HUMAN FUNCTIONING CARDIORESP Flashcards

Question

What is acute respiratory alkalosis?

Answer 1

Caused by hyperventilation eg anxiety, pain, heart failure Increase in pH and decrease in pressure of carbon dioxide

Answer 2

Chronic respiratpry acidosis - HCO3 and BE levels increase (less excreted in urine to reduce acidity) Chronic respiratory alkalosis - HCO3 and BE levels decrease (more excreted in acidity) Metabolic acidosis - hyperventilation to reduce PaCO2 (reducing acid in the blood) Metabolic alkalosis - hypoventilation to increase PaCO2 (increases acid in the blood)

Answer 3

Chronic inflammatory disease of the respitory system characterised by reversible airflow obstructions, characterised by bronchial hyperresponsiveness and bronchial inflammation. The airways have hypertrophied smooth muscle which contract spontaneously or in response to a triggering factor, hypertrophy of the mucus glands, odema of the bronchial wall, infiltration of white blood cells

Answer 4

Extrinsic asthma (allergic) - pollen, dust, pests Intrinsic asthma - (non allergic), viral infections, cold air, GERD (acid reflex), medication eg beta blockers, NSAIDS Childhood exposure to second hand smoke increases risk

Answer 5

Persistent dry cough Shortness of breath Chest tightness (tight bronchioles) Expiratory wheezes (hard for air to get out of the lungs) Hyperresonant lung percussion

Answer 6

For patients over 5: Typical clinical features of asthma, demonstration of reversible bronchoconstriction eg pulmonary function tests, spirometry (might struggle to exhale deeply, forced expiration is less) Asthma is reversible so symptoms might not always show. In this case can do a bronchial provocation test that provoke bronchoconstriction eg melacholine test then spirometry or exercise then test (risk) COPD will also show similar results in spirometry. COPD will usually have baeline obstruction ALL the time as opposed to SOME of the time. Can also do the bronchodilation reversibility test - albulerol will cause bronchodilation so spirometry will increase. In COPD patients there will be no/less change.

Answer 7

Intermittent asthma - symptoms less than twice per week, wake up less than 2 times per month, use of SABA less than 2 days per week. Lung function - forced expiratory volume less than 80%. Treated with SABA inhaler eg albuterol. Rescue inhaler. Persistent asthma: mild persistent, moderate persistent and severe persistent asthma Mild persistent - more than twice per week, waking up at night 3-4 times per month. FEV1 greater than 80% Moderate persistent - symptoms daily, waking up more than once per week. FEV1 - 60% - 80% Severe persistent - daily symptoms, waking up every night, extreme limitation. FEV1 less than 60%.

Answer 8

Mild persistent: daily therapy, low dose ICS eg budesonide. Rescue therapy SABA Moderate perisstent: daily therapy with low dose ICS and formoterol inhaler (daily and rescue). Or ICS and LABA or ICS and LAMA or ICS and LIRA Severe persistent - daily therapy ICS LABA and LAMA Bronchodilators Steroids Management of breathlessness Management of infections Management of trigger factors Management of exacerbations

Answer 9

An iireversible obstructive lung disease Risk factors - smoking for more than 30 years due to chronic destruction of lungs, exposure to chemicals, fumes and smoke 2 types: emphysema (pink puffer) - difficulty breathing, damage to alveoli loss of lung elasticity and inflation. loss of surfactatnt so loss of recoil. air trapping PINK - pink skin and pursed lip breathing, barrel chest, no chronic cough, keep of tripoding. Symptoms - Dyspnea at rest, weight loss, prolonged expiration, clubbing fingers Complications - frequent infections, risk for pneumothorax Enlarged air spaces and alveoli distal to the bronchial, and destruction of the walls of the air spaces. Loss of elastic tissue leads to floppy airways that collapse as the person breathes out. Makes it hard for them to breathe in as the inspiratory muscles have to overcome this positive pressure. Also causes CO2 to get trapped in the airways, so O2 can't get into the blood. and chronic bronchitis (blue bloater) - inflammation of the bronchi, excessive musus production, reaccuring infectiod and hacking cough BLUE - big and blue skin (cyanosis due to hypoxia (low oxygen)), obese, increase in red blood cells in the body which can cause blood clots due to vasocontriction (must report this), long term chronic cough and sputum, unusual lung sounds (crackles and wheezes), edema peripherally Right side heart failure rocks the body with fluid = edema and weight gain Decreased O2 saturation levels 88-93% Arterial blood gays- low oxygen and height carbon dioxide Low paO2 = hypoxia high paco2 = hypercapnic Will generally show increased acidosis (high co2 puts the body into acidocic state) Use biPAP for hypercapnia (not inhaler)

