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Physiology - Hayley > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Explain the characteristics of respiratory epithelium and how it differs between the conducting and respiratory airway

A

Pseudostratified columnar cells with cilia
Conducting epithelium - thick layer of cells to restrict gas exchange. Contains layers of cartilage to keep airway open and mucus producing goblet cells
Respiratory epithelium - single layer of cells

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2
Q

What levels of the airway are conducting and which are respiratory

A

Conducting - 1-14 (transitional bronchioles at 15)
Respiratory - 16-23

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3
Q

What muscles are used in inspiration

A

Accessory muscles - elevate ribs and sternum
Principle muscles - external intercostals and diagram

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4
Q

What muscles are used during active expiration

A

Internal intercostals and abs

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5
Q

What are the characteristics of conducting epithelium that has remodelled

A

thickening of smooth muscle and basement epithelium.
Thickening of sub mucosal layer that folds inwards into the lumen

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6
Q

Hyperpnea

A

Increased breathing that matched the metabolic need

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7
Q

Apnea

A

Absence of airflow due to lack of respiratory effort or airway obstruction (failure to breathe)

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8
Q

Dyspnea

A

Sensation of laboured breathing (shortness of breath)

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9
Q

What is the effect of neuromuscular control on the work of breathing

A

It changes the mechanical work of breathing by adapting to the information from the sensors

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10
Q

What areas of the brain are active in breathing - both subconsciously and conscious

A

Subconscious breathing is regulated in the brain stem - inspiration neurons are always active and expiration neurons become active during active breathing.
As soon as breathing become conscious it is controlled by higher centers in the brain.

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11
Q

What is the only area in the body that can respond to hypoxic blood condition

A

Carotid Bodies

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12
Q

How does the carotid bodies send information to the brain

A

Carotid body sensors are located to access the blood heading to the brain. Chemo and baroreceptors are sent to the brainstem via the carotid sinus nerve.

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13
Q

What are responsible for controlling acclimatization

A

Carotid Bodies

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14
Q

What causes hypocapnia

A

Hypoventilation

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15
Q

What results from alveolar hypoventilation

A

Respiratory acidosis

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16
Q

What results from alveolar hyperventialtion

A

Respiratory alkilosis

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17
Q

What site in the airway is most vulnerable for full obstruction during sleep

A

Pharynx

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18
Q

How many pharynx obstructions have to occur during sleep for it to be deemed clinical (likely to lead to pathology)

A

> 5

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19
Q

What occurs during sleep that causes OSAS and how does one overcome it

A

When neuromuscular control to the head and neck relaxes during sleep, the pharynx can collapse on itself, closing the airway.
Active breathing is required to overcome the obstruction, opening the pharynx.

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20
Q

Explain the difference in SPo2 levels of a patient with OSAS when they are awake and asleep

A

Awake - flat line
Asleep - oscillatory drops in pressure as airflow is obstructed

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21
Q

What are 3 anatomical and 3 non-anatomical contributors to OSAS

A

anatomical - narrow airway, crowded airway, collapsible airway
non-anatomical - ineffective pharyngeal dilatory muscle activity in sleep, low arousal threshold to airway narrowing, unstable control of breathing

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22
Q

What are the benefits of oscillometery compared to spirometry

A

Oscillometry is recorded during normal breathing, thus requires less patient compliance (can be good with children)

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23
Q

Before you begin testing with oscillometry, what recordings must you obtain first

A

3 artifact recordings with coeffiecnt of variability of <10% in adults and <15% in children

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24
Q

What frequency is used in oscillometry testing

A

5-50Hz, but typically 5-26Hz. Up to 35Hz can be useful in children.

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25
Q

What does resistance and reactance tell us about the larger and peripheral airways

A

Resistance is the degree of obstruction in larger airways
Reactance is sensitive to changes in peripheral airway

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26
Q

On a ‘real axis’ for oscillometry:
- what does the length of the line represent
- what does the vertical position represent
- what does the angle between the two lines represent

A
  • amplitude of the wave
  • the line furthest ahead will peak first
  • the angle determines the difference between the phases in the wave
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27
Q

On a ‘real axis’ in oscillometry:
- What is represented on the X axis
- What is represented on the Y axis

A

X axis is Resistance (Rrs)
Y axis is Reactance (Xrs)

