(3) Structure and Function

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___ is the movement of air into and out of the lungs

pulmonary ventilation

____ is the movement of oxygen and CO in and out of the lungs

external respiration

____ is the transport of oxyegen from the lungs to the tissue cells of the body, and of CO2 from the tissue cells ot the lungs

transport of respiratory gases

____ is between lung tissues

internal respiration

the ____ is at the bifurcation of the trachea

carina

the trachea bifurcates into the ___ and ____

right and main bronchus

there are ___ lobular bronchi on the right

3

there are ___ lobular bronchi on the left

2

the carina is ____ the trachea

carina

a ____ is when you put a catch into the trachea with radioopaque material; rarely done anymore

bronchogram

the right bronchus is very ____

vertical (goes up and down)

the left bronchus is very ____

horizontal (comes across)

the reason the left bronchus has to cross a little is because ____

the trachea is on the right

____ are done to find a blood source or cancer in the trachea-lungs

bronchoscopies

coughing up blood

hemoptysis

when objects are aspirated, they almost always go into the ____ main stem bronchi

right

if an object completely obstructed the airway, there would be ____ on that side

no airflow

this bronchus
- is shorter and wider
- makes no impressions
- has the azygous vein arching over the root to anastomose with the posterior SVC
- is posterior to the SVC, RA, right phrenic nerve, anterior pulmonary plexus, and PA
- is anterior to the right vagus nerve and pulmonary plexus

right bronchus

this bronchus
-is longer
- is narrower
- makes an impression on the esophagus
- has the aorta arching over it to become the descending aorta
- is posterior to the left phrenic nerve and left anterior pulmonary plexus
- is posteroinferior to the PA
- is anterior to the left vagus nerve, posterior pulmonary plexus, and descending aorta

left

the conducting zone is also known as the ___ respiratory tract

upper

the respiratory zone is also known as the ____ respiratory tract

lower

the components of the conducting zone (URT) are the _______

trachea, bronchi, bronchioles

the components of the respiratory zone (LRT) are the ____

respiratory bronchioles, alveolar ducts, and alveolar sacs

cilia last until the ____

brochioles (though there may be some in the respiratory bronchioles)

smooth muscle lasts until the ____

bronchioles (but there may be some up to the alveolar ducts)

cartilage lasts until the ____

bronchi (patchy even then)

pneumonioa could not be in the trachea or bronchus; it HAS to be where the ____ are

alveoli

usually, pneumonia is in the ___ down

respiratory bronchioles

unlike pneumonia, ____ can occur in the conducting zones

bronchitis

in pneumonia, the lung sounds are ____

diminished

a ____ can almost always tell you if there is fluid in the alveoli (black part gets consolidated/white)

CXR

pneumonia is almost always _____; rarely on both sides

unilateral

in kids, it is harder to get them to take deep breaths; so it is very easy to miss pneumonia in kids (in this case, it is good if they are ___

coughing

to diagnose pneumonia, you want to
- ____ the chest
- have the patient ____, which will be garbled if consolidated pneumonia

percuss; whisper

there are _____ million alveoli

500

there are ___ square meters of exchange surface

85

a terminal bronchiole becomes a ____

respiratory bronchiole

alveoli have a lot of ____ fibers

elastic

where is the blood gas interface?

capillary / alveolus

the respiratory membrane consists of _____ (3 thinsg)

- alveolar epithelium (type I pneumocytes)
- fused BM of the alveolar epithelium and the capillary endothelium
- capillary endothelium

___ secrete surfactant

type II pneumocytes

in ____, there is a lot of fluid and blood cells with edema in the alveoli (a lot of debris and exudate)

pneumonia

in ____, there are a lot of confluent (large) alveoli

emphysema

in ____ pneumonia, there is white consolidation in a particular lobe

consolidated

in ____ pneumonia, white consolidation is patchy throughout the lungs

non-consolidated

distinguishing between organisms that caused the pneumonia isn't all that critical because ___

they're all treated the same anyway

you can determine the cause of pneumonia by doing ____ (3 things)

- bronchial wash
- sputum
- just go w/ statistics

the most common cause of community-acquired pneumonia in ambulatory patients are _____ (do the top 4)

- M. pneumonia (16%)
- respiratory viruses (15%)
- S. pneumonia (14%)
- C. pneumonia (12%)

2 very uncommon causes of pneumonia are ___

- Legionella
- H. influenzae

what are 4 circumstances in which you would want to admit someone with pneumonia?

