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323 Cards in this Set
- Front
- Back
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What ribs are considered "true" ribs?
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Ribs 1-7, they attach to the costal cartilage
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What ribs are considered "False" ribs?
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Ribs 8-10, they attach to the costal margin
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What ribs are called "floating" ribs?
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Ribs 11-12, they do not attach to the sternum at all
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The left kidney lies anterior to which vertebrae?
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T11-L3
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The right kidney lies anterior to which vertebrae?
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T12-L4
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The cupula of the lungs extend where?
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into the neck, above the clavicle
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As a clinician, why should we remember the location of the cupula of the lungs?
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During a "Subclavian stick", we must be sure to not puncture the lungs
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What is the "angle of Louis"?
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The sternal angle, the attachment site of the manubrium to the sternal body
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Which ribs have the osteology of "typical" ribs?
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3-9
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What are some key atypical features of rib 1?
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Grooves for subclavian vessels, only1 articular facet (not 2).
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What muscle, attached to rib 1, separates the subclavian vein from the subclavian artery?
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anterior scalene
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What feature makes rib 2 atypical?
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Grooves for muscle attachement
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What muscles attach to rib 1?
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Anterior scalene, middle scalene (and others from previous lectures like subclavius)
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What muscles attach to rib 2?
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Posterior scalene (and others from previous lectures like serratus anterior)
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What makes ribs 10-12 atypical?
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10-12 have only 1 articular facet. 11-12 have no necks or attachments
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Which ribs have only 1 facet for attachment (only articulate with one vertebral body)?
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Ribs 1, 10, 11 and 12
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Which spinous process level corresponds with the superior angle of the scapula?
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T2
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Which spinous process level corresponds with the inferior angle of the scapula?
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T7
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Which vertebral body level corresponds with the jugular notch?
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T2
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The sternal angle lies in a transverse thoracic plane with which intervertebral disc?
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T4/T5
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The female breast is typically situated vertically over which ribs?
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2-6
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2/3 of the breast covers which muscle?
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Pec. Major
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1/3 of the breast covers which muscle?
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Serratus Anterior
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What are the 3 major arteries to the breast?
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Lateral thoracic artery, internal thoracic artery and posterior intercostal arteries
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What part of the lateral thoracic artery reaches the breast?
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Lateral Mammary Branches
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What part of the internal thoracic artery reaches the breast?
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Medial Mammary Branches
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Lateral mammary veins drain in to what major vein?
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Axillary
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Where do medial mammary veins drain?
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internal thoracic veins
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Why does an azygous veinous system need to exist?
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All blood must be shunted to the right side to enter the right side of the heart.
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The breasts are innervated by what nerves?
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anterior and lateral cutaneous branches of intercostal nerves 2-6
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What is the nipple innervated by?
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4th intercostal nerve
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Where does 75% of lymphatics drain?
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Left thoracic duct
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Why are the parasternal lymph nodes clinically important?
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They allow for lymph movement between the two breasts. Breast cancer can metastasize easily
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What are 2 commonly injured nerves during mastectomy?
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Long thoracic nerve and thoracodorsal nerve
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Fun Fact: Pec. Major and Pec. Minor can help with forceful respiration
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Sweeeeeeet
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What layered category of muscles are the MAJOR contributors to respiration?
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3 layers of intercostal muscles
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The external intercostal layer is continuous with what abdominal muscle?
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External oblique
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The internal intercostal layer is continuous with what abdominal muscle?
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Internal oblique
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Which 2 intercostal muscle layers have fibers running in the same direction?
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Internal and innermost
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How would we be able to distinguish the external intercostal muscle layer from the inner layers in a picture?
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External fibers run in a different direction (hands in pocket)
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What muscles, anterior to the back ribs, are analogous to the intertransversarii?
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Subcostal muscles
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Subcostal muscles span how many ribs, usually?
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2-3
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Transversus thoracic muscle origin and insertion?
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Origin: posterior inferior sternum. Insertion: posterior surface of ribs 2-6
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2 main artery sources for thoracic wall?
