Case Study3 REF
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Case Study #3 (BIOS 3753)
1)
Describe, in detail, the mechanics of human ventilation. Your answer must include the
following terms: diaphragm, 760mm/hg, Boyle’s law, external intercostal, internal
intercostal, 762mm/hg, 756mm/hg, pulmonary ventilation, volume, pressure,
contraction, relaxation, alveoli, inspiration, expiration, parietal pleura, visceral pleura,
pleural cavity and serous fluid. Using all terms will get you full credit.
a.
Boyle’s Law
states that
pressure
and
volume
are inversely related. This means
that as volume decreases, then the pressure must increase or vice versa. When a
human breathes,
pulmonary ventilation
, the muscular movements create
pressure changes in three specific pressures: atmospheric pressure,
intrapulmonary pressure, and intrapleural pressure. The
partial
and
visceral
pleura
and the
serous fluid
cause the lungs to stay attached to chest cavity
allwing easy expansion &
contraction
. At rest the atmospheric pressure is
760mm/hg
. During
inspiration
, the
external intercostal
muscles and
diagram
are
in a state of
contraction
causing an increase of volume and slightly negative
pressure of
756mm/hg
which expands the
alveoli
& helps gas exchange. During
expiration
, the
diaphragm
relaxes and
internal intercostal muscles
recoil which
causes the volume to decrease & pressure increase to
762mm/hg
pushing the air
out of the lungs.
2)
A 9 month old infant girl is brought into the emergency department by her mother
because of a history of irritability and restlessness. The mother reports that two months
earlier the infant had a middle ear infection (otitis media) that required a procedure to
lance the eardrum and drain the fluid (myringotomy). She also reports since then the
infants breathing has been labored and there is an audible wheezing and noise produced
especially at night.
After diagnostic tests were run, the diagnosis was confirmed as left-sided mediastinal pleurisy
with fluid (exudate).
The pleural cavity was tapped and drained of 200cc of serous fluid. The infant recovered and
breathing returned to normal.
a)
What are the normal contents of the pleural cavity?
o
Serous fluid
b)
What are the two layers of the pleura called?
o
Parietal pleura (outer)
o
Visceral pleural (inner)
c)
Do the pleural cavities of the two sides, right and left ever communicate?
o
There is no physical connection between right & left cavities
d)
Name the subdivisions of the parietal pleura.
o
Mediastinal part - mediastinum and its structures
o
Costal part - inner surface of the thoracic cage (i.e. ribs)
o
Diaphragmatic- diaphragm
.
o
Cervical(aka pleural or “cupula”)
e)
What are
friction rubs
in relation to the condition pleurisy? How do clinicians detect
it?
o
Friction rub is an audible raspy breath sound due to the pleural layers being
inflamed & rubbing against each other. A clinician typically detects it by using
a stethoscope to hear internal body sounds.
3. Trace a drop of blood from the azygous vein, through the heart and lungs to the aorta
(include all vessels, valves and chamber) Be complete!
a.
Azygous vein
superior vena cava
right atrium
right AV valve (tricuspid)
right ventricle
pulmonary semilunar valve open
pulmonary trunk
right & left pulmonary arteries
lungs(capillaries/alveoli)
pulmonary vein
left atrium
left AV value(bicuspid/mitral)
left ventricle
aortic semilunar
valve opens
aorta
3)
A 50 year car salesman complained of excruciating chest pain in his sternum
accompanied by nausea, vomiting and sob (shortness of breath.) He has had a history of
radiating chest pain into his left arm, for several years, after he exercises. Unfortunately,
he has succumbed to his condition before he could get to the hospital.
During his postmortem examination, the pathologist noted marked narrowing and
occlusion, with atherosclerotic plaque of both coronary arteries. The pathologist also noted a
fresh intimal (inner line of an artery) hemorrhage in the left anterior descending coronary
artery, near its origin to the left coronary artery. A blood clot was also found in the LAD.
Define the following terms:
a)
Infarct: An area of tissue that experiences necrosis (tissue death) because of lack of
blood supply caused by obstruction (i.e. thrombus or embolus).
b)
Thrombus: A fibrinous clot in a blood vessel that is impedes the blood flow at the
site it was formed.
c)
Embolus: An unattached mass, large enough to block flow, that travels through
bloodstream (i.e air bubble, blood clot).
d)
Ischemia: A decrease in blood supply to part of body caused by obstruction of blood
vessels.
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