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Sem 1 - Body Logistics > The Respiratory System > Flashcards

The Respiratory System Flashcards

1
Q

How can you locate the second rib?

A

You find the sternum angle between the manubrium and the sternum. The second rib attaches at this point and can be counted inferiorly.

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2
Q

Why is the inferior aspect of each lung curved upwards?

A

It is curved upwards because it lies on top of the domed diaphragm.

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3
Q

Why is the diaphragm higher on the right?

A

Because of the liver.

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4
Q

What two types of membrane are present in the respiratory system?

A

MUCOUS MEMBRANES which line the conducting portion of the respiratory tract. It bares mucous secreting cells to various degrees.
SEROUS MEMBRANES which line the pleural sacs which envelops each lung.

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5
Q

Why are lungs seen as “shiny”?

A

Because they are covered in moist pleura.

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6
Q

Name the four things that could fill the pleural cavity and what it would be called if this happens.

A

Air (pneumothorax)
Blood (haemothorax)
Pus (empyema)
A watery transudate or exudate (pleural effusion)

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7
Q

How can fluid be drained from the pleural cavity?

A

Fluid can be drained from the pleural cavity by inserting a wide-bore needle through an intercostal space (usually the 7th posteriorly). This usually occurs under ultrasound guidance.

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8
Q

Why is the needle for a chest drain inserted a fraction about the superior border of the lower rib?

A

To avoid the intercostal nerves and vessels which run alongside the inferior border of each rib.

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9
Q

Why are chest drains not inserted below the 7th rib?

A

Because there is a danger if penetrating the diaphragm.

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10
Q

How can cancer of the lung cause paralysis of on one side of the diaphragm?

A

This paralysis occurs if the cancer impinges on the left or right phrenic nerve.

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11
Q

What consequences can occur of cancer occurs in the apex (high up) in the lung?

A

Cancer in the apex of the lung can impinge on the brachial plexus, causing wasting of muscles in the lower arm or in the hand. Eg of the thenar eminence or of the interosseus muscles in the palm.

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12
Q

What is another name for a tumour at the apex of the lung?

A

A Pancoast tumour.

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13
Q

What disease can a Pancoast tumour cause? And what characterises this disease?

A

It can give rise to Horner’s syndrome due to the pressure on the sympathetic trunk.
Horner’s syndrome is characterised by mitosis (constricted pupil), ptosis (a weak, droopy, upper eyelid) and apparent anhidrosis (localised, decreased sweating).
However, there can be other benign causes of the syndrome.

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14
Q

Why can cancer of the Lung result in a hoarse voice?

A

Cancer of the lung can result in a hoarse voice as a result of impingement on the left recurrent laryngeal nerve which loops up under the aorta.
An aneurism of the aorta can also cause such hoarseness.

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15
Q

Name the seven components of the conducting (extrapulmonary) portion of the respiratory system.

A 
Nasal cavity
Pharynx 
Larynx
Trachea
Primary bronchi
Secondary bronchi 
Bronchioles (smaller than 1mm)
Terminal bronchioles
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16
Q

Name the three components of the respiratory (intrapulmonary) portion of the respiratory system.

A

Respiratory bronchioles
Alveolar ducts
Alveoli

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17
Q

What is the trend as the or the walls and size of lumen as air gets deeper into the lungs?

A

As you go further into the respiratory system, the walls of the passageways became thinner as their lumens decrease in diameter.

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18
Q

What type of epithelium does the nasal cavity, pharynx, larynx, trachea, primary bronchi and the secondary bronchi contain?

A

It contains Pseudostratified epithelium with cilia and goblet cells. It lines the airways from the nasal cavity to the largest bronchioles.

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19
Q

What type of epithelium do the bronchioles and terminal bronchioles contain?

A

They contain simple columnar epithelium with cilia and Clara cells but NO goblet cells.

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20
Q

What type of epithelium do the respiratory bronchioles and alveolar ducts contain?

A

They contain simple cuboidal epithelium with Clara cells and a few sparsely scattered cilia.

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21
Q

What type of epithelia do the alveoli contain?

A

They contain simple squamous / type 1 (and septal / type 2) cells.

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22
Q

What are the two types of nasal cavity?

A

Non-olfactory regions and olfactory regions.

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23
Q

What are non-olfactory regions?

A

Pseudostratified ciliated epithelium. Mucous glands and venous sinuses in lamina propria.
Venous plexuses swell every 20-30 minutes, alternating air flow from side to side, preventing overdrying. Arterial blood flow warms inspired air.
Patency (way they are held open) is maintained by surrounding cartilage or bone.

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24
Q

What are olfactory regions?

A

These are particularly thick Pseudostratified columnar epithelium without goblet cells, located in the posterior and superior regions of each nasal fossa.

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25
Q

What is special about the pseudostratified epithelium in the olfactory region?

