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Sem 2 Case 1 > Case 1 > Flashcards

Case 1 Flashcards

too hug yaffa

1
Q

How is normal breathing achieved ( inspiration)

A

Internal intercostal relax
external intercostal contract
Diaphragm contracts inferiorly

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2
Q

How is normal breathing achieved ( expiration )

A

Internal intercostal contract
external intercostal relax
Diaphragm relaxes
elastic recoil of lungs

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3
Q

How is forced expiration achieved

A

accessory muscles force diaphragm up
internal and external obliques
transversus abdominas and rectus abdominas

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4
Q

How is forced inhalation achieved

A

accessory muscles
scalene , sternocleidomastoid, serratus anterior and pec minor increase thoracic cavity volume

Diaphragm contracts and external intercostal muscles contract

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5
Q

what do young children have to rely on for breathing

A

the descent of the diaphragm

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6
Q

Where are the group’s neurons located that control breathing

A

Medulla oblongata

pons

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7
Q

what are the 3 major collections of neurones

A

dorsal respiratory group
ventral respiratory group
pneumotaxic centre

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8
Q

what provides the basic rhythm of respiration

A

dorsal respiratory group of neurones

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9
Q

what signal neurones to the diaphragm

A

RAMP

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10
Q

what is the advantage of neurones ramp

A

causes a steady increase in the volume of the lungs during respiration rather than gasps

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11
Q

what initiates RAMP signal

A

apneustic centre

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12
Q

what calms down RAMP

A

pneumotoxic centre

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13
Q

what part controls the filling phase of the lung

A

pneumotoxic centre

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14
Q

what can a strong pneumotoxic signal do

A

Inspiration is short.

Breathing rate increases

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15
Q

what does the apneustic area do

A

coordinates transition between inhalation and exhalation

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16
Q

what can override apneustic area

A

pneumotoxic signal

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17
Q

what respiratory group controls normal quiet respiration

A

dorsal respiratory group

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18
Q

What lies next to the dorsal respiratory group

A

ventral respiratory group

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19
Q

what can cause the dorsal respiratory signals to spill over into the ventral respiratory neurones

A

when you are breathing rapidly

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20
Q

what is the ventral respiratory group used for

A

very heavy exercise and thus this is an overdrive system. It can stimulate both inspiration and expiration

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21
Q

What is the Hering Breuer inflation reflex

A

stretch receptors that activate when the lungs become overstretched. when they do become overstretched they activate a feedback loop that switches off the inspiration ramp

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22
Q

what chemoreceptors does oxygen act on

A

peripheral chemoreceptors

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23
Q

Excess carbon dioxide what does that act on

A

access carbon dioxide acts directly on the respiratory centre itself thus increasing respiration

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24
Q

Where is Alpha 1 antitrypsin made and what is it for

A

The liver and it protects the lungs

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25
Q

What is Tidal Volume

A

The volume of air exchanged during normal inspiration or expiration

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26
Q

What is IRV (inspiratory reserve volume)

A

The maximum volume that can be inspired in addition to a tidal inspiration

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27
Q

What is ERV ( Expiratory reserve volume)

A

The maximum volume that can be expired in addition to a tidal expiration

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28
Q

What is RV ( residual volume )

A

The volume remaining in the lungs at the end of a maximum expiration.

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29
Q

Which Lung volume can’t be measured during a test

A

Residual Volume

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30
Q 
What do these stand for 
FVC/VC 
TLC
RV
TV
IRV
ERV
IC
FRC
A 
Forced/vital capacity 
Total lung capacity 
Reserve volume 
Tidal volume 
Inspiratory reserve volume 
Expiratory reserve volume 
Inspiratory capacity 
Functional reserve capacity
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31
Q

What kind of process is Inspiration

A

Active process

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32
Q

What kind of process is Forced inspiration

A

Active process

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33
Q

What kind of process is expiration

A

Passive process

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34
Q

What kind of process is Forced expiration

A

Active process

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35
Q

What muscles are used in Forced inspiration

A

Accessory muscles - sternocleidomastoid, scalene muscles, serrated anterior and pec minor

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36
Q

What prevents lungs collapsing in expiration

A

Surfactant and inter-pleural pressure

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37
Q

What muscles are used in inspiration

A

Diaphragm and external intercostal

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38
Q

What muscles are used in Forced expiration

A

Internal ones - innermost and internal intercostal and transversals thoracis

Abdominal - external and internal obliques and Transversus abdominis and rectus abdominis

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39
Q

What are the layers of muscles on the belly deep to superficial

A

Transverse abdominis then rectus abdominis

40
Q

What does the apneustic center do

A

Adjusts output of the DRG by continually stimulating it to build up the ramp signal from the DRG

41
Q

What does DRG stand for

A

Dorsal respiratory group

42
Q

What happens when respiratory drive increases for ventilation

A

DGR spills to the VGR and the inspiratory center of the VGR becomes activated

43
Q

What nerves do the Dorsal respiratory group

A

Phrenic nerve
Intercostal nerves
Nerves for the accessory respiratory shite

44
Q

What does the phrenic nerve innervate

A

Diaphragm

45
Q

What nerves send nerve shite to the PONS

A

Vagus

Glossopharyngeal

46
Q

What does Oxygen act on in terms of respiration group

A

Peripheral chemoreceptors

47
Q

Where are peripheral chemoreceptors located

A

Carotid and aortic bodies

48
Q

What do hydrogen ions do in terms of stimulation respiration

A

The have a direct effect in stimulating the neurones as CO2 reacts with water to form carbonic acid which dissociates into hydrogen and bicarbonate ions

