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YEAR 1 > resp theory > Flashcards

resp theory Flashcards

1
Q

4 steps of inspiration

A
  1. ventilation
  2. gas exchange (alveoli)
  3. gas transport
  4. gas exchange (tissues)
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2
Q

internal vs external inspiration

A

internal - cells converting O2
external - breathing

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3
Q

passive vs active movements

A

lungs - passive
inspiration - active
expiration - passive

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4
Q

forces keeping alveoli open

A

transmural pressure gradient
pulmonary surfactant
alveolar interdependence

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5
Q

forces prompting alveolar collapse

A

elastic recoil
alveolar surface tension

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6
Q

transmural pressure gradient

A

intrathoracic pressure is lower than alveolar pressure

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7
Q

intrapleural fluid cohesiveness

A

pleural membranes stick together - water molecules in pleural fluid attracted to each other

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8
Q

pneumothorax

A

air in pleural space

abolishes transmural pressure gradient - lung collapses

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9
Q

boyle’s law

A

increased volume of gas = decreased pressure

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10
Q

inspiratory muscles

A

diaphragm (down)
external IC (ribs up)

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11
Q

inspiration mech

A

inspiratory muscles increase volume of lungs -> intra-alveolar pressure falls -> air from atmosphere IN

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12
Q

expiration mech

A

muscles relax -> chest wall + lungs recoil -> intra-alveolar pressure rises -> air dips to atmosphere

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13
Q

alveolar surface tension

A

attraction of water molecules on surface

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14
Q

resp surfactant

A

produced by type 2 alveoli
lowers surface tension by getting between water

more important in smaller alveoli

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15
Q

respiratory distress syndrome of the newborn

A

lack of surfactant (premes)

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16
Q

alveolar interdependence

A

one alveoli starts to collapse -> surrounding stretched + recoil -> expanding forces open collapsing alveoli

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17
Q

accessory muscles of inspiration

A

(during forceful insp)
maj + min pectorals
sternocleidomastoid
scalenus

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18
Q

active expiration muscles

A

abdominal
internal IC

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19
Q

tidal volume (TV)

A

volume of air entering / leaving lungs in a single breath (0.5L)

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20
Q

inspiratory reserve volume (IRV)

A

extra volume that can be manually inspired (3.0L)

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21
Q

expiratory reserve volume (ERV)

A

extra volume that can be manually expired (1.0L)

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22
Q

residual volume (RV)

A

min volume remaining in lungs after max expiration (1.2L)

cannot be measured by spirometry
increases when elastic recoil is lost

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23
Q

inspiratory capacity (IC)

A

max volume of inspiration (3.5L)

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24
Q

IC =

A

IRV + TV

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25
Q

functional residual capacity (FRC)

A

volume of air in lungs after normal expiration (2.2L)

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26
Q

FRC =

A

ERC + RV

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27
Q

vital capacity (VC)

A

max volume of air that can be expired in a single breath (4.5L)

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28
Q

VC =

A

IRV + TV + ERV

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29
Q

total lung capacity (TLC)

A

total volume lungs can hold (5.7L)

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30
Q

TLC =

A

VC + RV

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31
Q

forced vital capacity (FVC)

A

max volume that can be forcibly expired (= VC)

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32
Q

forced expiratory volume in one second (FEV1)

A

volume of air expired in the first second
(should be >75%)

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33
Q

obstructive spirometry

A

FVC - low or normal
FVC1 - low
ratio % - low

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34
Q

restrictive spirometry

A

FVC - low
FVC1 - low
ratio % - normal

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35
Q

sympathetic broncho

A

bronchodilation

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36
Q

parasympathetic broncho

A

bronchoconstriction

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37
Q

dynamic airway compression (active ex)

A

pressure on alveoli pushes air out, pressure on airways not great

fine in normal, can cause lung collapse in obstructive

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38
Q

peak flow meter

A

gives an estimate of peak flow rate

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39
Q

pulmonary compliance

A

measure of the effort that goes into stretching lungs

less compliance = more work

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40
Q

pulmonary ventilation (PV)

A

volume of air breathed in / out per minute

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41
Q

PV =

A

TV X RR

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42
Q

alveolar ventilation

A

volume of air exchanged between atmosphere + alveoli per minute

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43
Q

AV =

A

(PV - anatomical dead space) x RR

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44
Q

alveolar dead space

A

ventilated alveoli that arent properly perfused

very small in normal lungs

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45
Q

V/Q matching

A

apex - V/q
base - v/Q

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46
Q

CO2 accum (v/Q)

