pulmonary anatomy + physiology

Question 1

most common type of tracheoesophageal anomaly

Answer 1

esophageal atresia with distal tracheoesophageal fistula

Question 2

“gastric bubble” on CXR

NG tube stuck in blind pouch of esophagus

Answer 2

esophageal atresia with distal tracheoesophageal fistula

Question 3

ciliated columnar epithelium

Answer 3

trachea

Question 4

tracheal epithelium of smokers

Answer 4

metaplasia: columnar cells → squamous epithelium (no cilia - can’t mobilize sputum - get chronic bronchititis)
opposite of distal esophagus metaplasia in BE: squamous → columnar with goblet cells

Question 5

nonfunctional cilia in:
respiratory tract
sinuses
eustachian tubes
fallopian tubes
flagella of sperm
chronic infections
infertility 
hearing loss

Answer 5

Kartagener syndrome: primary ciliary dyskinesia

Question 6

defective dynein arm (need for moving along microtubule)→ nonfunctional cilia

Answer 6

Kartagener syndrome: primary ciliary dyskinesia

Question 7

associated with situs inversus reversal of circulatory system + viscera (50%)

Answer 7

Kartagener syndrome: primary ciliary dyskinesia

Question 8

divides thorax from abdominal cavity

Answer 8

diaphragm

Question 9

4 embryological structures that form the diaphgragm

Answer 9

septum transversum
pleuroperitoneal membranes
dorsal mesentary of esophagus
abdominal wall

Question 10

congenital defect in pleuroperitoneal membrane → abdominal contents in pleural cavity → lung hypoplasia
usually occur on left side
associated with polyhydramnios

Answer 10

congenital diaphragmatic hernia

Question 11

flattened abdomen
cyanosis
inability to breath

Answer 11

congenital diaphragmatic hernia

Question 12

innervated by phrenic nerve (C3 C4 C5)

Answer 12

diaphragm

C3 C4 C5 keeps diaphragm alive

Question 13

neck or shoulder pain can suggest

Answer 13

irritated diaphragm (affecting phrenic nerves): referred pain due to:
gallbladder disease
splenic rupture

Question 14

structures that perforate the diaphgragm:
T8
T10
T12

Answer 14

I 8 10 EGGS AAT 12
T8: IVC
T10: esophagus, vagus
T12: aorta, azygous vein, thoracic duct

Question 15

cells that line alveoli

responsible for gas exchange

Answer 15

pneumocytes

Question 16

simple squamous epithelial cells
>97% alveolar surface
GAS EXCHANGE
susceptible to toxic insults (can’t replicate)

Answer 16

type I pneumocyte

Question 17

larger
cuboidal
located at alvelar septal junction
cover 3% alveolar surface
secrete SURFACTANT: dipalmitoyl phosphatidylcholine
REPLICATE after lung damage: precursor to type I and type II cells

Answer 17

type II pneumocyte

Question 18

↓ alveolar surface tension → more compliant (stay open)→ prevent atelectasis (alveolar collapse)

Answer 18

surfactant

Question 19

sample of amniotic fluid of premature baby

lecithin:sphingomyelin ratio >2.0 suggests

Answer 19

fetal lung maturity (type II pneumocytes are making enough surfactant)

Question 20

to enhance fetal lung maturity, give mom

Answer 20

corticosteroids: matures type II pneumocytes

Question 21

DOC for altitude sickness

Answer 21

acetazolamide

Question 22

rapid ascent to high altitude
begins few hours to 2 days after ascent
headache
fatigue
acute cerebral edema due to hypoxia-induced vasodDILATION
acute pulmonary edema: hypoxia causes vasoCONSTRICTION (↑ cap pressure → transudate of fluid into lungs)

Answer 22

acute mountain sickness

Question 23

visual black out occurs at what + G force

Answer 23

4-6 G
force pulling blood into abdomen + legs
insufficient blood return to heart
insufficient pumping of blood to brain

Question 24

G force achieved during spacecraft liftoff

Answer 24

8-9 G

need to be in semi reclined position on take-off

Question 25

occurs when diver breathing compressed air for hour at 120 feet (extreme depths for too long)
nitrogen dissolves into neural membrane →↓ neuronal excitability → diver becomes jovial/careless → drowsy →
loss of strength + coordination

Answer 25

nitrogen narcosis (not decompression sickness)

Question 26

at depth: high pressure → nitrogen gas dissolves into blood

surfacing: ↓ pressure → nitrogen escapes solution → formation of bubbles that can occlude vessels

Answer 26

decompression sickness (bends or Caisson Disease)

Question 27

joint/muscle pain in arms + legs
neuro sx: dizzy, paralysis, syncope
“the chokes”: air bubbles occlude lung capillaries → SOB, pulmonary edema, death

Answer 27

decompression sickness

Question 28

prevention of decompression sickness

Answer 28

surface slowly

allow nitrogen to be eliminated through lungs by expiration

Question 29

treatment of decompression sickness

Answer 29

hyperbaric O2 therapy (high pressure room):

convert nitrogen from gaseous state to dissolved state so it can be exhaled by lungs

Question 30

use of hyperbaric O2 therapy

Answer 30

decompression sickness
arterial gas emboli
CO monoxide poisoning
gas gangrene due to clostridium perfringens (anerobe) or osteomyelitis: increase O2 to part of area