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Anatomy 1 - MD > Week 3 - Pulmonary > Flashcards

Week 3 - Pulmonary Flashcards

1
Q

What is Respiration?

A

series of gas exchange
-uptake of O2 by cells
-CO2 to lungs

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2
Q

Ventilation

A

air moving in and out of the lungs

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3
Q

External Respiration

A

gas exchange between air in lungs and blood

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4
Q

Internal Respiration

A

gas exchange between blood and tissues

gradients

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5
Q

Respiratory System Functions

A

-gas exchange
-regulation of blood pH
-voice production
-olfaction
-protection

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6
Q

Gas Exchange

Respiratory System Functions

A

O2 enters blood, CO2 leaves

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7
Q

Regulation of Blood pH

Respiratory System Functions

A

altered by changing blood CO2 levels

release CO2

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8
Q

Voice Production

Respiratory SYstem Functions

A

movement of air past vocal folds makes sound/speech

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9
Q

Olfaction

Respiratory System Functions

A

smells occur when airborne particles are drawn into the nasal cavity

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10
Q

Respiratory System Functions

A

-gas exchange
-regulation of blood pH
-voice production
-olfaction
-protection

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11
Q

Protection

Respiratory System Functions

A

against microorganisms by preventing entry and removing them

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12
Q

Non-Respiratory Functions of Respiratory Systems

A

-route for water loss and heat elimination
-helps maintain normal acid-base balance
-removes, modifies, activates/inactivates various materials passing through pulmonary (ex. angiotensin 2)
-nose serves as the organ of smell

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13
Q

Steps of Respiration

A
  1. Inhalation
  2. gas exchange for capillaries and alveoli
  3. Transport gases
  4. Receive gases in blood and tissues
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14
Q

Respiratory Tree

A

connects the external environment to the exchange portion of the lungs
-increased flow in large airway, decreased flow in small airway

upper + lower respiratory tract

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15
Q

Upper Respiratory Tract

Respiratory Tree

A

single large conductive tube
-trachea
-primary bronchi
-secondary bronchi
-tertiary bronchi
-bronchioles
-terminal bronchioles

(entrance to larynx)

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16
Q

Lower Respiratory Tract

Respiratory Tree

A

starts after larynx and divides into smaller regions; small exchange portion
-respiratory bronchioles w/ start of alveoli outpouching
-alveolar ducts w/ outpouchings of alveoli

(trachea to lungs)

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17
Q

Ventilation Structures

A

-skeletal + musculature (ribs / intercostals)
-pleural membranes
-neural pathways

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18
Q

Function of Upper Respiratory Tract

A

preps the air for gas exchange
-warm the air
-humidify the air
-filter out particles for air is clean for gas exchange
-vocalize

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19
Q

Function of Lower Respiratory Tract

A

-exchange of gases (large surface area): network of pulmonary capillaries (80-90% of space bteween alveoli is filled w blood)
-protection: free alveolar macrophages (dust cells) + surfactant produced by type 2 alveolar cells reduce friction

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20
Q

Parietal Pleura

A

surrounds outside of the lung

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21
Q

Visceral Pleura

A

directly surrounds lung

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22
Q

Pleural Cavity (space)

A

between parietal and visceral layers

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23
Q

Serous Membrane

A

attaches lung to inner surface of throacic cage
-produces fluid for lubrication

failure to function = difficulty breathing (Pleurisy)

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24
Q

Pleural Sac

A

double walled closed sac separating each lung from thoracic wall

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25
Q

Pleural Cavity

A

intrapleural fluid secreted by surfaces of the pleura

lubricates pleural surfaces

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26
Q

Pleural Effusion

A

cavity inflamed with excess fluid
-large -> friction rub during auscultation

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27
Q

Pleural Membrane Detail

dependent upon intrathoracic pressure

A

-cohesion: w/ parietal + visceral layers due to serous fluid in pleural cavity
-increased pressure: parietal membrane expands, pulls visceral layer with it, followed by lungs
-disruption of integrity of pleural membrane: will result in rapid equalization of pressure + loss of ventilation function (increased pressure) - ex. Pneumothorax

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28
Q

Pneumothorax

A

collapsed lung
-resulting from trauma injuries

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29
Q

Lung Characteristics

A

paired, cone shaped organs in thoracic cavity
-separated by heart + other mediastinal structures
-covered by pleura
-extend from diaphragm inferiorly just above clavicles
-lie against thoracic cage (pleura, muscle, ribs)

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30
Q

Hilum of the Lung

A

medial roots of the lung with blood vessels and nerves where blood enters the lung