Answer 10

Inflammation of the pleural lining after a chest infection, sharp pain worsen by breathing and coughing

Answer 11

A difficulty breathing occuring at a level of activity where it would not be expected Some problems with identifying breathlessness include: No specialised receptors No identified area of the cortex No single easily identifiable stimulus (metabolic work, increased airways resistance, change in ABG's or weak/fatigued muscles) Very subjective, sensation - based on experience and personality

Answer 12

Rapid breathing

Answer 13

Ventilation in excess of metabolic requirements

Answer 14

Orthopnoea - short of breath when lying flat Paroxysmal nocturnal dyspnoea (PND) Short of breath at rest (SOBAR) Short of breath on exertion (SOBOE)

Answer 15

Added load on the mechanics of breathing eg during exercise Pshycogenic factors Weakness or fatigue of respiratory muscles Low CO2 or ischaemia Increase in ventilatory requirements Cardiovascular and respiratory deconditioning Blood gas abnormalities Perfusion limitation

Answer 16

Motor command theory - sense of effort: increases whenever the central command to the respiratory muscles must be increased eg when the muscle load is increased, when muscles are weak or to increase lung volume Length-tension theory - the brain expects a certain pattern of ventilation and deviations from this pattern can lead to the sensation of dyspnea. Mechanoreceptors - upper airway receptors may modify the sensation, lung receptors (irritant receptors) may give the sensation of tightness or constriction. Chest wall receptors: a disturbance between the force generated by the respiratory muscles and the resulting change in muscle length and lung volume may lead to dyspnea Pshychological/Emotional factors Chemoreceptors - hypoxia and breathlessness are not necesarily related, hypercapnia has been shown to cause dyspnoea

Answer 17

Chronic obstructive Pulmonary disease COPD Asthma Cystic fibrosis Bronchiectasis Primary ciliary Dyskinesia

Answer 18

Intersitial lung disease Neuromuscular disease Pleural effusion Pneumothorax Pneumonia

Answer 19

Shortness of breath Chronic cough Poor exercise tolerance Evidence of airway destruction Over inflated lungs Impaired gas exchange

Answer 20

Within the airways lumen - partly occluded by the presecen of excessive secretions as in chronic bronchitis, bronchiectasis and cystic fibrosis (reversible as airways can be cleared of secretions) The airway wall - partly occluded because of a decrease in the size of the airway wall, might be due to increase in contraction of bronchial smooth muscle eg asthma, hypertrophy of the mucous glands eg chronic bronchitis or inflammation (reversible if bronchspasm or inflammation, irreversible if due to scarring) Outside the airway - partly occluded due to destruction of the lung parenchyma (lung tissue) may cause loss of elasticity eg emphysema. (iireversible if changed in airway structure take place)

Answer 21

The bronchioles become less elastic and narrow when exhalation occurs. This reduced elasticity and inflammatory process causes the airways to narrow and collapse. A a result, CO2 gets trapped in the airways and prevents O2 from getting into the blood. This can cause mucus to also become trapped, which can lead to atelectais (airway collapse) and is a source of infection.

Answer 22

Centriacinar/Pentrilobular: Predominantly respiratory bronchioles More severe in upper zones Clasically seen in smokers Usually in association with chronic bronchitis Panacinar/Panlobular: Involved the whole ancinus (bronchioles, alveolar ducts and the alveoli sacs) Uniform throughout the lung or more severe at the bases Antitrypsin deficiency and early development of panacinar emphysema Emphysema is characterised by destruction of alveoli so hat there is a permenant dilation of airspaces. Bulla are large dilated airspaces that bulge out from beneath the pleura. Categoriased as anythingt hat degrades the alveoli eg bronchitis, asthma and TB

