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The Developing Human > Test #2 for 306 > Flashcards

Test #2 for 306 Flashcards

1
Q

TEF are also commonly associated with?

A

Esophageal Atresia

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1
Q

Thyroid hormones T3 & T4

A

Increase the rate of production of surfactant due to increase rate of phospholipid synthesis

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1
Q

When is the terminal sac period?

A

24 weeks to birth

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2
Q

Primitive Pharynx>LT Groove envaginates >LT Diverticulum>Lung Bud & TE Folds>TE Folds> Laryngotracheal Tube (larynx, trachea, bronchi, Lungs) && Primitive Oropharynx & Esophagus

A

Formation of the Lower RESP TRACT

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3
Q

Cartligage of the larynx is derived from Which pharyngeal arches

A

4th and 6th pharyngeal arches

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3
Q

Other lipids in Surfactant

A

phosphatylinositoil sphingomyelin blah blah

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3
Q

Oxygen Tension

PAO2: what is available or diffusion in the pulmonary capillary

A

PAO2:

1- partial pressure of O2 on the alveolar gas

2-actual number of Molecules available for diffusion into pulmonary capillary

3-Sum of pressures of all gases in alveoli=760mmHg

4-Formula: Barometric pressure - partial pressure of water vapor x Fi02 in the dry air

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3
Q

Oxygen Tension

A

-Partial pressure of waterr vaopr in the lung is 47mmHG at 37 degrees when alveolar gas is fully saturated

-

  • When in room air at sea level, the PAO@ is 150mmHg (760-47x.21=150mmHg)
  • to get PAO2, need to also include PaCO2
  • Resp quotient (R) : ratio of CO2 excretion to O@ uptake =.8
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4
Q

in RDS, what is deficient?

A

Surfactant

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5
Q

What do Type II Cells do?

A

Secrete surfactant an line the walls of the terminal sac

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6
Q

What are the 4 stages of Lung Development?

A

1-pseudoglandular 2-canalicular 3-terminal sac 4-alveolar

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7
Q

Minute Ventilation

A

Minute Vent = TV in ml x # of braths per minute or resp frequency

VE=vtxf

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8
Q

To whom are we thankful for being in school?

A

God, ourselves and our spouses

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9
Q

Esophageal atresia with BOTH proximal and distal TEF’s occurs more commonly in males or females?

A

Males (but only 1% of TEF’s)

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10
Q

Where is surfactant produced?

A

Smooth and Rough ER or type II Cells

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10
Q

What is the 3rd stage in lung development?

A

Terminal sac period

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11
Q

the lungs have a glassy hyaline membrane which cover the alveoli with this:

A

RDS Hyaline Membrane Disease

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12
Q

Oxygen in the blood

A

Forms:

1-plasma

2-Blood

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13
Q

Resistence

A

amt of pressure needed to move resp gases thru the airway at a constant flow rate

-depends on lung resistence/viscosity,

flow or airway resistence

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14
Q

On the left, the two secondary bronchi supply which lobe of the ling?

A

Upper and lower (only 2 lobes on the left)

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14
Q

SP-B&C

A

FUNCTIONAL proteins of surfactant; maintains the integrity of the cell wall

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14
Q

An adequate ratio of L/S is 2:1 indicating fetal lung

A

MATURITY

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14
Q

Hemoglobin

A

Total amounto f O2 carried by Hg depends upon

1-Concentration of the Hg (is Hg normal)

2-degree of saturation (is there adequate O2 available to have adequate saturation)

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14
Q

Clinical significance in low lung volumes

A

Compliance and FRC- indicators of severity of disease process (Low FRC=atelectasis)

  • compliance decreases with worseningof disease
  • compliance improves with onset of diuresis
  • *diuresis-mobilization of interstitial fluid (but you can see a decrease in compliance with this)
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15
Q

True or False: Gastric contents cannot back up into the trachea when you have esophageal atresia with a PROXIMAL TEF?

A

True

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15
Q

Excretion of Surfactant occurs by

A

EXOCYTOSIS

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15
Q

Alveolar Minute Ventilation:

A

AVE= (vt-dead space) x f

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16
Q

what also seperates from the primitive pharynx and gives rise to Lung Buds and TE Folds?

