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respiratory important Flashcards

1
Q

inspiration

A

intercostal muscles = contract
diaphragm = contracts
volume = increases
pressure = decreases
chest wall moves away from lung surface and parietal pleura moves away from visceral slightly
pressure enough to overcome elastic recoil, lungs expand - air forced in

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2
Q

what is the innervation of the diaphragm

A

phrenic nerve C3,4,,5

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3
Q

expiration

A

intercostal muscles = relaxes
diaphragm = relaxes
volume = decreases
pressure = increases

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4
Q

conducting airways

A 
No alveoli and no exchange with blood 
Trachea
Main Bronchus(Right and Left)
Lobar Bronchus
Segmental Bronchus
Terminal Bronchiole
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5
Q

respiratory airways

A

Contains alveoli and gas exchange with blood
Respiratory Bronchiole
Alveolar Duct
Alveolar Sac

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6
Q

what type of epithelium is respiratory epithelium

A

Ciliated pseudostratified columnar epithelium

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7
Q

type 1 pneumocytes

A

95% of alveolar area, thin barrier for diffusion, connected by tight junctions.

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8
Q

type 2 pneumocytes

A

60% of total number of cells, secrete

Surfactant and decreases surface tension

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9
Q

alveolar macrophages

A

Immune cells
Derived from monocytes
Ingest bacteria and particles

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10
Q

what are the layers of gas exchange

A
  1. Fluid lining alveoli
  2. Layer of epithelial cells (type I pneumocytes)
  3. Basement membrane of ^ cells
  4. Interstitial space between alveoli epithelium and capillary endothelial cells
  5. Basement membrane of capillary endothelium
  6. Capillary endothelial cells
  7. Red blood cell
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11
Q

describe the binding of oxygen to haem

A

Oxygen bindsreversibly tohaem, so eachhaemoglobinmolecule can carry up to fouroxygenmolecules. Haemoglobinis an allosteric protein; thebindingofoxygento onehaemgroup increases theoxygenaffinity within the remaininghaemgroups

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12
Q

what shifts the oxygen dissociation curve left?

A

decreased temperature
decreased 2,3-DPG
decreased H+
CO

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13
Q

what shifts the oxygen dissociation curve right

A

(reduced affinity)
increased temperature
increased 2,3-DPG
increased H+

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14
Q

why is there V/Q mismatch in healthy people

A

natural inequality of 5mmHg due to gravitational effects

increased filling of blood vessels at the bottom of the lung

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15
Q

examples of V/Q mismatch

A
  1. There may be ventilated alveoli but no blood supply at all (known as dead space or wasted ventilation) due to a blood clot for example
  2. There may be adequate blood flow through the areas of the lung but there is no ventilation (this is termed shunt) due to collapsed alveoli
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16
Q

what are 2 local homeostatic responses to V/Q mismatch?

A

Hypoxic pulmonary constriction
- vasoconstriction to divert blood away from the poorly ventilated area
Local bronchoconstriction
- diverts airflow away to areas of the lung with better perfusion

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17
Q

inspiratory reserve volume (IRV)

A

amount of air in excess tidal inspiration that can be inhaled with maximum volume

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18
Q

expiratory reserve volume (ERV)

A

amount of air in excess tidal expiration that can be exhaled with maximum effort

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19
Q

residual volume (RV)

A

amount of air remaining in the lungs after maximum expiration, keeps alveoli inflated between breaths and mixes with fresh air on next inspiration

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20
Q

vital capacity (VC)

A

amount of air that can be exhaled with maximum effort after maximum inspiration

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21
Q

functional residual capacity (FRC)

A

amount of air remaining in the lungs after a normal tidal expiration

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22
Q

inspiration capacity (IC)

A

maximum amount of air that can be inhaled after a normal tidal expiration

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23
Q

total lung capacity (TLC)

A

maximum amount of air the lungs can contain

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24
Q

tidal volume (TV)

A

amount of air inhaled or exhaled in one breath

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25
Q

FEV1

A

Forced expiratory volume in the first second. The volume of air that is forced out in one second after taking a deep breath.