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31
Q

Cardiac Notch of the Lung

A

depression in the lung to accomodate the heart

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32
Q

Anterior Chest

A

contains upper + middle lobe (very little lower lobe)
-apex 3-4cm above inner 1/3 clavicles
-base rests on diaphragm, 6th rib

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33
Q

Lateral Chest

A

extends from axilla apex to 7th/8th rib

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34
Q

Posterior Chest

A

almost all lower lobe (R middle does not project)
-apex of the lung is at C7-base of T10 (on deep inspiration to T12)

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35
Q

Right Lung

A

3 lobes - upper, middle, lower
-shorter due to liver

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36
Q

Left Lung

A

2 lobes - upper + lower
-narrower due to heart
-no middle lobe

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37
Q

Bronchial Blood Supply

A

supply bronchi, airway walls + pleura
-superior thoracic aorta (aortic arch)

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38
Q

Pulmonary Supply

A

pulmonary arteries enter at hilum and branch with airways

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39
Q

Trachea + Larger Bronchi

Characteristics

A

fairly rigid, nonmuscular tubes
-rings of cartilage prevent collapse

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40
Q

Bronchioles

Characteristics

A

walls contain smooth muscle
-no cartilage to hold them open
-innervated by autonomic N.S.
-sensitive to hormones + chemicals (coughing upon smelling toxic substances ex. carbon monoxide)

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41
Q

Alveoli

Characteristics / Function

A

function in gas exchange
-walls consist of single layered Type 1 Alveolar Cells
-pulmonary capillaries encircle each alveolus
-alveolar macrophages
-Pores of Kohn
-Type 2 Alveolar cells (surfactant)

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42
Q

Type 1 Alveolar Cells

Alveoli

A

single structural layer composing alveoli walls
-allows for gas exchange to occur

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43
Q

Type 2 Alveolar Cells

Alveoli

A

secrete pulmonary surfactant
-decrease surface tension/friction

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44
Q

Alveolar Macrophages

Alveoli

A

guard lumen and engulf foreign particles

45
Q

Pores of Kohn

Alveoli

A

permit airflow between adjacent alveoli (collateral ventilation)

46
Q

E-Cigarette Effects on Alveoli

A

oil from E-cigarettes coats the alveolar sac -> cannot clear respiratory infection as fast
-alveoli clogged by mucus -> alveoli break down -> no gas exchange -> decrease in O2 sat

47
Q

Conducting Zone

Characteristics / Function

A

all of the structures where air passes through before reaching the respiratory zone
-function: warms, humidifies, filters, cleans mucus secreted within conduction zone (preps for gas exchange in respiratory zone)

trachea -> bronchioles -> R + L main stem bronchi

48
Q

What structure of the lung is most prone to obstruction?

A

Right Bronchus
-inhaled foreign material will likely end up in R bronchus since the pathway goes straight down

49
Q

Respiratory Zone

A

region of gas exchange between air and blood (alveoli)
-includes respiratory bronchioles and alveolar sacs

50
Q

Surfactant

(Type 2 Alveolar Cells)

A

interspersed among water cells; decreases surface tension

51
Q

Respiratory Distress Syndrome (RDS)

A

net decrease surfactant in preemies
-1st breath = big effort to inflate lungs
-no surfactant = hard to inflate
-RDS destroys Tyep 2 Alveolar cells

52
Q

Air-Blood Barrier

Respiratory Membrane

A

composed of alveolar / capillary walls and their fused basal laminas

53
Q

Alveolar Walls

A

single layer of type 1 alveolar cells
-structural epithelium permits gas exchange by simple diffusion
-secretion of surfactant by type 2 alveolar cells

54
Q

Asthma

A

bronchiole constriction prevents O2 from reaching alveoli
-wheezing (expiratory) = hospitalization (no CO2 gas exchange)
-steroid inhaler decreases constriction
-croup = wheezing in children

55
Q

Muscles of Inspiration

A

all act as a group; one will take over/function upon injury to ensure proper breathing
-external intercostal muscles
-scalene muscles
-secondary / accessory muscles

56
Q

External Intercostal Muscles

Muscles of Inspiration

A

elevate / open up the ribcage
-change thoracic pressure and increase transverse diameter (forced inspiration) activated by intercostal nerves

57
Q

Internal Intercostal Muscles

Muscles of Expiration (forced mostly)

A

depress ribs, decrease transverse diameter (forced expiration)

58
Q

Scalene Muscles

Muscles of Inspiration

A

elevate 1st and 2nd ribs

59
Q

Secondary / Accessory Muscles

Muscles of Inspiration

A

aid in the motion of breathing when primary muscles are tired
-only contract upon forceful inspiration
-SCM, trapezius, serratus anterior, pectoralis major/minor, latissmus dorsi

