3. 40 mmHg
4. 46 mmHg

Question 19

one equation for partial pressure

Answer 19

P_x= total pressure X fractional concentration of X

fractional concentration is a percentage of whole gas mixture

Question 20

What is oxygen’s composition (fractional concentration) in dry air?

Answer 20

21% (159 mmHg)

Question 21

Why is oxygen partial pressure in upper airway different/lower than atmosphere?

Answer 21

1. there is humidity in airway that lowers the partial pressure of oxygen to 149 mmHg (instead of 159 mmHg in atmosphere)

Question 22

What is the main pushing force that moves oxygen from lungs to circulation

1. pressure gradient of gas
2. hemoglobin

Answer 22

1. oxygen movement via only partial pressure doesn’t get much oxygen into circulation
2. ***greater effect**** Hemoglobin has high affinity for oxygen so oxygen moves into hemoglobin and allows there to be continued movement of oxygen from lungs to circulation via pressure changes

Question 23

What muscles are involved in inspiration? (3)

Answer 23

1. Diaphragm - flattens and pulls lungs out increasing chest wall cavity
2. External intercostals - raise the ribs in bucket handle motion (water moves upward and outwards leading to chest cavity expansion)
3. Accessory muscles - scalene and sternocleidomastoid (help with breathing in distress)

Question 24

What muscles are involved in expiration when breathing?

Answer 24

1. only requires relaxation of 3 inspiratory muscles discussed in other card.

• lungs need to be elastic - tendency to shrink back
• contraction of the abdominals can help assist pushing diaphragm up
• Internal intercostals can help pull ribs downward and inward (during heavy breathing)

Question 25

What creates negative pressure in intrapleural space?

Answer 25

On inspiration lungs try to move inwards (due to its elastic characteristics) while chest cavity moves outwards → two opposite pressures leads to creation of negative pressures

Question 26

What is functional residual capacity?

Answer 26

The volume remaining in the lungs after a normal, passive exhalation

Question 27

Why is there no negative pressure in pneumothorax?

Answer 27

air enters the pleural space which leads to no negative pressure. * The lungs, due to their elasticity, collapse and even with chest wall expansion - negative pressure is still lost

Question 28

What is TLC (total lung capacity)?

Answer 28

maximum amount of air your lungs can hold

Question 29

What is RV (residual volume)?

Answer 29

The amount of air remaining in the lungs after a maximal expiration

Question 30

Explain the compliance curve for lungs, chest wall, and respiratory system

Answer 30

* The purple line is compliance of chest wall - It crosses to left of y axis because chest wall creates negative pressure in thoracic cavity * The black line is compliance of lungs - since lungs have elasticity component they only have positive pressure and only lands on right of Y axis * The blue line is combination of lungs and chest wall

Question 31

Explain how alveolar pressure can be negative and positive at different points of breathing?

Answer 31

1. during inspiration the alveolar space increases and causes negative pressure to bring in inspired air into lungs 2. during expiration there is decrease in alveolar volume and an increase in alveolar pressure which pushes air out of lungs

Question 32

1. What is lung compliance? 2. What is its relationship with elasticity of lungs?

Answer 32

1. the measure of stiffness of lung that reflects the extent of elastic recoil → it is a measure of lung expandability 2. The more compliant the lungs are the easier it is to inflate but less elastic. -losing elastic recoil 3. Less compliance the lungs are harder to inflate but more elastic recoil

Question 33

In lung volume over pressure graph → how do you determine compliance?

Answer 33

Slope is compliance

Question 34

What 3 factors control compliance?

Answer 34

1. Elastic tissue - more elastic tissue decreases compliance 2. Surface tension - this reduces lung compliance. With more surface tension there is atelectasis (alveolar collapse) → typically surfactant reduces surface tension 3. Ease of rib movement - with less rib movement there is less compliance (not easy to fill lungs)

Question 35

What changes to total lung capacity, functional residual capacity, and residual volume occur in emphysema?

Answer 35

1. emphysema leads to increased compliance 2. TLC increases because lungs can fill more easily 3. FRC is increased because elasticity is decreased - difficult to exhale 4. RV is increased because elasticity is decreased - difficult to exhale

Question 36

What changes to total lung capacity, functional residual capacity, and residual volume occur in fibrosis?

