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Phase 1 Medicine - Riona > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the functions of the nose? (4)

A

Warming of inspired air
Humidification
Filteration
Defence

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2
Q

What divides the nasal cavity into meatuses?

A

Conchae

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3
Q

What are the functions of the paranasal sinuses? (2)

A

Warm & humidify air

Reduce the weight of the skull

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4
Q

What are the 4 paranasal sinuses?

A

Frontal
Maxillary
Ethmoidal
Sphenoid

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5
Q

What innervates the frontal sinus?

A

Ophthalmic branch of CNV

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6
Q

Where does the maxillary sinus open into?

A

Middle meatus via hiatus semilunaris

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7
Q

What does the sphenoid sinus drain into?

A

Sphenoethmoidal recess

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8
Q

What do the pharyngeal constrictors do?

A

Contract sequentially to move food bolus down CNX

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9
Q

What do the inner longitudinal muscles do?

A

Contract to shorten & widen pharynx

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10
Q

What is the sensory innervation to the pharynx?

A

Naso - CNV2
Oro - CNIX
Laryngo - CNX

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11
Q

What are the true vocal cords lined by?

A

Stratified squamous non-keratinising epithelium

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12
Q

What are the 9 laryngeal cartilages?

A

Single:
epiglottis
thyroid
cricoid

Double:
cuneiform
coniculate
arytenoid

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13
Q

What is the larynx innervated by?

A

CNX (everything’s bloody innervated by this)

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14
Q

What does the carotid sheaf contain?

A

Common carotid artery
Internal jugular vein
Vagus nerve

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15
Q

At what level is the thyroid gland?

A

C5-T1

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16
Q

At what level is the carina?

A

Level of sternal angle

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17
Q

What are the borders of the anterior triangle of the neck?

A

Superior - inferior border of mandible
Inferior -medial border of sternocleidomastoid
Medial - immaginare line down middle of neck

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18
Q

What is the mucociliary elevator?

A

Combination of sweeping movements by the cilia & mucus to trap inhaled particles & move them out of the airways to be swallowed & destroyed

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19
Q

What is the sensory innervation of the trachea?

A

Recurrent laryngeal nerve

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20
Q

Which main bronchus is shorter, wider & more vertical?

A

Right

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21
Q

Where are the Clara cells & what do they produce?

A

Bronchioles

Surfactant lipoprotein - prevents bronchioles from collapsing upon expiration

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22
Q

What are the 3 cell types found in alveoli?

A

Type I pneumocytes
Type II pneumocytes
Alveolar macrophages

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23
Q

What cells produce surfactant?

A

Type II pneumocytes

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24
Q

What does surfactant do?

A

Helps overcome the initial part of inhaling by reducing surface tension

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25
Q

What are the 3 main openings in the diaphragm?

A 
Oesophageal hiatus (oesophagus, CNX)
Aortic hiatus (aorta, thoracic duct, azygous vein)
Caval opening (IVC)
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26
Q

What does the phrenic nerve innervate?

A 
3Ps (sensory) 
Pericardium
Pleura
Peritoneum
& diaphragm (motor)
C345 keeps the diaphragm alive!
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27
Q

What do the azygous & hemiazygous veins drain?

A

Posterior walls of thorax & abdomen

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28
Q

Where does the azygous vein recieve blood from?

A

Ascending lumbar veins & right subcostal veins

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29
Q

What are the true ribs?

A

1-7

Attached directly to sternum

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30
Q

What are the false ribs?

A

8-10

Connected to the 7th rib by cartilage

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31
Q

What are the floating ribs?

A

11-12

Not attached anteriorly

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32
Q

In which direction do the external intercostal muscles run?

A

Inferioanteriorly

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33
Q

What is the action of the internal intercostal muscles?

A

Depress ribcage

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34
Q

What is the action of the pectoralis major?

A

Flexion, adduction, rotates the humerus (medially)

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35
Q

What is the innervation of the pectoralis major?

A

Medial & lateral pectoral nerves

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36
Q

What is the main action of serratus anterior?

A

To rotate the scapula, raising the arm

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37
Q

What is the innervation of the serratus anterior

A

Long thoracic nerve

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38
Q

What do the subcostal muscles do?

A

The same as internal intercostals (depress ribcage)

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39
Q

What muscle is continuous with the transverses abdominis?

A

Transversus thoracis

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40
Q

What are the 2 parts of the lung pleura?

A

Visceral (inner)

Parietal (outer)

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41
Q

How many lobes does each lung have?

A

L - 2

R - 3

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42
Q

What are the fissures of the lung?

A

Oblique

Horizontal

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43
Q

What is at the level of the sternal angle?

A

2nd rib

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44
Q

Describe the process of inspiration

A
  1. Motor neurone of phrenic nerve causes diaphragm to contract & flatten
  2. This increases the thoracic volume
  3. The chest wall moves away from the lung surface, which moves the parietal pleura away from the visceral pleura slightly
  4. Intrapleural pressure decreases, and transpulmonary pressure increases
  5. Pressure strong enough to overcome elastic recoil > lungs expand
  6. Volume of lungs increases > pressure decreases (Boyle’s law)
  7. When the pressure decreases below the atmospheric pressure, air is forced in
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45
Q

When do the neutrons in the dorsal respiratory group in the medullary respiratory centre fire?

