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Medicine phase 1 > cardiovascular and respiratory system > Flashcards

cardiovascular and respiratory system Flashcards

1
Q

why are drugs prescribed

A

treatment for chronic conditions eg. diabetes
prevention of medical problems i.e. primary prevention of heart disease or vaccinations
short term management of acute problems i.e. antibiotics for infections
prescriptions of non-pharmaceuticals eg. urinary catheters

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2
Q

describe pharmacodynamics

A

what the drug does to us

involves the study of how a drug interacts with its target

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3
Q

pharmacokinetics

A

what our bodies do to the drug

study of how we maintain the concentration of drug in the body in the correct range

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4
Q

common targets for drugs

A

receptors
enzyme systems
transporters

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5
Q

phases of drug development

A

pre-clinical development - basic scientific understanding of disease process, molecule screening, pre-clinical testing
clinical development - initial studies in humans, initial studies in the diseased, efficacy studies, post-marketing surveillance

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6
Q

describe the phases of clinical trials

A

phase 1 studies: healthy volunteers, low doses and. short duration, strictly monitors toxicity and appropriate does - only provides indication of whether drug is safe
phase 2: affected patients , assessment of whether drug behaves as expected, additional monitoring of safety profile - only tests whether the drug does what it is supposed to
phase 3: typically assesses long-term outcomes such as mortality, heart attacks and disease progression
phase 4: after drug has been licensed - observation for unexpected problems associated with use of the drug

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7
Q

describe the diaphragm

A

the major inspiratory dome shaped skeletal muscle

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8
Q

muscles on inspiration

A

diaphragm, external intercostals, parasternal intercartilaginous muscles, scalenus, sternocleidomastoid

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9
Q

muscle of expiration

A

internal intercostals (except parasternal intercarilaginous muscles), abdominal muscles

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10
Q

what kind of muscles are the following:

rectus abdominis, external oblique, internal oblique and transversus abdominis

A

abdominal muscles

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11
Q

describe inspiration and expiration at rest

A

inspiration is active - diaphragm contracts downwards pushing abdominal contents outwards - external intercostals pull ribs outwards and upwards
expiration is passive - elastic recoil

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12
Q

describe pressure changes during breathing at rest

A

ribs and sternum elevate and diaphragm contracts
pressure outside and inside are equal then pressure inside falls so air flows in
pressure inside rises and air flows out

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13
Q

describe inspiration and expiration during strenuous breathing

A

inspiration is active - greater contraction of diaphragm and intercostals - inspiratory accessory muscles active
expiration is active - internal intercostal muscles oppose external intercostals by pushing ribs down and inwards

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14
Q

describe the pressure and volume changes during a breath

A

when no flow - Pa = 0 Pb = 0
inspiratory muscles contract, pleural pressure becomes more negative, increase in Pl, lungs expand and alveolar volume increases
Pa becomes negative allowing air to flow into alveoli
expiration begins and thoracic volume decreases
Pp and Pl return to pre-inspiration values
thorax and lungs recoil
air in alveoli compressed
Pa becomes greater than Pb and so air flows out of the lungs

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15
Q

what is pleural pressure

A

the pressure surrounding the lung, within the pleural space

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16
Q

function of pharynx

A

conducts air to larynx (chamber shared with digestive tract)

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17
Q

function of larynx

A

protects opening to trachea and contains vocal cords

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18
Q

function of trachea and bronchi

A

filters air, traps particles in mucus, cartilages keep airway open

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19
Q

function of alveoli

A

act as sites of gas exchange between air and blood

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20
Q

major functions of the upper airway

A

humidify air by saturating it with water, warm air to body temp, filters air

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21
Q

describe the filtering process of air

A

Upper airways to bronchioles are lined by pseudo-stratified, ciliated, columnar epithelium
Inhaled particles of dust/debris stick to mucus which is produced by goblet cells – mucus traps it
Mucus moves towards mouth by beating cilia
Cilia move up towards nose and mouth to cough out the debris preventing debris from entering the lung