Answer 36

1. Fibrosis leads to decrease in compliance - so lungs can't fill easily 2. Low TLC - can't fill up lungs completely 3. FRC and RV are low as well because increased elasticity leads to more exhalation of air, leaving little air left in lungs. *remember compliance and elasticity are opposite*

Question 37

What is the function of type II alveolar cells?

Answer 37

1. produces surfactant in the lungs which reduces surface tension in the alveolar lining 2. Surfactant increases alveolar stability

Question 38

1. What is considered part of upper respiratory tract? 2. What is the function of this part?

Answer 38

1. Everything from nostrils to the trachea 2. conditions air coming in, humidifies air coming in, captures particles/pathogens

Question 39

1. What is considered part of lower respiratory tract? 2. What is the function of this part?

Answer 39

1. From trachea to alveoli 2. site of gas exchange

Question 40

What is the function of goblet cells?

Answer 40

secretes mucus which sits above epithelia

Question 41

What is the function of ciliated epithelial cells in respiratory system?

Answer 41

* ciliated cells beat upwards and push mucus upwards so it can be readily expelled out of lungs (most of the time we swallow mucus)

Question 42

1. What is the function of alveolar macrophages? 2. What are some consequences of hyperactive macrophages?

Answer 42

* Scavenge inside of alveoli and pick up any particles or debris that make it down to alveoli. → Most abundant in smokers * hyperactive macrophages can contribute to emphysema (degradation of elastin)

Question 43

What are the steps to typical acute inflammatory response following bacterial infection of an alveolus?

Answer 43

1. Stimulated macrophages release cytokines and chemokines 2. Lead to vasodilation and vascular leakage which can lead to edema 3. There is thickening of hyaline membrane for alveolus 4. Chemokines attract neutrophils to come into alveoli 5. Neutrophils ingest bacteria and produce ROS and proteases which can damage lung but overall meant to get rid of pathogen *in chronic cases - you get deposition of fibrin and collaged which compromises elasticity of lungs (lung fibrosis)*

Question 44

What is Waldeyer's ring? (lymphatic system)

Answer 44

* a ring of lymphatic structures in the back of the throat

Question 45

Differentiate between deep and superficial lymphatic branches?

Answer 45

1. Deep lymphatic branches - drains lymph from lung parenchyma (where gas exchange occurs) ; usually around alveoli 2. Superficial lymphatic branches - drains lymph from exterior surfaces of lungs and pleural membranes

Question 46

What is the function of dendritic cells in interstitial tissue of lungs?

Answer 46

1. they sample antigens and when activated migrate to lymphatics to activate T cells and B cells 2. B cells produces IgA antibodies and are committed to these antibodies (B cells become fully differentiated and make IgA right beneath surface of epithelial layer)

Question 47

What is the role of IgA in mucosal immune defense?

Answer 47

1. Secreted IgA on the gut surface can bind and neutralize pathogens and toxins

Question 48

1. What is the Henderson-Hasselbach equation?

Answer 48

1. way of determining the pH of a buffer

Question 49

What is the modulated H-H equation for biological purposes in circulation and lungs?

Answer 49

* pH= 6.1 + Log ([HCO3-]/ (0.03 \* [pCO2])) * The HCO3^- part is regulated by kidneys * The pCO2 part is regulated by lungs

Question 50

What is the bicarbonate equation?

Answer 50

* CO₂ + H₂O H₂CO₃ H⁺ + HCO₃^- * Bicarbonate is HCO₃^- * Carbonic acid is H₂CO₃

Question 51

If there is too much CO₂ or H+ how is this regulated in the body?

Answer 51

* If there is too much CO2 then it gets blown out by lungs * If there is too much H+ then it gets excreted by kidneys

Question 52

1. What does metabolic acidosis? 2. What is compensation mechanism for this?

Answer 52

1. Decreased pH due to decreased bicarbonate (HCO₃^-) → with less HCO₃^- the bicarbonate eqn moves more the right increases [H+] concn → decreased pH 2. Compensated by lungs blowing of CO2 to raise pH (moves bicarbonate eqn to left, reducing H and increasing pH)

Question 53

1. What does respiratory acidosis? 2. What is compensation mechanism for this?

Answer 53

1. Decreased pH due to increased CO2 (moves bicarbonate eqn to right, increasing [H+], decreasing pH) 2. compensated by kidney retaining HCO3- (bicarbonate) (moves bicarbonate eqn to left to decrease [H+] and increase pH)

Question 54

1. What does metabolic alkalosis? 2. What is compensation mechanism for this?

Answer 54

1. Increased pH due to increased bicarbonate 2. Compensated by lungs retaining retaining CO2 (moves equation to right which increases concn of H+ → this decreases pH)

Question 55

1. What does respiratory alkalosis? 2. What is compensation mechanism for this?

Answer 55

1. Increased pH due to decreased CO2 2. Compensated by kidneys excreting increased HCO3- (leads bicarbonate eqn to move to the right [increasing H+ concn]) meant to decrease pH

Question 56

What is the anion gap equation?

