Podcast
Questions and Answers
What is the most common congenital bleeding disorder?
What is the most common congenital bleeding disorder?
- Hemophilia A
- Factor V Leiden
- Sickle Cell Disease
- Von Willebrand Disease (correct)
Von Willebrand Factor is primarily degraded by ADAMTS 12.
Von Willebrand Factor is primarily degraded by ADAMTS 12.
False (B)
Which chromosome carries the gene for Von Willebrand Factor?
Which chromosome carries the gene for Von Willebrand Factor?
Chromosome 12
Von Willebrand Factor is released from __________ in the endothelium.
Von Willebrand Factor is released from __________ in the endothelium.
Match the following types of Von Willebrand Disease with their characteristics:
Match the following types of Von Willebrand Disease with their characteristics:
Which of the following is NOT a part of the clinical presentation of DIC?
Which of the following is NOT a part of the clinical presentation of DIC?
In patients with DIC, a common laboratory finding is an increased level of fibrinogen.
In patients with DIC, a common laboratory finding is an increased level of fibrinogen.
What is the most specific laboratory test indicator for DIC?
What is the most specific laboratory test indicator for DIC?
The severe form of DIC, characterized by microvascular thrombosis and necrosis, is known as __________.
The severe form of DIC, characterized by microvascular thrombosis and necrosis, is known as __________.
Match the following investigations with their expected findings in DIC:
Match the following investigations with their expected findings in DIC:
Which of the following statements regarding the right lung is correct?
Which of the following statements regarding the right lung is correct?
The lower lobe of the lung can be visualized on a normal X-ray.
The lower lobe of the lung can be visualized on a normal X-ray.
Name the areas for auscultation of the lower lobe.
Name the areas for auscultation of the lower lobe.
The __________ fissure is found only in the right lung.
The __________ fissure is found only in the right lung.
Match the following lung fissures with their descriptions:
Match the following lung fissures with their descriptions:
What is the primary function of Clara cells in the lungs?
What is the primary function of Clara cells in the lungs?
Kulchitzky cells contain dense core vesicles with neurotransmitters such as serotonin.
Kulchitzky cells contain dense core vesicles with neurotransmitters such as serotonin.
What type of epithelium is found in the upper part of the bronchus?
What type of epithelium is found in the upper part of the bronchus?
The most potent constrictor of bronchial smooth muscles is __________.
The most potent constrictor of bronchial smooth muscles is __________.
Match the following substances with their effects on the conducting airways:
Match the following substances with their effects on the conducting airways:
What is the correct order of airflow through the respiratory structures?
What is the correct order of airflow through the respiratory structures?
The diameter of the right bronchus is narrower than that of the left bronchus.
The diameter of the right bronchus is narrower than that of the left bronchus.
What is the anatomical unit of the lung supplied by a tertiary bronchus called?
What is the anatomical unit of the lung supplied by a tertiary bronchus called?
Inhaled foreign body impaction is more common in the ______ bronchus.
Inhaled foreign body impaction is more common in the ______ bronchus.
Match the following bronchi types with their descriptions:
Match the following bronchi types with their descriptions:
What is the main defect in Immotile Cilia Syndrome?
What is the main defect in Immotile Cilia Syndrome?
Cystic Fibrosis is caused by a dominant gene mutation.
Cystic Fibrosis is caused by a dominant gene mutation.
What is the typical age of presentation for Immotile Cilia Syndrome?
What is the typical age of presentation for Immotile Cilia Syndrome?
In Cystic Fibrosis, the gold standard investigation is measurement of ___ levels.
In Cystic Fibrosis, the gold standard investigation is measurement of ___ levels.
Match the following conditions with their clinical features:
Match the following conditions with their clinical features:
What is the incidence percentage of Type 1 Von Willebrand Disease?
What is the incidence percentage of Type 1 Von Willebrand Disease?
Type 3 Von Willebrand Disease is inherited in an autosomal dominant manner.
Type 3 Von Willebrand Disease is inherited in an autosomal dominant manner.
What type of bleeding is associated with Type 1 Von Willebrand Disease?
What type of bleeding is associated with Type 1 Von Willebrand Disease?
Type 3 Von Willebrand Disease presents with __________ bleed.
Type 3 Von Willebrand Disease presents with __________ bleed.
Match the type of Von Willebrand Disease to its characteristic:
Match the type of Von Willebrand Disease to its characteristic:
Which segment of the left lung is responsible for the superior region?
