Lungs and respiratory system Flashcards
1
Q
Valsalva manoeuvre is
A
forced expiration against a closed glottis
2
Q
4 phases of valsalva manoeuvre
A
initial pressure rise, reduced venous return and compensation, pressure release, return of cardiac output
3
Q
3 types of cycles for ventilators
A
pressure cycled, time cycled, volume cycled
4
Q
ventilators can be invasive or
A
non-invasive
5
Q
2 types of pressure ventilator
A
positive or negative pressure ventilators
6
Q
main mechanism of action of positive pressure ventilators
A
increased pressure within airways - air pushed into trachea
7
Q
two types of positive pressure ventilators
A
flow generator, pressure generator
8
Q
flow generator usually used on
A
adults
9
Q
pressure generator usually used on (2)
A
children, adults when control of peak airway pressure is important
10
Q
flow generator produces known pattern of gas flow during
A
inspiration
11
Q
in flow generator, lungs fill at rate entirely controlled by
A
ventilator
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
13
Q
negative pressure ventilation reduces …….. which sucks air into …….
A
ambient pressure around thorax….. lungs
14
Q
negative pressure ventilation uses rigid chamber which encloses thorax or whole body below neck - pressure in tank is
A
reduced cyclically
15
Q
negative pressure ventilation is used for
A
long term respiratory support or for overnight use on patients with respiratory muscle weakness
16
Q
intermittent positive pressure ventilation is used during
A
surgical procedures that require muscle relaxation
17
Q
intermittent positive pressure ventilation used in ICU when patient is …………. or …………..
A
sedated or paralysed, unable to make any respiratory movement
18
Q
intermittent mandatory ventilation allows patient to
A
breath spontaneously
19
Q
synchronised intermittent mandatory ventilation avoids
A
stacking of ventilator - delivering mandatory breath during period of spontaneous breath
20
Q
mandatory minute ventilation monitors ……….. in order to top up …..
A
exhaled volumes, patient’s respiratory efforts
21
Q
inspiratory pressure support = patient initiates breath and ventilator
A
raises airway pressure to a preset value
22
Q
in inspiratory pressure support, at end of inspiration, positive airway pressure is removed to allow
A
unimpeded expiration
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
24
Q
46000 non-smokers die from … each year due to second hand smoke
A
CHD
25
second hand smoke causes more than ..... premature deaths per year
600 000
26
PULMONARY OEDEMA: excessive collection of watery fluid in lungs > collects in ..... > difficulty breathing
alveoli
27
PULMONARY OEDEMA: most common cause =
heart failure
28
PULMONARY OEDEMA: can be caused by
conditions affecting heart
29
PULMONARY OEDEMA: 7 causes
heart failure (increased pressure in pulmonary vessels), damage to lung capillaries, failure of lung lymphatics, kidney failure, lung damage, major injury, high altitude
30
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
renin-angiotensin-aldosterone; ADH; peripheral; sodium ion; venous
31
8 respiratory system functions
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)
32
6 principal organs of respiratory system
nose, pharynx, larynx, trachea, bronchi, alveoli
33
Conducting division of respiratory system = from .... to ..... Only involved in ... not gas exchange
nostrils; bronchioles; airflow
34
respiratory division of respiratory system involved in airflow and ... ...../ components = .... and other gas exchange regions of distal airway
gas exchange; alveoli
35
upper respiratory tract = nostril > ...
pharynx
36
lower respiratory tract = ..... > alveoli
larynx
37
3 parts of pharynx
nasopharynx, oropharynx, laryngoparynx
38
trachea and bronchi have what type of epithelium
pseudostratified columnar
39
trachea pseudostratified columnar epithelium mainly made up of which 3 cell types
goblet cells, ciliated cells, short basal stem cells
40
2 types of gland in connective tissue beneath tracheal epithelium
mucous glands, serous glands
41
bronchioles have what type of epithelium
ciliated columnar
42
alveolar ducts and smaller divisions have what type of epithelium
non-ciliated squamous
43
2 types of alveolar cell
squamous (type I) alveolar cells, cuboidal great (type II) alveolar cells
44
which type of alveolar cell are larger (thin and broad) and cover more surface area (~95%)
squamous (type I) alveolar cells
45
which type of alveolar cell are more numerous but smaller and occupy less surface area (~5%)
cuboidal great (type II) alveolar cells
46
2 functions of great alveolar cells
repair epithelium when squamous cells damaged, secrete pulmonary surfactant
47
what is pulmonary surfactant
mixture of phosopholipids and protein
48
where does pulmonary surfactant coat
alveoli and smallest bronchioles
49
pulmonary surfactant prevents collapse of alveoli upon ...
