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Y1 Body system lecture notes year 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the functions of the respirator system

A

Gas exchange: O2 passes form air to blood; CO2 passes from blood into air
Speech
Smell

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2
Q

How can the function of respiratory be divided

A

Conducting portion: transports air; conditions air (warms, moistens, filters)
Respiratory portion: thin, moist, delicate membrane; site of caseous exchange

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3
Q

What are the paranasal sinuses and their role

A

Cavities within the skull sitting parallel to the nasal cavity

Produces mucus to protect from pathogens which trickles out when infected, to cause a runny nose

Frontal sinuses
Ethmoidal air cells
Sphenoid sinus
Maxillary sinus

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4
Q

What are the chonchae in the nasal cavity

A

Three ridges which create turbulence

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5
Q

What is a meatus

A

Hole which allows the air to pass from the chonchae into the sinuses

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6
Q

What is the mediastinum

A

Midline region which encloses the heart, major vessels, major nerves, trachea and oesophagus

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7
Q

What are the structures of left and right lungs

A

Right:
3 lobes: superior, inferior, middle
Fissure: oblique, horizontal

Left:
2 lobes: superior, inferior
Fissure: oblique

There are segments with their own venous drainage, arterial supply and nerve supply

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8
Q

What is on the medial surface of the lungs

A

Bronchi: most posteriorly
Pulmonary arteries: anterior to bronchi, superior to veins
Pulmonary veins: anterior and inferior

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9
Q

What is the upper vs lower respiratory tract

A

Everything above the larynx is upper and everything below the larynx is lower respiratory tract

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10
Q

What are the functions of the thoracic cage

A

Protection: bony cage around vital organs
Respiratory: Changes in thoracic volume underlie movement of fresh air into lungs and stale air out

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11
Q

What is in each intercostal space

A

3 thin muscle layers:
External intercostal
Internal intercostal
Innermost intercostal

Neurovascular bundle:
Intercostal vein
Intercostal artery
Intercostal nerve

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12
Q

What are the characteristics of the pleura

A

A membranous sac that encloses the lung and forms the pleural cavity

Visceral and parietal

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13
Q

What is breathing

A

The bodily function that leads to ventilation of the lungs

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14
Q

What are the pleural cavities

A

Two pleural cavities either side of the heart in the thoracic

Pleural cavity contains a thin film of fluid which help the lung to slide and creates surface tension between parietal and visceral layer to aid inspiration

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15
Q

What are the two types of disease that can affect ventilation and some examples

A 
Obstructive: 
Increased RV, FRC (emphysema)
Reduced TLC (COPD)
Examples: Asthma, COPD, lung cancer
Restrictive: 
Reduced RV, FRC, VC, TLC
Intrinsic: pulmonary fibrosis
Extrinsic: pneumothorax, disorders if the thoracic skeleton
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16
Q

How does pressure change in inspiration vs expiration

A

Inspiration: atmospheric pressure > alveoli pressure

Expiration: atmospheric pressure < alveoli pressure

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17
Q

What is the equation to determine how airway obstruction has a major effect on air flow

A

Flow= (k. change in pressure. r4)/ L

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18
Q

What inspiratory muscles are used for each type of breathing

A

Quiet: diaphragm, external intercostals stabilise rib cage
Increasing effort: diaphragm, external intercostal lift and expand rib cage, accessory muscles, neck muscles, shoulder girdle muscles

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19
Q

What expiratory muscles are used for each type of breathing

A

Quiet: elastic recoil of tissues

Increasing effort: internal intercostals, abdominal wall muscles

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20
Q

How are the respiratory muscles innervated

A

Diaphragm: phrenic nerve (C3, C4, C5)

Intercostals: segmental thoracic nerves

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21
Q

What is tidal volume

A

The volume of air move in or out of the lungs during normal breathing

at rest 6-7 ml/kg
during exercise 15ml/kg

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22
Q

What is inspiratory reserve volume

A

As deep a breath in as possible

typical: 430 ml/kg

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23
Q

What is expiratory reserve volume

A

as deep a breath out as possible

typical: 22ml/kg

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24
Q

What is the residual volume

A

air remaining in lungs even after a maximal expiration

typical: 14.5 ml/kg

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25
Q

What is total lung capacity

A

Tidal volume + inspiratory reserve volume + expiratory reserve volume + residual volume

