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Pulmonary

FA complete review part 1 Embryology and Anatomy

QuestionAnswer
At what age is the lung fully and completely formed? 8 years old
What is the first stage of lung development? Embryonic ; Weeks 4-7
Errors in the Embryonic stage of lung development lead to: Tracheoesophageal fistula
What stage of lung development are terminal bronchioles made? Pseudoglandular (weeks 5-17)
What would be the result of a defective Pseudoglandular stage in lung development? Respiration imposible --> death
Respiration is possible at week of pregnancy? 25th week
When do pneumocytes start developing? 20th week
Third stage of lung development Canalicular (weeks 16-25)
Which stage of lung development ends at birth? Saccular
What state of lund development is from week 16 to birth? Saccular
When are terminal sacs developed in relation to the stages of lung development? Saccular stage
What is the last stage of lung development? Alveolar
How does breathing occur in utero? Occurs via aspiration and expulsion of amniotic fluid --> increased vascular resistance through gestation.
At birth, the amniotic fluid in lungs gets replaced by air, which causes ---> Decrease in pulmonary vascular resistance
Approximate number of alveoli at birth 20-70 million
What are two very common Congenital lung malformations? 1. Pulmonary hypoplasia 2. Bronchogenic cysts
What is pulmonary hypoplasia? Poorly developed bronchial tree with abnormal histology
What are some associated conditions of Pulmonary Hypoplasia? Congenital diaphragmatic hernia (usually left-sided), and bilateral renal agenesis (Potter sequence)
What is the most common cause of death in Potter sequence? Pulmonary hypoplasia
Which side is most commonly affected by Congenital diaphragmatic hernia? Left side
What i the cause of bronchogenic cysts? Abnormal budding of the foregut and dilation of terminal or large bronchi.
Discrete, round, sharply defined, fluid-filled densities on CXR in the terminal or large bronchi. Dx? Bronchogenic cysts
Description of Club cells Nonciliated; low columnar/cuboidal with secretory granules
Where are Club cells located? Bronchioles
What are functions or roles of Club cells? 1. Degrade toxins 2. Secret component of surfactant 3. Act as reserve cells
Are club cells ciliated or nonciliated? Nonciliated
What are the 3 types of alveolar cells? Type I pneumocytes, Type II pneumocytes and Alveolar macrophages.
Which alveolar cell covers 97% of alveolar surface? Type I pneumocytes
Type I pneumocytes line the _______________. Alveoli
What cells are squamous, thin for optimal gas diffusion? Type I pneumocytes
What is secreted by Type II pneumocyte? Surfactant from lamellar bodies
What is the purpose or role of surfactant? 1. Decrease alveolar surface tension 2. Prevents alveolar collapse 3. Decrease recoil 4 .Increase compliance
What cells serve as Type I pneumocyte precursors? Type II pneumocytes
Which alveolar cells secrete surfactant? Type II pneumocytes
When do type II pneumocytes proliferate the most? During lung damage
What is the most important lecithin of Surfactant? Dipalmitoylphosphatidylcholine (DPPC)
At what week does surfactant production begin? 20 week of gestation
Surfactant in fetus should be completed by week _______. 35
Cuboidal and clustered + precursors of type I pneumocytes + secretion of surfactant? Type II pneumocytes
Explanation of law of Laplace in respiratory terms Alveoli have increase tendency to collapse on expiration as radius decreases
What happens to alveoli during expiration? Collapse due to the decrease in radius
What is released by Alveolar macrophages? Cytokines and alveolar proteases
What pulmonary macrophages are often seen in pulmonary hemorrhage? Hemosiderin-laden macrophages
Condition in neonate with a surfactant deficiency? Neonatal respiratory distress syndrome
What are the physiological consequences of surfactant deficiency in NRDS? Increase in surface tension leads to alveolar collapse
What are common risk factors associated with NRDS? Prematurity, maternal diabetes, C-section delivery.
