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respiratory strand test questions Flashcards

1
Q

what is the role of surfactant

A

surfactant is a phospholipid which decreases the surface tension in alveolar cells

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2
Q

do the lungs act as a reservoir of blood

A

yes

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3
Q

how do lungs stop blood clots entering systemic circulation

A

filter them out

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4
Q

which metabolites play an important role in defence agains inflammation and homestasis

A

synthesis of a arachidonic acid metabolites such as eicosanoids

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5
Q

what is acute bronchitis

A

usually self limiting which is acute inflammation of the trachea and bronchi

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6
Q

what is pleurisy

A

inflammation of the pleura

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7
Q

what is pulmonary fibrosis

A

inflammation of the airways producing lung scarring and cyst formation

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8
Q

what are the energy uses in breathing

A

about half is dissipated during inspiration as heat to overcome resistance to airflow
the rest is stored as potential energy in elastic structures of the lung which drives normal expiration

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9
Q

what do flow volume loops measure

A

velocity of air flowing through the airways in relation to the volume of air moved during inspiration and expiration

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10
Q

how does the rib cage aid inspiration

A

increase diameter of the chest making the negative pressure in the lungs more negative

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11
Q

how do the joints in the ribs aid inspiration

A

joints between posterior ends of the ribs and the transverse vertebrae enable the lower ribs to swivel upwards and outwards
aids 25%
diaphrgam 75%

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12
Q

what specifically are restrictive lung diseases

A

reduced total lung capacity but airflow and airway resistance is normal

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13
Q

what are examples of intrinsic lung diseases

A

restrictive
lung tissue is destroyed which reduces lung volume
air spaces may be filled with inflammatory exudates
chronic inflammation or scarring

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14
Q

what are examples of extrinsic lung disorders

A

affect the muscles of respiration which impair movement

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15
Q

what are some examples of restrictive lung disease

A

pneumothorax
pulmonary embolism
ARDS
pulmonary fibrosis

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16
Q

what do the external intercostals do

A

move ribcage upwards and outwards to increase lateral and anterograde-posterior diameter of the thorax

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17
Q

how do the neck muscles aid in respiration with examples

A

pull rib cage up
sternocleidomastoids elevate the sternum
scalenus major elevate the first two ribs and the sternum

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18
Q

how do abdominal muscles aid respiration

A

the oblique, transverses and rectus abdomens pull the ribcage downwards

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19
Q

which muscles fix the shoulder girdle in respiration

A

pec major
lat dorsi
pull ribcage outwards

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20
Q

what does the position of the diaphragm

A

posture

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21
Q

how does being the upright posture affect the diaphragm

A

sinks and flattens out under gravity therefore movement required to reach expansion is smaller

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22
Q

how does effort of breathing change while in supine position

A

diaphragm is more dome shaped so more effort required on inspiration

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23
Q

describe the nervous supply to the diaphragm and the intercostal muscles

A

phrenic from c3-5 left and right

branches peripherally to the intercostal muscles

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24
Q

how much does the diaphragm move in eupnoea and heavy breathing

A

1.5cm to 7 cm

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25
Q

what would spinal injuries above C3/4 result in

A

apnoea and death

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26
Q

how does vaporisation of liquids contribute to total pressure

A

pressure of water vapour is independent of barometric pressure but dependant on temperature
therefore partial pressure of gas in humidified air must be reduced so that the total will be equal to barometric pressure

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27
Q

when you ventilate how does the intrapulmonary pressure change

A

falls and rise about 3 mmHg below and above atmospheric pressure

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28
Q

why is the intrapleural pressure usually sub atmospheric

A

elastic recoil of the lungs trying to separate the two layers

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29
Q

what happens to intrapleural pressures during deep inspiration

A

pressure drops 40 mmHg below atmospheric

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30
Q

what is used to measure intrapleural pressure

A

manometer

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31
Q

what is atelectasis and what is it caused by

A

failure of the lungs to expand
acutely by foreign bodies
chronically by tumour

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32
Q

what happens to the lungs and alveoli in atelectasis

A

collapse of lung and alveoli

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33
Q

what causes compression in atelectasis

A

pleural effusion or pneumothorax opposing inflation

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34
Q

what is bronchiectasis

A

permanently dilated bronchi with chronic infection

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35
Q

flow related collapse is common in which diseases

A

asthma and emphysema

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36
Q

airway collapse over time can lead to what

A

hyperinflation of the chest as air gets trapped

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37
Q

what is the closing capacity of the lungs

A

The closing capacity (CC) is the volume in the lungs at which its smallest airways, the respiratory bronchioles, collapse

