01 Pulmonary Anatomy - Boards and Beyond

  • RLL pneumonia

  • left: sharp angle
  • vomit and then pneumonia: usually right sided

  • supine: superior portion of right inferior lobe or posterior portion of right upper lobe

  • right PA: anterior to right bronchus
  • left PA: superior to left bronchus

  • caval foramen: IVC
  • esophageal hiatus: esophagus
  • aortic hiatus

  • dyspnea: can't contract diaphragm to breath
  • other side move down, push affected side up

Respiration

  • quiet: diaphragm sole muscle

  • accessory muscles: in hospital, see pts contract neck/abd when breathing = respiratory distress

Respiratory tract

  • URI: does not involve lower respiratory tract (sinusitis, pharyngitis, etc.)

  • barrier to infection

Alveoli

  • clara: not in alveoli, in terminal bronchioles

Surfactant

  • surfactant: alveoli stay open when exhale

  • Laplace law
  • if pressure in sphere below distending pressure, alveoli collapse
  • low sphere: small radius, distending pressure high, takes more pressure to keep small sphere open, also more likely to collapse
  • when inhale, alveoli gets large; when exhale, gets smaller
  • result: when alveoli need the air to keep open, air leaves, distending pressure gets high
  • surfactant shrinks surface tension as radius falls during exhalation
  • when exhale, surfactant molecules gets closer, concentration higher, reduce surface tension
  • falling radius and surface tension offsets one another

NRDS

  • NRDS if not mature

  • hyaline: glass like, what alveoli looks like
  • give O2: all goes to healthy alveoli, sick ones collapsed (shunting)

  • high glucose from mother stimulate baby's pancreas to make insulin

  • all related to O2
  • bronchopulmonary dysplasia: hyperplasia and fibrosis of airways (exposing premature lung to high O2 concentration, O2 toxicity)