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FAOS Pulmonary

Med 2

A thing Something about it
Larynx, trachea, and lung buds develop as outpouching of Esophagus
The ____ respiratory tract develops first, followed by the____ upper (larynx and trachea), lower (bronchi and lungs)
Respiratory system develops from___ during the ___ weeks, develops into the___ laryngotracheal groove (on ventral foregut), 3rd and 4th, laryngotracheal tube (partitioned by tracheoesophageal septum)
Larynx cab be described as a ____ structure that marks the division bw ___ musculocartilaginous, respiratory and digestive systems
Larynx is attached to ____ superiorly and ____ inferiorly hyoid bone, trachea
Laryngeal cartilage and musculature are derived from the _____ arches and innervated by ___ nerves, respectively 4/6th, superior laryngeal (CNX) and recurrent laryngeal (CNX)
Primitive laryngeal orifice arrises below the ___ arch, and swellings lateral and anterior to orifice develop into ____ 4th, arytenoid cartilages and epiglotis, respectively (swelling develop during week 5)
___ tissue occluding laryngeal orifice breaks down during week ____, surrounding folds differentiating into ________ Epithelial, 10, false and true vocal cords
Tracheal epithelium and glands are derived from ____, cartilage, smooth muscle and connective tissue derived from _____ Tube endoderm, splanchnic mesoderm (ventral part of lateral mesoderm)
1st and 2nd divisions of Bronchi—> Bronchioles can be described as ______. 1st- smaller left bud moving ___ than larger right bud, 2nd- ___ branches to left and ____ branches to right Asymmetrical, more lateral, 2, 3
Lung buds develop from LTD at the end of week ______, buds develop the bronchi and bronchial tree bw ____ months of gestation (____ and ____ periods) 4, 2 and 7 (pseudoglandular/ canalicular)
Terminal sacs and eventually alveoli begin to form in week ____ when the bronchial tree has completed and ________ production begins bw weeks _____ ( _____ and ____ periods) 26 (after tree has formed), surfactant, 25 and 28 (saccular, alveolar)
Embryonic period (4-7 weeks) Lung Bud —> tertiary bronchi; TE fistula/ EA could develop during this time
Pseudoglandular period (5-16 weeks) Continued branching, all major parts of lung are formed except for gas- exchange elements
Canalicular period (16-26 weeks) airway increases in diameter and lung vasculature develops. primitive end-respiratory units (respiratory bronchiole, alveolar duct, and terminal sac) formed
Saccular period (week 26- birth) Terminal sacs develop (distinguished by thin epithelial lining), type 1 squamous epithelial cells form gas-exchange surface, type 2 secretory pneumocytes produce surfactant
Alveolar period (Prenatal- childhood) clusters of primitive alveoli form, allow “breathing” in utero via aspiration and expulsion of amniotic fluid. alveoli continue to mature after birth, growing in numbers for first 3 years, and then growing in number and size for the next 5 years
when lungs invaginate and penetrate part of intraembryonic coelom (body cavity), results in ___ pleura from _____ mesoderm covering the lungs and ____ pleura from _____ mesoderm directly abutting body wall visceral, splanchnic, parietal, somatic
Several Parts Build a Diaphragm = Sept transversum(from meso—>cntrl tendon), Pleuroperitoneal folds(—>PP membranes—>fuse ST), Body wall(from dorsal/lateral sides AFTER PP folds close cavity--> peripheral, muscle portion), Dorsal mesentery of esophagus (ventral to aorta/dorsal to esoph)
Esophageal closure can form as result of ______ TE septum posterior deviation, esophageal atresia W/O proximal TEF unable to swallow amniotic fluid, polyhydramnios and enlarged uterus
Infants with Tracheoesophageal fistula will characteristically _____ and exhibit ____ due to abnormal connection cough during feedings, gastric dilation/ elevation of diaphragm/ and impaired breathing
