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Sem 2 > Lungs and respiratory system > Flashcards

Lungs and respiratory system Flashcards

1
Q

Valsalva manoeuvre is

A

forced expiration against a closed glottis

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2
Q

4 phases of valsalva manoeuvre

A

initial pressure rise, reduced venous return and compensation, pressure release, return of cardiac output

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3
Q

3 types of cycles for ventilators

A

pressure cycled, time cycled, volume cycled

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4
Q

ventilators can be invasive or

A

non-invasive

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5
Q

2 types of pressure ventilator

A

positive or negative pressure ventilators

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6
Q

main mechanism of action of positive pressure ventilators

A

increased pressure within airways - air pushed into trachea

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7
Q

two types of positive pressure ventilators

A

flow generator, pressure generator

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8
Q

flow generator usually used on

A

adults

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9
Q

pressure generator usually used on (2)

A

children, adults when control of peak airway pressure is important

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10
Q

flow generator produces known pattern of gas flow during

A

inspiration

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11
Q

in flow generator, lungs fill at rate entirely controlled by

A

ventilator

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12
Q

pressure generator produces preset pressure in airway and rate of lung inflation depends on pressure generated by ventilator and on

A

respiratory resistance and compliance

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13
Q

negative pressure ventilation reduces …….. which sucks air into …….

A

ambient pressure around thorax….. lungs

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14
Q

negative pressure ventilation uses rigid chamber which encloses thorax or whole body below neck - pressure in tank is

A

reduced cyclically

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15
Q

negative pressure ventilation is used for

A

long term respiratory support or for overnight use on patients with respiratory muscle weakness

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16
Q

intermittent positive pressure ventilation is used during

A

surgical procedures that require muscle relaxation

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17
Q

intermittent positive pressure ventilation used in ICU when patient is …………. or …………..

A

sedated or paralysed, unable to make any respiratory movement

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18
Q

intermittent mandatory ventilation allows patient to

A

breath spontaneously

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19
Q

synchronised intermittent mandatory ventilation avoids

A

stacking of ventilator - delivering mandatory breath during period of spontaneous breath

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20
Q

mandatory minute ventilation monitors ……….. in order to top up …..

A

exhaled volumes, patient’s respiratory efforts

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21
Q

inspiratory pressure support = patient initiates breath and ventilator

A

raises airway pressure to a preset value

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22
Q

in inspiratory pressure support, at end of inspiration, positive airway pressure is removed to allow

A

unimpeded expiration

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23
Q

positive end expiratory pressure is particularly useful in patients who are ……… or ……….. because there is a reduced ………. which leads to underventilation and a ………

A

anaesthetised or comatose; functional residual capacity; mismatched ventilation-perfusion balance

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24
Q

46000 non-smokers die from … each year due to second hand smoke

A

CHD

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25
Q

second hand smoke causes more than ….. premature deaths per year

A

600 000

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26
Q

PULMONARY OEDEMA: excessive collection of watery fluid in lungs > collects in ….. > difficulty breathing

A

alveoli

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27
Q

PULMONARY OEDEMA: most common cause =

A

heart failure

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28
Q

PULMONARY OEDEMA: can be caused by

A

conditions affecting heart

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29
Q

PULMONARY OEDEMA: 7 causes

A

heart failure (increased pressure in pulmonary vessels), damage to lung capillaries, failure of lung lymphatics, kidney failure, lung damage, major injury, high altitude

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30
Q

PULMONARY OEDEMA: reduction in cardiac output > fall in effective circulating volume and arterial filling > activation of …..-……-….. system, non-osmotic release of …, increased activity of renal sympathetic nerves > increased renal and ….. arteriolar resistance > water and …. retention > extracellular volume expansion and increased …. pressure > oedema

A

renin-angiotensin-aldosterone; ADH; peripheral; sodium ion; venous

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31
Q

8 respiratory system functions

A

O2/CO2 exchange, speech and vocalisation, pH and H+ control, smell, control of BP (angiotensin), pressure gradients promoting flow of venous blood and lymph, filtering of small blood clots, breath holding (expelling abdominal contents - Valalva Manoeuvre)