A

During inspiration

46
Q

What controls the basal rate of respiration?

A

The respiratory rhythm generator in the VRG of the medullary respiratory centre

47
Q

What does the apneurstic centre do? (lower pons)

A

Fine tunes medullary inspiratory neuron output & helps terminate inspiration by inhibiting these neurons

48
Q

What does the pneumotaxic centre do? (upper pons)

A

Smooths transition from inspiration to expiration

49
Q

Where are the slowly adapting stretch receptors found, what are they stimulated by & what do they do?

A

Smooth muscle layer of airways
Stimulated by large lung inflation
Send afferent impulses to brain & inhibit medullary inspiratory neutrons in DRG

50
Q

Where are the rapidly adapting stretch receptors found, what are they stimulated by & what do they do?

A

In between epithelial cells of airways
Stimulated by lung distension
Bronchoconstriction & an activity burst

51
Q

What will a decrease in PO2 do?

A

Stimulate peripheral chemoreceptors
Impulses to medullary inspiratory neurons
Increase in ventilation rate

52
Q

Give the dissociation equation involving CO2 & H2O

A

CO2 + H2O H2CO3 H+ + HCO3-

53
Q

What are J receptors stimulated by?

A

Lie in capillaries/interstitium of lung

Stimulated by increase in lung interstitial pressure, caused by collection of fluid in interstitium

54
Q

What are the effects of the stimulation of J receptors?

A

Rapid breathing
Dry cough
Sensation of pressure in chest
Dyspnoea

55
Q

Where is the apex of the lung? (surface anatomy)

A

2 finger widths (patient’s fingers) above the clavicle

56
Q

Lower margin of lungs are at what levels? (surface anatomy)

A

6, 8, 10

57
Q

Where is the oblique fissure? (surface anatomy)

A

Along 6th rib

58
Q

Where is the horizontal fissure? (surface anatomy)

A

Along 4th rib (only R)

59
Q

What does a lower V/Q ratio mean?

A

Decreased ventilation in the area
Decrease in O2 content of arterial blood
Results in vasoconstriction of blood vessels to that area

60
Q

What does a higher V/Q ratio mean?

A

Decreased perfusion in the area
Decrease in CO2 content of alveolar air
Results in bronchoconstriction of airways to that area

61
Q

What are the 3 layers of the gas exchange pathway in the lungs?

A

Thin alveolar epithelial cells (usually type I pneumocytes)
Basement membrane
Capillary epithelium

62
Q

What is the equation for percentage haemoglobin saturation?

A

O2 bound to Hb / maximum capacity of Hb to bind to O2

x100

63
Q

What is the oxygen-haemoglobin dissociation curve?

A

As PaO2 increases, SaO2 increases (saturation)

64
Q

An increase in PCO2, H+, temperature & DPG will do what to the dissociation curve?

A

Shift it to the right
At any given PO2, increasing one of these factors will decrease haemoglobin saturation (more PO2 is needed for the same saturation)

65
Q

What will happen to the affinity of haemoglobin to O2 when a tissue’s metabolic activity increases?

A

It will decrease, delivering more O2 to the tissue

66
Q

What is Dalton’s law?

A

The total pressure of a mixture of gases is equal to the sum of each of the gases as if it were present alone

67
Q

What is Boyle’s law?

A

The volume of a container & the pressure within the container are inversely related

68
Q

What is Henry’s law?

A

The amount of gas dissolved in a liquid is directly proportional to the partial pressure of that gas above that liquid
Solubility is directly proportional to partial pressure

69
Q

What is the alveolar gas equation?

A

PAO2 = PiO2 - PaO2/R

PAO2 - alveolar oxygen
PiO2 - inspired oxygen
PaO2 - arterial oxygen
R - respiratory quotient

70
Q

What is Laplace’s law?

A

The pressure within an alveolus is directly proportional to the surface tension & inversely proportional to the radius

71
Q

What is the CO2 + H2O reaction catalysed by?

A

Carbonic anhydrase enzyme

only present in erythrocytes

72
Q

What is the chloride shift?

A

HCO3- moves out of erythrocytes via a transporter that exchanges them for a Cl-

73
Q

Describe CO2 transport in the lungs

A

PCO2 is higher in the blood than in the alveolar space
CO2 diffuses into alveoli
Moves position of equilibrium to left
H+ + HCO3- combine to form H2CO3, which dissociates into CO2 + H2O
More CO2 can now diffuse out into alveoli

74
Q

What does haemoglobin act as a buffer for?

A

H+ ions

75
Q

What is the Henderson-Hasselbalch equation?

A

pH = pK + log( [A-] / [HA] )

76
Q

What is hypoxia?

A

Deficiency of O2 at tissue levels

77
Q

What are the causes of hypoxia?

A

Hypoxemia (reduced arterial PO2)
Anaemia
Ischaemic hypoxia (blood flow too low)
Histotoxic hypoxia (cell unable to utilise because of a toxic agent)

78
Q

What is hypercapnia?

