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PHAR 123 Extra* > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What tissues are included in the upper respiratory tract

A

Nose and nasal cavity
Paranasal sinuses
Pharynx
Larynx

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2
Q

What tissues are included in the lower respiratory tract?

A

Trachea
Bronchi and bronchioles
Lungs and alveoli

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3
Q

What is the purpose of the nose and nasal cavity?

A

Provides airway for respiration
Moistens and warms air
Filters inhaled air
Contains olfactory receptors
Involved in speech

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4
Q

What is the purpose of the paranasal sinuses?

A

They are are air containing cavities in the skull

Possible functions:
Decrease weight of skull
Increase voice resonance
Buffer against facial trauma
Humidifies and heats air
Immunological defence

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5
Q

What are the subdivisions of the pharynx?

A

Nasopharynx
Oropharynx
Laryngopharynx

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6
Q

What is the purpose of the nasopharynx?

A

It is simply a air passageway
Closes while swallowing
Contains nasopharyngeal and tonsils

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7
Q

What is the purpose of the oropharynx?

A

Food and air passageway
Epiglottis closes during inspiration to prevent aspiration
Contains palatine and lingual tonsils

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8
Q

What is the purpose of the laryngopharynx?

A

Connects throat to the esophagus
Extends to branching of respiratory (laryngeal) and digestive (esophageal) pathways

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9
Q

What is the purpose of the larynx?

A

Its main function is protective;
Aids in coughing and other reflexes
Prevents food and fluid from entering the lungs

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10
Q

What is the purpose of bronchi and bronchioles?

A

Contain mucus and cilia to remove contaminants

Can constrict or dilate to modify airflow

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11
Q

Describe the anatomy of the lungs

A

The right lung contains three lobes; left has two (one missing due to accommodating heart)

Oblique and horizontal fissures separate lobes

The lungs are covered by visceral pleura

The lungs move in and out of the pleural cavity during inspiration and expiration respectively

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12
Q

Describe the anatomy of the alveoli

A

Millions present on respiratory bronchioles

Each alveoli consists of:
Type I cells (squamous epithelium)
Type II cells (cuboidal epithelium, contain lamellar bodies which release surfactant)
Alveolar macrophages (engulf dust and bacteria and remove them from the alveoli)

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13
Q

How does gas exchange work at the alveoli

A

Gas exchange occurs between alveoli and the capillaries that surround them

CO2 is diffused out of the blood into the alveoli for exhalation
O2 is diffused out of the alveoli and into the blood

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14
Q

What is the difference between compliance and elasticity in the lungs?

A

Compliance: governs inspiration and how easily lungs can stretch

Elasticity: governs expiration and how easily lungs can recoil following stretching

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15
Q

What is the consequence of poor compliance?

A

Issues with getting air into the lungs (restrictive disease)
ex. pneumonia and pulmonary fibrosis

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16
Q

What is the consequence of poor elasticity?

A

Issues with getting air out of the lungs
ex. COPD and asthma

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17
Q

Describe blood flow in the lungs

A

Pulmonary vessels:
Responsible for gas exchange
Deoxygenated blood comes from the pulmonary artery and breaks into capillaries. Blood in capillaries does gas exchange and becomes oxygenated. Oxygenated blood enters the pulmonary vein towards the heart

Bronchial vessels:
Oxygenates the lung tissue itself (comes from systemic circulation)

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18
Q

What is the conducting system?

A

The conducting system includes all sites involved in conducting air into the lungs

Nose, nasal cavity, pharynx, larynx, trachea, bronchi, bronchiole, and terminal bronchioles

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19
Q

What is the respiratory zone (lung parenchyma)?

A

It consists of tissues that are involved in gas exchange.

Respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli

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20
Q

What are the three components of respiration?

A

Respiration is the exchange of gases between the atmosphere, blood, and cells. It can be broken into the following components:

Pulmonary ventilation (inspiration and expiration)
External respiration (lung and pulmonary action)
Internal respiration (tissues doing gas exchange)

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21
Q

How does inspiration occur?

A

Quiet inspiration (passive process):
Air is pulled into the lungs when atmospheric pressure is greater than alveolar pressure. Pressure in the alveoli is controlled by the contraction or relaxation of the diaphragm. External intercostal muscles also aid in expanding or contracting thorax.

Forced inhalation:
Forced inhalation additionally involves accessory muscles of inspiration and it is used in times of extra need.

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22
Q

How does expiration occur?

A

Quiet expiration (passive process):
Air is pushed out of the lungs when alveolar pressure exceeds atmospheric pressure. The diaphragm relaxes and raises upwards

Forced expiration:
It uses obliques and intercostals to contract inwards to help force air out. It is activated when air movement out of the lungs is impeded

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23
Q

What is the normal partial pressure of O2 in the alveoli?

A

Normal partial pressure oxygen (paO2) gradient:
Alveolar space =100 mmHg O2 (O2 is higher pressure, so it will move into deoxygenated blood)
Deoxygenated blood = 40 mmHg O2

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24
Q

What is the normal partial pressure of O2 during gas exchange?