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26
Q

What is vital capacity

A

Tidal volume + inspiratory reserve volume + expiratory reserve volume

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27
Q

What is functional residual capacity

A

Expiratory reserve volume + residual volume

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28
Q

What is measured by vitalograph

A

Forced vital capacity (FVC)

Forced expiratory volume in 1 second (FEV1)

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29
Q

What is measured by a peak flow meter

A

Peak expiratory flow rate (PEFR)

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30
Q

What is compliance

A

The change in lung volume pre unit change in intrathoracic pressure

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31
Q

What is the surfactant layer

A 
Reduces surface tension by acting as a detergent
Produced by type II alveolar cells
90% phospholipid 10% protein
Increases pulmonary compliance
Prevents atelectasis
Aids alveolar recruitment
Minimises alveolar fluid
Deficient in infant respiratory distress syndrome
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32
Q

What is the equation of proportion for rate of diffusion

A

Rate of diffusion @ surface area @ pressure gradient

@ = proportional to

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33
Q

What is the pressure gradient

A

The difference in partial pressure of the respective gases in the alveolus and the blood

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34
Q

What is the partial pressure of a gas in mixture of gases

A

The pressure that it would exert if it was the only gas in the container

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35
Q

What is the universal gas equation

A

PV =nRT

Pressure x volume = number of moles x the gas constant x temperature (kelvins)

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36
Q

How can the partial pressure of a gas be calculated?

A

Fractional conc x pressure of full mixture of gas

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37
Q

What are the characteristics of partial pressure of oxygen in alveoli

A

Lower than in room air because:

inspired air is humidified in the upper airway
o2 and co2 mixed
more O2 molecules consumed than CO2 molecules produced

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38
Q

How is oxygen diffusing capacity measured

A

Oxygen uptake/ (alveolar PO2 -mean pulmonary capillary PO2)

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39
Q

How is carbon monoxide diffusing capacity measured

A

carbon monoxide uptake/ alveolar PCO

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40
Q

What are problems which can occur within alveoli and how do these look

A

Alveolar fibrosis: thickening of alveolar wall
Pneumonia: alveolar consolidation
Pulmonary edema: frothy secretions
Interstitial edema
Emphysema: alveolar-capillary destruction (COPD)
Atelectasis: alveolar collapse

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41
Q

What is the process of pharyngeal dilator reflex

A

Pressure receptors -> brainstem -> pharyngeal muscle contraction

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42
Q

What are afferent and efferent signals

A

Afferent are going towards brain

Efferent are going away from brain

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43
Q

What are the characteristics of the upper airway

A

Continuous muscle activity is needed to keep the airway patent
Reflex control of the muscles is rapid and critical
Control of the muscles is often poor such as during sleep or with sedative drugs

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44
Q

What are the types of epithelial cells

A

Pseudostratified: nose and pharynx, long and thin

Columnar: trachea and bronchi, quite tall

Cuboidal: bronchioles, as tall as they are high

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45
Q

What are goblet cells

A

Secrete mucin in granules

Sit in epithelia cells

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46
Q

What are the two layers above the epithelial cells

A

Periciliary layer: Salty and watery

Mucous layer: sticky and mucousy

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47
Q

What inhibits cilia function

A

Tobacco smoke
Inhaled anaesthetics
Air pollution
Infection

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48
Q

What are the function of the airway lining fluid

A

Humidification

Airway defence

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49
Q

Where are inhaled particles deposited

A

Very large: nose and pharynx
Large: large airways
Small: bronchioles
Very small: exhaled again

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50
Q

What are the non-immunological pulmonary defences

A

Physical barrier and removal
Chemical inactivation: lysozyme, protease enzymes e.g. elastase, antimicrobial peptides e.g. human B defensins
Alveolar macrophages

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51
Q

What are the immunological pulmonary defences

A

Humoral:
IgA (nose and large airways)
IgG (small airways)
IgE (allergic disease

Cell-mediated:
Epithelial cells
Macrophages

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52
Q

How is oxygen carried

A

Dissolved in blood

Combined with haemoglobin

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53
Q

What is the volume of O2 in blood

A

0.0232 x PO2(12.5) = 0.29ml.dl-1

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54
Q

How is O2 saturation calculated

A

HbO2/ HHb+HbO2

Oxygenated Haemoglobin/ De-oxygenated haemoglobin + oxygenated haemoglobin

55
Q

What is the Hufner constant

A

1.39ml.g-1

Number of ml of O2 that one g go Hb can bind

56
Q

What is a buffer

A

A solution that can minimise changes in the free H+ conc and therefore in pH

57
Q

What are some buffer systems in blood

A

Bicarbonate
Plasma proteins
Haemoglobin
Phosphate

58
Q

What is the blood pH

A

7.35-7.45

59
Q

How is CO2 carried

A

Dissolved in blood
Carbamino compounds
Bicarbonate/carbonic acid

60
Q

What is the equalibrium equation of CO2 and HCO3- and what acts as a catalyst on this

