Anatomy and Histology Flashcards
What are ribs 1 through 7 called?
vertebrosternal ribs
What are ribs 8 through 10 called?
Vertebrocostal ribs
What are ribs 11 and 12 called?
floating ribs
The external obliques are the primary muscles for what motion?
inspiration
What 3 muscles compose the accessory scalenes for inspiration?
Pec major
Pec minor
serratus anterior
What are the 2 primary set of muscles for expiration?
internal obliques and abdominal muscles
What surface does the visceral pleura line?
the lung
What surface does the parietal pleura line?
the thoracic wall
to which rib does the parietal pleura extend?
the 10th rib
What does blunting of the costrophrenic angle indicate?
Pleural effusion
Which features of the right lung lie against the heart? Of the left?
Right lung: middle lobe
Left lung: lingula
What is the silhuoette sign and what does it tell you?
The blunting of the heart outline due to pneumonia or a mass. When the heart is obscured, the mass lies in front of the heart. When it the outline of the heart is still visible, the mass is behind the heart.
Aspirated objects usually end up in the right lung, true or false
True - the primary bronchus is short and straight, while the left bronchus is long and angled less steeply
The horizontal fissure separates which lobes of the right lung?
superior and middle
the oblique fissure separates which lobes of the right lung?
middle and lower
What is the highest structure in the root of the lung?
pulmonary artery
How many pulmonary veins are there on each side? where doe they leave the root of the lung?
two
inferior
Where does most of the bronchial circulation drain into?
pulmonary veins - mixing of the venous and arterial blood
NOT the azygos system generally speaking
What do parasympathetics from the vagus nerve innervate the lung?
bronchial smooth muscle and glands
What do sympathetics from the upper thoracic (T1-5) cardiopulmonary splanchnics innervate in the lung?
vascular smooth muscle
Where do the lymph vessels in the lung converge?
bronchomediastinal lymphatic trunks
Where does blood or fluid accumulating in the pleural space drain into - the visceral or parietal pleura?
parietal
Define the carina
The carina is the internal cartilaginous crest at the bifurcation of the trachea.
Define eparterial bronchus and bronchus intermedius
The right upper lobar bronchus is above its corresponding lobar artery and is said to be the eparterial bronchus. The bronchus intermedius divides to form the middle and lower secondary bronchii in the right lung.
What is supplied by the secondary bronchi?
lobes
The tertiary (segmental) bronchi supply what sections of the lung and how are they defined?
Tertiary (segmental) bronchi supply bronchopulmonary segments that are defined by the tertiary bronchi and the arteries that run with them. There are 10 in the right lung and 8 in the left.
Where do the bronchial veins run in the bronchopulmonary segments?
Segments are separated by connective tissue septae, and the veins are intersegmental along the septae. Bronchopulmonary segments are the smallest lung units that can be surgically resected.
Kerley B lines appear in a PA chest x-ray as white, horizontal, parallel profiles at the periphery of the lung bases. They represent what dilated structure in lower lung lobes?
lymphatics of interlobular septa
a pseudostratified columnar (respiratory) epithelium with cilia and mucous-secreting goblet cells makes up what part of the airway from the trachea through bronchi?
the conducting part
Do pulmonary arteries or veins run independently from the airway?
Veins
Where are the physical exam sounds produced?
cartilage bronchi
“It has C-shaped hyaline cartilage rings surrounding a lamina propria of loose connective tissue and submucosa of denser CT with mucous glands (with serous demilunes), nerves, and larger vessels. An elastic membrane is between the musosa and submucosa. The ends of the cartilage rings are united by a fibroelastic membrane and muscle. There is no continuous muscle layer.” ‘
What does this describe?
Trachea
a. They have cartilage plates rather than rings.
b. They have a continuous layer of smooth muscle under the cartilage plates.
c. The epithelium is the same, and goblet cells are present.
This describes what part of the respiratory tract?
bronchi
characterized by the lack of cartilage plates and glands in their walls, although cartilage elements may be present at branch points. The smooth muscle layer is relatively thick.
This describes what part of the respiratory system?
bronchioles
What is the change in epithelial layers between largest bronchioles to terminal bronchioles?
The epithelium in the largest bronchioles is ciliated, pseudostratified columnar that changes to simple columnar, then simple cuboidal in the terminal bronchioles, which are the end of the conduction portion of the airway. Each terminal bronchiole supplies a lung acinus (not to be confused with an alveolus), the functional unit of the lung that contains all of the components with alveoli
Smokers have what histological component in their terminal bronchioles that are unusual?
goblet cells
Goblet cells are replaced in the terminal bronchioles by domed-shaped, simple cuboidal club cells (formerly known as Clara cells). This produces what 2 products that are important physiologically (especially during expiration) and pathologically when injured?
domed-shaped, simple cuboidal club cells secrete a surface active lipoprotein that keeps the walls from sticking to each other, particularly during expiration.