Why is NRDS development is associated with maternal diabetes? Increase fetal insulin
What are common complications of NRDS? PDA and necrotizing enterocolitis
What is the treatment of Neonatal respiratory distress syndrome? 1. Maternal steroids before birth 2. Exogenous surfactant for infant
What are possible complication of Therapeutic supplemental O2 in NRDS? 1. Retinopathy of prematurity, 2. Intraventricular hemorrhage 3. Bronchopulmonary dysplasia
Normal Lecithin; Sphingomeylin ratio >2.0
What is the Lecithin: Sphingomyelin ratio needed to diagnose NRSD? < 1.5
What are the 2 zones into which the respiratory tree is divided into? Conducting zone and Respiratory zone
What are the parts of the Conducting zone of the respiratory tree? Nose, pharynx, larynx, trachea, and bronchi
What is the main function of the conducting zone of the respiratory tree? Warms, humidifies, and filters air but does not participate in gas exchange ---> "anatomic dead space"
What is the name given to the area or space of the conducting zone of respiratory tree, that does NOT participate in gas exchange? Anatomic Dead space
How far in the conducting zone does cartilage and goblet cells extendo to? End of bronchi
Epithelium found in the Bronchi? Pseudostratified ciliated columnar epithelium
Where is cartilage found in the conducting zone? Bronchi
Conducting zone path Trachea --> Bronchi --> Bronchioles---> Terminal bronchioles
Where in the conducting zone you can find Simple Ciliated Columnar epithelium? Bronchioles
Epithelium of bronchioles Simple Ciliated Columnar epithelium
Simple cuboidal epithelium is found in the _____________________ of the conducting zone of respiratory tree. Terminal bronchioles
Club cells are found from the __________________ to the __________________ ____________. Bronchioles ----> Respiratory bronchioles
What are the two main divisions of the respiratory zone? Respiratory bronchioles and Alveolar sacs
What is the type of epithelium found in the respiratory bronchioles? Simple cuboidal and squamous epithelium
In which section of the respiratory tree are the capillaries found? Alveolar sacs
What type of bronchioles are found in the respiratory zone of the respiratory tree? Respiratory bronchioles
What part of the respiratory tree participates in gas exchange? Respiratory zone
What does the Respiratory zone consists of? Lung parenchyma; respiratory bronchioles, alveolar ducts, and alveoli.
What are the roles of alveolar macrophages? Clear debris and participate in immune response
How many lobes are in right lung? 3 lobes
How many lobes in the left lung? 2 lobes
Which lung, right or left, has a Lingula? Left lobe
What is the right lung homolog of the Lingula? Right middle lobe
What organ occupies what-would be the third lobe of the left lung? Heart
What mnemonic can be used to describe the relation of the pulmonary artery to the bronchus at each lung hilum? RALS: Right Anterior Left Superior
Anatomical location of the Carina? Posterior to ascending aorta and anteromedial to descending aorta.
Which lung is more common for inhaled foreign bodies? Right lung
Why is the right lung more commonly affected by inhaled foreign bodies? Right mainstem bronchus is wider, more vertical, and shorter than the left.
Where is an aspirated object (eg. peanut) if the person is supine? Right lower lobe
MC lung location of foreign body if inhaled while laying on the right side? Right upper lobe
What position lead to aspirated object to be found in the right lower lobe? Upright and supine
Total number of ribs (one side) 12
Which is the MC position of needle for tension pneumothorax? Between rib 2 and rib 3 space
The horizontal fissure of the lung runs along the ________ rib. 4th
Which structures perforate the diaphragm at T8? IVC and the right phrenic nerve
The IVC and right phrenic nerve perforate the diaphragm at _____. T8
Which are the structure that perforate the diaphragm at T10? Esophagus and Vagus nerve
At which point will the CNX perforate the diaphragm? T10
The CNX (vagus) nerve and the _______________ perforate the diaphragm at ______. T10
Which structures are known to cross or perforate the diaphragm at T12? Aorta, Thoracic duct, and Azygos vein
What nerve (roots) innervate the Phrenic nerve? C3, C4, and C5.
Which vessels are known to perforate the diaphragm at T12? Azygos vein and Aorta
At which point is the thoracic duct will cross or perforate the diaphragm? T12
Pain from the diaphragm is referred to the--------> Ipsilateral shoulder and trapezius ridge
At what point or level does the Common Carotid bifurcates? C4
What structure is known to bifurcate at C4? Common Carotid
The trachea bifurcates at _____. T4
Which structure is known to bifurcate at T4? Trachea
At what level does the abdominal aorta bifurcates? L4
Common bifurcations (structure -------> level): 1. Common Carotid ------> 2. Trachea -----> 3. Abdominal aorta --------> The 4s: 1. C4 2. T4 3. L4
Created by: rakomi
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