Exam 1 Flashcards
When thinking about the lungs, what is a collapse of the lungs called?
Atelectasis (collapse)
What happens to the bronchioles during cases of Emphysema? (hint: dilation or constriction)
Dilation of the bronchioles (bronchiectasis)
What is the term used for dilation of the bronchioles? And which bronchioles does this usually effect?
- Bronchiectasis
- Medium sized bronchioles
How many lobes and bronchi does the RIGHT lung have?
3 lobes and 3 main bronchi
How many lobes and bronchi does the LEFT lung have?
2 lobes and 2 main bronchi
Looking at the right main bronchus, what is the orientation of this bronchus? (hint: vertical or horiz)
Vertical, yo
Where do the bronchi receive arterial blood from?
Pulmonary and bronchial
Great (Type 2) cells secrete _______ , to help facilitate _______.
Surfactant, Surface tension
The LARYNX, TRACHEA, BRONCHIOLES are lined with what type of epithelium?
Pseudostratified columnar epithelium (This goes all the way from the nose to the terminal bronchioles)
What are the true vocal cords lined with?
Stratified squamous epithelium
What three histologic structures/substances does a normal bronchus consist of?
- Respiratory epithelium (pseudostratified)
- Sub mucosal glands (mucus secretion)
- Cartilage (hyaline)
Bronchial mucosa has neuroendocrine cells that secrete what substances? (hint: 3 things)
- Calcitonin
- Serotonin
- Gastrin releasing Peptides
(C-S-G-P)
What do Type 1 pneumocytes facilitate?
facilitates gas exchange
If Type 1 pneumocytes are lost, what will help to replace them?
Type 2 pneumocytes multiply and differentiate to form new Type 1 cells
Which of the cells in the alveoli are more prone to injury (type 1 or type 2)?
Type 1
What is the shape of Type 2 pneumocytes?
CUBOIDAL
What do Type 2 pneumocytes produce?
Surfactant
What is the other type of cells that are commonly found in the alveoli?
Alveolar macrophage
Where are large particles that enter the through the nose deposited?
In the nose
Where are intermediate-sized particles deposited?
Bronchi, bronchioles
How are these intermediate-sized particles removed?
Mucociliary action
When smaller particles get through the airway and are deposited where? What removes them?
Deposited in the alveoli
Alveolar macrophages remove them
Congenital anomalies Stages 4wk - Embryonic 7-17wk - Pseudoglandular 17-27wk - Canalicular 27-40wk - Saccular 40wk-... - Alveolar
Anomalies
Embryo - Laryngeal/Tracheal stenosis, fistula, pulmonary sequestration, bronchogenic cysts
Pseudoglandular - pulmonary hypoplasia, malacia, adenomatoid malformation
Canalicular - pulmonary hypoplasia, arteriovenous malformations
Saccular - pulmonary hyperplasia
Alveolar - Lobar emphysema, lymphatic anomalies
Bronchial artesia, what lobe commonly involved?
Apical posterior segment of the left upper lobe
Later on in life what can happen to the over expansion of the lung lobe?
Can become emphysematous
Hypoplasia of the lung (aka agenesis) seen in what?
Trisomies 13, 18, 21
What are two other causes of hypoplasia?
- chest wall abormalities, ascites, pleural effusion
2. Oligohydramnios (inadequare volume of amniotic fluid)
Lungs bigger or smaller than the heart?
MUCH smaller
Bronchogenic cysts, when are they usually seen?
First 2 year of life
Where are bronchogenic cysts found?
Middle mediastinum
In newborns what can a BRONCHOGENIC CYST cause, and why?
Respiratory distress by compression of major airway
What can happen when there is a secondary infection of the cyst?
Hemorrhage and perforation
How many types of morphology are bronchogenic cysts divided into?
3 types
What are the 3 types of bronchogenic cysts?
Type 1 - 50% - large, ciliated epithelium
Type 2 - 40% - multiple small cysts, ciliated epithelium
Type 3 - 10% - solid, bulky lesion, MEDIASTINAL SHIFT
In bronchopulmonary sequestration… where is the pulmonary tissue situated?
Outside lung parenchyma
Where does the blood supply to the sequestered area arise from?
Aorta or its branches
What other congenital anomalies are often associated with extra-lobar pulmonary sequestrations? (hint: 4 things)
- Diaphragmatic hernia
- Diaphragmatic defect
- Cardiopulmonary anomalies
- Abnormal communication with foregut
What are the two types of bronchopulmonary sequestration?
Intra-lobar sequestrations - (90% on LEFT SIDE!)
Extra-lobar sequestrations
What does bronchopulmonary sequestration look like microscopically?
- Cystic spaces lined by CUBOIDAL or COLUMNAR epithelium
- Lumen contains FOAMY MACROPHAGES and EOSINOPHILIC material
Clinical features of sequestrations…
Dyspnea and Cyanosis occur in 90% of extra-lobar sequestration cases, in CHILDREN
Majority of extra-lobar sequestrations occur where?
77% - close to diaphragm
90% - in left suprarenal area
CASE:
- A female infant is born prematurely at 28 weeks gestation
- Shortly after birth, she shows signs of dyspnea, cyanosis, tachypnea
- She is placed on a ventilator for assisted breathing, and diagnosis of neonatal respiratory distress syndrome (hyaline membrane disease) is made
- -Which of the following is the cause of this syndrome?–
a) Bronchopulmonary dysplasia
b) Intraventricular brain hemorrhage
c) Lack of Fetal pulmonary maturity and deficiency of surfactant
ANS: C - Lack of fetal pulmonary maturity and deficiency of surfactant
Neonatal respiratory distress syndrome (hyaline membrane disease) is the most common cause of respiratory failure in what population? What does this result from?
Newborns
Deficiency of surfactant and immature development of the lungs
What is an indicator of fetal pulmonary maturity?
- Lecithin: Sphingomyelin ratio - 2:1
- This is measured in the amniotic fluid
What are some predisposing factors of fetal pulmonary maturity?
- Prematurity
- Maternal diabetes mellitus
- C-section birth
What is important to know to diagnose such cases as discussed previously? (eg. fetal pulmonary maturity)
- History
- Age
- Gender
Pursed lip breathing
partial closing of lips to allow air to be expired slowly; used by patients with COPD
Kussmal breathing
deep gasping respiration associated with SEVERE DIABETIC ACIDOSIS and COMA
Barrel chest (eg. bronchitis, emphysema)
condition characterized by increased AP chest diameter caused by INCREASED FRC due to AIR TRAPPING from SMALL AIRWAY COLLAPSE
What test do you use to palpate for fremitus?
- “99-test”
- Normally present on both sides equally
- Fremitus is a vibration
Bronchial breath sounds are abnormal where?
- PERIPHERAL AREAS where only vesicular (soft and rustling) sounds should be heard
If there are bronchial sounds heard in area distant from where they normally occur, the patient may have what condition? (hint: 2 things)
- Consolidation (occurs in pneumonia)
- Compression of the lung
Presence of adventitious sounds indicates what?
- ABNORMALITY
What are the three different adventitious sounds?
- Pleural rib
- Rhonchi
- Crackles or crepitations
What does localized rhonchi suggest?
- Obstructive etiology (eg. Tumor, foreign body, mucous)
Note: mucous secretions disappear with coughing, so would rhonchus
While rhonchi are very uncommon in COPD, what disease/disorder are they common in…
ASTHMATICS
When auscultating the chest, what would rhonchi sound like?
- Crackles
- produced by air passing over airway secretions
High pitched rhonchi are called what?
SIBILANT rhonchi
Low pitched rhonchi are called what?
SONOROUS rhonchi
