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Foundation > Week 1 - CO Poisoning, O2 transport > Flashcards

Week 1 - CO Poisoning, O2 transport Flashcards

Oxygen Transport

1
Q

Narcolepsy

A

Rare, long-term brain condition that results in sleep at inappropriate times (suddenly, all day drowsiness, cataplexy, sleep paralysis are all manifestations)

May be caused by a lack of the brain chemical hypocretin (orexin)

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2
Q

Sleep apnoea - what are the two types?

A

pauses in breathing / periods of shallow breathing during sleep, which can be caused by a blockage (OSA) or lack of effort to breath (CSA). Being overweight is a risk factor.

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3
Q

Insomnia

A

A broad term for many types of trouble sleeping including inability to fall asleep or stay asleep during the night. It is often caused by psychological/mental health issues such as anxiety and depression or environmental factors

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4
Q

Glasgow Coma Scale - definition

A

test to determine the level on consciousness following a traumatic brain injury
E - Eye response
V - Verbal response
M - Motor response

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5
Q

Glasgow Come Scale - ratings

A

E - Eye response (4-NT)
Spontaneous, sound, pressure, none, NT

V - Verbal response (5-NT)
Orientated, confused, non-coherent words, sounds, none, NT

M - Motor response (6-NT)
obeys command, localising to pressure, normal flexion, abnormal flexion, extension, none, NT

Severe: GCS 8 or less
Moderate: GCS 9-12
Mild: GCS 13-15

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6
Q

AVPU scale - definition and ratings

A

AVPU scale - test to determine level of consciousness (simplified version of the GCS)

Alert - awake, open eyes, respond to voice, bodily control

Verbal - Some sort of response when you speak to them (whether eyes, sounds, motor response)

Pain response - Response upon mild pain stimulus (trapezoid pinch, finger pinch, above eye pinch)

Unresponsive - No eye, voice or motor response to either verbal or pain queues

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7
Q

Normal temperature range

A

Approx 36-38 C

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8
Q

Normal pulse range

A

Approx 60-100

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9
Q

Normal respiration rate

A

Approx 12-20

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10
Q

Normal blood pressure

A

120/80

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11
Q

Normal O2 saturation

A

between 80-100 mmHg or 95-100% pulse ox

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12
Q

How to assess circulation in a patient - 4 ways

A

Bumucosa cyanosis - blue skin on lips, tongue, mucous membranes implying lack of oxygen in blood
Peripheral cyanosis - Blue skin in hand, feet, limbs
Capillary refill - End of finger should refill in 3 seconds after being squeezed
Distal pulse - pulse at wrists and ankles

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13
Q

How is oxygen transported?

A

Two methods

Mostly (97%) in haemoglobin and the remainder in plasma

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14
Q

How is CO2 transported?

A

Four different ways

  1. In plasma as a gas (a few %)
  2. Mix with water in blood plasma to form H+ ions and bicarbonate (a few more %)
  3. Mix with water in red blood cells to form H+ ions and bicarbonate (carbonic anhydrase on RBC membrane makes the reaction more rapid) (approx 70%)
    - Transporter protein trades the bicarbonate with chloride and H+ is picked up by haemoglobin
  4. CO2 binds with haemoglobin - carbaminohaemoglobin (HbCO2)
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15
Q

Bicarbonate in blood

A

Bicarbonate is important buffer within plasma - an important ‘blood gas’, low bicarbonate would indicate another issue

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16
Q

How does carbon monoxide poisoning work?

A

After carbon monoxide is breathed in, it enters your bloodstream and mixes with haemoglobin (the part of red blood cells that carry oxygen around your body) to form carboxyhaemoglobin.

