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Phase 1 > CVR 3: Respiratory > Flashcards

CVR 3: Respiratory Flashcards

1
Q

What is the anatomical name for the nostrils?

A

The anterior nares.

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2
Q

What are the turbinates and why are they useful?

A

“Shelves” fitted on lateral wall of nasal cavity, increase the surface area available for heating, humidifying, and filtering air.

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3
Q

How many turbinates are there? What are they called?

A

3 in each nasal vestibule.
Superior, middle, and inferior turbinates.

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4
Q

What are the spaces underneath each turbinate called?

A

Meatus e.g. the superior meatus is directly inferior to the superior turbinate.

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5
Q

What different sinuses/ducts drain into the superior meatus, the middle meatus, and the inferior meatus?

A

Superior meatus; sphenoid and posterior ethmoid sinuses.
Middle meatus; frontal, anterior ethmoid, and maxillary sinuses. Inferior meatus; orifice of the nasolacrimal duct.

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6
Q

What is the nasolacrimal duct?

A

Colloquially known as the tear duct; drains tears from the eye to the inferior nasal meatus.

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7
Q

How many paranasal sinuses are there? What are they?

A

4 pairs (8 in total)
Frontal
Maxillary
Ethmoid
Sphenoid

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8
Q

Where are the ethmoidal sinuses?

A

Intraocular (between the eyes).

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9
Q

What is the lamina papyracea?

A

The thin fragile bone separating ethmoid sinuses from orbital cavity.

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10
Q

Where are the sphenoidal sinuses?

A

Just inferior to the pituitary gland, optic canal, and medial to the cavernous sinus. Posterior to the ethmoid sinuses.

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11
Q

What is the pharynx and how is it divided?

A

Fibromuscular tube lined with epithelium, constrictor muscles move food downwards when swallowing.
Divided into the nasopharynx, oropharynx, and laryngopharynx.

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12
Q

What tube in the nasopharynx connects to the middle ear?

A

The eustachian tube.

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13
Q

What is the purpose of the eustachian tube?

A

Equalise air pressure in the ear when yawning or swallowing.
Drains fluid from the middle ear.

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14
Q

What structures are visible in the oropharynx?

A

The uvula, palatoglossus arch/fold (joins palate to tongue), palatopharyngeal arch/fold, tonsils.

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15
Q

Name the 9 cartilage of the larynx.

A

Single: epiglottis, thyroid, cricoid.
Pairs: Cuneiform, corniculate, arytenoid.

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16
Q

What is the function of the arytenoid cartilage?

A

Stretch or relax vocal cords of higher or lower tone.

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17
Q

Where would you perform an emergency cricothyroidotomy?

A

Anterior neck, in the gap between the thyroid and cricoid cartilage.

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18
Q

Which nerve runs posterior to the hila of the lung, the phrenic or vagus nerve?

A

Vagus nerve.
The phrenic nerve is anterior to the hila.

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19
Q

What structure is the “gateway” to the lower respiratory tract, beyond which should be sterile?

A

The larynx.

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20
Q

What two inter-related synchronous movements of the ribs allow inspiration/expiration?

A

Superior and anterior (the pump handle)
Lateral shaft elevation (the bucket handle)

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21
Q

At what vertebral level is the carina?

A

T5, same level as the sternal angle.

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22
Q

Describe the tracheal cartilage.

A

Semi-complete, does not join posteriorly where the oesophagus lies, so that neck can bend.

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23
Q

What is the difference between the respiratory bronchioles and the terminal bronchioles?

A

The respiratory bronchioles are the first part of the airway where gas exchange can occur, they have discernible alveoli protruding from them.
Terminal bronchioles are the last conducting airways, they do not have the ability for gas exchange.

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24
Q

What is an acinus?

A

The lung portion distal to a terminal bronchiole. Approx 30,000 acini per lung.

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25
Q

What is the difference between type I and type II pneumocytes in alveoli epithelium?

A

Type I pneumocytes most common. Flat squamous epithelia resembling plate-like structures allowing gas exchange.
Type II pneumocytes are surfactant producing.

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26
Q

What are pores of kohn and what is their function?

A

Channels between adjacent alveoli to provide collateral pathways and equalise pressure.

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27
Q

What nerve innervates the cricothyroid muscle?

A

The external branch of the superior laryngeal nerve.

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28
Q

Which pleura of the lung has pain sensation, visceral or parietal?

A

Parietal pleura.

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29
Q

Do the pleura of the lung run along the fissures between lobes, or just on the surface of the lung?

A

The visceral pleura continues along the fissures, the parietal is just on the surface.

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30
Q

What is the diaphragm?

