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Semester 2: Cardiorespiratory Fitness > PBL Topic 2 Case 1 > Flashcards

PBL Topic 2 Case 1 Flashcards

1
Q

Identify two ways in which the lungs can be expanded and contracted

A
  • Downward and upward movement of the diaphragm

- Elevation and depression of the ribs

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2
Q

Identify the muscles involved in inspiration

A
  • Sternocleidomastoid
  • Scalenes
  • External Intercostals
  • Pectoralis Minor
  • Serratus Anterior
  • Diaphragm
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3
Q

Identify the role of the sternocleidomastoid during inspiration

A
  • Elevates sternum
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4
Q

Identify the role of the scalenes during inspiration

A
  • Elevate rib 1 and 2
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5
Q

Identify the role of the pectoralis minor during inspiration

A
  • Elevate ribs 3-5
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6
Q

Identify the role of the external intercostals during inspiration

A
  • Elevate ribs 2-12
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7
Q

Identify the role of the diaphragm during inspiration

A

-Descends upon contraction and increases the volume of the thoracic cavity

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8
Q

Identify the muscles involved in quiet expiration

A
  • None
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9
Q

Identify the muscles involved in forced expiration

A
  • Internal Intercostals
  • Diaphragm
  • Rectus Abdominis
  • Abdominal Obliques
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10
Q

Identify the role of the internal intercostals during forced expiration

A
  • Depress ribs 1-11
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11
Q

Identify the role of the diaphragm during forced expiration

A
  • Ascends upon relaxation and decreases volume of thoracic cavity
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12
Q

Identify the role of the rectus abdominis during forced expiratinon

A
  • Depresses lower ribs
  • Pushes diaphragm upwards
  • Compressing the lungs
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13
Q

Identify the role of the abdominal obliques during forced expiration

A
  • Depresses lower ribs
  • Pushes diaphragm upwards
  • Compressing the lungs
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14
Q

Where is the lung attached to the chest cage?

A
  • At its hilum
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15
Q

What is pleural pressure and what are its typical values?

A
  • Pressure of the fluid in the pleural space

- Negative 5 to negative 7.5 as inspiration progresses

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16
Q

What is alveolar pressure and what are its typical values?

A
  • Pressure of the air in the alveoli
  • Negative 1 during inspiration, allowing air to move into the lungs
  • Positive 1 during expiration, allowing air to escape the lungs
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17
Q

What is transpulmonary pressure?

A
  • Difference between alveolar and pleural pressure
  • It is the pressure holding the lungs open
  • Equal and opposite the elastic recoil
  • Positive value
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18
Q

What is lung compliance?

A
  • Extent to which lungs will expand

- Per unit increase in transpulmonary pressure

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19
Q

What is the total compliance of both lungs together?

A
  • 200ml per cm H20 transpulmonary pressure
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20
Q

Identify two factors that affect lung compliance

A
  • Elastic forces of lung tissue

- Elastic forces caused by surface tension

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21
Q

What is surfactant and which cells secrete it?

A
  • Surface active agent that greatly reduces surface tension of water
  • Type 2 alveolar epithelial cells
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22
Q

Identify LaPlace’s law in relation to the alveoli

A
  • Pressure = 2 x Surface Tension / Radius of Alveolus
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23
Q

Identify the three fractions of work that takes place during inspiration

A
  • Elastic work
  • Tissue work
  • Airway resistance work
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24
Q

What is anatomic dead space and what is its typical value?

A
  • All spaces of the respiratory system other than the alveoli and related areas of gas exchange
  • 150 ml
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25
Q

What is physiologic dead space and what is its typical value?

A
  • Non functional alveoli

- 1500 ml

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26
Q

Which region of the respiratory centre causes inspiration?

A
  • Dorsal respiratory group

- Via repetitive bursts of inspiratory action potentials to diaphragm

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27
Q

Which region of the respiratory centre causes expiration?

A
  • Ventral respiratory group

- Via expiratory signals to the abdominal muscles

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28
Q

Which region of the respiratory centre controls the rate and depth of breathing?

A
  • Pneumotaxic Centre
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29
Q

Where is the dorsal respiratory group located?

A
  • Medulla
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30
Q

What is the role of the tractus solitarius?

A
  • Sensory termination of vagus and glossopharyngeal nerves

- From peripheral chemoreceptors, baroreceptors and several lung receptors

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31
Q

Where is the apneustic centre located?

