Week 6 Flashcards
(149 cards)
1
Q
What thoracic structures protrude above first rib?
A
Apex of lung
2
Q
What type of nerve is phrenic nerve?
Where does it originate?
Components?
A
Spinal nerve
C3,4,5
Somatomotor, general sensory, postganglionic sympathetic
3
Q
Parietal pleura extends farther than the lungs do.
A
4
Q
Fissures in lungs
Position relative to the diaphgram
A
Right horizontal tissue 4th rib
Right oblique fissure 6th rib
Right bolique fissure 6th rib
5
Q
How far does the lung / parietal pleura extends in mid-clavicular line?
How far does the lung / parietal pleura extends in mid-axillary line?
(passive respiration)
A
6th rib / 8th rib
8th rib / 10th rib
6
Q
Pulmonary recesses
A
Costodiaphragmatic recess
Mediastinal recess
7
Q
What is the root of the lung?
A
Pulmonary arteries, bronchi, and pulmonary veins
8
Q
Point where the root of the lung enters the lung?
What type of airway enters the left lung?
What type of airway enters the right lung?
A
Hilum
Single primary bronchus
2 Secondary bronchi (1 splits in two to go to middle)
9
Q
Right lung vein/artery arrangement/bronchi
A
Pulmonary arteries lie anterior to bronchi
Pulmonary veins lie anterior/inferior to arteries (to all structures)
10
Q
Left side
A
Pulmonary arteries lie superior to bronchus
Pulmonary veins lie inferior and aterior to all other structures
11
Q
What are the units of lung supplied by tertiary bronchus
A
Bronchopulmonary segments
12
Q
What is the difference in blood supply to bronchopulmonary segments?
A
Arteries are intrasegmental
Veins are intersegmental
Surgery in removing bronchopulmonary segment *
13
Q
Which main bronchus is wider and is more vertical?
A
Right
14
Q
At what level does the trachea divides?
A
At the junction of the ascending aorta and the arch
15
Q
In which mediastinum is the trachea located?
A
Superior mediastinum
16
Q
Name of the splitting trachea
A
Carina
17
Q
Does viceral pleura feel pain?
Does parietal pleura feel pain?
A
No
Yes
18
Q
What nerves are connected to lungs?
A
Cardiopulmonary plexus:
Vagus
Sympathetic
Same as heart
Visceral afferent
Visceral motor
19
Q
What part of lungs feels pain?
A
Pleura (parietal)
20
Q
Blood supply to lungs
A
Pulmonary artery
Superior and inferior left bronchial arteries
21
Q
Where is the lymph drained to in lung?
A
Bronchopulmonary nodes
22
Q
Where does the thoracic duct enters the venous system?
A
Between left subclavian and jugular
23
Q
What are the lymph nodes around trachea?
A
Paratracheal
24
Q
What is contained in superior mediastinum?
A
Aortic arch
Roots of great vessels
Esophagus
Trachea
Vagal
Phrenic
Cardiac Nerves
Thymus
Azygous drainings
25
Layers of superior mediastinum
Glandular
Venous
Arterial
Respiratory
Digestive
26
How is vagus located with the respect to the root of lung?
It is on the posterior side
27
How far from top to bottom does the posterior inferior mediastinum extends?
From T5 to T12 not (T9 like anterior)
28
Contents of posterior mediastinum
Descending aorta
Esophagus
Esophageal plexus
Azygos
Hemi azygos
Thoracic duct
Lymph nodes
Greater, lesser, and least thoracic splanchnic nerves
29
Where does the left vagus contributes to?
What also contributes to this plexus?
Where does the right vagus contributes to?
After the plexus where do the fibers converge on?
Anterior Esophageal plexus
Sympathetic from thoracic splanchnics
Posterior Esophageal plexus
Anterior and posterior vagal trunks
30
What are the branches of thoracic aorta
Esophageal
Bronchial
Posterior intercostal
Superior phrenic
Two subcostals
31
What artery supplies esophagus that starts from inferior to the diaphragm?
Esophageal artery that originates from celliac trunk
32
How azygos and hemiazygos veins are connected?