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28
Q

What force is prevailing is the reactance in oscillometry is negative

A

Elastin

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29
Q

What force is prevailing is the reactance in oscillometry is postiive

A

inertance

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30
Q

Equation for impendance

A

pressure/flow

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31
Q

Explain the expected impendence graph of a healthy adult during an oscillometry test

A

reactance starts at negative number (dominated by elastin) and increases with increasing frequency and when it crosses the 0 line it starts acting with less elastin and more inertance. Resistance starts as positive and drops a little bit but never goes negative

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32
Q

Resonance frequency

A

When the reactance is 0 (occurs around 8-12Hz in adults)

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33
Q

What would we expect the impendance to look like in an individual with central airway obstruction

A

Reactance - same as healthy subject
Resistance - this will not decrease as the frequency increases

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34
Q

What would we expect the impendence to look like in an individual with peripheral airway obstruction

A

Reactance - this will remain low and likely not cross 0 until high frequencies
Resistance - will start very positive then drop to normal range as frequencies increase

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35
Q

What is the area of reactance in an impedance graph

A

Area under the curve until reactance = 0.

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36
Q

What does an increase in area of reactance suggest

A

change in peripheral airway

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37
Q

What are the 5 moments of hand washing

A
  1. before touching a patient
  2. before a procedure
    after a procedure or bodily fluid risk
    after touching a patient
    after touch a patients surroundings
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38
Q

3 examples of obstructive airway disorder

A

Asthma, COPD, cystic fibrosis

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39
Q

What is the general approach to treating obstructive lung disease

A

reducing inflammation, relaxing airway muscles, improving lung function with lifestyle changes

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40
Q

What are 2 hallmark indicators of obstructive lung disease in spirometry testing

A
  1. Reduced FEV1/FVC% indicating significant difficult in expelling air from the lungs
  2. Peach expiratory flow significantly decreases
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41
Q

COPD
- Caused by
- What are the two primary conditioned associated with it
- Key symptom

A
  • Caused by long term exposure to harmful irritants, commonly cigarettes
    1. Chronic Bronchitis: inflammation and mucus buildup in airway
    2. Emphysema: stretching of the alveolar
  • excessive mucus production which worsens overtime
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42
Q

How does emphysema reduce lung function

A

the destruction of the alveolar walls reduces the lungs natural recoil ability which normally helps push air out during exhalation. With an increased amount of air left in the lungs this further contributes to hyperinflation.

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43
Q

What chemical changes are associated with COPD

A

Hypecapnia

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44
Q

What is the effect of COPD on exercising individuals

A

Their increased work of breathing recruits more accessory muscles, so o they begin to fatigue quicker and the tolerance to exercise and everyday tasks becomes challenging.

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45
Q

What is the key identifying symptom of cystic fibrosis

A

Production of thick, sticky mucus

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46
Q

What is the genetic cause of cystic fibrosis

A

Destruction of the CFTR gene leads to dysfunctional Cl- transport into the cells causing water retention outside of the cells.

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47
Q

What are the effects of the FEV1, FVC and FEV1/FVC% on cystic fibrosis patients

A

FEV1 - reduced
FVC - reduced as exhalation becomes difficult
FEV1/FVC% - reduced

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48
Q

Asthma

A

Chronic inflammation of the bronchial wall, leading to mucus production and airway narrowing, reducing the efficiency of airflow

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49
Q

What are 4 tests/test markers used to diagnose Asthma

A
  1. Spirometry - FEV1/FVC% below lower limit of normal (<0.75)
  2. Peak expiratory flow - monitored over 2 week period and a variation of >20% is supportive of asthma
  3. Exhaled NO fraction - used when diagnosis isn’t made just off spirometry and challenge testing
  4. Bronchial challenge testing - bronchoconstrictor is administered then airway function is assessed after each incremental dose of bronchodilator.
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50
Q

What are common symptoms of restrictive lung disease

A

Dry cough, crackles on lung auscultation, clubbing of the finger, tachypnea

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51
Q

What are three examples of structural abnormalities that would lead to a restrictive lung disease

A

kyphoscoliosis, pectus excavatum, ankylosing spondylitis

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52
Q

How do structural changes in restricted lung change the work of breathing

A

the stiffness and restricted movement of the chest wall decreases compliance of the lungs, requiring more effect to breathe.
Leads to tachypnea and increased work of breathing as they try to compensate for the reduced lung volumes.

