4. Respiratory System

Question 1

List FOUR functions of the respiratory system.

Answer 1

1. Gas Exchange - Oxygen for cell respiration and Carbon Dioxide as a waste product of cell respiration
2. Warming, cooling, moistening of the air
3. Immunity – removal of inhaled particles using nose, mucociliary escalator and alveolar macrophages
4. Voice production and olfaction (smell)

Question 2

What is the carina and why is it important

Answer 2

Where the trachea divides into two bronchi, an internal ridge called the carina is formed. The carina is a sensitive structure and triggers the cough reflex.

Question 3

Describe specifically the route air flows through the respiratory tract, identifying key structures.

Answer 3

Air flows through the nasal cavity which is directly connected to the paranasal sinuses

which leads on to the pharynx (aka throat), a muscular tube connecting the nasal cavity and oral cavity to the larynx (aka voice box).

From the larynx air moves into the** trachea** (aka windpipe) and then below the trachea we have the division into the** left and right bronchi** and this further divides into smaller and smaller tubes called bronchioles. The bronchioles end in small air sacs called alveoli.

Question 4

Describe the difference between external and internal respiration

Answer 4

External respiration: the exchange of gases between **air (lungs) ** that is inhaled and exhaled and blood. It is called ventilation.

Internal respiration is the exchange of gases between blood and **cells **

Question 5

What is the function and structure of the mucociliary escalator?

Answer 5

A ciliated epithelial membrane lining the respiratory tract. It contains **mucous secreting goblet cells. **

Mucus
- traps inhaled particles and acts as a surfactant. (Lowers the surface tension of a liquid, allowing easier spreading)
- has antimicrobial properties.

Cilia move the particle laden mucus towards the oesophagus where they can be coughed up and/or swallowed. This protects the lungs from inhaled pathogens.

Question 6

Describe the role of ‘nasal concha’.

Answer 6

There are three nasal concha in the nasal cavity.

They have foldings that create shelves that increase the surface area and trap water during exhalation.

They have a centrifuge effect pushing inhaled particles to the outer part of the nasal cavity where mucus is present and traps the particles.

Question 7

List FOUR functions of the nasal cavity.

Answer 7

1. Filtering Air
   * Hairs filter large particles and cilia/mucus trap smaller particles.
   * Nasal concha spin air to trap particles in mucus
2. Warms air
   Warms and moistens incoming air so it doesn’t dry out the lung cells which are sensitive and must remain wet.
3. Humidification
   A moist lining allows gases to dissolve and then diffuse.
4. Sneezing reflex in case of mucosal irritation
5. Olfactory function

Question 8

List FOUR functions of the paranasal sinuses.

Answer 8

Paranasal sinuses are connected to the nasal cavity and are air filled cavities within facial and cranial bones.

1. Moistening/humidifying of the air
2. Lighten the weight of the skull
3. Resonance in speech
4. Drain tears from the eyes – nasolacrimal duct connects the inside of the eye with the nasal cavity. It is why we get a runny nose when we cry.

Question 9

Name TWO of the four paranasal sinuses.

Answer 9

Frontal
Ethmoid
Sphenoid
Maxillary

Question 10

Describe the structure and function of the pharynx

Answer 10

The pharynx (throat) is a straight muscular 13cm tube which connects the nose and the throat terminating at the larynx.

It carries air, food and fluid down from the nose and mouth.

It consists of the nasopharynx, oropharynx and the laryngopharynx.

It contains eustachian tubes which Connects the nasal pharynx to the middle ear and allows**equalisation of pressure **in the middle ear.

Think being on a plane and opening mouth to equalise pressure

It contains adenoids, also called the nasopharyngeal tonsils.

Question 11

List FOUR functions of the pharynx.
aka - the throat

Answer 11

1) Warming and humidifying
2) Passageway for air and food - 13 cm tube connecting nose and throat
3) Taste
4) Hearing
5) Equalisation of pressure through eustachian tubes that connect the nasopharynx to the middle ear
6) Immune protection – adenoids
7) Speech - resonating chamber

Question 12

Describe how laryngeal muscles alter ‘tone’ when relaxed o contracted.

Answer 12

The larynx is the voice box (la la la). Laryngeal muscles attach to the vocal cords.

a. Relaxed – laryngeal muscles are relaxed which means the cords are loose and a low tone is produced

b. Contracted - laryngeal muscles are contracted which means the cords are tight and a high tone is produced

Question 13

Which hormone thickens and lengthens the vocal cords?