60
Q

Muscles of Expiration

A

contract only during forceful expiration
-internal intercostals (involuntray breathing)
-abdominal muscles: rectus abdominus, internal/external obliques, transverse abdominus

61
Q

Respiratory Muscle Activity

A

changes function dependent on injury
-injuries = decreased O2 sat to muscles
-muscles of active inspiration function during injury (ex. internal intercostals)

62
Q

Splinting

Respiratory Muscle Activity

A

leaning to one side from a rib injury
-hurts to breathe
-makes the non-injured side work harder

63
Q

Costal Chondritis

A

injury to muscle = inflammation of costal cartilage
-difficulty breathing

64
Q

Rib Muscle Injury

A

not enough gas exchange
-collapsed alveoli -> infection, atelectasis -> pneumonia

65
Q

Atelectasis

A

collapsed lung

66
Q

Major Muscles of Inspiration

A

contract every inspiration; relaxation -> passive expiration
ex. internal intercostals + diaphragm

67
Q

Accesory Muscles of Inspiration

A

contract only during forceful expiration

68
Q

When are the diaphragm and external intercostals relaxed?

A

before inspiration

69
Q

When does the diaphragm contract?

A

during inspiration
-elevation of ribs causes sternum to move upward/outward = increased thoracic cavity dimension
-lowering of diaphragm increases vertical dimension of thoracic cavity
-contraction of external intercostal muscles = elevation of ribs = increased horizontal dimension of thoracic cavity

70
Q

COPD

A

muscles overcompensate = barrel chest
-increased transverse diameter = more difficult to breathe (increased pressure)
-decreased O2 sat (O2 cannot reach alveoli for gas exchange) = cough
-muscles of inspiration are tired -> accessory muscles take over

71
Q

Diaphragm

Inspiration

A

primary inspiration muscle
-increase longitudinal diameter
-phrenic nerve innervates
-inspiration pulls diaphragm down
-75% of enlargement of throacic cavity during quiet respiration (normal breathing) is due to contraction / flattening of diaphragm

72
Q

4 Major Functions of the Respiratory System

A
  1. supply of O2
  2. removal of CO2
  3. regulation of homeostasis by blood pH regulation
  4. heat exchange
73
Q

Role of CO2

Major Functions of Respiratory System

A

controls breathing
-lungs maintain pH balance by adjusting amount of CO2

74
Q

Regulation of Homeostasis by pH

Major Functions of Respiratory System

A

acid base balance - acidotic or alkalotic - by supplying or removing O2/CO2
-RR regulation -> increase or decrease O2 and CO2
-alkalotic: 7.45+
-acidotic: 7.35-

75
Q

pH of Blood

A

7.35-7.45

76
Q

Arterial Blood Gas Values

(maintain homeostasis)

A

pH = 7.35-7.45
PCO2 = 35-45 mmHg
PO2 = 80-100 mmHg
SO2 = 95-98%

77
Q

Hypoventilation

A

decreased breathing
-increased CO2

78
Q

Hyperventilation

A

increased breathing
-decreased CO2

79
Q

What controls respiration?

A

involuntary control by respiratory center in the brain stem
-pons + medulla

80
Q

Hypercapnia

A

increased CO2 in the blood + provides normal stimulus to breathe

81
Q

Hypocapnia

A

decreased CO2 in the blood

82
Q

Hypoxemia

A

decreased O2 in the blood

83
Q

Hypoxic Drive

A

form of respiratory drive in which the body uses O2 chemoreceptors instead of CO2 receptors to regulate the respiratory cycle
-decreased O2 sat
-is a gradual change over time
-seen in COPD, smokers, emphysema, chronic asthmatics, chronic bronchitis

84
Q

Dangers of Hypoxic Drive

A

-decreased O2 supply = breathe more
-increased O2 supply = breathe less -> stops breathing
-giving pt too much oxygen will kill the pt
-pt needs low O2 flow (no more than 2 L N.C.)
-greatest risk: infants

85
Q

Apex

Auscultory Regions of the Lung

A

above clavicle + 1st rib

86
Q

Superior R Lobe of the Lung

Auscultory Regions of the Lung

A

2nd intercostal space, R sternal border

87
Q

Inferior Lobe of L Lung

Auscultory Regions of the Lung

A

8th intercostal space, L sternal border

88
Q

Superior Lobe of L Lung

Auscultory Regions of the Lung

A

3rd intercostal space, L sternal border

89
Q

Middle Lobe R Lung

Auscultory Regions of the Lung

A

4th intercostal space, R sternal border (nipple line)