A

bronchodilation
vasoconstriction

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47
Q

O2 accum (V/q)

A

bronchoconstriction
vasodilation

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48
Q

factors affecting rate of gas exchange

A
  1. partial pressure gradient
  2. diffusion coefficient
  3. surface area
  4. thickness of membrane
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49
Q

dalton’s law of partial pressures

A

total pressure exerted by gas mixture = sum of partial pressure of components

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50
Q

partial pressure

A

pressure that one gas in a mix would give off if it was the only one there

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51
Q

PA02 =

A

PiO2 - (PaCO2/0.8)

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52
Q

diffusion coefficient

A

solubility in membranes

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53
Q

PP gradient offset

A

O2 higher PP gradient, CO2 higher diffusion coefficient

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54
Q

O2 transport in blood

A
  1. haemoglobin bound
  2. physically dissolved (not much)
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55
Q

oxygen delivery index (DO2I) =

A

CaO2 X CI (cardiac index)

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56
Q

foetal haemoglobin

A

higher affinity for O2

57
Q

myoglobin

A

present in SkM + cardiac M
releases O2 at v low PO2

short-term storage of O2 (for anaerobic conditions)

58
Q

henry’s law

A

higher pressure of gas = more dissolved

59
Q

transport of CO2 in blood

A
  1. solution - henry’s law
  2. bicarbonate - RBC, carbonic anhydrase
  3. carbamino components - CO2 + anime (globin)
60
Q

haldane effect

A

removal of O2 increases affinity for CO2

61
Q

bohr effect

A

affinity for O2 is decreased in high CO2 concentration

62
Q

major rhythm generator

A

medulla

63
Q

pre-botzinger complex

A

generates breathing rhythm - firing contracts inspiratory muscles
DORSAL neurons

upper end of medullary resp centre

64
Q

ventral group neurons

A

activated by increased dorsal firing (hypervent)

cause active inspiration (active ex muscles)

65
Q

pneumotaxic centre

A

stimulated when dorsal neurons fire - terminates inspiration

located in pons

66
Q

apneustic centre

A

impulses excite dorsal neurons - prolong inspiration

located in pons

67
Q

involuntary modifications of breathing

A
  1. pulmonary stretch receptors (large TV)
  2. joint receptors (moving limbs increases - exercise)
68
Q

peripheral chemoreceptors

A

carotid + aortic bodies
sense tension of O2 + CO2 in blood

69
Q

central chemoreceptors

A

near surface of medulla
respond to [H+] of CSF

CSF separated by BBB, permeable to CO2 - less buffered than blood

70
Q

hypoxaemic drive

A

peripheral chemoreceptors (H+ doesnt cross BBB)

increase causes hyperventilation -> ditches CO2 more (acidosis)

71
Q

XR views

A

PA - posterior -> anterior
AP - anterior -> posterior
(lateral (replaced by CT))

72
Q

asthma triad

A

reversible airflow obstruction
T2 airway inflammation
airway hyper-responsiveness

73
Q

asthma cytokines

A

IL-5 - eosinophils
IL-4 - IgE
IL-13 - FeNO

74
Q

COPD components

A

chronic bronchitis
emphysema

75
Q

inflammatory cascade

A

inherited / acquired factors -> eosinophilic inflammation -> mediators + TH2 cytokines -> twitchy SM (AHR)

76
Q

gas transfer test (TLCO)

A

asthma - normal
emphysema - low
restrictive - low

77
Q

SM contraction pharma

A

myosin light chain (MLC) phosphorylated (Ca2+ and ATP)

relaxation - dephosphorylated (myosin phosphatase)

78
Q

asthma pathological changes

A
  1. increased SM mass (hyperplasia / hypertrophy)
  2. ISF accum (oedema)
  3. mucus secretion
  4. epithelial damage (exposes nerve endings)
  5. sub-epithelial fibrosis
79
Q

asthma stages

A

immediate (type l hyp)
- mast cells

delayed (type lV hyp)
- TH2, eosinophils

80
Q

rhinitis types

A
  1. allergic (same mech as allergic asthma)
  2. non-allergic
  3. mixed (occupational)
81
Q

allergic broncho-pulmonary aspergillosis (ABPA)