Answer 13

Testosterone

Question 14

Where is the epiglotis located and what does it do?

Answer 14

It is located in the larynx

It closes off the trachea during swallowing preventing food entering the lungs.

Question 15

List FOUR functions of the larynx

Answer 15

It is the voice box. It is where adams apple sits

1. Warming and humidifying (bit of a theme here!)
2. Production of sound and speech (aided by the tongue, lips and cheeks)
3. Protection – the epiglottis closes off the trachea during swallowing preventing food entering the lungs
4. Air passageway

Question 16

List FOUR functions of the trachea.

Answer 16

The trachea is the windpipe

1) Warming, humidifying and filtering (again!)

2) Air Flow - C Shaped rings of cartilage connected by smooth muscle keeps trachea open and unobstructed for air flow

3) Cough reflex – in response to irritation

4) Mucociliary escalator – traps inhaled particles and removes them from the respiratory tract

Question 17

How does the trachea respond to?

a. The sympathetic (fight or flight) nervous system

b. The parasympathetic (rest and digest) nervous system

Answer 17

a. The sympathetic (fight or flight) nervous system
Tracheal dilation as we need more oxygen to deal with a danger. Airways dilate, more blood and therefore oxygen flows, pupils dilate to improve peripheral vision

b. The parasympathetic (rest and digest) nervous system
Tracheal constriction as we don’t need a huge amount of oxygen to chill

Question 18

Describe in specific detail the ‘cough reflex’.

Answer 18

As we are often inhaling particles that may be dangerous, we are able to create a forceful expulsion from the respiratory system with a cough.

How does it work?
1. Irritation
The coughing reflex starts with iritation of the mucous membrane. Epithelial receptors in the respiratory tract are highly sensitive to this

This stimulates nerve endings in the larynx, trachea and bronchi

2. Inspiration
   A nerve impulse is sent via the vegus nerve to the respiratory center in the brain stem

This causes deep inhalation and closure of the glottis (vocal chords)

3. Compression
   Contraction of the abdominal respiratory muscles increases pressure.
4. Expulsion
   Forced removal of irritation

Question 19

Describe the structure of the trachea

Answer 19

The trachea is roughly 12cm long and is made of incomplete C shaped rings of hylaine cartridge adhering to the oesophagus.

These incomplete rings of cartilage are connected by smooth muscle which is called trachealis. This smooth muscle allows for some constriction and dilation but the c chaped rungs make sure we keep our respiratory system open

The trachea divides into the left and right bronchi at the vertebral level T5.

Where the trachea divides into two bronchi, an internal ridge called the carina is formed. The carina is a sensitive structure and triggers the cough reflex.

Question 20

Describe the structure and function of the Bronchi

Answer 20

The bronchi deliver air into the lungs.

The trachea divides into the left and right bronchi at the vertebral level T5.

Where the trachea divides into two bronchi, an internal ridge called the carina is formed. The carina is a sensitive structure and triggers the cough reflex.

Bronchi are similar in structre to the trachea containing cartilage rings that maintain an open airway.

Bronchi are lined with ciliated epithelium.

Question 21

Where do we find the bronchioles and what is their structure

Answer 21

The bronchioles are a continuation of the bronchi and lead directly into the alveoli where gas excahnge takes place.

They have no cartilage in their structure and instead contain smooth muscle.

Question 22

Explain fully how alveoli are maximised for gaseous exchange.

(know this!!!)

Answer 22

Alveoil are small hollow cavities that mae up most of the lung volume and act as the sight of gas exchange in the lungs

They do this:
1. With a large surface area of approx 80m2 from over 250 million alveoli in each lung!
2. Walls of the alveoli are very thin – one layer only – which makes gas exchange easier
3. Surrounded by many blood capillaries that are also only one layer thick making gas exchange easier.
4. Alveoli surfaces are moist and gas exchange is easier when in water

Question 23

Describe the difference between Type I and Type II alveolar cells.

Answer 23

Type 1: Simple epithelial cells that cover 90% of the alveolar surface. They are very thin to support gas exchange

Type 2: Secrete alveolar fluid that contains **pulmonary surfactant. **

Also: There is a third alveolar cell called alveolar macrophages which acts as another layer of immune defence. They are strategically located leukocytes that engulf and destroy microbes entering the alveoli

Question 24

Describe the role of pulmonary surfactant and why this is so important.

Answer 24

Secreted by type 2 alveolar cells.

It reduces surface tension preventing alveoli from collapsing and reducing the pressure required to reinflate them.