Answer 56

Na – (Cl + HCO3-) = anion gap * the difference in concn between cations and anions * does not take into considerations all cations and anions just the main ones with highest concentration

Question 57

1. What does high anion gap mean? 2. In what situations is anion gap increase seen?

Answer 57

* This means there are unmeasured anions that were added to the system. * When there is increase in more organic acids like lactate and ketoacids. This is because when acids are introduced they donate H+ to bicarbonate. * Now you have neg charge from acid and positive charge from Na+ (still neutral) -but- when checking cation/anion levels you have decrease in HCO3- and so anion gap increases * anion from lactate or ketoacids don't get counted

Question 58

What is your pharynx and what is it composed of?

Answer 58

1. basically your throat 2. nasopharynx (increase resonance for speech, contains auditory tubes, contains pharyngeal tonsil) 3. soft palate/uvula 4. osopharynx (contains palatine, linguil tonsils, and epiglottis

Question 59

What is the larynx?

Answer 59

* The voice box formed by cartilage * vocal cords are dense connective tissues covered in stratified squamous epithelium (not respiratory epithelium)

Question 60

What is phonation vs articulation?

Answer 60

1. phonation - vibration produces sound 2. Articulation - lips and tongues modify sounds for speech

Question 61

Describe respiratory epithelium and its basement membrane?

Answer 61

1. pseudostratified epithelium with thick basement membrane

Question 62

Which ones are the ciliated cells, goblet cells, DNES (diffuse neuroendocrine cells), and basal cells in this image

Answer 62

1. Arrow is ciliated cells that move mucus upwards 2. Arrowhead is goblet cells - secrete mucus 3. Triangle is basal cells - stem cells meant to replenish various cell types

Question 63

List the subdivisions that come off the trachea

Answer 63

1. trachea 2. left or right main bronchus 3. secondary bronchi 4. tertiary bronchi (or segmental bronchi) 5. Bronchioles

Question 64

In histology of trachea - what parts can be identified (3) and what is found within each part?

Answer 64

1. Epithelium - pseudostratified epithelium with thick basement membrane + mucosa is found here 2. Lamina Propria (LP) - connective tissue fibers and lymphoid cells 3. Submucosa (SM) - elastic fibers, seromucus glands, blood vessels, nerves, lymphatics

Question 65

In histology of bronchi - what does the walls contain? (5)

Answer 65

1. respiratory epithelium → as there is more branching the cells in epithelium become shorter 2. Plates of hyaline cartilage (arrows) 3. bands of smooth muscle (arrow heads) 4. seromucous glands (triangle) - as bronchus become smaller you see less and less goblet cells 5. Lymphoid aggregates (A collection of B cells, T cells, and supporting cells)

Question 66

In histology of bronchiole - what does the walls contain? (3)

Answer 66

1. smooth muscle is present 2. epithelium shrinks and becomes cuboidal 3. Goblet cells only seen in largest bronchioles

Question 67

What are club cells and where are they found

Answer 67

1. found in smaller airways like terminal bronchioles, respiratory bronchioles, alveolar ducts 2. function is to secrete surfactant, detoxify airborne chemicals via P450 enzymes, secrete lysozyme and antimicrobial agents

Question 68

Describe and identify terminal bronchioles vs respiratory bronchioles? *describe - meaning what is found in each*

Answer 68

1. Terminal bronchioles (star) have cuboidal epithelium and some smooth muscle → don't have gas exchange 2. Respiratory bronchioles (diamonds) - start of respiratory portion and do show gas exchange. Have Club cells, some alveoli, and little muscle

Question 69

1. What is alveolar ducts continuous with? 2. Do they have smooth muscle?

Answer 69

1. continuous with respiratory bronchioles 2. Extremely small amounts of smooth muscle

Question 70

1. What are alveoli walls composed? 2. What envelopes alveoli?

Answer 70

1. pneumocyte cells 2. anastomosing capillary network

Question 71

what are alveolar pores of kohn?

