Respiratory System Anatomy and Lung Development
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1
What anatomical landmark divides the upper and lower respiratory tracts?
The vocal cords.
2
What is the main function of the respiratory tract?
Gas exchange.
3
When does the embryonic stage of lung development occur?
At 5–7 weeks of gestation.
4
What forms during the embryonic stage of lung development?
Lung buds arise from the foregut and branch into the primary bronchi.
5
When does the pseudoglandular stage occur?
At 7–17 weeks of gestation.
6
What is the most distal airway formed during the pseudoglandular stage?
The terminal bronchiole.
7
Why is gas exchange not possible during the pseudoglandular stage?
Gas-exchanging structures have not yet formed.
8
When does the canalicular stage occur?
At 17–26 weeks of gestation.
9
What changes allow limited gas exchange during the canalicular stage?
Respiratory bronchioles develop and vascularization increases.
10
When does the saccular stage occur?
At 26–36 weeks of gestation.
11
What important substance do pneumocytes begin producing in the saccular stage?
Surfactant.
12
When does the alveolar stage begin?
Around 36 weeks of gestation.
13
How do alveoli change after birth?
They continue to develop and increase the lungs' gas-exchange capacity into childhood.
14
What is choanal atresia?
A congenital obstruction of one or both posterior nasal passages.
15
What is the most common congenital anomaly of the nose in the notes?
Choanal atresia.
16
What developmental failure can cause choanal atresia?
Failure of the oronasal membrane to rupture.
17
Which syndromes are associated with choanal atresia?
CHARGE and VACTERL syndromes.
18
What does CHARGE stand for?
Coloboma, heart defects, choanal atresia, growth and developmental retardation, genital or urinary abnormalities, and ear abnormalities.
19
What does VACTERL stand for?
Vertebral, anal, cardiac, tracheoesophageal, renal, and limb abnormalities.
20
How can unilateral choanal atresia present?
It may be asymptomatic or associated with recurrent respiratory infections.
21
What classic breathing pattern suggests bilateral choanal atresia?
Cyanosis at rest that improves with crying.
22
Why does crying improve cyanosis in bilateral choanal atresia?
Air can enter through the open mouth.
23
What feeding problems can occur in bilateral choanal atresia?
Difficulty breathing, sucking, and swallowing during feeding.
24
What bedside finding suggests choanal atresia?
A nasal catheter cannot be passed through the nasal passage.
25
What imaging study can define choanal atresia?
CT of the nasal passages.
26
What is the first priority in managing bilateral choanal atresia?
Stabilize the airway with an oral airway or intubation.
27
What is the usual definitive surgical approach to choanal atresia?
Transnasal repair after stabilization.
28
What are the most common congenital midline nasal masses listed in the notes?
Dermoid and epidermoid lesions.
29
What are the three large unpaired laryngeal cartilages?
Thyroid, cricoid, and epiglottic cartilages.
30
What are the three small paired laryngeal cartilages?
Arytenoid, corniculate, and cuneiform cartilages.
31
What causes congenital laryngeal atresia?
Failure of laryngeal recanalization, leaving no airway passage.
32
What is essential immediately after birth in congenital laryngeal atresia?
Immediate airway management.
33
What causes a congenital laryngeal web?
Incomplete recanalization of the laryngotracheal tube.
34
Where are most congenital laryngeal webs located?
At the anterior glottis between the vocal cords.
35
What airway abnormality can accompany a laryngeal web?
Subglottic stenosis.
36
How is a congenital laryngeal web visualized?
By direct laryngoscopy.
37
What degree of obstruction defines a grade I laryngeal web in the notes?
0–35% obstruction.
38
What degree of obstruction defines a grade II laryngeal web in the notes?
36–50% obstruction.
39
What degree of obstruction defines a grade III laryngeal web in the notes?
51–75% obstruction.
40
What degree of obstruction defines a grade IV laryngeal web in the notes?
76–100% obstruction.
41
How can a thin congenital laryngeal web be treated?
Laser or surgical incision and dilation.
42
What treatment is listed for a laryngeal web with anterior subglottic stenosis?
Laryngeal reconstruction.
43
What embryologic defect causes a posterior laryngeal cleft?
Failure of formation of the tracheoesophageal septum.
44
What symptoms suggest a posterior laryngeal cleft?
Recurrent aspiration, pneumonia, and respiratory infections.
45
What defines a type I laryngeal cleft?
An interarytenoid cleft.
46
What defines a type II laryngeal cleft?
A partial cricoid cleft.
47
What defines a type III laryngeal cleft?
A complete cricoid cleft extending into the cervical trachea.