Without it, when we exhale the alveoli would collapse and our lungs would not reinflate. The alveolar fluid keeps the alveoli moist to facilitate gas diffusion.

It is a mixture of lipids and proteins

The protein part is hydrophilic and resides in the alveolar fluid. The lipid part is hydrophobic and faces the air. So the fats are repelling away from the water and that is what keeps the alveoli open. They are opening up the space in order to distance themselves from the water.

Question 25

Why should attention be paid to lung development in premature babies?

Answer 25

Surfactant is not produced until **20-24 weeks gestation **so if a baby is less than 24 weeks it will need treatment to mature the lungs. Mums can be given steroids prior to birth to facilitate maturing of lungs.

Question 26

Why is an aspirated object more likely to enter the right lung?

Answer 26

Because it is more vertical, wider and shorter

Question 27

How does gas exchange work in alveoli?

Answer 27

It is in the alveoli that oxygen and carbon dioxide are exchanged between air and blood. The process of gas exchange is between the **alveoli and the capillaries.** After breathing in, oxygen moves from the alveoli into the blood and becomes oxygenated. Carbon dioxide moves from the deoxygentaed blood into the alveoli to be exhaled. The movement of both gases is through **diffusion. **

Question 28

What role does the nervous system play in control of air entry into bronchi

Answer 28

The bronchi is a muscular tube. Control of entry into bronchi is via: Sympathetic Nervous System (SNS) – bronchodilation. In a fight or flight situation we need to dilate the tracheal and bronchial muscles and the bronchial wall. Parasympathetic nervous system (PNS) – Bronchoconstriction.

Question 29

Which body organ separates the lungs?

Answer 29

The heart

Question 30

How many lobes are in the lung?

Answer 30

The heart sits fairly centrally but points to the left side a. Left lung -2 (due to heart) b. Right lung -3

Question 31

What role does the nervous system play in control of air entry into bronchi

Answer 31

The bronchi is a muscular tube. Control of entry into bronchi is via: Sympathetic Nervous System (SNS) – bronchodilation. In a fight or flight situation we need to dilate the tracheal and bronchial muscles and the bronchial wall. Parasympathetic nervous system (PNS) – Bronchoconstriction.

Question 32

Why is an aspirated object more likely to enter the right lung?

Answer 32

Because it is more vertical, wider and shorter

Question 33

Describe the main role of the pleura

Answer 33

Serous membranes (a single layer of epithelium) that surround the lungs. The visceral and parietal pleura form a double layer separated by 5 to 10 ml of **serous fluid** that** prevents friction** Pleura adhere to the lungs so that the lungs are **sucked to the pleura** which when breathing in helps expansion of the lungs and helps everything is move together.

Question 34

List TWO phases of ventilation.

Answer 34

Ventilation is the process of breathing. The two phases in a cycle of ventilation are Inhalation - breathing in - 2 seconds Exhalation - breathing out - 3 seconds

Question 35

Name TWO areas where breathing comes form.

Answer 35

Abdominal (diaghramatic) breathing Upper rib (intercostal) breathing

Question 36

Name TWO primary muscles of ventilation.

Answer 36

I. The intercostal muscles which are **attached between ribs** at right angles. Their **contraction pulls ribs upwards** on inhalation, expanding outwards and increasing the size of the rib cage. II. Diaphragm attached to the lower ribs, sternum and lumbar spine. A **domed muscle** that separates the thoracic and abdominal cavity. Contraction moves the diaphragm into the abdomen and **draws air into the lungs**.

Question 37

Name TWO secondary muscles of ventilation.(also known as accessory muscles)

Answer 37

They are often** over recruited** in patients suffering with breathlessness disorders and they can become fatigued and shortened. Most accessory muscles are located around the **neck and chest.** Secondary muscles include I. Trapezius II. Sternocleidomastoid III. Scalines.

Question 38

Name ONE pathology that could lead to over recruitment of ventilation muscles.

Answer 38

Asthma

Question 39

Indicate if the following processes are active or passive: a. Inhalation b. Exhalation

Answer 39

a. Inhalation – active - requires muscles. Needs energy for muscles to contract and open up the thoraic cavity b. Exhalation – passive – muscles relax, **elastic recoil of the lungs** aided by elasticity of the lungs and pluera. Does not need energy

Question 40

Define tidal volume.

Answer 40

The normal volume of air that enters the lungs during inspiration when no extra effort is required. Normally around 10% of lung capacity. A normal tidal volume is 500 ml but this differs by gender, size, altitude, smoking, exercise/fitness

Question 41

Name TWO factors (not gender) that contribute to a larger lung volume.

