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Phase 1 Medicine (Extra) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the innervation of the frontal sinuses?

A

Opthalmic division of the trigeminal nerve (CNV1)

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2
Q

What is the innervation of the maxillary sinuses?

A

Maxillary division of trigeminal nerve (CNV2)

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3
Q

What is the innervation of the ethmoid sinuses?

A

Ophthalmic and maxillary divisions of trigeminal nerve (CNV1 & CNV2)

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4
Q

What is the innervation of the sphenoid sinus?

A

Opthalmic division of trigeminal nerve (CNV1)

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5
Q

What is the minute volume of breathing?

A

5 litres/minute

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6
Q

Define respiratory acinus.

A

The tissue supplied with air by one terminal bronchiole.

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7
Q

Which layer of the pleura has pain sensation, and which nerve provides this?

A

The parietal pleura, via the phrenic nerve.

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8
Q

What is the approximate total combined area for gas exchange?

A

40-100m2

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9
Q

What causes local bronchoconstriction?

A

Decrease in blood flow to an area of the lung, resulting in decreased CO2 in the area.

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10
Q

Why is the plateu of the oxygen dissociation curve significant?

A

Even with a moderate reduction in alveolar O2 partial pressure, oxygen saturation won’t drop that much as the curve has plateued out.

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11
Q

How does carbon monoxide affect the oxygen dissociation curve?

A

CO has a much higher affinity for the oxygen binding sites of haemoglobin than oxygen does.
CO competes for sites, meaning less oxygen binds.
It shifts the curve to the left, meaning there is less release of oxygen at tissues.

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12
Q

Give the equation that relates the partial pressure of arterial CO2 to alveolar ventilation.

A

PaCO2 = k (V’CO2/V’A)

Arterial partial pressure of CO2 is inversely proportion to alveolar ventilation.

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13
Q

How does most H+ travel in the blood and how does it get expired?

A

Bound to haemoglobin.
As the red blood cells pass through the lungs oxygen binds which causes H+ to unbind.
H+ then combines with HCO3- and that dissociates to form CO2, which diffuses into the alveoli.

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14
Q

How does surfactant decrease surface tension of the alveoli?

A

It reduces the cohesive forces between the water molecules lining the lungs, allowing the lungs to expand.

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15
Q

What is FEF25?

A

The flow at the point when 25% of total volume to be exhaled has been exhaled.

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16
Q

What percentage of the predicted values does a patient’s FEV1 and FVC have to be to be considered normal?

A

80%

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17
Q

Describe the receptors in the nose, nasopharynx, and larynx.

A

Chemo and mechano receptors.

Stimulation appears to inhibit medullary respiratory centre.

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18
Q

Describe the receptors in the pharynx.

A

Activated by swallowing to stop respiratory activity.

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19
Q

Are the slowly adapting stretch receptors and rapidly adapting stretch receptors myelinated or unmyelinated?

A

Myelinated

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20
Q

Are C fibres and J receptors myelinated or unmyelinated?

A

Non-myelinated

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21
Q

How do peripheral chemoreceptors send signals?

A

Type II cells detect hypoxia and release stored neurotransmitters that stimulate the carotid sinus nerve.

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22
Q

Why aren’t peripheral chemoreceptors not very sensitive to small decreases in PO2?

A

Total oxygen transport in the blood is not reduced very much until the arterial pressure of O2 falls below 60mmHg.

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23
Q

What percentage of the total cardiac output does the bronchial circulation receive?

A

2%

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24
Q

What are three differences between pulmonary and systemic arteries?

A
  • Pulmonary arteries have thin vessel walls
  • Pulmonary arteries have minor muscularisation
  • There is no need for redistribution in the pulmonary circulation
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25
Q

Which receptors does the parasympathetic nervous system act on in the lungs?

A

M3 (muscarinic cholinergic)

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26
Q

How does the sympathetic nervous system affect the airways?

A

Releases noradrenaline at the adrenal glands and causes adrenaline to be released.
Adrenaline binds to b2 adrenergic receptors on the muscles of the airways to stimulate bronchodilation.

27
Q

What is the difference between muscarinic and nicotinic receptors?

A

Muscarinic receptors are g protein coupled receptors that function via a second messenger to affect ion channels.
Nicotinic receptors are ligand gated ion channels, so affects the ion channels directly without involving a second messenger.

28
Q

How does the alpha-1 adrenergic receptor work?

A

Acts postsynaptically to either stimulate or inhibit K+ channels.

29
Q

How does the alpha-2 adrenergic receptor work?

A

Acts presynaptically to inhibit noradrenaline release.

30
Q

How do beta adrenergic receptors work?

A

Act via stimulatory G proteins to increase cAMP in the postsynaptic cell.

31
Q

Which adrenoreceptors are found in the heart?

A

beta-1

32
Q

Which adrenoreceptors are found in the lungs?