Club cells also secrete a 16-kilodalton protein, CC16,that is a serum and airway fluid marker of pulmonary disease (club cell injury).
The alveolar septum for gas exchange consists of Type I cell with its coating of surfactant, the blood capillary endothelium, and a basal lamina shared by the two cells. What are type I cells?
pneumocytes
very thin cells lined with surfactant that prevents collapse by reducing surface tension
Type II alveolar cells comprise the thick wall of the alveolar septum along with collagen fibrils, elastic fibers, fibroblasts, and macrophages. What do they secrete? (2)
i. A phospholipid (DPPC, the name is too long!) responsible for reducing the surface tension.
ii. Surfactant proteins (A, the most common, and B, C, and D) regulate the synthesis, secretion, and spreading of surfactant and modulate immune and allergic responses.
Why can lung sounds only be heard in the bronchi and not the distal airway branches?
movement of gas molecules in the conduction airway (bronchi) is by convection (air movement, with velocity decreasing with increase in aggregate area), while movement in the respiratory airway is by diffusion.
change in volume of the airways is greater during respiration in the bottom of the lung compared with the top, and the lower lobes are more aerated than the upper lobes as a result of what?
Due to gravity’s effect on the weight of the lung, the airways are more compressed in the bottom of the lung, and the pull of elastic fibers keep them relatively more open in the upper lobe
What causes a tension pneumothorax?
A tension pneumothorax results when external air enters the pleural space from a puncture wound (or from surgery). The opening acts as a one-way valve during inspiration and expiration, the air accumulates, and the entire lung can collapse to a small size. This is a medical emergency due to the compression of mediastinal structures from the increasing pressure of the pneumothorax.
Define atelectasis
If there is collapse of a portion of the lung due, for example, to absorption of air after obstruction of a bronchus (atelectasis) the visceral and parietal pleura usually remain in contact. A displaced fissure along with increased density would be an indication in an x-ray.)
Respiratory epithelium comes from which embryonic layer?
endoderm
(cartilage, smooth muscle, connective tissue, visceral pleura) develop from what layer of the embryo?
(cartilage, smooth muscle, connective tissue, visceral pleura) develop from splanchnic mesoderm.
branching of the bronchi. The epithelium is undifferentiated simple cuboidal epithelium.
Which stage of embryonic development is this?
Embryonic period:
(6 to 16 weeks; the airway resembles an exocrine gland). Branching to the level of terminal bronchioles, but no air exchange segments. Epithelium begins to differentiate. Blood vessels elaborate, but are not closely applied to the airway.
What developmental stage is this?
Pseudoglandular period (6 to 16 weeks; the airway resembles an exocrine gland). Branching to the level of terminal bronchioles, but no air exchange segments. Epithelium begins to differentiate. Blood vessels elaborate, but are not closely applied to the airway.
(16-26 weeks): branching down to primordial alveolar ducts surrounded by a rich vascular network. Epithelium is thinning at the location of alveoli. Breathing is possible, but surfactant is not yet produced.
what stage of development is this?
canalicular stage
(26 weeks to birth): elaboration of primordial alveoli with the differentiation of Type I and Type II alveolar cells. Surfactant is being produced, and preterm viability is possible.
What stage of development is this?
Saccular (terminal sac) stage: (26 weeks to birth): elaboration of primordial alveoli with the differentiation of Type I and Type II alveolar cells. Surfactant is being produced, and preterm viability is possible.
(32 weeks to 8 years): alveoli and acini continue to develop, and more generations of airway branching continue after birth. Only about half the number of adult alveoli are present at birth
What stage of development is this?
Alveolar stage: (32 weeks to 8 years): alveoli and acini continue to develop, and more generations of airway branching continue after birth. Only about half the number of adult alveoli are present at birth
- What are the most superior structures in the root of each lung?
A. Pulmonary arteries
B. Bronchi
C. Lymphatics
D. Pulmonary veins
E. Bronchial arteries
- What are the most superior structures in the root of each lung?
A. Pulmonary arteries
The pulmonary trunk branches into left and right pulmonary arteries above the heart. The veins are lower because they enter the left atrium of the heart. The bronchi tend to be in the middle of each root, and the bronchial arteries and lymphatics are more central, too.
