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Foundations of Medicine > Week 4 Science and Scholarships: Respiratory > Flashcards

Week 4 Science and Scholarships: Respiratory Flashcards

1
Q

identify structures of upper respiratory tract

A

nose, oral cavity, pharynx and larynx

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2
Q

location + what makes up nasopharynx

A

-upper part of throat behind nasal cavity, passageway for air and food and contains opening of auditory tube

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3
Q

location + what makes up oropharynx

A

-middle part of throat behind mouth, serving as a passage for both air and food and contains tonsils

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4
Q

location + what makes up Laryngopharynx

A

-lower part of throat where respiratory and digestive tracts diverge, allowing for pasha of air and food in their respective channels

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5
Q

functions of nasal cavity

A

-conduction of air
-warm air
-clean air
-sense of smell

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6
Q

what divides nose

A

septum

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7
Q

how many conchae in nasal cavity

A

3 (superior and middle and inferior)

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8
Q

how many meatus in nasal cavity

A

3 (superior and middle and inferior)

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9
Q

identify the paranasal sinuses

A
  • Frontal sinus
  • Maxillary sinus
  • Ethmoidal cells
  • Sphenoid sinus

FEMS

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10
Q

where does the nasolacrimal duct end

A

inferior meatus

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11
Q

what connents larynx, pharynx and mandible

A

hyoid bone

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12
Q

what is the pharynx made of

A

pharyngeal constrictor muscles

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13
Q

identify the functions of larynx

A

-separates digetsive tract and airway
-voice generation
-protection of lower airways

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14
Q

describe structure of thyroid cartilage

A
  • Largest cartilage
  • Laryngeal prominence/Adam’s
    apple
  • Posteriorly open
  • Connected to cricoid cartilage, Epiglottis and Vocal ligaments
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15
Q

describe structure of cricoid cartilage

A
  • complete signet ring structure
  • Arch and lamina
  • Connected to Thyroid cartilage and Arytenoid cartilages
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16
Q

how does the arytenoid cartilage move

A

change the width of the rima glottidis

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17
Q

identify the three main layers of the trachea

A

mucosa
submucosa
adventitia

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18
Q

what makes up the mucosa in the trachea

A

-epithelium
-basal lamina (loose connective tissue)
-basement membrane
-glands
-smooth muscle

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19
Q

what makes up the submucosa in the trachea

A

-dense (fibrous) connective tissue
-hyaline cartilage and large veins

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20
Q

what makes up adventitia in trachea

A

connective tissue

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21
Q

where is respiratory epithelium found

A

in the mucosa

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22
Q

what is respiratory epithelium

A

pseudo stratified columnar epithelium with
-ciliated cells
-goblet cells
-basal cells

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23
Q

where are seromucous glands found

A

mucosa (lamina propria/basal lamina)

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24
Q

function of trachealis (smooth) muscle

A

joins posterior ends of C shaped hyaline cartilage

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25
Q

what is found in lamina propria of trachea

A

-defence cells
-elastic fibres
-seromucous glands
-mucosal venules

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26
Q

how would you describe the transition from looser to more dense connective tissue in trachea

A

gradual

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27
Q

inner CT of trachea (relative to lumen) is ___ than outer CT

A

looser
until it reaches adventitia

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28
Q

walls shared by alveoli are named

A

interalveolar septae

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29
Q

what makes up inter alveolar septum

A

little smooth muscle, lots of elastic fibre and extensive capillary network

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30
Q

what cells make up the alveolar epithelium

A

-type 1 alveolar cell/ septal cell/ pneumocyte (squamous+no visible nuclei))
-type 2 alveolar cell/ septal cell/ pneumocyte (cuboidal)
-alveolar macrophage (dust cell)

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31
Q

function of type 2 alveolar cells

A

release surfactant to decrease alveolar surface tension

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32
Q

function of alveolar macrophages

A

remove particulate matter on alveolar surfaces to maintain a thin gas exchange surface

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33
Q

what makes up respiratory membrane
+what’s the other name for this membrane

A

aka air blood barrier
-type 1 alveolar cell
-basement membrane
-capillary endothelium

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34
Q

structures of lower respirator tract run where to where

A

trachea to lungs

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35
Q

describe Boyles law in relation to lungs

A

When lung volume increases (inspiration) but the amount of gas inside remains the same, pressure decreases. Air follows the pressure from high (outside lungs) to low (inside lungs) until its equal.