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53
Q

What is the effect of structural abnormalities causing restrictive lung disease on the FEV1/FVC%

A

FEV1 low
FVC low
FEV1/FVC% can remain the same or be elevated

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54
Q

How does neuromuscular disease lead to restrictive lung disease

A

Progressive weakness of breathing muscles impair ventilation

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55
Q

What is the effect on the FEV1/FVC% in people with restrictive lung diseases caused by neuromuscular disease

A

FCV1 - remains the same
FVC - decreases
FEV1/FVC% - can remain the same or be elevated

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56
Q

How does pleural effusion lead to restrictive lung disease

A

Fluid accumulates in the pleural space compresses lung tissue

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57
Q

What mechanical and chemical changes occur during restrictive lung disease due to pleural effusion

A

Compression of the lung increases the work of breathing and causes dyspnea
Hypoxia due to inefficient gas exchange

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58
Q

How does a pneumothorax cause restrcitive lung disease

A

Air in the pleural space during a pneumothorax disrupts negative pressure to keep the lung inflated leading to lung collapse and impaired ventilation

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59
Q

What lung volumes are particularly effected during a pneumothorax

A

TLC and VC drop significantly as the lung is unable to expand

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60
Q

Interstitial lung disease
- what is is characterised by
- risk factors
- management

A

characterised by inflammation and scarring of the lung interstitial, affecting the space around the alveoli

risk factors: exposure to drugs, autoimmune or idiopathic

anti-inflammatory, immunosuppressants, anti-fibrotic treatments

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61
Q

What effects to the FEV1/FVC% does interstitial lung disease have

A

FFEV1/FVC% may be the same or elevated depending on how much FVC drops

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62
Q

Idiopathic pulmonary fibrosis
- characterised by
- effect on FEV1/FVC%
- mechanical work of breathing

A

Characterised by progressive scarring of the lung interstitial, the tissue between the alveoli, which impairs gas exchange and lung elasticity

FEV1/FVC% could remain constant or elevate depending on how much FVC changes

Work of breathing increases due to stiffening of lungs and reduced compliance

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63
Q

What is idiopathic pulmonary fibrosis driven by on the cellular level

A

abnormal activation of fibroblasts, which proliferate and produce excessive collagen, leading to the formation of fibrotic tissue in the lungs

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64
Q

Hypersensitivity pneumonititis
- characterised by
- triggered by
- effect on FEV1/FVC%

A

Characterised by inflammation in the lungs due to repeated inhalation of organic particles, leading to an immune-mediated reaction in the alveoli and bronchioles

FEV1/FVC% can be the same or elevated depending on how much FVC drops

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65
Q

Sarcoidosis
- characterised by
- which symptom of sarcoidosis isn’t present in other restrictive lung diseases
- chemical changes

A

Characterised by the formation of granulomas in the lung parenchyma, leading to reduced lung compliance

Enlargement of lymph nodes are common in sarcoidosis

Hypoxia due to reduced diffusion capacity of alveoli

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66
Q

Tidal Volume

A

volume of gas entering the lung in each breath during quiet breathing

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67
Q

Forced Vital Capacity (FVC)

A

maximal expiration followed by maximal inspiration

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68
Q

Total lung capacity

A

volume of gas in the lung after one breath

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69
Q

Expiratory reserve volume (ERV)

A

volume of gas that can be expired from the end expiratory lung volume (EELV)

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70
Q

Inspiratory reserve volume (IRV)

A

volume that can be inspired from end inspiratory volume volume (EILV)

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71
Q

Vital capacity

A

volume of gas from maximum inspiration to maximum expiration

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72
Q

What happens to the pressure inside the alveolar as the lung inflates

A

The pressure in the alveolar sacs (originally 0) becomes negative causing flow of air into the lungs

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73
Q

Functional residual capacity

A

Volume of gas remaining in the lung upon relaxation of the lung/passive exhalation

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74
Q

What is the alveolar pressure and pleural pressure when at functional residual capacity

A

Alveolar = atmospheric
Pleural = -5cmH2O

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75
Q

What occurs to FRC when sitting and in obesity

A

Sitting - abdominal contents displaces towards the chest wall, reducing FRC

Obesity - reduced FRC

76
Q

What is the most important muscle during expiration in exercise

A

Abdominals - these raise intra-abdominal pressure pushing the diaphragm upwards

77
Q

What two tests have to be used to measure FRC, RV and TLC

A

Helium Dilution and body plethysmography

78
Q

How does helium dilution work

A

Subject is asked to inhale and exhale in a closed-circuit spirometer containing a known concentration of helium and oxygen.

