Resp 1

Question 1

What are the basic concepts of the kinetic theory of gases?

Answer 1

Gases are a collection of molecules moving around in a space

Pressure is generated by collision of molecules with the walls

The more frequent and harder the collisions the higher the pressure

Question 2

What is Boyle’s law?

Describe the underlying physical basis

Answer 2

Presure is inversely proportional to volume

If a given amount of gas is compressed to a smaller volume molecules will hit the walls more often therefore raising pressure

Question 3

What is Charle’s law?

Describe the underlying physical basis

Answer 3

Pressure is proportional to absolute temperature (Kelvin scale)

As temperature increases molecules will have more kinetic energy and will therfore impact the walls of a container more often hence rainsing pressure

Question 4

What is the universal gas law?

What does it allow us to calculate?

Answer 4

P x V = n x R x T

Allows calculation of how volume will change with temperature and pressure changes

Question 5

What is meant by ‘STP’?

Answer 5

Standard temperature and pressure

Temp = 273K

Pressure = 101.0kPa

Question 6

Describe what is meant by ‘Partial pressure’ of a gas in a mixture of gases

Answer 6

In a given mixture of gases molecules of each type behave independently

Therefore each gas will contribute a portion of overall pressure

The fraction of pressure is equal to the fraction of gas each molecule type makes up in a given mix

Question 7

Describe the behaviour of gas mixtures in contact with water

Relate your answers to pressure

Answer 7

Water vapour:

Water moecules enter the gas via evaportation and exert vapour pressure

Gas dissolution:

Gases will enter water and exert ‘tension’

Question 8

When water molecules enter and leave a gas at the same rate, what has been reached?

What does this equilibrium depend on?

Answer 8

Saturated vapour pressure

Equilibrium is temperature dependent

Question 9

What is saturated vapour pressure at 37 deg C?

Answer 9

6.28kPa

Question 10

Describe ‘Tension’?

Hint: Not what your feeling now you’ve finally started revising

Answer 10

Tension is the ‘pressure’ exerted by gas molecules dissolved in water were the water not there

Question 11

Describe Tension equilibrium

What is it equal to?

Answer 11

When there is no net movement of gas molecules in and out of a body of water

At equilibrium tension is the same as the partial pressure of a gas in gas mixture

Question 12

How is tension relevant to gas exchange?

Answer 12

Tension in the pulmonary system drives oxygen out into tissues.

Question 13

What is indicated by gas tension in a liquid?

Answer 13

How readily a gas will leave a liquid

NOT: How much gas is in a liquid

Question 14

How is solubility relevant to gas tension?

Answer 14

Solubility determines how much gas will enter a liquid to establish a particular tension

Gas content of a liquid = Solubility x Tension

Question 15

How is our calculation of gas content of a liquid modified by chemical reaction of said gas and liquid?

Answer 15

Reaction must complete before tension is established

Equation:

Reacted gas + Dissolved gas = Total gas content

Question 16

Per minute in the lungs what is the required minimum blood flow and O2 absorption rate?

Surface area needed for this is roughly equivalent to?

Answer 16

5L of blood in pulmonary circulation

12mmol of O2

Surface area:

Roughly one tennis court

Question 17

How many alveoli does the averge human posess?

Answer 17

300 million

Question 18

What are the divisions of the airway from trachea to bronchiole?

Answer 18

Trachea branches to form Main bronchi

Main bronchi branch to 3 right and 2 right lobar bronchi

Lobar bronchi divide into segmental bronchi

Then subsegmental

Then bronchioles

Question 19

What are the layers (and hence the histological differences) between bronchi and bronchioles?

Answer 19

Bronchi:

Mucosa
Smooth muscle
Submucosa - contains glands
Crescent shaped cartilage (smaller than in trachea)

Bronchioles:

Epithelia
Smooth muscle (more than bronchi)

Question 20

What are terminal bronchioles and what do they divide into?

How many are there?

