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MBBS1 Thorax > Frank's Small Lungs > Flashcards

Frank's Small Lungs Flashcards

1
Q

What is the costodiaphragmatic recess?

A

The narrow gap between periphery of diaphragm and chest wall

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2
Q

What is residual volume?

A

The volume left in the lungs after the maximum breath out

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3
Q

What are well defined airways of the lung at the margin on a CT a sign of?

A

Pulmonary fibrosis

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4
Q

Where is myoglobin found?

A

In muscle

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5
Q

What is expiratory reserve volume?

A

The difference in volume between a full breath in and a normal breath out

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6
Q

What kind of joint are costochondral joints?

A

Synovial

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7
Q

When does lung compliance decrease in a healthy lung?

A

At low and high volumes

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8
Q

What anti-infection substances does mucus contain?

A

IgA, lysozyme and anti-trypsins

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9
Q

What bounds the thoracic space laterally?

A

The ribs

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10
Q

What is the relationship between temperature and solubility when gases dissolve in fluid?

A

The solubility of gas decreases with a rise in temperature (for example, gets more humid in hotter weather)

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11
Q

What bounds the thoracic space anteriorly?

A

The sternum

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12
Q

What is the posterior limit of the nasal cavities?

A

Nasopharynx

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13
Q

Where does pleura change from parietal to viscera pleura?

A

At the main bronchi

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14
Q

Why does haemoglobin release O2 when it reaches the tissues?

A

Lower PO2, higher temperature, high CO2 and acid levels decreasing affinity of haemoglobin for O2

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15
Q

How many lobes does the right lung have?

A

3

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16
Q

What does interstitial lung disease refer do?

A

Abnormal material between the airways

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17
Q

Does change partial pressure or concentration cause movement of gas?

A

Partial pressure

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18
Q

Where do costalchrondral joints arise from?

A

Ribs 8-10

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19
Q

Is normal breathing effort dependent or independent?

A

Effort dependent as inter pleural pressure is negative throughout

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20
Q

Which are the false ribs?

A

8-12

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21
Q

What forms the costal margin?

A

Anterior, inferior limit of the rib cage

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22
Q

What feature is typical of all thoracic vertebrae?

A

A transverse process

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23
Q

Where does pleura change from visceral to parietal?

A

At the main bronchi

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24
Q

What is happening when crackles are heard on listening to the lungs via stethoscope?

A

Airways are collapsing in expiration and snapping back open as pressure equalises in inspiration. Fineness or coarseness of crackle corresponds to size of the airway.

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25
Q

Which dermatome supplies the nipple?

A

T4

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26
Q

What O2 saturation is a sign of cyanosis?

A

85-90%

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27
Q

Where does the neurovascular bundle lie?

A

On the interior aspect of the rib

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28
Q

When will breathing 100% O2 or hyperventilation help a patient?

A

If they are at high altitude (breathing low PO2) or hypoxic

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29
Q

Where is mixed venous blood taken from?

A

The pulmonary artery, it is the best ‘average’

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30
Q

What is Dalton’s law?

A

The partial pressure of gas in a mixture is the pressure it would exert if it occupied the volume alone. It is expressed as fractional concentration (FO2) x barometric pressure (atm)

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31
Q

What is dynamic compliance?

A

Compliance of lung at any time during air movement

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32
Q

What kind of joint is the 1st sternocostal joint?

A

Primary cartilaginous

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33
Q

What do aryepiglottic muscles form?

A

A sphincter of the airways

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34
Q

Which ribs are atypical?

A

1st, 2nd, 11th 12th and occasionally 10th

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35
Q

How many segments does each lung have?

A

8-10

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36
Q

Where do internal intercostal arteries arise from?

A

Subclavian arteries

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37
Q

How does fibrosis affect elastic recoil?

A

Increases it

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38
Q

Where do anterior rami of the thoracic spinal nerves supply?

A

Intrinsic muscles of the chest and associated skin

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39
Q

What happens during pnemothorax?

A

If there is a breach of parietal pleura, air will rush into the inter pleural space ,as it usually has negative pressure, which causes an uncoupling of the lung from the chest wall often called collapsed lung as lung is unable to inflate properly

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40
Q

What is the blood supply of the anterior thoracic wall?

A

Anterior intercostal arteries from the internal thoracic arteries

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41
Q

What is PCO2 of atmospheric air?

A

0 kPa

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42
Q

What are intercostal nerves in relation to thoracic spinal nerves?

A

The anterior rami

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43
Q

Which dermatome supplies the anterior superior part of the chest?