The amount of helium in the exhaled breath is compared to that of the inhaled breath

79
Q

What does body plethysmography measure

A

total lung volume including residual volume and dead space

80
Q

How does body plethysmography work

A

When teh patients breathes in, the volume of air in the lungs increases, causing a drop in pressure within the box (because the total volume remains constant).
Conversely, when the patient exhales, the volume decreases, causing an increase in pressure.

Boyles Law states that pressure x volume is constant

81
Q

Definition of ventilation

A

total volume of gas exchanged from athmosphe and lungs in 1 minute

82
Q

Definition of alveolar ventilation

A

minute volume of gas entering the alveolar region

83
Q

Equation for alveolar ventilation

A

total ventilation (VE) - Dead space (VD)

84
Q

Where does the entire concentration of CO2 in expired gas come from

A

Only comes from the alveolar, so the alveolar volume would determine the amount of CO2 in expired air

85
Q

In healthy subjects what are the PCO2 of alveolar gas and arterial blood and what does this allow

A

They should be virtually identical allowing for PaCO2 to estimate alveolar ventilation

86
Q

What is the relationships between CO2 production, alveolar ventilation and PaCO2

A

If CO2 production remain constant and alveolar ventilation halves, PaCO2 doubles

(alveolar ventilation and PaCO2 are inversely proportional)

87
Q

As work rate increase throughout exercise what is the primary contributor to the increase in ventilation

A

Tidal Volume increases

88
Q

During exercise in healthy subjects, as tidal volume reaches the critical lung volume, what is modified to allow for the increase in work rate and ventilation

A

Predominately from an increase in respiratory rate and associated shortness of expiration and inspiration duration

89
Q

As work rate peaks during exercise and ventilation increases what can then occur to the tidal volume

A

As ventilation increases, disproportate increase in respiratory rate can cause tidal volume to decrease

90
Q

In healthy subjects during exercise what does their compliance curve look like

A

Lung expansion occurs over a near-linear region of the compliance curve, decreasing the elastic work of breathing

91
Q

What occurs to the EELV in healthy subjects during exercise and how is this advantagous

A

EEVL decreases

Allows the recoil of the compressed thoracic cage to ‘assist’ the inspiratory muscles during the subsequent inhalation

92
Q

What occurs to EELV in patients exercising with COPD

A

When VE demand become exceptionally high, the time of expiration required to accommodate the increase in respiratory rate can predispose to expiratory flow limitation and ‘dynamic hyperinflation’ so EELV increases

93
Q

In COPD patients who are exercising, their EIVL changes, what is the results of this change

A

EILV increases (less inhalation time due to respiratory rate increase)

Increase in EILV towards limiting levels, compromising the inspiratory muscles and reducing the scope of tidal volume increase by encroaching on the flatter upper regions of the compliance curve

94
Q

In COPD what is dynamic hyperinflation attributed to (3)

A
  1. Lower expiratory flows from decreased lung recoil
  2. Higher airway resistance
  3. Insufficient time to complete expiration before the next inspiration when the respiratory rate increases during exercise
95
Q

What factors related to tidal volume result in dynamic hyperinflation in patients with ILD during exercise

A
  1. Inability to expand tidal volume appropriately die to thoracic restriction during the increased metabolic demand of exercise
  2. High tidal volume and the plateau of this early in exercise
96
Q

What is the effect on respiratory rate of dynamic hyperinflation in ILD patients

A

Respiratory rate increases early and very steeply

97
Q

Where on the compliance cure does ventilation operate in patients with ILD

A

Operates in the flat region due to static lung compliance

98
Q

What is the effect on transfer factor of carbon monoxide in ILD and why

A

Disruption of the pulmonary microvasculature and the alveolar-capillary interface causing impaired gas exchange and decreased TLCO

99
Q

What occurs to the oxygen levels in the blood during exercise in ILD patients

A

arterial hypoxemia is common during exercise and can occur early in ILD

100
Q

What occurs to the work of breathing during exercise in ILD patients and why

A

Work of breathing increases dramatically in order to overcome the high elastic load of the stiff lungs while breathing close to TLC