Answer 23

Anything that degrades the alveoli walls, eg bronchitis, asthma and TB, heavily polluted air and prolonged exposure to certain dusts and genetic makeup Reduced elasticity and inflmmatory process causes the airways to narrow and collapse (due to an antitrypsin deficiency which causes a loss of elastin and alveolar wall destruction Results in carbon dioxide gets trapped in the airways and prevents oxygen from getting into the blood There is no cure for emphysema Permenant dilation of lung spaces (bulla are large dilated airspaces that bulge out beneath the pleura

Answer 24

Pink puffer: maintains normal blood gases, severe breathlessness, weight loss enxiety, physical tension, over expanded chest (emphysema?? Blue bloater: not normal blood gas levels, less breathless, nocturnal hypozmia, bloated, double the mortality of pink puffer, chronic cough, normally long term smoker, signs of fluid retention eg swollen ankles

Answer 25

Characterised by an excessive production of mucus in the bronchial tree

Answer 26

In chronic hypoxia the airways constrict as they detect low oxygen levels This causes an increased blood pressure in the pulmonary circulation The heart has to contract more strongly to pump the blood around the body The right ventricel is not as muscular as the left so hypertrophies to compensate Causes left ventricle to also hypertrophy, and the ventricles begin to fail Results in oedema (build up of fluid) Polycythemia also occurs but increases the tickness of blood which increases resistance to circulation

Answer 27

Avoidance Antibiotics Anti-inflammatory drugs Bronchodilators Pulmonary rehab (exercise) Coping strategies for breathlessness Chest clearence Long term oxygen therapy Assisted ventilation

Answer 28

Affects electrolyte and water transport in and out of body cells. This allows too much salt and not enough water into cells causing a thick sticky mucus. The function of chloride channels are affected, which results in cells that line the passageway of the lungs, pancreas producing unusually thick and sticky mucus. Mucus leads to bacterial infections, which leads to progressive lung damage as dying neutophils release DNA whose strands bind together and further thicken the mucus. Clinical features: Cough and mucus, bronchiectasis (widening of the lungs airways), delayed puberty or infertility in males, breathlessness, pleuritic pain, pneumothoraces, malnourishment

Answer 29

An uncoordinated cilia beat (the cilia waft in different directions). Leads to excess secretions and recurrent infections

Answer 30

Chronic irreversible and distortion and dilation of the bronchi Associated with persistant lung infections, foreign body inhalation, CF, TB, inhalation injury The airways tend to collapse, causing a pressure drop along floppy airways, and debris tend to remain in dilated sacs, so cough clearence is greatly impaired. Increase airway resistance. Airways become colonised with bacteria/ (not a final diagnosis, but a common pathway of several conditions, eg developed by CF and COPD patients). Clinical features: Voluminous amounts of sputum Foul smelling and haemoptysis Fatigue, loss of eppetite Dyspnoea Chronic lung infection Possibility of heart failure Antibiotics can help control infection, and steroids can asisst inflammation. Mucolytics help thin mucus. Surgical resurection or transplant may be needed.

Answer 31

Characterised by decreased lung volume, poor lung compliance, and increased work of breathing. Causes: shrunken lung tissue, compressed lung tissue within the chest wall, compressed lung tissue by the chest wall, reduced ability to expand the lung.

Answer 32

Disease that affect the supporting structures of the lunngs rather than the airpspaces Inflammatory changes lead to alveolitis fibrosis, thickening and remodelling of lung tissue leading to shrunk and stiff lungs Thickening of the interstitium of the alveolar walls Increased work of breathing and impaired gas exchange Covers 200 disorders

Answer 33

Fibrosing alveolitis/pulmonary fibrosis - crackles heard, finger clubbing potential, maybe cor pulmonale: cause is unknown or spontaneous Lung fibrosis - the fibrous lung tissue scars and reduces the elastic properties. Small lung volumes requiring abnormally high pressure to inflate. Airways narrow when lung volume reduces. Bronchioles dilate and are surrounded by thick scar tissue: hypoxia, impaired diffusion, shallow breathes

Answer 34

Steroids -often fibrosis is established so use is limited Collagen inhibitors O2 therapy - needed in later stages, especially when exercising Non-invasive ventilation - invasive is avoided as this can further reduce lung compliance Lung transplant