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38
Q

what happens when closing capacity exceed FRC

A

compromise gas exchange

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39
Q

what happens to lung compliance in pulmonary fibrosis

A

reduces as the lungs become less elastic

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40
Q

how is compliance in a new born different and old age

A

low compliance so lungs are not easy to inflate

decreases in old age

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41
Q

which diseases cause decrease in lung compliance

A

emphysema
pulmonary fibrosis
pulmonary congestion

42
Q

what is lung capacity

A

the amount of gas that an be accommodated will depend on the size of the lungs and the thorax related to age, sex and ethnicity

43
Q

what is lung volume

A

the amount of gas that can be moved with respiration and depends on inspiratory and expiratory effort

44
Q

what is a typical breathing rate at rest

A

12 - 15 breaths per minute

45
Q

what is the average tidal volume

A

500 ml

46
Q

who have larger FEV1 and FVC

A

swimmers divers and brass players

47
Q

how could you measure airway obstruction

A

FEV1/FVC or FEV1 expressed as a percentage of FVC

48
Q

at what age does FEV1 usually start to decline

A

30 but it is accelerated in COPD

49
Q

which drugs can be used to decrease the rate of FEV1 normally and in COPD

A

no drug has yet been shown

50
Q

how can you distinguish between COPD and asthma

A

measure FEV1 and PEFR after use of a b adrenreceptor agonist such as salbuatamol
asthma should be reversed

51
Q

what is the max improvement in FEV1 or PEFR after use of salbutamol

A

no greater than 15% or max 200 ml/s

52
Q

what type of flow increases resistance

A

turbulent flow

53
Q

what happens if workload to breathing becomes too much

A

respiratory fatigue

54
Q

what by definition is airway resistance

A

result of frictional forces opposing the flow of air

55
Q

airflow in the centre of tubes in analogous to what

A

blood

56
Q

which equations describes the resistance of laminar flow of air

A

poiseullies law which indicates that resistance increases to the power of 4 as the airways narrow

57
Q

what usually creates the most resistance to airflow in the lung

A

large airways, trachea and bronchi larger than 2 mm diameter
this is due to having a much smaller cross sectional area

58
Q

what can increase resistance to airflow outside of the conducting airways

A

tumour
mediastinal masses
hilar lymph nodes

59
Q

during anaesthetics what happens which can cause increased resistance to airflow

A

tongue falls back and causes block

60
Q

what objects outside the body can cause airway resistance

A

aspirated objects such as peanuts or pretzels

61
Q

inflammation in asthma can lead to what

A

oedema and mucus plugging

62
Q

during asthma what cells enter the airways and cause damage

A

eosinophils and lymphocytes

63
Q

which three things must you consider when determining treatment for lung obstruction

A

bronchospasm
inflammation
secretion

64
Q

what are mast cells activated during allergy

A

attachment of Fc portion of immunoglobulin IgE and other complement factors

65
Q

what happens when mast cells become activated by IgE

A

rise in intracellular Ca and release of chemical mediators - mainly histamine which is stored inside granules

66
Q

activation of mast cells leads to the synthesis of what

A

arachidonic acid derivatives such as leukotriene C4 that cause a slow but sustained contraction of bronchial smooth muscle

67
Q

during inspiration there is a small change in pressure until pressure reaches what amount

A

at 5-6 mmHg inflation becomes much faster and volume is changed rapidly

68
Q

what shape of inflation is there during inspiration and until what mmHg

A

non linear expansion until past 5-6 mmHg then reaches max around 15 mmHg

69
Q

what happens to the graph of expiration during deflation

A

the curve is displaced to the left so that the pressure at any volume is less on expiration than inspiration

70
Q

what is hysteresis

A

the presence of surfactant allows easier expiration and lower pressure than that of inspiration
Lung hysteresis is evident when observing the compliance of a lung on inspiration versus expiration. … Lung volume at any given pressure during inhalation is less than the lung volume at any given pressure during exhalation.
check diagram on homepage

71
Q

what do the elastic properties of the lungs mean for intrapleural pressure

A

tend to pull them away from the elastic wall giving rise to negative intrapleural pressure

72
Q

what happens to intrapleural pressure when you inhale

A

intrapleural pressure becomes from negative

73
Q

rate of simple diffusion is dependant on what

pulmonary diffusing capacity

A

thickness of the membrane (0.5 - 0.2) microns

gas concentration gradient in solution

74
Q

what is the law of diffusion across the membrane

A

Ficks law

75
Q

what test is more usually a test of pulmonary diffusing capacity

A

the single breath CO diffusion test

76
Q

what is the average oxygen diffusing capacity

A

15 - 35

around 20 ml/min/mmHg

77
Q

what affects the oxygen diffusing capacity

A

exercise increases it due to dilation of capillaries and opening of closed capillaries in the apex of the lung
it is decreased due to thickening of the membrane such as in scleroderma, pulmonary fibrosis, asbestosis
also decreased due to reduction of area such as in emphysema