Answer 71

Spaces that link adjacent alveoli together- equalize air pressure between alveoli and allow air flow to alveoli that are blocked

Question 72

Differentiate between type I and type II pneumocytes

Answer 72

1. type 1 - extremely flat cells. Form most of alveolar wall and create tight junctions between cells. closely assoc. with capillaries and cannot divide if damaged 2. Type II - cuboidal cells that project into lumen. they produce surfactant and can differentiate into type I cells.

Question 73

What are the three layers of blood gas barrier?

Answer 73

1. Surfactant and type I pneumocyte cytoplasm (arrow) 2. Fused basement membrane (arrow head) 3. Capillary endothelial cell cytoplasm (triangle)

Question 74

What is total ventilation?

Answer 74

**a measurement of the amount of air that enters the lungs per minute**

Question 75

what is the equation for total ventilation?

Answer 75

tidal volume X respiration rate

Question 76

What is the difference between total ventilation and alveolar ventilation?

Answer 76

total ventilation is total air that comes into lungs but alveolar ventilation is total air that reaches alveolus to do gas exchange

Question 77

What is normal PaCO2 ?

Answer 77

35-45

Question 78

1. If PaCO2 is low what does this mean? 2. What about if PaCO2 is high what does this mean?

Answer 78

1. hyperventilation 2. hypoventilation

Question 79

What is anatomic dead space?

Answer 79

areas in the respiratory tract that do not participate in gas exchange, such as nose and trachea

Question 80

What is alveolar dead space?

Answer 80

alveolar dead space refers to **the alveoli that are ventilated but not perfused (blood circulation)** and thus gas exchange does not take place.

Question 81

What is physiologic dead space?

Answer 81

equal to anatomic plus alveolar dead space

Question 82

What is normal physiological dead space V_D/V_T?

Answer 82

0.2-0.35 at rest

Question 83

What part of the lung is more compliant and expands more during inspiration? (thus more ventilated)

Answer 83

* base is more compliant and expands more

Question 84

What is diffusion limited gasses?

Answer 84

Scenario in which the rate at which gas is transported away from functioning alveoli and into tissues is limited by diffusion rate of gas across membrane

Question 85

What is perfusion limited gas?

Answer 85

these gasses are limited by the rate of perfusion/blood flow in capillaries

Question 86

Why may increasing time of gas diffusion (0.25 seconds) be bad for the patient during exercise but not rest?

Answer 86

* at rest they may be fine because there is an extra 0.5 second to diffuse oxygen into alveoli completely (since RBC spends 0.75 seconds in capillaries) but * During exercise they only have 0.25 seconds in capillaries and if time of gas diffusion increases more than this then oxygen levels can go down for individual

Question 87

pulmonary circulation is (BLANK A) flow, (BLANK B) pressure

Answer 87

Blank A - high flow Blank B - low pressure *pulmonary circulation can accept a lot of blood and is very compliant*

Question 88

Why is there little smooth muscle in pulmonary circulation?

Answer 88

Because all blood is going to alveoli and don't need to control blood path with vessel constriction - less work from heart *pulmonary vascular resistance is approx. 1/10th of systemic vascular resistance*

Question 89

What is perivascular cuffing?

Answer 89

* With pulmonary edema - fluid moves into perivascular space which surrounds the artery and leads to compression of the artery * This causes engorgement of interstitial perivascular spaces (early edema) and increased arterial pressure * Late edema is fluid in alveoli

Question 90

How does body reduce pulmonary vascular resistance via capillaries?

Answer 90

* Recruitment of more capillaries which means more total surface area → decrease resistance * Distention of capillaries allows them to hold more blood

Question 91

where is blood flow greater in lung? and why Also, how does pulmonary arterial pressure and alveolar change throughout lung zones and its effects on arteries opening/closing

Answer 91

1. blood flow is greater at base than at apex due to gravity 2. at hilum the pulmonary arterial pressure is lowest and alveolar pressure is actually greater so arteries next to alveoli collapse 3. At base of lungs the pulmonary arterial pressure is greatest/greater than alveolar pressure → so it opens arteries

Question 92

What is hypoxic pulmonary vasoconstriction and when is it beneficial?

Answer 92

1. decreased alveolar PO2 leads to depolarization of K+ → then vasoconstriction 2. this is beneficial when blood need to be redirected away from under ventilated areas or in fetus when lungs are not used

Question 93

What is the difference between arterial PO2 and arterial O2 content?