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32
Q

6 principal organs of respiratory system

A

nose, pharynx, larynx, trachea, bronchi, alveoli

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33
Q

Conducting division of respiratory system = from …. to ….. Only involved in … not gas exchange

A

nostrils; bronchioles; airflow

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34
Q

respiratory division of respiratory system involved in airflow and … …../ components = …. and other gas exchange regions of distal airway

A

gas exchange; alveoli

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35
Q

upper respiratory tract = nostril > …

A

pharynx

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36
Q

lower respiratory tract = ….. > alveoli

A

larynx

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37
Q

3 parts of pharynx

A

nasopharynx, oropharynx, laryngoparynx

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38
Q

trachea and bronchi have what type of epithelium

A

pseudostratified columnar

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39
Q

trachea pseudostratified columnar epithelium mainly made up of which 3 cell types

A

goblet cells, ciliated cells, short basal stem cells

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40
Q

2 types of gland in connective tissue beneath tracheal epithelium

A

mucous glands, serous glands

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41
Q

bronchioles have what type of epithelium

A

ciliated columnar

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42
Q

alveolar ducts and smaller divisions have what type of epithelium

A

non-ciliated squamous

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43
Q

2 types of alveolar cell

A

squamous (type I) alveolar cells, cuboidal great (type II) alveolar cells

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44
Q

which type of alveolar cell are larger (thin and broad) and cover more surface area (~95%)

A

squamous (type I) alveolar cells

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45
Q

which type of alveolar cell are more numerous but smaller and occupy less surface area (~5%)

A

cuboidal great (type II) alveolar cells

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46
Q

2 functions of great alveolar cells

A

repair epithelium when squamous cells damaged, secrete pulmonary surfactant

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47
Q

what is pulmonary surfactant

A

mixture of phosopholipids and protein

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48
Q

where does pulmonary surfactant coat

A

alveoli and smallest bronchioles

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49
Q

pulmonary surfactant prevents collapse of alveoli upon …

A

exhalation

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50
Q

what makes up respiratory membrane

A

1 squamous alveolar cell, squamous endothelial cell (capillary) and shared basement membrane

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51
Q

respiratory membrane is how thick?

A

0.5μm

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52
Q

3 functions of pleura and fluid (pleural cavity)

A

reduction of friction, creation of pressure gradient, compartmentalisation

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53
Q

accessory muscles of deep inspiration (7)

A

erector spinae, scalenes, sternocleidomastoids, pec minor, pec major, serratus anterior, internal intercostals (intercartilaginous part)

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54
Q

Muscles of quiet inspiration (3)

A

diaphragm, scalenes, external intercostals

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55
Q

Quiet expiration is

A

passive

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56
Q

Muscles of deep expiration (5)

A

internal intercostals (interosseous part), external and internal obliques, rectus abdominalis, transversus abdominis

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57
Q

Pneumothorax =

A

collection of air in pleural space

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58
Q

Latrogenic pneumothorax =

A

follows procedure e.g. biopsy, mechanical ventilation

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59
Q

Catamenial pneumothorax =

A

at time of menstruation - endometriosis

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60
Q

Traumatic pneumothorax =

A

follows chest trauma. can be open or closed

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61
Q

open traumatic pneumothorax =

A

damage to chest wall

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62
Q

closed traumatic pneumothorax =

A

chest wall undamaged

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63
Q

primary spontaneous pneumothorax =

A

no previous lung disease. Tiny blebs = foci of weakness > rupture

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64
Q

blebs of primary spontaneous pneumothorax =

A

small subpleural thin=walled air containing spaces

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65
Q

primary spontaneous pneumothorax most common in

A

young adults

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66
Q

secondary spontaneous pneumothorax more common in who

A

older people

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67
Q

people who develop secondary spontaneous pneumothorax usually have

A

underlying lung disease

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68
Q

secondary spontaneous pneumothorax usually follows rupture of

A

bulla/cyst of COPD

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69
Q

tension pneumothorax unique characteristic

A

engorged veins

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70
Q

tension pneumothorax has valve like mechanism where air can ….. pleural cavity but cannot ….