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22
Q

what is the trachealis

A

smooth muscle in the posterior aspect of the trachea

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23
Q

difference between the left and right main bronchus

A

Right main bronchus is wider, shorter and runs more vertically than the left main bronchus

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24
Q

what are RARs

A

rapidly adapting pulmonary stretch receptors

found in epithelium of respiratory tract

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25
Q

cough reflex process

A

stimulation of RARs by an irritant
afferent info sent via vagus nerve to brain
brain sends info to diaphragm and external intercostals to induce strong contraction
air rushes into lungs
abdominal muscles contract to induce expiration
glottis opens to forcefully release air are irritants

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26
Q

describe the respiratory tree

A

made of the conducting airways and respiratory airways
airways branch into smaller and more numerous bronchioles until terminating in a group of alveoli
trachea -> bronchi -> non-respiratory bronchioles -> respiratory bronchioles -> alveolar ducts

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27
Q

what are the conducting airways and what do they do

A

trachea, bronchi and non-respiratory bronchioles

involved in conducting air into body but not involved in gas exchange

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28
Q

what are the respiratory airways and what do they do

A

from terminal bronchioles to alveoli

bronchioles with alveoli is where gas exchange occurs

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29
Q

what is the respiratory unit

A

= gas exchanging unit
consists of respiratory bronchioles, alveolar ducts and alveoli
it is the basic physiological unit of the lung

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30
Q

structure of alveoli

A

polygonal in shape, composed of type 1 and type 2 epithelial cells, have a mesh of capillaries
alevolar macrophages clean up deris
perfectly designed for gas exchange: large SA, very thin walls and good diffusion characterisitic

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31
Q

what is the hilum

A

area of lung where blood vessels and brochus enter

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32
Q

functions of the type 1 and type 2 epithelial cells on alveoli

A

type 1 - occupy 97% of the surface area - primary site of gas exchange
type 2 - produce pulmonary surfactant to reduce surface tension

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33
Q

blood supply to lungs

A

two blood supplies:
pulmonary circulation - brings deoxygenated blood from heart to lung and oxygenated blood from lung to heart
bronchial circulation - brings oxygenated blood to lung parenchyma

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34
Q

describe the structure of arteries

A

thin walled
highly compliant
larger diameter
low resistance

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35
Q

the alveolar-capillary network

A

gas exchange occurs here through the dense mesh-like network of capillaries and alveoli
distance between alveoli and RBC is only 1-2µm making it ideal for gas exchange
RBCs pass through capillaries in less than one second

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36
Q

which direction do gases move

A

down their pressure gradients - from high to low

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37
Q

pulmonary circulation

A

Oxygen depleted blood
Passes from heart to lungs
Returns oxygenated blood to heart

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38
Q

systemic circulation

A

Oxygen rich blood
Passes from heart to rest of body
Returns deoxygenated blood to heart

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39
Q

describe the mediastinum

A

chest not including lungs
superior mediastinum boundaries - T1 posteriorly to sternal angle
inferior mediastinum is has an anterior (fat and thymus), middle (heart) and posterior (aorta and oesophagus) part - boundaries are from sternal angle to skeletal muscle of diaphragm

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40
Q

layers of the heart

A

endocardium (inner), myocardium, pericardium

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41
Q

what are trabeculae (heart)

A

ridges which increase flow of blood by causing turbulence

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42
Q

layers of the pericardium

A 
fibrous layer -  tough outer layer which anchors heart to diaphragm - Prevents rapid overfilling of the heart but can also restrict if there is an accumulation of fluid (pericardial effusion) compressing the heart, especially its right side and reducing the cardiac output 
serous layer - has two layers: an outer parietal layer and an inner visceral layer
Pericardial space (pericardial cavity) is between these two serous layers – has a small amount of lubricating serous fluid which reduces friction of the layers during heart beats
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43
Q

function of the two vena cava

A

superior VC - takes deoxygenated blood from head and neck and upper limb to heart
inferior VC - takes deoxygenated blood from below level of heart to heart

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44
Q

main layers of the aorta

A

tunica intima, media and adventitia

45
Q

first branch of the aorta

A

left and right coronary arteries which supply blood to heart

46
Q

describe the brachiocephalic trunk

A

splits into the right common carotid artery (goes to head and neck) and the right subclavian artery (upper limb)