A
  • Pons
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32
Q

Identify two roles of the apneustic centre

A
  • Continuous stimulation to dorsal respiratory group

- Co-ordinates transition between inhalation and exhalation

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33
Q

Describe the inspiratory ramp signal

A
  • Action potential begins weakly and increases in a ramp manner
  • Resulting in contraction of the diaphragm
  • Before ceasing abruptly, turning off excitation
  • Resulting in relaxation of the diaphragm
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34
Q

Where is the Pneumotaxic centre located?

A
  • Nucleus parabrachialis

- Upper pons

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35
Q

Identify the roles of the pneumotaxic centre?

A
  • Inhibits apneustic centre

- Thus controls switch off point of inspiratory ramp signal

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36
Q

Where is the ventral respiratory group located?

A
  • Medulla
  • Nucleus ambiguus rostrally
  • Nucleus retroambiguus cordally
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37
Q

Identify two roles of the ventral respiratory group

A
  • Neurones spill over into DRG during inspiration

- Expiratory signals to the abdominal muscles

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38
Q

Outline the Hering Breuer Reflex

A
  • Stretch receptors in bronchi and bronchioles
  • Impulses through vagus nerve to DRG during overinflation
  • Switch off inspiratory ramp signal
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39
Q

What substances act on the central chemoreceptors?

A
  • Carbon Dioxide

- Hydrogen Ions

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40
Q

Outline how CO2 and H+ act on central chemoreceptors

A
  • CO2 dissolves to form carbonic acid
  • Crosses blood brain barrier
  • Dissociates into H+ and HCO3- ions
  • H+ have a potent stimulatory effect on chemosensitive area
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41
Q

What substances act on the peripheral chemoreceptors?

A
  • Oxygen
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42
Q

Identify two peripheral chemoreceptors and their associated nerves

A
  • Carotid bodies, located in carotid sinus, impulses through Hering’s nerves and glossopharyngeal nerves
  • Aortic bodies, located in aortic arch, impulses through vagus nerve
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43
Q

Identify four causes of hypoxia

A
  • Inadequate oxygenation (atmospheric)
  • Pulmonary Disease
  • Anaemia
  • Poisoning of oxidation enzymes
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44
Q

Why is oxygen therapy inappropriate in cases of anaemia or poisoning of oxidation enzymes?

A
  • Oxygen is readily available

- It is the mechanisms of oxygen transport that is deficient

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45
Q

Identify two ways that pulmonary disease may cause hypoxia

A
  • Hypoventilation caused by increased airways resistance / decreased pulmonary compliance
  • Abnormal Va/Q ratio (increased physiologic dead space/shunt)
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46
Q

What should the cardiothoracic ratio be?

A
  • 50%
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47
Q

Identify two causes of a large CTR

A
  • Cardiomegaly caused by left ventricular dilatation or pericardial effusion
48
Q

How can you check for hyperinflation?

A
  • Count ribs

- Hyperinflation if more than 10 posterior ribs are visible

49
Q

What is meant by lung consolidation?

A
  • Lung tissue that is filled with liquid rather than air
50
Q

Identify three possible causes of lung consolidation?

A
  • Infection
  • Infarction
  • Inflammation
51
Q

What are lung shadows suggestive of?

A
  • Bronchiectasis
52
Q

What is meant by the term pneumothorax?

A
  • Air in the pleural space
53
Q

Identify the risk factors of primary pneumothorax

A
  • Smoking
  • Tall Stature
  • Apical pleural blebs
  • Being male
54
Q

What is the difference between primary and secondary pneumothorax?

A
  • Primary = No lung disease
  • Secondary = Lung Disease
  • Secondary lung disease has higher mortality rates
55
Q

Outline the pathophysiology of a spontaneous pneumothorax?

A
  • Rupture of pleural bleb
  • Pressure in pleural space becomes positive
  • Transpulmonary pressure reaches 0
  • Lung collapse due to elastic recoil
56
Q

Outline the pathophysiology of a tension pneumothorax

A
  • Valvular mechanism occurs in which air enters but cannot escape pleural space
  • Pleural pressure becomes increasingly positive
  • Mediastinal shift
  • Reduces venous return
57
Q

Outline the signs and symptoms of a pneumothorax

A

Spontaneous:

  • Tachypnoea
  • Dyspnoea
  • Reduce lung sounds in affected lung

Tension:

  • Tachycardia
  • Cyanosis
  • Hypotension
  • Mediastinal Shift
  • Tracheal Displacement
  • No lungs markings (complete translucency)
  • Sharply defined edge of deflated lung
58
Q

Identify the findings of a pneumothorax on chest x-ray

A
  • No lung markings (complete translucency)

- Sharply defined edge of deflated lung

59
Q

How can you differentiate between a pre-existing emphysematous bullae and a pneumothorax?

