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Question 1

• Which structures make up the large airways of the conducting zone of the respiratory tree? The small airways?

Answer 1

Large airways = nose, pharynx, larynx, trachea, bronchi; small airways = bronchioles, terminal bronchioles

Question 2

Which part of the conducting zone of the respiratory tree has the least airway resistance?

Answer 2

At the terminal bronchioles. where a large number of them run in parallel

Question 3

Name the three functions of the conducting zone of the respiratory tree.

Answer 3

The conducting zone warms, humidifies, and filters air

Question 4

Which zone of the respiratory tree includes the anatomic dead space?

Answer 4

The conducting zone (by definition, dead space does not participate in gas exchange)

Question 5

Cartilage and goblet cells extend to the end of the respiratory ____ (bronchioles/bronchi).

Answer 5

Bronchi

Question 6

Conducting zone epithelium is ___ (cuboidal/pseudostratified ciliated columnar) and ___ (cuboidal/simple squamous) in terminal bronchioles.

Answer 6

Pseudostratified ciliated columnar (cilia beat to remove mucus and debris), cuboidal

Question 7

What type of muscle is found in the walls of the conducting airways, and up to where does it extend?

Answer 7

• Smooth muscle; end of terminal bronchioles (beyond that point, it is sparse)

Question 8

What anatomic area does the respiratory zone encompass, and what is the major function?

Answer 8

The lung parenchyma: respiratory bronchioles, the alveolar ducts, and the alveoli all function in gas exchange

Question 9

What type of epithelial cells is found in respiratory bronchioles?

Answer 9

Predominantly cuboidal cells

Question 10

A patient aspirates debris into his lungs. Other than cilia, what helps clear the debris?

Answer 10

Alveolar macrophages (also participate in the immune response)

Question 11

Type ____ (I/II) pneumocytes make up 97% of the alveolar surface area.

Answer 11

I

Question 12

What is the advantage of having numerous thin type I pneumocytes line the walls of alveoli?

Answer 12

Maximum gas exchange is permitted by thin cells (squamous morphology)

Question 13

What are two important functions of type II pneumocytes?

Answer 13

To secrete surfactant (prevent alveolar collapse) and to serve as precursors to other pneumocytes (both types I and II)

Question 14

A patient suffers a pneumothorax, which damages his lungs. Which cells proliferate to repair the lungs after they have been damaged?

Answer 14

Type II pneumocytes (they are the precursors of both type I and type II pneumocytes)

Question 15

Describe club cells and their three functions. What is another (now outdated) name for them?

Answer 15

Nonciliated columnar/cuboidal pneumocytes with secretory granules that secrete surfactant, degrade toxins, act as reserve cells; Clara cells

Question 16

• Explain the law of Laplace using the equation for calculating collapsing pressure (P).

Answer 16

P = 2 (surface tension)/radius; alveoli have a tendency to collapse on expiration, because as their radius decreases, P increases

Question 17

What is dipalmitoylphosphatidylcholine? What is its function?

Answer 17

• A type of lecithin and an important component of surfactant; surfactant decreases alveolar surface tension and prevents atelectasis

Question 18

A neonate is born at 32 weeks. Why will this neonate have respiratory problems?

Answer 18

Surfactant synthesis starts at 26 weeks but does not mature until 35 weeks—therefore, the child is more likely to have respiratory distress

Question 19

A woman at 30 weeks’ gestation presents for an exam. The ratio of which two amniotic fluid markers can be used to assess fetal lung maturity?

Answer 19

The lecithin:sphingomyelin ratio (marker for surfactant quantity)

Question 20

A lecithin:sphingomyelin ratio is derived for a neonate to evaluate fetal lung maturity. What value is indicative of lung maturity?

Answer 20

• Ratio >2.0

Question 21

How many lobes does the right lung have? How many does the left lung have?

Answer 21

Three; two (Left has Less Lobes [2] and Lingula)

Question 22

What structure does the left lung have that the right lung does not?

Answer 22

The lingula, which is the homolog of the middle lobe of the right lung

Question 23

Where is the pulmonary artery in relation to the bronchus within the right lung hilus?

Answer 23

Anterior (RALS = Right Anterior; Left Superior)

Question 24

Where is the pulmonary artery in relation to the bronchus within the left lung hilus?

Answer 24

Superior (RALS = Right Anterior; Left Superior)

Question 25

The oblique fissure divides which two lobes in the right lung? The left lung?

Answer 25

The middle and inferior lobes; the superior and inferior lobes

Question 26

Both the right and left lungs have a(n) ____ (oblique/horizontal) fissure. Only the right lung has a(n) ____ (oblique/horizontal) fissure.

Answer 26

Oblique; horizontal

Question 27

In the posterior aspect of both the right and left lungs, the ____ (horizontal/oblique) fissure divides the superior and inferior lobes.

Answer 27

Oblique

Question 28

• A patient has penetrating trauma to the diaphragm at the level of T8. What vascular structure is the trauma surgeon most concerned about?

Answer 28

The inferior vena cava, which passes through the diaphragm at the level of T8 (8 letters in vena cava)

Question 29

What two structures perforate the diaphragm at the level of T10?

Answer 29

The esophagus and the vagus pass through at the level of T10 (C10, two trunks)

Question 30

• At what level does the esophagus perforate the diaphragm?

Answer 30

T10 (10 letters in [o]esophagus)

Question 31

What three structures perforate the diaphragm at the level of T12?

Answer 31

The aorta (red), thoracic duct (white), and azygos vein (blue) (at T-1-2, it’s the red, white, and blue—12 letters in aortic hiatus

Question 32

Neurons from vertebral levels ____, ____, and ____ come together to form the phrenic nerve, which innervates the diaphragm.

Answer 32

• C3, C4, C5 (C3, 4, 5 keeps the diaphragm alive)

Question 33

A man with diaphragmatic trauma has no pain there. To which anatomic region is the pain referred? What is the innervation of these regions?

Answer 33

shoulder (C5), the trapezius ridge (C3, C4)

Question 34

Which tendon can be found on the inferior aspect of the diaphragm surrounding the caval and esophageal hiatuses?

Answer 34

The central tendon

Question 35

What mnemonic can be used to recall the levels at which certain anatomic structures perforate the diaphragm?

Answer 35

I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) twelve (12)

Question 36

The abdominal aorta bifurcates at ____ (C4/T4/L4), common carotid at ____ (C4/T4/L4), and trachea at ____ (C4/T4/L4).

Answer 36

L4, C4, T4 (all are bifourcations)