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posterior intercostal arteries (off of thoracic aorta) and anterior intercostal arteries (off of internal thoracic artery)
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The internal thoracic vein drains into what large vein?
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Brachiocephalic vein
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Fun Fact: Thoracic veinous drainage is similar to the artery system except for the azygous vein
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yea
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Innervation of intercostal muscles
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intercostal nerves (anterior rami of T1-T11) and subcostal nerves (anterior rami of T12)
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What is the arrangement of vessels in the intercostal space?
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Superior to inferior: VAN (Vein, artery nerve)
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When performing a thoracocentesis through the intercostal space, what must we not hit?
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Intercostal nerves
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Diaphragm separates what 2 cavities?
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Thoracic and abdominal
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What passes through the central tendon of the diaphragm at the T8 level?
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inferior vena cava, right phrenic nerve,
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What passes through the muscular part of the diaphragm at T10 level?
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esophagus and vagus nerve
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The aortic hiatus is found at what level of the diaphragm?
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T12
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What is in the aortic hiatus?
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Abdominal aorta and thoracic duct
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What innervates the diaphragm?
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Phrenic nerve (C3-C5) innervates inferiorly to the diaphragm
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Fun Fact: Lungs cannot inflate without intact plura
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drop it like its hot
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The hilum of the lung is found at which vertebral levels?
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T5-T7
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What is Endothoracic fascia?
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connects the parietal pleura to the thoracic wall
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What is endothoracic fascia made of?
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loose connective tissue
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What is a plural recess?
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Areas between the parietal and visceral plural not invaded by the lungs
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Why are plural recesses, specifically the costodiaphragmatic, clinically important?
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These are the areas that can fill with fluid and prevent lungs from expanding
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Where is the costodiaphragmatic recess located?
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Below the 6th rib
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Thoracocentesis
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Draining of the fluid from the plural recesses, patient must hold their breath to avoid lung puncture
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Lobes of the right lung
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Superior, middle, inferior
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Lobes of the left lung
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Superior, inferior
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When looking at the mediastinal surface of the right lung, where is the bronchus located relative to the pulmonary artery?
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Posterior
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When looking at the mediastinal surface of the left lung, where is the bronchus located relative to the pulmonary artery?
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Inferior
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How many bronchopulmonary segments are on each lobe of the lungs?
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Each side has 10 segments (even though they have a different # of lobes)
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Why can we never have 100% oxygenated blood?
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In the lungs, Bronchial veins unite with pulmonary veins (carrying oxygenated blood)
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Explain what happens when half of the diaphragm is paralyzed.
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Injury to left or right phrenic nerve paralyzes half of diaphragm. Instead of lowering during inspiration, the paralyzed side rises as the abdomen is compressed by the working diaphragm side. paradoxical movement
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Thoracocentesis is performed between what ribs?
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9/10. down mid axillary line
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Pneumothorax
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Entry of air into the pleural cavity
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Hydrothorax
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Accumulation of fluid in the pleural cavity
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Hemothorax
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Accumulation of blood in the pleural cavity, due to damaged intercostal vessels
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Pulmonary embolism
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blood clot in the pulmonary artery, decreased rate of blood oxygenation
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When a patient is supine, where is the aortic arch regarding the transverse thoracic plane?
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Superior
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When a patient is supine, where is the central tendon of the diaphragm? (vertebral level)
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T9, the xiphisternal junction
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When a patient is standing, where is the aortic arch regarding the transverse thoracic plane?
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transected by the plane
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When a patient is standing, where is the central tendon of the diaphragm? (vertebral level)
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below T9 (T9/T10 disc)
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What separates the inferior and superior mediastinum?
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Transverse thoracic plane
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Why is breathing more difficult as we age?
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Connective tissue around heart gets thicker
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What is the transverse thoracic plane?
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imaginary line from the sternal angle to the T4/T5 disc
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What are the basic components of middle mediastinum?