- age (can be fatal in old/young)
- immunosuppressed
- low O2 sat
- level of care at home

if half of the lung tissue is consolidated, our normal O2 saturation of 97% might be diluted to __ because of the bad lung (60%)

78%

in humans the trachea is ____ in long and ____ in in diameter

4 inches long (10-12 cm), 3/4 inches diameter (2 cm)

The trachea's elastic elements make it flexible enough to stretch and move ____ during inspiration and recoil during expiration, but the cartilage rings prevent it from ____ and keep the airway patent despite the pressure changes that occur during breathing.

inferiorly, collapsing

The open posterior parts of the cartilage rings, which abut the esophagus, are connected by smooth muscle fibers of the ___ muscle and by soft connective tissue. Because this portion of the tracheal wall is not rigid, the esophagus can expand anteriorly as swallowed food passes through it.

trachealis

Contraction of the trachealis muscle decreases the trachea's diameter, causing expired air to rush upward from the lungs with greater force. This action helps to expel mucus from the trachea when we ___ by accelerating the exhaled air to speeds of 100 mph!

cough

The last tracheal cartilage is expanded, and a spar of cartilage, called the ___, projects posteriorly from its inner face, marking the point where the trachea branches into the two main bronchi.

carina

The mucosa of the carina is highly____and violent coughing is triggered when a foreign object makes contact with it. By the time incoming air reaches the end of the trachea, it is warm, cleansed of most impurities, and saturated with water vapor.

sensitive

The ____ zone organs also cleanse, humidfy, and warm incoming air. As a result, air reaching the lungs has fewer irritants ( dust, bacteria, etc.) than when it entered the system, and it is warm and damp, like the air of the tropics.

conducting

The walls of the alveoli are composed primarily of a single layer of squamous epithelial cells, called ____, surrounded by a flimsy basement membrane

type I cells

Gas exchanges occur readily by ____ across the respiratory membrane—O2 passes from the alveolus into the blood, and CO2 leaves the blood to enter the gas-filled alveolus.

simple diffusion

type __ cells have been shown to secrete a number of antimicrobial proteins that are important elements of innate immunity.

II

TRUE OR FALSE:
Alveoli are surrounded by fine elastic fibers of the same type that surround the entire bronchial tree.

true

Open alveolar pores connecting adjacent alveoli allow air pressure throughout the lung to be ____ and provide alternate air routes to any alveoli whose bronchi have collapsed due to disease.

equalized

Remarkably efficient alveolar ____ crawl freely along the internal alveolar surfaces.

macrophages

Although huge numbers of infectious microorganisms are continuously carried into the alveoli, alveolar surfaces are usually ___. Because the alveoli are " dead ends," aged and dead macrophages must be prevented from accumulating in them.

sterile

Most macrophages simply get swept up by the ____ of superior regions and carried passively to the pharynx. In this manner, we clear and swallow over 2 million alveolar macrophages per hour!

ciliary current

The paired lungs occupy all of the thoracic cavity except the ___, which houses the heart, great blood vessels, bronchi, esophagus, and other organs

mediastinum

Each cone-shaped lung is surrounded by pleurae and connected to the mediastinum by vascular and bronchial attachments, collectively called the ____

lung root.

