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Advance Anesthesia II > Pulmonary Anatomy PPT I > Flashcards

Pulmonary Anatomy PPT I Flashcards

First PPT of Pulmonary Anatomy

1
Q

In which bronchial level does gas exchange occur?

A

Level 17

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2
Q

What percentage of the adult complement of alveoli does a newborn’s lung have?

A

6-15%

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3
Q

At what age is full complement of alveoli is develop?

A

about 2 years after birth

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4
Q

Complement alveoli microvascular development continues between what age?

A

2-5 years after birth

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5
Q

The nasal cavity lateral wall have projections called?

A

Conchae

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6
Q

Conchae Functions

A
  • Increase surface area
  • Increase turbulance within the nasal cavity
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7
Q

The nasal cavity is separated from the oral cavity by:

A

The palate

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8
Q

Palate is further divide to:

A
  1. Anterior hard palate (bone)
  2. Posterior soft palate (muscle)
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9
Q

The Pharynx?

A

Muscular passage from the nasal cavity to the larynx

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10
Q

Three regions of the Pharynx:

A
  1. Nasopharynx (superior region behind the nasal cavity)
  2. Oropharynx ( middle region behind mouth)
  3. Laryngopharynx ( inferior region attached to larynx)
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11
Q

The oropharynx and Laryngopharynx are comomon passage for:

A

Air and Food

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12
Q

Tonsils of the Pharynx

A
  1. Pharyngeal tonsil (adenoids) in the nasopharynx
  2. Palatine tonsils in the oropharynx
  3. Lingual tonsils at the base of the tongue
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13
Q

The lungs:

A
  • Occupy most the thoracic cavity
  • Apex is near the clavicle (superior portion)
  • Each lung is divided into lobes by fissures
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14
Q

How many lobes are in the Right and Left lung?

A
  • Right lung 3 lobes
  • Left lung 2 lobes
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15
Q

Covering of the Lungs:

A
  • Pulmonary (visceral) pleura covers the lung surface
  • Parietal pleura lines the walls of the thoracic cavity
  • Pleural fluid fills the area between layers of pleura to allow gliding
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16
Q

Respiratory Tree Divisions:

A
  • Primary bronchi
  • Secondary bronchi
  • Tertiary bronchi
  • Bronchioli
  • Terminal bronchioli
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17
Q

How many division are in the Airway?

A

24 divisions

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18
Q

How many bronchioles division are in the Airway?

A

1-23 divisions

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19
Q

Muscles involved in Inspiration:

A
  1. Diaphragm
  2. External intercostals
  3. Sternocleidomastoid
  4. Scalenes
  5. Pectoralis minor
  6. Serratus posterior superior
  7. Erector spinae
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20
Q

Muscles involved in Quiet breathing?

A
  • Diaphragm
  • External Intercostals
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21
Q

Muscles involved in Forced Inspiration:

A
  1. Sternoclediomastoid
  2. Scalenes
  3. Pectoralis minor
  4. Serratus posterior superior
  5. Erector spinae
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22
Q

Muscles involved in Forced Expiration:

A
  1. Internal Intercostals
  2. Abdominal muscles
  3. Transversuss thoracis
  4. Serratus posterior inferior
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23
Q

During Inspiration:

A
  • Diaphragm and Intercostal muscle contract
  • Thoracic cavity increases
  • External air is pulled into the lungs
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24
Q

During full Inspiration the diaphragm moves:

A

inferiorly during contraction

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25
Q

During Expiration the diapragm moves:

A

Superiorly as it relaxes

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26
Q

Explain Expiration cycle:

A
  • Passive process dependent up on natural lung elasticity
  • Air is pushed out the lungs
  • Forced expiration occur
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27
Q

Normal pressure within the pleural space is always:

A

Negative ( intrapleural pressure)

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28
Q

Differences in lung and pleural space pressures keep lungs from:

A

Collapsing

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29
Q

What is the relationship between the pleural sac and the lung?

