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BIOS5092 > LECTURE 5 RESPIRATORY > Flashcards

LECTURE 5 RESPIRATORY Flashcards

1
Q

what does the bony thorax consist of?

A

sternum, 12 thoracic vertebrae, 12 pairs of ribs

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2
Q

what overlays the thorax?

A

2 clavicles & 2 scapulae (forming shoulder girdles that attach to upper limbs)

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3
Q

what does the middle of thorax correspond to?

A

T7

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4
Q

what is the level of T1?

A

uppermost margin of apex of lungs

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5
Q

where is the centre of thorax?

A

18cm below vertebra prominens in females, 20 cm in males

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6
Q

what does PA projection use as anatomy landmark?

A

vertebra prominens C7

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7
Q

what does AP projection use as anatomy landmark?

A

jugular notch

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8
Q

how many cm is t7 below jugular notch?

A

t7 is 8 to 10cm below jugular notch

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9
Q

what is the paranasal sinuses lined with?

A

by mucous membrane continuous with nasal cavity

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10
Q

what are the paranasal sinuses?

A

maxillary, frontal, ethmoid, sphenoid

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11
Q

what is the height of maxillary sinuses?

A

3-4cm vertical height- roots of molar teeth project onto floor of sinus (possible root for infection)

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12
Q

where are the frontal sinuses?

A

above orbits- generally paired but not symmetric

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13
Q

how do the sinuses appear on radiographs?

A

all sinuses overlap & superimpose so they dont have clear borders

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14
Q

what is the larynx suspended from?

A

hyoid bone

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15
Q

what is the larynx made of?

A

3 unpaired cartilages- epiglottis, thyroid cartilage, cricoid cartilage & 3 paired cartilages

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16
Q

what is the epiglottis?

A

seals larynx to prevent foreign bodies entering trachea

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17
Q

what is the thyroid cartilage?

A

“Adam’s apple” – largest and least mobile cartilage

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18
Q

what is the cricoid cartilage?

A

ring forming inferior and posterior wall of larynx – attached to first tracheal ring.

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19
Q

what is provides further protection to the trachea?

A

provided by vocal cords (known as vocal folds)

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20
Q

how long & wide is trachea in adults?

A

12cm long, 2.1-2.5 cm wide

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21
Q

how does the trachea appear in radiograph?

A

slightly to right side of thorax- gives right paratracheal stripe, but should be close to midline in PA view- anterior to oesophagus

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22
Q

what is the trachea made of?

A

15-20 posteriorly incomplete cartilagenous rings that prevent collapse & overexpansion- stacked structure prevents occlusion of trachea during head movement

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23
Q

what does the mucosa of trachea & bronchi comprise of?

A

ciliated cells, goblet (mucous producing) cells, sero-mucous glands in sub mucosa

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24
Q

what do upper airway radiographs visualise?

A

larynx & trachea

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25
Q

what level does the trachea divide at?

A

T5 into 2 primary bronchi (right is larger)

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26
Q

how big is right bronchi?

A

2.5cm long, 1.2cm wide- affected by foreign bodies more

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27
Q

how big is left bronchi?

A

5cm long & 1.1 cm wide

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28
Q

what do primary bronchi divide into?

A

secondary bronchi made of cartilage plates

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29
Q

how many lobes does right & left lung have?

A

r= 3 lobes, l= 2 lobes

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30
Q

what does the secondary bronchi divide to form?

A

tertiary bronchi- right lung (10) left lung (8-10)

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31
Q

what do tertiary bronchi divide into?

A

divide to form bronchioles- no cartilage in wall, have smooth muscle

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32
Q

how do bronchi appear in radiograph?

A

very thin walled, contain air & surrounded by air

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33
Q

what are the outpouching connected to bronchioles?

A

alveoli where gas exchange occur - they terminate in alveolar sacs

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34
Q

how many airway divisions are between the larynx & alveoli?

A

23

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35
Q

what are larger airways held open by?

A

cartilage

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36
Q

what are respiratory bronchioles held open by?

A

elastic tissue- susceptible to collapse

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37
Q

what is the outer surface of lungs covered in?

A

visceral pleura

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38
Q

what is the inner surface of thoracic all covered in?

A

parietal pleura

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39
Q

what do pleural membrane produce?

A

fluid that acts as lubricant

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40
Q

how does pleura appear in radiographs?

A

not normally visible on plain radiograph, except when they fold to form fissures

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41
Q

what does the mediastinum contain?

A

central cardiovascular & tracheobronchial structures, oesophagus, fat, thymus & lymph nodes

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42
Q

what effect can mediastinal masses have on radiograph?