A

Increase in PCO2 in arterial blood

79
Q

What are the causes of hypercapnia?

A

Hypoventilation
Lung disease
Inhaling too much CO2

80
Q

Define respiratory failure

A

A condition in which there is insufficient gas exchange to maintain arterial O2 & CO2 levels

81
Q

What is Type I respiratory failure?

A

Hypoxia but not hypercapnia

PaO2 low, PaCO2 normal

82
Q

What is Type I respiratory failure caused by?

A 
Low atmospheric pressure
V/Q mismatch
Avelolar hypoventilation
Shunt in heart
Asthma 
Pneumonia
83
Q

What is Type II respiratory failure?

A

Hypoxia & hypercapnia

Low PaO2, high PaCO2

84
Q

What is Type II respiratory failure caused by?

A

Increased airways resistance (asthma, COPD)
Reduced breathing effort (brainstem lesions, obesity)
Decreased lung area
Neuromuscular conditions
Head injuries affecting respiratory centres in the brain

85
Q

Define tidal volume (500ml)

A

Volume of air moved in & out of lungs during quiet breathing

86
Q

Define inspiratory reserve volume (3000ml)

A

Volume of air that can be inspired in addition to inspiration of tidal volume

87
Q

Define residual volume (1000ml)

A

Volume of air that cannot be expired from lungs

88
Q

Define vital capacity (5000ml)

A

Total volume of air that can be moved in & out of the lungs

89
Q

Define functional residual capacity (2500ml)

A

Volume of air that remains in lungs during quiet breathing

90
Q

Define FEV1

A

Forced expiratory volume in 1 second of expiration

91
Q

What is the difference between a blockage of the upper & lower airways?

A

Upper - choking

Lower - obstructive lung disease

92
Q

What are the differences between pulmonary and systemic circulation?

A

Pulmonary - thin vessel walls, minor muscularisation, lower pressure
Systemic - thicker walls, significant muscularisation

93
Q

What are the 4 key changes in the ageing lung?

A

Chest wall compliance decreases
Respiratory muscle strength decreases
Elastic recoil decreases
Gas exchange becomes impaired

94
Q

What are the 2 types of immunity?

A

Innate (requires no previous exposure)

Adaptive (requires previous exposure, immunological response)

95
Q

What are the 3 main antibodies/immunoglobulins in an immune response?

A

IgM - produced at beginning of infection
IgG - highly specific
IgE - allergic response

96
Q

What are the 4 types of hypersensitivity?

Gell & Coombs classification of inflammatory diseases

A

Type I - allergic, IgE
Type II - cytotoxic, IgG (attacks body’s own cells)
Type III - complexes, IgG (complexes on joints causing local inflammation)
Type IV - delayed, T-cell mediated

97
Q

Where is histamine released from and what does it cause?

A

Mast cells in a Type I reaction

Causes inflammation, vasodilation, mucous secretion & smooth muscle contraction

98
Q

What is the intrinsic tone of the airways controlled by?

A

Parasympathetic NS

ACh acts on cholinergic receptors on smooth muscle & causes them to contract

99
Q

What type of muscarinic cholinergic receptor is found in the smooth muscle of the airways?

A

M3

100
Q

What does adrenaline do to the airways?

A

Causes bronco dilation by acting on B2 adrenergic receptors in the airways

101
Q

What are the steps of coughing?

A
  1. air inspired
  2. epiglottis closes, vocal cords shut
  3. abdominal & intercostal muscles contract forcefully
  4. intrathoracic pressure increases, narrowing trachea
  5. epiglottis & vocal cords open widely
  6. air expired
102
Q

What do alveolar macrophages arise from?

A

Monocytes (WBCs) that circle in the blood

103
Q

What are the 6 main functions of a neutrophil in an innate immune mechanism?

A
  1. identification of threat
  2. activation
  3. adhesion to the thread
  4. migration/chemotaxis
  5. phagocytosis
  6. bacterial killing
104
Q

What is the role of B-lymphocytes?

A

Produce & release immunoglobulins
Becomes a plasma cell when activated
Antibodies bind to antigens & help in phagocytosis

105
Q

What is the role of T-lymphocytes?

A

Secrete cytokines

106
Q

What is respiratory epithelium?

A

Pseudostratified columnar ciliated interspersed with mucus secreting goblet cells

107
Q

Which structures are lined by respiratory epithelium?

A 
Nose
Olfactory epithelium
Oropharynx
Larynx
Trachea
108
Q

What are the true vocal cords lined by?

A

Stratified squamous non-keratinizing epithelium

109
Q

What are the bronchioles lined by?

A

Simple cuboidal epithelium

110
Q

What are the alveoli lined by?

A

Simple squamous epithelium

111
Q

What are the 7 layers of gas exchange?

A

1) alveolar epithelium
2) tissue interstitiel
3) capillary endothelium
4) plasma layer
5) red blood cell membrane
6) rbc cytoplasm
7) Hb binding forces

Phase 1 Medicine - Riona (13 decks)

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