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Semester 2 Case Studies > Case 1 > Flashcards

Case 1 Flashcards

1
Q

how does air flow?

A

region of high pressure to a region of low pressure

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2
Q

what kind of process is inhalation

A

an active process

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3
Q

what muscles are used in quiet inhalation

A

diaphragm, external intercostal muscles and potentially scalene muscles

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4
Q

how much of the air movement does diaphragmatic movement count for in quiet inhalation

A

75%

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5
Q

accessory muscles in forced inhalation

A

sternocleidomastoid, scalene, serratus anterior and pectoralis minor

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6
Q

why is air drawn into the bronchial tree during inhalation

A

due to positive atmospheric pressure exerted through upper respiratory tract and the negative pressure on the outer surface of the lungs, brought about by increase capacity of thoracic cavity

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7
Q

is quiet exhalation active or passive

A

largely passive - due to elastic recoilq

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8
Q

how does surface tension affect quiet expiration

A

fluid that lines the alveoli. as water molecules pull together they also pull on the alveolar walls, causing the alveoli to recoil and become smaller

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9
Q

what two factors prevent the lungs from collapsing

A

surfactant (reduces surface tension) and inter pleural pressure

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10
Q

is forced expiration passive or active

A

active

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11
Q

what are the muscles of forced expiration

A

external and internal oblique. transverses abdominis, rectus abdominis, transverses thoracis

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12
Q

what muscle pulls down the twelfth rib during forced expiration

A

quadratus lumborum

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13
Q

what are the respiratory centres

A

medulla oblongata and pons

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14
Q

what are the respiratory centres in the medulla oblongata

A

DRG and VRG

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15
Q

what does the DRG control

A

controls mostly inspiratory movements and their timing

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16
Q

what nerve innervates the diaphragm

A

phrenic nerve

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17
Q

what does VRG cause

A

forced expiration

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18
Q

what does VRG inspiratory centre do during forced inspiration

A

aids the DRG

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19
Q

how do the signals in the RAMP pathway occur

A

in action potential bursts

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20
Q

what do the 3 seconds of no signals in the RAMP pathway do

A

allow elastic recoil of the lungs and the chest wall to cause expiration (passive exhalation)

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21
Q

what is the advantage of the RAMP pathway

A

causes a steady increase in the volume of the chest during inspiration, rather than inspiratory gaps

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22
Q

what are the respiratory centres in the pons

A

apneustic and pneumotaxic centres

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23
Q

what are the stimuli for the respiratory centres in the pons

A

the vagus nerve and the glossopharyngeal nerves to the respiratory centres

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24
Q

where is the apneustic centres located

A

lower pons

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25
Q

what does the apneustic centre do

A

provides continuous stimulation to the DRG, resulting in long deep inhalation

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26
Q

what happens after 2 seconds of inhalation to the apneustic centres

A

they are inhibited by the pneumotaxic centres

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27
Q

where are the pneumotaxic centres located

A

in the upper pons

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28
Q

what does the pneumotaxic centre control

A

the ‘switch off’ point of the ramp signal, thus limiting inspiration

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29
Q

chemoreceptors:

A

P(CO2), P(02), pH of the blood

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30
Q

baroreceptors

A

changes in blood pressure

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31
Q

stretch receptors:

A

respons to changes in volume of the lungs (Hering-Breuer Reflex)

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32
Q

where do excess carbon dioxide and hydrogen ions in the blood act on

A

act directly on the respiratory centre itself

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33
Q

where does oxygen act on

A

on peripheral chemoreceptors in the carotid and aortic bodies

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34
Q

where is the chemosensitive area located

A

located bilaterally, lying beneath the ventral surface of the medulla

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35
Q

why can cross the blood-brain barrier

A

carbon dioxide

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36
Q

which has an effect in stimulation the neurone in the chemosensitive area

A

hydrogen ions have a direct effect unlike carbon dioxide

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37
Q

how does carbon dioxide effect the chemosensitive area

A

it cross the brain-blood barrier, reacts with water of the tissues to form carbonic acid, then dissociates into hydrogen and bicarbonate ions; the hydrogen ions then have a direct stimulatory effect on the chemosenstive area in the brain

