Sensory aspect

Question 1

Describe C fibre receptors and where they are found

Answer 1

“free” nerve endings
Larynx, trachea, bronchi, lungs
Small unmyelinated fibres (C)
Chemical irritant stimuli, inflammatory mediators
Release neuropeptide inflammatory mediators Substance P, Neurokinin A, Calcitonin Gene Related peptide

Question 2

Describe rapidly adapting stretch receptors and where they are found

Answer 2

Naso-pharynx, larynx, trachea, bronchi
Small, myelinated nerve fibres (A)
Mechanical, chemical irritant stimuli, inflammatory mediators

Question 3

Describe slowly adapting stretch receptors and where they are found

Answer 3

Slowly adapting stretch receptors
Located in airways smooth muscle
Myelinated nerve fibres
Predominantly in trachea and main bronchi
Mechanoreceptors
Respond to lung inflation

Question 4

cough sound waveforms

describe the 2 phases

Answer 4

2 phases with an initial explosive phase that is the first cough sound, followed by an intermediate phase with decreasing sound.

an additional third phase called voiced or glottal phase which gives rise to a second cough sound.

Question 5

Gastro-oesophageal reflux and cough mechanisms

Answer 5

-oesophageal bronchial reflex
direct action of protons on cough receptors
activation of brain stem cough centre

Question 6

what is plasticity of neural mechanisms?

Answer 6

Excitability of afferent nerves increased by chemical mediators eg prostaglandin E2
Increase in receptor numbers eg TRPV-1 (transient receptor potential vanniloid-1 or capsaicin receptor), voltage-gated channels
Neurotransmitter increase eg neurokinins
in brain stem

Question 7

general mechanism of cough

Answer 7

see slides

Question 8

current antitussives

Answer 8

Symptomatic suppressant therapies
Central action:
Opiates: Codeine, dihydrocodeine, pholcodeine,
Dextromethorphan, (Morphine, diamorphine)
Peripheral action:
Moguistine, levodopropizine,

Disease-specific therapies
Eosinophil-associated: Inhaled corticosteroids
Gastro-oesophageal reflux disease: Proton pump inhibitors, Histamine H2 antagonists
Post-nasal drip (rhinosinusitis): Topical steroids, antihistamines
Bronchiectasis: Postural drainage, Antibiotics

Question 9

sensory input from lungs, airway and chest wall

Answer 9

nose = trigeminal (V) 
pharynx =(glossopharyngeal IX and vagus X)
larynx = vagus X
Lungs = vagus X
Chest wall = spinal nerves

Question 10

Touch pathway

Answer 10

Spinal pathways:
Touch: uses the dorsal columns; fibres enter dorsal horn, passing up dorsal columns for switching at the medulla, passing through to the thalamus and then to the 1o somatosensory

Question 11

Pain pathway

Answer 11

Pain: uses the spino-thalamic tract; a-delta and C fibres enter via dorsal horn, immediately crossing over at level of entry before passing up tract to thalamus and then to 1o somatosensory cortex

Question 12

chest pain from respiratory system

Answer 12

Pleuropulmonary disorders:
Pleural inflammation eg infection, pulmonary embolism,
Pneumothorax, malignancy eg mesothelioma

Tracheobronchitis:
Infections, inhalation of irritants

Inflammation or trauma to chest wall:
Rib fracture, Muscle injury, Malignancy, Herpes zoster (intercostal
Nerve pain)

Referred pain: shoulder-tip pain of diaphragmatic irritation

Question 13

what is dyspnea

Answer 13

Troublesome shortness of breath reported by a patient
Occurs at inappropriately low levels of exertion, and limits exercise tolerance
Unpleasant and frightening experience. Can be associated with feelings of impending suffocation
Poor perception of respiratory symptoms and dyspnea may be life-threatening

Question 14

define air hunger cluster

Answer 14

hunger for more air

urge to breathe more

Question 15

define work/effort cluster

Answer 15

breathing requires effort and work and is uncomfortable

Question 16

define tightness cluster

Answer 16

tightness/ constriction in chest

heaviness in my chest