Answer 20

Terminal bronchioles are analogous to ‘twigs on a tree’

Not directly connected to alveoli but branch into a set of respiratory bronchioles, alveolar ducts and alveoli

~ 200,000 terminal bronchioles

Question 21

Describe the blood supply of alveoli

Answer 21

Each alveoli surrounded by capillary supplied by branching blood vessels throughout the lungs

Question 22

What are the 5 key features of the pulmonary circulation?

Answer 22

Low resistance (many parallel branches of short, wide vessels)

Low pressure

Recieves entire cardiac output

Forms practically no tissue fluid

Regional perfusion matched to ventilation

Question 23

What are the external features of the nose?

Answer 23

Root to Septum:

Root (Radix) at most posterior point on face between eyebrows

Bridge (Dorsum) running between tip and root

Tip

Septum forming the medial wall of the nasal cavities

Laterally:

Wings (Alars) form lateral walls of nasal cavity in the nose

Question 24

Describe the Internal structure of the nasal cavities

Answer 24

Extends from nostrils to posterior nares

Divides in two medially by nasal septum (cartilage and bone)

Lateral wall has 3 bony projections

Lined by pseudostratified columnar ciliated epithelium

Superior, middle and inferior Turbinate bones on the lateral walls each shaped like a stretched out seashell

Superior, middle and inferior meatus sit below each turbinate

Question 25

Label the back boxes What are represented by arrows labelled 1 to 4?

Answer 25

**Boxes, top left clockwise:** Frontal sinus Ethmoid sinus Orbit Masal cavity Orbit **Numbers:** 1 - 3 = Bony projections of the lateral wall (Turbinates) 4 = Nasal septum

Question 26

Label the black boxes What are represented by Arrows labelled 1 to 3 and 1a to 3a?

Answer 26

**Boxes, top left clockwise:** Frontal bone and frontal sinus Body of sphenoid and sphenoid sinus Oral cavity Hard Palate **Numbers:** 1 to 3 = Superior, middle and inferior turbinates 1a to 3a = Superior, middle and inferior meatus

Question 27

What are the functions of the nose?

Answer 27

**Respiration:** Filters air Humidifies and warms air **Organ of smell** **Recieves local secretions:** Sinuses Nasolacrimal duct (Fun fact: Tears travel through this duct while crying, hence the runny nose, you're essentially crying out your nose)

Question 28

What are the functions of nasal mucosa?

Answer 28

**Pseudostratified columnar ciliated:** Hairs filter large particles Epithelium moistened by mucus to trap particles Cilia help transport trapped particles Watery secretions humidify air

Question 29

Apart from the epithelium what other features of the nose have a respiratory function and what are the specific functions of each feature?

Answer 29

**Vessels beneath epithelium:** Warms air **Turbinates:** Slows airflow and helps mix air

Question 30

What are the names of the paranasla sinuses and how many are there?

Answer 30

Frontal Ethmoid Maxillary Sphenoid 8 in total (4 pairs)

Question 31

Label these structures

Answer 31

**Boxes, top to bottom:** Frontal Ethmoid Maxillary

Question 32

Label the black box

Answer 32

Sphenoid Sinus

Question 33

Describe the lining of the sinuses

Answer 33

Pseudostratified columnar ciliated epithelium with goblet cells and glands

Question 34

What might be the function(s) of the paranasal sinuses?

Answer 34

**Many theories:** Extension of nasal cavity for humidification and warming of air Secretion of mucus that drains into the nasal cavities to moisten them Lightening weight of the skull Buffer for trauma (protect cranial cavity) Insultation fo sensitive structures from temperature variation (Dental roots, eyes)

Question 35

Label lines 1 to 4

Answer 35

1 = Frontal sinus 2 = Ethmoid sinus 3 = Maxillary sinus 4 = Sphenoid sinus

Question 36

Label the black boxes The labelled structures are collectively called what?

Answer 36

**Boxes, top to bottom:** Nasopharynx Oropharynx Larynopharynx **Collectively:** Pharynx

Question 37

what is the Pharynx?

