Lecture - Resp (Yusuf Lower airways)

Question 1

Broadly, what structures are part of the lower resp system if the upper is nose, nasal, pharynx larynx

Answer 1

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Question 2

So in the upper resp system (that ends at the larynx), you have air-conudction. We now wish to identify other parts of the air-conducting tract, the lower resp system, which will then lead finally to the parts concerned with ______ (i.e gas exchange)

Answer 2

So the upper is just air and the lower is air plus gas exchange

Question 3

The lower resp system has:

• trachea
• bronchi: what are the three types of bronchi?
• bronchioles: what are the two types of bronchioles and in which tract are they?
• what else is there in the lower resp system (hint: the gas exchange happens here) and basically only in the resp bronchioles?
• why are there two different tracts?

Answer 3

So there are primary (MAIN), secondary (LOBAR) and teritiary (SEGMENTAL) bronchi

In terms of bronchioles, there is terminal and respiratory.

The terminal bronchioles (plus trachea, and bronchi) are part of the air-conducting tract

The respiratory broncioles have alvelor units and these are for the gas exchange so the resp bronchioles + alveolar units = resp tract

Question 4

Trachea

1. The lumen of the trachea is characteristically what shape in transverse section?
2. Is made up of about how many C shaped tracheal cartilages
   - why are they important?
3. Posterior to the c-shaped cartialges, what is there? From last year, I remember this exists so the food that goes down the esophagus doesn’t go clunck-clunck-clunck against the cartialges
4. So what exists between the adjacent bars of cartialge then?
   - why are the elastic fibres important?
5. Why lies in front and sides of the upper cartilage?
6. What are the vertebrae levels of the trachea (like the lenght of the trachea).
   - how long is the trachea at inspiration and expirtation? In fact, why does the lenght change in the first place?
7. How does the trachea terminate (into what?) and at what level? Draw this out
8. What is the carina? Where is it? LIke where would you see it?
9. With surface markings, how can you find the sternal angle, judular notch, cricoid cartialge and C6 vertebrae?
10. At what level does the trachea terminate and how is this line drawn? What about inspiration?
    - Why is there even a differnece between inspiration and expirttion?

Answer 4

4. SO the shape can change of the trachea
5. So like, you can feel that sternal angle as the ridge 4cm down from the manubrium and the jugular notch is like superior to the manubrium and btween the clavicles. If you go right behind the cricoid cartialge then you find the C6 vertebrae
6. So like, draw a line from sternal angle back and you get T4. Draw a line from just below to get to T5/6 during inspiration. Lenght changes because trachea will move up and down with the diaphragm

Question 5

The Bronchi

1. How many primary, secondary and tertirary bronchi are there?
   - how many on each side
2. Are all the lobar (secondary) bronchi localised inside the lung?
3. Okay, so what is intrapulmonary and what is extrapulmonary in terms of bronchi?
   - how what are the shapes, cartialges, outlines, fibres of both intra and extrapulmonary?
4. What can you say about the hilum of the left and right lung in terms of right superior lobar bronchus?
5. Label the image and tell me why the left lung is smaller than the right (like, why does the left only have 2 lobes and not 3 like the right)
6. What do the segmental bronchi look like?

Answer 5

4. So because the right superior lobar (secondary) bronchus is extrapulmonary, it has an extra hole for it at the hilum

Question 6

The Bronchioles

1. A brochiole is considered a conducting tube which is less than _____mm in diameter
2. What can you say about the cilia here? What about goblet cells and submucosal glands?
3. In the smallest bronchioles, where the cilia are absent, what takes over the function of internal drainage?
4. Okay, now talking about the terminal bronchiole being the narrowest part of the ____ ______ system - what is the epitheloum like? What sort of tissue is it surrounded by? Is there gas exchange at the terminal bronchioles?
5. Respiratory bronchioles: contain what on their wall?
   - are they part of the air conducting system?
   - they are the first component of what system? (gaseous exchange) where the blood in the caps is separated from air with a very thin mass of material so they can exchange CO2 to O2.
   - such an arrangement occurs from respiratory bronchioles to what?

