General Pulm notes

Question 1

What controls the right hemidiaphragm?

Answer 1

R phrenic nerve

Question 2

An acute change in PCO2 would be expected to produce:

Answer 2

a fall of 0.006 pH units for each 1 mm Hg increase in PCO2

Question 3

Which stat is the best single measure of the adequacy of alveolar ventilation?

Answer 3

PCO2 (arterial)

Question 4

What could cause hypoxemia?

Answer 4

-high altitude -a diffusion defect -venoarterial shunting

Question 5

What do alveolar macrophages do?

Answer 5

1. phagocytoses particles 2. releases chemotactic agents 3. releases lysosomal enzymes

Question 6

What proteins are found in mucous secretions?

Answer 6

1. alpha-one-antitrypsin 2. IgG 3. C3 4. Transferrin 5. Secretory IgA

Question 7

What is the CF mutation?

Answer 7

Delta 508. Affect the CFTR protein.

Question 8

Pulm fn test results for severe kyphoscoliosis

Answer 8

lower FEV1 and FVC, ratio is ok, TLC low. DLCO/VA is 100%. No change after bronchodilator

Question 9

Pulm fn test results for idiopathic pulmonary fibrosis

Answer 9

lower FEV1 and FVC, ratio is ok, TLC low. DLCO/VA is decreased! No change after bronchodilator

Question 10

Name the structures on this PA film

Answer 10

A. Trachea

B. R Pulm a.

C. R Clavicle

D. Aortic knuckle

E. Pulm a (pulm knuckle)

F. L Mainstem Bronchus

G. R hemidiaphragm

H. Gastric air bubble

I. Right lateral costophrenic recess (containing right lower lobe)

J. Pleura

Question 11

Name the structures on this Lat film

Answer 11

K. R Hemidiaphragm

L. L Hemidiaphragm

M. R major/oblique fissure

N. Minor/horizontal fissure

O. R upper lobe

P. R middle lobe

Q. R lower lobe

Question 12

Name the structures on this CT

Answer 12

A. L scapula

B. Descending Aorta.

C. Spinal cord

D. L Atrium

E. R Atrium

F. L Ventricle

G. Mitral valve

H. L ventricle

I. L ventricular wall

J. Esophagus

Question 13

Name the sturctures on this TEM

Answer 13

A. Type 1 alveolar pneumocyte

B. RBC

C. Capillary endothelial cell

D. Basement membrane

E. Capillary lumen

F. Alveolar airspace

Question 14

When does the respiratory system develop in embryology? Where does it start?

Answer 14

Week 4-6. Buds off esophagus (splachnic mesoderm). Laryngotracheal groove gives rise to opening and epiglottis.

Question 15

When is the pseudoglandular period? What’s happening?

Answer 15

Week 6-16. Looks like glands. Branching occuring, takes some splachnic mesoderm with it which becomes the visceral pleura.

Question 16

When is the canalicular period? What’s happening?

Answer 16

Weeks 16-26. Terminal bronchioles are splitting and have terminal saccules. Some gas exchange now possible.

Question 17

When is the saccular period? What is happening?

Answer 17

Week 26 - birth. Terminal saccules develop, more vasculature.

Question 18

When is the alveolar period? What happens?

Answer 18

Weeks 32 - 8 years. Type 1 cells become extremely thin, and capillaries really jam into close to them.
Type 2 cells at junctions
Continue to develop alveoli until 8 yrs. You develop about half after birth (I think)

Question 19

What occurs at birth in terms of respiration?

Answer 19

The birth canal squeezes fluid out of the thorax, then once thorax is free it has negative pressure to draw in air. Lymph drains remaining fluid.

Question 20

Common respiratory birth defects

Answer 20

Tracheoesophageal Fistula - esophagus is interrupted, so food goes in trachea. Just reconnect 2nd half of esophagus.

Congenital Diaphragmatic Hernia - Pleuroperitoneal membrane did not form properly, so stomach/GI go up there, lung can’t expand and grow properly.

Question 21

Respiratory distress syndrome

Answer 21

Lack of Type 2 cells/not enough surfactant released

Some membrane develops over the alveoli

More common in premature birth

Can give exogenous (bovine) surfactant