78
Q

what does the concept of partial pressures apply to

A

both gases and liquids

79
Q

when does a gas enter a liquid

A

gas molecules enter a liquid until the partial pressure in the liquid matches that of the surrounding air - even between air and liquid

80
Q

the rate at which a gas equilibrates in a liquid depends on what

A

the gas solubility and on chemical binding in the liquid

81
Q

what happens if there is CO2 retention in the alveoli

A

less O2 enters the blood

82
Q

which lung volume cannot be measured by spirometry

A

residual volume or any volumes left in the lung after a full exhale

83
Q

during expiration which pressure is greatest

A

expiration the PA (pressure in the alveoli) is greater than PB (pressure in the atmosphere)

84
Q

how is turbulence created and what is the difference in sound to laminar flow

A

laminar flow is silent
turbulent flow is noisy
turbulence results from high air flow and common near the edges of airways

85
Q

beyond which zone in the lung is there no cartilage and therefore rely on elastic recoil to prevent collapse

A

generation 11

86
Q

which diseases are common to have flow related collapse

A

emphysema and asthma

87
Q

what happens to FEV1 in obstructive disease

A

decreased

88
Q

what happens during alveolar fibrosis

A

there is increased thickness of the alveoli membrane

89
Q

what is alveolar consolidation

A

result of replacement of air with transudate, pus, blood or other cells

90
Q

what are adenoids

A

small bumps as the back of the nasal passage above the mouth - glands that produce antibodies or white blood cells

91
Q

which cells are present under cilia in the trachea lining

A

columnar epithelium

with pericillary layer and mucus layer on top

92
Q

what is the difference between adult and foetal Hb

A

adult = 2 alpha and 2 beta

foetal has 2 alpha and 2 gamma

93
Q

describe the 4 structures of Hb levels

A

primary - 141 ish amino acids per chain
secondary - globular structure
tertiary crevice for haemolytic and O2 binding
quaternary 4 chains

94
Q 
describe how these factors affect the O2 dissociation curve
increase temp 
increase 2-3DPG 
increase CO2
increased pH 
increase CO
A 
moves to right 
moves to right 
moves to right 
moves to left 
down
95
Q

during gases exchange what is the kPa range of PaO2 and PaCO2 in oxygenated red blood cells

A

PaO2 - 10-13 kPa

PaCO2 - 4.5 - 6 kPa

96
Q

what is the difference in alveolar pressure, PA, pulmonary arterial pressure Pa and Pulmonary venous pressure Pv in each of the zones of the lungs

A

zone 1: blood flow collapses PA > Pa > Pv
zone 2: Pa increases with respect to PA - vascular waterfall
Pa > PA > Pv
zone 3: blood flow depends on Pa and Pv
Pa > Pv > PA

97
Q

what are the two factors that effect ventilation perfusion mismatch

A

dead space near apex where there is not blood flow due to collapse and no gas exchange but high ventilation
shunt vessels - hypoxia - no ventilation but good perfusion of blood

98
Q

what is the difference in peripheral vs central chemoreception

A

peripheral - O2 decrease, CO2 increase, H+ increase

central - increase in CO2 and increase in H+

99
Q

what are the steps of the oxygen cascade

A 
dry air 
humidified air 
alveolar gas 
pulmonary capillary 
arterial blood 
mean capillary bed 
cytoplasm 
mitochondria
100
Q

what are the responses of high altitude

A

hyperventilation
cerebral oedema
pulmonary oedema
alkalosis

101
Q 
what do these drugs molecules have on bronchi 
muscarinic antagonists 
ACh
cAMP
Adrenaline
Adenosine
Theophylline
A

Theophylline – reduces bronchoconstriction by stopping PDE converting cAMP to AMP as cAMP causes bronchodilation
Muscarinic antagonists – reduce bronchoconstriction
Beta agonists – increases cAMP causing bronchodilation
ACH – increases bronchoconstriction
Adenosine – increases bronchoconstriction
Adrenaline – increases bronchodilation

102
Q

what are treatments for allergy induced asthma

A 
mast cell stabilisation 
glucocorticoids 
desensitisation to allergens 
leukotriene antagonists 
B2 agonists

Body Systems (77 decks)

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