Answer 6

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Question 7

• *The Bronchioles: ACINUS**
  1. This is at the distal part of the bronchiole tree. Respiratory bronchioles branch into a______ d_______

2. Alveloar ducts are thin walled tubes that connect the resp bronchioles to the a____ s_____, each of which contains a collection of a______ (what are they, what do they allow?)
3. Pulmonary acinus comprises the distal unit that contains gas-exchange surfaces of the lung in the form of what three things? (so these three things make up a acinus unit)

Answer 7

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Question 8

The Bronchioles: Air-Blood Barrier (Respiratory Membrane)

1. Gas exchange occurs when CO2 in the blood (carried to the lungs in the pul arteries) diffuses across the what and into the alveoli?
2. And gas exchange also includes what else?
   - how does the oxygenated blood return to the left atrium of the heart?
3. The laters of tissue that constitute the gas exchange is called what? (title)
   - Okay so what does the air-blood barrier contain? (slide 28)

Answer 8

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Question 9

LUNGS

1. Lie free in the thoracic cavity except where they are attached by their roots to what?
2. Conical in shape with a____, b____ and 3 surfaces
   - what are the three surfaces and what does each surface face?
   - the medial surface is divided into what?
3. What are the borders of the lung and what do they separate?

Answer 9

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Question 10

LUNGS: Hilum

1. What surface is it on? Above and behind the cardiac impression is a depression called the hilum
2. What 4 things does the hilum contain?
3. These structures form the r_____ of the lung (show me on a diagram where the root is found)
4. How is the organisation of the hilum different in the left and right lung?

Answer 10

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Question 11

LUNGS: Lobes

1. How many lobes are in the left lung and what are they divided by?
2. How many lobes are in the left lung and what are they divided by?
3. What are specific features of only the left lung? (2 features)
4. Each lobe is further subdivided into a number of segments - called what?
   - each segment is supplied by what? (3)
   - and drained by what? (3)

Answer 11

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Question 12

LUNGS: Bronchopulmonary segments

1. A bronchopulmonary segment is the smalled, functionally independent region of a lung and the smalled area of lung that can be what?
   - so it’s surgically r______

Answer 12

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Question 13

LUNGS: Bronchial arteries

1. Bronchial arteries travel and branch with the bronchi, ending about at the level of what?
2. Most of the blood supplied by the bronchial arteries is returned via he bronchial veins - true or false?
3. The blood from the first few divisions of bronchi is carried in _______ _____ to veins of posterior thoracic wall (which are?)
4. So it is easy to confuse the bronchial arteries with the pulmonary arteries because they both supply the lungs with blood, but there are important diffrences in terms of:
   - function
   - circulation
   - diameter

Answer 13

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Question 14

LUNGS: lymphatic drainage

1. Lymph is drained to what four things
2. What is the lymph finally carried in? Then to the R lympathc trunk and thoracic duct which then join the systemic venous sytem

Answer 14

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Question 15

LUNGS: Nerve Supply

1. Pulmonary plexuses are located in close proximity to the the ____ of the lung
2. Postsynaptic sympathetic fibres arise from the where to reach the pulmoanry plexuses?
3. Pre-synaptic parasym fibres (carried in the _____ nerve) synapse with the parasym ganglion cells present in the what?
4. On the diagram, where fo the SNS and PNS nerves come from (like spinal/brain)
5. Okay so SNS and PNS efferent fibres do what to:
   - diameter of bronchioles
   - secretion in glands of bronchiole tree
   - vessels
6. Visceral afferent fibres of pulmonary plexuses are either
   - reflexive - what does this mean?
   - nociceptive - what does this mean?
   - which SNS or PNS mostly carries the nocicpetive function?