A

enter; leave

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71
Q

in tension pneumothorax, pleural pressure …. meaning ventilation and circulation are compromised

A

rises

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72
Q

safest place for chest drain

A

5th intercostal space, mid/anterior axillary line

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73
Q

oxygen given to people with pneumothorax to manage

A

hypoxia

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74
Q

eupnea =

A

relaxed, quiet breathing

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75
Q

apnoea =

A

temporary cessation of breathing

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76
Q

dyspnoea =

A

laboured, gasping, shortness of breath

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77
Q

hyperpnoea =

A

increased rate and depth of breathing

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78
Q

hyperventilation =

A

increased pulmonary ventilation - high blood pH

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79
Q

hypoventilation

A

reduced pulmonary ventilation - low blood pH

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80
Q

Kussmaul respiration =

A

deep rapid induced by ACIDOSIS

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81
Q

Orthopnoea =

A

dyspnoea when lying down

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82
Q

tachypnoea =

A

accelerated respiration

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83
Q

ventral respiratory group has …. and …. neurons - inhibitory fibres (only one fires at once) used for deep respiration

A

inspiratory and expiratory

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84
Q

neurons of dorsal respiratory group are to the integrating centres in the spinal cord > phrenic nerves to …..; intercostal nerves to ….. for inspiration

A

diaphragm; external intercostals

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85
Q

dorsal respiratory group controls ….. and …..

A

inspiration and respiratory rhyhm

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86
Q

dorsal respiratory group has ….. centre only

A

inspiratory

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87
Q

ventral respiratory group innervates lower motor neurons controlling ……

A

accessory muscles of respiration

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88
Q

pontine respiratory group receives input from

A

higher brain centres

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89
Q

pontine respiratory group hastens/delays transition from …. to ….

A

inspiration; expiration

90
Q

pontine respiratory group adapts breathing to special circumstances such as (4)

A

sleep, exercise, vocalisation, emotional reponses

91
Q

T1-…. power intercostals (inspiration)

A

T12

92
Q

T6-… power abdominals - cough, expel, balance and posture

A

T12

93
Q

Boyles law =

A

pressure of gas irreversibly proportional to volume

94
Q

Charles’s law =

A

volume of gas proportional to temperature

95
Q

Dalton’s law =

A

total pressure of gas mixture = sum of all partial pressures

96
Q

Henry’s law =

A

at air water interface ,amount of dissolved gas is determined by solubility and partial pressure in air

97
Q

INSPIRATION: ribs swing up > parietal pleura follows > visceral pleura follows > alveoli stretched > lung expands > pressure …. > inflow of air

A

drops

98
Q

intrapulmonary pressure =

A

pressure inside respiratory tract at alveoli

99
Q

On quiet inhalation, intrapulmonary pressure =

A

-1mmHg

100
Q

On quiet exhalation, intrapulmonary pressure =

A

+1mmHg

101
Q

Intrapleural pressure usually

A

-4mmHg

102
Q

Intrapleural pressure drops to …. during inspiration (quiet)

A

-6mmHg

103
Q

Intrapleural pressure rises to …. during expiration (quiet)

A

-3mmHg

104
Q

Pneumothorax develops because without negative interpleural presure, ……… leads to collapsed lung

A

elastic recoil

105
Q

3 factors affecting resistance to airflow

A

diameter of bronchioles, pulmonary compliance, surface tension of alveoli and distal bronchioles

106
Q

bronchodilation stimulated by (2)

A

epinephrine and norepinephrine

107
Q

bronchoconstriction stimulated by (4)

A

histamine, acetylcholine, cold air, chemical irritants

108
Q

pulmonary compliance =

A

stiffness of lungs

109
Q

pulmonary surfactant disrupts …. > resists compression due to water and ….. components

A

hydrogen bonds; hydrophobic

110
Q

hypoxia =

A

deficiency of oxygen to tissue/ inability to use oxygen

111
Q

hypoxaemic hypoxia =

A

low arterial PO2 > usually due to inadequate pulmonary gas exchange

112
Q

Ischaemic hypoxia =

A

inadequate blood circulation

113
Q

Anaemic hypoxia =

A

anaemia > oxygen carrying capacity of blood

114
Q

Histotoxic hypoxia =

A

metabolic poison prevents tissue using oxygen

115
Q

hypoxia often marked by

A

cyanosis

116
Q

5 factors that effect gas exchange in lungs

A

pressure gradients of gases, solubility of gases, membrane thickness, membrane area, ventilation-perfusion coupling