Answer 41

Tall, non smokers, live at high altitude, athlete

Question 42

Why is there no difference between inspired and expired nitrogen gas levels?

Answer 42

The air around us is around 80% concentrated nitrogen but we don’t have much use for it so when we inhale it into the blood it does not dissolve, it doesn’t bind to Hb, it is not used so the concentration does not change. So whilst we do circulate a very small quantity of nitrogen it is tiny and doesn’t change. We breathe in 78% Nitrogen and we breathe out 78% nitrogen.

Question 43

What gases do we inhale and in what quantities? What gases do we exhale and in what quantities?

Answer 43

Inhale: Oxygen - 21% Carbon Dioxide - 0.04% Nitrogen - 78% Inhale: Oxygen - 16% Carbon Dioxide - 4% Nitrogen - 78%

Question 44

Which blood cell transports oxygen around the body?

Answer 44

Red blood cells

Question 45

List THREE ways (% highest to lowest) in which carbon dioxide is transported in the body.

Answer 45

70% - In plasma as HCO3- (bicarbonate) 23% - Red Blood Cells (bound to haemoglobin) 7 % - dissolved in plasma

Question 46

Explain in specific detail the role of carbon dioxide and the bicarbonate buffer reaction in controlling blood pH.

Answer 46

PH is the measure of acidity, alkalinity and neutrality and in the blood and it needs to be controlled within very narrow limits. Increased CO2 when dissolved in the blood cause an increase in H+ ions and thus acidity. ** CO2** leaves the cells that have produced it and** reacts with water** in the blood to create **H2CO3 (carbonic acid).** **H2CO3 immediately decomposes** because it is unstable. It decomposes** into bicarbonate (HCO3) and Hydrogen (H+) ions** Hydrogen is exhaled and excreted into urine to reduce acidity. Bicarbonate is alkaline which ‘buffers the acidity’ of blood to keep PH stable. So...CO2 + H2O > H2CO3 carbonic acid > decomposes into Hydrogen that leaves the body and bicarbonate ions which reduce acidity

Question 47

What causes respiratory acidosis?

Answer 47

**Blood PH needs to be controlled in very narrow limits. ** **when CO2 dissolves in the blood, a byproduct is hydrogen ions H+ and this leads to increased acidity** This leads to Respiratory acidosis - an accumulation of CO2 which challenges pH balance and increases acidity (low PH). - Metabolic acidosis is where things like exercise produce lactic acid - Keto acidosis is when fasting produces ketoacids which enter the blood. CO2 + H2O = H2CO3 (carbonic acid) > HCO3 + H+ ions.

Question 48

What is the normal PH range of the blood?

Answer 48

7.35-7.45 The more CO2 the more acidic and the lower the PH number

Question 48

What is the normal PH range of the blood?

Answer 48

7.35-7.45 The more CO2 the more acidic and the lower the PH number

Question 49

How does ventilation contribute to the acidity of body fluids?

Answer 49

Ventilation helps to lower the acidity of body fluids via getting rid of CO2 through exhalation.

Question 50

How is acidity managed inthe blood?

Answer 50

Bicarbonate buffer system Exhaling of CO2 and H+ Secretion of H+ through kidneys

Question 51

Define the following terms: a. Oxyhaemoglobin b. Deoxyhaemoglobin

Answer 51

a. Oxyhaemoglobin Plenty of oxygen bound to haemoglobin b. Deoxyhaemoglobin When haemoglobin lacks oxygen

Question 52

Complete the following formula: CO2 + xxx = xxx = xxx + H+ ions. Carbon dioxide + -------- = -------- -------- = -------- + (Hydrogen) H+

Answer 52

Carbon dioxide + water = Carbonic Acid = Bicarbonate + (Hydrogen) H+ CO2 + H2O = H2CO3 (carbonic acid) > HCO3 + H+ ions.

Question 53

Describe how chemical receptors in the brainstem play a role in ventilation control.

Answer 53

The **respiratory centre** is located in the **brainstem**. This receives inputs from different parts of the body and regulates breathing rates. **Chemical receptors** found in the **brainstem **measure CO2 and acidity (H+ concentration). If receptors detect high arterial CO2, this triggers hyperventilation in order to excrete or exhale excess CO2

Question 54

Describe how chemical receptors in the aorta and carotid arteries play a role in ventilation control.