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Heart with pericardium
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Where would we auscultate the left ventricle?
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5th intercostal space
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What traverses the space between the pericardium and the lungs parietal pleura?
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Phrenic nerve and pericardiophrenic artery/vein
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Fun Fact: Pericardium has outer fibrous portion and inner serous portion.
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yeaaa buddy
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Which layer of pericarduim is continuous with the tunica adventitia of the 3 great vessels?
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Outer fibrous pericardium
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The pericardial cavity is defined as what?
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The space between the visceral and parietal serous layers of pericardium
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Why do pericardial sinuses exist?
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Folding of primitive heart during development
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Why are pericardial sinuses clinically important?
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Infections can occur within them
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The transverse pericardial sinus lies anterior to which vessel?
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Superior vena cava
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The transverse pericardial sinus lies posterior to which vessels?
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aorta and pulmonary trunk
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Fun Fact: The transverse pericardial sinus is continuous from the left to the right sides of the heart
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truth
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What is the main blood supply to the pericardium?
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Pericardiophrenic artery, a branch of the internal thoracic artery
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Pericardium is innervated by what?
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Phrenic nerves (C3-C5)
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Why is pericardial pain felt in C3-C5 dermatomes?
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Phrenic nerves (C3-C5) are somatic nerve, not visceral
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Which nerve in the middle mediastinum passes anteriorly to the root of the lung?
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phrenic
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Which nerve in the middle mediastinum passes posteriorly to the root of the lung?
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vagus
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What are the annuli fibrosi of the heart?
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The fibrous rings that surround and anchor the valves to the cardiac fibers
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What affect can esophageal ulcers have on the heart?
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Esophagus is in close contact with left atrium of the heart. Ulcers can erode the left atrium
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The fossa ovalis in the heart is a remnant of what embryonic structure?
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Foramen ovale, a fetal shunt that allows blood to flow from the right atrium to left atrium in fetus (bypass pulmonary system in fetus because they don't have lungs)
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What is the crista terminalis?
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Separates the smooth and rough walls of the atrium
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Why is the wall of the right ventricle significantly weaker and less thick than the left ventricle wall in normal humans?
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The right side of the heart (deoxygenated) is LOW pressure. Left side of heart must withstand high pressure. Same is true for the atria
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Systolic pressure is controlled by what part of the heart?
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Left ventricle
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What are the chordae tendineae?
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"heart strings", connect papillary muscles to the bicuspid and tricuspid valves
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What are the papillary muscles in the ventricles for?
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To close the AV valves during systole and prevent regurgitation
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What is diastole?
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Filling of blood into the atria. lowest blood pressure of EKG.
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Which valves are open during diastole?
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tricuspid and bicuspid
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Which valves are open during systole?
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aortic and pulmonary
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What is systole?
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contraction of ventricles, blood is forced into systemic and pulmonary circulation. Highest BP on EKG
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Where is the right coronary artery located on the heart?
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In the atrioventricular groove, between the right atrium and ventricle
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What are 2 branches of the right coronary artery?
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SA node branch and right marginal artery
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What are the 2 branches of the left coronary artery?
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circumflex branch and anterior interventricular branch
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Where is the circumflex branch of the left coronary artery located?
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Left atrioventricular groove
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Where is the anterior interventricular branch of the left coronary artery located?
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interventricular groove
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Aside from the veins paired with arteries on the sternocostal heart surface, what 2 veins drain the heart surface?
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great and small cardiac veins
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What is the coronary sinus?
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A collection of veins that drain the myocardium.
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What 2 veins converge in the coronary sinus on the diaphragmatic side of the heart?
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small and middle cardiac vein
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Sympathetic innervation of the heart- neurotransmitter used
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norepinephrine
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Sympathetic innervation of the heart- nerves used
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post ganglionic sympathetic fibers enter the cardiac plexus
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Sympathetic innervation of the heart- function
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increase heart rate and force of contraction
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Parasympathetic innervation of the heart- neurotransmitter used
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Ach
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Parasympathetic innervation of the heart- nerves used
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Vagus Nerve
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Parasympathetic innervation of the heart- function
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Slow heart rate, constrict vessels
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SA Node location
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junction of superior vena cava and crista terminalis
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What is the pacemaker of the heart?