A

C4

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44
Q

How far does the diaphragm descend in inspiration?

A

6 cm

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45
Q

What is the Haldane effect?

A

At any given PO2, the quantity of CO2 carried is greater in deoxygenated blood than oxygenated blood. This is because Hb forms carbamino compounds more easily, and is a better buffer when deoxygenated.

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46
Q

Where do internal thoracic arteries arise from?

A

Subclavian arteries

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47
Q

What passes through the thoracic inlet?

A

Common carotid artery, oesophagus, trachea and internal jugular vein

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48
Q

What is resting tidal volume?

A

Volume drawn in for normal breath

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49
Q

How does HCO3- move out of haemoglobin?

A

Out of cell down concentration gradient and exchanged for Cl- using HCO3-/Cl- antiporter

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50
Q

Where are the blood vessels and nerves and how are they arranged in the intercostal neurovascular bundle?

A

In the subcostal groove between innermost and internal intercostal muscle, lies the neurovascular buncle which is arranged from superior to inferior:
Vein
Artery
Nerve

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51
Q

How much space does 1 mol of an ideal gas occupy at 1 atm pressure?

A

22.4L

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52
Q

Which nerves supply parietal pleura?

A

Intercostals

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53
Q

How do pulmonary veins lie at the hilum?

A

Anterioinferior

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54
Q

What is the diffusing capacity (or transfer factor) of a gas?

A

The permeability of the lungs to a given gas x area. A measure of alveolar/capillary membrane function

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55
Q

What is PO2 of atmospheric air?

A

21 kPa

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56
Q

What forms the costal margin?

A

Anterior, inferior limit of the rib cage

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57
Q

What is thoracic outlet syndrome? What is the cause, what are the symptoms?

A

Caused by compression of neurovasculature passing through the thoracic INLET perhaps by an extra (cervical) rib, apical lung cancer or old fracture of the clavicle. Symptoms are pain, weakness, numbness, tingling, swelling, fatigue or coldness in the forearm or hand

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58
Q

What do type I pneumocytes do?

A

Gas exchange

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59
Q

What do normal lungs sound like on percussion?

A

Resonant

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60
Q

Where do intercostal nerves supply?

A

Intrinsic muscles, parietal pleura, fascia and skin.

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61
Q

How do some diseased lungs sound on percussion?

A

Dull

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62
Q

What is La Place’s law?

A

That pressure is proportional to surface tension divided by radius

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63
Q

What does interstitial lung disease refer to?

A

Abnormal material between airways

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64
Q

Where do posterior rami of the thoracic spinal nerves supply?

A

Post-vertebral muscles of chest and skin overlying these

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65
Q

What is haemoglobin concentration in normals blood?

A

150g/L

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66
Q

What is the nasal epithelium?

A

Pseudostratified columner ciliated epithelium

67
Q

Why does hyperventilation or breathing 100% not usually increase O2 delivery to tissues?

A

Because haemoglobin is usually fully saturated with O2 anyway so raising PO2 will only be able to increase O2 dissolved in plasma a little.

68
Q

What is the large muscle covering the anterior superior part of the rib cage called?

A

Pectoralis major

69
Q

What kind of joint are the costochondral joints?

A

Synovial

70
Q

What state must iron be in to bind with O2?

A

Ferrous (Fe2+) not ferric (Fe3+)

71
Q

Which nerve supplies mediastinal and diaphragmatic pleura?

A

Phrenic

72
Q

How much more soluble in water is CO2 than O2?

A

20 x

73
Q

Which patients is cyanosis difficult to detect in?

A

Anaemic patients, as they have few haemoglobin so they must be severely hypoxic before a blue tinge will show

74
Q

What are the extrinsic muscles of the anterior chest wall?

A

Pectoralis major and minor and serratus anterior

75
Q

What kind of joint is the 2nd sternocostal joint?

A

Synovial

76
Q

Where should a needle through the rib cage be placed?

A

In the middle of intercostal space

77
Q

What is total lung capacity?

A

The whole volume of the lungs

78
Q

Where does pharynx become oesophagus?

A

At the posterio-inferior limit

79
Q

What is alveolar dead space?

A

Pathological, the volume of alveoli which can no longer exchange in gas exchange due to damage

80
Q

What type of joint with what kind of movement is the manubrio-sternal joint in adults?

A

Symphysis with hinge movement

81
Q

Where do bronchial veins drain?

A

Into the pulmonary veins

82
Q

What kind of joint is the manubro sternal joint?

A

Symphysis

83
Q

What kind of joint is the first sternocostal joint?