A

NOT aspergillosis (infection)
allergic resp to aspergillus

82
Q

mMRC dyspnoea scale

A

0 - strenuous exercise
1 - hurry on level / slight hill
2 - walks slower, stop for breath on level
3 - stop for breath 100m / few mins (level)
4 - cant leave house / dressing or undressing

83
Q

GOLD square (COPD)

A

Y axis - exacerbations
up - 2 / 1 + hospital
down - 0 or 1

X axis - mMRC scale
left - 0-1
right - 2

84
Q

resp failure types

A

1 - low O2
2 - low O2 AND high CO2

85
Q

type 2 resp failure pathway

A
  1. acute resp acidosis
    - bicarbonate comp -
  2. compensated resp acidosis
    - trigger / infection -
  3. decompensated resp acidosis
86
Q

resp acidosis ABGs

A

acute - low O2, high CO2, normal HCO3

compensated - low O2, high CO2, high HCO3

decompensated - low O2, very high CO2, high HCO3

87
Q

normal lungs hypoxaemia adjustments

A

increase TV or RR

88
Q

dangers of liberal O2

A

cannot see sats drops due to oxy sat graph curve

89
Q

type of hypoxia

A
  1. circulatory
  2. anaemic
  3. toxic
  4. hypoxaemic
90
Q

circulatory hypoxia

A

global - HF
local - obstruction

91
Q

anaemic hypoxia

A

iron deficiency
blood loss
sickle cell

92
Q

toxic hypoxia

A

CO poisoning
cyanide
fava-ism (beans + drugs)

93
Q

hypoxaemic hypoxia

A
  1. alveolar hypoventilation (opiates, laryngeal ob, obesity, bronchial ob, anaesthesia, kyphoscoliosis)
  2. impaired diffusion (interstitial thickening / vascular dysfunction)
94
Q

CO2 retainers

A

chest deformities
COPD (some)
CF
obesity
neuromuscular

95
Q

causes of CO2 retention

A

V/Q mismatch
- O2 tricks vessels into matching V/Q, CO2 stuck due to poor V, into blood

haldane effect
- CO2 displaces O2

96
Q

O2 guidelines

A

MI / stroke - ≥90% is good
CO2 retention risk - 88-92%
everything else - 94-98%

96
Q

unrestricted O2 access

A

cluster headaches
toxic hypoxia
sickle cell crisis
pneumothorax (no chest drain)

97
Q

bacteraemia

A

viable bacteria in blood

98
Q

URT colonisers

A

gram positive -
strep pneumoniae
strep pyogenes
staph aureus

gram negative -
haemophilus influenzae
moraxella catarrhalis

99
Q

whooping cough micro

A

bordetella pertussis

100
Q

viral pneumonia

A

RF for invasive aspergillus

101
Q

strep throat

A

exudate, pus, sore throat, dysphagia, dysphonia

mostly viral, some strep
no need for swab / abx

102
Q

tonsillitis

A

swollen tonsils, erythematous, dysphagia, dysphonia

tonsillectomy (grows back)
typically not treated

103
Q

feverPAIN score

A

sore throat abx rating
Fever (24h)
Purulence
Attended rapidly (3d onset)
Inflamed tonsils (severely)
No cough / coryza

0/1 - 13-18%
2/3 - 34-40%
4-5 - 62-65%

104
Q

quinsy

A

complication of tonsillitis - life threatening
peri-tonsillar abscess
can be drained (beware ICA)

105
Q

epiglottitis

A

children - crit emergency
histoically H influenzae, now bacterial (strep/staph)

secure airway (one shot!)
IV antibiotics

106
Q

coryza

A

self limiting
viruses

107
Q

sinusitis

A

frontal headache, retro-orbital pain, maxillary sinus pain, toothache, discharge

self limiting
fungal BAD (im comp, enters brain)

acute - follows coryza, purulent nasal discharge, self limiting

108
Q

diphtheria

A

life threatening (toxin)
characteristic pseudo-membrane
vaccinated (not for long)