A

Respiratory system

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30
Q

Dalton’s Law

A
  • The total pressure of a mixture of gases is the sum of the pressure of the individual gases
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31
Q

Gases, singly or in a mixture, move from areas of:

A

Higher pressure to areas of lower concentration

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32
Q

Boyle’s Law

A

If the volume of a container of gas changes, the pressure of the gas will change in an inverse manner

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33
Q

Partial pressure gas formula

A

Pgas = Patm x % of gas in atmosphere

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34
Q

Nitrogen % in Air

A

78%

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35
Q

Oxygen % in Air

A

21%

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36
Q

CO2 % in Air

A

0.033%

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37
Q

Nitrogen Pgas in dry 25 deg C at 760 mmHg

A

593 mmHg

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38
Q

Oxygen Pgas in dry 25 deg C at 760 mmHg

A

160 mmHg

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39
Q

CO2 Pgas in dry 25 deg C at 760 mmHg

A

0.25 mmHg

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40
Q

Water vapor Pgas in dry 25 deg C at 760 mmHg

A

0 mmHg

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41
Q

Mention the four lung volumes:

A
  1. Tidal volume (TV)
  2. Inspiratory reserve volume (IRV)
  3. Expiratory reserve volume (ERV)
  4. Residual volume (RV)
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42
Q

Lung capacities components:

A
  1. FRC
  2. Vital capacity
  3. Total lung capacity
  4. Inspiratory capacity
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43
Q

FRC is composed of:

A

ERV + RV

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44
Q

Vital capacity is composed of:

A

IRV + TV + ERV

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45
Q

Total lung capacity is made of:

A

TV + IRV + ERV + RV

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46
Q

Inspiratory capacity is made of:

A

TV + IRV

47
Q

Lungs with high complaince

A

Strech easily

48
Q

Lungs with low complaince

A
  • Requires more force
  • Restrictive lung disease
49
Q

What’s Restrictive lung disease?

A

Inadequate surfactant production

50
Q

What’s Lung compliance?

A

Change in lung volume for each unit change in transpulmonary pressure

51
Q

What is Transpulmonary Pressure?

A

Difference in pressure between alveolar pressure and pleural pressure

52
Q

What are the two compliance curve Phases of Respiration?

A
  1. Inspiratory compliance curve
  2. Expiratory compliance curve
53
Q

The compliance diagram of lungs shows:

A

Capacity of the lung to “adapt” to small changes of transpulmonary pressure

54
Q

Compliance of lungs occurs due to:

A

Elastic forces A & B

55
Q

Elastic forces A are composed of:

A

Elastin + Collagen fibers

56
Q

Elastic forces B:

A

Provided by surfactant

57
Q

Surfactant is present inside the walls of:

A

Alveoli

58
Q

Pulmonary Surfactant:

A
  • Synthesized by type II alveolar cells
  • Decreases surface tension
  • Prevents bacterial invasion
  • Cleans alveoli surface
59
Q

Pulmonary surfactant prevent alveolar collapse during:

A

Expiration

60
Q

Pulmonary surfactan consist of:

A
  • Hypophase (protein)
  • Phospholipid (dipalmitoylphosphatidylcholine)
  • Calcium ions
61
Q

Laplaces Law Formula:

A

* High Radius = low pressure to collapse

62
Q

Smaller alveoli have a greater tendency to

A

collapse

63
Q

How much fresh air is the Dead Space filled with?

A

150 mL

64
Q

How much air leaves the alveoli during the first exhalation?

A

350 mL

65
Q

Total pulmonary ventilation formula:

A

(Ventilation rate) x (Tidal volume)

66
Q

Local control of Arterioles and Bronchioles Table

A
67
Q

Most CO2 in the blood is transported as:

A

Bicarbonate ions in the plama

68
Q

What are the two circulations in the Lungs?

A
  1. Pulmonary circulation
  2. Bronchial circulation
69
Q

Pulmonary circulation:

A
  • Arises from RV
  • Receives 100% of blood flow
  • In series with systemic circulation
  • Receives 100% of CO ( 3.5 L/min/m2)
70
Q

Surface area of gas exchange is:

A

50-100 m2

71
Q

Bronchial Circulation:

A
  • Arises from the Aorta
  • Part of systemic circulation
  • Receives ~ 2% of LV output
72
Q

What’s the MEAN of Pulmonary Artery?

A

15

73
Q

What’s the MEAN of sytemic artery?

A

100

74
Q

Which lung zone occurs major ventilation?

A

Zone 3

75
Q

How many zones are in the lung?

A

3

76
Q

In healthy people there is

A

No zone 1

77
Q

Lung Zone 1

A

PA > Pa > Pv

Pa = arterial, PA = Alveolar, PV = Venous

78
Q

Lung Zone 2:

A

Pa > PA > Pv

Pa = arterial, PA = Alveolar, PV = Venous

79
Q

Lung Zone 3:

A

Pa > Pv > PA

Pa = arterial, PA = Alveolar, PV = Venous

80
Q

General hypoxemia (high altitude or hypoventilation) can cause:

A

Extensive pulmonary artery vasoconstriction

81
Q

The Respiratory Center is composed of neurons located bilaterally in:

A
  • Medulla Oblangota
  • PONS
82
Q

Respiratory Center is divided in 3 major groups:

A
  1. Dorsal respiratory
  2. Ventral respiratory
  3. Pneumotaxic center
83
Q

Dorsal respiratory group (medulla) is responsible for:

A

Inspiration

84
Q

Ventral respiratory group (medulla) is responsible for:

A

Expiration & Inspiration

85
Q

Pneumotaxic respiratory group (PONS) is responsible for:

A

Rate & pattern of breathing

86
Q

What’s the most fundamental role in ventilation control?