A

CO2 + H2O H2CO3 H+ + HCO3-

Carbonica anydrase

61
Q

What is the Henderson-Hasselbalch equation

A

pH = pK + log10 [HCO3-] / [CO2]

62
Q

What is the difference of respiratory and metabolic acidosis and alkalosis

A

R acidosis: Low pH, High PCO2, High HCO3-
M acidosis: Low pH, Low PCO2, Low HCO3-
R alkalosis: High pH, low PCO2, normal HCO3-
M alkalosis: High pH, normal PCO2, high HCO3-

63
Q

What part of the respiratory tract is formed by endoderm and mesoderm

A

Endoderm: Inner lining of respiratory tract

Mesoderm: Vasculature and connective structures

64
Q

How and when does the lung bud form

A

Grows ventrocaudally
Tracheo-oesophageal ridges separate the respiratory diverticulum from the foregut
Dorsally oesophagus
Ventrally trachea and lung bud which has now divided to form lung buds

65
Q

How can formation of the lung bud go wrong

A

Tracheo-oesophageal fistulas
Result from incomplete division of foregut into oesophageal and respiratory portions

Most commonly associated with oesophageal atresia (closed or absent) resulting in abdomen rabidly distending as stomach fills with air

66
Q

What is a fistula

A

Abnormal communication

67
Q

What are congenital abnormalities which are often found together

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-oesophageal fistulas
Oesophageal atresia
Renal abnormalities
Limb defects

VACTERL

68
Q

What is pulmonary agenesis

A

Occurs when lung bud fails to split
Complete absence of bronchi and vasculature
Can be unilateral or bilateral
Bilateral genesis is incompatible with life

69
Q

What is pulmonary hypoplasia

A

All components are present but incompletely developed
Severity determines the degree of respiratory compromise
May be found in association with congenital diaphragmatic hernia

70
Q

What four parts can maturation of the lungs be divided into and what happens in each stage and at what time

A

Pseudoglandular: branching of respiratory tree to form terminal bronchioles; 5-17 weeks
Canalicular: Terminal bronchioles give rise to respiratory bronchioles, mesodermal tissue becomes highly vascularised; 16-25 weeks
Saccula/terminal sac: further terminal sacs (primitive alveoli), epithelium thins and differentiates, blood-air barrier; 26 weeks- birth
Alveolar period: Increase number of respiratory bronchioles and alveoli; 36 weeks - 8years old

71
Q

What are the two types of epithelium in the terminal sac period

A

Type I pnuemocytes: across which gaseous exchange takes place
Type II pneumocytes: which secrete surfactant

72
Q

What is ventilation, where does it occur and how is it measured

A

Movement of gases in and out of the lungs
Occurs through airways
Measured as change in volume per unit time

73
Q

What is perfusion, where does it occur and how is it measured

A

Blood flow through any organ
Occurs through blood vessels
Measured as flow of blood per unit time

74
Q

What is emphysema

A

Widespread destruction and dilation of distal airway
Regional destruction of vascular beds
Poor gas exchange and hypoxia

75
Q

What is hydrostatic oressure

A

Force exerted by weight of a fluid due to gravity

76
Q

What is a shunt

A

Deoxygenated blood reaching left side of the heart either bypassing lungs or failing to get oxygenated when in the lungs

77
Q

What are the steps in the oxygen cascade

A

1: humidification
2: alveolar gas
3: alveolar-capillary diffusion
4: ventilation-perfusion mismatch and shunt
5: tissue diffusion
6: diffusion within cell

78
Q

What is oxygen delivery

A

Amount of oxygen leaving the heart in one minute

DO2

79
Q

How is oxygen delivery calculated

A

Amount of oxygen in blood (O2 carried by haemoglobin + dissolved O2) x amount of blood leaving heart (cardiac output)

80
Q

What is oxygen consumption

A

Amount of oxygen used by the body in one minute (VO2)