A

Primary cartilagious

84
Q

How is the first rib anchored into place?

A

By the scalene muscles of the neck and sternocleidomastoid muscle of the head

85
Q

What are the intrinsic muscles of the anterior chest wall?

A

The external, internal and innermost intercostal muscles

86
Q

Which ribs do costochondral joints arise from?

A

8-10

87
Q

When is breathing effort independent?

A

As residual capacity is reached during breathing out, no amount of force will empty the lungs further as inter pleural pressure becomes more positive.

88
Q

What is the FEV1/FVC ratio in obstructive lung disease and why?

A

FEV1 reduced due to obstruction of air escaping the lungs so the FEV1/FVC ratio is reduced.

89
Q

What bounds the thoracic outlet?

A

T12 posteriorly, 12th then 11th rib. 10th, 9th, 8th, 7th costal cartilages (costal margin) and finally xiphisternal joint.

90
Q

Does HbF have lower or higher affinity for O2 than HbA? Why?

A

Higher so it can pick up O2 across the placenta

91
Q

What kind of joint is the second sternocostal joint?

A

Synovial

92
Q

Where are voice sounds produced?

A

Larynx

93
Q

What is Boyle’s law?

A

Volume of a gas is inversely proportional to pressure

94
Q

What is resonant percussion with absence of lung sounds a sign of?

A

Pneumothorax

95
Q

How can the radius of the airway be decreased?

A

Parasympathetic stimulation of B2 receptors or inflammatory mediators such as histamine, prostaglandins and leukotrienes

96
Q

What are the features of 1st and 2nd ribs?

A

Flatter than typical ribs with attachments for scalene muscles

97
Q

What is the O2 saturation of mixed venous blood at rest?

A

75%

98
Q

What is FEV1/FVC ratio in restrictive lung disease and why?

A

Normal as FEV1 and FVC are equally reduced due to fibrosis (or other non-obstructive pathology). The ratio may even be high due to increased FEV1 value because of the decreased lung compliance associated with fibrosis

99
Q

Which ribs do sternochondral joints arise from?

A

1-7

100
Q

What is the protein configuration of foetal haemoglobin?

A

2 alpha and 2 gamma chains

101
Q

What kind of joints are costotransverse and costovertebral joints?

A

Synovial

102
Q

How do bronchi lie at the hilum?

A

Posterior

103
Q

What effect does increasing the partial pressure of a gas mixed with liquid have?

A

Causes the gas to dissolve more in the liquid (and vice versa, for example, when opening a can of coke, the pressure decreases therefore the gas escapes audibly)

104
Q

What is vital capacity?

A

The total amount it is possible to breath in or out

105
Q

What is the fascia attached to parietal pleura?

A

Endothoracic fascia

106
Q

What is hypercapnia?

A

High PaCO2 due to hypoventilation

107
Q

Where do sternochrondral joints arise from?

A

Ribs 1-7

108
Q

Which nerve supplies mediastinal and diaphragmatic pleura?

A

Phrenic nerve

109
Q

How many binding sites for O2 does myoglobin have?

A

One

110
Q

Which thoracic vertebra are atypical?

A

T1, T10, T11, T12

111
Q

When is breathing effort dependent?

A

At the beginning of a breath out until residual capacity is reached, breathing out harder will increase flow

112
Q

Where do posterior intercostal arteries arise from?

A

Thoracic aorta

113
Q

Which part of chest is fixed on breathing?

A

Vertebral column only

114
Q

What protein chains does adult haemoglobin have?

A

2 alpha, 2 beta

115
Q

Why does the haemoglobin binding curve begin to plateau when it reaches 75% saturation with O2?

A

The O2 sites are getting used up on haemoglobin

116
Q

What do bronchial veins drain into?

A

Pulmonary veins

117
Q

What bounds the thoracic space posteriorly?

A

The thoracic vertebral column

118
Q

How does haemoglobin buffer CO2?

A

1) It forms carbamino compounds using CO2 at the N-terminals of it’s side chains arginine and lysine
2) Histidine residues accept protons from carbonic acid producing HCO3-

119
Q

What is PCO2 of alveolar air?

A

5.3 kPa

120
Q

What factors affect diffusion across the alveolar membrane and what laws govern these?

A

Fick’s law and Graham’s law - a large area and thin membrane will cause fastest diffusion

121
Q

Name some obstructive lung diseases

A

Asthma, COPD (emphysema, chronic bronchitis)

122
Q

What are well defined airways at the margins of the lung a sign of on a CT?