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36
Q

what muscles of lower airways aid breathing

A

diaphragm, intercostal muscles, scalene muscles

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37
Q

where is the parietal pleura

A

attaches to the inner part of ribcage and diaphragm (bordering mediastinum)

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38
Q

where is the visceral pleura

A

closely connected to lungs and adheres to parietal pleura (on lung)

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39
Q

what is found in between visceral and parietal pleurae

A

pleural fluid which lubricates and has adhesive role.

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40
Q

what structures of lower airways are found outside lung

A

trachea and main bronchi

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41
Q

what structures of lower airways are found inside lung

A

bronchi

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42
Q

functions of conducting airway

A

NO gas exchange
transport air
cleaning
humidifiction
warming

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43
Q

features of trachea

A

-windpipe, flexible tube with cartilaginous rings
-conducts air from larynx to bronchi and facilitating airflow to and from the lungs

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44
Q

features of bronchi

A

-two main branches
-leads air into lungs
-further branches into smaller bronchioles

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45
Q

describe angles of L and R bronchus

A

-R is more straight
-L is more oblique

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46
Q

how many lobes on left lung and right lung

A

left=2
right=3

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47
Q

how many segments in lungs

A

9-10 (L)
10 (R)

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48
Q

how many generations in lung

A

23

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49
Q

what is the Hering-Breur inflation reflex

A

-when lungs become overstretched stretch receptors in the bronchi and bronchioles trasnmit signals through the vagus nerve to DRG
-switching off inspiratory signals and preventing further inspiration/prelonging expiration
-also increases RR
-serves as a protective reflex against over inflation of lungs

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50
Q

what structures are involved in voluntary breathing

A

cortex, corticospinal chord

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51
Q

what structures involves in involuntary breathing

A

medulla, pace maker cells

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52
Q

two main factors that make up respiration

A

ventilation and gas exchange

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53
Q

define ventilation

A

movement of air in and out of airways

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54
Q

identify the two main physical properties of lungs

A

compliance and recoil

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55
Q

what is meant by compliance of lung

A

-stretchiness of lungs
-determined by elastic forces of lungs and elastic forces caused by surface tension

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56
Q

the higher the compliance of a lung

A

the greater the volume of air in lungs

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57
Q

identify the main factor effecting recoil of lungs

A

surface tensions of alveoli

58
Q

describe the function of pleura

A

pleural pressure is negative, creating a vacuum between lung surface and thoracic cavity

59
Q

outline law of lapace

A

Pressure in alveoli is proportional to the surface tension and inversely proportional to the radius of alveoli

60
Q

how does the body prevent collapsed lung

A

pulmonary surfactant

61
Q

how to calculate Work on breathing (WOB)

A

pressure x volume

62
Q

what does quiet breathing involve

A

65% = elastic work
35% = frictional/resistive work

63
Q

airway resistance formula

A

pressure difference/ volumetric airflow

64
Q

describe air flow in upper vs lower respiratory system

A

upper turbulent and lower laminal

65
Q

describe inspiration (normal breathing)

A

Diaphragm contracts to increase thoracic volume , lungs lengthen.

66
Q

describe expiration (normal breathing)

A

Diaphragm relaxes to decrease thoracic volume , Elastic recoil of lungs and chest wall, compresses the lungs and expels air.

67
Q

describe inspiration (forced breathing)

A

Scalenes which elevate the upper ribs;
Sternocleidomastoid which elevates the sternum;
Pectoralis major which elevate the ribs and sternum;
External intercostal muscles which elevate the ribs

68
Q

describe expiration (forced breathing)

A

Abdominal recti, internal intercostals, , external and internal obliques, act to lower ribs and compress abdomen against the diaphragm.

69
Q

what do the “PA” values mean

A

blood in alveoli

70
Q

what do the “Pa” values mean

A

blood entering alveoli before gas exchange

71
Q

summarise ficks law

A

The higher the concentration gradient and the shorter the distance the more conductive the diffusion

72
Q

describe gas transport

A
  • O2 transported in blood is either dissolved (low amount) or bound to hemoglobin (high amount)
  • O2 shows cooperative binding to hemoglobin
  • CO2 transported in blood is either dissolved or converted to bicarbonate or bound to proteins (in erythrocytes)
  • N2 rapidly dissolves in blood (high amount)
  • Unloading O2 in capillaries of the body outside the lung
    facilitates the loading of CO2 = Haldane effect
73
Q

describe gas exchange at alveoli/tissues

A

Pressure gradients drive gas exchange:
Partial pressure of oxygen (PO2) is higher in the alveoli (about 100 mmHg) than in the blood (about 40 mmHg), so oxygen moves into the bloodstream.
Partial pressure of carbon dioxide (PCO2) is higher in the blood (about 45 mmHg) than in the alveoli (about 40 mmHg), so carbon dioxide moves into the alveoli to be exhaled.

