B4 CPR Pulmonology Flashcards
respiratory epithelium contents
ciliated pseudostratified columnar epithelium
Goblet Cells
what structure is start of respiratory system
respiratory bronchiole
what part of nasal cavity lined with olfactory epithelium
superior conca
bronchus vs bronchiole
bronchus have cartilage
respiratory system 2 functioms
conducting
gas exchange
components of conduction portions of respiratory
seromucus & vascular network in lamina propria
vibrissae
fxn superficial vascular netwrok lamina propira
warm inspired air
fxn mucus & serous glands lamina propira
moisten inspired air
3 parts wall sx of respiratory
mucosa (epithelium & lamina propira)
submucosa (seromucous gland, smooth musc)
adventitia (outer layer)
5 cells respiratory epithelium
ciliated columnar
goblet
brush
basal
small granule
cytoskeletal structure for,s axoneme cilia
microtubules
Primary Cilia Dyskinesia/Kartagener’s syndrome
defective/absent dynein arms
prevent mucocilliary clearance
can be in all arms, outer or inner arms
Smoker respiratory epithelium changes
metaplasia to stratified squamous
decrease ciliated columnar cell
increase goblet cell
smoker melanosis
benign focal pigment of oral mucus from mutagentic chemical tobacco
Brush cells from what
microfilaments of akctin
brush cells receptor
chemosensory receptor
afferent nerve endings
basal cell fxn
undifferentiated stem cells
small granule cell names & fxn
Neuroendocrine, Kulchitsky
regulate bronchial & vascular muscle tone response to- hypoxia
what is only tissue type that increases in number as go down respiratory tract
elastic fibers (toward alveoli)
nasal cavities of lamina propira microorganisms
bind/inactivated by IgA in plasma cells
What does the nasal cavity mucosa contain to help warm, humidify, and clean inspired air
loop capillary
seromucus gland
what sx has lots of cartilage
larynx
Sx of trachea
C rings hyaline cartilage
relax in swallow
bifurcates to R & L primary bronchi
perichondrium
connective tissue layer lining both sides of the cartilage and contains its vascular supply and stem cell
major feature/fxn nasal cavity vestibules
Vibrissae
filter & humidify air
major feature/fxn nasal cavity
warm, humidify, clean air
major feature/fxn superior nasal cavity
solubize/detect odorants
major feature/fxn nasopharynx
conduct air to larynx, pharyngeal, palatine tonsils
major feature/fxn larynx
phonation
major feature/sx trachea
conduct air to primary bronchi of lung
R vs L primary bronchi
both have superior, secondary, tertiary bronchus
R bronchi has 3 lobes in R lung
L bronchi has 2 lobes in L lung
what is final part of conducting respiratory system
terminal bronchioles (from smaller generations of tertiary bronchi)
change in bronchi as they branch
progressiveky smaller
acute vs chronic bronchitits
acute = viral
chronic = smoking/pollutants, leave permanent change
subtype of non small cell lung cancer (85% all lung cancer)
Adenocarcinoma
Squamous cell carcinoma
large cell carcinoma
adeno carcinoma
non small cell, most common
from bronchiole glands & alveoli epithelial cells
well differentiated
from p53 mutate
rare metastasize, best prognosis
squamous cell carcinoma
non small cell
metaplasia of epithelium to stratified squaous epithelium (reversible)
can lead to dysplasia (irreversible)
makes keratin pearls
doesn’t spread normally
large cell carcinoma
non small cell
poorly differentiated
lack squamous/glandular morphology
grow faster/more than other nonsmall
clear in nucleus when stain
metastasize
small cell carcinoma
oat cell
smokers highly aggressive
metastasize far/wide very fast
neoplastic transformation of small granyle in bronchial respiratory epithelium
poor prognosis
bronchiole sx
no mucosal gland/cartilage
terminal bronchioles have ciiated simple columnar/simple cuboidal epithelium
start mucociliary appartays
significance mucociliary apparatus
trachea to bronchioles
inner lining of conducting airqay
parasympathetic response in terminal bronchioles
constrict
sympathetic response in terminal bronchioles
dilate
bronchiolitis
likely from RSV
very common babies/kids
old people with pre existing
inflammation of bronchial wall, epithelial necrosis
Which structures are lined by respiratory mucosa, with prominent spiraling bands of smooth
muscle and increasingly smaller pieces of hyaline cartilage?
bronchi
What are the last bronchiole branches that lack alveoli and are lined by simple cuboidal
epithelium consisting mainly of club cells with innate immune and surfactant secretory
functions
terminal bronchioles
terminal bronchiole division
respiratory bronchioles then branch into alveolar ducts that branch into alveolar sacs
atria sx
distal terminations of alveolar ducts
give rise to alveolar sacs
what are alveolar sacs
cluster of alveoli
very thin lamina propira
differemt anout lamina propira in alveoli
thin
elastic & reticular fibers
smooth muscle
3 components blood-air barrier
thin capillary endothelial cells
two attentuated thin cells line alveolus
fused basal laminae of thin cell with capillary endothelial cells
emphysema
destruction of interalveolar wall
reduce SA for gas exchange
common froim cigarettes
why does cigarette smoke cause emphysema?