A

Laryngotracheal diverticulum

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16
Q

Tidal Volume

6-9 ml/kg

A

Amount of gas drawn through nose or ETT during a single cyycle of ventilation is called a TV:

Amount of air taken in with a breath is a TV

FRC is greather than TV

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17
Q

What week does the development of the larynx, trachea, bronchi & Lungs occur?

A

4th week

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17
Q

Which TEF rusults in air NOT being able to to enter the distal esophagus and stomach?

A

Esophageal atresia with a PROXIMAL TEF (1%)

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19
Q

TEF’s occur due to an incomplete separation during which week of development?

A

4th week

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21
Q

In an H-type TEF, what/where is the fistula?

A

Between the trachea and esophagus

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22
Q

When, in the terminal sac period, when does the epithelial lining sac become thin causing capillaries to bulge into them?

A

24-28 weeks

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23
Q

Where is surfactant stored?

A

Lamellar bodies

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24
Q

Also present in the terminal sac period are….

A

Type II Secretory Cells

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24
Q

What is the 2nd stage of lung development?

A

canalicular

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24
Q

Insulin will inhibit surfactant production

A

It inhibits the production of surfactant because there is no glucose available for use; seen in IDM: inhibits glycogen breakdown; insulin results in decrease lung maturation

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24
Q

Tissue Resistence

A

40% if resistance in newborns due to

icrease pulm interstitial fluid

cc/s (RLF)

early stage RDS

Pulmonary hypoperfusion

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26
Q

What are some complications from an H-Type TEF?

A

Gastric contents can enter the trachea (lungs)

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27
Q

Time COnstant

TC

TC in healthy infant

TC=0.15 sec

so in 1 TC 3% of the TV will be exhaled in 0.15 secs

3 TC 3x0.5=0.45 secs

5 TC=5x0.15 =0.75 seconds for 99% of TV to be exhaled

A

1 TC is defined as the time needed for alveolar pressure to reach 63% of the change in airway pressure

End of 3 TC 95% of the tidal volume is discharged

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28
Q

Glucosteroids (Betamethosone) do what to Surfactant?

A

Accelerates fetal lung development; increases the availibity of glucose, increases the surfactant production by type II Cells; Increases the beta adrenergic lining cells (increasing compliance)

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29
Q

Inspiration is

A

Active

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30
Q

the Laryngotracheal diverticulum consists of what?

A

Lung buds and the TE Folds

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31
Q

Hemoglobin is ReSTRICTIVE

A

Only so much, once it’s sturated-can’t go past 100%

NON-LINEAR

Amount of HG that binds to O2 increases sharply at LOW PO2’s

Each Hg molecle binds up to 4 MOL of O2

Each GRAM of Hg carries 1.34 ml of O2

Hg will Bind more if Plasma O2 is low

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33
Q

How does the Laryngotracheal Groove Develop?

A

Outgrowth from the caudal end of the primitive phayynx

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34
Q

Type I Cells are used for what?

A

Gas exchange

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34
Q

What kinds of cells doe the alveoli contain?

A

A continious lining of TI& Type II Pneumocytes

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35
Q

Expiration

in normal breathing

A

Is a passive event

Resp muscles relax

lungs and rib cage return to a resting state

amt of gas drawn through the ETT during a single cycle of ventilation is called a TIdal Volume

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35
Q

Radial size of alveoli

A

1-Indicates how much pressure is needed to inflate the lungs

2-law of LaPlace: pressure need to inflate the lung is 2x the surface tension and is inversly proportional to the radius of the structure

P=2st/r

If radius is increased, there is less pressure needed to inflate the lung

If radius is decreased, you need more pressure to inflate the lung

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36
Q

In which period of lung development does the lumen of the bronchi and bronchioles become larger and more vascular?

A

Canalicular Period

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36
Q

MIGRATES to the surface of the liquid layer in order to be functional

A

Surfactant

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37
Q

True of false: in the alveolar stage of transformation, the lungs are transformed from secretory into gas exchange units?