81
Q

How is VO2 measured

A

Direct calorimetry

Indirect calorimetry

82
Q

What are factors that affect VO2

A

Age: peak at age 0-2 years, then falls for rest of life

Temperature: metabolic rate doubles with every 10 degrees C

Exercise

83
Q

What is the respiratory exchange ratio (respiratory quotient)

A

The ratio of carbon dioxide production (VCO2) to oxygen comsumption (VO2)

RER

84
Q

How is the respiratory exchange ratio affected

A

Acid-base balance
Hyperventilation
Metabolic fuel

85
Q

How is energy generated

A

Glycolysis
Tricarboxylic acid cycle
Oxidative phosphorylation

86
Q

What are the characteristics of glycolysis

A

Occurs in cytoplasm
Glucose to pyruvate or lactate
No oxygen required
2 ATP molecules per glucose

87
Q

What are the characteristics of tricarboxylic acid cycle

A

Occurs mostly in mitochondria
Acetyl CoA (from glycyolysis) to CO2
38 ATP molecules per glucose

88
Q

What are the characteristics of oxidative phosphorylation

A

Occurs in mitochondria
NADH provides H+
H+ combines with O2 to produce water
ATP produced

89
Q

What are the causes of cellular hypoxia

A

Anoxic: lack of O2 in blood
Anaemic: lack of haemoglobin
Stagnant: lack of blood supply

90
Q

What is the ventral respiratory group (VRG)

A

Contains mixed neurones, some fire during inspiration, some during expiration

91
Q

What is the dorsal respiratory group (DRG)

A

Contains neurones which fire during inspiration

92
Q

What does the bpneustic centre do

A

Stimulates inspiratory neurones

93
Q

What does the pneuomotaxic centre do

A

Inhibits inspiratory neurones

94
Q

What are pulmonary stretch receptors

A

Afferent fibres from smooth muscle of bronchi and trachea

Run in the vagus nerve to the respiratory centre (medulla)

95
Q

What generates a cough

A

Receptors throughout the airways which when stimulated initiate an explosive expiration

96
Q

What are baroreceptors

A

Sense blood pressure, can also influence ventilation

Increase in BP leads to decrease in ventilation and vice versa

97
Q

What are J-receptors

A

Juxtacapillary
Lie close to capillaries around the alveolar walls
Activated by trauma such as pulmonary oedema, inflammatory agents, pneumonia
Activation triggers increased ventilation

98
Q

What do chemoreceptors do

A

The chemical regulation of breathing

99
Q

What are central chemoreceptors

A

Specialised regions close to medulla respiratory centres but also close to a rich blood supply

Sensitive to O2, CO2 and H+

100
Q

How does the body respond to altitude

A

Hyperventilation and respiratory alkalosis
Increased 2,3-DPG causes better unloading of oxygen
Polycythaemia-slow to develop
Bicarbonate excretion from CSF and kidneys
Diuresis
Hyponatraemia
Acetazolamide

101
Q

What is surface pressure

A

1 atmosphere

100 kPa

102
Q

How does pressure change in the sea

A

10m depth increases pressure by 1 atmosphere

103
Q

What is the mechanism of a cough

A

Cough receptors or lung irritant receptors -> cough centre in medulla -> vagal stimulation leading to cough

104
Q

What do expectorants do

A

Increase volume of secretion in a productive cough

105
Q

What do mucolytics do

A

Decrease the viscosity of mucus in a productive cough

106
Q

What is useful vs useless cough

A

Useless: persistent and unproductive, dry cough

Useful: expels secretions, productive cough

107
Q

How is a dry cough suppressed

A

Afferent side: reduce stimuli

Efferent side: medullary cough centre

108
Q

What are the most common causes of chronic cough

A

Upper airways cough syndrome

Bronchial asthma

Chronic obstructive pulmonary disease (COPD)

Gastroesophageal reflux disease

109
Q

What does chronic lung disease do

A

Inflammation
Bronchoconstriction
Secretions

110
Q

What are types of bronchial asthma

A

Asthma associated with allergic reactions
Asthma not associated with specific allergen
Exercise induced asthma
Asthma associated with chronic obstructive pulmonary disease

111
Q

How is asthma treated

A

Non specific reduction of bronchial hyperactivity: life style, corticosteroids

Dilation of narrowed bronchi: Mimicking dilator neurotransmitter: sympathomimetics
Direct acting bronchodilators: methylxanthines
Blockade of constrictor transmitter: anticholinergics

