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respiratory_week_1_20190518190149 Flashcards

1
Q

what are the 4 steps of external respiration

A

ventilation (gas exchange between atmosphere n alveoli)exchange between air in alveoli and blood coming into lungstransport in blood between tissues and lungsexchange between blood and tissues

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2
Q

boyle’s law

A

at any temperature the pressure exerted by gas varies inversely with volume of gas

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3
Q

what is the forces that link lungs to thorax

A

intra pleural fluid cohesivenessnegative intrapleural pressure - creates gradient

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4
Q

values of different pressures

A

atmospheric - 760mmHg/101pKaintra alveolar - 760mmHg/101pKa (less for air to flow)intrapleural - 756mmHg

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5
Q

what muscles are used in active process of inspiration and forceful inspiration

A

external intercostals lift ribs and move sternum accessory: sternocleidomastoid, scalenus and pectoral

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6
Q

why is the phrenic nerve important in inspiration and expiration and where is it located

A

passes motor information to diaphragm and receives sensory information from it cervical 3, 4 and 5

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7
Q

what causes the lungs to recoil in the passive process of expiration

A

elastic connective tissue and alveolar surface tension (attraction between water molecules produce force which resists lung stretching)

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8
Q

what are the muscles of active expiration (hyperventilation)

A

abdominal muscles and internal intercostals

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9
Q

what are signs of pneumothorax

A

shortness of breath, chest pain, hyper resonant percussion note and decreased/absent breath sounds

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10
Q

which forces keep alveoli open

A

transmural pressure gradient pulmonary surfactant (secreted by type II alveoli and lowers surface tension to prevent smaller alveoli collapsing)alveolar independence

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11
Q

What are the lung volumes and capacities?

A

SEE PICTURE ON DOCUMENT

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12
Q

what is the FEV1/FVC ratio

A

proportion of forced vital capacity that can be expired in first second normal is >70%

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13
Q

what is equation of airway resistance

A

F = ΔP/R

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14
Q

what does airway obstruction do to airway pressure

A

causes fall in airway pressure along airway downstream resulting in airway compression and rising pleural pressure

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15
Q

what causes decreased pulmonary compliance (greater change in pressure needed for change in volume - stiffer)

A

pulmonary fibrosis, pulmonary oedema, lung collapse, pneumonia, absence of surfactant

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16
Q

what causes increased pulmonary compliance

A

if elastic recoil of lungs is lost and age

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17
Q

what increases the work of breathing

A

decreased pulmonary compliance, increased airway resistance, decreased elastic recoil

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18
Q

what is anatomical dead space

A

inspired air which remains in airways where it is not available for gas exchange - makes it more advantageous to increase depth of breathing rather than rate

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19
Q

what is alveolar dead space

A

ventilated alveoli which are not adequately perfused with blood

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20
Q

what is physiological dead space

A

alveolar dead space + anatomical dead space

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21
Q

what is the effect of decreasing O2 on pulmonary and systemic arterioles

A

vasoconstriction of pulmonaryvasodilation of systemic

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22
Q

what is the partial pressure gradient and what is the equation

A

pressure exerted by one gas if it occupies full volumePaO2 = PiO2 (PaCO2/0.8)when calculating PiO2, water vapour must be accounted for

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23
Q

what does a big gradient between alveolar PO2 and arterial PO2 suggest

A

problem of gas exchange in lungs or a right to left shunt in heart

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24
Q

what is ficks law of diffusion

A

the amount of gas that moves across sheet of tissue is proportional to area of sheet but inversely proportional to thickness