Answer 54

The **respiratory centre** is located in the **brainstem**. This receives inputs from different parts of the body and regulates breathing rates. **Chemical receptors** found in the aorta and carotid artery measure CO2, O2 and acidity levels. If receptors detect high arterial CO2, this triggers hyperventilation in order to excrete or exhale excess CO2.

Question 55

Describe how stretch receptors play a role in ventilation control.

Answer 55

The respiratory centre is located in the brainstem. This receives inputs from different parts of the body and regulates breathing rates. **Stretch receptors** in the walls of the bronchi and bronchioles detect over inflation.

Question 56

What is the main purpose of hyperventilation?

Answer 56

To excrete /exhale excess CO2

Question 57

List TWO signs / symptoms of rhinitis.

Answer 57

Runny nose Itchy nose Sneezing Stuffy nose Reduced smell

Question 58

Define rhinitis.

Answer 58

Inflammation of the nasal mucosa leading to mucosal swelling and in increase in the volume and viscosity of nasal secretions

Question 59

Describe the difference between ‘allergic’ and ‘non-allergic’ rhinitis.

Answer 59

Allergic rhinitis (hay fever) is a response to an allergen such as pollen or dust mites. IgE stimulates mast cells to release histamine. Histamine is what causes the inflammation. Non-Allergic rhinitis is associated with environmental and lifestyle changes such as pollution, diet, stress, drugs such as NSAIDS.

Question 60

List TWO causes of non-allergic rhinitis.

Answer 60

Aka hay fever Pollution, diet, NSAIDS, stress

Question 61

List ONE complication of rhinitis.

Answer 61

If nasal mucosa are continually inflamed nasal polyps can form Ear infections Loss of smell

Question 62

Describe TWO ways in which smoking can contribute to respiratory disease.

Answer 62

**Smoking damages the delicate cilia** that line the respiratory tract and sweep trapped particles out of the lungs. As a result of this damage mucus and trapped particles build up in the lungs, causing - a smokers cough - increasing the risk of **pulmonary infections, bronchitis and emphysema** Also ...Cigarettes contain carcinogens which are known to cause cancer.

Question 63

List one respiratory pathology that causes cyanosis.

Answer 63

Cyanosis is where the skin takes on a blue hue in the extremities due to a deficiency of oxygen in the blood. Potential pathologies that cause this include: - A peripheral arterial disease – a blockage - Lung disease and therefore poor gas exchange - Heart failure and therefore an inability to pump oxygenated blood adequately.

Question 64

List TWO respiratory pathologies that cause finger clubbing.

Answer 64

Finger clubbing is where you get a pyramid gap when you put two finger nail beds together. It could be caused by lung cancer, COPD or cystic fibrosis

Question 65

Regarding sputum investigation, list what it looks like and one possible respiratory pathology for the following: a. Purulent sputum b. Mucoid sputum c. Serous sputum d. Blood in sputum

Answer 65

a. Purulent sputum Thick, yellow /green >>> Infections such as bronchitis and pneumonia b. Mucoid sputum Clear, grey/white >>> Asthma and viral bronchitis c. Serous sputum Clear, frothy, pinky fluid >>> Pulmonary Oedema which is fluid on the lungs and common in heart failure or severe lung disease. d. Blood in sputum Blood >>> normally indication of a more sinister disease such as lung cancer, TB, pulmonary embolism, clotting disorders

Question 66

With regards to the common cold and influenza, complete the following table: Definition Onset? Symptom distribution? Duration? Cause? Headache? Runny nose? Complications?

Answer 66

Cold Vs Influenza: Cold: Infection of the upper respiratory tract – viral Influenza - Acute respiratory disease associated with various strains of the flu virus. Onset? Gradual Vs Sudden onset Symptom distribution? Localised to upper respiratory tract Vs Systemic Duration? 2-7 days Vs 7-14 days Cause? Low immunity and therefore susceptibility to rhinovirus virus Vs influenza virus Headache? Rare Vs Common Runny nose Mostly Vs Sometimes Complications? Unlikely Vs Secondary infections & Chronic fatigue syndrome

Question 67

Why does chronic fatigue syndrome often follow an episode of influenza?

Answer 67

Viral infections and a compromised immune system often precede chronic fatigue syndrome .

Question 68

Outline the pathophysiology of nasal polyps.

Answer 68

**Chronic inflammation** causes the blood vessels in the lining of the nose and the sinuses to become** more permeable**, allowing water to accumulate in the cells. Over time, as **gravity pulls on his waterlogged tissues** they may develop polyps

Question 69

List TWO causes of nasal polyps.