exhalation
50
what makes up respiratory membrane
1 squamous alveolar cell, squamous endothelial cell (capillary) and shared basement membrane
51
respiratory membrane is how thick?
0.5μm
52
3 functions of pleura and fluid (pleural cavity)
reduction of friction, creation of pressure gradient, compartmentalisation
53
accessory muscles of deep inspiration (7)
erector spinae, scalenes, sternocleidomastoids, pec minor, pec major, serratus anterior, internal intercostals (intercartilaginous part)
54
Muscles of quiet inspiration (3)
diaphragm, scalenes, external intercostals
55
Quiet expiration is
passive
56
Muscles of deep expiration (5)
internal intercostals (interosseous part), external and internal obliques, rectus abdominalis, transversus abdominis
57
Pneumothorax =
collection of air in pleural space
58
Latrogenic pneumothorax =
follows procedure e.g. biopsy, mechanical ventilation
59
Catamenial pneumothorax =
at time of menstruation - endometriosis
60
Traumatic pneumothorax =
follows chest trauma. can be open or closed
61
open traumatic pneumothorax =
damage to chest wall
62
closed traumatic pneumothorax =
chest wall undamaged
63
primary spontaneous pneumothorax =
no previous lung disease. Tiny blebs = foci of weakness > rupture
64
blebs of primary spontaneous pneumothorax =
small subpleural thin=walled air containing spaces
65
primary spontaneous pneumothorax most common in
young adults
66
secondary spontaneous pneumothorax more common in who
older people
67
people who develop secondary spontaneous pneumothorax usually have
underlying lung disease
68
secondary spontaneous pneumothorax usually follows rupture of
bulla/cyst of COPD
69
tension pneumothorax unique characteristic
engorged veins
70
tension pneumothorax has valve like mechanism where air can ..... pleural cavity but cannot ....
enter; leave
71
in tension pneumothorax, pleural pressure .... meaning ventilation and circulation are compromised
rises
72
safest place for chest drain
5th intercostal space, mid/anterior axillary line
73
oxygen given to people with pneumothorax to manage
hypoxia
74
eupnea =
relaxed, quiet breathing
75
apnoea =
temporary cessation of breathing
76
dyspnoea =
laboured, gasping, shortness of breath
77
hyperpnoea =
increased rate and depth of breathing
78
hyperventilation =
increased pulmonary ventilation - high blood pH
79
hypoventilation
reduced pulmonary ventilation - low blood pH
80
Kussmaul respiration =
deep rapid induced by ACIDOSIS
81
Orthopnoea =
dyspnoea when lying down
82
tachypnoea =
accelerated respiration
83
ventral respiratory group has .... and .... neurons - inhibitory fibres (only one fires at once) used for deep respiration
inspiratory and expiratory
84
neurons of dorsal respiratory group are to the integrating centres in the spinal cord > phrenic nerves to .....; intercostal nerves to ..... for inspiration
diaphragm; external intercostals
85
dorsal respiratory group controls ..... and .....
inspiration and respiratory rhyhm
86
dorsal respiratory group has ..... centre only
inspiratory
87
ventral respiratory group innervates lower motor neurons controlling ......
accessory muscles of respiration
88
pontine respiratory group receives input from
higher brain centres
89
pontine respiratory group hastens/delays transition from .... to ....
