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ESA 3 steven > Respiratory > Flashcards

Respiratory Flashcards

0
Q

What does the upper respiratory tract consist of?

A

Nose, paranasal sinuses, pharynx and larynx

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1
Q

What is the function of the respiratory system?

A

Ensure all tissues receive the O2 they need and to dispose of the CO2 they produce

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2
Q

What does the lower respiratory tract consist of?

A

Trachea, bronchioles and lungs (alveoli)

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3
Q

What are the functions of the upper respiratory tract?

A

Conduct air, condition air, smell, speech, swallow and protect the airway from inhaling food particles

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4
Q

Outline the structure of the nose

A

External nose
Nasal cavity which is divided by median nasal septum.
Lateral wall has 3 conchae and the spaces between them are meatus

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5
Q

What are the paranasal sinuses?

A

Frontal, ethmoidal, maxillary and spheroidal

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6
Q

What are the components of the pharynx? How does one of these parts connect to the middle ear?

A

Nasopharynx - behind the nose - connect via eustachian tube
Oropharynx - mouth
Laryngopharynx - larynx

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7
Q

What is the epithelium in most of the conducting system of the respiratory tract?

A

Pseudostratified ciliated epithelium with goblet cells

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8
Q

How does the epithelium of olfactory cells differ?

A

Thicker pseudostratified without goblet cells containing olfactory dendrites

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9
Q

Boyle’s law?

A

Pressure inversely proportional to volume

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10
Q

Charles’ law?

A

Pressure proportional to absolute temperature

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11
Q

Universal gas law?

A

Pressure x volume = molecules x universal gas constant x temperature

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12
Q

Partial pressure?

A

Hypothetical pressure of lone gas

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13
Q

Vapour pressure?

A

Pressure exerted by a vapour

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14
Q

Saturated vapour pressure?

A

Gas mixture is in equilibrium with water

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15
Q

Tension?

A

How readily gas will leave liquid

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16
Q

Tidal volume?

A

Normal volume of air displaced between inhalation and exhalation

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17
Q

Respiratory rate?

A

Rate of breathing

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18
Q

What is the sternal angle composed of?

A

Manubrium

Sternal body

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19
Q

Where do ribs 1-7, 8-10 and 11-12 attach?

A

Via costal cartilage to sternum
To the above costal cartilage
End free in the muscles

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20
Q

What are the bony features of a rib?

A

Head, neck shaft, costal groove, tubercle

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21
Q

What are the 3 intercostal muscles?

A

External
Internal
Innermost

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22
Q

Where is the neurovascular bundle supplying the intercostal muscles found?

A

In the costal groove

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23
Q

Where do the intercostal arteries come from and where do the veins drain to?

A

Posterior intercostal artery - thoracic aorta
Anterior intercostal artery - internal thoracic artery
Veins - into superior vena cava or the internal thoracic vein

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24
Q

How much does the diaphragm contribute to chest expansion when breathing at rest?

A

70%

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25
Q

What are the 3 openings of the diaphragm, where are they found and what goes through them?

A

T8 vena cava
T10 oesophagus
T12 - aorta (aortic hiatus)

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26
Q

What nerve supplies the diaphragm and what is its nerve roots?

A

Phrenic - C3, 4 and 5

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27
Q

What muscles contribute to inspiration?

A

External intercostal

Diaphragm

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28
Q

What are the muscles for passive and force expiration?

A

Passive - elastic recoil
Forced - internal and innermost intercostal
Abdominals

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29
Q

What is significant about the costodiaphragmatic recess?

A

The lung never fills it

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30
Q

Outline the role of the visceral and parietal pleura

A

Visceral covers lung. Parietal lines cavity. Separated by fluid which allows friction free movement and also stops them being pulled apart

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31
Q

What 3 factors affect diffusion rate?

A

Area, gradient and diffusion resistance

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32
Q

What is the inspiratory and expiratory reserve?

A

The extra volume that can be breathed in/out when compared to rest

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33
Q

What is the residual volume?

A

The amount of air that’s always left in the lungs. Measured using helium

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34
Q

What is the alveolar ventilation rate and how is it calculated?

A

The air that is wasted by being left in the airways

Pulmonary ventilation rate - (dead space volume x rate)

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35
Q

What is a pneumothorax?

A

Air in the pleural cavity causing loss of fluid surface tension and lung collapse

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36
Q

What is compliance?