47
Q

describe the last two branches of the aorta

A

left common carotid artery goes to head and neck

left subclavian artery gos into the axillary artery and supplies upper limb and armpit

48
Q

function of ductus venosus

A

allows blood to bypass liver to the IVC - at birth this closes and becomes the ligamentum venosum

49
Q

function of the foramen ovale

A

allows blood to flow from RA to LA in foetus

50
Q

function of ductus arteriosus

A

links pulmonary trunk with the aorta allowing blood to flow into the systemic circulation of the foetus

51
Q

how are nutrients and oxygen delivered to foetus

A

umbilical cord connects placenta to foetus so umbilical vein can deliver

52
Q

difference between foetal RBCs and maternal RBCs

A

foetal RBCs have more haemoglobin and this haemoglobin has a higher affinity for O2

53
Q

what is the fossa ovalis

A

embryological remnant of the formamen ovale

54
Q

what are aortic sinuses

A

dilations just above the aortic valve - 3 of them - 2 arise from the left and right coronary arteries

55
Q

crista terminalis

A

at the opening of the right atrial appendage and is the site of origin of the pectinati muscles

56
Q

coronary sinus

A

collection of veins joined together to form a large vessel that collects blood from the myocardium - opening of coronary sinus is where the venous blood from the heart enters

57
Q

pulmonary veins

A

4 in total - left and right inferior and left and right superior
carry oxygenated blood to the LA

58
Q

which ventricles is thicker and why

A

LV is 3x thicker as it has to pump blood to the whole body

59
Q

describe atrial septal and ventricular septal defects

A

present at birth

small holes sometimes close themselves and larger ones will compromise the lungs and heart due to increased bp

60
Q

describe atrioventricular septal defects

A

large holes between atria and between ventricles - requires surgery as it will compromise the patient leading to breathing problems, weak pulse, racing heart beat and tiring easily

61
Q

four heart valves and their locations

A

tricuspid - RA and RV
bicuspid (mitral) - LA and LV
aortic semilunar - LV and aorta
pulmonary semilunar - RV and pulmonary artery

62
Q

structure of semilunar valves

A

half moon shaped structure

no chordae tendineae

63
Q

how the atrioventricular valves work

A

as pressure increases in ventricles, valve leaflets come tightly together, they are prevented from flapping back into atrium by chordae tendinae and papillary muscles anchoring the valve tightly in place

64
Q

opening and closing of AV valves

A

blood fills atria, putting pressure on AV valve forcing it open
ventricles fill, AV valve flaps hang into ventricles
atria contract forcing additional blood into ventricles
ventricles contract, blood is forced agains AV valve cusps
AV valves close
papillary muscles contract and chordae tendineae tighten preventing valve flaps from everting into atria

65
Q

opening and closing of semilunar valves

A

ventricles contract, intraventricular pressure rises, blood is pushed up against semilunar valves forcing them open
as ventricles relax and pressure falls, blood flows back from arteries filling the cusps of S valves forcing them to close

66
Q

why is coronary artery disease so serious

A

CAs are end arteries meaning they are the only blood supply to the tissue they are supplying - if blocked, the tissue it is supplying will be killed

67
Q

what does blockage of coronary arteries lead to

A

ischaemia - restriction in blood to tissue causing a shortage of O2 that is needed - results in collateral circulation developing
infarction- death of tissue

68
Q

what is a coronary artery bypass graft

A

if there is a CA blockage there may be a cholesterol build up
saphenous vein is often used to bypass blockage
internal mammary or internal thoracic artery can be used and is sometimes preferred as it is an artery doing an artery’s job

69
Q

function of the moderator band

A

it is a thickening of muscle present in the right ventricle and carries the right bundle branch to the anterior papillary muscle
allows for more rapid conduction across to the anterior papillary muscle and helps with conduction times

70
Q

what are purkinje fibres

A

specialised conducting fibres, bigger than cardiac myocytes and create a synchronised contraction across the ventricles, thus maintaining our regular heart rate

