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4b. RESPIRATORY > Respiratory Science > Flashcards

Respiratory Science Flashcards

1
Q

Is inspiration active or passive?

A

Active

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2
Q

Is expiration active or passive?

A

Passive (can be active)

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3
Q

What is the name of the two areas of the Pons? What are their functions?

A

Pneumotaxic (ends inspiration), apneustic excites dorsal group of medulla.

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4
Q

What are the three areas of the Medulla? What are their functions?

A

Pre-Botzinger generates impulses for breathing. Dorsal is inspiratory. Ventral is forced expiration.

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5
Q

Describe the law of LaPlace. Which factor is important?

A

2T/r, where radius is most significant

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6
Q

Describe the concept of alveolar interdependance.

A

Surrounding alveoli exert a force on each other.

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7
Q

Which substance reduces alveolar surface tension?

A

Surfactant

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8
Q

Which are the major muscles of respiration?

A

Diaphragm and EXTERNAL intercostals

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9
Q

Which muscles are used in forceful inspiration?

A

Sternocleidomastoid, scalanus, pectorals

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10
Q

Which muscles are used in active expiration?

A

Abdominal, and internal intercostal muscles

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11
Q

What is the term used to describe the volume of air circulated within one normal breath?

A

Tidal volume

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12
Q

In terms of spirometry, what are the reserve volumes?

A

Volumes reached on maximal inspiration/expiration

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13
Q

What is the residual volume?

A

Air that is always present in the lungs (dead space)

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14
Q

Which three components is the vital capacity made out of?

A

Inspiratory reserve, tidal, expiratory reserve

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15
Q

What does Boyle’s Law state?

A

Gas moves from higher to lower pressure.

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16
Q

Dalton’s Partial Pressure Law states two things. What are these two formulae?

A

Pt = P1 + P2 + Pn, ventilation = TV x RR

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17
Q

Describe the overall effect on the bronchi by autonomic innervation.

A

Parasympathetic - constricts, sympathetic - dilates.

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18
Q

What is meant by pulmonary compliance?

A

Ability of the lungs to expand/retract.

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19
Q

Which factors may decrease pulmonary compliance (make the lungs ‘stiffer’)?

A

Fibrosis, oedema, pneumonia, lung collapse, lack of surfactant.

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20
Q

Which factors may increase compliance (making the lungs ‘less stiff’)?

A

Loss of recoil, emphysema

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21
Q

What is meant by the V/Q ratio?

A

Ventilation/perfusion. Typically more oxygen in top of lungs (V) and less at the bottom (Q - due to CO2 and perfusion)

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22
Q

Define partial pressure.

A

The pressure a gas would exert if it occupied the total volume of its mixture

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23
Q

Define the diffusion coefficient concept. Explain how it differs in CO2 and O2.

A

Solubility of a gas - how easily it moves across the cell membrane. CO2 is non-polar so moves much more easily.

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24
Q

State which two components affect diffusion in Fick’s Law and how they do so.

A

Area and thickness. Larger area means greater diffusion, larger thickness means less.

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25
Q

Give examples of some non-respiratory functions of the respiratory system.

A

Water loss, heat elimination, enhances venous return, acid-base balance, speech, singing, mucus and cilia, smell, etc

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26
Q

Define FEV1 and FVC.

A

FEV1 - forced expiratory volume after 1 second. FVC - forced vital capacity. Maximum inspiratory and expiratory volume.

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27
Q

State Henry’s Law.

A

Gas solubility in blood is proportional to partial pressure.

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28
Q

State how much oxygen is held as bound (vs dissolved), and use Henry’s Law to explain why.

A

98.5% - gas solubility is proportional to partial pressure, hence low solubility

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29
Q

State the composition (subunits) of haemoglobin

A

2 x alpha, beta (adult), gamma (foetus)

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30
Q

The haemoglobin curve is split into a smaller gradient section, and a larger gradient section. Explain why.

A

Smaller gradient - higher PO2 - oxygen loading isn’t much affected at higher concentrations.
Higher gradient - lower PO2 - oxygen is released rapidly to tissue in hypoxia, buffering necrosis

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31
Q

What is the formula for the oxygen delivery index?

A

DO2I = CaCO2 x CO x 10

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32
Q

Which factors can affect how much oxygen is being delivered to tissue (DO2I)?