A

TRUE

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37
Q

What is the Primary Lipid in Surfactant?

A

Lecithin (phosphatidylcholine)

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37
Q

Linear relationship of oxygen in the plasma

A

Increase in FiO2, there is an approximate increase in PaO2

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38
Q

Chemoreceptors, chest wall reflexes, lung relexes, respiratory center,

A

CONTROL respirations

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39
Q

Which bronchus is larger in the embryo and adult?

A

Right mainstem bronchus; it is larger and straighter

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40
Q

what other lipid in surfactant is unique to lung cells and is a good marker for surfactant in amniotic fluid?

A

Phosphatidlglycerol

40
Q

PEEP or CPAP

A

High pressures neede to expand a non-compliant lung

-to decrease this high pressure-add PEEP or CPAP

41
Q

Physilogical Dead Space

NOT AVAILABLE FOR RESP

3ml/kg

A

1-anatomic- portion of the air that never gets to the alveoli

2-alveolar-portion f tidal gas not perfused

3- Total of 1 & 2 = physiological dead space

4-wasted ventilation

42
Q

Sphingomyelin levels remain constant

A

throughout gestation

44
Q

What gives rise to the epithelium and glands of the larynx, trachea, bronchi & Pulmonary Epithelium?

A

Endodermal lining of the endotracheal groove

45
Q

In Normal Breathing

INSPIRATION

A

Inspiration is contraction of the resp muscles

&

Enlargement of the intrathoracic space

46
Q

Low lung Volumes

restrictive lung disease

A

1-restrictive lung disease

a) pulmonary hypoplasia (small lungs CDH)
b) surfactant defiency
c) extrinsic lung disease
d) instrisic lung restriction (liesions, PIE)

47
Q

Gas Exhange

A

Gas echange occurs consistently due to FRC (Sizeable amount of gas in the lungs after inspiration and expiration; it is the source of ongoing gas echange

-VENTILATION in related to the concentration of CO2

FRC=30cc/kg

48
Q

During which stage of lung development can the lung structures and cells support life?

A

During the terminal sac period at 26-28 weeks when the epithelium of the alveoli is thinned enough to allow for gas exchange (VQ Matching)

49
Q

When is the terminal sac development?

A

24 weeks to birth

49
Q

SP-A

A

Responsible for spreading surfactant, antioxidant, antimicrobial

49
Q

Airway resistence

A

Low in newborn

Determined by:

flow rates

length of connecting tubing

inner diamater or airwy (wrong ETT size)

physical properties of the gas

50
Q
A
51
Q

When will the lungs increase in size due to the increase in the # of immature alveoli?

A

3 years of age

53
Q

Type I Cells for during what stage of lung development?

A

The terminal sac period

54
Q

TC

A

TC is critical when I-Time or E-Time is so short that it is insuffiient for pressure equilibration

If I-time is

If E-TIme is too short

56
Q

what is formed with the Tracheoesophageal folds grow towards one another and fuse?

A

Trachesophageal Septum

57
Q

Do the respiratory and other system remain immature during the canalicular period?

A

YES

58
Q

When do mature alveoli form?

A

after birth (95% do not develop until after birth)

60
Q

What week does the primitive main stem bronchus/connection of each bronchial bud beome enlarged?

A

5th

61
Q

Respiratory Failure

RESP requires a lot of energy

A

1-Food Substrate-muscle fatigue from hypoglycemia

2- hypoxia

3- Elastic recoil (Passive in expiration)

a) surfactant interface
b) ability of resp muscles to relax (FRC) resting volume

62
Q

Where is surfactant transported to once it is produced?

A

Golgi appartus

64
Q

What is the first stage of lung development?

A

Pseudoglandular period

65
Q

During the 4th week of development, the lungs divide to form what two structures?