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SA Node
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AV Node function
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receives impulse from SA Node and distributes it to the ventricles via atrioventricular bundle; splits into right and left
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What is pericardiocentesis?
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removal of pericardial fluid build-up during cardiac tamponade
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What is Cardiac Tamponade
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fluid in the pericardial sac. compression of the heart and weakened pumping occur
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Why is there weak pumping of the heart during cardiac tamponade?
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Fibrous pericardium cannot expand
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Significance of transverse pericardial sinus?
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once pericardium is removed, CT surgeons can place ligature through the sinus to tie off great vessels during bypass or transplant
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3 layers of the entire cardiovascular system (tunics)
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intima, media, adventitia
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Tunica intima has what type of epithelium?
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simple squamous (endothelium)
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Fun Fact: The tunica intima has a subendothelial layer with smooth muscle and loose connective tissue
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turn my swag on
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Endothelium is oriented in which direction
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longitudinally (the same direction as blood flow)
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Endothelium main functions
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permeability barrier, prevents clotting, vascular resistance,
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What cardiovascular layer is most prominent in arteries?
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Tunica Media
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What comprises the tunica media?
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concentric layers of elastic fibers and smooth muscle
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What separates the tunica media and intima?
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internal elastic lamina
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What fibers are found in the tunica media ECM?
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Reticular fibers (collagen III), proteoglycans
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What synthesizes the ECM in the tunica media?
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smooth muscle cells
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What is the most prominent cardiovascular layer in veins?
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Tunica adventitia
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Why is the tunica media the most prominent layer in arteries?
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Contains elastic and can control for blood pressure
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What fibers make up the ECM of the tunica adventitia?
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type 1 collagen, elastic, smooth muscle
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If a blood vessel has a vasa vasorum, which cardiovascular layer is it likely to be found?
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Tunica adventitia
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Vasomotor nerves (nervi vascularis) are found in which cardiovascular layers?
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tunica adventitia
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3 distinct layers of the heart?
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endocardium, myocardium, epicardium
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Endocardium is analogous to which layer of blood vessels?
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Tunica intima
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What is Subendocardium?
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A layer beneath the endocardium; loose ct, elastic, smooth muscle
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Describe the conduction system of the heart. Start with SA node
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SA node initiates impulse: AV node - Bundle of His (atrioventricular bundle) - left/right bundle branches - apex of heart/ventricles
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Why is damage to Purkinje fibers extremely dangerous?
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These fibers control the rhythmic contraction of the heart.
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Why do Purkinje fibers stain lighter than normal cardiac cells?
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They have less myofibrils
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What is responsible for the clear area surrounding Purkinje fiber nuclei?
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Glycogen is stored here
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A cardiac bundle branch block can lead to what symptoms in a patient?
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Frequently passing out
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What cardiac layer contains Purkinje fibers?
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Subendocardium
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Fun Fact: Purkinje cells are often bi-nucleate
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out here grindin
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Myocardium is analogous to which cardiovascular layer in vessels?
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Tunica media
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Where are myocardium more prominent? Atria or ventricles?
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Ventricles. have an inner circular layer and outer spiral layer
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What is the cardiac skeleton?
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A layer of thick fibrous connective tissue that anchors the cardiac muscle (myocardium)
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Why is ischemia to the myocardium so dangerous?
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Myocardial cells (heart muscle) is post mitotic. It CANNOT regrow. Necrotic muscle is replaced by scar tissue
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Why is it common to see lipofuschin in cardiac muscle?
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The cardiac muscle is not actively dividing and replacing itself. The same cells are with us from birth. Accumulation of endocytized material is easily seen.
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What types of cells are seen in myocardium after a heart attack?