inspiration; expiration
90
pontine respiratory group adapts breathing to special circumstances such as (4)
sleep, exercise, vocalisation, emotional reponses
91
T1-.... power intercostals (inspiration)
T12
92
T6-... power abdominals - cough, expel, balance and posture
T12
93
Boyles law =
pressure of gas irreversibly proportional to volume
94
Charles's law =
volume of gas proportional to temperature
95
Dalton's law =
total pressure of gas mixture = sum of all partial pressures
96
Henry's law =
at air water interface ,amount of dissolved gas is determined by solubility and partial pressure in air
97
INSPIRATION: ribs swing up > parietal pleura follows > visceral pleura follows > alveoli stretched > lung expands > pressure .... > inflow of air
drops
98
intrapulmonary pressure =
pressure inside respiratory tract at alveoli
99
On quiet inhalation, intrapulmonary pressure =
-1mmHg
100
On quiet exhalation, intrapulmonary pressure =
+1mmHg
101
Intrapleural pressure usually
-4mmHg
102
Intrapleural pressure drops to .... during inspiration (quiet)
-6mmHg
103
Intrapleural pressure rises to .... during expiration (quiet)
-3mmHg
104
Pneumothorax develops because without negative interpleural presure, ......... leads to collapsed lung
elastic recoil
105
3 factors affecting resistance to airflow
diameter of bronchioles, pulmonary compliance, surface tension of alveoli and distal bronchioles
106
bronchodilation stimulated by (2)
epinephrine and norepinephrine
107
bronchoconstriction stimulated by (4)
histamine, acetylcholine, cold air, chemical irritants
108
pulmonary compliance =
stiffness of lungs
109
pulmonary surfactant disrupts .... > resists compression due to water and ..... components
hydrogen bonds; hydrophobic
110
hypoxia =
deficiency of oxygen to tissue/ inability to use oxygen
111
hypoxaemic hypoxia =
low arterial PO2 > usually due to inadequate pulmonary gas exchange
112
Ischaemic hypoxia =
inadequate blood circulation
113
Anaemic hypoxia =
anaemia > oxygen carrying capacity of blood
114
Histotoxic hypoxia =
metabolic poison prevents tissue using oxygen
115
hypoxia often marked by
cyanosis
116
5 factors that effect gas exchange in lungs
pressure gradients of gases, solubility of gases, membrane thickness, membrane area, ventilation-perfusion coupling
117
tidal volume =
air inhaled/exhaled normal breathing
118
minute volume =
air exhaled per minute
119
vital capacity =
exhaled after maximum inspiration
120
functional residual capacity =
remaining in lungs after normal expiration
121
total lung capacity =
volume of lungs when maximally inflated
122
forced vital capacity =
forcibly and quickly exhaled after maximum inspiration
123
forced expiratory volume =
exhaled during 1st 2nd 3rd second etc of FVC
124
forced expiratory flow =
average rate of flow during middle half FVC test
125
Peak expiratory flow rate =
maximum volume during forced expiration
126
BRUCE protocol -
exercise tolerance testing - 20 minutes can be modified
127
patients with obstructive lung disease have
narrowed airways
128
examples of obstructive lung disease (2)
COPD, asthma
129
in obstructive lung disease FEV1/FVC ratio appears
low
130
obstructive lung disease if FEV1 less than or ration or less
80%; 0.7
131
GOLD criteria COPD: mild COPD > FEV1 = ...% or more and has ... spirometry after bronchodilator
80%; normal
132
GOLD criteria COPD: moderate COPD > FEV1 = ...-....% after ....
50-79%; bronchodilator
133
GOLD criteria COPD: severe COPD > FEV1 = ...-....% after ....
30-49%; bronchodilator
134
GOLD criteria COPD: moderate COPD > FEV1 = less than ....% after ......