The anterior, lateral, and posterior lung surfaces lie in close contact with the ___ and form the continuously curving costal surface.

ribs

The concave, inferior surface that rests on the ___ is the base.

diaphragm

On the mediastinal surface of each lung is an indentation, the ___, through which pulmonary and systemic blood vessels, bronchi, lymphatic vessels, and nerves enter and leave the lungs.

hilum

All conducting and respiratory passageways distal to the main bronchi are found ____

in the lungs

The left lung is smaller than the right, and the ____ —a concavity in its medial aspect— is molded to and accommodates the heart

cardiac notch

The left lung is subdivided into superior and inferior lobes by the ____

oblique fissure

the right lung is partitioned into superior, middle, and inferior lobes by the ____

oblique and horizontal fissures

Each lobe contains a number of pyramid-shaped bronchopulmonary segments separated from one another by ____

connective tissue septa

Each segment is served by its own artery and vein and receives air from an individual segmental ( _____) bronchus.

tertiary

Initially each lung contains ten bronchopulmonary segments arranged in similar ( but not identical) patterns. Subsequent fusion of adjacent segmental arteries reduces the number in the left lung to___ or ____ segments.

eight or nine

The bronchopulmonary segmentsare clinically important because pulmonary disease is often confined to one or a few segments. Their connective tissue partitions allow diseased segments to be___ without damaging neighboring healthy segments or impairing their blood supply.

surgically removed

The smallest subdivisions of the lung visible with the naked eye are the ___, which appear at the lung surface as hexagons ranging from the size of a pencil eraser to the size of a penny .

lobules

Each ___ is served by a large bronchiole and its branches

lobule

In most city dwellers and in smokers, the connective tissue that separates the individual lobules is blackened with ___

carbon

Systemic venous blood that is to be oxygenated in the lungs is delivered by the ___, which lie anterior to the main bronchi

pulmonary arteries

In the lungs, the pulmonary arteries branch profusely along with the bronchi and finally feed into the pulmonary capillary networks surrounding the ___

alveoli

Freshly oxygenated blood is conveyed from the respiratory zones of the lungs to the heart by the __.Their tributaries course back to the hilum both with the corresponding bronchi and in the connective tissue septa separating the bronchopulmonary segments

pulmonary veins

In contrast to the pulmonary circulation, the ____ provide oxygenated systemic blood to lung tissue

bronchial arteries

The bronchial arteries arise from the ___, enter the lungs at the hilum, and then run along the branching bronchi

aorta

The bronchial arteries provide a ___-pressure, ___-volume supply of oxygenated blood to all lung tissues except the alveoli

high, low,

the alveoli receive blood from the ___-pressure, ___-volume pulmonary circulation

low, high

Some systemic venous blood is drained from the lungs by the tiny bronchial veins, but there are multiple anastomoses between the two circulations, and most venous blood returns to the heart via the ____

pulmonary veins.

The lungs areinnervatedby parasympathetic and sympathetic motor fibers, and visceral sensory fibers. These nerve fibers enter each lung through the ____ on the lung root and run along the bronchial tubes and blood vessels in the lungs

pulmonary plexus

Parasympathetic fibers ___ the air tubes, whereas the sympathetic nervous system ____ them.

constrict, dilates

The pleurae form a thin, double-layered serosa. The layer called the parietal pleura covers the thoracic wall and superior face of the diaphragm. It continues around the heart and between the lungs, forming the lateral walls of the mediastinal enclosure and snugly enclosing the lung root. From here, the pleura extends as the layer called the ___ pleura to cover the external lung surface, dipping into and lining its fissures.

visceral

The pleurae produce ____, which fills the slitlike pleural cavity between them. This lubricating secretion allows the lungs to glide easily over the thorax wall during our breathing movements.

pleural fluid

Although the pleurae slide easily across each other, their ___ is strongly resisted by the surface tension of the pleural fluid

separation

in asthma, the airway collapses during ____

expiration

in bronchitis, when patients take a deep breath and exhale as hard as they can, they will have a ____ sound

wheezing

in emphysema, patients can force air out of the lungs but the airway _____; if ask to do a deep breath, they get to a point where air just won't move out anymore

collapses

the problem with airway collapse is an _____ in the residual volume (air trapping)

increase

COPD patients are said to have a ____ shaped chest

barrel

CXR is not good for tiny lung cancer still localized to a bronchopulmonary segment (a better way to find it is ____)

chest CT

the phrenic nerve arises from ___

C3, C4, C5

the phrenic nerve innervates the ___

diaphragm

the spinal nerves innervate ____

accessory muscles

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