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26
Q

PEF

A

peak expiratory flow

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27
Q

what does a flow-volume curve show

A

flow as the volume inside the lungs decreases

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28
Q

what does a volume-time curve show

A

FEV over time

FEV6 should be equal to FVC

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29
Q

airways obstruction

A

blockage of airways
FVC normal (>80% of predicted value)
FEV1/FVC ratio is less than 0.7
E.g COPD, asthma, Cystic fibrosis

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30
Q

airways restriction

A

decreased ability to expand
FVC reduced (<80% of predicted value)
FEV1/FVC ratio is normal (>0.7)
E.g Pulmonary fibrosis, sarcoidosis

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31
Q

definition of Hypoxia

A

deficiency of O2 at tissue level (low PO2)

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32
Q

what are the 4 types of Hypoxia

A
  • Hypoxaemia (hypoxic hypoxia) – most common
  • Anaemia or CO hypoxia
  • Ischaemia hypoxia
  • Histotoxic hypoxia
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33
Q

causes of hypoxaemia - hypoventilation

A

resulting in increased arterial partial CO2 pressure
failure to ventilate the alveoli adequately
caused by: muscular weakness, obesity & loss of respiratory drive

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34
Q

causes of hypoxaemia - diffusion impairment

A

Results from the thickening of the alveolar membranes or a decrease in their surface area - causes the blood partial O2 pressure and alveolar partial O2 pressure to fail to equilibrate

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35
Q

causes of hypoxaemia - shunting

A
  • An anatomical abnormality of the cardiovascular system that causes mixed venous blood to bypass ventilated alveoli in passing from the right side of the heart to the left side e.g. ventricular septal defect (VSD) - Eisenmenger’ Syndrome
  • An intrapulmonary defect in which mixed venous blood perfuses unventilated alveoli
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36
Q

causes of hypoxaemia - V/Q mismatch

A

most common (occurs in COPD)

  • Arterial partial CO2 pressure may be normal or increased, depending on how much ventilation is reflexively stimulated
  • Can be caused by; a pulmonary embolus (blockage of an artery in the lung), asthma, pneumonia & pulmonary oedema
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37
Q

definition of hypercapnia

A

increased arterial partial CO2 pressure

caused by hypoventilation

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38
Q

what is the main drive to breath

A

hypercapnia (high CO2)

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39
Q

Boyles Law

A

P1V1=P2V2

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40
Q

Daltons law

A

PT = P1 + P2 + P3 +…

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41
Q

Henrys law

A

C = k P

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42
Q

Poiseuille’s law

A

R = 8nL/pi r ^4
It states that the flow (Q) of fluid is related to a number of factors: the viscosity (n) of the fluid, the pressure gradient across the tubing (P), and the length (L) and diameter(r) of the tubing.

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43
Q

alveolar gas equation

A

PA02 = PiO2 - PaCO2/R

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44
Q

Laplace law

A

P = 2T/r

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45
Q

where is CO2 predominantly controlled

A

respiration in lungs

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46
Q

where is HCO3- predominantly controlled?

A

kidneys

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47
Q

Henderson-Hasselbalch equation

A

pH = pKa + log [conjugate base]/[acid]

48
Q

examples of respiratory acidosis

A

COPD
asthma
severe obesity
hypoventilation

49
Q

examples of respiratory alkalosis

A

hyperventilation

50
Q

examples of metabolic acidosis

A

hyperkalaemia
diabetic ketoacidosis
renal failure

51
Q

examples of metabolic alkalosis

A

diarrhoea

vomiting

52
Q

what cell types are involved in innate immunity

A

monocytes/macrophages, mast cells, dendritic cells, NK cells

53
Q

what cell types are involved in adaptive immunity

A

B cells, T cells

54
Q

what are the 5 classes of antibodies

A

IgG, IgA, IgM, IgE, IgD

55
Q

features of innate (non-specific) defence

A 
front line 
provides barrier to antigen 
present from birth 
slow response 
no-memory 
integrates with adaptive response
56
Q

features of adaptive (specific) defence

A 
specific to antigen 
learnt behaviour 
memory to specific antigen 
quicker response 
requires lymphocytes 
diversity requires somatic mutation
57
Q

what are the 2 medullary systems

A

DRG

VRG

58
Q

Dorsal respiratory group

DRG

A

Rapidly fire during inspiration

Input to spinal nerves that control diaphragm and inspiratory intercostals

59
Q

ventral respiratory group (VRG)

A

Respiratory rhythm generator is located in Pre-Botzinger Complex of neurons
Sets the respiratory basal rate
Neurons fire during both inspiration and expiration
Have input to muscles of inspiration
Lower VRG also contains expiratory neurons
Input to muscles of expiration