A

Normal partial pressure oxygen (paO2) gradient:
Alveolar space =100 mmHg O2 (O2 is higher pressure, so it will move into deoxygenated blood)
Deoxygenated blood = 40 mmHg O2

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25
Q

What is the normal partial pressure of CO2 during gas exchange?

A

Normal partial pressure carbon dioxide (paCO2) gradient:
Alveolar space = 40mmHg
Deoxygenated blood = 45 mmHg (higher CO2 pressure=movement into the alveoli)

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26
Q

What are ventilation and perfusion matching?

A

The exchange of gas and blood supply must be balanced for proper external respiration. Must be enough air in the alveoli, blood flow in the capillaries, and hemoglobin to carry the oxygen

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27
Q

What is the consequence of ventilation-perfusion mismatch?

A

This mismatch is often caused by obstruction of airways and/or capillaries. These situations lead to hypoxemia.

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28
Q

What is the difference between internal and external respiration?

A

Internal respiration: exchange of gasses between blood and cells

External respiration: exchange of gasses between blood and alveoli

29
Q

What is some terminology used to describe breathing patterns?

A

Eupnea (normal breathing)

Apnea (breathing that stops)

Dyspnea (shortness of breath)

Tachypnea (rapid breathing)

Costal breathing (associated with hyperventilation and the use of accessory muscles)

Diaphragmatic breathing (diaphragm and abdominal muscles)

30
Q

What is type 1 respiratory failure?

A

It is the inability of the lungs to perform adequate gas exchange.

Potential causes:
Lung disorder (asthma, COPD)
Pneumonia
Pulmonary - edema, fibrosis, embolism, hypertension

Type 1 respiratory failure causes hypoxemia (blood O2 concentration falls below 90%). CO2 levels remain normal or low. It is associated of breath confusion, tachypnea

31
Q

What is type 2 respiratory failure (ventilatory failure)?

A

It occurs when breathing is not sufficient to rid the body of CO2.

Potential causes:
Decreased CNS drive
Impaired neuromuscular function
Chronic bronchitis or COPD
Excessive inspiratory load

Type 2 respiratory failure causes hypercapnia (high CO2). It may eventually develop to hypoxemia, CNS depression, and respiratory acidosis

32
Q

What indicator can be used to determine acid-base balance?

A

Levels of arterial blood gases can help us determine acid-base balance, which helps determine the causes of respiratory issues.

Blood pH is controlled by the action of the lungs and kidneys.

33
Q

What is normal blood pH?

A

7.4 (7.35-7.45)

pH<7.35 (acidosis)
pH>7.45 (alkalosis)

34
Q

What is the normal partial pressure of oxygen?

A

80-100 mmHg

35
Q

What is the normal O2 blood concentration?

A

> 95%

36
Q

What is the normal partial pressure of carbon dioxide?

A

35-45 mmHg

37
Q

What is the normal concentration of HCO3?

A

22-26 mmol/L

38
Q

What is spirometry?

A

A spirometer objectively assesses an individual’s pulmonary performance. It measures how much air you can move in and out of lungs (requires a trained lab tech)

39
Q

What is peak-flow meter?

A

It is utilized in people with asthma and it can be used by an individual to compare current results to personal best (home monitoring)

40
Q

What is inspiratory reserve volume (IRV)?

A

The volume of air inhaled during a deep breath

41
Q

What is Tidal Volume (TV)?

A

It is the volume of air that is inhaled and exhaled during normal breathing

42
Q

What is expiratory reserve volume (ERV)?

A

The max volume of air exhaled during a deep exhale

43
Q

What is residual volume (RV)?

A

This is the volume of air that remains in the lungs after forceful exhalation

44
Q

What is the functional residual capacity (FRC)?

A

It is the volume of air in the lungs following normal exhalation

45
Q

What is vital capacity (VC)?

A

It is the volume of air inhaled following deep exhale

46
Q

What is total lung capacity (TLC)?

A

This is the volume of air in the lungs

47
Q

What is FEV1?

A

Forced expiratory volume in 1 second

48
Q

What is FVC?

A

Forced vital capacity

49
Q

What is the significance of the FEV1/FVC ration?

A

Helps differentiate between restrictive and obstructive lung disease

Obstructive disease (air has hard time leaving ex. asthma) = low FEV1/FVC, normal FVC

Restrictive disease (air has hard time entering lungs) = normal FEV1/FVC, low FVC

50
Q

How to determine whether an obstruction is present in the lungs?

A

Spirometry to determine the reversibility of airway obstruction by conducting a control test and one where a bronchodilator is given to the patient

If forced expiration volume in one second (FEV1) increases, obstruction is present (bronchodilator opens up obstruction)

This is how asthma can be diagnosed

51
Q

What is the effect of fitness on the respiratory system?

A

Proper respiration requires a strong cardiovascular system.