30%; bronchodilator
135
patients with restrictive lung disease cannot
fully expand lungs
136
patients with restrictive lung disease have FEV1/FVC ratio that appears
normal
137
example of restrictive lung disease
pulmonary fibrosis
138
type I respiratory failure is hy....... and is due to ...........
hypoxaemic; ventilation-perfusion mismatch
139
type I respiratory failure has PaO2 less than .... with ...... PaCO2
60mmHg; normal/low
140
In type I respiratory failure, hyperventilation increased carbon dioxide removal but does not increase
oxygenation
141
Type I respiratory failure can be seen in (3)
pulmonary oedema, pneumonia, acute asthma
142
type II respiratory failure is hy.....
hypercapnic
143
type II respiratory failure has ... CO2 (...... 50mmHg)
high; more than
144
type II respiratory failure often due to
ventilation-perfusion mismatch
145
acute type II respiratory failure usually has pH less than
7.3
146
chronic type II respiratory failure usually has pH ..... due to renal compensation and increase in .....
only slightly decreased; bicarbonate
147
People with COPD often have ...... respiration
pursed lip
148
Chest x ray COPD often normal but 4 things which could be seen
bullae, overinflation, flattened diaphragm, deficiency of blood vessels in peripheral half of lung fields
149
COPD can be caused by ..... deficiency
alpha1- antitripsin
150
alpha1 antitripsin is a glycoprotein usually produced in the ..... that inhibits ........
liver; neutrophil elastase
151
gene for alpha 1 antitripsin is on chromosome ...
14
152
hereditary alpha 1 antitripsin deficiency accounts for ~....% of emphysema cases
2
153
3 main phenotypes for alpha1 antitripsin
MM (normal), MZ (Heterozygous deficiency), ZZ (homozygous deficiency)
154
1 in how many people are homozygous for alpha1 antitripsin deficiency?
1/5000
155
homozygotes for alpha1 antitripsin deficiency who develop breathlessness under 40 have radiographic evidence of ...... and are usually ....
basal emphysema; cigarette smokers
156
pneumonia = infection of lung ......, alveoli and airways - usually with virus or ....
interstitium; bacterium
157
3 classifications of pneumonia by locality
CAP (community acquired), HAP (hospital acquired), VAP (ventilator acquired)
158
2 classifications of pneumonia by localisation
bronchopneumonia, lobar pneumonia
159
3 classifications of pneumonia by mechanism/pathogen
bacterial pneumonia, viral pneumonia, aspiration pneumonia
160
6 symptoms of pneumonia
cough (dry/phlegm), rapid HB, fever, breathlessness, fatigue, headaches
161
4 risk factors for pneumonia
babies/very young children, elderly, smokers, health conditions/weakened immune system
162
incidence of pneumonia =
5/1000
163
pneumonia makes up for ...-...% of all lower respiratory tract infections with 1/.... requiring hospitalisation
5-10%; 1/3
164
COPD is characterised by
airway obstruction which is usually progressive and not fully reversible
165
COPD = chronic bronchitis +
emphysema
166
6 risk factors for COPD
tobacco smoke, indoor air pollution, outdoor air pollution, occupational dusts and chemicals, cannabis use, frequent lower respiratory tract infections during childhood
167
percentage of adult population with COPD
10%
168
....% of people with COPD die within 5 years of diagnosis
25%
169
COPD causes how many deaths per year?
30 000
170
121 symptoms of COPD
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
3 types of pulmonary fibrosis
replacement fibrosis, focal fibrosis, diffuse parenchymal lung disease
172
replacement fibrosis =
secondary to lung damage
173
focal fibrosis =
response to irritants
174
diffuse parenchymal lung disease =
in fibrosing alveolitis (idiopathic pulmonary fibrosis) + extrinsic allergic alveolitis
175
3 distributions of pulmonary fibrosis
localised (unresolved pneumonia), bilateral (TB), widespread (drug use)
176
most common cause of pulmonary fibrosis
idiopathic
177
3 presentations of pulmonary fibrosis
acute, subacute, chronic
178
acute pulmonary fibrosis =
fulminant, progressive, remitting, resolving course
179
subacute pulmonary fibrosis =
resolving, remitting, relapsing, progressive course
180
chronic pulmonary fibrosis =
insidious and slowly progressive
181
PROCESS OF PULMONARY FIBROSIS: (1) macrophages and alveolar epithelial cells are activated by several mechanisms > produce growth factors including (4)
fibronectin, platelet-derived growth factor, transforming growth factor beta and IGF-I
182
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 ....