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neutrophils, monocytes, lymphocytes, leukocytes
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Why does angiogenesis occur after MI?
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Ischemic region releases angiogenic factors to allow for scar tissue to grow
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Epicardium is analogous to which cardiac layer in blood vessels?
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Tunica adventitia
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What is found in epicardium
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Thick loose CT, adipose tissue, arteries veins and nerves
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Vasa Vasorum
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blood vessels within a blood vessel's tunica adventitia
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What is Mesothelium
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outermost layer of epicardium, simple squamous serous membrane. allows for smooth movement of heart in pericardial sac
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Right atrioventricular valve is also called ...
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tricuspid
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Left atrioventricular valve is also called ...
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bicuspid
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Fun Fact: Heart valves are attached to the cardiac skeleton
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yes they are
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Why is left ventricular hypertrophy seen in hypertensive patients?
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They must pump blood against a higher resistance. Since we cannot make more cardiac muscle cells, the current ones enlarge.
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Why is a hypertrophied heart a weaker pump?
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it is less flexible (distensible)
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Elastic arteries are also called ...
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conducting arteries
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Primary function of elastic arteries
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Rebound of elastin helps maintain BP during diastole
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Marfan's Syndrome
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defective elastin can lead to aortic dissection
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Histology of Marfan's Syndrome
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we see disruption of elastic lamellae; mucopolysaccharide stain
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Muscular arteries are also called ...
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Distributing arteries
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Is there a clear internal elastic lamina in elastic arteries?
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No, it is easily blended with the elastic tunica media
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What is a clear indication of muscular arteries?
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Defined elastic lamina between tunica intima and media
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How many concentric layers of smooth muscle are seen in muscular arteries?
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3-40
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Why are post menopausal women at higher risk for atherosclerosis?
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Estrogen may play a role in protecting us
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Which layer of cardiovascular vessels is most likely affected by atherosclerosis?
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Tunica intima
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Discuss the pathology of atherosclerosis
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PDGF can stimulate macrophages and smooth muscle to proliferate in the tunica intima. Endothelium degrades and these cells accumulate lipids and stick to the wall. vascularized plaques form
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Foam Cells
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Macrophages and smooth muscles cells that accumulate lipids in the tunica intima
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What molecules stimulate smooth muscle proliferation and endothelial changes?
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PDGF
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Why is atherosclerosis common at bifurcations of the aorta?
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The angle of the vessels allow RBCs to hit the angled wall and damage endothelium. Damaged endothelium is the initiating factor of atherosclerosis
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"Response to injury hypothesis" of atherosclerosis pathogenesis
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endothelial damage initiates pathogenesis
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"monoclonal hypothesis" of atherosclerosis pathogenesis
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smooth muscle proliferation initiates pathogenesis
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Arteriole characteristics
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1-2 concentric smooth muscle layers in tunica media, very thin sub-endothelium and adventitia
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In arterioles, endothelial cells have what appearance?
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Longitudinal (stretched)
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In arterioles, smooth muscle cells have what appearance?
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dark circles
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Function of capillaries
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gas exchange, waste removal
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Continuous capillaries characteristics
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zona occludens, pinocytotic vesicles, continuous basal lamina
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Where are Continuous capillaries found?
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cardiac muscle, CNS, PNS, connective tissue, exocrine glands
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Where do continuous capillaries NOT have pinocytotic vesicles?
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CNS and PNS
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Fenestrated capillaries characteristics
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continuous endothelium with pores (with diaphragm)
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Where do we see fenestrated capillaries?
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skeletal muscle, renal glomeruli
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What is different about renal glomeruli fenestrated capillaries compared to other fenestrated capillaries?
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The do not have diaphragms on their pores
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Sinusoidal capillaries characteristics
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large open pores, non-continuous basal lamina, macrophages on their walls,
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Where are sinusoidal capillaries found?
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liver, lymphoid tissue, bone marrow, spleen (red pulp)
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Kuppfer cells
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Macrophages in the liver lumen
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How is diabetes mellitus related to microvascular disease?