71
Q

components of the upper respiratory tract

A

nasal cavity, pharynx and larynx

72
Q

components of the lower respiratory tract

A

trachea - splits into left and right bronchus
primary bronchi - superior and inferior lobe bronchus in both left and right lungs and in the right lung there is also the middle lobe bronchus
lungs

73
Q

functions of the respiratory tract

A

conduction of air (warms and humidifies)
respiration (gas exchange)
protection against pathogens

74
Q

main components of the pharynx

A

Nasopharynx – base of skull to soft palate
oropharynx – soft palate (uvula) to epiglottis (elastic cartilage)
laryngopharynx – epiglottis to where the bifurcation occurs to the oesophagus and the trachea
food passes through the oropharynx and laryngopharynx

75
Q

what lines most of the respiratory pathways

A

pseudostratified ciliated columnar epithelium with goblet cells

76
Q

how many lobes in each lung

A

left - 2

right - 3 lobes

77
Q

functions of the CV system

A

Transport of nutrients, oxygen, waste products around the body
Transfer of heat – generally core to skin
Buffers body pH – when cells metabolise they release carbon dioxide altering pH – so CV system controls the pH
Transport of hormones eg. Adrenaline from adrenals
Assists in response to infection
Assists in formation of urine-filtration and circulation – takes blood to kidneys

78
Q

diastole

A

phase of heartbeat when heart muscles relax and chambers fill with blood

79
Q

which side of the heart has a higher pressure

A

left - if there is a hole in septum, blood go from an area of high to low pressure

80
Q

what is ventricular hypertrophy

A

remodeling- increase in chamber size- caused by pressure overload

81
Q

what are the different heart sounds

A

One sound is the sound of AV valves closing and the other sound is the sound of pulmonary and aortic valves closing
A third heart sound may be due to oscillation of blood flow into ventricle

82
Q

systole

A

contraction

83
Q

stroke volume

A

amount of blood ejected per beat

the more the heart fills up the harder it will contract therefore the bigger the stroke volume

84
Q

what is a heart node

A

a specialised type of tissue that behaves as both muscle and nervous tissue
generates nerve impulses when in contracts

85
Q

describe the sinoatrial node

A

located in the upper wall of RA
pacemaker cells are located here
impulses are generated here

86
Q

electrical excitation pathway in the heart

A

impulse generated by pacemaker cells in SA node - spreads through atria walls via gap junctions causes atria walls to contract and so blood moves into ventricles
impulses converge at AV node in AV septum - AV node delays the impulses to ensure atria has time to fully eject blood into the ventricles before ventricle systole
impulse passes into AV bundle and is transmitted to the purkinje fibres of ventricles

87
Q

what influences the rate at which the SA node generates impulses

A

the autonomic NS
SNS increases firing rate of SA node – increases heart rate
PSNS decreases firing rate of SA – decreases heart rate

88
Q

describe the AV bundle

A

Right bundle branch – conducts the impulse to the purkinje fibres of the right ventricle
Left bundle branch – conducts impulse to the purkinje fibres of the LV – left ventricle is much larger so left bundle branch is much larger - Branches go on to activate the anterior and posterior papillary muscles, interventricular septum and walls of LV

89
Q

describe purkinje fibres

A

abundant with glycogen and have extensive gap junctions
located in ventricle walls and can rapidly transmit cardiac action potentials from the AV bundle to the myocardium of ventricles
having more gap junctions than the AV nodal cells and surrounding myocytes means they can transmit impulses 6x faster than ventricular muscles and 150x faster than AV nodal fibres

90
Q

describe the SA nodal action potential

A

Conductive cells contain a series of sodium ion channels that allow a normal and slow influx of sodium ions – causes membrane potential to rise slowly from an initial value of -60mV to -40mV
movement of Na ions creates spontaneous depolarisation
Calcium ion channels open and Ca enters cell, further depolarising it until approx. 5mV
Calcium channels close and K channels open allowing outflux of K and resulting in repolarisation
Membrane potential reaches approx. -60mV - K channels close and Na channels open again to repeat