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38
Q

do the Pco2, pH and Po2 values change during strenuous exercise

A

no they remain normal

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39
Q

what happens at the onset of exercise to the arterial Pco2

A

there is no increase, as alveolar ventilation increases instantaneously without an initial increase in arterial Pco2

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40
Q

which nerve is the carotid body associated with

A

glossopharyngeal nerve and then to the DRG

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41
Q

which nerve is the aortic body associated with

A

the vagus nerve which goes to the DRG

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42
Q

where are stretch receptors located

A

located in the muscular portions of the walls of the bronchi and bronchioles throughout the lungs

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43
Q

where do stretch receptors transmit signals to

A

the vagus nerve into the DRG when the lungs become over stretched

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44
Q

what happens where the lungs become overly inflated

A

the stretch receptors activate an appropriate feedback response that ‘switches off’ the inspiratory ramp and thus stops further inspiration

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45
Q

what happens in normal tissues if it becomes more active

A

Po2 falls and Pco2 rises

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46
Q

what do rising Pco2 levels do

A

they relax smooth muscle in walls of arteries and capillaries, causing vasodilation and increasing blood flow

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47
Q

what is hypoxia

A

lack of oxygen

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48
Q

what are the effects of hypoxia on the body

A

drowsiness, lack of energy, mental and muscle fatigue, headache and nausea

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49
Q

what is cyanosis

A

blueness of the skin

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50
Q

how is cyanosis caused

A

result of excessive amounts of deoxygenated haemoglobin in the skin blood vessels

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51
Q

what is pleural pressure

A

the pressure of the fluid in the pleural cavity which is the space between the visceral and parietal pleura

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52
Q

is pleural pressure usually slightly negative or positive

A

usually slightly negative (-5)

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53
Q

what happens to the pleural pressure during inspiration

A

expansion of the chest cage pulls outward on the lungs with greater force and therefore creates more negative pressure (7.5)

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54
Q

what is alveolar pressure

A

pressure inside the alveoli

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55
Q

what happens to the alveolar pressure when there is no air flow

A

it is equal to the atmospheric pressure which is considered to zero

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56
Q

what has to happen to pressure in alveoli during inspiration

A

the pressure must fall to a value slightly below atmospheric pressure (below 0)

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57
Q

what happens to alveolar pressure during expiration

A

the alveolar pressure rises to about +1 and this forced 0.5 litres of inspirited air out of the lungs during the 2 or 3 seconds of expiration

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58
Q

what is transpulmonary pressure

A

this is the difference between the alveolar pressure and the pleural pressure

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59
Q

what is recoil pressure

A

measure of the elastic forces in the lungs that tend to collapse the lungs at each instant of respiration

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60
Q

what does the work of breathing depend on

A

the tidal volume - increased = more work done by lungs

respiratory frequency

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61
Q

what is airflow

A

partial pressure / airways resistance

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62
Q

what is partial pressure

A

alveolar pressure - atmospheric pressure

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63
Q

what happens in the airway is long

A

greater airway resistance

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64
Q

what happens in airway is short and narrow

A

the greater the airway resistance

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65
Q

What is compliance

A

indication of the lung’s expandability or how easily the lungs expand and contract

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66
Q

what happens when the compliance is low

A

the greater the force required to fill and empty the lungs

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67
Q

what happens when the compliance is great

A

the easier to fill and empty the lungs

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68
Q

what is surfactant

A

surface active agent in water, which means it greatly reduced the surface tension of water

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69
Q

what cells secrete surfactant

A

type II alveolar epithelial cells

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70
Q

what confirms a pneumothorax

A

chest X-ray

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71
Q

what does a collapsed lung look like on an X-ray

A

extra black space indicates the presence of air

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72
Q

what are the steps to do a chest X-ray

A

A - airways

B - breathing and bones

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73
Q

what Is the order for chest X-ray

A 
A - airways 
B - breathing and bones 
C - cardiac 
D - diaphragm 
E - everything else
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74
Q

what films are used for pneumothorax

A

standard erect posterior anterior are usually adequate although if too injured to stand used anterior posterior

