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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
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