inhibit a1AT (protect lung from elastase that marophages produce)
lungs are unable to recoil due to decrease elasticity
main components COPD
emphysema
chronic bronchitis
two cells of alveoli walls
type I (squamous) alveolar cells
type II (alveolar septal) alveolar cells
Ti alveolar cells
most of surface
minimal barrier that readily permeable to gas exchange
TII alveolar cells
cuboidal where septal walls converge
foamy appearance from lamellar bodies
lamellar bodies
organelles with phospholipid, glycosaminoglycabs, proteins
continuous secrete as pulmonary surfactant
function of lamellar bodies
post translational assemply/packing surfactant components
helps decrease surface tension in alveoli
incomplete differentation of TII alveolar cells & RDS
lead cause for infant respiratory distress
difficulty expanding alveoli
hyaline membrane disease as look glassy/protein rich when collapsed alveoli
alveolar macrophages/dust cell sx/fxn
darker from iron/erythrocytes
phagocytose erythrocyte from damaged capillaries/airboene particles
migrate to bronchioles to motor removal esophagus
dust cells = heart failure cells
in congestive heart failure
lungs congest with blood & phagocytozised
hemosiderin is chem rxn see occur
major fxn/sx bronchi
repeat branching
air deeper into lungs
major fxn/sx bronchioles
air conduction
help bronchoconstrict/bronchodikate
major fxn/sx terminal bronchioles
air to respiratory area lungs
exocrine club cells with protective/surfacant
major fxn/sx respiratory bronchioles
air deeper with gas exchange, protective/surfacant club cells
major fxn/sx alveolar sac/duct
conduct air
gas exchange
major fxn/sx alveoli
all gas exchange
surfacant TII dust celkl
path of sx from terminal bronchioles
to respiratory bronchioles
to alveoli ducts
to alveoli
what structure characterize TII alveolar with surfacant synthesis
lamellar bodies
mad of multivestibular bodies
what make regenerated epithelium
TII pneumocytes
blood circulation lungs consist of
pulmonary circulation (O2 poor)
bronchial circulation (O2 rich)
what structures accompany bronchial tree pulmonary circulation
pulmonary artery branches
respiratory bronchiole arterial branches give rise capillary networks in Intraalveolar septa
venules from capillary to small pulmonary veins
bronchial circulation blood path
from thoracic artery to bronchial arteries
branch in tree to anastamose with branch pulmonary artery
mix blood with cappilary netwroks
lymph drainage of lung
superficial near lung in visceral (parallel deep network)
deep lymph in CT (hilum nodes)
where are lymph vessels not foudn
past alveolar ducts
sympathetic NS lungs
from R & L sympathetic trunks
bronchodilation
vasoconstriction (increase ventilation-perfusion)
inhibit bronchial tree glands
parasympathetic NS lungs
R/L vagus nerves
bronchoconstriction
vasodilation
pleural fluid path
produce by parietal circulation
reabsord lymph system
inspiration
active
pressure in cavity decreases
contraction of muscle move cage up
expiration
passive
muscles relax
elastic tissue retract
blood path to lungs
sternal angle at 2nd rib trachea bifurcates
aortic arch
thoracic artery
bronchial artery
trachea location (spinal levels)
c6- T4/5
end at carina
what is carina
lowest cartilage ring of trachea
area of bifurcation
tracheal disorders & dyspnea
tracheal stenosis, tracheomalacia, foreign body aspiration
structural difference between R & L bronchi
R main bronchi is shorter, wider and vertical
L main bronchi is longer, narrower and horizontal
what bronchi most objects get stuck in
R bronchi almost always
lay Left recumbant as aspirate if on R
difference in lobes on Left side
cardiac notch for L side of heart
lingua
apex of lung location
2-3 cm above medial third of clavicle
anterior border lungs
behind sternum @ 2 costal cartilage then diverge @ 4 costal cartilage
lower border of lung location
6th rib midclavicular line
8th rib midaxillary line
10th rib paravertebra line
(chest tube 2 down from 10)
where does oblique fissure run
T4 posteriorly to 6th rib anteriorly
where does horizontal fissure run
around 4th intercostal
4 parts of parietal pleura
cervical
costal
diaphragmatic
mediastinal
innervation visceral pleura
vagus
insensitive pain
parietal pleura innervation
somatic nerevs
sensitive to pain
cupola
in pleural recess
@lung apex
vulnerable injury neck trauma
pancoast tumors
apical lung tumors in cupola
lay supine foreign body enters
the superior portion of right lower lobe
superior, posterior, medial
lay on R side foreign body enters
Right upper lobe
apical, posterior, anterior
upright, foreign body enters
lower portion of right lower lobe
medial basal, anterior basal, lateral basal, posterior basal
pulmonary vein clinical
need for afib treatment
diagnosing pulmonary veno-occlusive disease
bronchial circulation clinical
bronchial arteries enlarge in chronic lung disease
targets for embolism in sever hemoptysis
lymphatic drainage & lung cancer
carinal nodes enlargements
located in inferior tract of bronchiole, which makes this enlarged
when enlarged likely metastasized
pulmonary plexus
sympa & parasympa
@ root each lung
sympathetic lung nerve supply
upper thoracic sympa ganglia
T1-4
bronchodilator
vasoconstrictor
visceral afferent nerve lung
info about inflation & chemical irritation
send to central NS
doesn’t do pain
costal pleura innervation
supply by intercostal nerves
diapragmatic/mediastinal pleura innervation
phrenic nerve
auscultation upper lobes
anteriorly above 4th (R lung)
above 6th (L lung)