60
Q

what are the 2 pontine systems

A

Apneustic centre

Pneumotaxic centre

61
Q

Apneustic centre

A

Area of lower pons
Major source of input to medullary inspiratory neurons
fine tunes medullary inspiratory neuron output and helps to continue activating inspiratory neurons to inhibit expiration

62
Q

Pneumotaxic centre

A

Area of upper pons
Modulates activity of apneustic centre and smooths transition from inspiration to expiration
Switches off inspiratory neurons to prevent hyperinflation thus allowing expiration

63
Q

what are pulmonary stretch receptors and what are the 2 types

A

mechanoreceptors
types: Slowly adapting stretch receptors (SASR)
Rapidly adapting stretch receptors (RASR)

64
Q

slowly adapting stretch receptors (SASR)

A

In smooth muscle layer of airways in lungs
Stimulated by large lung inflation
Send afferent impulses to brain and inhibit medullary inspiratory neurons in DRG

65
Q

Rapidly adapting stretch receptors (RASR)

A

In-between epithelial cells of airways
Stimulated by lung distension and irritants
Stimulation causes bronchoconstriction and an activity burst

66
Q

what are the 2 types of chemoreceptors

A

Peripheral

central

67
Q

peripheral chemoreceptors

A

Aortic bodies (arch of the aorta) and carotid bodies (high in the neck at bifurcation of common carotid arteries)
Stimulated by a decrease in arterial PO2 and an increase in arterial H+ concentration. Not sensitive to small reductions of the arterial partial O2 pressure
Provide excitatory input to medullary inspiratory neurons to increase the rate of respiration

68
Q

central chemoreceptors

A

In medulla
Provide excitatory synaptic input to medullary inspiratory neurons
Very small increases in the arterial partial CO2 pressure causes a marked reflex increase in ventilation
Stimulated by an increase in the H+ concentration in the CSF which is represented by an increase in Co2 levels

69
Q

respiratory drive - control by PO2

A

Decrease in PO2 will stimulate peripheral chemoreceptors

Send impulses to medullary inspiratory neurons and cause an increase in ventilation rate

70
Q

respiratory drive - control by CO2

A

Increase in PCO2 will cause an increase in the concentration of H+ in the blood
As CO2 + H2O -> H+ + HCO3-
Stimulates peripheral chemoreceptors and medullary inspiratory neurons
Increase in CO2 in brain CSF
H+ stimulates central chemoreceptors
Ventilation increased to remove excess CO2

71
Q

sympathetic airway tone

A

bronchodilation
Neurotransmitter: Noradrenaline acts on adrenal glands which secrete adrenaline
receptor: B2 (beta-adrenergic)
effect: indirect

72
Q

parasympathetic airway tone

A

bronchoconstriction

neurotransmitter: Acetylcholine
receptor: M3 (muscarinic)
effect: direct

73
Q

what does the upper respiratory tract consist of

A

nose > larynx

74
Q

what are the functions of the upper respiratory tract

A

1) filter, warm, humidify, inspired air (turbinates!)
2) voice production (larynx)
3) quality of voice (sinuses and larynx affect this)

75
Q

how many turbinates are there

A

3: superior, middle, inferior

76
Q

what are the 4 regions of airflow

A

sphenoethmoidal recess, superior meatus, middle meatus, inferior meatus

77
Q

what are the 4 pairs of paranasal sinuses

A

frontal, maxillary, ethmoid, and sphenoid

78
Q

what are the 3 areas of the pharynx

A

base pf the skull to C6
nasopharynx
oropharynx
laryngopharynx

79
Q

what are the 9 cartilages of the Larynx and which are elastic and hyaline

A

Single: epiglottis, cricoid, thyroid
Paired: cuneiform, corniculate, arytenoid

Elastic= epiglottis
Hyaline= thyroid, cricoid, arytenoid
80
Q

what does the superior laryngeal nerve innervate

A

internal= all sensation to laryngopharynx

external= motor to cricothyroid

81
Q

what does the recurrent laryngeal nerve innervate

A

motor to all laryngeal muscles except cricothyroid

82
Q

what are the borders of the anterior triangle

A

Superiorly– inferior border of the mandible (jawbone)
Laterally– anterior border of the sternocleidomastoid
Medially– sagittal line down the midline of the neck

83
Q

what does the lower respiratory tract consist of?