A
  • CT scan
60
Q

When is simple aspiration carried out?

A
  • Young patients

- Presenting with a medium or large primary pneumothorax

61
Q

Outline the procedure of a simple aspiration

A
  • Infiltrate lidocaine
  • Second intercostal space, mid-clavicular line
  • Cannula through pleura, attached to three way tap
62
Q

When is intercostal tube drainage carried out?

A
  • Older patients

- Presenting with secondary pneumothorax

63
Q

Outline the procedure of an intercostal tube drainage

A
  • Infiltrate lidocaine
  • Fifth-intercostal space, mid-axillary line
  • Cannula through pleura, attached to three way tap

-

64
Q

Why is an underwater seal used in a chest drain?

A
  • Air can pass from tube into atmosphere by forming bubbles

- Air cannot pass back into tube

65
Q

When is emergency surgery for a pneumothorax required?

A
  • Continued bubbling after 5-7 days

- Recurrence of primary spontaneous pneumothorax in first year (1 in 5 cases)

66
Q

Identify three ways in which pleurodesis can be achieved?

A
  • Pleural abrasion
  • Partial pleurectomy
  • Chemical pleurodesis with talc (contra-indication for surgery)
67
Q

What is pleurodesis?

A
  • Surgery in which lung is adhered to chest wall
  • Seals pleural cavity
  • Prevents build-up of air
68
Q

Outline ATLS Protocol: Airways and Breathing

A

Assess volume, rhythm character and symmetry of breathing

  • Determine accessory muscle use e.g. abdominal movement
  • Supplemental oxygen (60% and adjusted in light of ABGs) to patients with dyspnoea, tachypnea or chest pain
69
Q

Outline ATLS Protocol: Circulation

A
  • Palpate carotid pulse in unconscious patient
  • Palpate peripheral pulses (e..g radial and brachial) in conscious patient
  • Venous access for administration of drugs / fluids
70
Q

Outline ATLS Protocol: Airways: Disability

A
  • Conscious level assessed using Glasgow Coma Scale

- Score of 8 or less denotes coma associated with airway compromise

71
Q

Outline ATLS Protocol: Airways: Exposure, Evidence Examination

A
  • Clinical examination
  • Patient undressed with privacy maintained
  • Warm blankets/ environment/ fluid to prevent hypothermia
72
Q

What does the autonomic nervous system control?

A
  • Visceral functions of the body
73
Q

Identify the two subdivisions of the autonomic nervous system

A
  • Sympathetic

- Parasympathetic

74
Q

How does the position of the ganglia differ in the sympathetic and parasympathetic subdivisions?

A
  • Sympathetic: Located immediately after leaving the spinal canal
  • Parasympathetic: Located much closer to effector
75
Q

What is a cholinergic neurotransmitter substance?

A
  • One that secretes acetylcholine
76
Q

What is an adrenergic neurotransmitter substance?

A
  • One that secretes noradrenaline
77
Q

What type of nerve fibres do preganglionic neurones possess?

A
  • Cholinergic
78
Q

What type of nerve fibres do postganglionic parasympathetic neurones possess?

A
  • Cholinergic
79
Q

What type of nerve fibres do postganglionic sympathetic neurones possess?

A
  • Adrenergic
80
Q

Identify the two types of cholinergic receptors and their location

A
  • Muscarinic: Effector Cell

- Nicotinic: Ganglia

81
Q

What type of receptors are adrenergic receptors?

A
  • G-protein coupled receptors
82
Q

Identify the two major types of adrenergic receptors

A
  • Alpha (1 and 2) and Beta (1 and 2)
83
Q

Which second messenger system is used by alpha receptors?

A
  • Phospholipase C
84
Q

Which second messenger system is used by beta receptors?

A
  • Adenylyl Cyclase cAMP
85
Q

How do alpha and beta receptors differ in their response to adrenaline and noradrenaline

A
  • Adrenaline excited both receptors equally

- Noradrenaline mainly excites alpha receptors

86
Q

Identify examples of B1, B2 and B3 receptors

A
  • B1: Heart rate and force of contraction
  • B2: Vasodilation and bronchodilation
  • B3: Lipolysis
87
Q

What is Mass Discharge

A
  • When all portions of sympathetic nervous system discharge simultaneously
  • Due to hypothalamic activation
  • In response to fright / fear pain
88
Q

Outline the Alarm Phase

A
  • Fight or Flight Response
  • Increased blood flow to active muscles and away from organs
  • Increased glycolysis by liver and muscles
  • Increased strength and mental alertness
  • Mainly adrenaline / noradrenaline
89
Q

