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Respiratory > Peer teaching > Flashcards

Peer teaching Flashcards

1
Q

Which nerve innervates the diaphragm?

A

phrenic nerve

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2
Q

What are the roots of the phrenic nerve?

A

C3 C4 C5

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3
Q

How many lobes does the right lung have?

A

3

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4
Q

How many lobes does the left lung have?

A

2

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5
Q

What is the parasympathetic supply of the lungs?

A

the vagus nerve

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6
Q

At what vertebral level is the carina?

A

T4/T5

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7
Q

What is the anatomical surface marking of the horizontal fissure?

A

Right 4th rib

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8
Q

What type of epithelium is respiratory epithelium?

A

ciliated pseudostratified columnar with goblet cells

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9
Q

What type of pneumocyte forms most of the alveolar surface area?

A

Type 1

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10
Q

Which type of pneumocyte is most numerous?

A

Type 2

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11
Q

Which type of pneumocyte provides a thin barrier for diffusion?

A

Type 1

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12
Q

What type of pneumocyte secretes surfactant?

A

Type 2

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13
Q

What are the macrophages found in the lungs called?

A

Alveolar macrophages

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14
Q

What is the fossa ovalis a remenant of?

A

the foramen ovale

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15
Q

What is the function of the foramen ovale in the fetus?

A

hole between right and left atria. Allows blood to pass from right to left atrium

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16
Q

What does the ductus arteriosus become?

A

the ligamentum arteriosum

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17
Q

What does the ductus arteriosus connect in the fetus?

A

the pulmonary artery with the aorta. Allows bypass of the lungs

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18
Q

What vessel does oxygenated blood from the placenta pass through to the fetus?

A

the umbilical vein

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19
Q

Which gas is the predominant driver to breathe?

A

CO2

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20
Q

Where in the brain will you find the pneumotaxic centre?

A

the pons

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21
Q

Where in the brain will you find the apneustic centre?

A

the pons

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22
Q

What is the function of the pneumotaxic centre?

A

involved in putting the breaks on inspiration

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23
Q

What is the function of the apneustic centre?

A

moderates the effects of the pneumotaxic centre

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24
Q

Which respiratory groups will you find in the medulla?

A

dorsal respiratory group, ventral respiratory group

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25
Q

When is the DRG predominantly active?

A

inspiration

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26
Q

When is the VRG predominantly active?

A

both inspiration and expiration

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27
Q

In the resting state, why is expiration largely passive?

A

recall of the thoracic wall

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28
Q

What are the central chemorecpetors primarily influenced by?

A

PaCO2

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29
Q

Where are the central chemorecpetors located?

A

In the brainstem at the pontomedullary junction

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30
Q

Why are the central chemoreceptors primarily inflenced by PaCO2?

A

blood brain barrier is relatively impermeable to H+ and HCO3-

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31
Q

Where will you find the peripheral chemoreceptors?

A

aorta - ascending aorta

carotid bodies -bifurcation of the common carotid

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32
Q

What are the peripheral chemoreceptors influenced by?

A

PaCO2 PaO2 and pH

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33
Q

What does an increase in PaCO2 result in?

A

increased breathing rate

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34
Q

Describe the ventilatory response when there is normal PaO2 but raised PaCO2.

A

linear- increased PaCO2, increases breathing

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35
Q

Which type of chemoreceptor are responsible for all ventilatory responses to hypoxia ?

A

peripheral chemoreceptors

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36
Q

Give examples of lung receptors

A

stretch
J
irritant

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37
Q

Are stretch receptors in the lung slow or rapidly adapting?

A

slow adapting

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38
Q

Which two centres form the pontine respiratory group?

A

pneumotaxic centre and apneustic centre

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39
Q

What are the inputs to the respiratory control centres?

A

Central chemorecepetors
Peripheral chemoreceptors
Lung receptors
Muscle proprioceptors

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40
Q

What does the diaphragm do in inspiration?

A

contracts&raquo_space; flattens&raquo_space; increases volume of the thorax

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41
Q

What does perfusion refer to?

A

blood supply

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42
Q

How much is anatomic dead space?

A

150mls

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43
Q

How much is alveolar dead space?

A

25mls

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44
Q

what do we call alveolar dead space + anatomic dead space?

A

physiological dead space

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45
Q

How much is physiological dead space?

A

175mls

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46
Q

What is the average tidal volume?

A

500mls

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47
Q

When stood up, describe the perfusion of the lungs

A

preferential perfusion to the lower parts of the lungs

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48
Q

What is hypoxic mediated vasoconstriction?

A

Blood is diverted away from the parts of the lungs that don’t have air in as blood vessels in these areas constrict . This is completely different to what happens in the systemic circulation!

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49
Q

What does PaCO2 mean?

A

partial pressure of CO2 in the arteries

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50
Q

What does PACO2 mean?

