Respiratory Flashcards
Acetyl cysteine, recombinant human DNAse are examples of what, and what is their action
Mucolytics
What type of cells produce surfactant?
type two alveolar
An FEV1/FVC ratio >0.7 indicates a
Restrictive
An increase in pH with a decrease in temperature and a decrease in DPG concentration shifts the Hb-O2 dissociation curve to the
Left
Anti IgE monoclonal antibody (omalizumab) inhibits
Binding of ige to mast cells
Antimuscarinics are more effective than Beta-2 agonists in the treatment of
COPD
d02 value?
1000ml/min
V02 at rest?
250ml/min
At rest work of breathing is what % of expenditure
2-5%
Exercising breathing is what % of expenditure?
30%
Increased blood pressure will lead to a what in ventilation?
Decrease
Basic structure of haemoglobin (rule of 4)
4 x globin chains (141-146 AAs per chain) 4 x haem groups 4 x iron atoms and binds 4 x O2 molecules
Branching during development is associated with interaction of the
overlying visceral mesoderm
Breath sounds generated
large airways
cheyne stokes respiration is characterised by
progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea.
CO is poisonous as
Extremely high affinity for haemoglobin
CO2 is approximately how much more soluble in water than oxygen
24 times more soluble
Compliance is defined as
the change in lung volume per unit of change in intrathoracic pressure
Continued injury to infant lungs as a result of RDS may result in
Detachment of alveolar lining
Bronchopulmonary dysplasia
Dalton’s law is defined as
The partial pressure of a gas in a gas mixture = total pressure x fractional concentration of the gas
Increased compliance is seen in what disease?
Emphysema
Diseases with decreased compliance
circumferential burns, kyphosocliosis, fibrosis
Emphysema is the process of
widespread destruction and dilatation of distal airways due to chronic inflammation; leads to significant reduction in gas exchange
Epithelial lining of bronchioles
Cuboidal
trachea and bronchi lining
Columnar
Peak of V02
2-3years
Flow is affected most by what?
radius of lumen
FRC =
ERV+RV
FRC typical volume
2500ml
How much does work increase by from laminar to turbulent flow?
2X
If the closing capacity exceeds FRC, the alveoli will be
Under perfused
Fully humidified air at 37c 02 has a value of what
19.95kpa
In restrictive condition how is work of breathing minimised?
quick shallow breathing
expiratory effort uses what muscles?
abdo, and internal intercostals
infant respiratory distress syndrome is due to what?
lack of surfactant
Inhaled corticosteroids, although 1st line regular asthma therapy, have what adverse effects
Iatrogenic Cushing’s syndrome
Hoarse throat
Inhibition of hypothalamic pituitary axis
innervation to the diaphragm
C3,4,5
Which receptors lie close to capillary walls around alveolar triggered by trauma and increase what
J-receptors - increase ventilation
Lungs from which layer of the mesoderm
Endoderm
Mast cell stabilisers such as cromolyn, nedocromil, inhibit
no effect on smooth muscle inhibit mast cell contents
mean pulmonary capillary PO2 is very difficult to measure, what measurement is used in replacement?
CO diffusing capacity
What is minute volume?
Tidal volume X breathinf frequency
what is oxygen saturation?
Hb02 / HHB+Hb02
Partial pressure of O2 in the alveoli is lower than in air because
Inspired air is humidified in the upper airway
In the alveoli oxygen is taken up while carbon dioxide is added
The body consumes more O2 molecules than it produces CO2 molecules (typically 1.25 x)
Before what week is survival of a foetus unlikely due to lack of lung development?
week 26
pressure is proportional to
1/V
Restrictive lung diseases have what reduced volumes/capacities
RV, FRC, VC, TLC
Rapid distention of the abdomen could indicate what?
treacheoosophageal fistula
Small (0.5-3 μm) particles like Particulate pollution, stone dust, asbestos are deposited via sedimentation in the
BRONCHIOLES
Surfactant is made up of what?
90% phospholipid and 10% protein
Surfactant Protein B deficiency is
fatal, even with surfactant treatment
terminal bronchioles form by what week in development
16
Alveolar dead space defined as
Good ventilation but no perfusion
Apices of lungs are how much bigger than what base
4X
BBB relies on what to inform its oxygenation status?
CO2
The dorsal respiratory group has neurones that
inspiration
The higher brain centres influence breathing via two methods:
cortical - voluntary hyperventilation/breath holding
hypothalamic - triggered by emotions or sensory reflexes to pain or cold
Hypoxic drive?
Uses low 02 to drive breathing
The influence of the pons on the medulla oblongata is by the action of two centres signalling to the dorsal respiratory group, what are they?
Apneustic- Stimulates
Pneumpotaxic- inhibit (toxic)
Law of laplace ?
Balloons! P= 2t/r, where t = surface tension
Week five of lung development =
secondary bronchi
which histogenesis period of the lungs has primitive alveoli, occurs from week 26 to birth, and has the development of a blood-air barrier beginning the production of surfactant
terminal sac
Which histogenesis period occurs 16-25 weeks, has respiratory bronchioles, vascularised mesodermal tissue
canilicular
What part of the respiratory system appears at week 4 of embryological development
Ventral bud of lung from foregut
haldane effect
deoxygenated can carry more co2
What is the cause and mechanism of Methaemoglobin
drug induced
metHb does not carry oxygen due to a defective Fe3+ mechanism
Plumonary agenisis
one or two sides fail of the lungs (both sides is fatal)
VC=
IRV ERV and TV
Tidal volume at rest?
350ml
typical irv
3000ml
typical erv
1500ml
typical VC
5l
typical residual
1000ml
13.3kpa
partial pressur in alveoli
typical co2 partial pressur ein alveoli
5.3kpa
TLC =
TV + IRV + ERV + RV
3x co2 carriage in blood
Dissolved
Carbamino compounds (bound to R-NH2 groups on protein)
As carbonic acid/bicarbonate (mostly carried like this)
The ventral respiratory group has neurones which fire
inspiration and expiration
tense state of haemoglobin is
deoxygenated
Protons formed from bicarb are buffered by what
Hb
The partial pressure of a gas in solution is
inversely proprotional to its solubility
on inspiration the PA and PB are related how?
PB>PA air drawn in
on expiration the PA and PB are related how?
PA>PB air out
IgG is found where?
Small airways
IgA is found where?
Nose and large airways
What zone is alveolar dead space in?
1
Huffner constant
amount of 02 Hb can carry
An fev1/fvc ratio less than 0.7 indicates what?
obstructive condition