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Pulmonary
FA complete review part 1 Embryology and Anatomy
| Question | Answer |
|---|---|
| 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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