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B2 > Pulmonary Embryology > Flashcards

Pulmonary Embryology Flashcards

1
Q

The _____ is a cartilagenous tube extending from the larynx to the bronchial tubes. Rings of ______ in this structure prevent collapse.

A

trachea, hyaline cartilage

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2
Q

The ______ is an arrangement of ___ cartilages connected by membranes and ligaments. All of these cartilages are made up hyaline except for _____

A

larynx, 9, epiglottis

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3
Q

The larynx attaches to the ____ bone _____ [position] and opens into the ______

A

hyoid bone, superiorly, laryngopharynx

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4
Q

The larynx is _____ continuous with the trachea

A

inferiorly

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5
Q

What are the three basic functions of the larynx?

A

provides an airway for breathing, routes food and air, protects vocal cords

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6
Q

The _____ is a _______, dome shaped parition that separates the thoracic from abdominal arteries

A

diaphragm, musculotendinous

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7
Q

The epithelium of the internal lining of the trachea and lungs is derived from the ______

A

endoderm

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8
Q

Cartilagenous, muscular and connective tissue of the respiratory system is derived from the _________

A

sphlancnic mesoderm

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9
Q

The respiratory system develops from the _______ which is an outgrowth from the _____ body wall of the _____ and appears during gestational week ___

A

respiratory diverticulum, ventral, foregut, 4

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10
Q

The respiratory diverticulum expands _____ and _______ ridges form which separates the _____ from the foregut

A

caudally, tracheo-esophageal, lung bud

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11
Q

Once the tracheo-esophageal ridges form, the diverticulum is then called the ______ with the _____ portion consisting of the trachea and the _____ portion consisting of the esophagus

A

tracheo-esophogeal septum, ventral, dorsal

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12
Q

What is the tracheo-esophageal fistula?

A

an abnormal partitioning of the esophagus and trachea by septum; found in 1/3000 births

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13
Q

86% of tracheo-esophageal fistulas are _____ where the upper esophagus ends in a ______ [artesia], while the lower esophagus forms a fistual with the trachea

A

type III, blind pouch

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14
Q

The upper esophagus forms fistula in ___ of tracheo-esophageal fistula cases

A

1%

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15
Q

In ___ of cases of tracheo-esophageal fistula, the esophageal artesia is isolated, whereas in _____ there is no artesia but there is still abnormal communication between the trachea and esophagus

A

4%, H-type

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16
Q

What is the clinical presentation for tracheo-esophageal fistula?

A

excessive salivation/drooling; choking/aspiration pneumonia; inability to pass feeding catheter into stomach

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17
Q

What 2 characteristics are seen on an x-ray of a pt with tracheo-esophageal fistula?

A

dilated upper esophageal pouch; increased air in abdomen/stomach

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18
Q

How is tracheo-esophageal fistula diagnosed?

A

via bronchoscopy (airway endoscopy)

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19
Q

How does tracheo-esophageal fistula lead to polyhydramnios?

A

amniotic fluid does not pass into stomach

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20
Q

How does tracheo-esophageal fistula lead to pneumonia?

A

passage of fluid into trachea

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21
Q

What is one possible cause of tracheal stenosis/agenesis?

A

vascular compromise to the developing trachea

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22
Q

The muscle and cartilage of the larynx forms from the ______ of which pharyngeal arches?

A

mesenchyme, 4, 6

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23
Q

True/False: The epiglottis is a flexible, cartilagenous flap over trachea and esophagus that is derived from the 6th pharyngeal arch

A

FALSE 4

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24
Q

In gestinational week ___, the laryngeal orifice is seen at the ___ pharyngeal pouch

A

5, 4th

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25
Q

True/False: Besides the epliglottis, the other laryngeal cartilages are derived from the 4th and 6th pharyngeal arches

A

TRUE

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26
Q

When the mesenchyme of the pharyngeal arches proliferates, the _____ changes from a slit into a ____

A

laryngeal orifice, T-shape

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27
Q

The mesenchyme from the pharyngeal arches differentiates into what three structures?