117
Q

tidal volume =

A

air inhaled/exhaled normal breathing

118
Q

minute volume =

A

air exhaled per minute

119
Q

vital capacity =

A

exhaled after maximum inspiration

120
Q

functional residual capacity =

A

remaining in lungs after normal expiration

121
Q

total lung capacity =

A

volume of lungs when maximally inflated

122
Q

forced vital capacity =

A

forcibly and quickly exhaled after maximum inspiration

123
Q

forced expiratory volume =

A

exhaled during 1st 2nd 3rd second etc of FVC

124
Q

forced expiratory flow =

A

average rate of flow during middle half FVC test

125
Q

Peak expiratory flow rate =

A

maximum volume during forced expiration

126
Q

BRUCE protocol -

A

exercise tolerance testing - 20 minutes can be modified

127
Q

patients with obstructive lung disease have

A

narrowed airways

128
Q

examples of obstructive lung disease (2)

A

COPD, asthma

129
Q

in obstructive lung disease FEV1/FVC ratio appears

A

low

130
Q

obstructive lung disease if FEV1 less than or ration or less

A

80%; 0.7

131
Q

GOLD criteria COPD: mild COPD > FEV1 = …% or more and has … spirometry after bronchodilator

A

80%; normal

132
Q

GOLD criteria COPD: moderate COPD > FEV1 = …-….% after ….

A

50-79%; bronchodilator

133
Q

GOLD criteria COPD: severe COPD > FEV1 = …-….% after ….

A

30-49%; bronchodilator

134
Q

GOLD criteria COPD: moderate COPD > FEV1 = less than ….% after ……

A

30%; bronchodilator

135
Q

patients with restrictive lung disease cannot

A

fully expand lungs

136
Q

patients with restrictive lung disease have FEV1/FVC ratio that appears

A

normal

137
Q

example of restrictive lung disease

A

pulmonary fibrosis

138
Q

type I respiratory failure is hy……. and is due to ………..

A

hypoxaemic; ventilation-perfusion mismatch

139
Q

type I respiratory failure has PaO2 less than …. with …… PaCO2

A

60mmHg; normal/low

140
Q

In type I respiratory failure, hyperventilation increased carbon dioxide removal but does not increase

A

oxygenation

141
Q

Type I respiratory failure can be seen in (3)

A

pulmonary oedema, pneumonia, acute asthma

142
Q

type II respiratory failure is hy…..

A

hypercapnic

143
Q

type II respiratory failure has … CO2 (…… 50mmHg)

A

high; more than

144
Q

type II respiratory failure often due to

A

ventilation-perfusion mismatch

145
Q

acute type II respiratory failure usually has pH less than

A

7.3

146
Q

chronic type II respiratory failure usually has pH ….. due to renal compensation and increase in …..

A

only slightly decreased; bicarbonate

147
Q

People with COPD often have …… respiration

A

pursed lip

148
Q

Chest x ray COPD often normal but 4 things which could be seen

A

bullae, overinflation, flattened diaphragm, deficiency of blood vessels in peripheral half of lung fields

149
Q

COPD can be caused by ….. deficiency

A

alpha1- antitripsin

150
Q

alpha1 antitripsin is a glycoprotein usually produced in the ….. that inhibits ……..

A

liver; neutrophil elastase

151
Q

gene for alpha 1 antitripsin is on chromosome …

A

14

152
Q

hereditary alpha 1 antitripsin deficiency accounts for ~….% of emphysema cases

A

2

153
Q

3 main phenotypes for alpha1 antitripsin

A

MM (normal), MZ (Heterozygous deficiency), ZZ (homozygous deficiency)

154
Q

1 in how many people are homozygous for alpha1 antitripsin deficiency?

A

1/5000

155
Q

homozygotes for alpha1 antitripsin deficiency who develop breathlessness under 40 have radiographic evidence of …… and are usually ….

A

basal emphysema; cigarette smokers

156
Q

pneumonia = infection of lung ……, alveoli and airways - usually with virus or ….