Answer 93

1. Arterial O2 content is greater than PO2 because of hemoglobin 2. The content is larger because O2 is attached to hemoglobin in circulation + what O2 is dissolved (which is smaller)

Question 94

What does the plateau at top of curve indicate?

Answer 94

1. this means that even though there is a drop in lung PO2 (perhaps due to hypoventilation) Hb saturation can be maintained and will not drop a lot 2. With severe hypoxia then you may see Hb saturation on steep side of curve

Question 95

In this hemoglobin dissociation curve… -what does left shift mean? what causes left shift when it comes to 1. H+ 2. PCO2 3. 2,3 BPG

Answer 95

* left shift means Hb holds onto O2 more readily 1. Increased pH or decreased H+ causes left shift 2. Decreased PCO2 3. Decreased 2,3 BPG

Question 96

In this hemoglobin dissociation curve… -what does right shift mean? what causes right shift when it comes to 1. H+ 2. PCO2 3. 2,3 BPG

Answer 96

* right shift means Hb gives up O2 more readily 1. low pH or high H+ causes right shift 2. High CO2 (Bohr effect) causes right shift 3. High 2,3 BPG causes right shift

Question 97

How does carbon monoxide change arterial O2 content vs arterial PO2?

Answer 97

1. O2 content decreases 2. arterial PO2 stays the same *this issue with CO is with binding to hemoglobin*

Question 98

How does hyperbaric chamber help with carbon monoxide poisoning?

Answer 98

* Hyperbaric chamber greatly increases PO2 in the alveoli * This increased dissolved O2 pressure decreases the half-life of CO-Hb and kicks off the CO from Hb due to increased O2 pressure

Question 99

What are the three ways CO2 is carried in blood? (which is most common) ## Footnote **this is in pulmonary circulation, not systemic circulation**

Answer 99

1. dissolved in blood 2. carbamino compounds (second most common - accounts for 30 %) 3. bicarbonate (most common - accounts for 60%)

Question 100

What is the Haldane Effect?

Answer 100

This is the opposite of Bohr effect meaning that Hb cannot carry as much CO2 because there is increased amount of O2. * this means blood cannot carry CO2 in form of bicarbonate and carbamino Hb since its too busy carrying increased O2 presence- this will increase PCO2

Question 101

Maturation of lungs Embryonic Period 1. what weeks of fetus growth? 2. What happens in this stage?

Answer 101

1. 1-7 weeks 2. appearance of lung buds and main pulmonary arteries

Question 102

Maturation of lungs Pseudoglandular Period 1. what weeks of fetus growth? 2. What happens in this stage?

Answer 102

1. 5-16 weeks 2. Formation of terminal bronchioles

Question 103

Maturation of lungs Canalicular period 1. what weeks of fetus growth? 2. What happens in this stage?

Answer 103

1. 16-26 weeks 2. terminal bronchiole divides into two or more respiratory bronchioles → then divides into 3-6 alveolar ducts

Question 104

Maturation of lungs Terminal Sac (Saccular) period 1. what weeks of fetus growth? 2. What happens in this stage?

Answer 104

1. 26 wks to birth 2. terminal sacs (primitive alveoli) form

Question 105

Maturation of lungs Alveolar period 1. what weeks of fetus growth? 2. What happens in this stage?

Answer 105

1. brith to childhood/adolescence 2. maturation of alveoli

Question 106

What is a tracheoesophageal fistula?

Answer 106

1. abnormal connection in one or more places between the esophagus and the trachea. These two should not connect.

Question 107

What is esophageal atresia?

Answer 107

a condition in which an abnormal gap forms between the baby’s esophagus and stomach. Instead of ending in the stomach, the esophagus ends in a pouch.

Question 108

what is polyhydramnios?

Answer 108

excessive accumulation of amniotic fluid which can happen with esophageal atresia because fetus cannot swallow amniotic fluid

Question 109

How does diaphragm develop during fetal development?

Answer 109

1. fusion of pleuroperitoneal folds with septum transversum and mesentery of esophagus

Question 110

What is congenital diaphragmatic hernia?