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75
Q

what treatment is used for a complete primary

A

aspirate / chest drain

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76
Q

what treatment is used for a moderate primary

A

aspirate

77
Q

what treatment is used for a small primary

A

observe

78
Q

what treatment is used for a complete secondary

A

chest drain

79
Q

what treatment is used for a moderate secondary

A

chest drain

80
Q

what treatment is used for a small secondary

A

chest drain

81
Q

what treatment is used fro a complete traumatic

A

chest drain

82
Q

what treatment is used for a moderate traumatic

A

chest drain

83
Q

what treatment is used for a small traumatic

A

observe / chest drain

84
Q

what else is given during immediate manage of a pneumothorax

A

supplemental oxygen

85
Q

where does aspiration take place

A

second intercostal space, mid-clavicular line

86
Q

where is a chest drain inserted

A

inter pleural space between two ribs

87
Q

what does a chest drain do

A

it allows air to escape from the inter pleural space so that the underlying lung can re-inflate

88
Q

how is pneumothorax drained via a chest tube

A

as pressure in the inter pleural space becomes positive, due to coughing, air passes along the chest drain and out into the atmosphere through an underwater seal and the pneumothorax is drained

89
Q

what is ATLS

A

advanced trauma life support

90
Q

what is the principle of ATLS

A

treat the greatest threat to life first

91
Q

is a definitive diagnosis necessary to treat patient initially under ATLS protocol

A

no

92
Q

what is the primary survey of ATLS protocol

A

A - airway maintenance with cervical spine protection

93
Q

what does ABCDE stand for in ATLS protocol

A

A - airway maintenance and cervical spine protection
B - breathing and ventilation
C - circulation with haemorrhage control
D - disability and neurologic status
E - exposure and environment

94
Q

what Is the secondary survey of ATLS protocol

A

a head to toe evaluation of the trauma patient, including a complete history and physical examination including the reassessment of all the vital signs

95
Q

what happens if at any point during secondary survey of ATLS protocol the patient deteriorates

A

another primary survey is carried out as a potential threat to life may be present

96
Q

what type of fibres are acetylcholine

A

cholinergic

97
Q

what type of fibres are norepinephrine

A

adrenergic

98
Q

what fibre are all preganglionic neurons

A

cholinergic

99
Q

what type of fibres are in postganglionic of sympathetic

A

adrenergic

100
Q

what receptors do acetylcholine activate

A

nicotinic receptors and muscarinic resceptors

101
Q

where are nicotinic receptors found

A

found in the autonomic ganglia at the synapses between the pre and post ganglionic neurones of both para and sympathetic systems

102
Q

where are muscarinc receptors found

A

found on all effector cells that are stimulated by the postganglionic cholinergic neurones of the parasympathetic nervous system

103
Q

where are alpha 1 receptors found

A

in walls of blood vessels and cause smooth muscle contraction

104
Q

what do alpha 2 receptors do

A

inhibit adenylate cyclase - decreasing cAMP formation

negative feedback for release of norepinephrine from presynaptic neurone

105
Q

what do all beta receptors stimulate

A

adenylate cyclase

106
Q

where are beta 1 receptors found

A

located in the heart, increase cardiac output

107
Q

where are beta 2 receptors found

A

in the lungs - bronchodilator

108
Q

where are beta 3 receptors found

A

in fat cells - lypolisis in adipose tissue

109
Q

what type of receptors are alpha and betas

A

they are G protein coupled receptors (intracellular messengers)

110
Q

how does noradrenaline stimulate receptors

A

stimulates alpha receptors more than beta receptors

111
Q

how does adrenaline stimulate receptors

A

stimulates alpha and beta receptors equally

112
Q

what are the three phases of the stress response

A
  1. Alarm phase
  2. resistance phase
  3. exhaustion phase
113
Q

what happens during alarm phase of the stress response

A

response is directed by the sympathetic nervous system and causes increased secretion of adrenaline

114
Q

what happens in alarm phase pt.2

A

energy reserves are mobilised, mainly in the form of glucose

115
Q

what happens in the resistance phase of the stress response

A

the dominant hormone is cortisol which is a glucocorticoid

116
Q

what happens during exhaustion phase of stress response

A

homeostatic regulation breaks down and the exhaustion phase begins
the failure of one or more organ systems will prove fatal