Failure of fusion bw components of diaphragm may lead to _____ and infant will present with ______ Congenital diaphragmatic hernia, respiratory distress and bowel sounds in the thoracic cavity (may also see loops of bowel in thoracic cavity)
Hypoplastic Lung lacks ____, will show an overgrowth of _____ and which leads to _____ respiratory capacity, smooth muscle, pulmonary hypertension
Conducting zone = nose to terminal bronchiole
Gas exchange zone = respiratory bronchiole, alveolar ducts, alveolar sac (w/ alveoli)
RALS [mnemonic]= Right pa is Anterior, Left pa is Superior to bronchi
Aspirated object more likely to lodge in Right mainstem bronchus (smaller angle, wider diameter)
Bronchial arteries branch from _____ to supply bronchi and pulmonary connective tissue Descending aorta
Branches of Pulmonary and bronchial arteries enter the ______ centrally along the ____ Bronchopulmonary segment, segmental (3tiary) bronchi
Bronchial veins unite to form single vessel in each lung that empty into _____&____ azygos vein on right, hemiazygous on left (venous blood and lymphatics run along edges of each BP segment)
____ pleura lacks sensory innervation while ____ pleura is innervated via ____&____ nerves (highly sensitive) Visceral, Parietal, intercostal/ phrenic
Horizontal fissure can be found at ______, and oblique fissure runs from _____ 4th rib, 5th to 6th (up to 4th posteriorly)
Diaphragm attaches posteriorly to vertebral column via ______, and the _____ wraps around esophagus to prevent hiatal hernia left and right crura, right crus
At full exhalation the lower lung boarders extend to ____ anteriorly, ____ at midaxillary line, and ____ posteriorly. Pleural reflection extends to [just add ___] 6th, 8th, 10th, 2
Muscles involved in quiet inspiration? diaphragm, and to a lesser extent the intercostals (mainly external)
Oropharynx, laryngopharynx, anterior epiglottis, upper half of posterior epiglottis, true vocal cords all lined by Stratified squamous epithelium
Rest of upper respiratory tract (conducting zone) lining consists of ____, before transitioning to ____, and then finally ____ ciliated pseudostratified columnar epithelium (nasal cavity-terminal bronchioles), ciliated simple cuboidal (respiratory bronchioles), simple squamous (alveolar ducts and alveoli)
95% of alveolar surface area, and 10% of total alveolar cell population, is comprised of Type 1 pneumocytes (nonproliferative)
5% of alveolar surface area, and 12% of total alveolar cell population, is comprised of Type 2 pneumocytes (cuboidal, proliferate after cell damage, precursor for new type 1 and 2 cells)
40% of alveolar cell population is comprised of endothelial cells (thin, wrapped in a cylinder to form capillaries)
____ occupy 11% of terminal bronchioles and 22% of respiratory bronchioles Clara cells (nonciliated, secretory granules, secrete component of surfactant, degrade toxins, and act as reserve cells)
Surfactant is stored in cytoplasmic ______ of _____ pneumocytes Lamellar bodies, type 2
Pulmonary capillary endothelial cells are joined by _____ Tight junctions, no fenestrations (prevents fluid leakage but allows gas exchange)
Pseudostratified olfactory epithelium can be found in the ____ Superior conchae of the nasal cavity
Olfactory cells are ____ neurons, each has a single dendrite with a few _____ cilia that serve to increase surface area Bipolar, nonmotile
Pulmonary vascular resistance is lowest at FRC
Volumes that increase in obstructive lung diseases RV (most), FRC, TLC
Volumes that decrease in obstructive lung diseases FVC, FEV1 (most), FEV1/FVC
Volumes that decrease in restrictive lung diseases RV, FRC, TLC, FVC (most), FEV1 [FEV1/FVC = increases or normal]
Everything but the respiratory bronchioles, alveolar ducts, and alveoli can be considered Anatomic dead space (~150mL, oooor use body weight in lbs)
