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Jess Resp > First Aid Embryology + Anatomy > Flashcards

First Aid Embryology + Anatomy Flashcards

1
Q

Describe the five stages of lung development and the weeks in which they occur

A

Every Pulmonologist Can See Alveoli

  1. Embryonic: wks 4-7: from lung bud -> tertiary bronchi
    (including trachea, bronchia buds, mainstem/primary and secondary (lobular) bronchi in between)
  2. Pseudoglandular: wks 5-17: tertiary bronchi -> terminal bronchioles
  3. Canalicular: wks 16-25: terminal bronchioles -> respiratory bronchioles -> alveolar ducts. Prominent capillary network
  4. Saccular: wks 26-birth: alveolar ducts -> terminal sacs
  5. Alveolar: wks 38-8 years: development of adult alveoli. (Born with 20-70 million, have 300-400 million by 8 years)
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2
Q

What can errors in the embryonic stage of lung development cause?

A

A tracheoesophageal fistula

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3
Q

When is respiration capable?

A

25 weeks

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4
Q

When do pneumocytes start developing?

A

20 weeks

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5
Q

How does pulmonary hypoplasia develop and what other congenital malformations is it commonly associated with?

A

Poorly developed bronchopulmonary tree with histological abnormalities. Associated with a congenital diaphragmatic hernia (usually L sided) and bilateral renal agenesis

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6
Q

What is the POTTER sequence?

A
  1. Pulmonary hypoplasia
  2. Oligohydramnios (triggers it)
  3. Twisted face
  4. Twisted skin
  5. Extremity defects
  6. Renal failure (in utero)
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7
Q

Describe the structure of club cells, what do they do and where are they?

A

Nonciliated, low columnar/cuboidal cells with secretory granules in the bronchioles. They degrade toxins and secrete a component for surfactant, they also act as reserve cells

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8
Q

What are the two types of epithelial alveolar cells? What is their function?

A

Type 1 and 2 pneumocytes

Type 1: simple squamous thinly lines alveoli for gas exchange

Type 2: cuboidal and clustered

  • produce surfactant
  • act as stem cell precursors for both type 1 and 2 and proliferate during lung damage
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9
Q

What is surfactant composed of? When does its synthesis begin and when does it achieve mature levels? and when does its synthesis begin?

A

Composed of multiple lecithins (mainly DPPC)

Begins to be synthesized at 20 weeks gestation and is mature at ~35

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10
Q

Name a crucial component to lung development and fetal surfactant synthesis.

A

Corticosteroids

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11
Q

What is the law of laplace?

A

Alveoli have an increased tendency to collapse on expiration as the radius drops

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12
Q

What do alveolar macrophages do?

When might you see hemosiderin-laden (HF) macrophages?

A

They phagocytose foreign materials and release cytokines and alveolar proteases. Once the debris is eaten, they migrate to the bronchi and travel up the mucociliary escalator to be excreted

HF macrophages may be seen in pulmonary edema and alveolar hemorrhage

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13
Q

How does the lung field appear in a patient with neonatal respiratory distress syndrome? Name two treatments

A

“Ground glass” appearance

Treatments:

  1. maternal steroids before birth (stimulate surfactant production)
  2. Exogenous surfactant for infant
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14
Q

What can supplemental O2 result in when provided to patients with neonatal respiratory distress syndrome? a

A

RIB

  1. Retinopathy of prematurity
  2. Intraventricular hemorrhage
  3. Bronchopulmonary dysplasia
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15
Q

Name 3 RFs for neonatal respiratory distress syndrome

A
  1. Prematurity
  2. Maternal diabetes (insulin inhibits expression of surfactant protein A)
  3. C-section delivery, as in a normal vaginal delivery there is enough stress for the fetus to release a sufficient amount of glucocorticoids (a class if corticosteroids) for surfactant production
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16
Q

Describe the mechanism of action of surfactant

A

Decreases surface tension -> decreases alveolar collapse -> decreases lung recoil and increases lung compliance

17
Q

What causes bronchogenic cysts? How do they appear on a CXR and how do they present?

A

Caused by abnormal budding of the foregut and dilation of the terminal or large bronchi. They appear as rounded, sharply defined, fluid-filled cysts on a CXR but will be air-filled if infected. They’re often asymptomatic but can drain poorly -> causing compression and/or recurrent respiratory infections

18
Q

Name three screening tests for fetal lung maturity

A

L/S ratio in amniotic fluid, foam stability index, surfactant-albumin ratio

19
Q

What is persistently low O2 tension in a newborn indicative of?

A

Patent ductus arteriosus

20
Q

What are the large and small airways of the conducting zone, and what is this zone’s purpose?

A

Conducting zone: warms, humidifies and filters air (NO gas exchange)

Large airways: nose, pharynx, larynx, trachea, bronchi

Small airways: bronchioles -> terminal bronchioles

21
Q

Name where in the respiratory tract that the following structures cease

a) goblet cells and cartilage
b) pseudostratified ciliated columnar epithelia
c) smooth muscle cells (for the most part)
d) Cilia

A

a) end of bronchi
b) beginning of terminal bronchioles (transitions into cuboidal)
c) End of terminal bronchioles
d) Respiratory bronchioles

22
Q

What makes up the lung parenchyma/respiratory zone?

A

Respiratory bronchioles, alveolar ducts and alveoli

23
Q

Describe the differences in the lobular structure between the R and L lung

A

R lung: 3 lobes

L lung: 2 lobes (no middle) with a lingula (space for the heart)

24
Q

Where is the horizontal fissure?

A

Between the RUL and RML

25
Q

Describe the relationship of the pulmonary artery to the bronchus at each lung hilum

A

RALS

R Lung: pulmonary artery is Anterior to the bronchus in the hilum

L lung: pulmonary artery is Superior to the bronchus in the hilum

26
Q

Describe the location of the carina in relation to the ascending and descending aorta

A

Ascending: posterior
Descending: anteromedial

27
Q

Which lung is a more common site for foreign inhaled bodies and why?

A

Right lung as the primary bronchi is shorter, wider and more vertical

28
Q

Where will the inhaled peanut go…

a. Supine
b. Lying on R side
c. Upright

A

a) superior portion of RLL
d) RUL
c) RLL

29
Q

Which structures perforate the diaphragm at the following vertebral levels

a) T8
b) T10
c) T12

A

T8: IVC and R phrenic nerve
T10: Esophagus and cranial n 10 (vagus)
T12: T-1-2, red-white-blue! Aorta, thoracic duct, azygous vein

30
Q

What innervates the diaphragm? Where are the possible locations for referred pain and why?

A

C3,4,5 Phrenic N

Shoulder: C5 axillary nerve
Trapezius ridge (lower border of scapula): C3,4
31
Q

Where do the following structures bifurcate?

a) Common carotid
b) Trachea
c) Abdominal aorta

A

BiFOURcate
a) C4
b) T4
C) L4

Jess Resp (20 decks)

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