Dirrect connection to the ascending lumbar veins
Esophageal venous plexus
33
Where does esophageal venous plexus system drains to?
Azygos system
Portal system
34
What is the relationship between azygos and bronchus
It runs above
35
36
37
38
What are the parts of parietal pleura?
Costal, mediastinal, diaphragmatic, and cervical
39
What separates internal thoracic wall from costal parietal pleura?
Endothoracic fascia
40
What are two portions of respiratory system?
Conducting (7/8) begins in mouth
and respiratory
41
Order of structures in pulmonary system from mouth to aveoli
oral cavity
pharynx
larynx
trachea
extrapulmonary bronchi
interpulmonary bronchi
bronchioles
respiratory bronchioles
avolar ducts
alveoli
42
What is the purpose of conducting part of respiratory system?
Warm air
Clear air
Moisten air
43
What is the usuall direction of elastic fibers?
Where are they usually found?
What is the direction of smooth muscle?
Longitudinal
Lamina propia
Circular
44
6 cell types in respiratory epithelium
Ciliated columnar cells "ciliated pseudostratified epithelium"
Columnar cell
Mucous goblet cells
Brush Cell
Diffuse Endocrine
Basal Cells or Immature Cells
45
Respiratory epithelium: Columnar cell
Does it have cilia?
What does it secrete?
No
Serous
46
Respiratory epithelium: Brush cell
What does the brush cells has and does not?
What are different types of brush cells?
What is the purpose for nerve endings on brush cells?
What reflex are they responsible for?
No cilia but many microvili
Like goblet (release mucinogen) and second type will have nerve ending from trageminal nerve V (to act as O2/CO sensor/sneeze reflex)
47
Respiratory epithelium: Ciliated columnar
Where is it found?
What is specific about cilia?
Throughout entire respiratory system until respiratory portion
The cilia beat in one direction
48
Respiratory epithelium: Mucous cells
What do they secrete?
When this protein is secreted by mucus cells turned into mucous?
Purpose for this molecule?
Mucinogen
When hydrated
Trap bacteria and particles
49
Respiratory epithelium: Diffuse Endocrine or Small Granule Cells
Characteristic on EM?
Function?
Lots of dots
Thought to control mucous and seromucous secretion and vessel diameter
50
Respiratory epithelium: Basal Cells or Immature Cells
Where are they are? Charactersitict?
Function?
Short on the basement membrane. Part of pseudostratified epithelium that does not reach lumen.
Stem cells
51
How is smokers epithelium affected? (population of cells)
What is this transformational process called?
Goblet cells increased due to pollutants
Cilliated cells decreased due to increased carbon monoxide
Metaplasia
52
What is the opening to the nose called?
What keeps bugs and other stuff from entering the nose?
What is inside of nose?
Nostril or narris
Thick long hair
Nasal fossa surounded by inferior/middle/superior conchae/turbinates and spongy bone on the lateral side
53
What is the function of conchae/turbinates?
What are these structures lined with?
What cranial nerve is connected there?
They are covered with mucosa and produced mucous
To create channels
CN I - smell
54
What is released in nasal cavity from lamina propia? What is the cause of that?
Which concha is superior to the entrace to maxillary sinus?
What is the importance of maxillary sinus?
IgA and IgE binding to basophils and inflammation
Middle concha
The site of the drug delivery (access to superfincial venous plexus) beneath the nasal cavity mucosa)
55
Swell bodies
What are they?
When they become enlarged?
Venous plexus in lamina propria that enlarge alternately on two sides of nasal cavity (about every 30 minutes) giving mucosa on occluded side time to recover from desiccation and help to direct air to the olfactory epithelium
During cold cause blockage (not mucous)
56
What is vesitbule?
What is vibrissae?
Anterior portion of the nasal cavity
Nasal hair
57
Four types of cells in olfactory epithelium
How cells are identified?
Olfactory Cell
Sustentacular cells
Basal Cell
Brush cells?
By the position of their nuclei because there are many nuclei
58
Where are the olfactory cells located at?