A

interstitium; bacterium

157
Q

3 classifications of pneumonia by locality

A

CAP (community acquired), HAP (hospital acquired), VAP (ventilator acquired)

158
Q

2 classifications of pneumonia by localisation

A

bronchopneumonia, lobar pneumonia

159
Q

3 classifications of pneumonia by mechanism/pathogen

A

bacterial pneumonia, viral pneumonia, aspiration pneumonia

160
Q

6 symptoms of pneumonia

A

cough (dry/phlegm), rapid HB, fever, breathlessness, fatigue, headaches

161
Q

4 risk factors for pneumonia

A

babies/very young children, elderly, smokers, health conditions/weakened immune system

162
Q

incidence of pneumonia =

A

5/1000

163
Q

pneumonia makes up for …-…% of all lower respiratory tract infections with 1/…. requiring hospitalisation

A

5-10%; 1/3

164
Q

COPD is characterised by

A

airway obstruction which is usually progressive and not fully reversible

165
Q

COPD = chronic bronchitis +

A

emphysema

166
Q

6 risk factors for COPD

A

tobacco smoke, indoor air pollution, outdoor air pollution, occupational dusts and chemicals, cannabis use, frequent lower respiratory tract infections during childhood

167
Q

percentage of adult population with COPD

A

10%

168
Q

….% of people with COPD die within 5 years of diagnosis

A

25%

169
Q

COPD causes how many deaths per year?

A

30 000

170
Q

121 symptoms of COPD

A

smoker/exsmoker 35+; exertional breathlessness; chronic cough; regular sputum production; tachypnoea; palpable liver edge; wheeze; winter exacerbations; tar staining of fingers; central cyanosis; FEV1/FVC ration less than 0.7; barrel chest

171
Q

3 types of pulmonary fibrosis

A

replacement fibrosis, focal fibrosis, diffuse parenchymal lung disease

172
Q

replacement fibrosis =

A

secondary to lung damage

173
Q

focal fibrosis =

A

response to irritants

174
Q

diffuse parenchymal lung disease =

A

in fibrosing alveolitis (idiopathic pulmonary fibrosis) + extrinsic allergic alveolitis

175
Q

3 distributions of pulmonary fibrosis

A

localised (unresolved pneumonia), bilateral (TB), widespread (drug use)

176
Q

most common cause of pulmonary fibrosis

A

idiopathic

177
Q

3 presentations of pulmonary fibrosis

A

acute, subacute, chronic

178
Q

acute pulmonary fibrosis =

A

fulminant, progressive, remitting, resolving course

179
Q

subacute pulmonary fibrosis =

A

resolving, remitting, relapsing, progressive course

180
Q

chronic pulmonary fibrosis =

A

insidious and slowly progressive

181
Q

PROCESS OF PULMONARY FIBROSIS: (1) macrophages and alveolar epithelial cells are activated by several mechanisms > produce growth factors including (4)

A

fibronectin, platelet-derived growth factor, transforming growth factor beta and IGF-I

182
Q

PROCESS OF PULMONARY FIBROSIS: (2) fibronectin, platelet-derived growth factor, transforming growth factor beta and IGF-I stimulate the deposition of type I and type II ….

A

collagens

183
Q

PROCESS OF PULMONARY FIBROSIS: (3) there are two main features of pulmonary fibrosis: (1) cellular infiltration with ……… and plasma cells > thickening and fibrosis of alveolar walls

A

T lymphocytes

184
Q

PROCESS OF PULMONARY FIBROSIS: (3) there are two main features of pulmonary fibrosis: (2) …. > increased cells within alveolar space (mainly macrophages and type II …… shed from alveolar walls)

A

ALVEOLITIS; pneumocytes

185
Q

cigarette smoke contains plycyclic aromatic hydrocarbons and nicosamines which are potent carcinogens and mutagens > release enzymes from ……. and ….. > destroy elastin > lung damage

A

neutrophil granulocytes and macrophages

186
Q

smoking and asbestos are …. in promoting bronchial carcinoma

A

synergists

187
Q

4 effects of smoking on large airways

A

increase in submucosal gland volume, increase in number of goblet cells, chronic inflammation, metaplasia and dysplasia of surface epithelium

