case 5 resp Flashcards
(102 cards)
1
Q
what type of cartilage exists in the trachea?
A
hyaline
2
Q
which cells in the airway make mucus?
A
goblet cells
3
Q
in which syndrome does mucociliary escalator not work?
A
kartagener syndrome
4
Q
parasympathetic innervation of the airways has what 3 main functions?
A
- bronchoconstriction
- vasodilation
3 mucus secretion
5
Q
sympathetic innervation of the airways has what 3 main functions?
A
- bronchodilation
- vasoconstriction
- modulation of cholinergic transmission
6
Q
what is the relationship between airway resistance and airflow?
A
high resistance = low airflow
7
Q
structurally how can an airway have increased resistance?
purely structurally
A
long airway + small radius = high resistance
8
Q
low amount of what protein will cause neonatal respiratory distress syndrome?
function of this thing?
A
surfactant
surfactant stops alveolar collapse
9
Q
how does compliance change in emphysema?
A
high compliance
10
Q
how does compliance change in pulmonary fibrosis?
A
low compliance
11
Q
what happens to airways in asthma (structurally)?
A
constricts
12
Q
is this condition obstructive or restrictive?
asthma
A
obstructive
13
Q
is this condition obstructive or restrictive?
pulmonary fibrosis
A
restrictive
14
Q
is this condition obstructive or restrictive?
emphysema
A
obstructive
15
Q
is this condition obstructive or restrictive?
motor neurone disease
A
restrictive
16
Q
Va:Q ratio
what does Va stand for?
what does Q stand for?
A
Va - ventilation
Q - perfusion
17
Q
what is the anatomical dead space?
what is the value of the Va:Q ratio in the dead space?
A
where there is no capillary perfusion but there is ventilation.
infinity
18
Q
how can an anatomical dead space be created pathologically?
A
pulmonary embolism
19
Q
in a right to left shunting of blood what is Va:Q ratio?
how can this shunting occur in the lungs pathologically?
-2
A
0
occluded airway or
fluid filled alveoli (i.e. pulm oedema)
20
Q
how does perfusion change moving down the lung?
A
increases
21
Q
how does ventilation change moving down the lung?
A
increases
22
Q
in a normal alveoli, how much O2 is there in mmHg?
A
100 mmHg
23
Q
in a normal alveoli, how much CO2 is there in mmHg?
A
40mmHG
24
Q
in a normal alveoli, how much O2 is there in kPa?
A
13.3kPa
25
in a normal alveoli, how much CO2 is there in kPa?
5.3kPa
26
if there is low Va (ventilation) in a certain area of the lung how does pulmonary vasculature react to stop V:Q matching?
why does it do this?
pulmonary vasculature vasoconstricts
stop Va:Q mismatching
27
someone is at high altitude and gets global lung hypoxia.
how does pulmonary vasculature react in this situation?
what complication will this lead to?
-2
global pulmonary vasculature vasoconstricts
pulmonary HTN --> R.sided heart failure
28
where is the central control area for breathing in the brain?
what is this centre called?
medulla, brain
medullary respiratory centre
29
what two receptors feed the
medullary respiratory centre
information?
central chemoreceptors &
| peripheral receptors
30
of the two receptors feeding the medullary respiratory centre with info:
which is sensitive to CO2 only?
central chemoreceptors
31
of the two receptors feeding the medullary respiratory centre with info:
which is sensitive to O2 and CO2?
peripheral receptors
32
of the two receptors feeding the medullary respiratory centre with info:
which has a fast response time?
peripheral receptors
33
of the two receptors feeding the medullary respiratory centre with info:
which has a slow response time?
central chemoreceptors
34
where are the central chemoreceptors found?
ventrolateral surface of medulla
35
where are the peripheral chemoreceptors found?
near carotid and aortic arteries
36
the medullary respiratory centre is most sensitive to what:
hypoxia
hypercapnia
or both
both - synergy of hypoxia & hypercapnia increases minute ventilation the most
37
what are the functions of the lung?
| -6
blood reservoir
make ACE
bring blood into contract with alveoli (gas exchange)
source of heparin (blood thinner)
source of thromboplastin (blood clotter)
protects body from emboli vis mechanical filtration
38
how do pulmonary arterioles differ from systemic arterioles?
| -4
thinner
less elastin
less smooth muscle
more compliant
39
what happens to pulmonary arterial pressure moving up the lung?
decreases
40
where is ventilation best in lung, bottom or top?
bottom
41
why does top of lung have worst ventilation?
top of lung has more negative pressure - so alveoli keep expanded - thus less ventilation
42
as you move up the lung, blood flow through the pulmonary vasculature only occurs when?
why
in systole
because pulmonary arterial pressure decreases moving up the lung
43
in which pathologies will there be no blood flow through pulmonary vasculature?
- 2 main ones
why?
- step by step
sepsis, massive haemorrhage
because these pathologies have less blood volume, so less BP, so less pulmonary arterial pressure, so blood not pushed through vasculature/ can not overcome alveoli pressure
44
for blood to move through pulmonary vasculature what must the pulmonary arterial pressure overcome?
-2 things
alveoli pressure
| pulmonary venous pressure
45
there is an over ventilated area in the lung.
how does lung respond to minimise V/Q mismatch?
bronchoconstriction
46
there is local ischaemia in an area of the lung.
how does lung respond to minimise V/Q mismatch?
bronchoconstriction
47
there is local hypoxia in an area of the lung.
how does lung respond to minimise V/Q mismatch?
vasoconstriction
48
if there is increased perfusion pressure (i.e. more blood flow in the lung) say during exercise.
what adaptations does the lung have to stop pulmonary vascular resistance in response to the increased perfusion pressure?
