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y3 summary > transition - physiology > Flashcards

transition - physiology Flashcards

1
Q

where is resp rhythm generated

A

medulla

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2
Q

where are the peripheral chemoreceptors situated

A

carotid bodies, aortic bodies

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3
Q

what do the peripheral chemoreceptors sense

A

oxygen co2 and h+ in the BLOOD

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4
Q

where are central chemoreceptors situated

A

surface of medulla

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5
Q

what do central chemoreceptors respond to

A

H+ conc of the CSF (csf separated from blood by BBB)

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6
Q

what is hypoxic drive of respiration via

A

peripheral chemoreceptors

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7
Q

when is hypoxic drive important

A

in chronic co2 retention (COPD)

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8
Q

what is H+ drive of respiration via

A

peripheral chemoreceptors

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9
Q

what is the function of H+ drive of respiration

A

major role in adjusting acidosis by the addition of non-carbonic acid H+ to blood

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10
Q

Loss of transmural pressure gradient across the lungs?

A

pneumothorax

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11
Q

inspiratory muscles

A

diaphragm contraction and external intercostals to lift ribs and move out sternum

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12
Q

accessory muscles

A

sternocleidomastoid and scalenus

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13
Q

muscles of active inspiration

A

internal intercostals and abdominal muscles

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14
Q

what keeps alveoli open

A

transmural pressure gradient, pulmonary surfactant and alveolar interdependence

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15
Q

parasymp effect on lungs

A

bronchoconstriction

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16
Q

sympathetic effect on lungs

A

bronchodilation

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17
Q

is what condition is the v/q ratio high

A

PE = decrease perfusion, but normal ventilation

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18
Q

heart failure shifts frank-starling curve what way

A

right

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19
Q

what factors shift oxygen haemoglobin dissociation curve right - and what does that mean

A

inc pCO2
inc H+ (dec pH)
inc 2,3-DPG
inc temp

= decreased affinity for O2 to bind to haemoglobin

20
Q

cardiac output calculation

A

CO = SV x HR

21
Q

stroke vol calculation

A

SV = EDV - ESV

22
Q

what determines preload

A

EDV

23
Q

left sided HF features

A

pulmonary oedema and SOB

24
Q

what is the pO2 value in anaemia

A

normal

25
Q

maximum volume of air that can be inspired at the end of a normal quiet expiration

A

inspiratory capacity

26
Q

what one is the green one

A

normal

27
Q

what one is red

A

asthma

28
Q

what one is blue

A

COPD

29
Q

what is the COPD spirometry confirmed diagnosis

A

post bronchodilator FEV1/FVC<0.7

30
Q

Question 1: functional residual capacity:
A usually increased in obese people
B measured by spirometry
C decreased in COPD
D normally 40% of total lung capacity
E approximately 20% vital capacity

A

= D

FRC: expiratory reserve + residual volume

FRC decreased in obese people due to diaphragm being pushed up by fat
Cannot measure FRC by spirometry because you cannot take residual volume out of lungs
COPD- in emphysema FCR is increased

31
Q

Question 2: patient with pulmonary fibrosis, FEV1/FVC% is likely to be
A 45
B 50
C 60
D 65
E 85

A

Ans: 85

32
Q

Question 3: 67 YEAR OLD, SMOKES SINCE TEENS AND BEEN DIAGNOSED WITH COPD. His FEV1/FVC is <70% and his airflow limitation is moderate. What is his post bronchodilator FEV1 (% predicted of normal) likely to be>?
A 20%
B 40%
C 60%
D 80%
E 90%

A

Ans: 60

33
Q

Question 4: 23 y woman sees GP about intermittent breathlessness. Feels breathless when she’s in a crowded room. When she’s breathless she also notices numbness and tingling around mouth. FBC reveals Hb 10.5g/dl
A increased work of breathing due to reversible airways obstruction
B increased central and autonomic arousal
C reduced 02 carrying capacity of blood
D stimulation of peripheral chemoreceptors
E reduced SA for gas exchange

A

Ans: B

Tingling round mouth- co2 out from ventilation so blood ph increases ie respiratory alkalosis
Calcium decreased

34
Q

Question 5: what is correct about normal lungs
A low po2 causes pulmonary vasoconstriction
B larger airways are supplied by pulmonary circulation
C beta 1 agonists cause bronchodilation
D parasympathetic stimulation causes bronchodilation
E SA for gas exchange remains constant in absence of disease

A

Ans: A

In lungs low po2 causes vasoconstriction, would rather perfuse more well ventilated areas
Large airways have their own blood supply via bronchiole arteries
B2 agonists cause bronchodilation
Parasympathetics cause bronchoconstriction
SA changes when you exercise, hyperventilate

35
Q

Question 6: 72 y/o woman has had 2 MIs in the past and a recent echocardiogram has shown moderately impaired LV function. She has SOB worse at night
A increased alveolar surface tension
B increased work of breathing due to reversible airways obstruction
C reduced o2 carrying capacity of blood
D reduced pulmonary compliance and impaired gas diffusion
E stimulation of central chemoreceptors

A

Ans: D

Oedema affects pulmonary compliance and gas exchange

36
Q

Question 7: in patient with COPD
A inspiration more difficult than expiration
B dynamic airway compression likely to occur during active expiration
C presence of emphysema will help alleviate dynamic airway compression
D o2 saturations should be maintained near 100% if patient is retaining co2
E dynamic airway compression likely to occur during inspiration

A

Ans: b

37
Q

Question 8: which is correct about patient with emphysema
A gas exchange unaffected
B work of breathing decreased
C pulmonary compliance increased
D total lung volume decreased
E FEV1/FVC ratio increased

A

Ans: c

Work of breathing increases with emphysema

38
Q

Question 9: for TPX:
A intra-pleural pressure becomes more negative
B trachea can deviate to same side
C patient likely to be hypotensive
D breath sounds increased
E chest pain not a symptom

A

Ans: c

INTRA-PLEURAL PRESSURE BECOMES MORE + IN EQUALIBRIUM WITH LUNG OR OUTSIDE PRESSURE

39
Q

Question 10
Previous fit 22 year old has been unwell for 2 days, px with cough productive of green sputum, fever, SOB. Her PO2 is 8.2kPa. What are her saturations likely to be?
A 70
B 75
C 80
D 90
E 98

A

ANS: D
Function residual capacity- normally 40% of lung capacity

40
Q
A

a - DKA

41
Q
A

c

42
Q
A

B

acute MI with pul oedema
nitrate infusion dilates peripheral veins and decreases preload

43
Q
A

D

thyroid function tests

44
Q
A

A

45
Q
A

= a

Tingling around mouth and fingers = respiratory alkalosis

46
Q
A

E

47
Q
A

D

y3 summary (7 decks)

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