91
Q

purkinje action potential

A

Rapid depolarisation period then there is the plateau phase in which membrane potential (MP) declines slowly due to the opening of the slow Ca channels, allowing Ca to enter while few K channels are open, allowing K to exit
When MP reaches approximately zero the Ca channels close and K channels open – repolarisation
MP drops until it reaches resting levels once more and then repeats

92
Q

what are adrenoceptors

A

receptors that bind adrenergic agonists

exist in alpha and beta forms

93
Q

which adrenoceptor is predominantly found in the heart

A

B1

94
Q

activation of B1 receptor can lead to

A

Positive inotropy – increased strength of contraction
Positive chronotropy – increase heart rate
Positive lusitropy – increased rate of relaxation
Positive dromotropy – increases conduction velocity

95
Q

where does the vagus nerve terminate

A

right vagus- SA node

left vagus- AV node

96
Q

factors controlling flow within vessels

A

length and diameter of vessel
viscosity of liquid
pressure gradient across length of the vessel - increasing pressure gradient increases flow

97
Q

how can blood viscosity be increased

A

Dehydration coupled with immobility increase risks of an increased blood viscosity and so decreased blood flow – can lead to deep vein thrombosis

98
Q

importance of blood vessel radius

A

As the radius of the wall gets smaller, the proportion of the blood making contact with the wall will increase - the greater amount of contact with the wall will increase the total resistance against the blood flow

99
Q

mechanisms that encourage blood flow in veins

A

Valves direct blood towards heart
Skeletal muscle pump – veins are often deep in muscles, when these muscles move they have a peristaltic effect in moving blood back to heart
Respiratory movements aid venous return – breathing changes pressure in thoracic cavity which aids the return
Sympathetic nerves - noradrenaline constricts veins - increased venous return to the heart – by creating pressure gradient

100
Q

what is preload and why can it be a problem

A

Venous return to the right ventricle is termed PRELOAD
If PRELOAD increases the heart has to work harder to pump the blood out. This can be a problem in: heart failure and coronary artery disease - angina
nitrates reduce preload on the heart to reduce cardiac work

101
Q

baroreceptors

A

receptors sensitive to change in pressure

102
Q

how do baroreceptors regulate bp

A

present in carotid sinus & aortic arch - Carotid receptor more important as it is more sensitive
baroreceptors are stretch receptors and they generate action potentials at a particular frequency at all times
Fall of blood pressure reduces stretch which reduces the frequency of action potentials to neurons in the medulla
this frequency is increased when the baroreceptors receive a stretch stimulus secondary to increase in blood pressure
efferent impulses in the form of sympathetic and parasympathetic nerves arise. Impulses are carried to the heart via the parasympathetic Vagus nerve

103
Q

ways to affect BP

A

Cardiac output
TPR (total peripheral resistance) by affecting radius of vessels
Local controls
Capillary fluid shift – changing hydrostatic or osmotic pressure

104
Q

what cells line all vessels and the inside of the heart chambers

A

endothelial cells

105
Q

role of vascular smooth muscle in vessels

A

Present in all vessels with the exception of the smallest capillaries
Determines vessel radius by contracting and relaxing
Secretes an extracellular matrix which gives the vessels their elastic properties
Can multiply in some diseases - eg hypertension

106
Q

why is arterial elasticity important

A

Compliance is important to allow large arteries to act as a pressure reservoir
This prevents pressure falling to 0 as blood leaves the arteries during diastole

107
Q

what is blood pressure

A

circulation of fluid contained within a space of definite volume
pressure falls as blood fills ventricles and in atrial systole

108
Q

how do each vessels structure link to its function

A

aorta and arteries contain a small amount of blood at high pressure so are very thick walled/elastic
arterioles are a variable resistance system which distributes the blood - dissipate most of the pressyre
capillaries have a vast surface area where the interchange of substances with the extracellular fluid of the tissue occurs - as little as one cell thick to allow rapid exchange within tissues
venules, veins and vena cava - a collecting and reservoir system which contains most of the blood at low pressure - very distensible

Medicine phase 1 (14 decks)

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