-2
if the lung did not adapt what complications will develop?
-2 (they are linked to each other)
vessels distend
recruits dormant pulmonary capillaries
pulm HTN --> R.sided heart failure
49
vasoconstriction will cause what to happen to lumen size?
what does this increase in the airways?
what complication will now occur?
decreases/narrower
resistance
pulm HTN
50
pulmonary HTN will eventually lead to what major complication?
R.sided heart failure
| cor pulmonale
51
Right ventricular failure due to a lung problem is called what?
how will the RV adapt to increased pulmonary HTN?
cor pulmonale
RV muscle becomes thicker
52
what happens to cardiac output in cor pulmonale eventually?
↓CO
53
where does the oedema occur in R.sided heart failure?
systemic oedema
54
where does the oedema occur in L.sided heart failure?
pulmonary oedema
55
features or cor pulmonale (basically R.sided heart failure)
```
cyanosis
SOB
ascites
raised JVP
big neck and veins
swollen ankles
```
56
drug group to get rid of fluid in cor pulmonale?
diuretics
57
restrictive lung diseases can be divided into what two categories?
pulmonary &
| extra-pulmonary
58
which lung cell type produces surfactant?
type 2 alveolar cells
59
which cells in the lung make collagen?
fibroblasts
60
which cells in the lung make elastin?
fibroblasts
61
define fibrosis
tissue scars and thicken (too much collagen)
62
CT of lung with pulmonary fibrosis shows what hallmark feature?
honeycomb appearance
63
symptoms & signs of pulmonary fibrosis?
| -5
```
dry cough
SOB
finger clubbing
peripheral cyanosis
fine end inspiratory crackles
```
64
with pulmonary fibrosis, what decreases on spriometry?
FVC, functional vital capacity
65
extra-pulmonary restrictive lung disease examples?
| -5
obesity
scoliosis/ kyphosis
motor neuron disease
pleural effusion
66
why does pleural effusion cause restrictive lung disease?
extra fluid (between parietal and visceral) compresses on lung
67
define FEV1?
air you blow out in 1 second
68
define FVC?
total volume of air blown out
69
define respiratory failure?
pulmonary gas exchange is insufficient and hypoxaemia occurs (with or without hypercarbia)
70
what are the two types of respiratory failure?
type 1: hypoxaemia only
| type 2: hypoxaemia and hypercarbia
71
what is the cut off value for hypoxaemia?
- kPa
- and mmHg
PaO2 <8kpa/ 60mmHg
72
what is the cut off value for hypercarbia?
- kPa
- and mmHg
PaCO2 >7kPa/55mmHg
73
mainstay (immediate) treatment for hypoxaemia?
give O2
74
which respiratory failure occurs when there is ventilatory failure?
define this type of respiratory failure?
type 2
type 2: hypoxaemia and hypercarbia
75
mainstay (immediate) treatment for type 2 respiratory failure?
ventilation
76
high CO2/ hypercarbia symptoms
drowsy
sleep in day
confused
headache
77
high CO2/ hypercarbia sign at the hand?
hand flap
78
why should you not over oxygenate a pt with hypercarbia which is ultimately result of ventilatory problem?
over oxygenation can reduce their ventilatory drive since low O2 tells medulla to ventilate more.
79
what electrolyte is lacking in cystic fibrosis mucus?
what effect does this have on mucus viscosity?
Cl-
mucus thick
80
how does peripheral nervous system affect mucus production?
more PNS = more mucus
81
2 types of COPD?
emphysema
| chronic bronchitis
82
pathophysiology of chronic bronchitis?
sub mucosal glands and goblet cells hypertrophy --> excess mucus made --> can not get rid of all mucus --> get infected again --> more inflammation and thus more mucus made again.
83
main way smoking causes chronic bronchitis?
paralyses mucociliary escalator
84
emphysema pt use what type of breathing?
why?
pursed lip breathing
created negative pressure to stop airways collapsing
85
which protein is destroyed in emphysema?
elastin
86
step by step outline how COPD can cause cor pulmonale and systemic oedema?
sever COPD --> lung hypoxic --> pulmonary vasculature constrict --> more pulmonary resistance --> pulmonary HTN --> pressure on right ventricle, eventually fails --> cor pulmonale --> back pressure in systemic venous now so fluid pushed out
87
obstructive value on spirometry?
<0.7
88
restrictive value on spirometry?
>0.7
89
how does sputum become green in infection?
neutrophils go to fight infection --> neutrophil rupture --> ooze out myeloperoxidase --> myeloperoxidase make sputum green
90
what score is used for pneumonia severity?
CURB65
91
what does CURB65 stand for?
```
confusion
urea
rep rate
BP
65+ age
```
92
define pneumonia?
lung tissue itself infected
93
hallmark feature of bronchiectasis?
dilated airways filled with mucus
94
hallmark feature of bronchiectasis on CXR?
signet ring
95
main cause of bronchiectasis>
infection
96
what test is used to check for CF?
sweat chloride test
97
pt has bronchiectasis.
what is head on ausculation?
coarse crackles
98
what test is used to estimate left atrium pressure in LV heart failure?
pulmonary capillary wedge pressure
99
why is it risky to give lots of opioids in pt with type 2 resp failure?
opioids diminish resp drive
100
pt has hypercapnia.
how will headache severity change during day?
headache worst in morning
101
how do you treat infant respiratory distress syndrome?
cPAP
102
which pneumonia, hospital or community has higher mortality?
hospital