Answer 69

Nasal polyps are the end product of **chronic inflammation** due to: - Viral > bacterial or fungal - - Allergies: chronic rhinitis

Question 70

List TWO signs / symptoms of nasal polyps.

Answer 70

Nasal polyps are soft, noncancerous masses of oedematous nasal mucosa. - **Difficulty breathing, runny nose, persistent stuffiness.** - Chronic sinus infections, reduced sense of smell. - Dull headaches, snoring at, mouth breathing. - Can cause **sleep apnoea**.

Question 71

Describe the difference between tonsillitis and quinsy.

Answer 71

Tonsillitis describes inflammation of the tonsils whereas Quincy is an abscess that has formed around the tonsils as a result of tonsillitis. Quincy is a complication of tonsillitis.

Question 72

Name TWO signs / symptoms of tonsillitis.

Answer 72

- **Sore throat that becomes worse when swallowing. ** - Fever over 38 degrees Celsius. - Coughing, headache and red/inflamed tonsils sometimes with white plaque

Question 73

List ONE sign / symptom that is more characteristic of quinsy.

Answer 73

**Unilateral throat pain** and earache, **dysphagia**, limited mouth opening, swollen lymph nodes

Question 74

Using pathophysiology, compare the difference between ‘COPD’ and ‘Asthma’.

Answer 74

Asthma is a chronic airway disease with **reversible** narrowing of the bronchi and bronchioles. **The airflow limitation is due to narrowing bronchi and bronchioles.** Chronic Obstructive Pulmonary Disorder (COPD) causes airflow limitation. It is a **chronic** inflammatory response of the lungs. It is **progressive and not fully reversible**.** The airflow limitation is due to airway and functional lung tissue damage. ** **In asthma** we see that smooth muscle contracts and immune cells infiltrate the bronchioles as part of the inflammatory process which obstructs the airways. When the bronchial are relaxed and normal there is good space for air. We have a layer of smooth muscle inside of which is a mucous membrane and then an open airway. When the bronchiole is inflamed the tubes are limiting flow of air. They are constricted. Inflammatory cells and debris filled the airway then when you have bronchoconstriction the smooth muscle contracts and constricts the airway. **COPD **is a combination of two main pathologies which are emphysema and chronic bronchitis. In emphysema alveoli walls are damaged and breakdown meaning there is less surface for gas exchange. It is down to compromised exchange. In chronic bronchitis lining of the bronchial tree becomes inflamed and started to produce excess mucus which acts as a physical obstruction of airflow

Question 75

Describe the difference between intrinsic and extrinsic asthma.

Answer 75

Asthma is classified into extrinsic or intrinsic. The classification essentially is whether the disease is related to a specific allergen or brought on by non-specific factors. Extrinsic (atopic): This is a true allergic response. It is immunologically mediated. The body percieves allergens such as pollen or dust lead as a threat and when exposed to them release IgE antibodies causing the release of histamine through mast cells and leading to swelling. Intrinsic: Can be related to emotions such as anxiety or stress, exercise, chemicals, NSAIDS, dust and cold air. It's a bronchial reaction but it is **not due to antibody stimulation**

Question 76

List TWO triggers of extrinsic asthma.

Answer 76

Pollen Dust mites Animal dander

Question 77

List TWO triggers of intrinsic asthma.

Answer 77

Pollution NSAIDs Cold Air Exercise

Question 78

Name THREE conditions that make up the atopic triad.

Answer 78

Hayfever, Eczema, asthma

Question 79

List THREE key signs / symptoms of asthma.

Answer 79

- Current episodes of breathlessness and chest tightness - Wheezing when exhailing - Nocturnal coughing - Overuse of accessory muscles of ventilation

Question 80

Name the following medicines that are normally used in asthma: a. Blue inhaler b. Brown inhaler

Answer 80

a. Blue inhaler Bronchodilator - Ventolin b. Brown inhaler Corticosteroids - Beconase

Question 81

Describe the difference between emphysema and chronic bronchitis associated with COPD.

Answer 81

Chronic Obstructive Pulmonary Disorder (COPD) causes airflow limitation. It is a chronic inflammatory response of the lungs. It is progressive and not fully reversible. The airflow limitation is due to airway and functional lung tissue damage. COPD is a combination of two main pathologies which are emphysema and chronic bronchitis. Functional lung tissue - In emphysema alveoli walls are damaged and breakdown meaning there is less surface for gas exchange. It is down to compromised exchange. Airway - In chronic bronchitis lining of the bronchial tree becomes inflamed and started to produce excess mucus which acts as a physical obstruction of airflow

Question 82

List ONE cause (not smoking) of COPD.