48
What defines a type IV laryngeal cleft?
A laryngotracheal cleft extending into the thoracic trachea.
49
What is the gold standard for diagnosing a laryngeal cleft?
Operative laryngoscopy and bronchoscopy.
50
What treatment is commonly used for a mild type I laryngeal cleft?
Conservative management.
51
What treatment is commonly used for a type IV laryngeal cleft?
Open surgical repair.
52
What is the most common congenital abnormality of the upper airway?
Laryngomalacia.
53
What is the characteristic sound of laryngomalacia?
Inspiratory stridor.
54
When does laryngomalacia typically become apparent?
During the first two weeks of life.
55
What happens to supraglottic tissue during inspiration in laryngomalacia?
It collapses inward and narrows the airway.
56
What shape may the epiglottis have in laryngomalacia?
An omega shape.
57
What examination demonstrates supraglottic collapse in laryngomalacia?
Flexible laryngoscopy.
58
When is a swallow study useful in laryngomalacia?
When the patient has feeding difficulties or suspected aspiration.
59
What is the usual course of mild laryngomalacia?
It often resolves spontaneously during the first two years of life.
60
What operation can relieve severe laryngomalacia?
Supraglottoplasty.
61
What is vocal cord paralysis?
Impaired movement of one or both vocal folds.
62
What examination helps diagnose vocal cord paralysis?
Flexible laryngoscopy.
63
How does bilateral vocal cord paralysis affect breathing?
Both vocal folds may fail to open adequately.
64
What management is listed for unilateral vocal cord paralysis?
Reinnervation, with specialist referral.
65
How long may idiopathic vocal cord paralysis take to resolve?
Six to twelve months.
66
What airway procedure can cause acquired vocal cord paralysis?
Prolonged or repeated intubation.
67
What is a saccular cyst?
A cyst arising from the laryngeal saccule that may contain fluid or air.
68
How is a saccular cyst treated in the notes?
Endoscopic aspiration and marsupialization.
69
What is a laryngocele?
An abnormally enlarged, air-filled laryngeal saccule.
70
How is a small laryngocele usually treated?
Endoscopic excision.
71
How is a large laryngocele usually treated?
Open surgery, sometimes after tracheostomy.
72
What is a congenital subglottic hemangioma?
A benign vascular growth that can narrow the subglottic airway.
73
When do subglottic hemangiomas commonly begin to cause symptoms?
Within the first 2–6 months of life.
74
What is the most common stridor pattern in subglottic hemangioma?
Biphasic stridor.
75
Which syndrome is associated with subglottic hemangioma?
PHACE syndrome.
76
What does PHACE stand for?
Posterior fossa, hemangioma, arterial, cardiac, and eye abnormalities.
77
What is the mainstay medication for infantile subglottic hemangioma?
Propranolol.
78
What are important potential adverse effects of propranolol?
Bradycardia, hypotension, and bronchospasm.
79
What is congenital subglottic stenosis?
Congenital narrowing of the subglottic larynx.
80
What stridor patterns can occur in congenital subglottic stenosis?
Biphasic or inspiratory stridor.
81
What radiographic sign can be seen in subglottic stenosis?
The steeple sign.
82
What grading system describes the severity of subglottic stenosis?
The Cotton–Myer grading system.
83
What obstruction defines Cotton–Myer grade I?
Up to 50% obstruction.
84
What obstruction defines Cotton–Myer grade II?
51–70% obstruction.
85
What obstruction defines Cotton–Myer grade III?
71–99% obstruction.
86
What defines Cotton–Myer grade IV?
No detectable airway lumen.
87
What treatment can be used for grade I or II subglottic stenosis?
Dilation or endoscopic laser surgery.
88
What procedures may be used for severe grade III or IV subglottic stenosis?
Anterior cricoid split or laryngeal reconstruction.
89
What structural abnormality causes congenital tracheal stenosis in the notes?
Complete tracheal rings.
90
Which part of the trachea is most commonly affected by complete tracheal rings?
The distal trachea.
91
What symptom may congenital tracheal stenosis cause at birth?
Respiratory distress that may not improve with intubation or tracheostomy.
92
What surgical treatments are used for congenital tracheal stenosis?
Resection or tracheal reconstruction.
93
What embryologic problem causes tracheoesophageal fistula?
Incomplete separation of the primitive foregut into trachea and esophagus.
94
What is the most common type of esophageal atresia with tracheoesophageal fistula?
Type C: esophageal atresia with a distal fistula.
95
What findings suggest esophageal atresia at birth?
Frothing, choking, cyanosis, and an inability to pass a feeding tube into the stomach.
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