A

A measure of lung stretchiness with higher being easier to stretch. Volume change/pressure change

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37
Q

What factors affect compliance?

A

Surface tension - higher being harder to stretch

Surfactant - disrupts surface tension. More so for small lungs

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38
Q

Why is the resistance of the smaller airways comparatively low?

A

They are connected in parallel

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39
Q

What is FVC and FEV1?

A

Forced vital capacity is the maximum expiratory volume

Forced expiratory volume in one second

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40
Q

What is a restrictive deficit and how could you tell if a patient has one?

A

Lungs difficult to fill but air leaves normally. FVC is reduced but FEV1 is still approximately 70%. Due to muscle weakness

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41
Q

What is an obstructive deficit and how could you tell a patient has one?

A

Lungs are easy to fill but hard to exit. Usually due to compressed small airways. FEV1 is reduced but FVC is relatively normal

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42
Q

How could you measure functional residual capacity?

A

Helium dilution test - breathe in known concentration of helium and see how much the concentration changes

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43
Q

What is a transfer factor test?

A

Test to measure diffusion capacity. Breathe in a small amount of CO and see how much ends up in the blood

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44
Q

What is a nitrogen washout test?

A

Used to measure dead space. Breathe in 100% oxygen and then measure the volume breathed out before nitrogen appears

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45
Q

How soluble is oxygen in blood in mmol/L?

A

Not very - 0.13

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46
Q

What are the axes labels for an oxygen dissociation curve? What are the normal values for tissue and lung pO2?

A

Y - oxygen bound (mmol) or saturation (%)
X - pO2
Lung - 13.3
Tissue - 5

47
Q

What properties does haemoglobin have that enable it to be a good transporter of oxygen?

A

Has a tense and relaxed state that allow lots of oxygen to bind in the lungs and allows it to be readily given up in the tissues.

48
Q

What happens to the oxygen dissociation curve if there is a fall in pH or a rise in temperature?

A

Shift to the right “Bohr shift”

49
Q

What affects the diffusion of gases across the alveolar membrane?

A

Area
Gradient
Resistance

50
Q

How can you calculate transfer factor/diffusion capacity?

A

Carbon monoxide

51
Q

What is the reaction CO2 undergoes in blood?

A

CO2 + H2O HCO3- + H+

Can also bind to proteins and dissolve in water

52
Q

What is the Henderson Hasselbalch equation?

A

pH=pK+log([HCO3-]/(pCO2x0.23))

53
Q

What influences the hydrogen carbonate concentration in plasma?

A

Ratio of CO2 reacting in the plasma and the red blood cell.

Primarily dependent on how much CO2 reacts in the RBC which is in turn dependent on how much H+ binds to haemoglobin

54
Q

How does haemoglobin buffer acids?

A

If acid is produced it can bind to haemoglobin or react with HCO3- to form CO2 which is breathed out.

55
Q

What is the function of car amino compounds?

A

Proteins which bind to CO2. This affects transport but not acid base balance

56
Q

What is the normal content of CO2 in arterial and venous blood?

A

Arterial 21.5mmol/L

Venous 23.5mmol/L

57
Q

What are the ratios of the forms CO2 is transported in?

A

80% HCO3-
11% carbamino
8% dissolved

58
Q

Why is acidaemia and alkalaemia dangerous?

A

Denature enzymes

Tetany due to lower Ca2+

59
Q

Where are peripheral chemoreceptors located, what do they detect and what do they stimulate?

A

Carotid and aortic bodies
Hypoxia
Increase breathing, heart rate and blood to brain

60
Q

What detects changes in CO2? What happens with long term changes?

A

Central chemoreceptors in the medulla

Choroid plexus cells change “normal” HCO3- levels in CSF

61
Q

What can cause diffusion impairment?

A

Fibrotic lung disease - thicken
Emphysema - destroy alveoli
Oedema - fluid increases distance

62
Q

What is the difference between type 1 and 2 respiratory failure?

A

Type 1 has normal CO2, type 2 has high

63
Q

What are some symptoms and causes of type 1 resp failure?

A

Breathless, exercise intolerant, central cyanosis
Poor perfusion - embolism
Poor ventilation - pneumonia, consolidation, early asthma
Diffusion impairment - oedema, fibrosis

64
Q

What are some causes of type 2 resp failure?