90
Q

Inferior Lobe R Lung

Auscultory Regions of the Lung

A

6th intercostal space, R sternal border

91
Q

Pectus Excavatum

Characteristics

A

chest falls in; posterior depression of the sternum + costal cartilage
-1/700 births
-Male 3.4: Female 1
-37% occur in families w/ chest wall deformities (genetic predisposition)
-1st/2nd ribs + manubrium are in normal position

92
Q

Pectus Excavatum

Defects that come into play

A
  1. Scoliosis - >25% deformity = needs surgery, cannot breathe, chest/muscle pain while breathing, gait problems
  2. Kyphosis
  3. Myopathy - muscles diseases/problem
  4. Marfan’s Syndrome + EDS
  5. Cerebral Palsy - decreased motor function due t deoxygenation from birthing trauma = possible deficits (dysphagia, seizures)
93
Q

Pectus Excavatum

Symptoms

A

-fatigue
-difficulty exercising
-dyspnea
-poor O2/CO2 exchange
-tachycardia
-heart pumping issues (depending on severity)

94
Q

Pectus Carinatum

A

anterior protrusion of chest

pigeon chest

95
Q

Poland’s Syndrome

A

congential absence of pectoralis major/minor, ribs, breast abnormality, chest wall depression, syndactyly, brachydactyly or absence of phalanges
-syndactyly: digits fail to fully separate into fingers + toes
-brachydactyly: digits are shorter in proportion to other parts of the body

96
Q

Thoracic Outlet Syndrome (TOS)

A

presence of “extra” cervical rib causes compression of thoracic outlet due to injury or deformity (between C7 + 1st rib)
-first rib, clavicle + scalene muscle
-raises brachial plexus
-0.5-1% of population (not all are symptomatic)
-95% neurogenic symptoms (ulnar nerve C8-T1 usually affected)
-5% vascular symptoms (subclavian artery + vein)
-Unilateral Raynaud’s Disease always suspect TOS

97
Q

Thoracic Outlet

A

space in which subclavian artery/vein + brachial plexus pass through upper limb
-C8-T1

98
Q

Complications of TOS

A

-prolonged compression + trauma
-intimal injury
-stenosis, thrombosis
-post-stenotic dilation or aneurysm
-distal microembolisation

99
Q

Inspection of Rib Fractures

A

-splinting posture (holding painful area to limit chest wall movement during inspiration)
-discoloration/swelling
-shallow, rapid RR (minimized chest movements)

think about structures beneath ribs

100
Q

Palpation of Rib Fractures

A

point tenderness, crepitus, possible deformity
-crepitus - crackling sound upon palpation

101
Q

Functional Tests for Rib Fractures

A

-movement of torso (causes chest pain)
-increased pain with deep RR, coughing or sneezing

102
Q

Stress Rib Fractures

A

cracked bone not visible upon X ray
-may see bridging upon follow up X ray (where osteoblasts build new bone)
-caused by: rowing, swimming, overextend injuries, shin splints, overtraining, improper biomechanics
-often seen: posterolateral portion of 4th-9th ribs
-special tests: rib compression test
-heal by resting

need MRI for bone swelling/edema

103
Q

Costochondral Injury

A

MOI: overstretching, costochondral junction (hyperflexion, horizontal abduction, “snap” or “pop” at time of injury)
-symptoms: anterior pain (cartilage junction), increased pain with deep breathing, coughing, sneezing

104
Q

Pneumothorax

A

accumulation of air in pleural cavity; collapsed lung

105
Q

Spontaneous Pneumothorax

A

formation of blebs -> lose intrathoracic pressure = drop a lung
-primary spontaneous pneumo
-secondary spontaneous: caused by previous injuries, infection or pneumothorax

rare

106
Q

Tension Pneumothorax

A

one way valve created from blunt/penetrating trauma
-air going in, no air going out, pressure change
-occlusive dressing as a valve
-GSW, stabbing

107
Q

Clincal Signs of Pneumothorax

A

-no oxygenation
-cyanosis
-decreased/no lung sounds
-diminished breath sounds
-tracheal deviation
-mediastinum compressed
-JVD
-blood in X-ray/sonogram

108
Q

Vital Signs in Pneumothorax

A

low BP -> bleeding out, heart compression -> shock, tachycardic

109
Q

Hemothorax

A

blood enters the pleural space
-blood accumulates -> compressed lung
-signs/symptoms: produced by hypovolemia, + respiratory compromise, anxiety/apprehension, hypovolemic shock, decreased breath sounds, flat neck veins

Anatomy 1 - MD (6 decks)

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