Prevention of release of transmitter: mast cell stabilisers

Antagonism of released transmitter: leukotriene receptor antagonists

112
Q

How do corticosteroids work and how can they be taken

A

Anti-inflammatory

Reduced bronchial reactivity

Inhaled and orally

113
Q

What are the characteristics of leukotriene receptor antagonists

A

Uses: allergen induced asthma, exercise induced asthma, reduced frequency of exacerbations

Given orally
Not effective in acute asthma

Minor adverse effects: headaches, gastritis, flu-like symptoms, CS syndrome

114
Q

What are some sympathomimetic agents

A

B2 agonist agents:
Short acting: salbutamol, terbutaline
Long acting: salmeterol, formetrol

Non-selective: adrenaline

115
Q

What are the characteristics of COPD

A 
Slowly progressive
Airflow obstruction
Little or no reversibility
Does not change much over several months
Predominantly caused by smoking
Symptoms improve in 90% if stop smoking
Reduced FEV1/FVC ratio
116
Q

What is FEV1

A

Forced expiratory volume in 1 second
Volume of air that can be expelled from maximum inspiration in the first second
Time dependent and reflects airway caliber

117
Q

What is FVC

A

The forced vital capacity of the lung
The volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum expiration
Volume dependent and reflects lung volume

118
Q

What are the symptoms of COPD

A

Breathlessness
Wheezing
Phlegm
Cough

119
Q

How are pack years calculated

A

(Number of cigarettes per day/ 20) x number of years

120
Q

What is asthma

A

A chronic inflammatory disorder of the airways
Airway hyper-responsiveness
Recurrent episodes of wheezing and breathlessness
Chest tightness, Coughing particularly at night or in the early morning
Variable airflow obstruction that is often reversible, either spontaneously or with treatment
Investigated using peak flow meter

121
Q

What are the differences between intrinsic and extrinsic asthma

A

Extrinsic: Family history, starts in childhood, eczema/rhinitis, percipitating factors, positive skin tests, episodic

Intrinsic: Adulthood, negative skin tests, persistent symptoms, no clear percipitating factors, exacerbated by infections

122
Q

What are the symptoms of lung cancer

A 
Cough
Breathlessness
Wheeze
Stridor
Dysphagia
Hoarse voice
Chest pain
Bone pain
Neurology
Anorexia
Weight loss
Clubbing
123
Q

What investigations are done in lung cancer patients

A 
Chest X-ray
CT scan
Bronchoscopy
Percutaneous fine needle aspiration/biopsy
Mediastinoscopy
VATS
Bone scan
Endobronchial ultrasound
124
Q

What are the symptoms of Cystic Fibrosis

A 
Weight loss
Increase cough 
Thich green sputum
Haemoptysis
Fatty stools
Reduced vision
Clubbing
125
Q

What is bronchiectasis

A

Chronic dilation of one or more bronchi
Poor mucous clearance
Predisposition to bacterial infection

126
Q

What are the symptoms of bronchiectasis

A 
Persistent purulent sputum
Haemoptysis
Breathlessness
Wheeze
Sinustitis 
nasal symptoms
Weight loss
Pleurisy
Nasal polyps
127
Q

What investigations are done for bronchiectasis

A 
History 
Genetics
Sweat test
Faecal elastase
Ciliary beat frequency
Sperm analysis
Autoantibody screen
Sputum analysis
Aspergillus antibodies
Lung function
128
Q

What treatment is given for bronchiectasis

A 
Physiotherapy
Prompt antibiotics
Intravenous antibiotics
Nebulised antibiotics
Annual influenza vaccination
129
Q

What are the symptoms of pneumonia

A

Progressive breathlessness
Fever with shivering attacks
Left sided sharp chest pain
General lathargy

130
Q

What are the treatments of pneumonia

A 
Antibiotics
Oxygen
Analgesia
Fluids
Physiotherapy
Nutrition
Stop smoking
131
Q

What is type 2 vs type 1 respiratory failure

A

Type 1: Low level of oxygen in the blood without an increased level of CO2 in the blood, so PaCO2 may be normal or low
Type 2: Buildup of CO2 levels (PaCO2) that has been generated by the body but cannot be eliminated

132
Q

What is a tension pneumothorax

A

The tissue forms a one way valve allowing air to enter the pleural space and preventing its escape, pushing the mediastinum to the opposite side resulting in obstruction of venous return to the heart

133
Q

What are the symptoms of a tension pneumothorax

A

Very bruised
Excrutiating pain in his left chest which is tender to touch
Very short of breath

Y1 Body system lecture notes year 1 (5 decks)

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