Answer 110

When diaphragm fails to properly separate the abdomen from thorax and show it leads to intestines moving up into the thorax * can lead to hypoplasia of lungs - usually on left side

Question 111

1. What is TTN (transient tachypnea of newborn) 2. symptoms? 3. how is treated

Answer 111

1. Caused by impaired fetal lung fluid clearance. Normally in utero, the fetal airspaces and air sacs are fluid filled. 2. tachypnea, labored breathing 3. supportive care with supplemental oxygen or CPAP to maintain alveolar integrity

Question 112

How does fetus usually get rid of fluid in airspaces late in pregnancy or at birth?

Answer 112

chloride and fluid secreting channels in lung epithelium are reversed so fluid absorption occurs and fluid is removed

Question 113

1. What are risk factors for TTN (transient tachypnea of newborn) (5)

Answer 113

1. C-section 2. Precipitous delivery 3. Late preterm (34-36 weeks) or early term (37-38) 4. Maternal sedation or medication 5. Gestational diabetes 6. and more

Question 114

What is normal pregnancy length?

Answer 114

40 weeks

Question 115

1. What is Neonatal Pneumonia 2. symptoms? 3. how is treated

Answer 115

1. respiratory infection in newborn that can be bacterial, viral, fungal, etc. Since there is underdevelopment of respiratory cilia and less macrophages the fetus cannot clear pathogens well. 2. Tachypnea, suspicious appearing tracheal aspirates, cough, apnea, high or low temperature, poor feeding, abdominal distension, and lethargy 3. with early onset give penicillin and aminoglycoside as initial treatment

Question 116

what are risk factors for neonatal pneumonia? (4)

Answer 116

1. Maternal group B strep carrier 2. PROM (prolonged rupture of membranes) 3. Maternal fever 4. Prematurity 5. and more

Question 117

1. What is RDS (respiratory distress syndrome) 2. symptoms? 3. how is treated

Answer 117

1. Caused by insufficiency of alveolar surfactant → increased surface tension in alveoli resulting in collapse of alveoli and low lung volumes 2. Tachypnea, nasal flaring, grunting, subcostal/intercosta/suprasternal retractions 3. Administer surfactant and usually resolves within 3-4 days

Question 118

What are risk factors for RDS? (4)

Answer 118

1. prematurity 2. gestational diabetes 3. male infant 4. multiple gestation

Question 119

1. What is MAS (meconium aspiration syndrome) 2. how is treated

Answer 119

1. When fetus passes meconium (first poop) before birth and are at risk or have aspirated meconium in utero or after birth. Meconium causes inflammation and epithelial injury → leads to partial obstruction 2. focus on decreasing inflammation

Question 120

What are risk factors of MAS (meconium aspiration syndrome) (3)

Answer 120

1. MSAF (meconium stained amniotic fluid) 2. Postterm (more than 42 weeks) 3. Fetal distress

Question 121

where does the costal part of diaphragm end?

Answer 121

Ends of ribs 11 and 12 (11 because right side of diaphragm is higher up due to liver being there)

Question 122

what is the motor supply/innervation to the diaphgram?

Answer 122

Phrenic nerve (C3,C4,C5)

Question 123

what is the sensory supply to the diaphragm?

Answer 123

1. central part of diaphragm - phrenic nerve 2. peripheral parts - intercostal nerves

Question 124

What is the main artery that gives off blood supply to diaphragm?

Answer 124

Inferior phrenic artery (right and left)

Question 125

1. what are the three openings in the diapgram? 2. And at what levels of spine are they at?

Answer 125

1. Caval opening - T8 2. Esophageal Hiatus - T10 3. Aortic Hiatus - T12

Question 126

What goes through Caval opening of diaphgram?

Answer 126

1. IVC (inferior vena cava) 2. Right phrenic nerve

Question 127

What goes through esophageal hiatus opening of diaphgram?

Answer 127

1. esophagus \*\*\*know\*\* 2. ant. and post. vagal trunks 3. esophageal branch of left gastric vessels 4. lymphatic vessels *just need to know #1 but rest is extra*

Question 128

What goes through Aortic Hiatus opening of diaphgram?

Answer 128

1. Descending aorta 2. Thoracic duct 3. Possibly azygous veins

Question 129

What two movements do intercostal muscles cause with their contraction?

Answer 129

1. anteroposterior movement - pump handle movement 2. lateral movement of thorax

Question 130

What is the parietal pleura vs visceral pleura?

Answer 130

1. parietal - lines thoracic wall, diaphragm, and mediastinum 2. Visceral pleura - firmly attached to outer surface of lungs

Question 131

what are the two pleural recesses?