On the roof of the nasal cavity and on the superior nasal conchae
59
Olfactory epithelium: Olfactory cells
What type of cells are olfactory cells?
What is on apical surface of the olfactory cell?
What is the basal portion?
What is special of olfactory cells with respect to division?
Where are the nuclei?
Is cillia motile?
Bipolar neurons
Dendirtes with cilia
Axon
Only neural cells that divide
Half way
No
60
Where is the nuclei located of Sustentacular cells and Basal cells?
What does basal cells communicate with?
Have nuclei at apical / basal surface surface
Bipolar neurons
61
Spatio-temporal patterning
Olfactory adaptation
Smell connected to frontal cortex
Losing the smell after extended exposure
62
What type of secretions are Bowman's glands?
In what epithelium are they found?
Function?
In which layer are these glands found
Clinical importance?
Seromucous (more serous)
Olfactory
Windshield wipers over the olfactory epithelium (synthesis of an odorant binding protein)
Lamina propia
Can pass the BBB
63
What are paranasal sinuses?
Examples?
Air spaces within cranial bone lined with respiratory epithelium
Frontal - black
Maxillary - red
Ethmoid - green
Posterior ethmoid - purpole
Sphenoid - yellow
64
What are these procedures?
1. Endoscopic sinus surgery
2. Radiofrequency ablation
3. Sinus stents
Endoscopic sinus surgery = opening sinus and removing its content
65
What type of epithelium is in sinuses?
Respiratory epithelium
66
What are two parts of larynx?
Glotis (vocal cords) / tracheal
Superglottis / lingual
67
What type of epithelium is found on epiglottis and on which side?
Stratified squamous on oral cavity side
Pseudostratified on the other side
68
What pushes epiglottis to prevent food going into trachea?
Tongue moving backward
69
What type of cartilage is found in epiglottis?
Elastic
70
What is the function of larynx?
Phonation (producing sounds)
71
True vs. False vocal cords
Location? Glands? Muscle?
False: Upper fold; glands; no muscle
True: Lower fold; no glands; no muscle
72
What separates true vocal cord from false vocal cord?
laryngeal ventricle
73
How to open epiglottis?
Pull the tounge
74
Name structures
(E) epiglottis
(F) false vocal cords
(T) true vocal cords
(V) opening of ventricles
(A) anterior commissure
(VL) vocalis ligament
(VM) vocalis muscle
(R) Reinke’s space (Reinke’s edema)
75
What are two sturctures in true vocal cords under epithelium?
Vocalis ligament and vocalis muscle
76
Reinke’s edema
Edema in Reinke’s spaces due to excessive talking
77
Where does the laryngitis occur?
Between vocal cords
78
Tracheae
List layers in trachea?
What is a component of lamina propria?
What is well defined in lamina propria?
What shape and where is the cartilage?
What connects the ends of cartilage?
What does the pericardium of the cartilage fuses with?
Respiratory epithelium, lamina propria, submucosa, adventitia
Collagen and elastic fibers
Elastic lamina
Adventitia / C-shape
Trachealis muscle
Submucosa and adventitia
79
Two types of bronchi?
Where are they found?
Rigidness?
Extrapulmonary - outside of lungs
Intrapulmonary - inside of lungs
Exrapulmonary more rigid
80
Where does cartilage becomes irregular?
In that region, what is between cartilage and lamina propia?
In extrapulmonary bronchi
Smooth muscle spirals
81
Intrapulmonary Bronchi
What is the other name for secondary bronchi and where do they go to?
What is the other name for tertiary bronchi and where do they go to?
Lobar bronchi / lobes
Segmental / bronchopulmonary segments
82
Mucosa
Layers?
How far do seromucous glands that are between cartilage plates and smooth muscle extend?
Mucosa (respiratory epithelim, lamina propia, and submucosa)
Muscularis
Submucosa
Hyaline Cartilage Lyaer
Adventitia
Lamina propia
83
What is the defnition of bronchiole?
Do they have seromucous glands?
How does the epithelium changes in bronchioles?
What is the lamina propria composed of in bronchioles?