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DM shows thickening of basal lamina in kidney endothelium. increased collagen 4 and laminin synthesis
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Venule function
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gas exchange
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Venule walls compared to artery walls
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very thin walls, pressure is reduced so they don't need to be that big
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Thin tunica media indicates what general type of vessel?
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One that has low pressure blood, generally veins
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Which cardiovascular layer is well developed in veins?
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Tunica Adventitia
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What part of the vessel wall forms valves in veins?
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Sub-endothelium
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Because valves in veins are made from sub-endothelium, what overlies the valves?
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endothelium
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Large veins (vena cava) have what characteristics
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thick intima, small media, BIG adventitia with prominent smooth muscles
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Lymphatic vessels characteristics
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no tunic layers defined, very thin walls (low pressure), can have valves
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Blood supply to the thymus
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internal thoracic and superior thyroid arteries
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Why is the left brachiocephalic vein twice as long as the right?
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The left one must cross over to get blood to the right. Vena cava are on the right
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L. brachiocephalic vein receives lymph from ...
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left thoracic duct (3/4 of lymph)
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R. brachiocephalic vein receives lymph from ...
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right lymphatic duct (1/4 of lymph)
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Brachiocephalic vein is combination of which 2 veins?
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internal jugular and subclavian
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Great blood vessel anterior to trachea
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Brachiocephalic trunk
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Great blood vessel left of trachea
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Left subclavian artery
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Great blood vessel anteriolateral to trachea
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left common carotid artery
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What nerve lies on the anterior surface of the anterior scalene muscle?
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Phrenic Nerve is the only thing on the anterior surface
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Superior vena cava is the combination of which 2 vessels?
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Right and Left Brachiocephalic trunk
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What nerve runs between the common carotid artery and internal jugular nerve?
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Vagus
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If the anterior scalene is cut unilaterally, what would we clinically see?
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Paradoxical breathing. 1 side of diaphragm is not innervated by phrenic nerve
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Why do the right/left recurrent laryngeal nerves descend and wrap around the right subclavian and aorta, respectively, before ascending to the larynx?
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The nerves are attached to the larynx and the vessels develop after. The vessels are created through the nerves and drag the nerve down as the vessels grow.
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The ligamentum arteriosum is a remnant of what fetal structure?
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Ductus arteriosus (connects pulmonary artery to aorta to bypass lungs in fetus)
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What major artery supplies the superior mediastinum?
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Thoracic aorta
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There are variations in aortic branches. Why is a retroesophageal right subclavian artery dangerous?
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The large artery wraps around the esophagus, can cause choking
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Innervation of superior esophagus
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recurrent laryngeal nerves and sympathetic fibers of the middle cervical ganglion
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Innervation of lower esophagus
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parasympathetics- vagus nerve. sympathetics- gray rami of T1-T4
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3 regions of nasal chamber
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vestibule, respiratory segment, olfactory segment
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Nose- Vestibule function
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communicate with external environment via nares
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What type of epithelium is in the vestibule?
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Strat. Squamous
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What type of epithelium is in the respiratory segment of the nasal cavity?
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Pseudostratified ciliated with goblet cells
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Nose- Function of Chonchae/Turbinates
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Creates turbulence in the air entering the body. Warms, moistens and cleans the air
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How do the conchae/turbinates clean inhaled air after it is inhaled?
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The turbulence can cause particles to become trapped in the mucus
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During allergic reactions, we see edema in what nasal cavity tissue?
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Lamina Propria
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What characteristic of Lamina Propria makes it swell during rhinitis?
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Very vascularized
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What are Demilunes in the nasal cavity?
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The secrete antibacterial lysozymes
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Where are demilunes found in the nasal cavity?
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Lamina Propria
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Why is breathing difficult during allergic reactions?
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Distension of lamina propria in nasal cavity, histamine also
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Why do dogs have a better sense of smell than humans?