B. Bronchi
C. Lymphatics
D. Pulmonary veins
E. Bronchial arteries
- What is the highest intercostal space a needle could be inserted laterally into the thorax and miss lung tissue?
A. 6th
B. 8th
C. 10th
D. Below the 12th rib
- What is the highest intercostal space a needle could be inserted laterally into the thorax and miss lung tissue?
A. 6th
B. 8th
The lungs extend down to the 8th rib laterally. The pleural cavity extends to the 10th rib.
C. 10th
D. Below the 12th rib
- What muscle is most responsible for increasing the volume of the thoracic cavity during quiet respiration?
A. Pectoralis major
B. External intercostal
C. Rectus abdominis
D. Internal intercostal
E. Diaphragm
- What muscle is most responsible for increasing the volume of the thoracic cavity during quiet respiration?
A. Pectoralis major
B. External intercostal
C. Rectus abdominis
D. Internal intercostal
E. Diaphragm The external intercostal and pectoralis major muscles become more active with labored breathing. The internal intercostal and rectus abdominis muscles are active in expiration.
The x-ray below shows an opaque mass that is obscuring the right margin of the heart (silhouette sign). Where is the mass located?
A. Lingua
B. Right lower lobe
C. Right middle lobe
D. Root of the right lung
A. Lingua
B. Right lower lobe
C. Right middle lobe
D. Root of the right lung
The middle lobe of the right lung lies against the heart. A mass (tumor or fluid) in it will give it the same density as the heart, obscuring the heart margin. A mass in the lower lobe will be behind the heart, and the contrast between heart and air in the middle lobe will remain. The lingua is the middle lobe equivalent in the left lung. The mass is too low to be at the root.
What cells reduce surface tension in bronchioles?
A. Goblet cells
B. Club cells
C. Type I pneumocytes
D. Type 2 pneumocytes
What cells reduce surface tension in bronchioles?
A. Goblet cells
B. Club cells
Goblet cells produce mucous, which would block small airways, not keep them open. Type I pneumocytes (alveolar cells) are the squamous linings of the alveoli across which gas exchange occurs. Type II pneumocytes produce surfactant, the alveolar equivalent of club cell secretions in the bronchioles.
C. Type I pneumocytes
D. Type 2 pneumocytes
- Where are the linear opacities of Kerley B lines seen in an x-ray in a person with pulmonary obstruction?
A. Root of the lung
B. Along bronchioles throughout the lung
C. Interlobular septa at the lung periphery
D. Parallel to visceral pleura
E. Along bronchopulmonary segment septae
- Where are the linear opacities of Kerley B lines seen in an x-ray in a person with pulmonary obstruction?
A. Root of the lung
B. Along bronchioles throughout the lung
C. Interlobular septa at the lung periphery
Kerley B lines are dilated lymphatics in the interlobular septa at the lung periphery. They are seen at the lung periphery where they are not obscured by larger blood vessels.
D. Parallel to visceral pleura
E. Along bronchopulmonary segment septae
Where is the first place gas exchange can occur?
A. Terminal bronchiole
B. Tertiary bronchus
C. Alveolar duct
D. Respiratory bronchiole
- Where is the first place gas exchange can occur?
A. Terminal bronchiole
B. Tertiary bronchus
C. Alveolar duct
D. Respiratory bronchiole
The terminal bronchiole is the smallest portion of the conducting part of the airway. A tertiary bronchus (or any bronchus) is the larger part of the airway. Alveolar ducts have walls lined with alveoli, but alveoli first appear scattered along the walls of respiratory bronchioles.
In what month of fetal development are alveoli developed to the extent gas exchange can occur?
A. 4
B. 5
C. 6
D. 7
E. 8
In what month of fetal development are alveoli developed to the extent gas exchange can occur?
A. 4
B. 5
C. 6 - Gas exchange is possible at 6 months, but surfactant is not produced by Type II cells until weeks after that.
D. 7
E. 8
Identify all of the layers in the following image. What part of the respiratory system is it? why?
bronchi: cartilate plates, mucosa, submucosa, ciliated epithelium
Where in the respiratory system is this from? why?
Bronchi. Ciliated epithelium with goblet cells
terminal bronchioles have cuboidal epithelium with club cells
respiratory bronchioles club cells/clara cells as well as alveoli
Where are goblet cells found?
only in the larger bronchioles, not in terminal bronchioles (with the exception of smokers)
What cells produce surface active lipoprotein other than type II pneumocytes?
club cells in the terminal bronchioles and respiratory bronchioles