101
Q

What are the 3 main classes of bronchodilators used to treat asthma

A

Beta-2 agonists
Anticholinergics
Methylxanthines

102
Q

What are the 3 main anti-inflammatory methods for asthma treatment

A

Corticosteroids
Biolics
Leukotriene Modifiers

103
Q

What are 3 Biologics for Asthma and what to they each target

A

Omalizumab (anti-IgE)
Anti IL-5 monoclonal antibodies
Dupilumas (anti IL-4)

104
Q

Cystic fibrosis monotherapy targets what type of mutations + example

A

Targets class 3 and 4 CFTR mutation (there is a protein but it doesn’t function)

E.g Ivacaftor

105
Q

Cystic Fibrosis triple therapy targets what CFTR mutation and what is an example of this

A

Targets class 2 mutation (CFTR protein gets degraded before it reaches the surface)

E.g elexacaftor/tezacadtor/ivacaftor

106
Q

What 4 factors determine the reference range for spirometry results

A

age, height, weight, ethnicity

107
Q

What spirometry results must you get before concluding the test

A

Have to of conducted it a minimum of 3 times with at least two FVC readings with 5% or 150ml of each other

108
Q

What three measurements does a spirometry trace measure

A

volume, time and flow

109
Q

What would be the pathological interpretation for the following spirometry outcomes
1. FCV normal, FEV1 normals, ratio normal
2. FCV low or normal, FEV1 low, ratio low
3. FCV low, FEV1 low, ratio normal
4. FCV low, FEV1 low, ratio low

A
  1. Normal
  2. Airway obstruction
  3. Lung restriction
  4. Combination of obstruction and restriction
110
Q

What airway, proximal or distal, determine airflow resistance at large lung volumes and drive the FEV1/FVC ratio

A

Proximal

111
Q

What airway, proximal or distal, determines the airflow resistance at small lung volumes and drive the measurements later in maximal exhalation

A

Distal

112
Q

Airway obstruction impairs lung emptying, what other two factors are usually associated with it

A

air trapping and hyperinflation that may reduce the FVC but more directly assessed by the residual volume measurement

113
Q

Explain the shape of the spirometry curve for a normal, obstructive and restrictive lung

A

Normal - steep rise to FEV1

Obstructive - shallow rise so doesn’t match FEV1 of normal, but does release the same amount of gas (FVC is the same)

Restrictive - very small curve, doesn’t match FEV1 or FVC

114
Q

According to the GIL, what z scores are associated with different severity of disease

A

Greater than -2.5 = mild
-2.5 - -4.0 = moderate
less than -4.0 = severe

115
Q

According to GIL, what FEV1 is associated with different levels of severity

A

More than 70% = mild
50%-70% = moderate
35%-50% = severe
less than 35% = very severe

116
Q

Is someone has a reduced FEV1 this tells you they likely have which category of disease

A

Obstructive

117
Q

What results are required in a bronchodilator response test to be indicative of asthma

A

There needs to be at least a 10% change in dilation upon administering the bronchodilator

118
Q

What can a bronchodilator test aid in differentiating between

A

COPD and asthma

119
Q

Salbutamol, terbualine and ipratroium are all typs of what

A

bronchdilators

120
Q

Explain the morphology of the flow volume loop in in normal, obstructive and restrictive conditions

A

Normal - Rapid increase and stead decrease exhalation. Peak volume 6L, broad and deep inspiration

Obstructive - think shark fin. Volume could be normal or reduced. In general smaller on all aspects

Restrictive - Much more similar in shape to normal curve, but smaller in all values.

121
Q

Adverse effects to doing spirometry

A

Respiratory alkalosis as a result of hyperinflation
Lightheadedness/fainters
Headache
Coughing

122
Q

What are some absolute contraindications of spirometry

A

Heamodynamic instability
Recent MI
Respiratory infection, pneumothorax, pulmonary embolism
Retinal detatchment

123
Q

What are some relative contraindication to spirometry

A

Patient cant follow instructions
Patient can hold the mouthpiece
Recent abdominal surgeries
Hypertension

124
Q

What does DLCO measure

A

The surface area of the lung available for has exchange

125
Q

How do they perform DLCO. What gas is used and why

A

Carbon monoxide is used as it has a high affinity to Hb similar to oxygen.

