2.02 Flashcards

(52 cards)

1
Q

Role of adrenal medulla in sympathetic activity of respiratory system

A

Releases adrenaline and noradrenaline

  • RELAXATION of smooth muscle in bronchioles
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2
Q

Role of parasympathetic division in respiratory system

A

CONSTRICTION of bronchioles

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3
Q

How are sympathetic impulses delivered in respiratory system?

A

sympathetic chain

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4
Q

How are parasympathetic impulses delivered in respiratory system?

A

Vagus nerve

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5
Q

What is the effect of the parasympathetic nervous system on the bronchioles?

A

Relaxation of smooth muscle in bronchioles

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6
Q

Which neurotransmitter is a key mediator of allergic reactions in the bronchioles?

A

Histamine

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7
Q

Which receptors on the bronchial smooth muscle are responsible for the cholinergic response?

A

M2 receptors

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8
Q

Where are the M1, M2, and M3 muscarinic receptors located?

A

M1 = parasympathetic ganglia
M2 = nerve terminals
M3 = airway smooth muscles.

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9
Q

Where are the dorsal respiratory group and the ventral respiratory group located?

A

Medullary Respiratory Centre

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10
Q

What are the functions of the dorsal respiratory group and the ventral respiratory group?

A

Dorsal respiratory group = controls normal breathing, sending impulses to the diaphragm and intercostals.

Ventral respiratory group = controls forceful breathing, activating accessory muscles of inhalation and exhalation

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11
Q

What complex controls respiratory rhythm?

A

Pre-Bötzinger

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12
Q

Where are the apneustic center and the pneumotaxic center located?

A

Pontine respiratory center

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13
Q

What are the functions of the apneustic center and the pneumotaxic center?

A

Apneustic center = promotes inhalation by stimulating the dorsal respiratory group

Pneumotaxic center = inhibits the apneustic center.

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14
Q

How do the dorsal respiratory group and the ventral respiratory group work together to control normal and forceful breathing?

A

Normal breathing =
dorsal respiratory group stimulates the diaphragm and intercostals.

Forceful breathing = ventral respiratory group activates accessory muscles of inhalation and exhalation.

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15
Q

Explain the differences in the neural pathways and functions of the sympathetic and parasympathetic control of the bronchioles.

A

The sympathetic nervous system, via the adrenal medulla, causes bronchodilation, while the parasympathetic nervous system, via the vagus nerve, causes bronchoconstriction. The pathways and effects are opposite between the two systems.

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16
Q

Function of M1 receptors

A

facilitate neurotransmission within the parasympathetic nervous system.

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17
Q

Function of M2 receptors

A

mediate the cholinergic response of bronchial smooth muscle, causing bronchoconstriction.

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18
Q

Function of M3 receptors

A

contribute to the cholinergic bronchoconstriction response.

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19
Q

primary neurotransmitter involved in the cholinergic response of bronchial smooth muscle?

A

ACh

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20
Q

Describe the mechanism by which the cholinergic response leads to constriction of the bronchioles.

A

binding of acetylcholine to M2 receptors on the bronchial smooth muscle activates a signaling cascade that leads to an increase in intracellular calcium, which ultimately causes contraction and constriction of the bronchioles.

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21
Q

What nerve mediates the cholinergic innervation and response of the bronchial smooth muscle?

A

The vagus nerve provides the parasympathetic innervation to the bronchial smooth muscle and mediates the cholinergic response

22
Q

How do the M2 receptors on the nerve terminals differ in their function from the M3 receptors on the bronchial smooth muscle itself?

A

M2 receptors on the nerve terminals regulate the release of acetylcholine, while M3 receptors on the smooth muscle itself transduce the contractile response.