Less than 1mm and no cartilage
No
Goes from columnar cillated to cuboidal Clara cells; less golbet cells and more clara cells
Smooth muscle and elastic fibers
84
Clara Cells
What structures do they have on apical surface?
What enzyme do they contain?
What do they secrete?
Can they divide?
What is a shope of these cells?
Microvilli (not cillia)
p450 in smooth ER
Glycoproteins that protect the mucosa
Yes they can; they regenerate epithelium
Dome
85
One of four diseases of COPD = asthma
Drugs?
What is it?
What part of NS innervates brohchiole?
Symptoms?
Widespread constriction
Albuterol mimics sympathetic response
Sympathetic and parasympathetic
Wheezing, difficulty expelling air from lungs (expiration)
86
How structures change down toward aveoli?
87
Respiratory bronchile
What is it lined with?
Describe lamina propia
Clara Cells
Very thin smooth muscle and elastic fibers at alveolar openings
88
Alveolar Ducts
What are they lined with?
Do they contain lamina propia?
Simple Squamous epithelium (Type 1 pneumocytes)
Yes, with smooth muscle and lots of elastic fibers
89
Alveoli
When are they developed?
Cells in linings?
85% of alveoli develop after birth until the age of 10
Both type 1 and typ2 pneumocytes
90
Type 1 pheumocytes
Shape?
Can divide?
% of these cells in aveoli?
Function
Simple squamous epithelium
No
95%
Gas exchange
91
Type II Pheumocyte
Shape?
% of these cells in aveoli?
What connections do type I and type II cells form?
Can the regenerate?
What is the function?
Cuboidal
5%
Occuding junctions
Yes
Surfactant production
92
Intraveolar septum: thin portion (TnP)
Function?
Parts (blood-gas-barrier)?
Exchange of gases
1. surfactant layer
2. cytoplasm of type I pneumocyte
3. fused basal lamina between type I and capillary endothelium
4. cytoplasm of capillary endothelium
93
Intraveolar septum: thick portion
What is found in thick portion?
Function?
Are there lympathics?
Elastic, collage, and reticular fibers; fibroblasts, macrophages and mast cells
Fluid removal -- the fluid is drawn into interalveolar septum
No, aveoli are too small; lymphatics follow bronchial tree
94
Surfactant
When is it produced?
Where is it stored?
Function?
What is given to mother to induce surfacant production in baby?
26-28 weeks
Lamellar bodies (TEM)
Reduces surface tension
Glucocorticoids
95
Intraavolar septum: macrophages
2 types (dust cells)?
Relation to heart failure?
Associated with alveolar wall (fixed population)
Macrophages that roam free
Leakage of blood; phagocytosis; lungs stain for iron
96
Pores of Koh
Function?
Connect aveoli and equlibrate pressure
Allow passage of roaming macrophages
Allow collateral ventilation in case of bronchole obstruction
97
Pulmonary vs. Systemic blood pressure in lungs
Pulmonary artery 12-25 mmHg
Bronchial artery 110-135 mmHg (follow bronchial tree to level of respiratory bronchioles)
they anastomose
98
Emphyseme
What is a1-antitrypsin?
What is it?
How is smoke related?
Herediaty?
a1-antitrypsin is a protein that protects the lung from action of elastase
Emphysema is a destruction of the inner alveolar wall. Decreased elasticity, poor expiration.
Substances that inhibit a1-antitrypsin
2-3% due to mutation in a1-antitrypsin
99
Tension vs. Open Pneumothorax
The hole locks during expiration leading to a buildup pressure in chest cavity
In open pneumothorax, expiration and inspiration is reversed.
100
What fluid can take over pulmonary cavity?
Pneumothorax
Hemothorax
Hydrothorax
101
Pneumothorax mainfestation
Respiratory distress
Cyanosis
Tracheal deviation
Chest pain
Hyper resonance
102
Sources of blood in hemothorax
Lung
Intercostal vessels
Internal thoracic (internal mammary artery)
Thoracicoactromial
Lateral thoracic
Mediastinal great vessels
Heart
Abdominal sturcture
103
What is pleural effusions?