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25
what is henrys law
the amount of gas dissolved in a given type and volume of liquid (blood) at a constant temperature is proportional to partial pressure of the gas in equilibrium with liquid
26
what is the equation for the oxygen delivery index
DO2l = CaO2 x Cloxygen content of arterial blood x cardiac index
27
what is equation for oxygen content of arterial blood
1.34 x haemoglobin conc x %Hb saturated with O2
28
what does the steep part of lower sigmoid curve signify
peripheral tissues will get a lot of oxygen for a small drop in capillary PO2
29
what is the Bohr effect do to the sigmoid curve
shift to right due to increased release of O2 caused by: increase PCO2, increase H+, increase temp, increase 2,3-BPG
30
what is special about HbF
2 alpha and 2 gamma structure so interacts less with 2,3BPG so higher affinity for O2
31
how much CO2 transported in solution and how is this done
10% - done by Henrys Law
32
how much CO2 transported as carbonate and how is this done
60% - formed in blood by CO2 + H2O ⇌ H2CO2 ⇌ H+ + HCO3- enzyme is carbonic anhydrase which occurs in RBC
33
how much CO2 transported as carbamino compounds and how is this done
30% - formed by combination of CO2 with terminal amine groups in blood proteins (e.g. globulin of haemoglobin to give carbamino-haemoglobin) reduced Hb can bind more CO2 than HbO2
34
what is the Haldane effect
removal of O2 from Hb increases ability to pick up CO2 and H+ O2 shifts CO2 dissociation curve (upwards diagnonal straight line) to right
35
parasympathetic stimulation of post-ganglionic cholinergic fibres
bronchial contraction mediated by M3 ACh receptors on ASM cells which increases mucus secretion by M3 on gland/globlet cells
36
parasympathetic stimulation of non-cholinergic fibres
vascular relaxation mediated by nitric oxide and VIP
37
sympathetic stimulation response
bronchial smooth muscle relaxation via B2-adrenoceptors on ASM activated by adrenaline &vascular contraction mediated by a1-adrenoceptors on vascular smooth muscle cells
38
what is the mechanism of contraction of smooth muscle
phosphorylation of regulatory myosin light chain (MLC) in presence of intracellular Ca2+ and ATP
39
what is the mechanism of relaxation of smooth muscle
dephosphorylation of MLC by myosin phosphatase which has constitutive activity
40
how does extracellular signals, such as adrenaline, regulate MLC and myosin phosphatase
adrenaline stimulations phosphorylation and inhibition of MLC as well as phosphorylation and stimulation of myosin phosphatase - relaxation of bronchial smooth muscle
41
what are the steps of the development of chronic asthma
1) increased mass of smooth muscle2) accumulation of interstitial fluid 3) increased secretion of mucus4) epithelial damage - exposes sensory nerve endings5) sub epithelial fibrosis
42
what is thought to be the cause of asthma
immune imbalance between TH1 and TH2 lymphocytes - detailed steps on document
43
what are the three different kinds of short acting agonists (SABA)
salbutamol, albuterol and terbutaline
44
when are SABAs used
first line treatment for mind, intermittent asthma - relievers
45
what is the mechanism of SABAs
stimulate B2 adrenoceptors to increase mucus clearance and decrease mediator release from mast cellsside effects - tachycardia, cardiac dysrhythmia and hypokalaemia
46
what are the three different kinds of long acting agonists (LABA)
salmeterol (slow to act), formoterol and isoprenaline
47
when are LABAs used
in addition to glucocorticoidsused for persistent asthma patients or patients with chronic obstructive pulmonary diseasework up to 12 hours
48
what are the mechanism of LABA
same as SABA just longer acting
49
what are the two different kinds of CysLT1 bronchodilators
montelukast, zarfirlukast
50
when are CysLT1 bronchodilators used
in combination with others e.g. corticosteroidseffective against antigen induced (allergies) and exercised induced bronchospasm (2nd line treatment)
51
what is the mechanism of CysLT1 bronchodilators
antagonists - act competitively with CysLT1 receptor since CysLTs (LTC4, LTD4 and LTE4) cause smooth muscle contraction, mucus secretion and oedema
52
what are the five different kinds of muscarinic antagonists (anticholinergics)
ipratropium (short acting and non selective)tiotropium, glycopyronium, umeclidinium and aclidinium (long active and selective)
53
when are muscarinic antagonists used
high therapeutic ratio so used in COPD on own or LAMA/LABA dual (LAMA prevents contraction)
54
what is the mechanism of muscarinic antagonists
block post junctional M3 receptors in response to AChblock of M3 desirable but not M1/M2 because release of ACh can actually be increased by auto receptor antagonism
55
what are the two different types of bronchodilators / anti-inflammatory Xanthines
theophylline (oral maintenance) and aminophylline (IV acute attacks) found in coffee
56
when are Xanthines used
used to treat asthma and COPD - in combination with b2-adrenoceptor agonists and glucocorticoids
57