Shifts curve so far left that it can’t release oxygen
Affects bodies ability to make ATP

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17
Q

Describe oxygen dissociation curve

A

The shape of the curve is SIGMOID, determined by the nature of positive cooperativity (i.e. When one oxygen attaches to haemoglobin, the affinity for oxygen increases until the haemoglobin reaches 100% saturation - 4 oxygen molecules)

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18
Q

Partial pressure

A

In a mixture of gases, each constituent gas has a partial pressure which is the notional pressure of that constituent gas if it alone occupied the entire volume of the original mixture at the same temperature

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19
Q

Dalton’s Law

A

Total Pressure = Sum of all partial pressures

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20
Q

Henry’s Law

A

Mass of dissolved gas (at given volume, equilibrium) is proportional to the partial pressure of the gas
“…when a gaseous mixture (e.g., the atmosphere) is in contact with a solution, the amount of any gas in that mixture that dissolves in the solution is in direct proportion to the partial pressure of that gas”
I.e. When there is more oxygen present, more oxygen moves into the bloodstream

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21
Q

Carboxyhaemoglobin

A

haemoglobin and carbon monoxide

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22
Q

Oxyhaemoglobin

A

oxygenated haemoglobin (deoxy is de-oxygenated haemoglobin)

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23
Q

Methaemoglobin

A

iron molecules in the ferric state (Fe3+) rather than the ferrous state (Fe2+) which means it cannot bind to oxygen.

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24
Q

When the oxygen dissociation curve moves to the left or the right, what does this mean?

A

Left for lungs - Left shift indicates higher affinity for oxygen to encourage binding to haemoglobin in the lungs
Right for muscles - Indicates lower affinity of haemoglobin for oxygen, due to bodies need for more oxygen (such as in working muscles)

Factors that determine shift include:

  • TEMP - when temperature INCREASES, shifts right to encourage further oxygen in tissues
  • 2-3 DPG
  • H+ IONS
  • CO2 - increased presence of CO2 shifts right, as it means muscles are creating energy which requires oxygen (and CO2 is a bioproduct that needs to be carried away)
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25
Q

Give an overview of glycolysis: input, products, where it takes place

A

Glucose (6C) from food is broken down into two pyruvate (3C), as it is a simpler format to extract energy

Input: Glucose (6c)
Output: 2 pyruvate (3c) + 2ATP (net) + 2NADH
Where: cytoplasm / cytosol

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26
Q

Give an overview of the Krebs Cycle, describing input/s, key intermediate stages and products and where it takes place

A

Input: Acetyl CoA
Citrate (6c), oxaloacetate (4c)
Output: Per cycle - 3x NADH, 1x FADH, 1x ATP, 2 CO2 as waste
Where: mitochondria - outer membrane

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27
Q

Intermediate step between glycolysis and Krebs cycle

A

Pyruvate is transformed into Acetyl CoA, which then begins the citric acid cycle.

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28
Q

Give an overview of the electron transport chain/ oxidative phosphorylation, describing input/s, key intermediate stages, products and where it takes place

A

All of the electrons removed from the processes so far are carried by NADH and FADH to start the electron transport chain. Simply, redox reactions occur as electrons are transferred from their donors (NADH/FADH) to the acceptors (Oxygen). This process fuels ATP synthase, which is the main producer of the ATP required for cell processes

Input: NADH, FADH, electrons, oxygen as transporter
Output: 34/36 ATP, H2O as waste
Where: mitochondria - inner membrane

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29
Q

What happens when oxygen is not present? (describe anaerobic respiration)

A

Anaerobic respiration occurs when oxygen is not present (for example, when athletes need energy quickly).
Glycolysis still occurs - glucose to pyruvate
Pyruvate then turned into lactic acid
OUTPUT: NAD+
The biproduct (waste) of this process is lactic acid rather than CO2 and H2O

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30
Q

How has respiration been impaired by CO? (two ways)

A

Binding with haemoglobin to restrict oxygen uptake

Binding with cytochrome c oxidase which impacts ability to transport electrons

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31
Q

What is the central nervous system?

A

brain and spinal cord - CONTROL CENTER

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32
Q

What is the peripheral nervous system?

A

cranial / spinal nerves - COMMUNICATION LINES

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33
Q

What is the somatic nervous system?

A

Controls VOLUNTARY muscles and transmits sensory information to CNS

34
Q

What is the autonomic nervous system?

A

Controls INVOLUNTARY body functions

35
Q

What are the parasympathetic and sympathetic nervous systems?