Physiological dead space is considered as ____ + _____ Anatomic dead space/ alveolar dead space (filled with air but not perfused by blood, V/Q mismatch), in healthy lungs PDS and ADS are essentially equal
Oxygen and CO2 must cross a trilaminar barrier consisting off endothelial cell wall, basement membrane, type 1 pneumocyte
At normal respiratory rate, RBCs are fully saturated (equilibrate) after traversing _____ of alveolar capillary a quarter (extra space is for accommodation during increased HR; exercise, sex, and shit) (perfusion limited)
Histamine (as a lung product) promotes Vascular permeability and exudative processes
Kallikrein (as a lung product) activates bradykinin (vasodilator), levels increased by ACE inhibitors
Angiotensin-converting enzyme (ACE) (as a lung product) converts angiotensin 1—>2, INactivates (breaks down) bradykinin
Minute ventilation = (dead space ventilation + alveolar ventilation) x breaths/min
Increasing alveolar ventilation through increased depth (tidal volume) or breathing rate results in proportionate ____ in ____ decrease, Paco2 (partial pressure of CO2 in arterial blood)
Accessory inspiratory muscles include External intercostals, scalenes, and sternocleidomastoids
Inspiration with accessory muscles causes increase in ____ diameter in upper ribs and ____ diameter in lower ribs Anteroposterior, transverse
Expiratory accessory muscles (exercise, cough, asthma and shit) include interosseous part of the intercostals, rectus abdominis, transverse abdominis, internal/ external obliques
Volume vs pressure graphs, slope = Compliance
The major determinant of airflow bw lungs and environment Intra-alveolar pressure, varies from (-) during inspiration to (+) during expiration
Intra-alveolar pressure - intrapleural pressure = Transpulmonary pressure, pressure difference across the lung wall
Pressures created by the lungs (inward) and the chest wall (outward) are equal and opposite when Gas volume in the lungs is equal to FRC
At rest and maximum expiration, intrapleural pressure= ____, intra-alveolar pressure= ____ -5, 0 (no airflow)
During inspiration, intrapleural pressure= ____—>____, intra-alveolar pressure= ____ -5/-8, <0 (air flows into lungs)
At maximum inspiration, intrapleural pressure= ____, intra-alveolar pressure= ____ -8, 0
During expiration, intrapleural pressure= ____—>___, intra-alveolar pressure= ____ -8/-5, >0 (air flows out of the lungs) [FORCED expiration= both positive]
The major source of airway resistance medium sized bronchi
Airways dilate via (receptors): B2- adrenergic, sympathetic stimulation
Airways constrict via (receptors): M3- cholinergic receptors, parasympathetic
High lung volumes lead to _____ resistance decreased
Low lung volumes lead to _____ resistance increase
Iron in hemoglobin is in the ___ state Ferrous (Fe2+) [ferric state, Fe3+ = methemoglobin, cant bind 02]
O2 saturation vs O2 content Percentage of total oxygen binding sites on hemoglobin actually occupied by oxygen, total amount of O2 in blood
BAT ACES- causes of right shifted hemoglobin dissociation curve? BPG, Altitude, Temp, Acid, CO2, Exercise, Sickle cell
The Bohr effect describes During exercise, Pco2 and temp increase, pH falls in active muscle tissue, promoting a right shift in hemoglobin dissociation curve and greater O2 UNLOADING to tissues
[hemoglobin dissociation curve] Po2 >70 mmHg, hemoglobin is essentially ____ saturated; arterial blood has Po2 of around___ 100%, 100 mmHg
[hemoglobin dissociation curve] Po2=40 mmHg, hemoglobin is ____ saturated; venous blood has Po2 of around___ 70%, 70mmHg
[hemoglobin dissociation curve] Po2 =25 mmHg, hemoglobin is ____ saturated 50%
CO2 travels the body mostly as ____, formed by enzyme _____ HCO3- (bicarbonate), carbonic anhydrase