A

thyroid cartilage, cricoid cartilage, arytenoid cartilage

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28
Q

The _______ is the site of vocal cord attachment for speech

A

arytenoid cartilage

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29
Q

The ______ is the site of muscle attachment for speech and completely encircles the trachea

A

cricoid cartilage

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30
Q

The ______ is the bulk of the front wall and protects the vocal cords

A

thyroid cartilage

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31
Q

The epiglottis formed from the 4th pharyngeal arch gives rise to the _____ which is innervated by branches of _____

A

superior laryngeal nerve, CNX

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32
Q

The arytenoid swellings and vocal cords from 6th pharyngeal arch give rise to the _____ which is innervated by branches of _____

A

recurrent laryngeal nerve, CNX

33
Q

Each pharyngeal arch contains what four characteristics?

A

cartilagenous component, cranial nerve, artery, muscular component

34
Q

The epiglottis, cuneiform cartilage, and corniculate cartilage become apparent between ______ gestational age

A

7-10 weeks

35
Q

The _______ results from the failure of the _______ to develop and allows communication between the ____ larynx and esophagus. It is found in 1/10,000 and 1/20,000 births

A

congenital laryngeal cleft, tracheo-esophageal septum, posterior

36
Q

What are three symptoms of congenital laryngeal cleft?

A

aspiration, choking, weak voice

37
Q

Describe types 0-4 of congenital laryngeal cleft

A

type 0 = occult submucosal; type 1 =interarytenoid only; type 2 = partial cricoid; type 3 = complete cricoid +/- cervical trachea; 4=extends into thoracic trachea, up to the carina

38
Q

In what week of development do the lung buds appear? How many buds are there and how many bronchial buds or lobes?

A

5th week, 2 lung buds (R and L), there are 2 bronchial buds on left side and 3 on the right side

39
Q

In the __ week embryo, segments of primitive lobes form. ____ are on right and ____ are on left

A

6, 10, 8

40
Q

In the __ week embryo, segments divide further and expand caudolaterally. Then, by the end of the 6th month, there are ____ generations of subdivisions and an additional ___ divisions postnatally

A

8, 17, 6

41
Q

During development of the pleural membrane, the bronchial buds “punch” into the ______ which derives from the sphlancnic mesoderm

A

visceral pleura

42
Q

The _________ is the space between the pleural and visceral pleura at the point when there is no split between pleural and pericardial cavities

A

pericardioperitoneal canals

43
Q

The pericardioperitoneal canals get separated by the ______ which creates the pleural and pericardial cavities

A

pleuropericardial fold

44
Q

After the pleural and pericardial cavities are created, the lungs grow and expand into the pleural cavity, which is aided by maturation of the ___

A

pericardium

45
Q

The pulmonary arteries grow _____ from the _______ and the branches position themselves next to _____ branches

A

caudally, aortic sac, bronchial

46
Q

True/False: all arterial branches are completed by 16 weeks gestational age

A

True

47
Q

True/False: arterioles and capillaries stop proliferating at birth

A

FALSE - keep proliferating for several years after birth

48
Q

During the ______ which is gestational week _____ period, branching continues to form terminal bronchioles but there is no division yet of terminal into respiratory bronchioles

A

pseudoglandular, 5-16

49
Q

During the ______ period which is gestational week ______, the respiratory bronchioles are formed and are lined with _____

A

canalicular, 16-26, cuboidal epithelium

50
Q

The respiratory bronchioles divide into _____ during the canalicular period and these end in nascent terminal sacs, which are lined with ________ in contact with capillaries

A

alveolar ducts, flattened epithelial cells

51
Q

During the ______ period which is gestational week ____, there is robust formation of the terminal sacs also known as _______

A

terminal sac period, GW26, primitive alveoli

52
Q

When does gas exchange begin to occur?

A

by end of 7th gestational month

53
Q

During the _______ period, which lasts from _____ to _____, the alveolar epithelium (type I) cells become ____ which allows epithelial-endothelial contacts to be more intimate

A

alveolar, 8 months, childhood, squamous

54
Q

Also during the alveolar period, there is formation of ________ which secrete surfactant and are cuboidal

A

type II alveolar epithelial cells

55
Q

Surfactant is a ____ that lowers surface tension at interface between ____ and ____. Secretion of this substance increases dramatically in the final gestational month.

