General Pulm notes Flashcards
What controls the right hemidiaphragm?
R phrenic nerve
An acute change in PCO2 would be expected to produce:
a fall of 0.006 pH units for each 1 mm Hg increase in PCO2
Which stat is the best single measure of the adequacy of alveolar ventilation?
PCO2 (arterial)
What could cause hypoxemia?
-high altitude -a diffusion defect -venoarterial shunting
What do alveolar macrophages do?
- phagocytoses particles 2. releases chemotactic agents 3. releases lysosomal enzymes
What proteins are found in mucous secretions?
- alpha-one-antitrypsin 2. IgG 3. C3 4. Transferrin 5. Secretory IgA
What is the CF mutation?
Delta 508. Affect the CFTR protein.
Pulm fn test results for severe kyphoscoliosis
lower FEV1 and FVC, ratio is ok, TLC low. DLCO/VA is 100%. No change after bronchodilator
Pulm fn test results for idiopathic pulmonary fibrosis
lower FEV1 and FVC, ratio is ok, TLC low. DLCO/VA is decreased! No change after bronchodilator
Name the structures on this PA film
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
Name the structures on this Lat film
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
Name the structures on this CT
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
Name the sturctures on this TEM
A. Type 1 alveolar pneumocyte
B. RBC
C. Capillary endothelial cell
D. Basement membrane
E. Capillary lumen
F. Alveolar airspace
When does the respiratory system develop in embryology? Where does it start?
Week 4-6. Buds off esophagus (splachnic mesoderm). Laryngotracheal groove gives rise to opening and epiglottis.
When is the pseudoglandular period? What’s happening?
Week 6-16. Looks like glands. Branching occuring, takes some splachnic mesoderm with it which becomes the visceral pleura.
When is the canalicular period? What’s happening?
Weeks 16-26. Terminal bronchioles are splitting and have terminal saccules. Some gas exchange now possible.
When is the saccular period? What is happening?
Week 26 - birth. Terminal saccules develop, more vasculature.
When is the alveolar period? What happens?
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)
What occurs at birth in terms of respiration?
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.
Common respiratory birth defects
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.
Respiratory distress syndrome
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