A

Parasympathetic - CALMS body to conserve/maintain energy

Sympathetic - AROUSES body to expend energy

36
Q

Cells types in nervous system

A

Neurons - send signals
Glial cells - provide support, digestion, insulation in CNS and PNS
PNS - Schwann and satellite cells
CNS - astrocytes, microglia, oligodendroglia

37
Q

Resting potential

A

difference in voltage between the inside and outside of the neuron

38
Q

Action potential

A

occurs when a neuron sends information down an axon, away from the cell body.

39
Q

Sodium pump

A

sodium and potassium both need to move across the nerve cell membrane through active transport. Unequal distribution inside and outside generate the electrical impulses required to send messages

40
Q

Introduction / consent

A

Obtaining consent from patients, discussing confidentiality

  • Who you are - name and role
  • What is the purpose - our learning
  • How long will it take - outline amount of time it will take to gather information
  • What will happen to the information / who will you share it with - passing any details on to doctor / medical team
  • What if they say no - if you don’t want to talk, won’t affect your care

Initiating consultation (consent above)

  • Introduction: Role as medical student - to learn, to listen, to understand, as conduit to doctor (need to make it clear that you will share any information shared with doctor)
  • Establish purpose
  • Consent
  • Establish rapport
  • Establish comfort
41
Q

Describe respiratory system gross anatomy

A 
Nasal / oral cavity
Pharynx
Larynx
Trachea
Right / left Bronchus
Right - three bronci
left - two bronchi
Bronchioles
Alveolus
42
Q

Describe alveolus structure and function

A

Terminal end of the lung capillaries, where gas exchange occurs
Macrophages
Pneumocytes -
Type 1: gas exchange, squamous (flat) / thin
Type 2: secretion of surfactant, cuboidal

Pulmonary surfactant:
is a mixture of lipids and proteins which is secreted into the alveolar space by epithelial type II cells. The main function ofsurfactantis to lower the surface tension at the air/liquid interface within thealveoliof thelung

43
Q

Gibb’s reflective cycle

A

Description, feelings, evaluation, analysis, conclusion, action plan

44
Q

Differences between left and right lung

A

Left - smaller to make room for heart, 2 lobes

Right - longer and more upright, 3 lobes

45
Q

Functional residual capacity of the lungs

A

Maximum expiration (breathe out) + residual volume (what’s left)

46
Q

Cellular respiration

A

process of converting biochemical energy to ATP

47
Q

Hamburger shift

A

Exchange of bicarbonate ions and chloride ions across membranes of RBCs

48
Q

Haldane effect

A

Left for lungs, haem has high affinity to pick up oxygen

49
Q

Bohr effect

A

Right for muscle, haem has low affinity for oxygen to drop off oxygen in tissues

50
Q

Carbaminohaemoglobin

A

Carbon dioxide binds with oxygen

51
Q

Three examples of exclusion criteria for anatomy body donors

A

Obesity
Post-mortem examination
Some infectious diseases - hepatitis, HIV/AIDS

52
Q

Describe key points from Human tissue act of 2004

A

Permits with consent donation of whole bodies for anatomical examination following certified/registered death
Must be licensed to examine the body, removal of body parts / organs, storage

53
Q

Describe the Calgary Cambridge model of communication

A

Initiate, gather information, physical examination, explanation / planning, close the session (all supported by structure and relationship building)

54
Q

What is consent? Three factors

A

Consent means a voluntary, uncoerced decision, made by a competent person on the basis of adequate information and deliberation, to accept some proposed course of action

INFORMED
COMPETENT
VOLUNTARY

55
Q

Oxygen cascade

A

pO2 drops at every step from atmospheric gas to mitochondria (from about 21kPa to 3kPa)

56
Q

Conducting zone of the respiratory system

A

Trachea, bronchi, bronchioles, terminal bronchioles

57
Q

Transitional and respiratory zones of the respiratory system

A

Respiratory bronchioles, alveolar ducts, alveolar sacs

58
Q

What determines oxygen delivery? (two elements)

A

Cardiac output x oxygen content

59
Q

Where is oxygen stored? (three locations and approximate amounts)

A

Lungs - 450ml
Blood - 850ml
Dissolved and in tissues - 250ml

60
Q

What is a clinical skill?