A

Bronchial buds (from the primitive pleural cavity) and the BRONCHI

66
Q

Ventilation

A
  • Movement of gas convection through the airways
  • Molecular diffusion into alveoli and pulmonry capillaries
  • CO2 ELIMINATION is VENTILATION

O2 UPTAKE is OXYGENATION

67
Q

Oxygen Tension

PaO2 is the BEST indicator of degree of O2 intake within the lungs

A

paO2 (oxygen concentration in arterial blood (ABG’s))

1- Partial pressure of O2

2-amountof O2 dissolved in arterial blood (plasma)

3-Expressed in units or Torr or mmHg

4-Acceptable limits in newbornd is 50-80 mmHg

68
Q

During reopening of the larynx, what forms from the fold of mucus membranes?

A

Vocal cords

69
Q

Which cells are osmophillic?

A

Type II Cells because they produce surfactant

71
Q

Most Common TEF fistula includes what deformations? This occurs 85% of the time

A

Superior part of the esophagus (blind pouch) with the inferior part being joined to the trachea via a fistula

73
Q

In which week does the main bronchus subdivide into 2 more bronchial buds, forming secondary bronchi?

A

later in the 5th week

75
Q

When is the psuedoglandular period?

A

5-17 weeks Not possible for survival

76
Q

Clinical Significance:

A

HYPERVENTILATION Can decease PACO2 by 20-30 mmHg- Increasing the PAO2 by the same amount

  • You get a higher paO2
  • Live in Denver-barometric level is 600mmHg-ingants have 1/3 less available O2 in alveeoli when breathing room air
78
Q

there is an increase in the number of alveoli as well as the size of the alveoli at what age?

A

8 years

78
Q

When/where do hypoplastic occur?

A

Occurs with posterolateral CDH

80
Q

SP-A is the predominant protein in surfactant

A

YES

82
Q

Why does a TEF occur?

A

Because there is incomplete seperataion of the trachea and espghagus

83
Q

A defect/atresia with both proximal and distal TEF’s can causse gastric contents to enther the trachea?

A

Yep, it sure can

84
Q

Surfactant

A

Breaks the surface tension at the air/liquid interface of alveoli; they are polar and line up

85
Q

Fators that shift the curve to the right

Decrease affinity for O2

A

Decrease Ph

Increase PCo2

Increase H ions

87
Q

What cells cover 95% f tge alveolar surfac & Are made up of Squamous epithelial cells?

A

Type I Pneumocytes

88
Q

H-Type fistula occurs in ??? %%%%%?????

A

4%; people think it’s the most common type, but it is not

89
Q

Expiration is

A

Passive

90
Q

TC is RDS

A

Lung isn’t expanding; lung with decreased compliance will complete inflation and deflation quicker

92
Q

Type II Pneumocytes are made up of what kinds of cells?

A

Made up of Cuboidal cells

94
Q

At 24 weeks, what kind of squamous epithelial cells line the sac?

A

Type I Cells

95
Q

As the lungs develop, what kind of pleura is acquired?

A

Visceral pleura

97
Q

Epiglottis forms from what pair of pharyngeal nerves?

A

3rd & 4th

98
Q

The 4th stage of lung development is the?

A

Alveolar Period

99
Q

What is the second stage of lung development?

A

Canalicular Period

100
Q

When do tertiary bronchi develop?

A

7th week

101
Q

Lecithin increases from

A

34 weeks

102
Q

On the Right, the superior bronchus will supply which lobe of the ling?

A

Upper (superior)

104
Q

Laryngeal Muscles are derived from what?

A

myoblasts of the 4th & 6th pharyngeal arches

105
Q

When are Type II Pneumocytes detected?

A

25-30 Weeks BUT potential for alveolar stability does not occur intil 3-36 weeks

107
Q

The larynx is closed primarily, but it reopens again during which week of development?

A

10th

108
Q

When does the the endotracheal groove envaginate to form the laryngotracheal Diverticulum?

A

end of the 4th week

109
Q

In the Alveolar period, what does each resp bronchial terminates into?

A

thin-walled terminal sacs

110
Q

where does the epithelial lining of Larynx develop from?

A

The cranial end of the laryngotracheal tube

111
Q

Clinical uses for Peep/CPAP

A

corrects stelectasis

Increasess FRC

improves V/Q mismatch

Improves Pulm edema

113
Q

What is the 3rd stage of lung development?