A

beta-2

33
Q

Which adrenoreceptors are found in adipose tissue?

A

beta-3

34
Q

Which factors determine whether a ligand acts as an agonist or antagonist at a receptor?

A

Affinity

Efficacy

35
Q

Name an agonist for muscarinic and nicotinic receptors.

A

Muscarinic agonist = muscarine

Nicotinic agonist = nicotine

36
Q

Name an antagonist for the muscarinic receptor.

A

Atropine

37
Q

What are four broad groups of drugs that can be used to treat respiratory diseases such as asthma?

A

Short acting beta-2 agonists
Long acting beta-2 agonists
Short acting muscarinic antagonists
Long acting muscarinic antagonists

38
Q

Briefly describe the cough reflex.

A

Receptors in the larynx, trachea, and bronchi are irritated.
Nerve impulses are sent to the medulla via the vagus nerve.
This causes a deep inspiration.
The epiglottis and vocal cords close.
Abdominal muscles contract and push against the diaphragm.
Internal intercostal muscles also contract.
Increase in pressure within the lungs.
Vocal cords and epiglottis opens.
Air is forced out.

39
Q

What are the key mediators of inflammation?

A

Cells that function as phagocytes - neutrophils, macrophages, and dendritic cells.

40
Q

What is diapedesis?

A

Passage of leukocytes out of the blood and into the surrounding tissues.

41
Q

What do tissue macrophages recognise in pathogens that cause a response?

A

PAMPs (pathogen-associated molecular patterns)

DAMPs (damage-associated molecular patterns)

42
Q

Describe the action of a Toll-Like Receptor (TLR).

A

Expressed on macrophage and dendritic cell membranes.
Recognise and bind to PAMPs (pathogen-associated molecular patterns).
Stimulates second messengers which in turn stimulate production of inflammatory mediators.
Inflammatory mediators stimulate cells of innate and adaptive immune response.

43
Q

What is the primary function of the alveolar macrophage?

A

Destroy bacteria swiftly with little help (without inducing a massive immune response).
However they can recruit neutrophils to cause a large response.

44
Q

Where is myeloperoxidase found and what is its function?

A

Primary neutrophil granules.

Carries out antimicrobial activity.

45
Q

Where is elastase found and what is its function?

A

Primary neutrophil granules.

Breaks down elastin in lungs (enables neutrophil to get through the lung).

46
Q

Where is collagenase found and what is its function?

A

Secondary neutrophil granules.
Breaks down collagen to allow neutrophils to penetrate collagenised areas.
Also has a chemotactic role (causes more neutrophils to migrate to the area).

47
Q

Describe neutrophil adhesion.

A

At first neutrophils are loosely tethered to endothelial cells via selectins. Neutrophil can roll along the vessel surface and ‘look’ for chemoattractants (margination).
Chemoattractants act on neutrophil to induce release of integrins which bind tightly to endothelium.

48
Q

Which type of antibody is made at the beginning of an infection?

A

IgM

49
Q

Which is the most abundant type of antibody?

A

IgG

50
Q

Which type of antibody is made to things we’re allergic to?

A

IgE

51
Q

Which antibodies are involved in type 2 hypersensitivity reactions?

A

IgG

52
Q

Which antibodies are involved in type 3 hypersensitivity reactions?

A

IgG

53
Q

What measure of O2 changes with altitude?

A

PiO2 (pressure of inspired O2)

FiO2 never changes

54
Q

What is the value of FiO2?

A

0.21

55
Q

What is the equation to work out the pressure of an inspired gas?

A

Pigas = Patm x Figas

pressure of gas = atmospheric pressure x fraction of inspired gas

56
Q

How is PaCO2 related to ventilation?

A

Indirectly proportional

57
Q

Give the equation to calculate PaO2.

A

PaO2 = PAO2 - A-aDO2

58
Q

What is A-aDO2?

A

Arterial-alveolar difference in O2.

This tends to be 1KPa due to V/Q mismatch.

59
Q

What are the normal PaO2 and PaCO2 at sea level?

A 
PaO2 = 10.5 - 13.5KPa
PaCO2 = 4.5 - 6.0KPa
60
Q

How does pressure change with altitude?

A

It decreases in a non-linear fashion.

61
Q

How does the pressure change as you descend below sea level?

A

For every 10m of water, pressure increases by 1atm.

10m underwater = 2atm, 20m underwater = 3atm etc

62
Q

What is the significance of Henry’s law when diving?

A

Proportionally more gas dissolves in tissues at depth.
If the rate of ascent is faster than the body’s ability to expell gases which were dissolved inert gas bubbles will form.

63
Q

What happens in the diving reflex with free diving?

A

Apnoea (stop breathing)
Bradycardia (slow heart rate)
Peripheral vasoconstriction

64
Q

Which phase of lung embryology does angiogenesis occur?

A

Pseudoglandular phase (week 5-16)

Phase 1 Medicine (Extra) (7 decks)

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