*same partial pressure values at tissues and same movement ; however, occurs between blood and tissues instead

74
Q

identify where peripheral chemoreceptors are found

A

carotid body and aortic body

75
Q

identify the main driver of alveolar ventilation

A

CO2

76
Q

what causes hypercapnia

A

high CO2

77
Q

what causes hypoxia

A

low O2

78
Q

what causes acidosis

A

high H+

79
Q

what receptor is the main driver of increased ventilation

A

central chemoreceptors

80
Q

what is measured in the brain for hypercapnia

A

H+ (initially CO2 that undergoes reactions to become H+ as H+ itself can’t easily pass blood brain barrier)

81
Q

what’s the main centre for ventilation processing

A

pons and medulla

82
Q

where does central processing occur to regulate respiratory rate

A

-pneumotaxic centre
-apneustic centre
-dorsal group
-ventral group
-pre-botzinger complex

83
Q

how does exercise effect ventilation

A
  1. Increase demand for oxygen in muscle
  2. Increased production of CO2 in muscle
  3. Stimulation of chemoreceptors surrounding muscle (metaboreceptors)
  4. Increased PaCO2 and reduced PaO2
  5. Stimulation of peripheral and central chemoreceptors
  6. Increased activity of phrenic and intercostal nerves
  7. Increase in RR/elevated tidal volume/enhanced O2 diffusion/activation of respiratory muscle/accelerated ventilatory response
84
Q

how does air flow in the lungs in terms of pressure

A

I: Increases in lung volume results in a negative alveolar pressure (relative to atmospheric pressure), resulting in air inflow. Expansion of chest wall pulls outwards on lungs, creating a ‘more negative’ pleural pressure.

E: Relaxation of diaphragm and elastic recoil of lungs results in positive alveolar pressure, resulting in air outflow. Pleural pressure decreases back to baseline.

85
Q

what drives gas exchange at tissues

A

PO2 in tissues low and PCO2 in tissues high (CO2 moves out of tissues H to L)

86
Q

central vs peripheral chemoreceptors

A

-central is located in medulla vs peripheral in carotid and aortic body
-central regulates H+ and CO2 vs peripheral regulates partial pressures of O2/CO2
-central responsible for 70% of ventilation response vs peripheral 30%

87
Q

Describe the action of central and peripheral chemoreceptors in regulating respiration

A

Central chemoreceptors : increase in H+ and CO2 (low pH)–> (H+ is not permeable to BBB therefore CO2 passes BBB and then is converted into H+) –> H+ is detected by central chemoreceptors in the medulla..

Peripheral: Increase in PaCO2 (hypoxia b/c proportional) –> detected by peripheral chemoreceptors in carotid and aortic body –

These work simultaneously, respective sensory involuntary afferent messages are sent to the CPG and then efferent messages are sent to the respiratory muscles t/f altering rate and depth of ventilation t/f increase pH to WNL

88
Q

muscle wasting (testing abduction and adduction) is indicative of

A

-peripheral lung tumour, compressing T1 nerve root

89
Q

peripheral cyanosis is indicative of

A

low peripheral perfusion

90
Q

clubbing is indicative of

A

HPO:lung carcinoma

91
Q

tar staining is indicative of

A

smoking

92
Q

wrist tenderness is indicative of

A

hypertrophic pulmonary osteoarthropathy

93
Q

asterixis are indicative of

A

severe CO2 retention eg COPD

94
Q

what is anhidrosis, partial ptosis and miosis indicative of

A

horners syndrome: apical lung tumour

95
Q

anhidrosis is what

A

decreased/absent sweating response

96
Q

what is partial ptosis

A

asymmetric eyelid droop

97
Q

what is miosis

A

asymmetric pupil dilation

98
Q

nasal polyps are indicative of

A

chronic inflammation eg asthma

99
Q

septal deviation is indicative of

A

nasal obstruction

100
Q

what is inflamed pharynx indicative of

A

URTI

101
Q

what is central cyanosis indicative of

A

severe hypoxemia, COPD, PE, pneumonia

102
Q

tenderness of frontal, ethmoidal or maxillary sinuses indicates

A

URTI

103
Q

which lymph nodes do u palpate in respiratory exam

A

submental
submandibular
pre and post auricular
occipital
anterior and posterior cervical chain
supraclavicular