During a 10 second breath-hold, DLCO measures uptake of carbon monoxide

126
Q

What factors can influence the alveolar membrane gas diffusion efficiency and what law defines this

A

Fick’s Law
- Surface area
- Thickness
- Pressure
- Solubility of the gas

127
Q

How does the single breath technique work in DLCO measurements

A

patient is asked to full exhale to RV then to rapidly inhale the gas. They hold their breath for 10 seconds at TLC and exhales the gas.
The exhaled gas is collected for analysis

128
Q

How does the intrabath technique work for DLCO measurements

A

They CO is measured during different phases of exhalation to measure the gas diffusion capacity at different lung volumes

129
Q

How does the rebreathing technique work for DLCO measurements

A

Patient takes multiple breaths in a closed circuit and the amount of CO absorbed it measured

130
Q

In what diseases is DLCO useful for aiding in diagnosis

A

Parenchymal and non-parenchymal lung disease

131
Q

What percentage of DLCO is associated with differing levels of severity

A

> 75% Normal
60% of LLN Mild
40%-60% Moderate
<40% Severe

132
Q

What disease can primarily affect DLCO testing

A

Anaemia

133
Q

What is the equation for DLCO

A

DLCO = Va x Kco

Va = number of contributing alveolar unnits measured by tracer gas (helium)
Kco - amount of CO absorbed over unit time

134
Q

What diseases would we expect for there to be a decreased DLCO

A

Emphysema - due to alveolar destruction

Smoking

Interstitial Lung Disease - pulmonary fibrosis and thickening of the membrane

135
Q

What diseases would we expect with a normal DLCO and restictive pattern on the PFT

A

A normal DLCO with a restrictive pattern on spirometry would suggest neuromuscular or chest wall disorder

136
Q

What diseases would we expect for there to be a decreased DLCO and normal spiromoetry

A

In dyspnoea cases with unknown ethology, normal spirometry with low DLCO increases the likelihood of pulmonary vascular disease

Obestity, asthma, good pasture syndrome, lupus

137
Q

Why would you perform a muscle strength test

A

Someone is suspected of a neuromuscular disease

Lung function test show reduced C or and increase DLCO with unknown eteology

138
Q

What three measurements are taken during a muscle stregnth test

A

Maximal Inspiratory Pressure
Maximal Expiraotry Pressure
Sniff Nasal Inspiratory Pressure

139
Q

In muscle strength testing, what values of inspiratory pressure and SNIP are clinically significant of muscle weakness in men and woman

A

MIP - >80cmH2O men, >70cmH2O women
SNIP - >70 cmH2O men, >60cmH2O women

140
Q

What values of FVC, VC, MIP, MEP and SNIP are indication of needing non-invasive ventilation

A

FVC - <50% predicted
VC <60% predicted
MIP <60cmH2O
MEP <40cmH2O
SNIP <40cmH2O

141
Q

What two issues is arterial blood gas analysis good for identifying

A

potential respiratory derangements or metabolic derangements

142
Q

What is the normal PaO2

A

11-13.5kPa

143
Q

Normal PaCO2

A

4.5-6kPa

144
Q

Normal pH of blood

A

7.35-7.45

145
Q

Normal SaO2

A

95%-100%

146
Q

What PaO2 would be indicative of needing long term oxygen in chronic lung patients

A

<7.3kPa

147
Q

Explain the morphology of a flow-volume loop of someone with variable extra thoracic obstruction

Give some examples of extra thoracic obstruction

A

Expiratory phase is normal but the inspiratory phase is flattened (this is hallmark of someone struggling to keep their upper airway open during inspiration)

usually involves obstruction in the upper airway - vocal cord dysfunction, vocal cord paralysis, tracheomalacia

148
Q

Describe the morphology of a flow-volume loop for a patient with variable intrathoracic obstruction and give examples of these diseases

A

Inspiratory phase is normal, but expiratory phase is truncated in height

intrathoracic tumours and bronchial compression from masses

149
Q

What does capnography measure

A

measures the concentration of end tidal volume of carbon dioxide in exhaled breath, providing continuous, real time assessment

150
Q

In capnography, what levels are considered normal, elevated and low and what can cause these

A

35-45mmHg normal
>45mmHg elevated - hypoventilation, respiratory depression, increased CO2 production
<35mmHg low - hyperventilation, decreased cardiac output, pulmonary embolism

151
Q

How do exhaled nitric oxide fractions differ between children and adults

A

Children will have a decreased FeNO exhaled

152
Q

For an obstruction to be considered apnea, what percentage of the airway needs to be blocked and for how long