Answer 37

Common passage for food, water and air

Question 38

What are the Eustachian tubes?

Answer 38

Tubes connecting nasopharynx to middle ear

Question 39

What are the structures of the/within the larynx with relevance to the respiratory system?

Answer 39

Epiglottis Glottis and false vocal cords

Question 40

Define glottis

Answer 40

The 2 vocal cords and the aperture between them (Apeature technically called rima glottidis)

Question 41

What is the function of the epiglottis?

Answer 41

Closes during swallowing and therefore protects against aspiration of food

Question 42

What are the functions of the vocal cords?

Answer 42

Act as a valve guarding trachea Phonation

Question 43

What are the positions of the vocal cords while performing different functions?

Answer 43

Abducted (away from midline/open) during respiration Adducted (towards midline/closed) during swallowing Partially abducted during phonation Initially adducted then rapidly abducted during cough reflex

Question 44

What is the difference between the two diagrams? Label the boxes

Answer 44

**Left - Adducted vocal cords** **Right - Abducted vocal cords** **Boxes, top to bottom:** Base of tongue Epiglottis False vocal cord True vocal cord Glottis Inner lining of trachea (accept 'trachea') Corniculate cartilage

Question 45

Label the boxes

Answer 45

**Boxes, top right clockwise:** Epiglottis Vocal cords Cricoid cartilage Eosophagus Trachea Thyroid cartilage Hyoid bone

Question 46

From where does the reccurent laryngeal nerve arise and what does it innervate?

Answer 46

Arises from vagus Supplies all intrinsic laryngeal muscles except cricothyroid

Question 47

Describe the course of the reccurent laryngeal nerves

Answer 47

**Right:** Branches from vagus in nech, curves under subclavian artery and back up the neck in the groove between the trachea and eosophagus to supply intrinsic muscles of larynx **Left:** Branches from vagus in neck, curves around the arch of the aorta and comes back up neck in groove between trachea and eosophagus to supply the intrinsic muscles of the larynx

Question 48

What s the clinical relevance of the reccurent laryngeal nerves?

Answer 48

Can be involved in disorders of the chest Lesions may cause hoarseness of voice

Question 49

What nerve supplies the cricothyroid muscle? From where does it arise?

Answer 49

Superior laryngeal nerve Vagus nerve

Question 50

If you were to contract an upper respiratory tract infection (URTI) then when in the body might it commonly spread?

Answer 50

Sinuses via openings into nasal cavities resulting in sinusitis To the middle ear via Eustachian tubes

Question 51

What disorders of the Larynx may cause repiratory difficulty?

Answer 51

Oedema (anaphylaxis/severe infection) Tumour Aspiration of foreign body Bilateral cord paralysis (cords adducted)

Question 52

What disorders of the Pharynx can cause repiratory difficulty?

Answer 52

Tongue falling into airway while unconscious can obstruct airway Sleep apnoea (decrease pharyngeal uscle tone during sleep obstructs airway during sleep)

Question 53

What disorders of the nose might cause significant respiratory difficulty?

Answer 53

Nasal polyps may lead to mouth breathing (not ideal, less humidification)

Question 54

In an unconscious patient what may be obstructing the pharynx?

Answer 54

Vomit (may be aspirated to lung) Tongue Foreign body

Question 55

The respiratory system contains two types of membrane, what are they and where are they found?

Answer 55

**Mucous membranes:** Lines the conducting portion of respiratory tract, secretes mucous **Serous membranes:** Lines the pleural sacs which envelope each lung

Question 56

Label this diagram

Answer 56

**Boxes from top picture, top to bottom:** Visceral pleura Rib Parietal pleura **Boxes from lower picture, top center clockwise:** Left lung Moist pleura (makes lung shiny) Impression of heart (Cardiac notch) Impression of aorta

Question 57

What is the conducting portion of the respiratory tract? Include each structure in descending order

Answer 57

Nose Pharynx Larynx Trachea Primary bronchi Secondary bronchi (lobar) Tertiary bronchi (segmental) Bronchioles Terminal bronchioles

Question 58

What is the respiratory portion of the respiratory system? Include each structure in descending order

Answer 58

Respiratory bronchioles Alveolar ducts Alveoli

Question 59

What structures of the lung are intrapulmonary and which are extrapulmonary?