Answer 35

Pleural effusion - excess fluid in the pleural cavity disturbing hydrostatic pressure, reduces expansion. If the drained fluid is straw colour indicates due to heart failure, cloudy indicates malignancy Pneumothorax - trauma, need to restore negatuve pressure in pleural space. Air will enter the pleural space in inspiration but cannot escape during expiration. In a tension pneumothorax, air from ruptured lung enters pleural cavity, building up pressure, compressing lung and displacing organs to the other side of the chest. Pleurisy - inflammation of the pleural layers due to infection, associate with pneomonia. Can hear pleural friction rub on ascultation, sharp pleural pain

Answer 36

Scoliosis Kyphoscoliosis Ankylosing Spondylitis Reduces chest capacity Prone to chest infections/pneumonia May need non invasive ventilation Thoracic mobility exercises Mortality due to respiratory failure A distorted spine increases work of breathing because of reduced chest wall compliance, micro atelectasis and altered alveolar surface tension. Resiratory muscles may also be forced to work inefficiently. An effective cough might also be difficult.

Answer 37

Weak inspiratory muscles restrict expansion eg polio Sputum clearence is impaired due to weak cough

Answer 38

Infective or chemical agents inflame lung tissue and then fill alveoli with extudate eg pneumonia Dry cough that can become productive of purulent and maybe blood stained

Answer 39

Bacterial, viral or fungal infection in the alveoli Bronchi become inflammed and fill with fluid Flu like symptoms It is an acute respiratory tract infection The lung fills with liquid and solidifies Aspiration pneumonia occurs when there is an inhalation of any unwanted substance into the lungs. It is common in neuromuscular disease due to poor gag reflex

Answer 40

Caused by bacteria, contagious spread through the air, propelling TB germs, can lie dormant for years until immune system is weakeened Symptoms: fever, night sweats, persistent cough, weight loss and haemoptysis. Disease causes damage to the lung tissue and pleural effusion may develop which leads to severe breathlessness The infection can spread to the blood stream and cause sepsis

Answer 41

Necrosis (death of cells) of pulmonary tissue and the formation of cavities. Oral bacteria, fould smelling secretions and daemoptysis.

Answer 42

Small cell lung cancer: highly malignant, most viscious and rapidly spreading Non-small cell: - Squamous cell carcinoma: most common type, develops in the cells which line the airways, most often caused by smoking. - Adenocarcinoma: develops from the cells which produce mucus in the lining of the airways Large cell carcinoma: large, rounded cells, occurs in peripheral lung tissue Smoking is the main cause. Air pollution, asbestos, TB, COPD, Radon exposure and cerrain occupations increase risk Symptoms: haemoptysis, pleural effusion, hoarseness of voice, chest infections, pain and cough, anaemia, weight loss and fatigue. Mesotheliaoma: cancer that forms in the mesothelium, caused by asbestos.

Answer 43

Totoal blockage of the throat as the muscles relax Apnoea (lack of breathinn lasting 10 seconds) Obesity is the main risk factor Snoring and interrupted sleep Daytime sleepiness, headaches and poor memory May require nocturnal ventilation

Answer 44

Oxyegn and nutrient transport Waste removal - ensures elimination of metabolic byproducts Thermrugulation Supports the immune system - transport white blood cells to initiate immunological response. Hormone transportation pH Level Maintainence Blood pressure regulation Nutrient storage and distritbution

Answer 45

Encased in the mediastinum Aortic arch sits level with 1st rib The apex sits between 4th and 5th ribs on the left side of chest

Answer 46

Small striated and branching with single nucleus Each cell connected to neighbour by intercalated discs - a synytium. Allows passage of electrical currents and small molecules between adjacent cells (controlled by the metabolic state of cells) Involuntary control Involuntary contractions that are coordinated and rhythmed Capacity to contract in a rythmic manner in the absence of external stimuli.

Answer 47

4 heart valves - tricuspid - pulmonary semilunar - mitral (bicuspid) - aortic (semilunar) Purpose is to prevent backflow of blood and to keep blood flowing in one direction.

