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Transition Block 1 2018/19 > Physiology > Flashcards

Physiology Flashcards

1
Q

Which systems can be involved in shortness of breath?

A

Respiratory

Cardiovascular

Haem (anaemia)

Endocrine (DKA)

Psychiatric (anxiety)

many more causes

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2
Q

Shortness of breath may be ___ or ___.

A

acute or chronic

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3
Q

What are some respiratory causes of shortness of breath?

A

Asthma

COPD

Pneumonia

Lung cancer

Pulmonary embolism

Pulmonary fibrosis

Interstitial lung disease

…

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4
Q

What are some cardiovascular causes of shortness of breath?

A

Ischaemic heart disease (angina > MI spectrum)

Hypertension

Valvular disease

Cardiomyopathy

Arrhythmias

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5
Q

Where generally are the body’s respiratory centres found?

A

Brainstem

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6
Q

Neurons in which parts of the brainstem control the

a) rhythm of respiration
b) inspiration / expiration modifications?

A

a) Medulla

b) Pons

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7
Q

Which group of receptors detects the H+ concentration of the CSF?

A

Central chemoreceptors

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8
Q

Which group of receptors detect the oxygen, CO2 and H+ concentrations of the blood?

Where are they found?

A

Peripheral chemoreceptors

Common carotid arteries and Arch of the aorta

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9
Q

What is an increase in CO2 concentration called?

A

Hypercapnia

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10
Q

How does CO2 reach the central chemoreceptors?

A

Via blood brain barrier

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11
Q

In what form do the central chemoreceptors detect CO2 in the CSF?

A

H+

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12
Q

Which chemoreceptors detect the oxygen concentration of the blood?

A

Peripheral chemoreceptors

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13
Q

Which receptors detect

a) hypercapnia via an increased H+ conc. in the CSF

b) hypoxia via a decreased O2 conc. in the blood?

A

a) Central chemoreceptors

b) Peripheral chemoreceptors

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14
Q

What is the main driver of respiration?

A

Effect of increased [CO2] on central chemoreceptors

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15
Q

The central chemoreceptors are the main drivers of respiration.

What are two peripheral chemoreceptor drivers of respiration?

A

Hypoxic drive

H+ drive

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16
Q

At which partial pressure of oxygen do the peripheral chemoreceptors trigger an increased rate of respiration - hypoxic drive?

A

< 60 mm Hg

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17
Q

Which muscles control the inflation and deflation of the lungs?

A

Respiratory muscles

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18
Q

How do signals reach the respiratory muscles from the chemoreceptors?

A

Peripheral nerves to intercostal muscles

Phrenic nerve (C3,4,5) to diaphragm

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19
Q

Contraction of which muscle increases the vertical dimensions of the thorax?

A

Diaphragm

C3,4,5

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20
Q

Contraction of which muscles increases the horizontal diameter of the thorax?

A

External intercostal muscles

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21
Q

What are the major muscles of respiration?

A

Diaphragm

External, internal and innermost intercostal muscles

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22
Q

What are some accessory muscles of respiration?

A

SCM

Scalenus anterior

Pectoralis major

Pectoralis minor

Latissimus dorsi

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23
Q

___ pressure is usually greater than ___ pressure.

(intra-pleural , intra-alveolar)

A

Intra-alveolar pressure > Intrapleural pressure

i.e the pressure WITHIN the airways is > the pressure in the pleural cavity

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24
Q

What is the difference between intra-alveolar and intrapleural pressure called?

A

Transmural pressure gradient

25
Q

Why is maintaining the transmural pressure gradient important?

What can cause it to be abolished?

A

Allows lungs to stick to pleura during thorax expansion and collapse

Pneumothorax

26
Q

What is a pneumothorax?

A

Air within the pleural space

Abolishes the transmural pressure gradient

27
Q

Which substance is produced by Type II pneumocytes and opposes alveolar surface tension?

A

Pulmonary surfactant

28
Q

What is the main factor contributing to airway resistance?

A

Airway radius

29
Q

Airway ___ is the main determinant of resistance to air flow.

A

Airway radius

30
Q

What causes bronchoconstriction?

A

Parasympathetic impulses

31
Q

What causes bronchodilation?

A

Sympathetic impulses

32
Q

During inspiration, the diaphragm moves (up / down).

A

down

to increase vertical dimensions of the thorax

reducing intra-alveolar pressure

encouraging air to move into the lungs from the greater atmospheric pressure, down the pressure gradient

33
Q

During expiration, the diaphragm moves (up / down).

A

up

to decrease vertical dimensions of the thorax

increasing intra-alveolar pressure

encouraging air to move out of the lungs to the atmosphere, down the pressure gradient

34
Q

What is the normal force which is applied to the airways by increasing intra-pleural pressure during expiration?

A

Dynamic airway compression

35
Q

Dynamic airway compression is the normal force applied to the airways by increasing intrapleural pressure during expiration.

In which patients does this pose a problem?

A

Patients with obstructed airways / reduced lung elasticity

i.e those with COPD, fibrosis

36
Q

What is pulmonary compliance?

A

Effort required to inflate the lungs

37
Q

Which disease reduces pulmonary compliance?

A

Pulmonary fibrosis

38
Q

What are

a) Type I pneumocytes
b) Type II pneumocytes?

A

a) Alveoli

b) Cells which produce pulmonary surfactant

39
Q

Which structures accept oxygen from and transfer carbon dioxide to the alveoli?

A

Pulmonary capillaries

40
Q

What is found between the alveoli and pulmonary capillaries?

A

Interstitial space

Affected in interstitial lung disease, which impairs compliance and gas exchange

41
Q

Pulmonary capillaries branch from the pulmonary (arteries / veins).

A

pulmonary arteries

42
Q

The ___ ___ of CO2 is 20x that of oxygen.

A

diffusion coefficient

i.e how readily it passes across membanes

43
Q

What is the equation for cardiac output?

A

CO = HR x SV

44
Q

How is stroke volume calculated?

A

SV = EDV - ESV

45
Q

The stroke volume depends on the ___ given to the heart’s muscle fibres by the venous return.

A

preload

46
Q

Up to an optimal length, ___ ___ is directly proportional to preload.

A

stroke volume is directly proportional to preload

Frank-Starling Law of the heart

47
Q

Which cardiovascular disease shifts the Frank-Starling curve to the right?

A

Heart failure

48
Q

___-___ heart failure is a common cause of shortness of breath.

A

Left-sided heart failure

or Cor pulmonale

49
Q

Which disease results in an impaired ability for the blood to transport oxygen?

A

Anaemia

reduced number of circulating red blood cells, which contain haemoglobin, which binds oxygen

50
Q

What are some core investigations for shortness of breath?

A

FBC, ABG

ECG, Troponin T

CXR

51
Q

What is a tidal volume?

A

Volume of air entering/leaving the lungs during a single breath

52
Q

What is inspiratory reserve volume?

A

Volume of air which can be inspired on top of a normal tidal volume

53
Q

What is inspiratory capacity?

A

Inspiratory capacity = Tidal volume + Inspiratory reserve volume

54
Q

What is expiratory reserve volume?

A

Volume of air which can be expired after a normal tidal volume

55
Q

What is residual volume?

A

Volume of air left in the lungs after a full expiration

56
Q

What is vital capacity?

A

Max volume of air which can be expired after a maximal inspiration

57
Q

What is FEV1?

What is FVC?

A

FVC - a forcefully expired vital capacity

FEV1 - volume of FEV1 which can be expired in the first second

58
Q

A normal FEV1/FVC ratio is > ___%.

A

> 75%

Transition Block 1 2018/19 (3 decks)

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