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Larger olfactory segment area; more olfactory epithelium
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4 types of cells in the olfactory segment of the nasal cavity
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Olfactory cells, supporting cells, basal cells, brush cells
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What are Olfactory cells?
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sensory cells in nose
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What are nasal sustentacular cells?
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supporting cells, similar to glial cells in CNS
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What is the function of basal cells in the olfactory segment?
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Renew the olfactory and supporting cells
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What are brush cells in the olfactory segment?
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Touch receptors; cause sneezing in response to dust
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What nerve innervates the brush cells of the olfactory segment?
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Trigeminal nerve (CN 5)
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Olfactory cells in the olfactory segment have what types of neurons?
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bipolar neurons that can regenerate
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What is the olfactory vesicle in the olfactory cells of the olfactory segment?
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contains non-motile cilia with olfactory receptors
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Why can we regain a lost sense of smell?
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Neurons in olfactory cells can regenerate
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Function of Bowman's Glands in the nasal cavity
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Clean the olfactory surface so we can smell new things
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What type of epithelium is found on the lingual surface of the epiglottis?
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Strat. Squam. Non-Keratinized
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What type of epithelium is found on the laryngeal surface of the epiglottis?
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Psuedostratified
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Why do older people have raspy voices?
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Ossification of laryngeal cartilage
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What are the 3 types of laryngeal cartilages?
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Thyroid, cricoid and arytenoid cartilages
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What is cranial nerve 1?
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Olfactory nerve
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Vocalis muscle innervation?
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Vagus nerve (CN 10)
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Epithelium of the 2 true vocal folds of the larynx?
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Stratified Squamous non keratinized
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Epithelium of the 2 false vocal folds of the larynx?
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pseudostratified
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What causes the tracheal basement membrane to thicken?
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Smoking, chronic coughing
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What type of cartilage makes up the cartilage layer of the trachea?
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Hyaline
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What is the function of the trachealis muscle?
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increase velocity of air forced out of the trachea; cough and clear passageway
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Compare the cartilage design of trachea to the bronchi.
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Trachea has C-shaped cartilage, bronchi have rings of cartilage
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Fun Fact: Primary Bronchi are extrapulmonary (outside of the lungs)
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true
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3 differences in bronchioles (compared to bronchi)
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in bronchioles, cartilage is replaced by smooth muscle, columnar become cuboidal, goblet cells disappear
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Why are goblet cells absent in smaller bronchioles?
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We don't want mucus in the actual lung
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What is the single easiest way to distinguish a bronchiole form a bronchi?
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lack of cartilage
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Where are Clara cells found?
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Bronchioles
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CC16 protein Function
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prevent adhesion of adjacent walls during expiration
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CC16 found in the blood indicates what?
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Damage to the lung
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Clara cells secrete what?
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lipoprotein CC16
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Where specifically does gas exchange take place in the lungs?
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Alveolar sac
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Terminal bronchioles have what function?
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Smallest bronchioles with a purely conducting function. (no gas exchange)
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Track the flow of air from the bronchi to the alveolar sac
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bronchi- bronchiole - terminal bronchiole - respiratory bronchiole - alveolar duct - alveolar sac
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First part of respiratory tree where gas exchange occurs?
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Respiratory bronchioles
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Why do alcoholics have frequent pneumonia?
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Alcohol kills cilia
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Why are goblet cells found lower in the bronchioles in smokers?
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Upper cilia are killed by smoke, dust reaches lower portions of the bronchioles, goblet cells come here to try to remove this. This is why smokers have deep coughs
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Asthma Pathogenesis
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mast cells in lamina propria release histamines, vasoactive agents when bound to allergens. smooth muscles in bronchioles constrict
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What types of drugs are used to relax smooth muscle cells of bronchioles during asthma attacks?
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Epinephrine and sympathomimetic drugs
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How is cystic fibrosis inherited?
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Autosomal recessive
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What is cystic fibrosis, fundamentally?