117
Q

what happens with mineral balance in the exhaustion phase of the stress response

A

the production of aldosterone throughout the resistance phase results in the conservation of Na at the expense of K, as body’s K content declines, neurones and muscle fibres begin to malfunction

118
Q

when does stress occur

A

when the perceived demands of a situation are appraised as exceeding a person’s perceived resources and ability to cope

119
Q

what is the role of appraisal

A

Lazarus argued that stress involved in a transaction between the individual and their external world, and that a stress response was elicited if the individual appraised a potentially stressful event as actually being stressful

120
Q

what is primary appraisal

A

when the individual initially appraises the event itself

121
Q

how can an event be appraised

A
  1. irrelevant
  2. benign and positive
  3. harmful and a threat
  4. harmful and a challenge
122
Q

what is the secondary appraisal of stress

A

the individual evaluating the pros and cons of their different coping strategies

123
Q

what happens during acute stress response according the Cannon

A
  • increased sympathetic activation
  • increased cognitive performance
  • increased muscular priming
  • increased immune functioning
124
Q

what happens during chronic stress response according to Cannon

A
  • decreased immune functioning
  • decreased cognitive functioning
  • this eventually leads to exhaustion
125
Q

what are the three distinct functional states of sodium channels

A

resting, open, refractory

126
Q

what class of drug is lidocaine

A

class Ib

127
Q

what is PTSD

A

ir is a condition where exposure to an intense and frightening emotional experience leads to lasting changes in behaviour, mood and cognition

128
Q

major symptoms of PTSD:

A

feeling numb to the world, reliving trauma repeatedly, sleep disturbances, over alertness

129
Q

what is category A of PTSD

A

exposure to an event involving actual/threatened death or serious injury

130
Q

what is category b of PTSD

A

1+ symptoms of reliving the trauma repeatedly

131
Q

what is class C of PTSD

A

3+ symptoms of persistent avoidance of trauma stimuli or numbing of general responsiveness

132
Q

what is category D of PTSD

A

2+ symptoms of persistent increased arousal

133
Q

how is PTSD diagnosed

A

had symptoms for one or more months

134
Q

how is prevention of PTSD better achieved

A

through the support offered by others who were also involved

135
Q

what is the primary goal of CBT for PTSD

A

undergo some sustained emotional processing of the traumatic experiences

136
Q

what is CBT

A

A structured therapy that focuses on clearly identified and achievable treatment goals

137
Q

what is the aim of CBT for PTSD patients

A

to desensitise the patient to the traumatic event

138
Q

other aim of CBT

A

to modify unhelpful and maladaptive beliefs and to generate more flexible rational and adaptive beliefs

139
Q

what is the bystander effect

A

psychosocial phenomenon in which someone is less likely to help and intervene in an emergency situation when other people are present

140
Q

what is pluralistic ignorance

A

everybody in the group misleads everybody else by defining the situation as a non-emergency

141
Q

what causes a person to not react to a clear cut emergency

A

diffusion of responsibility

142
Q

what is catamenial pneumothorax

A

pneumothorax caused by endometriosis of a woman at the time of menstruation

143
Q

what does monoaimine oxidase do

A

breaks down norepinephrine molecules after they have been released in the sympathetic synapse

144
Q

do you get a decrease of blood pressure as a result of PTSD

A

no

145
Q

what is the alveolar pressure required to draw in 0.5L of air in normal inspiration

A

-1mmHg

146
Q

how does adrenaline lower cAMP levels

A

acts on the alpha 2 adrenergic membrane receptors

147
Q

what pulse rate suggests a tension pneumothorax

A

pulse over 135bpm

148
Q

what is first line treatment for PTSD

A

eye movement desensitisation and reprocessing

149
Q

the activation of what receptor leads to peripheral vasoconstriction

A

alpha receptors

150
Q

where are chest drains placed

A

best paced between the 5th and 6th ribs, anterior axillary line

151
Q

what channels does lidocaine block

A

sodium channels

152
Q

what is the brand name for lidocaine

A

Xylocaine

153
Q

mode of action of lidocaine

A
  • stabilises the neuronal membrane by inhibiting the ionic fluxed required for the initiation and conduction of pulses, thereby effecting local anaesthetic action
154
Q

mode of action of lidocaine pt2

A

at sodium channels, neutral uncharged lidocaine molecules diffuse through neural sheaths into the axoplasm where they are subsequently ionised by joining with hydrogen ions. the resultant lidocaine cations are then capable of reversibly binding the sodium channels from the inside and keeping them locked in an open state that prevents nerve depolarisation. as a result, the membrane of neurone will ultimately not depolarise and thus fail to transmit an action potential.

