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Time Completed: 01:08:33

Final Score 46%

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97

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Physiology

Respiratory

Question 114 of 180

The walls of the alveoli are predominantly formed by:

Answer:

The single layer of epithelial cells forming the walls of the alveoli and alveolar ducts are nonciliated squamous cells, predominantly very thin type I alveolar pneumocytes joined by tight junctions lying on a basement membrane. These form the gas exchange surface with the pulmonary capillary endothelium. A few type II alveolar pneumocytes make up a small proportion of the alveolar surface area and secrete surfactant which bathes the alveoli, reducing the surface tension and preventing alveolar collapse.

Respiratory Epithelial Function

Mucociliary Clearance

The respiratory tract from the trachea down until the respiratory bronchioles is lined with ciliated columnar epithelial cells. Goblet cells and submucosal glands secrete a thick, gel-like mucus. Synchronous beating of the cilia moves the mucus and associated debris to the mouth where it is swallowed or expectorated, a process known as mucociliary clearance.

Impaired Mucociliary Clearance

Factors that increase the viscosity of the mucus (e.g. cystic fibrosis, asthma, inflammation or poor humidity) or factors that impair ciliary activity (e.g. smoking, pollutants, infection or general anaesthetics) lead to defective mucociliary clearance and recurrent infections.

Mucus contains substances that protect the airway from pathogens and from destructive proteases released from dead bacteria and immune cells e.g. alpha-1-antitrypsin, lysozyme, IgA. Genetic deficiency of alpha-1-antitrypsin leads to early-onset emphysema as a result of uninhibited protease activity in the lung resulting in destruction of elastin in the alveoli.

Epithelial Cells

The single layer of epithelial cells forming the walls of the alveoli and alveolar ducts are non ciliated squamous cells, predominantly very thin type I alveolar pneumocytes joined by tight junctions lying on a basement membrane. These form the gas exchange surface with the pulmonary capillary endothelium.

A few type II alveolar pneumocytes make up a small proportion of the alveolar surface area and secrete surfactant which bathes the alveoli, reducing the surface tension and preventing alveolar collapse.

Macrophages in the airways ingest foreign materials and destroy pathogens. In the alveoli, alveolar macrophages take the place of cilia by clearing debris.

Modified by FRCEM Success. Original sourced from Wikimedia Commons.

Structure of an Alveolus. (Image modified by FRCEM Success. Original sourced from Wikimedia Commons.)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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