Escape of fluid into the pleural cavity
104
Define
Pleuritis (syn. pleurisy)
Development?
Inflammation of the pleura
Rough surfaces of the pleurae produce a so-called **pleural friction rub**
The inflamed surfaces of the pleura may also cause the parietal and visceral layers of the pleura to adhere **pleural adhesions**
105
Define
Mesothelioma of Pleura
What is it associated with?
**Primary malignant tumors** arising from the **visceral** or **parietal pleura**.
Occupational harazd e.g. Asbestosis
106
Define
Thoracentesis
Insertion of needle into pleural cavity.
\*\*\* Angle properly to avoid diaphragm and/or liver
107
Trauma of thoracic wall
Possible locations?
Simple vs. Complicated?
108
Trauma of thoracic wall
Define flail chest
Symptoms?
Fracture of several adjacent ribs
Complete sternocondral separation
109
# Define embolus
Examples?
Pulmonary embolism symptoms?
Blocks blood vessel
Blood clot, Air, Fat, Amniotic fluid, Foreign body, Mass of bacteria
Sudden onset of dyspnea, dyspnea, tachycardia
110
Bronchogenic Carcinoma
Define
Typical location
The tumor arises from the bronchial epithelium.
## Footnote
Tumor typically located near hilum, projecting into bronchi.
111
# Define decision-making capacity and competency
Competence/incompetence?
Decisional capacity/incapacity?
Decisional-making capacity:
the ability to understand relevant information
appreciate the medical situation and its consequences
communicate a choice
engage in rational deliberation
Competence/incompetence – legal terms
Decisional capacity/incapacity – medical determination.
112
Surrogate
Order of importance?
An authorized person making medical decisions and acting on the patient’s behalf
Sopouse - Children - Parents - Sibling - Nearest relative by blood
113
Standards for Surrogate Decisions
Substituted judgment
Best interests
114
Advanced Directives
Types
Durable (or medical) power of attorney for health care
Directive to Physicians
Living Will
POLST
Wallter cards
115
List the 5 A’s involved in assessment of tobacco use
* * Ask about tobacco use.** This also involves addressing myths about quitting. For example, it is a myth that past attempts decrease ability to quit or that older smokers don’t benefit from quitting.
* * Advise users to stop.** Provide the patient with information on the medical benefits.
* *Assess willingness to quit.** An important factor is to match the intervention with the stage of quitting (see below).
* *Assist in quitting.**
* * Arrange for follow-up.**
116
Treatments
Which component is important in therapy?
Books, Carbon monoxide monitor, Websites, Behavioral programs (coping skills)
Behavioral \> Medicine
117
Smoking
118
What belongs to conducting zone vs. respiratory zone?
Volume of each?
Conducting (first 16 generations): trachea, bronchi, bronchioles, and terminal bronchioles; 150 ml
Respiratory (final 7 generations): respiratory bronchioles, alveolar ducts, alveolar sacs.; 3000ml
119
Functional unit of respiratory part of lungs?
Acinus
120
Lung volumes
**Total Lung Capacity (TLC)** = volume following maximal inspiration
**Residual Volume (RV)** = volume left after maximal expiration
**Vital Capacity (VC)** = TLC – RV
**Tidal Volume (VT)** = volume inspired under normal resting conditions
**Functional Residual Capacity (FRC)** = volume remaining at end of normal tidal expiration
**Expiratory Reserve Volume (ERV)** = volume expelled during maximal forced expiration starting at the end of normal tidal expiration
**Inspiratory Reserve Volume (IRV)** = volume inspired during maximal inspiratory effort starting at the end of normal tidal inspiration
**Inspiratory Capacity (IC)** = volume inspired during maximal inspiration starting after at the end of normal tidal expiration
121
How to measure residual volume?
(1) Nitrogen washout C1 \* V1 = C2 \* V2 ; V1 = FRC
(2) Helium dillution C1 \* V1 = C2 \* (V1 + V2) ; V2 = FRC
(3) Boyle's law P\*V=K
ΔVbox = ΔVlungs
FRC = (ΔV/ΔP) x (P x ΔP)
122
What muscle are responible for inspiration?