109
Q

acute bronchitis

A

cold that ‘goes to chest’, preceded by coryza
self limiting

productive cough, fever, normal exams, potential transient wheeze

110
Q

pneumonia definition

A

Sx + SGx of LRI w/ new infiltrate on CXR

111
Q

CURB65

A

Confusion (new onset)
Urea >7
Resp rate >30
BP sys <90 / dias <60
65 (age)

112
Q

pneumonia path types

A

lobar - whole lobe (strep)
bronchopneumonia - patchy consolidation (varies, pre-existing disease)

113
Q

effusion -> empyema progression

A

simple pleural effusion
- pH >7.2, high glucose, high LDH, clear fluid

complicated pleural eff
- pH <7.2, low glucose, low LDH, positive gram stain
- requires chest drain

empyema
- frank pus, chest tube

114
Q

chronic bronchial sepsis / persistent bacterial bronchitis

A

hallmarks of bronchiectasis, NONE on CT scan

115
Q

pleural fluid colours

A

straw - cardiac failure, hypoalbuminaemia
bloody - trauma, malignancy, infection, infarction
milky - empyema, chylothorax
foul smelling - anaerobic empyema
food particles - oesophageal rupture

bilateral - LVF, PE, drugs

116
Q

pleural effusion types

A

transudates - protein <30
HF
cirrhosis
hypoalbuminaemia
atelectasis
peritoneal dialysis

exudates - protein >30
malignancy
infection
pulmonary infarction
asbestos

117
Q

cystic fibrosis trans-membrane conductance regulator (CFTR)

A

actively transports chlorine out of cells

lost in CF - Na+ flows in, lost osmotic gradient

118
Q

resp epithelium

A

pseudostratified columnar epithelium + goblet cells

119
Q

UNDER resp epi

A

lamina propria !
seromucous glands + thin-walled venous sinuses

120
Q

NOT resp epithelium

A

start of nose (keratinised) + pharynx + vocal folds = squamous stratified

roof of nasal cavity = olfactory epithelium

121
Q

trachea histology

A

C shaped cartilage rings (open part fibroelastic tissue + SM)
shape allows oesophagus space to move (god has made the things in such a way to make the life easy)
LP = CT

122
Q

bronchi his changes

A

cartilage rings -> irregularly shaped cartilage plates

becomes more discontinuous distally (lost in bronchioles)

123
Q

bronchioles histology

A

lack cartilage + glands
epithelium - columnar -> cuboidal
LP = SM

terminal (no resp) -> respiratory (yes resp)

124
Q

terminal bronchiole histology

A

contain non-ciliated club (clara) cells
- stem cells, detox, immune modulation, surfactant

125
Q

alveoli histology

A

type 1 - discontinuous squamous
type 2 - polygonal + microvilli +surfactant (lamellar bodies exocytosis)

present - alveolar macrophages (dust cells) -> migrate up tree + to pharynx (swallowed / move into CT)

126
Q

visceral pleura histology

A
  1. simple squamous epithelium (mesothelium)
  2. fibrosis + elastic CT
127
Q

TB infection mech

A
  1. pathogen inhaled -> alveoli
  2. phagocytosis, carried to hilar lymph nodes
  3. granulomatous response -> caseous necrosis
128
Q

lung cancers

A

SCLC - 25%
central, worst prognosis

NSCLC
adenocarcinoma - 35%
non-smokers, asbestos, peripheral

squamous cell - 30%
smokers, central

large cell - 10%
second worse prognosis, peripheral

129
Q

pancost tumour

A

lung apex -> shoulder pain, arm weakness etc

130
Q

SVC local invasion

A

puffy eyelids, headache, JV + chest vein distension

131
Q

IPF pathology

A

fibrosis (foci) + honeycombing
lymphocytes

132
Q

pneumoconiosis

A

fibrosis + evidence of inhaled substance

133
Q

sarcoidosis

A

well formed + non-caseating granulomas, hilar node involvement

134
Q

hypersensitivity pneumonitis

A

loose non-caseating granulomas
lymphocytes + fibroblastic foci

135
Q

adult respiratory distress syndrome (ARDS)

A

also diffuse alveolar damage syndrome (DADS)
ALSO shock lung

injury ->
1. fibrous exudate lines alveolar walls
2. cellular regeneration
3. inflammation

135
Q

neonatal RDS

A

lack of surfactant

136
Q

cor pulmonale

A

RH hypertrophy / dilation caused by pulmonary hypertension

YEAR 1 (11 decks)

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