A

A dome-shaped fibromuscular sheet, separating the thorax from the abdomen.

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31
Q

How is respiration controlled by ventilation and perfusion?

A

Constriction/dilation of bronchioles (ventilation) and arterioles (perfusion).

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32
Q

What arteries supply bronchial and peri-bronchial tissue, and the visceral pleura? What major vessel do these arteries originate from?

A

Branches of bronchial arteries, originating from the descending aorta.

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33
Q

How does the pressure of the pulmonary arteries differ from the pressure of the bronchial arteries?

A

Pulmonary artery pressure is similar to right ventricular pressure e.g. 25/8 (RV = 25/0)
Bronchial artery pressure is the same as systemic pressure e.g. 125/80 (LV = 125/0) as arises from the left ventricle.

34
Q

Which vessels comprise the vascular portion of the broncho-vascular bundle?

A

The broncho-vascular bundle involves the pulmonary artery, which runs parallel to the bronchus.

35
Q

Is the pulmonary vein included in the broncho-vascular bundle?

A

No, the pulmonary vein travels separately from the broncho-vascular bundle.

36
Q

What main nerves are the origins of the pulmonary plexus?

A

Sympathetic trunk and vagus nerve.

37
Q

Activation of what receptors on respiratory smooth muscle causes bronchodilation?

A

Beta 2 receptors.

38
Q

Some Asthma and COPD treatments block the muscarinic receptors of M3 subtype on muscle cells. Why would this treatment be effective?

A

Activation of muscarinic receptors stimulates smooth muscle constriction in parasympathetic stimulation. Blocking this pathway prevents bronchioles from constricting.

39
Q

Where does the Eustachian tube end in the upper respiratory tract?

A

Nasopharynx

40
Q

Which recurrent laryngeal nerve loops around the arch of the aorta, left or right?

A

Left

41
Q

Which meatus does the nasolacrimal duct drain in to?

A

Inferior meatus

42
Q

What is a typical minute volume in L?

A

5L/min

43
Q

What is a typical physiological dead space in ml?

A

175ml.

44
Q

What is the dead space?

A

Volume of air not contributing to ventilation.

45
Q

What is the difference between the anatomical dead space and the alveolar dead space? Give typical volume amounts in ml.

A

Anatomical dead space = air in non-gas exchanging section of the airway, about 150ml.
Alveolar component of dead space is much smaller, about 25ml. Comprised of alveolar that do not have capillary blood supply for gas exchange.

46
Q

What is the difference between systemic and pulmonary circulation response to hypoxia/acidosis/CO2?

A

In systemic circulation, aim is to increase perfusion to tissues with higher O2 demand e.g. hypoxic tissue. Response is vasodilation. Whereas in high O2 environments, vessels vasoconstrict.

In pulmonary circulation, aim is to reduce perfusion to alveoli that are not well ventilated, to minimise ventilation/perfusion mismatch. Response is vasoconstriction. Whereas in high O2 environments (increased ventilation), vessels vasodilate to increase perfusion.

47
Q

Describe the relationship between PaCO2 and VA (alveolar ventilation).

A

PaCO2 is inversely proportional to VA.
An increase in ventilation will decrease PaCO2 (e.g. in hyperventilation; “blowing off CO2”)

48
Q

How does PAO2 relate to PiO2 and PaCO2?

A

PAO2 = PiO2 - PaCO2 / R

Increase in PiO2 will increase PAO2.
Increase in PAO2 will decrease PaCO2.

R = the respiratory quotient, assumed to be 0.8 in exam.

49
Q

In healthy people, what is the difference in PAO2 and PaO2?
What is this difference called?

A

approx. 1KPa
A-aDO2, or the alveolar arterial O2 difference.

50
Q

What causes a right shift in the oxygen dissociation curve?

A

Increased acidity
2,3 DPG
Increased temperature
Increased PCO2

51
Q

What equation is used by blood gas machines to estimate bicarbonate, and what measured values are required for this calculation?

A

The Henderson-Hasselbach equation.
Uses pH and PaCO2.

52
Q

What main function does the superior laryngeal nerve have?

A

To supply all of the sensory laryngeal innervation via two branches (internal and external laryngeal nerve).

53
Q

Which circulation is being described? It receives about 2% of cardiac output, supplies lung tissue with oxygenated blood and has systemic pressures around 120/80mmhg.

A

Bronchial circulation

54
Q

What is the level of the carina as judged by thoracic vertebral levels?

A

T5

55
Q

The pulmonary acinus describes the part of lung distal to which part of the airway?

A

Distal to the terminal bronchiole

56
Q

What is the main function of type II pneumocytes?