A

Any discrete and observable act within the overall process of patient care

61
Q

Describe the parts of a neuron

A

Soma with a cell body and dendrites
Long axon (nerve fiber) covered in myelin separated by nodes of ranvier
Ends with terminal boutons

62
Q

What are the 4 basic types of a neuron?

A

Bipolar
Unipolar
Multipolar
Pyramidal

63
Q

What are the functions / characteristics of a neuron? (3 processes)

A

Receive, process and generate signals
–Action potentials
–Chemical neurotransmission (synapses)
–Electrical neurotransmission (gap junctions)

THEY DO NOT PROLIFERATE (exception: neural stem cells)

64
Q

What is the basic process of a synapse?

A

Nerve impulse triggers release of neurotransmitters into synaptic gap
Channel opens and nerve impulse sent
(without neurotransmitter, channel closed, no signal sent)

65
Q

Describe the three types of glial cells in the CNS

A

Astrocyte - clean up, transport, stability, digestion, regulation
Microglia - digestion
Oligodendroglia - insulation

66
Q

Describe the two types of glial cells in the PNS

A

Satelitte cells - support

Schwann cells - insultation

67
Q

What are the meniges of the CNS? (6 layers)

A

Skin, periosteum, bone, dura mater, arachnoid, pia mater

68
Q

What are the functions of CSF? (four)

A

Buoyancy
Protection
Chemical stability
Prevention of brain ischaemia (restriction of blood vessels to brain)

69
Q

What are the lobes of the brain? (six)

A 
Frontal 
Parietal
Occipital
Temporal
Brain stem
Cerebellum
70
Q

What are the three part of the brain stem?

A

Midbrain
Pons
Medulla

71
Q

What are the regions of the spinal cord? 4 with corresponding vertebrae & post-spine region

A 
Cervical (C1-8)
Thoracic (T1-12)
Lumbar (L1-5)
Sacral (S1-5)
Conus / Cauda equina
72
Q

Regions for dermatomes (5)

A 
Trigeminal
Cervical
Thoracic
Lumbar
Sacral

Only make sense if person is on all fours

73
Q

Define eteroceptors, proprioceptors, enteroceptors

A

Exteroceptors- respond to stimuli outside the body
Special senses (e.g. photoreceptors, olfactory
neurones, cochlear hair cells) and body surface (e.g.
mechanoreceptors, chemoreceptors….)
Proprioceptors- Stimuli from muscles tendons and joints.
Enteroceptors (visceroceptors) - Internal surfaces such as walls of viscera, blood vessels.

74
Q

What are mechanoreceptors?

A

Type of exteroceptor subdivided by sensation (vibration, temperature, touch for example)

75
Q

What is the CNS blood supply?

A

Arteries - carotid, vertebral (circle of Willis, Cerebral arteries)
Veins - venous sinuses, jugular veins

76
Q

Describe the circle of willis

A

Can be seen from inferior view of brain

Brings together the Internal carotid artery, middle cerebral artery and the basilar artery

77
Q

What is the McWhinney model?

A

Patient centred approach
Patient presents problem, gather information, parallel search of two distinct frameworks (DISEASE / DOCTOR and ILLNESS / PATIENT), which are then integrated and used collaboratively

78
Q

What is the vital capacity of the lungs ?

A

Inspiratory reserve volume + Tidal volume + expiratory reserve volume

79
Q

What is the functional residual capacity of the lungs?

A

Expiratory reserve volume + residual volume

80
Q

What is your normal breathing at rest called?

A

Tidal volume

81
Q

What’s the difference between gap junction and synapse

A

A gap junction is called an electrical synapse in neurons and nerves. So an electric synapse is a specific type of gap junction, namely the electrically conductive link between two neighboring neurons.

A chemical synapse is a biological junction through which neurons’ signals can be exchanged. A chemical synapse is not a gap junction, because of the 20 to 40 nanometer distance that separates the cells.

Foundation (3 decks)

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