Which segment of the left lung is responsible for the superior region?
The right lung contains 9 segments.
The right lung contains 9 segments.
List the parts of the acinus.
List the parts of the acinus.
What is a common cause of severe bleeding according to the clinical disorder details?
What is a common cause of severe bleeding according to the clinical disorder details?
In a supine position, aspiration is most likely to involve the posterior segment of the right ________ lobe.
In a supine position, aspiration is most likely to involve the posterior segment of the right ________ lobe.
Match the type of emphysema with its associated condition:
Match the type of emphysema with its associated condition:
Warfarin inhibits vitamin K epoxide reductase.
Warfarin inhibits vitamin K epoxide reductase.
Which cells in the conducting airways are responsible for mucus secretion?
Which cells in the conducting airways are responsible for mucus secretion?
What clinical disorder is indicated by a prolonged APTT and a normal PT?
What clinical disorder is indicated by a prolonged APTT and a normal PT?
The right lung has a superior lingular segment.
The right lung has a superior lingular segment.
A patient with a hematological malignancy may present with __________ due to disseminated intravascular coagulation.
A patient with a hematological malignancy may present with __________ due to disseminated intravascular coagulation.
Which of the following conditions does NOT cause bleeding disorders?
Which of the following conditions does NOT cause bleeding disorders?
What determines the segments most frequently involved in aspiration?
What determines the segments most frequently involved in aspiration?
What type of bleeding is indicated by a negative Ristocetin Agglutination Test?
What type of bleeding is indicated by a negative Ristocetin Agglutination Test?
Match the following clotting factors to their potential clinical conditions:
Match the following clotting factors to their potential clinical conditions:
____________ is the most common cause of disseminated intravascular coagulation.
____________ is the most common cause of disseminated intravascular coagulation.
Which of the following structures is NOT found at the hila of the lungs?
Which of the following structures is NOT found at the hila of the lungs?
Hilar lymphadenopathy is less common than pulmonary artery dilatation.
Hilar lymphadenopathy is less common than pulmonary artery dilatation.
What is the primary site for gas exchange in the lungs?
What is the primary site for gas exchange in the lungs?
The site of gas exchange in the lungs is known as the __________.
The site of gas exchange in the lungs is known as the __________.
Match the airway generations with their corresponding structures:
Match the airway generations with their corresponding structures:
Study Notes
Bronchi
- Three types of bronchi: primary, secondary, and tertiary
- Primary are the main bronchi, secondary are lobar bronchi, and tertiary are segmental bronchi
- Right bronchus is wider, shorter, and at a steeper angle to the carina than the left bronchus
- This makes the right bronchus more susceptible to inhaled foreign body impaction
- Airway diameter decreases from trachea (25 mm) to alveoli (0.25-0.3 mm), resulting in a significant increase in cross-sectional area (from 5 cm² to 700,000 cm²)
Secondary Pulmonary Lobule
- The functional unit of the lung
- It consists of 3-5 terminal bronchioles enclosed in connective tissue septa
- Airflow follows this pathway: terminal bronchiole → respiratory bronchioles → alveolar ducts → alveoli
Bronchopulmonary Segments (BPS)
- Anatomical unit of the lung supplied by a tertiary bronchus
- Contains a pulmonary artery within it (intrasegmental artery)
Disseminated Intravascular Coagulation (DIC)
- Pathogenesis of DIC:
- Stimulus → Endothelial activation → Release of tissue factor (Thromboplastin) → Continuous and excessive thrombin formation and activation → Consumption of platelets and clotting factors → Bleeding + hyperfibrinolysis (Trapping of fibrinogen)
- Etiology of DIC:
- Sepsis (most common)
- Hematological malignancy
- Trauma
- Pancreatitis
- Burns
- Massive blood transfusion
- Kasabach-Merritt syndrome
Clinical Approach to Bleeding
- Prolonged APTT and normal PT suggests no bleeding, possibly due to Factor XII deficiency, High molecular weight kininogen deficiency, or Prekallikrein deficiency
- Prolonged APTT and normal PT with reduced platelet count suggests mild bleeding, possible due to Hemophilia A (Factor VIII deficiency)