Outline the Resistance Phase

A
  • Mobilisation of energy reserves, mainly lipids and amino acids
  • Conservation of glucose
  • Mainly glucocorticoids
90
Q

Outline the Exhaustion Phase

A
  • Lipid reserves deplete
  • Structural or functional damage to vital organs
  • Inability to produce glucocorticoids
  • Failure of electrolyte balance
91
Q

Outline how local anaesthetics work

A
  • Block the initiation and propagation of action potentials
  • By blocking sodium channels
  • Through interaction with interaction with amino acid residues of s6 transmembrane helical domain of channel protein
92
Q

Outline two uses of lidocaine

A
  • Local anaesthetic

- Treatment and prevention of ventricular dysrhythmias

93
Q

What is the half life of lidocaine?

Identify two ways in which hepatic blood flow can be reduced

A
  • 2 hours
  • Reduced cardiac output after MI
  • Drugs that reduce contractibility (B1 adrenoreceptor antagonists)
94
Q

Identify three adverse effects of lidocaine

A
  • Drowsiness
  • Disorientation
  • Convulsions
95
Q

Lidocaine is considered a Class 1B drug, what does this mean?

A
  • Binds to alpha subunit on sodium channel
  • Inhibits action potential
  • During phase 0
96
Q

What is meant by the term use-dependence?

A
  • The more frequently the channels are activated, the greater the degree of block produced
97
Q

Identify two causes of post traumatic stress disorder?

A
  • Witnessing violent death of others

- Victim of sexual abuse, rape, torture, terrorism or hostage taking

98
Q

Outline 3 pre-disposing factors to PTSD

A
  • Personality
  • Previously unresolved traumas
  • History of psychiatric illness
99
Q

Identify six clinical features of PTSD

A
  • Flashbacks
  • Insomnia
  • Emotional blunting
  • Emotional detachment
  • Avoidance
  • Hyper-vigilance
100
Q

Identify three complications of PTSD

A
  • Depressive illness
  • Alcohol misuse
  • Chronic course (most cases recover at the end of the first year)
101
Q

Identify 4 methods of treatment / management of PTSD

A
  • Cognitive Behavioural Therapy
  • Social support by those involved
  • Eye movement desensitisation and reprocessing
  • SSRIs and venlafaxine
102
Q

What is CBT?

A
  • Structured therapy involving..
  • Removing maladaptive behavioural responses
  • Replacing them with new responses
103
Q

What is the bystander effect?

A
  • Phenomenon in which someone is less likely to intervene in an emergency situation when other people are present.
104
Q

What is pluralistic ignorance?

A
  • A state in which everybody in the group misleads everyone else by defining the situation as non-emergency.
105
Q

What is diffusion of responsibility?

A
  • People are less likely to offer help to someone if there are others present
  • They perceive responsibility as being shared between all present
  • Therefore see themselves as being less personally responsible.
106
Q

Identify four factors that affect the likelihood of a person receiving help.

A
  • Ambiguity of situation
  • Cost-benefit analysis of helping
  • Gender, women more likely to receive help than men
  • Competence
107
Q

If a person wishes to receive help in an emergency situation, either as a victim or active helper, what should they do?

A
  • Choose a specific person in the crowd to help them
  • Provide the person with a specific instruction
  • Rather than appealing to the larger group.
108
Q

What does Lazarus mean by primary appraisal?

A

Individual appraises event as either irrelevant, positive, threatening or challenging

109
Q

What does Lazarus mean by secondary appraisal

A

Individual appraises coping strategies, which include direct action, seeking information, doing nothing or defence mechanisms

110
Q

Identify four types of stressful events

A
  • Salient events
  • Overload, multitasking
  • Ambiguous events
  • Uncontrollable events
111
Q

What is the interaction between psychology and physiology in stress?

A
  • Appraisal causes a change in physiology

- Which is detected and then appraised causing a further response

112
Q

Identify psychological factors that affect the ongoing process of appraisal

A
  • Control
  • Personality
  • Coping
  • Social support
113
Q

What is the Cochrane Collaboration?

A
  • International Organisation
  • Prepare, maintain and promote accessibility to systematic reviews
  • Stresses the importance of RCTs as the gold standard study type
  • High degree of methodological rigour and are updated frequently
114
Q

What is meant by the term stress reactivity?

A
  • Physiological changes in response to stress
  • Sweating, increased blood pressure
  • Varies between people
115
Q

What is meant by allostatic load?

A
  • Fluctuation in physiological changes as the individual recovers from stress
  • Recovery is less compete and increasingly depleted

Semester 2: Cardiorespiratory Fitness (18 decks)

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