A

vocal cords > alveoli

84
Q

what is in the conducting zone

A

trachea > terminal bronchioles

85
Q

what is in the respiratory zone

A

respiratory bronchioles > alveoli

86
Q

components of the respiratory tree

A 
Trachea
R & L main bronchi
R & L lobar bronchi
Segmental branches
Terminal bronchioles
Respiratory bronchiole
Alveolar duct
Alveolar sac
Alveoli
87
Q

describe the lung blood supply

A

1) deoxygenated pulmonary arteries &

2) oxygenated bronchial artery (from thoracic aorta)

88
Q

innervation of the lungs

A

vagus

89
Q

venous drainage of the lungs

A

1) bronchial veins (drain deoxygenated to azygous) &

2) four pulmonary veins (drain oxygenated blood into LA)

90
Q

inferior lung borders

A

ribs 6,8,10

91
Q

inferior pleural borders

A

ribs 8,10,12

92
Q

features of the right lung

A

3 lobes, 2 fissures

93
Q

features of the left lung

A

2 lobes, 1 fissure

94
Q

where is the apex of the lung

A

3cm above medial 1/3 clavicle

95
Q

position of the hilum of the lung

A

costal cartilage 2,3,4

96
Q

positions of structures in hilum of lung

A

Right: PA anterior to bronchus
Left: PA most superior
Both: bronchus= posterior & PV anterior and inferior

97
Q

what structures pass through the diaphragm and at what levels

A

IVC= T8
Oesophagus=T10
Aorta= T12

98
Q

what 3 structures are in the carotid sheath

A
  1. carotid
  2. internal jugular
  3. vagus
99
Q

minute volume =

A

5L/min

100
Q

what kind of pressure causes air to move into lungs

A

negative intra-alveolar pressure

101
Q

what is transpulmonary pressure (Ptp)

A

difference in pressure between inside and outside of lung (alveolar pressure - intrapleural pressure)

102
Q

alveolar pressure (Palv)

A

air pressure in pulmonary alveoli

103
Q

intrapleural pressure (Pip)

A

pressure in pleural space- ‘intrathoracic pressure’

104
Q

compliance

A

change in lung volume caused by given change in Ptp

greater the lung compliance, more readily the lungs expand

105
Q

what is compliance affected by

A

stretchability of elastic lung tissue

surface tension of alveoli

106
Q

ventilation

A

flow of air into and out of the alveoli

107
Q

perfusion

A

flow of blood to alveolar capillaries

108
Q

dead space

A

150ml UA + 25ml ALV = 175ml

109
Q

CO2 elimination equation

A

PACO2 = k V’CO2 / V’A

110
Q

hypersensitivity

A

diseases in which immune responses to environmental antigens cause inflammation and damage to the body itself

111
Q

Gell and Coombes Classification

A

Type 1 – IgE, allergy, hay fever, acute anaphylaxis > histamine > reaction
Type 2 – IgM/IgG, transfusion reactions, autoimmune diseases
Type 3 – IgG = circulatory immune complexes, farmers/pigeon fanciers lung
Type 4 – T cell-mediated Delayed Type Hypersensitivity, TB, sarcoidosis

112
Q

type 1 respiratory failure

A

low oxygen pO2 < 8kPa
normal pCO2 < 6kPa
type1 = 1 change (only O2 is low)
ARDS

113
Q

type 2 respiratory failure

A 
low oxygen pO2 < 8kPa
high pCO2 > 6kPa
type2 = 2 changes (low O2 + high CO2) 
hypoxia with hypercapnia
COPD
114
Q

foetal circulation features

A

Lungs filled with fluid
one umbilical vein- oxygenated blood from placenta
two umbilical arteries- deoxyg blood to placenta
three shunts:
ductus venosus (hepatic system)
foramen ovale (betw RA & LA)
ductus arteriosus (PA to desc aorta)

115
Q

first breath

A 
Fluid squeezed out & inc surfactant
Air inhaled 
O2 vasodilates PAs > lungs perfused 
Pressure in systemic circulation inc > shunts in liver & DA to close
Umbilical arteries and shunts constrict
116
Q

foetal to adult features

A 
UV > ligamentum teres
UA > medial umbilical ligaments
DV > ligamentum venosum
DA > ligamentum arteriosum
FO > fossa ovalis

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