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Genetic defect in Cl- channel protein
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Describe the pathology of cystic fibrosis
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Cl- channels are altered. sodium and water are resorbed. mucus is thick. Obstructs bronchioles
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Average lifespan of patients with cystic fibrosis, assuming aggressive therapy.
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32 years
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Surfactant function
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decrease surface tension on alveoli to increase gas exchange
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2 types of cells in alveolar epithelium
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Type 1 and 2 pneumocytes
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Type 1 pneumocytes function
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gas exchange; 95% of alveolar cells
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Type 1 pneumocytes use what junctions?
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Tight junctions
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Fun Fact: Type 1 pneumocytes are NON dividing
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yes
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Type 2 pneumocytes function
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secrete and create surfactant
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Type 1 pneumocytes epithelium
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Simple squamous
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Type 2 pneumocytes epithelium
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simple cuboidal
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What is the Alveolar septum
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site of gas exchange between air and blood
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What are the layers air must pass to get into the blood?
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surfactant - alveolar epithelium - basal lamina - endothelium basal lamina - endothelium
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Respiratory distress syndrome
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Premature Newborns may not be able to produce surfactant properly. alveoli can collapse on themselves
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What is the only part of the respiratory tract to have surfactant?
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alevoli
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Surfactant is released in type 2 pneumocytes by what granules?
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lamellar bodies
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Goodpasture syndrome pathogenesis
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antibodies are made to type 4 collagen. basal lamina of alveolar septum is disrupted.
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What causes emphysema/COPD?
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Narrowing of the bronchioles
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Discuss the pathogenesis of emphysema /COPD?
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Bronchioles narrow (by smoking). Air spaces distal to terminal bronchiole remain dilated. alveolar walls are damaged. poor gas exchange
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What type of occupation may have a higher incidence of emphysema/COPD?
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Coal miner
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Discuss a possible treatment to COPD?
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Kill the damaged sacs to allow for the intact sacs to fully expand
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What makes alveolar macrophages unique?
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They can remove inhaled particulate from the air
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What happens to the lungs in congestive heart failure?
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Lungs can fill with blood
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How do Hemosiderin-filled macrophages form?
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During congestive heart failure, RBCs enter the alveolar space. Alveolar macrophages phagocytose RBCs.
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What is Hemosiderin?
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Iron pigment in RBCs
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What are "heart failure cells"?
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Hemosiderin-filled macrophages
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Intercostal veins, nerves and arteries travel between which muscles?
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Internal and innermost intercostal muscles
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Fibrous pericardium innervation
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phrenic nerve (C3-C5)
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What spinal segments do afferents from the pericardium go to?
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C3-C5
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What spinal segments do afferents from the heart go to?
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T1-T4
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Where is the moderator band located?
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Right ventricle
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What is the moderator band?
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Right ventricle, assists in conduction system
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Where is the sinus veranarus?
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Right atrium
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Where does lymph from the bonchomediastinal trunk enter venous circulation?
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internal jugular and subclavian veins intersection
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How many segments are in the superior lobe of the right lung?
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3
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Why are there no clara cells in the trachea or bronchi?
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CC16 serves to prevent adjacent walls from adhering. Walls in the trachea and bronchi are not that adjacent
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If the spinal cord is severed at C7, theoretically, what damage do we see in breathing? (based on nerves)
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None, phrenic nerves comes from C3, C4, C5
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Thoracic Outlet syndrome
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Can be caused by cervical ribs. possible pinching of the brachial plexus over rib 1
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What is flail chest?
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After having broken ribs, during inhalation, a piece of chest wall may move paradoxically. Full lung expansion is weakened. If large piece of chest wall is paradoxical= ventilator for patient
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Which layer of intercostal muscles in most active during inspiration?
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External intercostals
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Which layer of intercostal muscles in most active during expiration?
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internal intercostals
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What is coronary angioplasty?
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Catheterization procedure using a balloon to widen a narrowed artery
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What lower limb veins is used for coronary artery bypass grafting?
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Great Saphenous Vein
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The left recurrent laryngeal nerve loops under what vessel?
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Aortic arch
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