A
  • particularly tall in the olfactory region
  • it does not contain any mucous secreting goblet cells
  • the cilia are non motile
  • contain olfactory cells
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26
Q

What are olfactory cells?

A

These are bipolar neurones in which one dendrite extends to the surface to form a swelling from which non-motile cilia extend parallel with the surface. These cilia increase surface area and respond to odours.
Axons or the olfactory join to form an olfactory nerve.

27
Q

Where are serous glands located (when in the olfactory region) and what is their role?

A

Serous glands are in the lamina propria (which blends with the submucosa). They are also known as Bowmans glands and they flush odorants from the epithelial cell surface.

28
Q

What lung are foreign objects more likely to lodge into and why?

A

Foreign objects are more likely to lodge into the right bronchus because its path is more vertical.

29
Q

What is the difference between the cartilage and muscle in the trachea and the primary bronchi?

A

In the trachea, the cartilage is arranged in a regularly spaced C shaped rings whereas in the primary bronchi, the cartilage is arranged in rings.
The trachealis muscle has some control over the tracheal lumen whereas, in the primary bronchi the spiral muscle completely encircles the lumen.

30
Q

What is the role of cartilage in the trachea and primary bronchi?

A

Cartilage maintains the patency (open lumen) of the airway and provides strength to the wall. The rings of cartilage permits more flexibility that would a solid, hollow, cylindrical wall of cartilage.

31
Q

What are the two types of choking?

A
  • One type of choking is caused by a large, static oesophageal bolus.
  • The other type of choking is caused by something caught in the tracheal lumen.
32
Q

What do secretions from the epithelium and the submucosal glands of the trachea and primary bronchi contain?

A

Mucins,
Water,
Serum Proteins,
Lysozymes (that destroy bacteria),
Antiproteases (inactivate bacterial enzymes),
Immunoglobulins especially IgA which are contributed by lymphocytes.

33
Q

What is the mucocilary escalator?

A

Is formed by mucus secreting goblet cells and beating (at12Hz) ciliated cells. Is it when the mucus catches bacteria and the cilia sweep this debris out of the airway.

34
Q

What are the layers in the tracheal mucosa?

A
  • unusually thick basement membrane

- Lamina propria rich in immune cells and with a layer of elastic fibres.

35
Q

What occurs in the trachea in COPD?

A

In chronic obstructive pulmonary disease, there is goblet cell hyperplasia (a smaller proportion of ciliated cells) and hypertrophy of the submucous glands.
This means that thr is more mucous and fewer cilia to move the mucus.

36
Q

What ion channel molecule is not present in the apical membrane of cystic fibrosis suffers? What effect does this have?

A

The cystic fibrosis transmembrane regulator (CFTR) is not present.

  • As a result of this, less chloride ions move out of the epithelia and into the mucus.
  • This mean that less Sodium ion follow so mucus is less salty
  • The osmotic pressure is then lower so less water moves into the mucus by osmosis.
  • This means that the mucus is not sufficiently hydrated so it becomes viscous and it can less readily be moved into the oropharynx for swallowing.
  • Seriously pulmonary infection often results from this.
37
Q

How much blood (and what percentage of its weight) is contained in the entire pulmonary vasculature?

A

The entire pulmonary vasculature contains up to 500ml of blood which is 40% of lung weight.

38
Q

What is the difference between the primary and secondary and tertiary bronchi?

A

The histology is similar except the cartilage is no longer present as full rings. However, it still makings the patency.

39
Q

How do the lungs get oxygen?

A

The bronchial artery comes straight from the aorta and provides the lungs with oxygen (because the pulmonary artery contains deoxygenated blood so, this does not contain enough oxygen to keep the cells in the lungs alive).

40
Q

What do bronchioles NOT have that the other, larger parts of the respiratory system (eg trachea) do have?

A

They have no sub epithelia cartilage or glands. The surrounding alveoli keep the lumen open.

41
Q

Why does asthma occur?

A

Asthma occurs because bronchioles do not have cartilage so they can constrict and almost close down when smooth muscle becomes excessive. The airways also become inflamed and mucous is produced.
This bronchoconstriction can become excessive and cause more problems with expiration than inspiration. (The positive pressure in the alveoli facilitates the closure of the bronchioles.)

42
Q

What is a bronchospasm and how is this linked to asthma?

A

A bronchospasm is excessive contraction or spasm of the bronchial smooth muscle. In asthma, a hyper-responsiveness of the airways results in this problem.

43
Q

Other than bronchospasms, what else occurs during an asthma attack?

A

The airways themselves also become inflamed with swelling of bronchial mucous membrane (mucosa) and secretion of excessive thick mucus that is difficult to expel.

44
Q

What is the worst sign of asthma?

A

The worst sign is a silent chest in which the patient becomes too fatigued and so are unable to generate enough airflow to wheeze. This is an ominous sign of impending respiratory failure and requires immediate medical attention.

45
Q

What are Clara cells?