**Diaphragm**
**Cxternal intercostal** = pull ribs up
Accessory muscles
* *scalene** muscles, which lift the first two ribs
* *sternomastoid** muscles, which raise the sternum
123
What muscle are responsible for expiration?
**abdominal**
rectus abdominus
internal and external obliques
ütransversus abdominis
**internal intercostals pull the rib cage down**
124
What causes changes in lung volume?
The transpulmonary pressure
125
Equations / definitions:
Alveolar pressure
Intrapleural pressure
Transpulmonary pressure (PL) = alveolar pressure (PA) – intrapleural pressure (PIP)
Transrespiratory pressure (PRS) = alveolar pressure (PA) – atmospheric pressure (PB)
Transthoracic pressure (PCW) = intrapleural pressure (PIP) – atmospheric pressure (PB)
126
How emphysema affects volume/pressure relationship of lungs?
127
What is ΔV/ΔP?
What is ΔP/ΔV?
ΔV/ΔP = Compliance
ΔP/ΔV = Elastance
128
What the pressure-volume graph for lungs is not a straight line?
When does compliance increases?
When does compliance decreases?
The compliance of the lung varies at different lung volumes. For example, the lung is much less compliant at high lung volumes. This is normal.
Emphesyma / low volume
Fibrosis / low high volume
129
What is hysteresis?
The change depeends on initial state
130
What causes elastic properies of lungs?
Elastin and collagen fibers that surround the bronchi and alveoli
131
How filling the lung with saline affects compliance and hysteresis?
Eleminates hysteresis
Increases compliance
132
Suface tension in lungs
Cause?
Contributes to what?
Liquid molecules in alveoli
Surface tension
133
Leplace’s law
Why small aveoli does not collapse and large burst?
P = T/r
Surfactant
134
Surfactant
What is it secreted by?
Composition?
Phospholipid component?
Mechanism of surfactant?
Type II aveolar cells
lipids (85-90%) and proteins (10-15%)
dipalmitoyl phosphatidylcholine (DPPC)
Their intramolecular repulsive forces oppose the attractive forces of the liquid responsible for creating surface tension
135
What is hystersis due to?
Surface tension -- not surfactant
By reducing surface tension, hysteresis is reduced
136
Problems with surfactant
infant respiratory distress syndrome (RDS)
acute respiratory distress syndrome
Absence/loss of surfactant
Born premature \<6 some \<12 wk all
hypoxia/hypoxemia leads to a decrease in surfactant
increases effort required to inflate lungs because of decreased compliance;
increases tendency for alveoli to collapse
137
What two forces determine functional residual capacity?
Elastic recoil properties of the chest wall
The elastic recoil properties of the lung that tend to collapse lung volume
138
How fibrosis affects the airway pressure vs. vital capacity graph?
139
How emphysema affects the airway pressure vs. vital capacity graph?
140
Regional differences of lungs
Which system operates at lower volume?
Which part apex or base is more complaint?
The base operates at lower volume because of lower gradient
The base is more compliant = ventilated better
141
What resistances need to be overcomed during ventilation?
Elastic
non-elastic (airflow/viscous)
142
Poiseuille's law
V = dP \* PI \* r^4 / (8 \* n \* l)
143
Reynolds number
Re = 2 rvd/n
144
What is the relationship between flow and pressure difference in turbulent flow?
V = sqrt(dP)
145
Nervous system regulation of ariways
Other controls?
Sympathetic b2
Parasympathetic M
Inflammatory mediators = leukotrienes or histamne (astma)
146
Normal pH status
Plasma?
Intracellular?
7.40 (7.35 to 7.45) = ph = -log[H+] = 40nM (35 to 45 nM)
Life between 6..8 and 7.8
Intracellular 7.0
147
Isohydric principle
All acids use protons
148
What are the main buffers in ECF?
Non-bicarbonate - non-volatile
Hemoglobin (important)
Plasma proteins (20% of Hb)
Phosphates (few% of Hb)
NOT NH4+
Bicarbonate - volatile
149