A

Ineffective breathing - respiratory depression, muscle weakness, chest wall problems
Ventilation problems - emphysema, COPD, asthma

65
Q

What defines asthma?

A

Airway inflammation and remodelling

Reversible obstruction

66
Q

Outline the inflammatory and remodelling changes in asthma

A

Smooth muscle - contract/hypertrophy and hyperplasia
Goblet cells - hyper secrete/hyperplasia
Blood vessels - vasodilate and leak/angiogenesis
Epithelium - shed/thicken

67
Q

What are signs and symptoms indicative of asthma?

A

Wheeze, cough (worse at night and on exercise), breathless, tight chest
Barrel chest, hyper resonant chest

68
Q

What tests can be done for asthma?

A

FEV1 increases after given salbutamol
Allergy testing
X ray to rule out other conditions

69
Q

How is asthma managed?

A

Relax airway - B2 agonist - salbutamol
Prevention - steroids

Ventilate

70
Q

Define COPD

A

Airflow obstruction that is progressive, irreversible and doesn’t change markedly over a period of months
Emphysema and chronic bronchitis

71
Q

Explain emphysema

A

Destroy terminal bronchioles and distal air spaces which reduces surface area. Supporting tissue destroyed closing small airways and elastic tissue is destroyed leading to hyperinflation

72
Q

Explain chronic bronchitis

A

Mucus hyper secretion due to inflammation. Chronic productive cough and frequent infections

73
Q

What causes COPD

A

Smoking
Alpha 1 antitrypsin deficiency
Occupational exposure
Pollution

74
Q

What are the symptoms of COPD

A

Cough and sputum

Breathless

75
Q

Explain the MRC dyspnoea score

A 
1 - strenuous exercise
2 - hurrying/hill
3 - walk slower or have to stop
4 - can't walk 100m
5 - struggle to dress or leave house
76
Q

What are some signs of COPD?

A 
Purse lip
Tachypnoea
Accessory muscle
Hyperinflation - barrel chest
Wheeze
Cyanosis
77
Q

What would Spirometery show for COPD?

A

FEV1 < 80%

FEV1/FVC < 70%

78
Q

Compare COPD and asthma

A

COPD - smoker, over 65, productive cough and persistent breathlessness
Asthma - under 65, unproductive cough, variable breathlessness, wake at night and changes day to day

79
Q

What investigations are done for COPD?

A

X-ray to exclude others
Hi res CT
ABG
Alpha 1 antitrypsin

80
Q

How is COPD managed?

A

Stop smoking, bronchodilators, steroids, antimuscarinics
Pulmonary rehab - exercise
Surgery to reduce hyperinflation or a transplant

81
Q

Explain the pathology of TB

A

Aerosol
Primary infection resolves with few symptoms
Post primary - persist beyond first few weeks usually re-exposure
Ingest by macrophage but escape and multiply resulting in tissue destruction and cytokines production

82
Q

Symptoms of TB?

A

Weight loss
Night fever
Cough

83
Q

How is TB treated?

A

Rifampicin, isoniazid - 4 months

Pyrazinamide, ethambutol - 2 months

84
Q

What are some risk factors for TB?

A

HIV, crowding, Asian, homeless

85
Q

What are some common fauna in the respiratory tract?

A

Viridans streptococci
Neiserria spp
Candida

86
Q

What defences does the respiratory tract have?

A

Muco-ciliary clearance
Cough/sneeze
Lymphatic follicles
IgA/G and macrophages

87
Q

What is pneumonia?

A

Pulmonary parenchyma infected with consolidation

The distal air spaces become fluid filled and stiff impairing gas exchange

88
Q

How is pneumonia classified?

A

Clinical setting - hospital/community acquired
Presentation - acute/sub acute/chronic
Organism - bacterial/fungal/viral
Lung - lobar/broncho/interstitial

89
Q

What are some causes of pneumonia?

A 
Streptococcus pneumonia - elderly, acute, fever, pain
Haemophilus influenza - COPD
Chlamydia - bird contact
Influenza
Hospital - MRSA
Aspiration - anaerobes and oral flora
90
Q

Explain lobar pneumonia

A

Complete lung lobe consolidation
Usually due to pneumococcus
Community and acute onset

91
Q

Explain bronchopneumonia

A

Start in airways and spread to alveoli and lung tissue
Pre-existing disease - influenza/COPD/aspiration
Patchy consolidation
Can be caused by pneumococcus, H influenza, S aureus
Treat with amoxicillin or co-amoxiclav

92
Q

What are the potential outcomes of pneumonia?