A

can obliterate or displace mediastinal contours- wider when patient is supine due to increased venous return

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43
Q

what does the base of each lung rest on?

A

diaphragm- right is higher due to presence of lover on right

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44
Q

what is the costophrenic angle?

A

outermost lowest portion of pleural cavity where diaphragm meets ribs

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45
Q

where does the apex of lung project to?

A

points superiorly & posterior to clavicle

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46
Q

what is the costal surface of lungs in contact with?

A

ribs

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47
Q

what enters & leaves through the hilus?

A

bronchi, pulmonary & lymphatic vessels, nerves

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48
Q

what is the hilus?

A

junction of lung & mediastinum- best investigated using MRI

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49
Q

what are the 3 lobes in right lung?

A

superior, middle, inferior

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50
Q

what seperates superior lobe from middle?

A

horizontal (transverse) fissue- runs from hilus to 4th rib

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51
Q

what seperates the middle lobe from inferior in right lung?

A

oblique fissue

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52
Q

what sperates the superior & inferior lobe in left lung?

A

seperated by oblique (major) fissure

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53
Q

how do lung fissures appear in lateral film?

A

visible as fine, white lines

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54
Q

what is the course for major lung fissures?

A

course obliquely, roughly from level of 5th thoracic vertebra to diaphragmatic surface of pleura a few cm behind sternum

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55
Q

what are each lobes divided into?

A

bronchopulmonary segment

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56
Q

what is each lobe supplied by?

A

tertiary bronchus, pulmonary artery branch, bronchial artery branch & drained by pulmonary vein - surrounded by CT

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57
Q

what are lungs supplied by?

A

both pulmonary & systemic circulation

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58
Q

what is pulmonary circulation?

A

low pressure, originates in right ventricle & terminates in left atrium- carries deoxygenated blood into lungs for gas exchange

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59
Q

what does systemic circulation supply?

A

bronchi & bronchioles

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60
Q

what is the bronchial artery a branch of?

A

thoracic artery

61
Q

what does the bronchial vein drain in to?

A

azygos vein

62
Q

what is the highest point that right dome reaches?

A

6th intercostal space

63
Q

when supine, what is diaphragm doing?

A

it is elevated, lower lobes compressed

64
Q

on full inspiration, how many ribs should be visible?

A

10 ribs above diaphragm

65
Q

when is exposure made of inspiratory images?

A

exposure is made on second inspiration

66
Q

what does contraction of diaphragm do to domes?

A

lowers done- predominated when supine, lifts & flares ribs- parasternal & scalenes are also active

67
Q

what happens to diaphragm on standing?

A

diaphragm shortens, parasternals and scalene more activated

68
Q

what happens to diaphragm in respiratory disease?

A

additional recruitment of other rib cage muscles and neck inspiratory muscles if there are high lung volumes and/or high resistance

69
Q

what are the forces that act on lungs?

A

alveolar pressure, negative intrapleural pressure, intrapleural surface tension, elastic forces

70
Q

what is the role of alveolar pressure?

A

pressure tends to keep the lungs inflated

71
Q

what is the role of negative intrapleural pressure?

A

the pressure in the space between the two pleural layers is subatmospheric: this tends to suck the lungs outwards

72
Q

what is the role of intrapleural surface tension?

A

the pleural space is filled with fluid. Surface tension makes the outer layer of the lungs loosely adhere to the inner wall of the chest

73
Q

what are the elastic forces acting on the lung?

A

elastic tissue in the lung opposes inflation and facilitates deflation

74
Q

what happens when gas enters the intrapleural space?

A

the negative intrapleural pressure (a force keeping the lungs inflated) is lost- elastic forces (collapsing the lung) dominate, and the lung deflates

75
Q

what are radiographic signs of a pneumothorax?

A

Visceral pleura becomes visible – parallel to chest wall – especially on expiratory films- CT is often more useful- both inspiratory & expiratory images are needed- mediastinal shift to contralateral lung

76
Q

what is the vital capacity?

A

total amount of air that can be moved through the airways by a maximal inspiration which is followed by a maximal expiration

77
Q

what is tidal volume?

A

amount of air moved through airways during normal breathing

78
Q

what is inspiratory reserve capacity?

A

extra air that can be added to the lungs after a tidal inspiration

79
Q

what is expiratory reserve capacity?

A

extra air that can be removed from the lungs after a tidal expiration

80
Q

what is the residual volume?

A

amount of air left in lungs are a tidal expiration

81
Q

how do we transport oxygen?