- Prolonged APTT and prolonged PT with reduced platelet count suggests severe bleeding, possibly due to Hemophilia B (Factor IX deficiency), or von Willebrand disease (VWF)
Clinical Anatomy of Lungs
- Right lung has three lobes: upper, middle, and lower
- Left lung has two lobes: upper and lower
- The lower/inferior lobe is challenging to visualize on a normal X-ray due to its posterior position
- Lateral X-ray or CT scan is needed for visualization
- Fissures are depressions on the lung surface extending to the hilum
- Major fissure/Oblique fissure is present in both lungs
- Minor fissure/Horizontal fissure only in the right lung
- Azygos fissure is rare, has a tadpole appearance, and contains the azygos vein
Phantom tumor/Pseudotumor
- Fluid collection in the horizontal fissures
- Etiology: Heart failure with low ejection fraction
- Resolves with diuretics
Hematology
- The most common congenital bleeding disorder is Von Willebrand disease
- Von Willebrand factor (VWF) is a protein essential for platelet adhesion and factor VIII carriage
- Types of Von Willebrand disease:
- Type 1 (most common): Partial quantitative defect
- Type 2: Qualitative defect
- Type 3 (rare): Complete quantitative defect
Lung Anatomy and Physiology
- Structures at the hila:
- Pulmonary artery (PA)
- Pulmonary vein (PV)
- Bronchus
- Lymphatics
- Causes of hilar enlargement:
- Hilar lymphadenopathy (TB, sarcoidosis)
- PA dilatation
- Mediastinal mass
- Mass in the bronchus
Weibel's Generation of Airways
- Generation 0: Trachea
- Generation 1: Bronchi
- Generation 2: Bronchioles
- Generation 5: Terminal bronchioles
- Generation 16-17: Respiratory bronchioles
- Generation 18-21: Alveolar ducts
- Generation 22: Alveolar sacs
- Generation 23: Site of gas exchange (acinus)
Club/Clara Cells
- Non-ciliated cuboidal epithelial cells in terminal bronchioles
- Function: Detoxification of xenobiotics and progenitor cells for bronchiolar cells
Kulchitzky Cells
- Dense core vesicles with serotonin, calcitonin, and CGRP
- CGRP is a major neurotransmitter in migraine
Epithelium of Conducting Airways
- Trachea: + cartilage, - smooth muscles, - mucus producing cells
- Bronchi: + cartilage, + smooth muscles, + mucus producing cells
- Bronchiole: - cartilage, + smooth muscles, + mucus producing cells (max in terminal bronchiole)
Bronchus Epithelium
- Upper Part: Pseudostratified ciliated columnar epithelium
- Middle Part: Ciliated simple cuboidal epithelium
- Lower Part: Simple cuboidal epithelium
Bronchiole Epithelium
- Lining: Simple cuboidal epithelium
- No mucus glands
- Occasional goblet cells
- Few neuroendocrine cells
- Clara cells
Substances Acting on Conducting Airways
- Leukotriene: Potent constrictor of bronchial smooth muscles
- Vasoactive Intestinal Peptide (VIP): Potent dilator; non-adrenergic non-cholinergic (NANC) peptide
Cholinergics
- Broncho-constrictor
- Methacholine challenge test: To assess airway hyperresponsiveness
Anticholinergics
- Bronchodilators
- Used in asthma
- Examples: Ipratropium, tiotropium
Role of Cilia
- Defective mucociliary escalator mechanism can lead to:
- Immotile Cilia Syndrome/Primary Ciliary Dyskinesia
- Cystic Fibrosis
Immotile Cilia Syndrome/Primary Ciliary Dyskinesia
- Autosomal recessive inheritance
- Defective dynein arm
- Median age of presentation: 5 years
- Clinical Features:
- Recurrent episodes of sinusitis and otitis media
- Neonatal respiratory distress
- Kartagener's syndrome (triad + male infertility) - cilia required for rotation of body organs → results in situs inversus
Cystic Fibrosis
- Autosomal recessive inheritance
- Defect: CFTR gene mutation (F508 mutation) on chromosome 7q → Cl ion defect
- Clinical Features:
- Thick secretions
- Normal cilia
- Affected sites: Bronchi, biliary tract, intestine, reproductive system
- Gold standard investigation: Nasal nitric oxide levels (Always low)
- Rx: Ivacaftor (Cl channel opener)
Pulmonology
- The text describes the structures of the lungs, causes of hilar enlargement, and the functional anatomy of airways in the context of medical imaging.
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Description
Explore the anatomy and function of bronchi in the respiratory system. Learn about the primary, secondary, and tertiary bronchi, as well as the secondary pulmonary lobule and bronchopulmonary segments. This quiz covers key concepts essential for understanding lung anatomy and physiology.