A

Clara cells are cells that secrete a surfactant lipoprotein (GAGs) which prevent the walls sticking together during expiration.
They also secrete abundant Clara cell protein (CC16) Which is a measurable marker in bronchoalveolar lovage fluid (if lowered then lung damage) and in serum (if raised then leakage across the air-blood barrier).

46
Q

Why do terminal bronchioles not have goblet cells?

A

Because they are the smallest airway conduction portion so, the lack of goblet cells prevents individuals from ‘drowning’ in their own mucus.

47
Q

Name the four places Nathan alveoli can open into.

A
  • A respiratory bronchiole (some alveoli)
  • An alveolar duct (more alveoli)
  • An alveolar sac (many alveoli)
  • Another alveolus
48
Q

What are the characteristics of alveolar walls? (4)

A
  • Abundant capillaries
  • Supported by a basketwork of elastic and reticular fibres
  • Have a covering composed chiefly of type I pneumocytes (alveolar cells)
  • Have a scattering of intervening type II pneumocytes (alveolar cells-surfactant secreting)
49
Q

What is the difference between type I and type II alveolar cells? What is their relative coverage?

A

Type I alveolar cells are simple, squamous. They cover 90% of the surface area and permit gas exchange with capillaries so are a LOT smaller than type II
Type II alveolar cells are cuboidal. They cover 10% of the surface area and produce surfactant.

50
Q

What is emphysema?

A

Emphysema is the destruction of the alveolar walls and permanent enlargement of the air spaces due to loss of elastin. As a result of the alveolar walls collapsing, the bronchiole walls cannot be held open and so collapse. This makes it difficult lungs to empty so air gets trapped in the alveoli.
A classic sign is barrel chasteness which is when the rib cage remains partly expanded all the time.
Emphysema can be caused by smoking or alpha 1-antitrypsin deficiency.

51
Q

What is pneumonia?

A

Inflammation of the lungs caused by bacteria. The lung consolidates as the alveoli fill with inflammatory cells.
The most common bacteria that causes pneumonia is Streptococcus Pneumoniae but it can be cause by other pathogens too.

52
Q

Explain what causes surface tension

A

Hydrogen bonds. At the surface, the water molecules are more crowded. So, they ate more attracted to each other than the surrounding air chihuahua creates surface tension.

53
Q

What is the purpose of pleural fluid?

A

The pleural fluid reduces friction, allowing the pleura to slide easily during breathing.
The fluid also provides surface tension to prevent the longs recoiling and collapsing.

54
Q

What keeps the pleura together and allows them to expland and contract?

A

The vacuum or negative pressure

55
Q

What is the intrapleural pressure during inspiration and expiration?

A

Inspiration it is -8cmH2O
Expiration it is -4cmH2O
Both these pressures are below atmospheric.

56
Q

What is Boyle’s law?

A

When the volume of a container increases, the pressure decreases and when the volume of a container decreases, the pressure increases.

57
Q

Explain inspiration

A

The diaphragm contracts and moves down and the ribs move outwards. This causes the volume of the thoracic cavity to increase. As this volume increase, the pressure decreases (Boyle’s law).
This means that , because air moves from an area of higher pressure, the atmosphere, to an area of low pressure, the lungs.

58
Q

Explain expiration

A

The diaphragm relaxes and moves up and the chest wall recoils. This reduces the volume of the thoracic cavity which increases the pressure. Therefore, air moves form an area of high pressure, the lungs, to an area of lower pressure, the atmosphere.

59
Q

What is the name for pressure within the lungs?

A

Intrapulmonary pressure.

60
Q

What are the two types of pneumothorax?

A

OPEN PNEUMOTHORAX
-Opening in the chest wall (with or without lung picture)
-Allows atmospheric air to enter the pleural space
-Is caused by penetrating pragmatic such as stabbing, gunshots, impalements or surgery.
CLOSED PNEUMOTHORAX
-chest wall is intact
-Rupture of the lung and visceral pleura (or airway) allows air into the pleural space.

61
Q

Explain how a chest drain works

A

A straw attached to the chest tube prom a patient is placed under 2cm of fluid to create a water seal.
This means that, just like a straw, air can be pushed through the straw but Connor be draw back up the straw.

62
Q

What is surfactant?

A

A mixture of lipids and proteins produced and secreted by type two pneumocytes into the alveolar space to reduce surface tension.

63
Q

What is the role of surfactant during inspiration and expiration?

A

During inspiration, when the alveoli expand, surfactant molecules move apart.
During expiration, as the lungs reduce in volume, the surfactant molecules move closer together and become concentrated. This reduces the surface tension as water molecules cannot get as close together.

64
Q

Why is surfactant important?

A

Surfactant is important because it prevents the lung collapsing. Because, if the lung completely recoiled an collapsed when breathing, the tension would become much higher and air would not be able to enter. (LaPlace’s law). This would then lead to stiff lungs which are very difficult to ventilate.

Sem 1 - Body Logistics (14 decks)

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