A

as oxygen (gas) has low water solubility and carbon dioxide is higher, a carrier is required, haemoglobin (Hb)

82
Q

how much oxygen can each Hb molecule carry?

A

4 oxygen molecules (4 binding sites)

83
Q

what is saturation a measure of?

A

how many binding sites are occupied- if every Hb molecule is carrying 4 oxygen, saturation is 100%- the max is 95-98%

84
Q

what does arterial oxygen content indicate?

A

how much oxygen the blood is carrying - content= saturation X (Hb)

85
Q

when is o2 transport normal?

A

when person has normal (Hb) & normal saturation o2 transport

86
Q

when is o2 transport low?

A

if person has low (HB) and normal saturation 02 transport

87
Q

what is the relationship between oxygen pressure & saturation?

A

when PO2 is high, saturation is high- when PO2 is low, saturation is low

88
Q

what happens if the partial pressure of carbon dioxide (PCO2) increases?

A

our pH will fall

89
Q

how much is PCO2 allowed to change before respiration is altered?

A

change by +1 Torr

90
Q

what happens if PaCO2 increases & decreases ?

A

ventilation increases or ventilation decreases- pao2 is allowed to fall much more severly before ventilation is stimulated, about 100 torr to 50 to 60 torr

91
Q

what is a tension pneuomothorax?

A

injury to chest wall & injury is acting like a valve causing gas to fill the lung cavity & increasing pressure- stops heart getting back to blood

92
Q

what can diseases of the lung tissue produce in radiographs?

A

opacity & lucency

93
Q

what is the ratio of air to tissue?

A

11:1

94
Q

what causes opacities in radiographs?

A

atelectasis, pulmonary oedema, pheumonia, haemorrhage, tumour

95
Q

what are radiographic signs of aspiration?

A

unilateral hyperinflation (expiratory images show gas trapping), atelectasis, visualise foreighn body with CT)

96
Q

what is atelectasis?

A

collapse/incomplete expansion of alveolia- can be obstructive (resorption to obstructed bronchus) & nonobstructive (pneumothorax, deficiency of surfactant, compression by transudate, exudate or tumours)

97
Q

what are radiographic signs of atelectasis?

A

increased radiodensity, displacement of fissures & hilus + mediastinal shift

98
Q

what is bronchiectasis?

A

Irreversible dilation of the bronchi caused by destruction of walls during infection- uncommon

99
Q

what are symptoms of bronchiectasis?

A

chronic cough, purulent sputum (looks pussy due to infection), recurrent infections

100
Q

what are radiographic signs of bronchiectasis?

A

peribronchial fibrosis (fibrous tissue around bronchi), increased pulmonary markings, atelectasis, dilate bronchi

101
Q

what is chronic bronchitis (COPD)?

A

Increased mucus production and narrowing, cough- can be due to smoking & can be confused for pneumonia in radiographs

102
Q

how is chronic bronchitis diagnosed?

A

chronic cough for 3 months for 2 years

103
Q

what is emphysema?

A

destruction of alveolar walls causes dilated air spaces- causes empty space in lungs

104
Q

what are the radiographic signs seen in emphysema?

A

hyperinflation of lungs (gas becomes traps), hyperlucency (less lung tissue & vascularity making dark lung fields), increased retrosternal air space, loss of vascularity, flattened diaphragm (due to lungs over-expanded), small heart, thickened bronchial walls

105
Q

what is cystic fibrosis?

A

Abnormal exocrine function affecting several body systems (cannot secrete chloride ions so mucus is very sticky & remains in airways)- Causes cough, wheezing, recurrent pneumonia, dyspnoea (breathelessness)

106
Q

what are radiographic signs of cystic fibrosis?

A

hyperinflation, peribronchial thickening, bronchiectasis (widening of airways)

107
Q

what is epiglottitis?

A

Acute inflammation of pharynx due to bacterial or viral infection, drug abuse and other burns- causes breathing difficulties

108
Q

what are the radiographic signs of epiglottitis?

A

swollen epiglottis- only radiograph patients with stable airways

109
Q

what is neoplasia?

A

metaplasia of brochial cells- if epithelial cells transform you get large cell tumours (squamous cell carcinoma or adenocarcinoma e.g. cells of mucous glands)- if endocrine cells transform, get small cell tumours)

110
Q

where can tumours appear in neoplasia?

A

centrally located (hilar- small cell tumours) or peripherally located (large cell tumours in lungs)

111
Q

what are symptoms of neoplasia?

A

bronchial irritation, atelectasis & infections, nerve damage due to local growth, distant metastases

112
Q

what are the common types of neoplasia?