A

Surfactant production

57
Q

Which laryngeal cartilage(s) is (are) being described here; they provide an attachment point for various key structures in the larynx, including the vocal process and vocal ligament

A

Arytenoid cartilages

58
Q

What is PaCO2?

A

The arterial partial pressure of CO2

59
Q

Which of these parameters does NOT shift the oxygen haemoglobin dissociation curve to the RIGHT?

Increased acidity // Increased 2,3 DPG // Reduced temperature // Increased PCO2

A

Reduced temperature

60
Q

What two factors multiply together to give PiO2?

A

FiO2 x ambient pressure = PiO2

61
Q

Is FiO2 lower at high altitude?

A

No, FiO2 stays the same (21%).
PiO2 lowers because ambient pressure lowers.
PiO2 = FiO2 x ambient pressure.

62
Q

Regional distribution of blood flow is affected more by gravity in pulmonary or systemic circulation?

A

Pulmonary

63
Q

Describe the difference in vessel walls of the pulmonary and systemic circulations.

A

Pulmonary vessels have thinner walls with less smooth muscle than systemic vessels.

64
Q

Describe the regional differences in ventilation and perfusion across the lung; what is the cause?

A

Base of lung; increased ventilation (V) and perfusion (Q) than apex. Q is higher than V = alveolar under ventilated.
Apex of lung; decreased V and Q than base. V is higher than Q = alveolar over ventilated.
This is mainly due to gravity.

65
Q

How is pulmonary blood pressure measured?

A

Pulmonary arterial wedge pressure; invasive using catheter.

66
Q

In Pouiseuille’s Law, resistance varies with the power of the radius. What power, and what does this mean happens when there is a small change in the radius?

A

Radius to the power of 4.
A small change in the radius will cause a large difference in resistance (wider radius = reduced resistance)

67
Q

Which two mechanisms allow the pulmonary circulation to respond to an increased cardiac output in exercise to maintain a stable mean pulmonary arterial pressure?

A

Recruitment and distension of capillaries.

68
Q

What are the three basic classifications of diseases that affect the pulmonary circulation?

A

Shunting e.g. VSD
V/Q mismatch e.g. PE
Increased pulmonary vascular resistance e.g. pulmonary hypertension.

69
Q

Why does diffusion impairment cause hypoxia?

A

More difficult for O2 to diffuse into the blood, for example due to increased membrane thickness of alveoli or decreased surface area of membrane.

70
Q

How does shunting cause hypoxaemia?

A

Blood bypasses the lungs without oxygenation.
Anatomical shunt e.g. ventricular septal defect (VSD) blood can pass from right ventricle to left ventricle directly, bypassing the lungs.
Physiological shunt e.g. lobar collapse, blood passes through non-ventilated alveoli.

71
Q

What is total lung capacity (TLC)?

A

The volume of air in the lungs upon the maximum effort of inspiration. Average = 6L.

72
Q

What is residual lung volume?

A

The volume of air remaining in the lungs after maximum forceful expiration, keeps the alveoli open at all times.

73
Q

What is the vital capacity of the lungs?

A

The maximum volume of air exhaled during a forced exhalation after a forced inhalation.

74
Q

What is tidal volume?

A

The amount of air that moves in or out of the lungs with each respiratory cycle.
Males = 500ml average.
Females = 400ml average.

75
Q

What is FEV1 and FVC? How are they measured?

A

FEV1 = Forced Expiratory Volume in 1 second.
FVC = Forced Vital Capacity.
Measured using a spirometry.

76
Q

How do you measure residual lung volume?

A

Difficult to measure, need to use gas dilution or total body plethysmography.

77
Q

In spirometry, what abnormal value diagnoses an obstruction?

A

FEV1/FVC <0.7

78
Q

In spirometry, what abnormal value diagnoses a restriction?

A

FVC of <80% predicted value.

79
Q

In the bicarbonate buffer system, what happens to CO2 + H2O if pH is high (alkalosis/not enough hydrogen ions)?

A

Carbonic anhydrase catalysis the combination of CO2 + H2O, to form carbonic acid (H2CO3), a weak acid that easily dissociates into hydrogen ions and bicarbonate.
Bicarbonate can then be secreted in the urine by the kidneys.

CO2 + H2O <-> H2CO3 <-> H + HCO3

80
Q

In the bicarbonate buffer system, what happens to hydrogen ions and bicarbonate if pH is low (acidosis/too many hydrogen ions)?

A

Hydrogen ions and bicarbonate combine to form carbonic acid, which can then dissociate into carbon dioxide and water. Carbon dioxide can then be removed by the lungs.

CO2 + H2O <-> H2CO3 <-> H + HCO3

Phase 1 (11 decks)

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