Answer 131

1. costodiaphragmatic recess 2. costomediastinal recess * these are like gutters where parietal pleura oppose eachother

Question 132

Where do you listen to to hear… 1. apex of right lung 2. middle lobe of right lung 3. superior lobe of right lung 4. inferior lobe of right lung 5. apex of left lung 6. inferior lobe of left lung 7. superior lobe of left lung

Answer 132

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Question 133

where do the roots of the lungs align with vertebra?

Answer 133

level T5 to T7

Question 134

1. what is the pulmonary ligament? 2. Its purpose?

Answer 134

1. fold of pleura that projects inferiorly from the root of the lung. 2. It allows movement of lung root during respiration

Question 135

What does RALS mean in terms of anatomy of lungs?

Answer 135

1. Right anterior left superior 2. meaning on _right_ lung the pulmonary artery is **anterior** to the bronchus 3. on the _left_ lung the pulmonary artery is **superior** to the bronchus

Question 136

Where do vagus and phrenic nerve land in relation to root of lungs?

Answer 136

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Question 137

Describe the impressions found on RIGHT LUNG

Answer 137

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Question 138

Describe the impressions on the LEFT LUNG

Answer 138

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Question 139

in relation to spine vertebrae → where does trachea start and end?

Answer 139

1. C6 to T4/T5 (sternal angle)

Question 140

What is the carina?

Answer 140

splits the main bronchi → creates main bronchi

Question 141

Which main bronchi is food/foreign object most likely to be stuck in?

Answer 141

1. right main bronchus because it is wider and more vertical than left

Question 142

Which level of bronchial tree if first division that individually supplies a lobe of the lung?

Answer 142

1. secondary bronchus (3 on right and 2 on left)

Question 143

1. Is terminal bronchioles considered part of anatomic dead space? 2. What about respiratory bronchioles?

Answer 143

1. yes 2. no

Question 144

How are bronchial arteries and veins positioned throughout the lungs?

Answer 144

1. arteries follow along with the bronchus (segmental/tertiary bronchus) 2. veins lie between and around the margins of the bronchopulmonary segments in the connecting tissue

Question 145

What do bronchial veins drain into?

Answer 145

1. Bronchial veins drain into pulmonary veins (which then drain into left atrium) or azygous vein (which then drain into SVC)

Question 146

1. Where does the lymph from lungs end up draining into? 2. And which one receives more lymph/coverage of lungs

Answer 146

1. _Right_: right lymphatic duct (D) ; _Left_: thoracic duct (E) 2. The right lymphatic duct gets lymph from all of right lung and part of left lung

Question 147

1. What is the superior part/beginning of posterior mediastinum? 2. What is the inferior end? *in terms of vertebral level*

Answer 147

1. begins at sternal angle (T4/T5) 2. T12

Question 148

What is found in posterior mediastinum?

Answer 148

1. esophagus 2. thoracic aorta and branches 3. azygous venous system 4. Thoracic duct and lymph nodes 5. Thoracic sympathetic trunks and ganglion 6. Vagus nerves

Question 149

Identify which is azygos, hemiazygos, and accessory hemiazygos vein

Answer 149

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Question 150

1. What is the cisterna chyli 2. Where does it start (in relation to vertebral level)? 3. What opening of diaphragm does it pass through?

Answer 150

1. the origin of thoracic duct 2. Begins at T12 and goes upwards 3. aortic opening. Ascends on the right side of aorta

Question 151

The thoracic duct recieves lymph from all regions of the body except? 1. blank a 2. blank b 3. and blank c (2 parts to c)

Answer 151

1. right arm 2. right thorax 3. right head and neck

Question 152

How do you determine respiratory vs metabolic acidosis? (pH, PCO2, HCO3-)

Answer 152

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Question 153

What is normal pH range?

Answer 153

7.35-7.45

Question 154

What is normal HCO₃^- range?

Answer 154

22-28 mEq/L

Question 155

What is normal PCO₂ range?

Answer 155

1. 33-45 mmHg

Question 156

What is the expected compensation for 1. respiratory acidosis 2. metabolic acidosis 3. respiratory alkalosis 4. metabolic alkalosis

Answer 156

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Question 157

1. Decreased HCO3- or increased CO2 (Blank A) pH 2. Increased HCO3- or Decreased CO2 (Blank B) pH 3.

Answer 157

1. Blank A = decreases 2. Blank B = increases

Question 158

What is normal anion gap?

Answer 158

12 mEq/L