A

Mostly bronchogenic carcinoma – arises from bronchial or alveolar epithelium e.g. adenocarcinoma, small cell tumours, squamous cell carcinoma, non small cell tumours

113
Q

what is adenocarcinoma?

A

33% of tumours, most common form in nonsmokers, 75% are peripheral

114
Q

what are small cell tumours?

A

25% of tumours, most are central (hilar mass)

115
Q

what are squamous cell carcinoma?

A

25% of tumours, most are central (hilar mass)- hard to detect

116
Q

what are non small cell tumours?

A

15% of tumours- most are peripheral

117
Q

what is atelectasis?

A

obstruction of airways

118
Q

when are masses malignant or benign?

A

if mass is more 4cm+= malignant- if fully calcified, lesions are benign

119
Q

what is doubling time?

A

time required to double tumour mass (increase diameter of sphere by 25%)

120
Q

what is the average double time is malignent neoplasms?

A

180 days

121
Q

what is the doubling time if lesion is benign?

A

if doubling time is <30 days or >2 years= lesion is benign

122
Q

what are the nodules in young non smokers with no history of neoplasma?

A

usually inflammatory

123
Q

what are common patterns of metastatic tumours?

A

miliary (rash with lesions- lots of small tumours in both sides of lungs), solitary nodules, cavitating, oedema if lymphatics obstructed

124
Q

how do metastatic tumours are in lungs?

A

via blood stream, lymphatic or direct invasion

125
Q

where is the main origin of metastatses?

A

breast, kidney, gut, gonads

126
Q

what is a pleural effusion?

A

abnormal accumulation of fluid in pleural space- due to disease processes

127
Q

what are the 2 types of pleural effusions?

A

transduate (oedema- affecting the heart) or exudate (inflammation, tumour)

128
Q

what are the symptoms of pleural effusion?

A

pain, dyspnoea

129
Q

what is the diagnoses of pleural effusion?

A

chest radiograph (increased radio opacity, giving ground glass appearance), CT, ultrasound- uni or bilateral

130
Q

where does increase radio opacity show in pleural effusions?

A

between lower lobe & diaphragm

131
Q

what is pneumonia?

A

Infection of alveoli, pulmonary interstitium or both- can be bacterial or viral

132
Q

where does lobar pneumonia occur?

A

infectios begins in alveoli- gives of exudate in responce to inflammation- spread across lobe- air bronchograms due to patent larger aiways- usually begins in lower lobes

133
Q

what is bronchopneumonia?

A

most common, initially inflammation in airways, causes patchy consolidation

134
Q

what is atypical pneumonia?

A

inflammatory thickening of airways & interstitium

135
Q

what are symptoms of pneumonia?

A

general sign of infection, coughing, chest pain, airway obstruction, sputum, haemoptysis

136
Q

what are signs of pneumonia on plain radiographs?

A

localise infiltrates & assess extend of consolidation

137
Q

what are pulmonary embolisms?

A

often misdiagnosed- a thrombus migrates to pulmonary vessels causing obstruction- stops blood flowing through it

138
Q

what does obstruction of blood flow cause in pulmonary embolism?

A

pulmonary hypertension causing right heart failure- V/Q mismatch happens when part of your lung receives oxygen without blood flow or blood flow without oxygen (low po2)

139
Q

what are symptoms of a pulmonary embolism?

A

dyspnoea at rest, chest pain, haemoptysis (cougling up blood)

140
Q

what do plain radiograph show in pulmonary embolisms?

A

perfusion scanning shows area with low blood flow (using labelled albumin)- ventilation scanning shows good ventilation

141
Q

what is acute respiratory disease syndrome (ARDS)?

A

Sign of acute lung injury causing damage to alveoli and pulmonary capillaries

142
Q

what are radiographic signs show in ARDS? ·

A

Bilateral pulmonary infiltrates – symmetric or asymmetric

143
Q

what is tuberculosis?

A

multi systemic bacterial infection

144
Q

what are radiographic signs of tuberculosis?

A

patchy or nodular infiltrate, often in upper lobes- calcified inflitrates, cavity formation

145
Q

what is pulmonary oedema?

A

initially fluid builds up in interstitium due to CVD, alveoli are flooded cause interstitial oedmea

146
Q

how does interstitial oedema appear in radiographs?

A

loss of definition of structures, local ground glass opacity

147
Q

how does alveolar flooding appear in radiographs?

A

bilateral symmetrical opacities

148
Q

what do inspiratory & expiratory images show?

A

small pneumothorax, abnoral diapragm movement, foreign bodies, differentiate opacities in ribs & lungs

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