A

phospholipid, air, alveoli

56
Q

When respiration begins at birth _____ and _____ is absorbed by the alveoli and remains deposited on the inside of ______ membranes

A

lung fluid, surfactant, type I alveolar cell

57
Q

How is surfactant secreted by type II alveolar cells of the embryo thought to elicit uterine muscle contraction and labor?

A

secretion of surfactant into the amnionic fluid activates macrophage which migrate into the uterus and upregulate immune cells –> increases prostaglandin secretion –> uterine muscle contraction and labor

58
Q

________ is caused by deficiency of surfactant and affects 2% of live newborns and accounts for ___ of newborn death

A

neonatal respiratory distress syndrome, 20%

59
Q

Neonatal respiratory distress syndrome leads to low _____ and subsequenct _____ of the lungs

A

compliance, atelectasis (alveoli collapse)

60
Q

How does neonatal respiratory distress syndrome lead to hyaline membrane disease?

A

Labored breathing damages alveolar epithelium —> protein deposition and hyaline changes

61
Q

What are three causes of neonatal respiratory distress syndrome (NRDS)?

A

type II cells undeveloped, lack of compression during c-section, maternal diabetes

62
Q

How does lack of compression during c-section lead to neonatal respiratory distress syndrome?

A

lack of cortisol –> lack of surfactant

63
Q

How does maternal diabetes lead to neonate respiratory distress syndrome?

A

high insulin decreases surfactant

64
Q

How is neonatal respiratory distress syndrome treated?

A

with corticosteroids from gw 23-24 and artificial surfactant (endotracheal)

65
Q

What are the 4 structures involved with diaphragm development?

A

septum transversum, pleuroperitoneal membranes, dorsal esophageal mesentery, body wall

66
Q

The septum transversum forms the ____ whereas the pleuroperitoneal membranes fuse with ____ and _____

A

central tendon, tendon, esophageal mesentery

67
Q

The dorsal esophageal mesentery becomes _____ of diaphragm muscle

A

crural portion

68
Q

The body wall becomes the ____ portion of the diaphragm muscle

A

costal portion

69
Q

What are the two types of congenital diaphragmatic hernias?

This birth defect is present in 1/3000 people

A

Bochdalek type, morgagni type

70
Q

The Bochdalek type is the most common (80-90%) and most severe and can lead to severe ______. It is ____ and in 85% of cases left-sided. It can be isolated or complex. The abdominal organs move into the _____ and the heart is pushed to the ____

A

lung hypoplasia, posterolateral, parasternal left chest, right

71
Q

The Morgangi type is an ____ and ____ defect. There is no significant pulmonary hypoplasia and only mild to no respiratory distress. What happens in this type to the diaphragm?

A

anterior, parasternal; incomplete muscularization

72
Q

Describe 2 features of the hypoplastic lung

A

smaller/hypoplastic airways and alveoli; smaller pulmonary vascular bed

73
Q

Describe 2 implications of a smaller pulmonary vascular bed in the hypoplastic lung

A

Increased constriction of pulmonary blood vessels; decreased gas exchange area

74
Q

What is the principal determinant of lethality in congenital diaphragmatic hernia?

A

the persistent pulmonary HTN caused by the increased pulmonary vascular resistance as a result of the smaller pulmonary vascular bed

75
Q

_____ are filled with lung or air and result in dilation of terminal bronchi. These draina poorly and cause chronic infections

A

congenital lung cysts

76
Q

True/False: Unilateral lung agenesis is compatible with life

A

TRUE

77
Q

In _____ caused by congenital diaphragmmatic hernia or congenital heart disease there is reduced _____

A

lung hypoplasia, lung volume

78
Q

What causes the development of ectopic lung lobes?

A

additional respiratory diverticulum develop off of hindgut independent of main system

79
Q

Abnormal division of bronchial tree leads to ______ which are of little functional significance

A

supernumary lobules

B2 (15 decks)

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