A

Resolution - organisation with fibrous scarring

Complications - abscess, bronchiectasis, empyema

93
Q

What makes aspiratory pneumonia more likely? What organisms causes it?

A

Neurological dysphasia, epilepsy, alcoholics, drowning

Viridans strep, anaerobes

94
Q

What are the symptoms of pneumonia?

A

Fever, chills, sweats
Cough sputum - sputum can be clear/purulent/rust coloured
Dyspnoea
Chest pain, malaise, anorexia, vomiting, headache, myalgia, diarrhoea

95
Q

What are signs of pneumonia?

A 
Bronchial breath sounds
Crackles
Wheeze
Dull percussion
Reduced vocal resonance
96
Q

What investigations are done for pneumonia?

A 
Chest x-ray
O2 sat
Arterial blood gas
FBC, platelets, WCC (>20 or <4 is severe)
LFT, urea, CRP (response to treatment)
Samples and microbiology
97
Q

What score is used to determine if a pneumonia patient should be hospitalised?

A

C - confusion AMT 7
R - respiratory rate >30
B - blood pressure < 90/60
65 - over 65 years old

98
Q

How is pneumonia treated?

A

Antibiotics - amoxicillin or co-amoxiclav

99
Q

How is pneumonia prevented?

A

Immunise - flu vaccine and pneumococcal vaccine

Chemo prophylaxis - for asplenic/immunocompromised patients

100
Q

What factors can cause lung cancer?

A

SMOKING

asbestos, radon, genetics

101
Q

What are some symptoms of lung cancer?

A

Primary tumour - cough, dyspnoea, wheeze, haemoptysis, chest pain, weight loss, lethargy, malaise
Metastases - SVC obstruction, hoarseness (left laryngeal nerve palsy), dyspnoea (phrenic nerve palsy), dysphagia, bone pain, CNS symptoms

102
Q

What is para neoplastic syndrome?

A

Presence of symptoms or disease due to cancer but not the cancerous cells themselves. Cytokines, hormones and immune system

103
Q

What are some paraneoplastic symptoms?

A

Hypercalcaemia, cushings, clubbing, anaemia, DIC, nephrotic syndrome

104
Q

What imaging is used for lung cancer?

A

X - ray when suspected

CT, PET, bone scan to diagnose and stage

105
Q

Explain the TNM staging for lung cancer

A

T - 1: lung 4: heart and mediastinum
N - 0: no involvement 3:lymph involvement on other side of mediastinum
M - 1: distant metastasis

106
Q

What are the two types of lung cancer? Which has the worse prognosis?

A

Non small cell

Small cell - worse

107
Q

How is lung cancer treated?

A

Surgery, radiotherapy, chemotherapy, combined chemo and radio, biological targeting

108
Q

What is the interstitial space?

A

Potential space between alveolar cells and the capillary basement membrane. Only apparent in disease states

109
Q

What is interstitial lung disease?

A

Development of fibrous tissue in the interstitium. This makes the lungs less compliant. The FEV1/FVC ratio is not affected as it is a restrictive deficit. Longer diffusion pathway impairs has exchange

110
Q

What are the signs and symptoms of interstitial lung disease?

A

Shortness of breath, reduced exercise tolerance, dry cough, tachypnoea, tachycardia, crackles, cyanosis

111
Q

What are some types of interstitial lung disease?

A 
Occupational - asbestosis
Treatment - chemo
Connective tissue - arthritis
Immunological - sarcoidosis
Idiopathic
112
Q

Explain the cellular actions that occur in fibrosing alveolitis

A

Macrophages attract neutrophils and eosinophils which damage the lungs via proteases and ROS

113
Q

What are some possible pleural effusions?

A

Haemothorax, chylothorax, empyema, simple effusion

114
Q

What is the difference between transudate and exudate and suggest causes of each

A

Transudate fluid has low protein - increased hydrostatic pressure, decreased oncotic pressure, increased permeability
Exudate fluid has high protein - neoplasm, infections

115
Q

What are the signs and symptoms of pleuritis?

A

Sharp pain on inspiration - worse when coughing, sneezing, laughing
Small breaths
Hear pleural rub

ESA 3 steven (5 decks)

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