Answer 59

**Intra:** Secondary bronchi to Alveoli **Extra:** Nose to Primary bronchi (enter the lung at the hilum)

Question 60

Label this picture

Answer 60

**Boxes from top right clockwise:** Trachea Superior left lung lobe Primary bronchus Secondary (lobar) bronchus Tertiary (Segmental) bronchus Inferior lobe of left lung Inferior lobe of right lung Middle lobe of right lung Superior lobe of right lung

Question 61

How does diameter of passageways change from nose to alveoli?

Answer 61

Diameter decreases as you travel towards alveoli Passage walls also get thinner

Question 62

What epithelia are present in the conducting portion of the respiratory system?

Answer 62

**Nasal cavity to large bronchioles:** Pseudostratified columnar ciliated epithelium w/goblet cells **Smaller bronchioles and terminal bronchioles:** Simple columnar ciliated epithelia with clara cells

Question 63

What epithelia are present in the respiratory portion of the respiratory system?

Answer 63

**Respiratory bronchioles and alveolar ducts:** Simple cuboidal with clara cells and sparse cilia **Alveoli:** Type 1 - Simple squamous epithelia Type 2 - Cuboidal epithelia

Question 64

Label the box

Answer 64

Olfactory Mucosa

Question 65

Epithelia in the nose can be split into two broad regions, what are these regions?

Answer 65

Non-olfactory regions Olfactory regions

Question 66

Describe in detail the mucosa of the non-olfactory regions of the nasal cavities

Answer 66

Pseudostratified columnar ciliated epithelium w/mucous glands and venous sinuses in lamina propria

Question 67

What is the function of the venous sinuses in the nasal cavity mucosa?

Answer 67

Swell every 20-30 minutes alternating airflow from nostril to nostril to prevent overdrying

Question 68

Describe the location and structure of the olfactory mucosa

Answer 68

Posterior, superior region of each nasal fossa Thick pseudostratified columnar epithelium without goblet cells and with non-motile cilia Contain olfactory cells (bipolar neurons) Serous glands in the lamina propria (Bowman's glands) flush odourants from epithelial surface

Question 69

Label the boxes

Answer 69

**Boxes from top left clockwise:** Duct Olfactory epithelium Duct Olfactory glands (Bowman's glands) Olfactory nerves

Question 70

Label the boxes

Answer 70

**Boxes from center top clockwise:** Junctional complex Cilia Pseudostratified columnar ciliated epithelia Axon Basal cell Olfactory (Bowman's) Gland Olfactory cell Basal lamina Microvilli Olfactory vesicle

Question 71

Label the boxes

Answer 71

**Boxes left to right, top to bottom:** Mucous glands Vestibule of larynx Ventricular folds of the false vocal cords (x2) Ventricles Vocal fold (x2) Vocalis muscle (x2) Intraglottic cavity

Question 72

What is the function of the ventricles and ventricular folds? What lines the ventricular folds?

Answer 72

Ventricles along with ventricular folds contribute to resonance of the voice Ventricular folds lined by pseudostratified epithelium and contains mucous glands and numerous lymph nodes

Question 73

Describe the structure of the true vocal cords

Answer 73

Lined by stratified squamous epithelium Contains a vocal ligament (large bundle of elastic fibres running anteroposterior) Also a vocalis muscle (bundle of skeletal muscle under somatic control)

Question 74

What is the clinical relevance of the paths of the primary bronchi?