Answer 48

Viscous Temperature is 38 degrees pH is 7.35 - 7.45 (slightly alkaline) Salt concentration is 0.9% 8% of total body weight - male av 5-6 litres - female av 4-5 litres

Answer 49

Fomed elements (cells and cell like structures) make up 45% Plasma (liquid that contains dissolved substances) is 55% of blood

Answer 50

A continuous system - systemic circulation, ox blood from heart to body - pulmonary circulation, blood from heart to lungs Blood flows with almost no resistance in larger vessels Considerable resistance exists in smaller vessels (poiseuilles law)

Answer 51

Both include: - a distributary system - a variable resistance system - an exchange system - a collecting system

Answer 52

Distributes metabolites and oxygen Collect waste products and carbon dioxide Regulation of BP Pulsatile through arterioles 3/4 of blood volume found in systemic circulation 2/3 of blood in veins Involved in thermoregulation and distribution of hormones

Answer 53

Respiration; gas exchange Reservoir of blood available to L side of heart to allow increase in CO A filter for small thrombi

Answer 54

Right atrium - deox blood from body enters the heart Right ventricle - the right atrium contracts and forces blood into right ventricle Pulmonary artery - right ventricle contracts and supplies the lungs with deox blood via pulmonary artery Lungs - blood receives O2 in the lungs and releases CO2. Left atrium - ox blood returns to the heart via the left atrium. Left ventricle - left atrium contracts and forces blood into the left ventricle Aorta - the left ventricle contracts and distributes oxygenated blood via the aorta throughout the body. Tissues - nutrients and oxygen are transported to the tissues of the body. Vena Cava - the cycle is restarted when deox blood returns to the heart via the superior and inferior vena cava.

Answer 55

Pertaining to the systole aspect of the cardiac cycle (heart contraction)

Answer 56

Pertaining to the diastole aspect of the cardiac cycle (heart relaxation)

Answer 57

Volume of blood in the ventricle at the end of diastole

Answer 58

Volume of blood in the ventricle at the end of systole.

Answer 59

Volume of blood pumped by the heart in one minute.

Answer 60

Volume of blood pumped by the heart each contraction.

Answer 61

The period from the end of one contraction of the heart to the end of the next Each cycle is generated by a spontaneous action potential (AP) generated by the Sinoatrial Node.

Answer 62

A brief change in voltage (membrane potential) across the cell membrane of heart cells Action potential arises from specialised pacemaker cells These cells have autonomic action potential generation capability and are found in the SA node in the right atrium The action potential passes along the cell membrane, causing the cell to contract, and is essential for stimulating and maintaining regular contractions of the heart.

Answer 63

Specialised groups of cells within the heart capable to spontaneously generate action potentials. - SA node and AV node - Purkinje fibres Atrial and ventricular muscle cells have high resting potentials and show no spontaneous activity.

Answer 64

The AP spreads rapidly through both atria Contraction of atrial muscle Stimulation of the AV node (a delay of 0.1 seconds at the AV node allows ventricular filling.

Answer 65

Atrium is still in diastole Blood flows from venous system into atrium increasing pressure Atrial pressure is greater than ventricular pressure so AV valve opens Blood flows passively into ventricle so volume increases The SA node fires The AP spreads throughout the atris and the atria contract (atrial systole) Increased atrial pressure so more blood into the ventricles Ventricular pressure increases AV valves open trhoughout atrial systole Ventricular contraction at end of ventricular diastole Volume of blood in ventricles known as end diastolic volume.

Answer 66

After AV valve closure and before aortic valve opening. The ventricle is effectively a closed cell. (first stage in the cycle) Isovolumetric Ventricular Relaxation is the second time all valves are shut.

Answer 67

The study of the body's response to any form f physical activity or exercise Aute exercise Chronic exercise eg repeated bouts Response to environ Response if different pops

Answer 68

Arteriovenous oxygen difference is the difference in the oxygen content of the blood between the arterial blood and venous blood. It is a good way of seeing how much O2 is delivered and used by muscle.

Answer 69

The highest rate of oxygen consumption attainable during maximal or exhaustive exercise.

Answer 70

The amount of air that moves in or out of the lungs with each respiratory cycle (normal breath)

Answer 71

12-15 breaths per minute at rest

Answer 72

The process of inspiration and expiration, for a young adult averages 5-6 litres per minute. Pulmonary ventilation = respiratory rate x tidal volume.

HUMAN FUNCTIONING CARDIORESP Flashcards

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