Bicarbonate enters RBC in exchange for ____, broken down by ____ Cl-, carbonic anhydrase
Haldane effect describes The oxygenation of hemoglobin promoting the dissociation of CO2 from hemoglobin [lungs]
Respiratory Acidosis is brought about by Decreased alveolar ventilation—> retention of CO2—> increase in blood [H+] and [HCO3-]; [metabolic acidosis —> hyperventilation to blow off excess CO2]
Respiratory alkalosis is brought about by Increase in alveolar ventilation —> loss of CO2 —> decrease in blood [H+] and [HCO3-]; [metabolic alkalosis —> hypoventilation to retain CO2]
At high lung volumes ___ vessels contribute more to increased PVR, at low lung volumes ____ vessels contribute more Alveolar, larger extra-alveolar
When is blood flow nearly uniform throughout the entire lung When lying supine
Alveolar pressure > arterial pressure > venous pressure describes zone ____ of the lungs 1, high alveolar pressure compresses capillaries—> reduced blood flow (also, high V/Q here, >.8)
Highest Po2 and lowest Pco2 describes zone ___ of the lungs 1, greater ventilation relative to blood flow (unspent/ “wasted” ventilation)
Arterial pressure > alveolar pressure > venous pressure describes zone ____ of the lungs 2, blood flow here driven by differences bw arterial and alveolar pressures (V/Q= .8)
Arterial pressure > venous pressure > alveolar pressure describes zone ____ of the lungs 3, blood flow here driven by differences bw arterial and venous pressures (as in systemic circulation) (also, low V/Q here, <.8)
Lowest Po2 and highest Pco2 describes zone ____ of the lungs 3, decreased gas exchange and airway closure (unspent/ “wasted” perfusion)
Hypoxia in the lungs lead vaso____ Constriction, serves to shunt blood to areas of better ventilation. Chronic hypoxia —> pulmonary hypertension [other organs vasodilate when hypoxic]
Factors leading to pulmonary vasoconstriction Low O2, low pH, endothelin, sympathetic tone
Factors leading to pulmonary vasodilation Histamine, Prostaglandins, NO, parasympathetic tone
Alveolar-arterial O2 gradient (A-a gradient, AaDo2) should be < ____ 15, or (pt’s age/4)+4
Hypoventilation will lead to ______ in A-a gradient no increase
Decreased inspired O2 will lead to ____ in A-a gradient no increase
Poor gas exchange will lead to ____ in A-a gradient increased
O2 can become diffusion limited gas under what conditions exercise, pulmonary fibrosis, emphysema (diffusion limited = O2 does not equilibrate/fully saturate by the end of the pulmonary capillary) (healthy person exercising, WILL equilibrate)
V/Q mismatch observations in airway obstruction Airway blocked—> V=0 —> V/Q=0 —> there is a shunt. Po2 and Pco2 for pulmonary capillary blood approach values of mixed venous blood, A-a gradient increases
V/Q mismatch observations in pulmonary embolism blood flow blocked —> Q=0 —> V/Q= infinity —> there is complete dead space
Medullary respiration center is located in Reticular formation
Dorsal respiratory group is responsible for inspiration and determines the rhythm of breathing. input from vagus and glossopharyngeal nerves, output travels via phrenic and intercostals (T1-T11)
Ventral respiratory group is responsible for forced expiration and increased inspiratory effort, so not normally used
Location and purpose of Pneumotaxic center Upper pons, inhibits inspiration (gasping breath)
Location and purpose of Apneustic center Lower pons, stimulates inspiration
Cerebral cortex roll in respiratory control Exerts voluntary control over breathing
Central Chemoreceptors in medulla respond to pH of CSF, decreases causing hyperventilation
Stimulation of Juxtacapillary receptors causes what physical response Rapid, shallow breathing
Peripheral chemoreceptors (carotid/ aortic bodies) Increase Paco2, or decreased pH or Pao2 cause increase in respiratory rate. Pao2<60 mmHg before breathing stimulated
Created by: JustinCo