A

partial pressure of CO2 in the alveoli

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51
Q

PiO2 means?

A

pressure of inspired oxygen

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52
Q

V’ A means? (should be a dot over the V)

A

Alveolar ventilation

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53
Q

V’CO2 means? ( should be a dot over the V)

A

CO2 production

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54
Q

What is the equation for CO2 elimination?

A

PaCO2= K V’CO2 / V’A

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55
Q

List three ways CO2 is transported in the body

A

bound to Hb
dissolved in the plasma
as carbonic acid

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56
Q

What is minute ventilation?

A

volume of air breathed per minute

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57
Q

Give some physiological causes of high PaCO2

A

Reduced minute ventilation- V’A reduced
Rapid shallow breathing resulting in increased dead space ventilation and reduced V’A
Increased dead space as a result of ventilation perfusion mismatch. (V/Q mismatch)
Increased CO2 production (V’CO2)

58
Q

What is the alveolar gas equation?

A

PAO2 = PiO2 - PaCO2 / R

59
Q

What is the normal blood pH range?

A

7.35-7.45

60
Q

What is the carbonic acid equilibrium equation?

A

CO2 + H2O <> H2CO3 <> H+ = HCO3-

61
Q

What is the henderson-hasselbach equation?

A

pH = 6.1 log10 ([HCO3-] / [0.03xPCO2])

62
Q

What happens to HCO3- in a chronically acidotic patient ?

A

HCO3- increases ( more HCO3- absorbed at kidneys)

63
Q

What are the 4 main acid-base disorders?

A

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

64
Q

In respiratory acidosis what would you see happen to PaCO2, pH and HCO3-

A

PaCO2 increased
pH decreased
HCO3- mild increase

65
Q

In respiratory alkalosis what would you see happen to PaCO2, pH and HCO3-?

A

PaCO2 decreased
pH increased
HCO3- mild decrease

66
Q

What do you see in metabolic acidosis?

A

reduced HCO3-

reduced pH

67
Q

What would you see in metabolic alkalosis?

A

increased HCO3-

increased pH

68
Q

What is the respiratory quotient approximately?

A

0.8

69
Q

What does FRC stand for in spirometry?

A

functional residual capacity

70
Q

What does VC stand for in spirometry?

A

vital capacity

71
Q

What does TLC stand for in spirometry?

A

Total lung capacity

72
Q

What is vital capacity (VC)?

A

the maximum amount of air a person can expell from the lungs after a maximum inhalation

73
Q

What is tidal volume?

A

amount of air breathed in with each normal breath

74
Q

What is total lung capacity ?

A

Maximum amount of air that can fill the lungs

75
Q

What is the total lung capacity of an adult male?

A

6L

76
Q

What is functional residual capacity?

A

the volume of air present in the lungs after passive expiration

77
Q

What is residual volume?

A

the volume of air that remains in the lungs after maximum forceful expiration

78
Q

What is FVC?

A

forced vital capacity

79
Q

What is forced vital capacity ?

A

forced expiratory volume irrespective of time

80
Q

What is FEV1?

A

Forced expiratory volume in one second

81
Q

Vital capacity + ? = total lung capacity ?

A

residual volume

82
Q

what does PEF stand for?

A

peak expiratory flow

83
Q

What are transfer estimates referring to?

A

the transfer of gas from the alveolus to the alveolar capillaries

84
Q

What is DLCO?

A

diffusion capability for carbon monoxide

85
Q

What percentage of predicted FEV1 can a patient have a still be considered normal?

A

more than 80% of predicted FEV1

86
Q

What percentage of the predicated value does FVC have to be to be considered normal?

A

more than 80% of predicated FVC

87
Q

What is an obstructive lung disease?

A

a condition that makes it hard to exhale all the air from the lungs

88
Q

What is a restrictive lung disease?

A

difficulty fully expanding the lungs with air

89
Q

Is asthema obstructive or restrictive?

A

obstructive

90
Q

What ratio do we look at when testing for airways obstruction?

A

FEV1/FVC ratio

91
Q

What is an abnormal FEV1/FVC ratio?

A

below 0.7

92
Q

What does a ratio of FEV1/FVC below 0.7 indicate ?

A

obstructive lung disease

93
Q

What is the name for increased CO2 levels in the blood?

A

hypercapnia

94
Q

Describe type 1 respiratory failure

A

Lung failure
PO2 is low
PCO2 is low or normal

95
Q

Describe type 2 respiratory failure

A

Pump failure
PO2 is low
PCO2 is high

96
Q

What type of respiratory failure when alveoli fill with fluid such as water, blood or pus?

A

type 1

97
Q

What type of respiratory failure could you see in an asthema attack?

A

type 2

98
Q

What is type 1 respiratory failure also referred to as?