A

Rate & Pattern of breathing

87
Q

In Chemoreceptors (CTZ) Oxygen is a large reservoir attached to:

A

Hemoglobin

88
Q

Chemoreceptors are more sensitive to changes in:

A

Pco2 ( sense through pH changes)

89
Q

Chemoreceptors Ventilation is adjusted to maintain:

A

Arterial PCo2 of 40 mmHg

90
Q

Chemoreceptor (CTZ) are located:

A
  • Through the body
  • In the Brain and Arteries
91
Q

Activity of respiratory muscle is transmitted to the brain by:

A

The phrenic and intercostal nerves

92
Q

Neural centers that control rate and depth are located in:

A

The medulla

93
Q

The PONS appears to smooth out:

A

Respiratory rate

94
Q

Normal Respiratory Rate (eupnea) is:

A

12-15 bpm

95
Q

What is Hypernia?

A

Increase of respiratory rate due to oxygen needs

96
Q

Factors that influence the Respiratory rate and Depth:

A
  1. Level of Co2
  2. Increase Co2
  3. Chemical factors
97
Q

Change in Oxygen concentration in the blood are detected by:

A
  • Chemoreceptors
  • In the aorta and carotid artery
98
Q

Obstructive Pulmonary Disorders are a broad spectrum of pathologies characterized by:

A
  • Decrease FEV1/ FVC with normal FVC
99
Q

Spirometry Volume loops graphic

A
100
Q

Bronchospasm symptoms:

A
  • Chest tightness
  • Tachypnea
  • Tachycardia
  • Wheezing
  • Dyspnea
  • Cough
  • Thick, tenacious sputum
  • Prolonged expiratory phase
  • Used of accessory muscles
  • Intercostal & supraclavicular retractions
  • Pulsus paradoxus
  • Silent chest
  • Agitation
  • Confusion
  • Somnolence
  • Cyanosis
101
Q

CODP is classified as:

A
  • Chronic bronchitis (histology)
  • Pulmonary emphysema (Clinically)
102
Q

Chronic Bronchitis Anatomic Pathology:

A
  • Increase size & number of mucous glands in airway mucosa
  • Mucus accumulation & airway obstruction
  • Decrease small airway diameter
103
Q

Chronic Bronchitis Pathology:

A
  • Bronchospasm
  • Airway inflammation
  • Abundant secretions
  • Recurrent infections
  • Cigarette smoking
  • Environmental contamination
104
Q

Pure Emphysema features:

A
  • Rarely infectious
  • Minimal secretions
  • Increased V/Q mismatch
  • Smoking
  • Pulmonary cripple
  • Irreversible
105
Q

Emphysema Pathology

A
  • Destructive loss of alveolar walls within the acinus
  • Without accompanying fibrosis
106
Q

Other causes of COPD:

A
  • Marphan syndrome
  • HIV
  • Malnutrition
  • Bullous sarcoidosis
  • Salla disease
  • Meckel syndrome
107
Q

Obstructive Sleep Apnea (OSA):

A
  • Intermittent cessation of airflow at the nose and mouth during sleep
  • Apneas of at least 10 seconds duration
  • Most cases apneas last 20-30 sec
  • Can last 2-3 min
  • Is a leading cause of daytime sleepiness
  • Contributes to CVS disorders
  • 2% in middle-aged women
  • 4% in middle-aged men
108
Q

Sleep apneas are divided into:

A
  1. Central sleep apnea
  2. Obstructive sleep apnea
109
Q

Central sleep apnea:

A

Neutral drive to all respiratory muscle is abolished

110
Q

Pathogenesis of OSA:

A
  • Occlusion of the oropharyngeal airway
  • Results in progressive asphyxia
  • Brief arousal from sleep
  • The patient returns to sleep and the process is repeated up to 300-400 /night
  • Sleep becomes fragmented
111
Q

Mallanpati Class I

A

Complete visualization of soft palate

112
Q

Mallanpati class II

A

Complete visualization of the Uvula

113
Q

Mallanpati Class III

A

Visualization of only the base of the Uvula

114
Q

Mallanpati Class IV

A

Soft palate is not visible

Advance Anesthesia II (7 decks)

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