L15: Neurological And Vascular Aspects

Question 1

What detects the changes in pac02

Answer 1

Central chemoreceptors

Question 2

where are central chemoreceptors located

Answer 2

In medulla oblongata

Question 3

What detects the changes to pao2 and blood ph

Answer 3

Peripheral chemoreceptors

Question 4

Where are peripheral chemoreceptors located

Answer 4

In carotid/aortic arch

Question 5

Where does the chemoreceptors in the medulla oblongata and carotid/aortic arch send nerve supply to

Answer 5

Brainstem respiratory centre

Question 6

What does the brainstem respiratory centre do

Answer 6

Change the activity of the muscles to change alveolar ventilation and respond the the changes in blood

Question 7

Describe what happens when the we excercise and paco2 increases and pao2 decreases

Answer 7

1) changes are detected by central chemoreceptors and peripheral chemoreceptors
2) signal is sent to the brainstem respiratory centre
3) signal is sent to the diaphragm and intercostal muscle to increase the rate of ventilation
3) carbon dioxide levels drop and oxygen levels increase

Question 8

What does injury to the brain most likely to result in

Answer 8

Affect breathing

Question 9

What can a tumour in the brainstem cause

Answer 9

Pressure on the medulla oblongata so chemoreceptors are blocked off and breathing stops

Question 10

What other brainstem lesions can compress the brain

Answer 10

Haemorrhage (bleeding)

Ischaemia

Question 11

What is ischaemia

Answer 11

Swelling of the brain

Question 12

What type of drugs can affect breathing

Answer 12

Sedative drugs

Question 13

What do sedative drugs do

Answer 13

Reduce the respiratory drive

Reduce ventilation

Question 14

Example of sedative drugs

Answer 14

Morphine
Opiates
Benzodiazepines

Question 15

What are sedative drugs

Answer 15

A group of drugs that slow down brain activity

Question 16

What other diseases can affect ventilation

Answer 16

Neuromuscular disease

Question 17

Examples of neuromuscular disease

Answer 17

Motor neurone disease

Duschennes muscular dystrophy

Question 18

What is motor neurone disease

Answer 18

Degeneration of ventral horns in the spinal cord where the upper motor neurone and lower motor neurone meet

Question 19

Where does the symptoms for motor neurone disease usually start

Answer 19

Limbs

Swallowing muscles

Question 20

In terms of IRM what does motor neurone disease result in

Answer 20

Diaphragm weakness

Poor swallowing

Question 21

What does diaphragmatic weakness cause

Answer 21

Respiratory failure

Question 22

What does poor swallowing cause

Answer 22

Recurrent aspiration

Question 23

How do we manage respiratory failure in motor neurone disease

Answer 23

it cannot but reversed but breathing can be supported by:

Non invasive ventilation

Question 24

What does nan invasive ventilation do

Answer 24

Reduce arterial carbon dioxide

Question 25

What happens to our muscles when we sleep

Answer 25

Relax

Question 26

What can relaxation of big muscles cause during our sleep

Answer 26

Airway obstruction (sleep apnoea)

Question 27

What is the REM sleep

Answer 27

Muscle tone decreases | Sympathetic NS activity increases

Question 28

What happens to the oxygen levels in obstructive sleep apnoea

Answer 28

Oxygen levels drop more than 3%

Question 29

What happens to the sympathetic nervous system activity during obstructive sleep apnoea

Answer 29

Increases

Question 30

What are the clinical features with obstructive sleep apnoea

Answer 30

``` Obesity Craniofacial abnormalities Snoring Daytime sleepiness Choking overnight Morning headaches ```

Question 31

What are the conditions that can affect face structures causing obstructive sleep apnoea

Answer 31

Down’s syndrome Acromegaly Micrognathia in treacher Collins syndrome

Question 32

What is micrognathia in treacher Collins syndrome

Answer 32

Small jaw

Question 33

How do we manage obstructive sleep apnea

Answer 33

Fix face abnormalities if possible | Continuous positive pressure (face mask)

Question 34

What are the common pulmonary vascular disease

Answer 34

Pulmonary embolism | Pulmonary hypertension

Question 35

What is pulmonary embolism

Answer 35

Clots within the pulmonary vasculature

Question 36

What are the symptoms of pulmonary embolism

Answer 36

Pleuritic chest pain Dyspnoea Haemoptysis

Question 37

What are the causes of pulmonary embolism

Answer 37

``` Post surgery Immobility Malignancy Pregnancy Smoking ```

Question 38

How do we diagnose pulmonary embolism

Answer 38

Use a scoring system

Question 39

What does the scoring system involve

Answer 39

Symptoms No likely alternative diagnosis Risk factors

Question 40

When do we investigate for a pulmonary embolism

Answer 40

When the score is high based from the scoring system

Question 41

How do we diagnose pulmonary embolism

Answer 41

ECG Chest x-ray CT pulmonary angiogram Ventilation perfusion scan

Question 42

What does a pulmonary embolism chest x-ray show

Answer 42

``` Atelactasis Small effusion Pleural based wedge Some areas look darker than normal side Multiple cavities ```

Question 43

what will a pulmonary embolism CT pulmonary angiogram show

Answer 43

Thrombus

Question 44

What will a ventilation perfusion (VQ) scan show in pulmonary embolism

Answer 44

VQ mismatch

Question 45

How do we manage pulmonary embolism

Answer 45

Get rid of clot Thrombolysis Anticoagulation

Question 46

What is anticaoagulation

Answer 46

Blood thinner

Question 47

Examples of anticoagulation

Answer 47

Warfarin LMWH NOACS

Question 48

What is pulmonary hypertension

Answer 48

Pulmonary artery is greater than 25mmHg

Question 49

Symptoms of pulmonary arterial hypertension

Answer 49

Breathlessness Fatigue Right heart failure Loud 2nd heart sound

Question 50

What causes pulmonary arterial hypertension

Answer 50

thromboembolic disease (clots) Chronic lung disease Idiopathic Left sided heart

Question 51

How do we investigate pulmonary arterial hypertension

Answer 51

ECG | CT scan