Answer 82

Apart from smoking which accounts for 90% of COPD in western countries, exposure to lung irritants such as Air pollution Industrial chemicals Dusts Genetic susceptibility

Question 83

Explain how smoking can contribute to the development of COPD.

Answer 83

Specifically when related to smoking it creates high levels of oxidative stress in the respiratory tract. This creates free radicals and depletes antioxidants leading to damage to the cilia. Damage to cilia leads to problems with the mucociliary escalator. Particles that would have been trapped and swept out of the respiratory tract, now go deeper and the mucus obstructs the airway.

Question 84

List THREE main signs of COPD.

Answer 84

**Chronic cough with sputum Dyspnoea** Prolonged expiration and wheeze Frequent infection The signs are tackypnoea, breathlessness on exertion, pursed lips breathing, patients may lean forward and rest arms on the table, flapping tremor, cyanosis, hyperinflation of the chest, clubbed nails.

Question 85

Using definitions compare the difference between pneumonia and pulmonary fibrosis.

Answer 85

Both illnesses affect alveoli. With pneumonia it is an infection leading to inflammation and swelling. With pulmonary fibrosis it is a buildup of fibrotic scar tissue on the alveoli which interferes with gas exchange and leads to breathlessness **Pneumonia is an infection of the alveoli and terminal bronchioles**, mostly bacterial. It is associated with an infiltration of neutrophils with leads to inflammation and oedema. Pulmonary fibrosis is the gradual replacement of the one layer thick epithelial cell lining in alveolae with fibrotic tissue. **Fibrotic scar tissue** is less able to exchange oxygen and CO2 * Whilst bronchitis affects bronchi and bronchioles, pneumonia is an infection that affects the terminal bronchioles and most importantly the alveoli themselves.

Question 86

List TWO signs / symptoms of pneumonia.

Answer 86

**Cough** and **purulent sputum** which may be blood stained **Breathlessness**, fever, malaise Crepitations on Auscultation Tachypnoea

Question 87

List ONE autoimmune cause of pulmonary fibrosis.

Answer 87

Rheumatoid Arthritis

Question 88

List TWO signs / symptoms of pulmonary fibrosis.

Answer 88

Pulmonary fibrosis is the gradual replacement of the one layer thick epithelial cell lining in alveolae with fibrotic tissue. **Progressive dyspnoea**, chronic cough, fatigue, recurrent respiratory infection, discomfort in the chest, loss of appetite,

Question 89

List TWO risk factors for sleep apnoea.

Answer 89

**Obesity** Male gender Smokers middle-aged alcohol sedatives leading to a collapse of the airway nasal obstruction from rhinitis or polyps

Question 90

List TWO signs / symptoms of sleep apnoea.

Answer 90

**Loud snoring Daytime sleepiness** Morning headache Morning drowsiness Nocturnal choking Recuced libido

Question 91

Define pneumothorax.

Answer 91

Air accumulation within the pleural cavity causing part or all of a lung to collapse. Often the air enters due to something like a rib fracture that pierces the pleural membrane and damages the visceral or parietal pleura. This leads to an influx of air between the lung and surrounding membrane. Broadly we can categorise pneumothorax based on whether the heart is affected in its positioning. If pressure builds up but it doesn't cause the heart is to shift it is called a **Simple Pneumothorax.** If you get an accumulation of air on one side of the thorax pushing the heart away it is called **Tension Pneumothorax**

Question 92

With regards to pneumothorax, identify: a. ONE spontaneous cause b. ONE traumatic cause

Answer 92

a. ONE spontaneous cause * rupture of cyst/ pocket of air * Tuberculosis * cystic fibrosis, emphasyma. The loss of elasticity is more likely to cause a rupture b. ONE traumatic cause * Damage to the pleura through fracture * surgical complication

Question 93

List TWO signs / symptoms of pneumothorax.

Answer 93

**Dyspnoea **and pleuritic (sharp) Cyanosis due to lungs collapsing Loss of consciousness, coma We would see reduced breath sounds and decreased cardiac output

Question 94

Explain how a pulmonary embolism develops.