A

Respiratory disease, heart failure, anaemia

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33
Q

What may be indicated by presence of myoglobin in the blood?

A

Muscle wasting

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34
Q

In the blood, carbon dioxide is carried in three different forms. What are they, and what are their relative concentrations?

A

Solution (10%), bicarbonate (60%), carbamino compounds (30%).

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35
Q

Describe the main equilibrium which provides stasis for acidosis and alkalosis.

A

CO2 + H2O H3CO2 H+ + HCO3-

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36
Q

Apart from blood pressure, what else do the carotid baroreceptors detect?

A

Tensions of O2, CO2, [H+].

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37
Q

When oxygen levels drop below which level should they be rapidly corrected?

A

< 8kPa

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38
Q

Which chronic adaptations may be adopted in response to chronically low oxygen levels?

A

Polycythemia, increase in capillaries, increase in 2,3-BPG (more O2 offloaded), increase in mitochondria, and kidneys conserve acid.

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39
Q

What is the difference between the larynx and pharynx?

A

Larynx becomes trachea, pharynx becomes oesophagus

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40
Q

Name the three major areas of the pharynx.

A

Oropharynx, nasopharynx, laryngopharynx

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41
Q

Name the three cartilages in the nose.

A

Vomer, erthmoid, septal cartilage

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42
Q

Name the main cartilages in surrounding the epiglottis.

A

Thyroid, cricoid, hyoid, hyaline (trachea), carytenoids

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43
Q

What are the physiological purposes of the rima glottidis?

A

Control/pitch of voice, cough reflex

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44
Q

How many lobes does each lung have?

A

Left - 2, right - 3.

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45
Q

What is the purpose of hyaline cartilage in the trachea?

A

Minimises potency

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46
Q

Name the layers of the pleura, from innermost to outermost.

A

Visceral, pleural cavity, parietal pleura

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47
Q

Name the bony extension which is a landmark in cardiopulmonary resus.

A

Xiphoid process

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48
Q

Name the landmarks of the sternum. There are six.

A

Sternoclavicular joint, jugular notch, sternal angle, body, xiphoid process, manubrium

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49
Q

Name the three types of ‘joint’ in the ribcage. Which one is the true joint?

A

Sternocostal (true), costochondral, costovertebreal

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50
Q

Which four principles of breathing ensure correct breathing?

A

Alveolar diffusion, air moves into the lung, warm moist clean air, and protection of the lung.

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51
Q

Describe the mechanism of inspiration.

A

Diaphragm down and out; intercostals out; pleura moves lungs outwards

52
Q

Describe the mechanism of expiration.

A

Diaphragm up and in; intercostals in; pleura in.

53
Q

Does inspiration or expiration result in a decrease in pressure?

A

Inspiration

54
Q

What three subcategories can pulmonary function tests be divided into?

A

Effort dependant, bronchial challenge, peak expiratory flow rate (PEFR)

55
Q

Describe how FEV1 changes in asthma and COPD, obstructive and restrictive diseases?

A

All decrease.

56
Q

Describe how FVC changes with asthma and COPD, obstructive and restrictive diseases?

A

Asthma remains the same. In all others, it decreases,

57
Q

Describe and explain how FEV1/FVC changes in obstructive vs restrictive disease?

A

Obstructive - ratio decreases. Restrictive - ratio remains roughly constant.

58
Q

In terms of pulmonary function tests, how may asthma and COPD be differentiated?

A

FVC is normal in asthma and lowered in COPD. Asthma has a >15% response to B2-ACRs, COPD < 15%

59
Q

What is the normal blood value range of [H+]?

A

35 - 45 Mol/L

60
Q

Define acidosis and alkalosis and the control mechanisms for each.

A

Increase/decrease of [H+] respectively. Getting rid of CO2 (lungs), and secreting HCO3- (hence H+) into the blood

61
Q

What are the normal range values for pH, PaO2, PaCO2, and base excess (BE)?

A

7.35-7.45, 9.3-13.3 kPa, 4.7-6 kPa, (-2) - (+2) mM/L

62
Q

Describe the compensatory mechanism for respiratory alkalosis.

A

Metabolic acidosis - equation is shifted so H+ and HCO3- are favoured. Negative base excess

63
Q

Describe the compensatory mechanism for respiratory acidosis.