Answer 74

Path of right bronchi more vertical than left therefore foreign objects more likely to lodge in right bronchus

Question 75

What structure(s) are shown? Use this image to estimate age of specimen, what features are important to your evalutation? Label the boxes

Answer 75

**Trachea and Oesophagus** **Age:** Elderly, as indicated by calcified bone tissue present in cartilage **Boxes from top left clockwise:** Cartilage (C-shaped) Bone tissue Fibroelastic membrane containing trachealis muscle Trachea Bone tissue Cartilage Oesophagus

Question 76

What strucutre is shown? Label the boxes

Answer 76

**Wall of trachea** **Boxes left to right:** C shaped cartilage Submucosa with seromucous glands Lamina propria Epithelium

Question 77

What is shown? Label boxes

Answer 77

A section throught the mucosa of the trachea or bronchi **Boxes, top 2:** Epithelium **Boxes, bottom 6:** Seromucous glands

Question 78

What is secreted by submucosal seromucous glands in the trachea and larger bronchi?

Answer 78

Mucins Water Serum proteins Lysozyme Antiprotease Lymphocytes contribute Immunoglobulins (Especially IgA)

Question 79

Identify the salient histological features the tracheal mucosa

Answer 79

Ciliated Thick basement membrane Lamina Propria rich in immune cells Lamina propria includes a layer of elastic fibres

Question 80

Label the boxes and identify the cell type/location

Answer 80

**Boxes from top to bottom** Goblet cells Ciliated epithelial cells Basal cells Connective tissue **Epithelium type:** Tracheal pseudostratified ciliated eipthelium/respiratory epithelium

Question 81

Describe the effect of cystic fibrosis on epithelia and the respiratory tract

Answer 81

Sufferers lack the cystic fibrosis transmembrane regulator (CFTR) ion channel on the apical membranes of epithelial cells Chloride ion transport across the membrane compromised In the respiratory tract water does not adequately leave the epithelium and hydrate the secreted mucous Viscous mucus is less readily moved by the oropharynx for swallowing Serious pulmonary infection can occur

Question 82

What is the blood capacity of the pulmonary vasculature

Answer 82

500ml of blood

Question 83

Label the boxes and identify the tissue

Answer 83

**Box at the very top:** Cresent shaped cartilage **Remaining boxes from bottom clockwise:** Submucosal glands Artery Epithelium Smooth muscle Vein **Tissue:** Secondary or tertiary bronchi

Question 84

Label the boxes and identify the tissue

Answer 84

**Boxes from top to bottom:** Pulmonary artery Bronchial artery Island of cartilage Same as above Bronchus Island of cartilage Pulmonary artery Bronchial artery Glands in submucosa Bronchiole Pulmonary artery

Question 85

What differentiates a bronchiole from a bronchus?

Answer 85

Less than 1mm diameter No cartilage Epithelium is pseudostratified at first however progresses to simple ciliated columnar then simple cuboidal as diameter decreases

Question 86

Describe how asthma affects bronchioles

Answer 86

Excessive constriction can occur due to lack of cartilage During expiration bronchioles can collapse/severely constrict (During inspiration bronchioles held patent by alveoli)

Question 87

Where are clara cells found? What are the functions of a clara cell?

Answer 87

**Location:** Small bronchioles between ciliated cuboidal cells **Function 1:** Secrete surface lipoprotein to prevent walls of bronchioles sticking together during expiration **Function 2:** Secrete Clara cell protein (CC16) A marker of alveolar damage (if lowered) A marker in serum (if present then leakage across air/blood barrier)

Question 88

What are terminal bronchioles and how do their structures differ from othe bronchioles? Why is this important?

Answer 88

**Terminal bronchioles are \<0.5mm** Absence of goblet cells to prevent individuals drowning in their own mucus

Question 89

Label the boxes and identify the location

Answer 89

**Boxes from top to bottom:** Terminal pronchiole Respiratory bronchiole Alveolar duct Alveolar sacs

Question 90

Individual alveoli can open into what structures?

Answer 90

An alveolar sac An alveolar duct A respiratory bronchiole Another alveolus (via alveolar pore)

Question 91

What are the functions of cells in the alveoli?