A

hypoxemic

99
Q

What is type 2 respiratory failure also referred to as?

A

hypercapnic

100
Q

What is low oxygen defined as?

A

PO2 less than 8KPa

101
Q

What is high CO2 defined as?

A

CO2 greater than 6KPa

102
Q

What does the Q stand for in V/Q mismatch?

A

perfusion

103
Q

How many zones do we usually divide the lung into when referring to ventilation and perfusion?

A

3 zones

104
Q

In which zone of the lung will you find the largest alveoli ?

A

zone 1

105
Q

Which zone is found at the apex of the lung?

A

zone 1

106
Q

What is the average V/Q ratio?

A

0.8

107
Q

When standing up, which part of the lung gets greater perfusion?

A

the lowest portion- zone 3

108
Q

When standing up, which part of the lung has the best ventilation?

A

the lowest portion-zone 3

109
Q

Which portion of the lung has the lowest V/Q ratio?

A

the lowest portion- zone 3. ( this area has the greatest perfusion)

110
Q

What portion of the lung has the highest V/Q ratio?

A

the upper portion- zone 1 (the apex)

111
Q

What does PA mean?

A

alveolar pressure

112
Q

What does Pv mean?

A

venous pressure

113
Q

What does it mean when there is an absolute pulmonary shunt. What is the V/Q ratio when this occurs.

A

No ventilation!

V/Q=0

114
Q

What would the be the effect of pneumonia be on the V/Q ratio?

A

decrease ventialtion

therefore decrease the V/Q ratio

115
Q

Put Pa PA and Pv in order for zone 1 of the lung

A

PA>Pa>Pv

116
Q

Put Pa PA and Pv in order for zone 2

A

Pa>PA>Pv

117
Q

Put Pa PA and Pv in order for zone 3 of the lung

A

Pa>Pv>PA

118
Q

What is a pulmoary embolism?

A

clot travels to the lungs

119
Q

What are the corners of Virchow’s triad?

A

circulatiory stasis, endothlial injury and hypercoaguable state

120
Q

Which type of antibodies are made at the start of an infection and are not very specific?

A

IgM

121
Q

What is IgE made in response to?

A

allergens

122
Q

Describe type 1 hypersensitivity reactions

A

antigens bind to IgE on mast cells/basophils

e.g anaphylaxis, allergy, asthma

123
Q

Describe type 2 hypersensitivity reactions

A

cytotoxic T cells killing

e.g transfusion mismatch, goodpasture’s syndrome

124
Q

Describe type 3 hypersensitivity reactions

A

IgG forms immune complexes

e.g lupus, systemic lupus erthematosis

125
Q

Describe type 4 hypersensitivity reactions

A

Delayed T helper cells activate macrophages

e.g contact dermatitis

126
Q

List the barriers to diffusion in the alveolus

A
  1. Surfactant
  2. Layer of epithelial cells- type 1 pneumocytes
  3. Basement membrane of type 1 pneumocytes
  4. Interstitial space
  5. Basement membrane
  6. Endothelia
  7. Erythrocyte
127
Q

What is on the x axis of an oxygen dissociation curve?

A

partial pressure of O2

128
Q

What is on the y axis of an oxygen dissociation curve?

A

% oxyhaemoglobin saturation

129
Q

What is hypoxia?

A

deficiencyH of O2 at tissue level

130
Q

How many types of hypoxia are there?

A

4

131
Q

What is the most common type of hypoxia?

A

hypoxemia (hypoxic hypoxia)

132
Q

What type of hypoxia might high altitude, hypoventilation or V/Q mismatch cause?

A

hypoxemia (hypoxic hypoxia)

133
Q

Ischaemic hypoxia occurs as a result of decreased what?

A

perfusion

134
Q

What is cellular hypoxia referred to as?

A

histotoxic hypoxia

135
Q

What are the 4 types of hypoxia?

A

hypoxemia (hypoxic hypoxia)
anaemia
ischemic hypoxia
histotoxic hypoxia

136
Q

What are the causes of hypoxemia?

A

hypoventilation
Diffusion impairment
V/Q mismatch
Shunting

137
Q

What is the affect of DPG on haemoglobin’s affinity to oxygen?

A

increased DPG decreases haemoglobins affinity for oxygen

138
Q

When Hbs affinity for oxygen decreases, which way does the oxygen dissociation curve shift?

A

right

139
Q

What factors decrease Hbs affinity for oxygen?

A

increase in DPG
increase in temperature
increase in acidity

140
Q

Why is does haemoglobin at more metabollically active tissues give up oxygen molecules more readily?

A

Temperature is higher at more metabolically active tissues

Greater PCO2 at more metabolically active tissues

141
Q

What is special about fetal haemoglobin?

A

Has a higher affinity for oxygen than adult haemoglobin

Respiratory (2 decks)

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