A

Metabolic alkalosis - equation shifts to H2CO3 (hence taking in H+). Positive BE

64
Q

What is the purpose of the nasal cavity in regard to air?

A

Warms, moistens, filters

65
Q

Describe the structure of the nasal epithelium.

A

Keratinised stratified sqaumous epithelium

66
Q

Describe the structure of the respiratory epithelium.

A

Pseudostratified columnar and goblet cells, with basal cells, lamina propria, and cilia.

67
Q

Describe the structure of the vocal folds.

A

Rima glottidis. A flat surface with stratified squamous epithelium

68
Q

Describe the function of bronchiole club cells.

A

Stem cells, immune modification, detoxification

69
Q

What is the name of the cartilage around the trachea?

A

Hyaline

70
Q

What is the name of the arteries that supply the lung itself?

A

Bronchial arteries

71
Q

Describe the differences between respiratory and terminal endothelium.

A

Terminal - cartilage, psuedostratified columnar, decreases to cuboidal with club cells and contains smooth muscle.

72
Q

Describe the two types of alveolar cell.

A

Type 1 - simple squamous epithelium

Type 2 - surfactant production

73
Q

Describe the location and composition of the neurovascular bundle and its collateral.

A

Inferior surface of rib is NVB. Contains (posterior - thoracic aorta and azygous vein), (anterior - internal thoracic artery and vein) and nerve from anterior ramus

74
Q

Which nerve innervates the diaphragm?

A

Cervical spine nerves 3, 4, 5 (phrenic) keep the diaphragm alive.

75
Q

Name the three main accessory muscles of respiration (and the vein that seperates them)

A

Deltoid, pectoralis major, serratus anterior and lattissmus dorsi. Cephalic vein.

76
Q

Name the location where fluid may accumulate and cause pleural effusion.

A

Costodiaphragmatic recess/angle

77
Q

What are the four sections of the breast?

A

Superomedial, superolateral, inferomedial, inferolateral

78
Q

Which vessels supply the breast?

A

Internal thoracic, subclavian (both arteries and veins)

79
Q

Describe lymphatic drainage from the breast.

A

Unilateral from axillary nodes, bilateral from parasternal nodes

80
Q

Describe the anatomy of the hilum.

A

Pulmonary veins inferior, bronchi superomedial, pulmonary artery superior, lymph nodes central

81
Q

What is the purpose of the phrenic nerve?

A

Innervates the diaphragm (breathing)

82
Q

Where does the phrenic nerve originate?

A

C3,4,5

83
Q

Where specifically can the apex of the lung be auscultated?

A

Superior to the medial 1/3rd of the clavicle

84
Q

Where can the middle and base of the lung be auscultated?

A

Ribs 4-6, T11

85
Q

What is contained within the carotid sheath?

A

Internal and common carotid arteries, jugular vein, and vagus nerve

86
Q

What is the name of the intertwining of nerves in front of the carina?

A

Pulmonary plexus

87
Q

Describe the two steps which occur to allow deep inspiration.

A

Diaphragm descends maximally. Accessory muscles are recruited.

88
Q

Name the (four) muscles involved in active expiration, and how they move to achieve this.

A

Vocal folds adduct. External oblique, internal oblique, and transverse abdominus contract.

89
Q

Name the main consequence of cough and why this is the case.

A

Rupture of the visceral pleura, buildup of pressure.

90
Q

Where should a chest drain for tension pneumothorax be inserted?

A

5th intercostal space, mid axillary line.

91
Q

What is Fick’s Law of oxygen uptake?

A

VO2 = CO x (CaO2 - CvO2)

92
Q

What is the term for a diagnosis of exclusion regarding dyspnoea?

A

Dysfunctional breathing.

93
Q

Define immunocompromisation, and some causes.

A

Decreased T cell function. Steroids, chemotherapy, immunosupression.

94
Q

During embryonic development, give the name of the structure of the pre-lung bud.

A

Respiratory diverticulum.

95
Q

What is the name of the structure that, in embryology, seperates the trachea and oesophagus?

A

Tracheoesophagel ridge.

96
Q

Name the two main malformations that may occur between the trachea and oesophagus in embryo.

A

Atresia or fistula.

97
Q

Which gene mutation (of which there are x varieties) causes cystic fibrosis?