A

> 90% needs to be blocked for longer than 10 seconds

153
Q

What does the AHI measure

A

Number of apneas and hypopneas per hour of sleep

154
Q

What is hypopnea

A

This is a >30% obstruction in the airflow that lasts for longer then 10 seconds

155
Q

What is ODI

A

number of oximetry decreases in an hour

156
Q

What is the Mallampati Score

A

This measures the risk of obstructive sleep apnae by looking at the gap at the back of the mouth when someone sticks out their tounge

157
Q

central vs obstructive sleep apnea

A

Central sleep apnea occurs because the brain doesn’t send proper signals to the muscles that control breathing. This condition is different from obstructive sleep apnea, in which breathing stops because the throat muscles relax and block the airway

158
Q

What are the broad difference between the 4 different types of respiratory tests done during sleep

A

Type I - full tests + scientist observation (>7 channels)
Type II - full test, no observation (>7 channels)
Type III - >4 channels
Type IV - >1 channel

159
Q

What disease are they likely looking for if they are performing a type I respiratory sleep test

A

neuromuscular sleep disorders

160
Q

What is the normal REM latancy

A

90 Minutes

161
Q

How many delta waves are required to move from stage 2 sleep to stage 3

A

20% of the waves need to be delta to move onto stage 3

162
Q

Stage 1 sleep waveforms

A

Beta and alpha waves

163
Q

What occurs to the chemoreceptiveness of the brain during sleep

A

The sensitivity to CO2 and PaO2 is decreased

164
Q

Stage 2 sleep wave forms

A

Theta wave with K complexes

165
Q

What are K complexes in sleep

A

sharp negative monophasic or polyphasic waves followed by a slower positive wave

they must persist for 0.5 seconds

Could also see sleep spindles

166
Q

REM sleep waveforms

A

resemble Beta waves

no K complexes or sleep spindles

167
Q

Stage 3 sleep waveforms

A

Delta waves

168
Q

What does a CPAP do

A

Provides positive pressure during expiration to avoid the airway from collapsing

169
Q

What does an ASV do

A

This adapts pressures during someone sleeping as their minute ventilation decreases

170
Q

What neurotransmitter is used in the somatic nervous sytem

A

Ach

171
Q

What neurotransmitter is used in the autonomous nervous system

A

SNS - noradrenaline
PNS - Ach

172
Q

What are the two receptors that the sympathetic nervous system act on

A

Alpha 1 - muscle contraction
Alpha 2 - inhibits adrenergic responses

Beta 1 - vasocontraction
Beta 2 - Dilation in airway

173
Q

What are the three types of beta-2-agonoists

A

SABA - short acting (e.g salbutamol)
LABA - long acting (e.g salmeterol)
ULABAs - ultra long acting (e.g indacterol)

174
Q

What two receptors does Ach primarily act on in the parasympathetic nervous system and what are the effects of both of these receptors

A

M2 - inhibits relaxation of smooth muscle

M3 - bronchocontriction

175
Q

What type of bronchodilators are commonly used in COPD

A

Anticholinergic bronchodilators

176
Q

What are two types of anticholenergic bronchodilators used to treat COPD

A

SAMA - short acting (e,g ipratropum bromide)

LAMA - lasts 24 hours (e.g tiotropium)

177
Q

What is the key factor in making a diagnosis of obstructed airway disease when performing bronchodilation test

A

The FEV1/FVC ratio must drop less than 0/7 to confirm the presence of persistent airflow limitation

178
Q

What type of disease would be suggested if a patient had a normal DLCO with a restrictive pattern on PFT

A

neuromuscular or chest wall disorder

179
Q

What can cause a decrease in DLCO

A

COPD, emphysema, smoking, ILD, pulmonary fibrosis

180
Q

What can cause an increase in DLCO

A

obesity, asthma, which are characterised by large lung volumes

181
Q

What is radial traction

A

Elastic fibres of the surrounding alveoli pull on the walls of small airways and hold them open.
The higher the elastic recoil of the lungs, the greater the radial traction will be.
Radial traction helps to prevent airway collapse in expiration.

182
Q

What is normal breathing rate

A

20 breaths per minute

183
Q

What is hypersomnolence

A

An inability to stay awake & alert during major waking episodes, resulting in periods of irrepressible need for sleep / unintended lapses into drowsiness or sleep

184
Q

What sort of sensor is a carotid body

A

Chemoreceptor

185
Q
A

Physiology - Hayley (9 decks)

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