A

Terminal Sac Period

114
Q

PEEP or CPAP

A

1- PEEP mechanical ventilation

2- CPAP baby is breathing spontaneouosly

-breaks the following cycle:

reduces the amount of pressure needed to ventilate; also imporved by adding surfactant

116
Q

Why does Laryngeal web form?

A

it forms if there is an incomplete opening of the larynx in the 10th week

117
Q

what findings would you expect from a TEF with esophageal atresia?

A

Rapid abdominal distention; the stomach and intestines rapidly fill up with air

118
Q

What is the ratio of Lipids to protein in Surfactant?

A

9:1 90% Lipids 10% Protein

119
Q

when does the canalicular period of lung development occur?

A

16-25 weeks of gestation

120
Q

A L/S ratio of

A

Fetal lung immaturity

121
Q

Factors that influence compliance

A

1-number of alveoli (if not enough, decrease in compliance)

2-surfactant

3-interstitial changes (scars/PIE/Pneumonia)

4-V/Q Mismatch

5-lung volume

CO2 moves faster than O2

122
Q

Time Constant

Time Constant = resistance x Compliance

A

How long it takes for the lung to inflate and deflate

or

measure of how ling is takes for the lung to inflate and deflate

depends of compliance and resistanve

124
Q

Concentration of surfactant in amniotic fluids occurs at a 2:1 ratio at about what week indicating lung maturity?

A

34-34 weeks

125
Q

Terminal bronchioles divide to form smaller bronchioles during the canalicular peiord

A

There are 3-6 alveolar ducts at about 24 weeks

127
Q

By 24 weeks, about how many orders of branches have formed and about how many respiratory bronchioles have formed?

A

about 17

128
Q

VQ Matchiing

A

Capillary touhing the alveolar surface to have exchange

1-matching of ventilation and perfusion

2: ratio reflects the correlation between alveolar ventilation and capillary perfusion for lung as a whole

3-when ventilation is matched to perfusion-the ratio is 1

VQ mismatch is defective of gas exchange

130
Q

95% of these cells cover the alveolar surface. These cells are interconnected by tight junctions……

A

Type I Cells

131
Q

On the right, the inferior bronchus subdivides into two bronchi to form?

A

1- Middle lobe of the right lung & the other to the lower (inferior lobe)

132
Q

Rib Cage in NN

A

1- More cylindrical than elipsoid

2-ribs more horizontal than oblique

3- Reuslts

a) Muscles are shorter
b) less mechanical advantage
c) angle of the diaghragm is different (more horizontal so air move inward rather than upward)
d) ribcage is pliable and unstable
e) retractions

133
Q

Pulmonary ad systemic circulation is established in what period?

A

Alveolar period

134
Q

When is the alveolar period?

A

Late fetal to 8 years of age

135
Q

Factors that shift the Curve to the LEFT

Hg has an INCREASD affinity of O2

A

Presence of Hgf

decrease 2,3 DPG

Alkalosis

Decrease PCO2

Decrease Temp

136
Q

In the pseudoglandular period:

A

Resembles an endocrine gland all major parts of the lung form except alveoli

137
Q

Can air enter the esophagus if you have an Esophageal atresic with a PRXIMAL TEF?

A

No, so there is NO abdominal distention

138
Q

Where does the trachea come from/differentiated from?

A

The distal end of the laryngotracheal tube

139
Q

Surfactant is diffused/dispersed by

A

PROTEINS

140
Q

when does adequate production of surfactant occur?

A

During the alveolar period

141
Q

Oxygen Tension

A

FiO2:

1- Fraction of inspired O2

2-Measured in %%%%

3-RA has .21% O2

(In air trasnport: Altitude increases % oxygen availaible in ambient air; O2 availability is decreased because the MOLECULES are smaller and are harder to analyze

142
Q

Is some respiration possible in the canalicular period?

A

Yes……16-25 weeks, if born between 22-25 weeks, there is a chance but some still die

143
Q

Factors affecting Hg Affinity for O2

A

% of fetal and adult Hg

1-95% HGf

2- Hgf does not bind to 2,3 DPG

a) Result: Hgb holds onto O2 tightly
b) Left shift in Oxyhgb Curve

The Developing Human (2 decks)

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