Answer 91

**Type 1 (90%):** Simple squamous cells permit gas exchange **Type 2 (10%):** Produce surfactant **Macrophages:** Line alveolar surface and phagoctose particles

Question 92

Label the boxes

Answer 92

**Top to bottom left to right:** Basal lamina Type 2 alveolar cell Surfactant Fibroblast Alveolar lumen O2 CO2 Macrophage Endothelial cells Erythrocyte Capillary lumen

Question 93

What is the cause of emphysema? What are the structural changes to lung tissue?

Answer 93

**Cause:** Alpha-1-antitrypsin deficiency Smoking **Structural changes:** Destruction of alveolar walls and permanent enlargement of air spaces

Question 94

How does emphysema affect lung function and what is the hallmark sign?

Answer 94

**Function changes:** Damage to alveolar walls cause bronchioles to collapse on expiration making it difficult to empty the lungs **Hallmark:** Pursed lip breathing

Question 95

What condition would this be? What allows you to form your answer?

Answer 95

Emphysema Enlarged alveolar spaces

Question 96

What is seen here? What disease might this be? What are the common causes?

Answer 96

**Seen:** Lung tissue, alveolar spaces filled with inflammatory cells **Disease:** Pneumonia **Common causes:** Streptococus pneumoniae Haemophilus influenzae Staphylococcus aureus Legionella pneumophilia Mycoplasma pneumoniae

Question 97

What structures are lined by the pleura?

Answer 97

**Visceral:** Lungs **Parietal:** Throacic cage Diaphragm Mediastinal surface

Question 98

What are pleural reflections?

Answer 98

Sharp angles in the pleura where it changes direction from the costal surface to the mediastinal or diaphramatic surfaces

Question 99

Where is the apex of the lung/pleural cavity found?

Answer 99

3cm above the medial 1/3 of the clavicle

Question 100

Describe the route of the pleaural reflections/surface markings of the pleura starting at the apex and travelling anteriorly Describe the entire course, all the way back to the apex

Answer 100

Course inferiorly and medially behing the sternoclavicular joints to meet at the midline behind the sternal angle (2nd rib) Course down to the 4th rib At 4th rib/costal cartilage the left pleura deviates laterally and continues inferio-laterally At 6th rib/costal cartilage the right pleura deviates laterally and continues infero-laterally Each pleural reflection meet the 8th rib at the mid clavicular line Meet the 10th rib at the mid axillary line Meet the 12th rib at the scapular line The medial border of the pleural cavity ascends vertically long the lateral border of the paravertebral muscles up to the apex

Question 101

Describe the surface markings of the lungs starting at the apex and travelling anteriorly Feel free to relate this to the pleural markings to save time

Answer 101

Lungs fill the pleura except at lower margins, therefore they follow the pleural markings at apex, 2nd, 4th and 6th ribs (except cardiac notch, which is more pronounced in the lung compared to pleura The lower margins of the lung cross the: - 6th rib at the mid clavicular line - 8th rib at the mid axillary line - 10th rib at the scapular line Thereafter medial border of the lung ascends along with the pleura vertically along the paravertebral muscles up to the apex

Question 102

Why are surface markings of the lungs and pleura clinically important?

Answer 102

Procedures such as: Cannulation of subclavian Liver biopsy Exposure of the kidney May produce a pneumothorax (possibly unnoticed) which will causing rapid deterioration

Question 103

What are the fissures of the lungs?

Answer 103

**Oblique fissure:** Separates the upper and lower lobe of the left lung Separates the upper and middle lobe of the right lung **Horizontal fissure:** Separates the middle and lower lobe of the right lung

Question 104

Describe the courses of the lung fissures

Answer 104

**Oblique fissures:** Extends from spinous process of T2 posteriorly to the 6th costal cartilage anteriorly **Horizontal fissure:** Extends from Oblique fissure of the right lung at the mid axillary line aalong the 4th rib to the anterior edge of the lung (follows the 4th rib all the way)