A

Pulmonary fibrosis

123
Q

What kind of joint is the manbro sternal joint in young adults?

A

A hinge joint

124
Q

What bounds the thoracic inlet?

A

T1, 1st rib and costal cartilage and upper margin of manubrium

125
Q

What features do typical ribs have?

A

A head with two articular facets, neck, tubercle, angle, tear-shaped shaft, subcostal groove and costal cartilage anteriorly

126
Q

What is static compliance?

A

Change in volume per unit of change in distending pressure (basically, can the lung expand with increasing pressures)

127
Q

Which dermatome supplies the umbilicus?

A

T10

128
Q

How many lobes does the left lung have?

A

2

129
Q

Where do anterior intercostal arteries arise from?

A

Internal thoracic arteries

130
Q

How is wheezing generated?

A

By turbulent flow in airways

131
Q

Where are the two joints each rib makes with it’s own thoracic vertebra?

A

Between the body of the vertebra and with the transverse process of the vertebra

132
Q

What are the joints that ribs make with vertebrae called?

A

Costotransverse and costovertebral joints

133
Q

What do type II pneumocytes do?

A

Secrete surfactant

134
Q

What is functional residual capacity?

A

The volume left in the lungs after a normal breath

135
Q

What is the large muscle that covers the anterior superior part of the rib cage on each side?

A

Pectoralis major

136
Q

Where does the epiglottis arise from?

A

Anterior of the larynx against the tongue

137
Q

Where do anterior intercostal arteries arise from?

A

Internal thoracic arteries

138
Q

What is atelectasis?

A

Collapsed alveloi

139
Q

What is Henry’s law?

A

For gases dissolved in fluid, dissolved gas concentration is equal to the partial pressure of gas above the fluid x solubility of that gas in that liquid

140
Q

How do healthy lungs sound on percussion?

A

Resonant

141
Q

Where is the cough centre?

A

Medulla

142
Q

Where is the neurovascular bundle located?

A

On the inferior aspect of the rib

143
Q

Where are voice sounds produced?

A

Larynx

144
Q

What is the blood supply of the posterior thoracic wall?

A

Posterior intercostal arteries from descending thoracic aorta

145
Q

What is peak expiratory flow rate and when will it be reduced?

A

The maximum speed of exhalation measured using a peak flow meter. It will decrease when airway resistance increased such as in obstructive lung disease

146
Q

What is anatomical dead space?

A

The volume of airway that does not undergo gas exchange even in healthy individuals e.g. trachea and bronchi

147
Q

What is meant by a ‘diffusion limited’ gas? Give an example

A

Limited only by the rate of diffusion over the alveolar/capillary membrane because the gas binds so avidly to haemoglobin that the rate of transfer at low concentrations is not dependant on blood flow. E.g. carbon monoxide

148
Q

Why is the haemoglobin binding curve steeper when it is 25% saturated with O2?

A

After the first O2 binds haemoglobin changes it’s configuration so it has a higher affinity for further O2 binding. Moves more to the relaxed state. Cooperative binding.

149
Q

Which are the true ribs?

A

1-7

150
Q

What is meant by a ‘perfusion limited’ gas?

A

A gas which is not so soluble, transfer depends on the amount of haemoglobin so increased blood flow will increase transfer

151
Q

What is Darcy’s law?

A

That flow is equal to (alveolar pressure - mouth pressure) divided by resistance to flow

152
Q

How far does visceral pleura extend inferolaterally?

A

As far as rib 8

153
Q

What is a feature of T10?

A

One demi facet on its body

154
Q

How does emphysema affect elastic recoil?

A

Decreases it

155
Q

If the diaphragm contracts which way will it move?

A

Downwards

156
Q

What is partial pressure?

A

The pressure that would be required to dissolve that amount of gas in the fluid according to Henry’s law.

157
Q

What is PO2 of alveolar air?

A

13.5 kPa

158
Q

What kind of bone is a rib?

A

Flat

159
Q

What features do typical thoracic vertebra have?

A

Heart shaped with two articular facets on either side. From the posterior of the body arises the vertebral arch (pedicles, pars, interarticulates, transverse processes, laminae and spine) There is a central intervertebral foramen for the spinal nerves

160
Q

What is Charles’s law?

A

Volume of a gas is proportional to absolute temperature

161
Q

Where do posterior intercostal arteries arise from?

A

Thoracic aorta

162
Q

How do pulmonary arteries lie at the hilum?

A

Anterior on R, superior on L

163
Q

What is the majority of CO2 carried as?

A

HC03- in plasma

MBBS1 Thorax (6 decks)

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