104
Q

what is tracheal tug indicative of

A

forced inspiration

105
Q

how to check tracheal tug

A

three fingers vertically on trachea and check for depression

106
Q

how to check tracheal deviation

A

three fingers horizontally on trachea and check for movement away from midline

107
Q

contralateral tracheal deviation indicates

A

tension pneumothorax

108
Q

what do you look for in general inspection of posterior and lateral chest

A

shape, symmetry, scars and skeletal deformities

109
Q

how to check checks expansion

A

1.wrap hands around back of check at T12 with thumbs meeting over spine
2.ask patient to take deep breath, expansion between thumbs should be >5cm

110
Q

what orientation should you percuss/auscultate posterior chest

A

zig zag
-left right from top to bottom
-6 locations (mid clavicular)

111
Q

what orientation should you percuss/auscultate lateral chest

A

-under axilla (MAL) both sides/lobes
-4th rib, anterior axillary line on right side (right middle lobe)
-8th rib MAL on both sides (left+right lower)

112
Q

dullness when auscultating lungs indicates

A

consolidation, effusion, lobar collapse

113
Q

hyperresonance when auscultating lungs indicates

A

pneumothorax

114
Q

what do you get patient to do when auscultating

A

-breathe through their mouth
-say 99 (vocal resonance)
*seperately

115
Q

what do normal breath sounds like

A

vesicular breathing
-no adventitious sounds eg crackles, wheeze and stridor

116
Q

what does normal vocal resonance sound like

A

muffled
-abnormal would have decreased breath and hyperresonance

117
Q

decreased breath when checking vocal resonance indicates

A

pneumothorax, effusion, lobar collapse

118
Q

what do u look for in general inspection of anterior chest

A

scars, symmetry, shape, skeletal deformities (excavatum and carinatum)

119
Q

barrel chest indicates

A

COPD

120
Q

what orientation do you percuss and ausculate anterior chest

A

-6 spots
-alternating sides
-supraclavicular area (percuss only)

121
Q

when is dulness normal when percussing anterior chest

A

over the liver and heart

122
Q

when do you use bell in respiratory exam

A

auscultating above clavicle

123
Q

function of lower respiratory tract

A

-gas exchange
-mucocilliary clearance: goblet cells, mucous and cilia (escalator)
-airflow regulation:changing width of bronchial tube and bronchioles

124
Q

what is the interalveolar septum

A

-CT core of septa that contains extensive capillary network supplied by pulmonary arteries
-consists of basement membrane, CT

125
Q

features of bronchioles

A

-narrower air passages within lungs
-branching from bronchi and responsible for directing air to specific regions of lung

126
Q

features of alveoli

A

-tiny air sacs at end of bronchioles where gas exchange occurs
-allowing oxygen to enter blood and CO2 to exit

127
Q

features of lung

A

-paired, spongy
-plays key role in facilitating the exchange of gases between air and blood

128
Q

name the four components of ventilation

A

pulmonary ventilation
diffusion
gas transport
gas exchange

129
Q

describe pulmonary ventilation as part of ventilation mechanism

A

inflow and outflow of air between the atmosphere and alveoli

130
Q

describe diffusion as part of ventilation mechanism

A

movement of oxygen and carbon dioxide between alveoli and pulmonary circulation

131
Q

describe gas transport as part of ventilation mechanism

A

transport of oxygen and carbon dioxide in blood stream

132
Q

describe gas exchange as part of ventilation mechanism

A

exhnage of gases within body tissue

133
Q

quiet vs forced breathing

A

Q=normal, rhythmic, exhalation and inhalation during rest or light activities (mainly driven by external intercostals and diaphragm)
F=active, intense inhalation and exhalation involves addition respiratory muscles to met increased oxygen demand or when additional ventilation is needed

134
Q

list the 5 functions during inspiration and expiration

A

I=warming , humidification and filtration
E=return of heat and condensation

135
Q

function of pneumotactic centre

A

regulates seeped of inhalation and exhalation

136
Q

function apneustic centre

A

regulates seeped of inhalation and exhalation

137
Q

function of dorsal group

A

regulates inhalation and airway defence

138
Q

function of ventral group

A

regulates exhalation only

139
Q

function of Pro-botzinger complex

A

regulates respiratory rhythm

140
Q

Outline an overview of homeostatic control of respiration

A

1.Stimulus: changes to CO2, pH, O2 levels
2.detected by CCR or PCR
3.Sent to the CPG (pneumotactic centre, DRG, VRG, pre-botzinger complex)
4.these centres send messages to the muscles of respiratory system
5.changes to ventilation to maintain homeostasis

141
Q
A

Foundations of Medicine (18 decks)

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