Answer 94

A pulmonary embolism results from obstruction within the pulmonary arterial tree. A thrombosis is a fixed clot whereas an embolism is a clot that is mobile and circulating and can get lodged in a smaller area. The obstruction, the embolus (mobile clot) often occurs as a result of a thrombosis (fixed clot), travelling up from one of the deep veins in the leg. The most common of these is a DVT. Fat embolisms can occur following bone fractures were a small part of yellow bone marrow can break off into the blood.

Question 95

Why is calf pain an important sign in pulmonary embolism?

Answer 95

Suggestive of deep vein thrombosis where a thrombosis is travelling up the deep veins in the leg

Question 96

Outline the pathophysiology of cystic fibrosis.

Answer 96

Cystic fibrosis is a multi organ genetic disease that affects chloride channels and subsequently key exocrine glands. Chloride channels help maintain the proper balance of salt and water within a cell. In cystic fibrosis a genetic mutation causes a dysfunction of the salt and water balance. Mucus or secretions that should normally be thin and slippery becomes thick and clogged up in the lungs and some digestive organs. This causes chronic respiratory infections. In the pancreas it can lead to problems ejecting the enzymes that the pancreas produces for digestion support and breakdown of food. Ultimately this can lead to problems with digestion and absorption of nutrients.

Question 97

List TWO signs / symptoms of cystic fibrosis.

Answer 97

Respiratory symptoms include: persistent cough, , recurring lung infections, wheezing, chest pain GIT symptoms: bloating, obstruction, bleeding, dyspepsia, malnutrition, stools floating in toilet

Question 98

Describe the nature of chest pain in pleurisy.

Answer 98

Pleurisy describes pleural inflammation where the pleural surfaces become coated with inflammatory materials and hence roughened. This results in sharp chest pain while breathing that is aggravated by inspiration, coughing, sneezing or moving around. It may be relieved with shallow breathing. With pleurisy we struggle to take deep breaths because of the pain

Question 99

List TWO factors that aggravate the pain in pleurisy.

Answer 99

Pain is aggravated by breathing in, coughing, sneezing or moving around

Question 100

What is the larynx made up of

Answer 100

Nine pieces of cartilage including the epiglottis Vocal chords

Question 101

What are the two types of respiration and give the formula

Answer 101

Aerobic Respiration O2 + Glucose = 38 ATP (total yeild) + water + CO2 Anaerobic Respiration FILL THIS IN Glucose = 2 ATP + Lactic acid

Question 102

Alveolar gas exchange - fill in the diagram

Answer 102

Question 103

Outline four key differences between the cold and the flu

Answer 103

1. Flu lasts longer 2-7 days Vs up to 7-14 days 2. Flu comes on fast. It is acute. Rapid onset. 3. For a cold symptoms are localised to the upper respiratory tract and include sneezing, stuffy nose, sore throat. For the flu it is systemic meaning that the symptoms extend beyond the upper respiratory tract and include fever, aches and pains, headache, sort throat, malaise. 4. Cold is caused by the rhinovirus. The flu is caused by the influenza virus 5. More likely to get headache with the flu and a runny nose with the cold 6. Complication with the flu are more likely

Question 104

Using pathophysiology, explain the difference between Asthma and COPD

Answer 104

Asthma is a chronic airway disease with **reversible **narrowing of the bronchi and bronchioles. Bronchiole hypernresponsiveness The airflow limitation is caused by - Inflammation leading to oedema in the bronchi and bronchioles - Mucus build up - Smooth muscle proliferation COPD – Chronic **obstructive pulmonary** disorder is also chronic but unlike asthma, it is **progressive** and **not fully reversible**. It is basically a chronic inflammatory response of the lungs The airflow limitation is due to airway and functional lung tissue damage and is due to a combination of 2 diseases: Emphysema – alveoli walls are damaged and break down meaning there is less surface area for gas exchange (the pulmonary part). - Results in breathlessness. - Pink puffer - Expiration through pursed lips Chronic Bronchitis - the lining of the bronchial tree becomes irritated and inflamed and starts to produce excess mucus which becomes obstructive. (the obstructive part). -Results on coughing and wheezing. -Blue bloater - skin and lips taking on a blueish tint.

Question 105

Explain the difference between allergic and non-allergic rhinitis

Answer 105

Rhinitis is an inflammation of the nasal mucosa. Allergic rhinitis refers to rhinitis triggered by a specific allergen such as pollen or dust mites. In this case IgE stimulates mast cells that erupt and release histamine. Itchy runny nose, eye irritation etc Non-allergic rhinitis is more lifestyle driven and brought on by environmental factors. For example it could be exercise, cold air, stress, pollution, diet, NSAIDS