188
Q

4 effects of smoking on small airways

A

increase number and distribution of goblet cells, airway inflammation and fibrosis, epithelial metaplasia/dysplasia, carcinoma

189
Q

3 effects of smoking on parenchyma

A

proximal acinar scarring, increase in alveolar macrophage numbers, emphysema (centri-acinar/ pan-acinar)

190
Q

11 cancer causing chemicals in tobacco smoke

A

tar, arsenic, benzene, cadmium, formaldehyde, chromium, polonium-210, 1,3-butadiene, polycyclic aromatic hydrocarbons, nitrosamines, acrolein

191
Q

cytokines involved in systemic inflammation in COPD (4)

A

IL-I(beta), IL-6, IL-18, TNF alpha

192
Q

acute phase proteins involved in systemic inflammation in COPD

A

CRP, SAA

193
Q

smokers have …… within lumen which are capable of releasing …. and proteases > increase emphysema

A

neutrophil granulocytes; elastases

194
Q

Imbalance between protease and …. can cause damage in airways

A

antiprotease

195
Q

major serum antiprotease example

A

alpha-1 antitripsin

196
Q

alpha1 antitripsin can be inactivated by

A

cigarette smoke

197
Q

smoke has adverse effect on surfactant which causes …. of lungs

A

overdistension

198
Q

CHRONIC BRONCHITIS: hypertrophy of mucus secreting …. in bronchial tree; increased number of … cells; increased …. production

A

glands; goblet; mucus

199
Q

CHRONIC BRONCHITIS: infiltration of inflammatory cells - mainly

A

CD8+

200
Q

CHRONIC BRONCHITIS: ulcers may form as squamous epithelium replaces

A

columnar cells

201
Q

CHRONIC BRONCHITIS: progression of disease = progressive squamous cell …. and ….. of bronchial wall

A

metaplasia; fibrosis

202
Q

EMPHYSEMA: classified according to site of damage - 3 types

A

centri-acinar emphysema, pan-acinar emphysema, irregular emphysema

203
Q

EMPHYSEMA: centri-acinar emphysema = concentrated around respiratory bronchioles and …. alveolar ducts therefore alveoli are …..

A

distal; well-preserved

204
Q

EMPHYSEMA: most common type =

A

centri-acinar

205
Q

EMPHYSEMA: pan-acinar emphysema = distension and destruction involve

A

whole acinus

206
Q

EMPHYSEMA: pan-acinar emphysema = in extreme form, lungs become mass of

A

bullae

207
Q

EMPHYSEMA: pan-acinar emphysema = ventilation-perfusion ….

A

mismatch

208
Q

EMPHYSEMA: pan-acinar emphysema = occurs in alpha1 ……. deficiency

A

antitripsin

209
Q

EMPHYSEMA: pan-acinar emphysema = shows …….. shadowing

A

right lung base

210
Q

EMPHYSEMA: irregular emphysema = scarring and damage affecting lung ….. patchily without regard for acinar structure

A

parenchyma

211
Q

Long term, patients with emphysema become …. and respiration becomes …… driven

A

hypoxaemic; hypoxic

212
Q

EMPHYSEMA: destruction of elastin > loss of lung elasticity > loss of pressure > …….

A

hyperinflation

213
Q

2012, percentage of men who smoke

A

22%

214
Q

2012, percentage of women who smoke

A

19%

215
Q

2012, overall percentage of population who smoke

A

20%

216
Q

nicotine = highly toxic …. and agonist of …… cholinergic receptors

A

alkaloid; nicotinic

217
Q

nicotine stimulates neurons of autonomic ganglia and blocks ……..

A

synaptic transmission

218
Q

nicotine induces peripheral vasoconstriction, tachycardia and therefore …. blood pressure

A

raises

219
Q

nicotine in the brain binds to ….. neurons

A

dopaminergic

220
Q

in adrenal medulla, nicotine binds to receptors on …. cells and ultimately causes release of …. into bloodstream

A

chromaffin; adrenaline

221
Q

nicotine replacement therapy increases rate of smoking cessation by

A

70%

Sem 2 (11 decks)

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