49
Q

What is the Hering Breuer Reflex

A

When the lungs are over inflated the stretch receptors activate

50
Q

What does the hering breuer reflex do to the rate of respiration

A

Increase it

51
Q

What does rising Pco2 do on smooth muscle in walls of arteries and capillaries

A

Vasodilation and increases blood flow

52
Q

What does hypoxia mean bitch

A

Lack of o2 motherfucker

53
Q

What is cyanosis caused by

A

Hypoxia

54
Q

Where is the lung suspended from

A

It’s hilum from the mediastinum

55
Q

What is the pressure normally of the fluid in the pleural cavity

A

Slightly negative

56
Q

What does hypoxia mean

A

Lack of oxygen

57
Q

What does pleural pressure mean

A

Pressure of “fluid” between visceral and parietal pleurae

58
Q

When the Diaphragm is relaxed what are the relative pressures in Plural pressure , alveolus and atmospheric

A

Ppl>Palv

Palv=Patm

59
Q

In inspiration what are the pressure differences in Ppl, Palv and Patm

A

Ppl<

60
Q

In terms of long/short and narrow and wide what would cause greater airways resistance

A

Longer the airway and the narrower the airway the greater the airways resistance

61
Q

What is compliance

A

An indication of a lungs expandability / how easily the lungs expand and contract

62
Q

What type of alveolar epithelial cells secretes surfactant

A

Type II alveolar epithelial

63
Q

What is surfactant a mixture of

A

Phospholipids, proteins and ions

64
Q

What is a pneumothorax

A

Collection of air between the visceral and parietal pleura causing a real rather than potential pleural space.

65
Q

What are the types of Pneumothoraxes

A

Primary Spontaneous
Secondary spontaneous
Traumatic
Tension

66
Q

Explain the following pneumothorax PRIMARY and SECONDARY spontaneous

A

Primary = most common and caused by a rupture of a small subpleural emphysematous bulla .
Secondary = More deadly and caused by COPD or asthma (underlying Lung disease)

67
Q

What is the difference in traumatic pneumothorax and tension

A

Traumatic = blunt trauma or penetrating, can also be associated with a haemothorax.

Tension = Most commmon during mechanical ventilation/ following a traumatic pneumothorax. Air flow is ONE WAY, LUNG INTO PNEUMOTHORAX . Air cant escape

68
Q

What would the treatment for a tension pneumothorax be

A

Needle aspiration and chest drain

69
Q

What is Dysponea

A

Laboured breathing

70
Q

What would the percussion note be of a pneumothorax

A

Resonant

71
Q

What is the most consistent finding in the clinical features of the pneumothorax

A

Reduction in breath sounds on the affected side

72
Q

On an x ray what would the lung look like on the side with a pneumothorax

A

Extra black space

73
Q

In a tension pneumothorax what can happen and be observed in an x ray

A

Trachea displacement and lung shrivels up away from the affected side

74
Q

To confirm diagnosis what can be seen on the x ray in relations to the pleura

A

Clear line of visceral pleura with absence of peripheral lung markings beyond it

75
Q

What will the arterial blood gases be in a pneumothorax

A

Hypoxia

76
Q

What is a needle aspiration

A

Needle in 2nd intercostal space used as diagnostic tool for pneumothorax and to relieve pressure before a chest drain

77
Q

What is a chest drain

A

Long tube that enters through the 5th intercostal space and goes down to a container with water that acts as a one way valve

78
Q

What is the ATLS protocol for

A

Standard method for the initial management of severely injured patients

79
Q

In the ATLS protocol what does ABCDE stand for

A 
A = airways 
B = breathing and ventilation 
C= circulation with haemorrhage control 
D= disability and Neurological status 
E = exposure and environment
80
Q

What are the two divisions of the Autonomic nervous system

A

Sympathetic and parasympathetic

81
Q

What do the SNS and PNS secrete

A

Acetylcholine

Norepinephrine

82
Q

What are the majority of the sympathetic in terms of adrenergic and cholinergic

A

Sympathetic are adrenergic

83
Q

What are the fibres of Ach and Norepinephrine said to be

A 
Ach = cholinergic 
N = adrenergic
84
Q

What do the acetylcholine receptors activate

A

Nicotine receptors and muscarinic receptors

85
Q

Where are the Ach nicotinic receptors found

A

Autonomic ganglia at the synapses between the preganglionic and postgangionic neurons - both SNS and PNS

86
Q

Where are Ach muscarinic receptors found

A

All effector cells that are stimulated by the postganglionic cholinergic neurons of the PNS

87
Q

What are all preganglionic neurons

A

Cholinergic

88
Q

In the postganglionic system what are most of the sympathetic and parasympathetic

A 
SNS = adrenergic 
PNS = cholinergic
89
Q

What are the two major types of adrenergic receptors

A

Alpha and Beta

90
Q

Where are alpha 1 found

A

Alpha 1 = found in the walls of blood vessels

91
Q

What do Alpha 1 and Alpha 2 receptors do

A

Alpha 1 = smooth muscle dilation of walls of blood vessels

Alpha 2 = decreases cAMP formation. By inhibiting addenylate cyclase

92
Q

What controls the Vasoconstriction and vasodilation of Alpha 1

A

SNS - stimulation of SNS causes vasoconstriction and less stimulation of SNS causes vasodilation

93
Q

What do all beta receptors of adrenergic receptors stimulate

A

Adenylate cyclase

94
Q

Where do Beta 1,2,3 live

A

Beta 1 = heart
Beta 2 = lungs
Beta 3 = fat cells

95
Q

What do Beta 1,2,3 do to the Heart, Lungs and Fat cells

A

Increase cardiac output
Bronchodilation
Lipolysis of Adipose tissue

96
Q

What receptors are G-protein couple receptors

A

Alpha and Beta

Sem 2 Case 1 (6 decks)

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