23
Q

Muscles of passive inhalation

A

Diaphragm
External intercostals

24
Q

Muscles of active inhalation

A

Sternocleidomastoid
Scalene
Serratus anterior
Pectoralis minor

25
Muscles of passive exhalation
No muscles needed as passive recoil
26
Muscles of active exhalation
Internal intercostals Internal oblique External obliques Rectus abdominus Transfersus thoracis
27
Types of Pneumonia
Lobar Bronchopneumonia Atypical Community Acquired Hospital Acquired Aspiration
28
Lobar Pneumonia bacteria and consolidation areas
Streptococcus Pneumoniae Klebsiella Pneumoniae Haemophilus influenzae Moraxella cattarhalis Continuous consolidation of a lobe
29
Bronchopneumonia bacteria and consolidation areas
Staph A Haemophilus influenzae Discontinuous consolidation (often bilaterally in BASAL lobes)
30
Atypical pneumonia bacteria and consolidation areas
Mycoplasma pneumoniae Legionella pneumophila Chlamydia psittaci Typicall NO consolidation Pt presents w/ fatigue, malaise, and low-grade fever.
31
Hospital acquired pneumonia bacteria
Staph A G-ve enterobacteria (pseudomonas aeruginosa) >48 hrs after admission
32
Community acquired pneumonia bacteria
Strep. pneumoniae H. influenzae Moraxella catarrhalis
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Aspiration pneumonia bacteria and risk factors
Aerobic bacteria (strep. pneum., Staph aur., Pseudomonas A.) In Pts. w/ incompetent swallowing mechanism (stroke, intoxicated, intubation) Tyically cause RIGHT lung consolidation (due to R Bronchi shape)
34
Pneumonia symptoms
- Fever and malaise - Cough w/ purulent sputum/haemoptysis - Confusion - Expiratory crepitations - Sepsis - Dyspnoea
35
Pneumonia Ix
- FBC (CRP & WBC) - CXR (consolidation) - Sputum culture - U & Es
36
Scoring system used in pneumonia
CURB-65
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CURB-65
Confusion Urea > 7 mmol Respiratory Rate >/= 30 BP (systolic 65 y.o 1 point for each.
38
Pneumonia Mgx
CURB-65 < 1 = Oral Abx (e.g. amoxicillin - if allergic, give macrolide or tetracycline) CURB-65 > 2 = IV Abx AND fluids - dual Abx therapy (e.g. amoxicillin AND macrolide)
39
Primary TB pathophysiology
- Inhalation of mycobacterium - Mycobacteria trigger Th1 response, using T helper cells to upregulate macrophages. - Macrophages surround bacteria to form a granuloma Ghon focus = granuloma containing macrophages Ghon complex = Ghon focus and hilar lymphadenopathy - Macrophages consume mycobacteria - Inflammation leads to caseating necrosis - Lungs undergo fibrosis and calcification Can then lead to Latent or Secondary infection.
40
Latent infection
Infection w/o disease as mycobacterium is contained through granuloma formation Pt is asymptomatic and non-infectious A change in immune status or environment can lead to secondary infection
41
Secondary infection
Reactivation of infection Pt is infectious Commonly occurs in immunocompromised Occurs at Apex of lung (poor lymph drainage and high O2 supply) Can spread to CNS, vertebral bodies, kidneys, and GI system.
42
Bacteria that causes TB
Mycobacterium tuberculosis
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TB symptoms
- Chest pain - Malaise and weight loss - Low grade fever - Drenching night sweats - Persistant cough w/ haemoptysis - Clubbing
44
TB Ix
- CXR (opacification, cavitation) - Nucleic acid aplification test (NAAT) of sputum sample. - Sputum sample - HIV test
45
TB Mgx
Abx [e.g. rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months, followed by rifampicin and isoniazid for another 4 months]
46
Side effects of TB drugs
- Rifampicin [orange coloured secretions] - Isoniazid [ peripheral neuropathy] - Pyrazinamide [hepatotoxicity] - Etambutol [optic neuritis (red-green colour blindness)]
47
Lung cancer risk factors
Smoking Asbestos Radiation
48
Lung cancer symptoms
- Persistant cough +/- haemoptysis - Weight loss - Chest pain and dyspnoea - Wheezing - Hoarse voice - Clubbing - Supraclavicular,cervical lymphodenopathy
49
Lung Ca Ix
- CXR (check for mass) - CT chest w/ contrast ***** - Bronchoscopy (to take biopsy) - PET-CT/CT chest, abdomen, pelvis (used to check metastases)
50
Lung Ca Mgx
Non-small cell cancers = Surgery (lobectomy) AND chemo/radiotherapy and immunotherapy Small cell carcinoma = chemotherapy
51
NICE Cancer referral guidelines
- Urgent 2 week referral = CXR findings OR aged > 40 w/ haemoptysis Urgent XR (2 weeks) = > 40 y.o. AND 2 (if never smoked) or 1 (if smoked) of: - Cough - Fatigue - Dyspnoea - Chest pain - Weight loss - Appetite loss
52
Types of Lung Ca
- Small cell carcinoma (rapid growth and early metastases, produces hormones, and can lead to paraneoplastic syndromes e.g. SIADH and Cushing's) - Non-small cell carcinoma - Squamous cell carcinoma - Adenocarcinoma - Large cell carcinoma (from most to least common)