A

CFTR (x = 5)

98
Q

Describe how the thicker secretions of cystic fibrosis occur.

A

Elevated number of Cl and Na ions

99
Q

Describe the two major hallmarks of primary immunodeficiency.

A

Recurrent infection, SPUR (serious, persistant, unusual, recurrent)

100
Q

To which main cells do primary immunodeficiencies (an umbrella term) occur?

A

Antibodies (SPAD), Neutrophil, T cells, or combined (SCID)

101
Q

Describe the cause and diagnosis of specific antibody IgA immunodeficiency.

A

B cell deficiency, asymptomatic and often diagnosed after a transfusion.

102
Q

Describe the cause and treatment of common variable immune deficiency (CVID).

A

Low IgA, IgE, IgG. Ig Replacement, and stem cell therapy.

103
Q

Describe hypogammaglobulinaemia.

A

Full name - Bruton’s X-linked hypogammaglobulinaemia. Body can’t produce mature B cells. Bacterial infection common.

104
Q

What is hereditary angiodema? What causes it?

A

Swelling of the face due to genetic influences. A complement system defect.

105
Q

Leukocyte adhesion deficiency is a SCID. Describe its cause and consequence.

A

Neutrophils can’t leave the blood. Combined T and B cell defect. Common bacterial infection.

106
Q

Describe Kostmann’s syndrome (a SPID).

A

Neutropenia. Autosomal recessive abnormality. Medication, stem cell transplant, or G-CSF (growth factor) required to treat.

107
Q

Describe the cause and mechanism of chronic granulatomous disease.

A

Phagocytes can’t kill, but instead form granulomas. This is because they lack reactive oxygen/nitrogen species.

108
Q

Describe Chediak-Higashi syndrome (a SPID).

A

Albino. A mutation on the LYST gene which results in lack of lymphocytes.

109
Q

For reticular dysgenesis (a SCID), describe the cause, effects, and treatment.

A

Neutrophils can’t be produced. Infection, fatal sepsis. Bone marrow transplant.

110
Q

Describe the cause of DiGeorge syndrome.

A

Low T cell count as no maturation, lack of/underdeveloped thymus, microdeletion of 22q11

111
Q

Which drugs may cause immunosupression (IMPORTANT)?

A

Azathioprine, methotrexate, cyclophosphamide

112
Q

Describe the four levels of epidemilogical outbreak.

A

Sporadic, endemic, epidemic, pandemic

113
Q

Describe how, in the context of autoimmunity, central / peripheral tolerance may be achieved?

A

Central - T cells destroyed in the thymus itself. Peripheral - T(reg) cells destroy rogue T cells in periphery.

114
Q

Which three factors lead to autoimmunity?

A

Genetic factors, immune regulation, environment

115
Q

Describe the difference between the terms immunisation and vaccination.

A

Immunisation - process within self to gain protection. Vaccination - iatrogenic administration.

116
Q

Which two immune components cause type 1 hypersensitivity? In asthma, which additional cell is activated?

A

IgE (which attaches to) mast cells (causing degranulation). Eosinophils

117
Q

Which three mechanisms does type 1 hypersensitivity activate?

A

Muscle spasm (bronchoconstriction, wheeze), infiltration (of lymphocytes/eosinophils - yellow sputum) and inflammation (odema)

118
Q

Which three main components does type 2 hypersensitivity involve?

A

Cell surface receptors, IgG, IgM

119
Q

Which three main receptors cause type 2 hypersensitivty?

A

Self, foreign, penicillin (blood)

120
Q

Which immune components does type 3 sensitivity involve?

A

Immune complexes (complement and neutrophils), IgG and antigens

121
Q

Which immune components does type 4 sensitivity involve?

A

T cells. Th1, Th2, Tfh, Treg, Th17.

122
Q

Define the four hypersensitivities in terms of A, B, C, D.

A

Allergic, antibodies, anaphylaxis, antiBodies, Complex, Delayed

123
Q

Which type of embolus causes pulmonary embolism?

A

A venous (red) embolus.

124
Q

Which three factors make up Virchow’s Triad?

A

Vessel wall factors, hypercoaguability, abnormal blood flow

125
Q

Which scale is used to determine sleepiness?

A

Epworth Sleepiness Scale

4b. RESPIRATORY (3 decks)

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