As fitness improves:
Lungs can accommodate higher volumes of air
Increased diffusion of respiratory gases
Strengthens other muscles of inspiration/expiration
VO2 max increases

52
Q

What is the effect of smoking on the respiratory system?

A

Nicotine causes bronchoconstriction
Lung fibrosis
Excess mucous secretion (obstruction)
Inhibited cilia
Destruction of elastic fibers

53
Q

What is the effect of age on lung function?

A

Respiratory tissues and chest wall becomes more rigid
Weak respiratory muscles
Vital capacity gradually decreases
Macrophages activity decreases
Cilia less active

These factors are why older adults are more susceptible to more lethal outcomes following infections like pneumonia and bronchitis

54
Q

What is asthma?

A

Airways are hyper-responsive to a variety of stimuli. The response to stimuli results in bronchial inflammation which results in airway obstruction

Asthma is a chronic inflammatory disorder characterized by:
Dyspnea
Wheezing
Cough

Paroxysmal (rapid onset of symptoms) or persistent symptoms (asthma looks different in each patient)

55
Q

Is asthma a common condition in children?

A

Yes, it is the #1 chronic condition in Canada among children. It is also the leading cause of ER hospitalizations of children

Most people are diagnosed by age 5

56
Q

Are some people genetically disposed to having a higher incidence of asthma?

A

Many genes are involved in factors that can influence the onset of asthma:
Development of asthma –> pre-disposed to atopy (genetic tendency to develop an allergic disease)

The severity of the condition –> Airway hyper-responsive

Response to therapy can also be different concerning genetic differences (ex. number of beta receptors)

57
Q

Which environmental conditions in early childhood are associated with lower rates of developing asthma?

A

Are exposed to high levels of bacteria or endotoxin
Have older siblings
Early enrolment into childcare
Exposure to cats and dogs
Exposure to fewer antibiotics

58
Q

What is the hygiene hypothesis?

A

Limited exposure to normal environmental stimuli may cause the immunologic system to develop reactions against relative benign substances.

59
Q

Are there sex-based differences in asthma?

A

Childhood asthma has a greater prevalence in males

In adults, females experience asthma more than men

60
Q

Can maternal health affect the likelihood of the child developing asthma?

A

Increasing maternal –> lower risk of asthma

If the mother does not control her asthma during pregnancy, the baby is more likely to develop it.

Prenatal exposure to maternal smoking

Certain medication use (acetaminophen, antibiotics, and acid-suppressors)

61
Q

What factors in childhood affect the likelihood of developing asthma?

A

Viral infections predictive of asthma later in life:
Respiratory syncytial virus (RSV)
Human rhinovirus (HRV)

Medication use in infancy (not 100% proven):
Acetaminophen
Ibuprofen
Antibiotics

62
Q

What factors in adulthood affect the likelihood of developing asthma?

A

Obesity
Tobacco smoke (first and second-hand)
Occupational exposures
Rhinitis

63
Q

What are some common asthma triggers?

A

Irritants
Respiratory tract infections
Weather
Stress
Hormonal fluctuations
Medications (ASA/NSAIDs, beta-blockers)

64
Q

What is the specific pathology of asthma?

A

Begins with sensitization to an allergen:
Allergen exposure–>production of IgE antibodies (regulated by Th2 cells). Th2 cells are over-expressed in sensitized individuals

IgE antibodies bind to mast cells:
Subsequent exposure to allergen–>binds to IgE antibody on mast cell–>release of mediators

Various mediators released:
Histamine (increase permeability of tissues)
Leukotrienes (regulate immune system and contraction and dilation of bronchioles)
Cytokines (inflammatory mediator)
TNF-a (responsible for cell signalling)

65
Q

What are the two types of bronchoconstriction?

A

Allergen induced bronchoconstriction:
(mast cell mediators bind to smooth muscle causing bronchoconstriction)

Non-allergen induced:
Irritants
Exercise
Cold air
NSAIDs or ASA
Stress

66
Q

What is the early phase reaction in bronchial inflammation?

A

Occurs within several minutes of inhalation of allergen

Mast cells release mediators –> histamine and leukotrienes acts quickly

Leads to bronchospasms

67
Q

What is the late-phase reaction in bronchial inflammation?

A

Occurs within hours

Cytokines and TNF-a recruit inflammatory cells

Inflammation builds due to continued bronchospasm and constriction (continued inflammation leads to airway remodelling which is irreversible)

68
Q

What is the late-phase reaction in bronchial inflammation?

A

Occurs within hours

Inflammation builds due to continued bronchospasm and constriction.

Continued inflammation eventually leads to airway remodelling, a process that is irreversible

69
Q

What does airway remodelling look like?

A

Pathologic changes:
Vascular dilation (increased permeability)
Edema (smaller airways)
Epithelial damage
Inflammatory cell infiltration
Smooth muscle and mucous gland hypertrophy

PHAR 123 Extra* (3 decks)

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