155
Q

what neurone does not depolarise when lidocaine is used

A

postsynaptic

156
Q

Hypothalamic Pituatary-Adrenal System

A
  • the stressor activates the HPA
  • the hypothalamus stimulates the pituitary gland
  • the pituitary gland secretes adrenocorticotropic hormone (acth)
  • ACTH stimulates the adrenal glands to produce the hormone corticosteroid
  • cortisol enables the body to maintain steady supplies of blood sugar
  • adequate and steady blood sugar levels help a person cope with a stressor
157
Q

functions of cortisol

A

releases stored glucose from the liver, controls swelling after an injury and also surpasses the immune system

158
Q

true or false: chronic stress is maladaptive

A

true

159
Q

oxygen needs of the body

A

250ml/min at rest

160
Q

carbon dioxide production:

A

200ml/min at rest

161
Q

what is the functional residual capacity

A

when respiratory muscles are relaxed the lung volume at this point is the FRC

162
Q

why does a lung collapse?

A

when the pleural pressure is equal to the atmospheric pressure there is no force to counter the elastic recoil force

163
Q

what is airway resistance proportional to:

A

length/radius

164
Q

what cells are in the trachea

A

ciliated epithelium

165
Q

what cells are in the primary bronchus

A

basal cells

166
Q

secondary and tertiary bronchus have what cells

A

goblet cells and club cells

167
Q

what cells do smaller bronchi, bronchioles and terminal bronchioles have

A

serous cells, brush cells and club cell

168
Q

what cells do respiratory bronchioles and alveolar sacs have

A

alveolar type I and II cells

169
Q

how many alveolar sacs are there on average

A

150 million

170
Q

lining cells:

A

ciliated, intermediate, brush, basal epithelium

171
Q

contractile cells:

A

smooth muscle

172
Q

secretory cells:

A

goblet, mucous, serious (glands)

173
Q

connective tissue:

A

fibroblast, interstitial cell produce elastin, collagen, proteoglycans, cartilage

174
Q

neuroendocrine:

A

nerves, ganglia, neuroepithelial cells

175
Q

vascular cells:

A

endothelial, smooth muscle, pericyte

176
Q

immune cells:

A

mast cell, dendritic cells, lymphocyte, eosinophil, macrophage, neutrophil

177
Q

functions of airway macrophages

A
  • induction of inflammation: pathogens

- inhibition of inflammation: clearance of self cells and extracellular matrix turnover products

178
Q

type I alveolar cells

A

simple squamous epithelium, non-ciliated and main site of gas exchange - covers 90% of alveolus

179
Q

type II alveolar cells

A

produce surfactant to reduce surface tension preventing alveoli collapse and renew of type I cells

180
Q

what are the four types of clinical studies

A

randomized controlled trials (RCTs), cohort studies, case-control studies and qualitative studies

181
Q

what is a randomised control study

A

A randomized controlled trial is a form of scientific experiment used to control factors not under direct experimental control.

182
Q

what is a cohort study

A

A cohort study is a particular form of longitudinal study that samples a cohort, performing a cross-section at intervals through time. It is a type of panel study where the individuals in the panel share a common

183
Q

what is a case control study

A

case–control study is a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribut

184
Q

what is a qualitative study

A

Qualitative research investigates the why and how of decision making, not just what, where, and when. Therefore, the need is for smaller but focused samples rather than large random samples. Qualitative analysis involves categorizing data into patterns as the primary basis for organizing and reporting results.

185
Q

what does the carotid body detect that the aortic body does not

A

pH

186
Q

what valves does thematic fever effect

A

mitral and aortic valves

187
Q

what us cause of rheumatic fever

A

group A beta-haemolytic streoptocci

188
Q

what immunoglobulin is most likely to cause rheumatic feeer

A

IgM

Semester 2 Case Studies (11 decks)

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