what is the mechanism of Xanthines
non selective phosphodiesterase inhibitor which increases cAMP (second messengers that relax smooth muscle and exert anti-inflammatory effect)adverse effects involving CNS, CVS, GI and kidneys due to interactions involving CYP450s
58
what are the four different kinds of glucocorticoids
beclometasone (chronic asthma), budesonide, fluticasone and prednisolone (severe or rapid deteriorating asthma)
59
when are glucocorticoids used
2nd line additives,regulates inflammatory and immunological responseineffective in relieving bronchospasm but do treat/prevent asthmaused as ICS/LABA combo in COPD - benefit to patients who develop severe exacerbationssometimes unresponsive in COPD due to chronic tobacco smoke
60
what is the mechanism of glucocorticoids
decrease formation of TH2 and causes apoptosis, prevent production of IgE, reduce number of cells and decrease Fcs expression, prevent allergen-induced influx into lung also recruit HDACs to switch off transcription of genes encoding inflammatory proteins
61
what is the one type of cromones
sodium cromogilcate
62
when is cromones used
second line drugs used prophylactically (to prevent) in treatment of allergic asthma in children reduces both phases of asthma attack but late phase requires frequent dosing inhaled steroid
63
what is the mechanism of cromones
mast cell stabiliser and includes weak anti-inflammatory effect
64
what is the two types of monoclonal antibody treatment
omalizumab and mepolizumab
65
when is monoclonal antibody treatment used
for patients with severe, persistent allergic asthma requires IV administration
66
what is the mechanism of monoclonal antibody treatment
omalizumab - directed against IgE - inhibits binding to IgE which inhibits TH2 response and associated mediator releaseMepolizumab - directed against IL-5 - blocks TH2 and used for severe refractors eosinophilia asthma (>4%)
67
what is the one type of PDE4 inhibitor
rofumilast
68
when is PDE4 inhibitor used
suppresses inflammation and emphysema in COPD oral treatment for severe COPD accompanied by chronic bronchitis
69
what is the mechanism of PDE4 inhibitor
PDE4 is prominent PDE expressed in neutrophils, T cells and macrophages to inhibition has inhibitory effects on inflammatory and immune cells
70
what is the components of triple inhalers that have recently been approved for moderate/severe COPD (not asthma or bronchospasm)
fluticasone, umeclidinum and vilanterol
71
how much oxygen given in acute asthma
at least 60% O2intubated ventilation if falling PaO2 continues
72
minimal symptoms and few exacerbations
SAMA/SABA
73
more symptoms and few exacerbations
LABA/LAMA
74
all range of symptoms with frequent exacerbations
ICS/LABA/LAMA (increased eosinophilia)or LABA/LAMA
75
acute COPD exacerbation treatment
nebuliser high dose salbutamol and ipratropium or oral prednisolone24-28% O2 titrated against PaO2/PaCO2
76
when is the only time COPD patient intubated
if reversible e.g. pneumonia
77
what happens at C6 vertebrate
larynx becomes trachea (palpated at jugular notch) and pharynx becomes oesophagus
78
the isthmus of the thyroid gland is anterior to what?
tracheal cartilages 2-4
79
what arteries supplies chest wall
bilateral posterior intercostal arteries
80
where is phrenic nerve found
in neck on anterior surface of scalenus anterior muscle and in thorax descending over lateral aspects of heart
81
what is lung lobe
area of lung that each of lobar bronchi supply with air (right has 3 - upper, middle, lower)
82
what is bronchopulmonary segment
area of lung lobe that each one of segmental bronchi supply with air (each lung has 10)
83
which muscles are between ribs and intercostal spaces
external intercostals internal intercostals innermost intercostals
84
what is the nerve supply of intercostal spaces
anterior rams of spinal nerve
85
what is the posterior blood supply of intercostal spaces
thoracic aorta and azygous vein
86
what is anterior blood supply of intercostal spaces
internal thoracic artery and internal thoracic vein
87
why is the right dome of diaphragm usually more superior
presence of liver
88
what does the muscular part of diaphragm attach to
sternum, lower 6 ribs & costal cartilage and L1-L3 inferiorly
89
what is the costodiaphragmatic recess and where is it located
most dependent part of the pleural cavity (inferior when upright) located between diaphragmatic parietal pleura and costal parietal pleura
90
what is the most inferior region laterally of pleural cavity
costophrenic angle
91
what causes blunting of angles and fluid level seen on CXR
abdominal fluid in pleural cavity draining into recess
92
where is lung apex auscultated
superior to medial 1/3rd of clavicle
93
where is middle lobe auscultated
between ribs 4 and 6 in mid-clavicular and mix auxiliary lines
94
where is lung base found
T11
95
where is sternal angle located
rib 2
96
where is horizontal fissure located
rib 4
97
where is oblique fissure located
rib 6 anteriorly rising to T3 vertebral level posteriorly

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