collagens
183
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
T lymphocytes
184
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)
ALVEOLITIS; pneumocytes
185
cigarette smoke contains plycyclic aromatic hydrocarbons and nicosamines which are potent carcinogens and mutagens > release enzymes from ....... and ..... > destroy elastin > lung damage
neutrophil granulocytes and macrophages
186
smoking and asbestos are .... in promoting bronchial carcinoma
synergists
187
4 effects of smoking on large airways
increase in submucosal gland volume, increase in number of goblet cells, chronic inflammation, metaplasia and dysplasia of surface epithelium
188
4 effects of smoking on small airways
increase number and distribution of goblet cells, airway inflammation and fibrosis, epithelial metaplasia/dysplasia, carcinoma
189
3 effects of smoking on parenchyma
proximal acinar scarring, increase in alveolar macrophage numbers, emphysema (centri-acinar/ pan-acinar)
190
11 cancer causing chemicals in tobacco smoke
tar, arsenic, benzene, cadmium, formaldehyde, chromium, polonium-210, 1,3-butadiene, polycyclic aromatic hydrocarbons, nitrosamines, acrolein
191
cytokines involved in systemic inflammation in COPD (4)
IL-I(beta), IL-6, IL-18, TNF alpha
192
acute phase proteins involved in systemic inflammation in COPD
CRP, SAA
193
smokers have ...... within lumen which are capable of releasing .... and proteases > increase emphysema
neutrophil granulocytes; elastases
194
Imbalance between protease and .... can cause damage in airways
antiprotease
195
major serum antiprotease example
alpha-1 antitripsin
196
alpha1 antitripsin can be inactivated by
cigarette smoke
197
smoke has adverse effect on surfactant which causes .... of lungs
overdistension
198
CHRONIC BRONCHITIS: hypertrophy of mucus secreting .... in bronchial tree; increased number of ... cells; increased .... production
glands; goblet; mucus
199
CHRONIC BRONCHITIS: infiltration of inflammatory cells - mainly
CD8+
200
CHRONIC BRONCHITIS: ulcers may form as squamous epithelium replaces
columnar cells
201
CHRONIC BRONCHITIS: progression of disease = progressive squamous cell .... and ..... of bronchial wall
metaplasia; fibrosis
202
EMPHYSEMA: classified according to site of damage - 3 types
centri-acinar emphysema, pan-acinar emphysema, irregular emphysema
203
EMPHYSEMA: centri-acinar emphysema = concentrated around respiratory bronchioles and .... alveolar ducts therefore alveoli are .....
distal; well-preserved
204
EMPHYSEMA: most common type =
centri-acinar
205
EMPHYSEMA: pan-acinar emphysema = distension and destruction involve
whole acinus
206
EMPHYSEMA: pan-acinar emphysema = in extreme form, lungs become mass of
bullae
207
EMPHYSEMA: pan-acinar emphysema = ventilation-perfusion ....
mismatch
208
EMPHYSEMA: pan-acinar emphysema = occurs in alpha1 ....... deficiency
antitripsin
209
EMPHYSEMA: pan-acinar emphysema = shows ........ shadowing
right lung base
210
EMPHYSEMA: irregular emphysema = scarring and damage affecting lung ..... patchily without regard for acinar structure
parenchyma
211
Long term, patients with emphysema become .... and respiration becomes ...... driven
hypoxaemic; hypoxic
212
EMPHYSEMA: destruction of elastin > loss of lung elasticity > loss of pressure > .......
hyperinflation
213
2012, percentage of men who smoke
22%
214
2012, percentage of women who smoke
19%
215
2012, overall percentage of population who smoke
20%
216
nicotine = highly toxic .... and agonist of ...... cholinergic receptors
alkaloid; nicotinic
217
nicotine stimulates neurons of autonomic ganglia and blocks ........
synaptic transmission
218
nicotine induces peripheral vasoconstriction, tachycardia and therefore .... blood pressure
raises
219
nicotine in the brain binds to ..... neurons
dopaminergic
220
in adrenal medulla, nicotine binds to receptors on .... cells and ultimately causes release of .... into bloodstream
chromaffin; adrenaline
221
nicotine replacement therapy increases rate of smoking cessation by
70%
