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X. MRCS: Pathophysiology > Lung/Thorax > Flashcards

Lung/Thorax Flashcards

(55 cards)

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1
Q

Parts of the lung

A 
Apex
Base
Lobes
Surfaces
Borders
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2
Q

Lobes of the lungs

A

Right: superior, middle, inferior. Divided by oblique and horizontal fissure.
Left: Superior, inferior. Divided by oblique.

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3
Q

Surfaces of the lung

A

Mediastinal surface
Daiphragmatic surface
Costal surface

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4
Q

Borders of the lung

A

Anterior border
Inferior border
posterior border

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5
Q

Lung root

A

Collection of structures that suspends lung from mediastinum.
Contains: bronchus, pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary nerve plexus, lymphatics
Structures leave/enter through hilum

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6
Q

Bronchial tree

A

Tracheal bifurcation at level of sternal angle T4/T5 (carina)
Right main bronchus: shorter, wider, more vertical. 3 lobar bronchi. Segmental bronchi for each bronchopulmonary segment.
Left main bronchus: inferior to arch of aorta, anterior to descending aorta/oesophagus. 2 lobar bronchi.

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7
Q

Sternal angle (Angle of Lois)

A 
T4/5
2nd rib articulation
Aortic arch
Azygous vein
Ligamentum arteriosus
Bifurcation of pulmonary trunk
Bifurcation of trachea
L recurrent laryngeal nerve
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8
Q

Blood supply to the lung

A 
Deoxygenated: 
Pulmonary arteries
Oxygenated: 
Trachea: inferior thyroid artery
Bronchi, lung roots, visceral pleura, lung parenchyma: bronchial arteries (branches of descending aorta. Left bronchial: directly of aorta. Right: 3rd posterior intercostal artery)
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9
Q

Venous drainage from the lung

A 
Oxygenated drainage: 
Pulmonary veins (two for each lung)

Deoxygenated:
Trachea: brachiocephalic/ azygos/hemiazygos veins
Right bronchial vein (drains into azygos vein)
Left bronchial vein (hemiazygos vein)

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10
Q

Nerve supply to the lung

A

Pulmonary plexuses
Parasympathetic: vagus nerve. Stimulates secretion of bronchial glands, contraction of bronchial smooth muscle and vasodilation of pulmonary vessels.
Sympathetic: derived from sympathetic trunk: Stimulate relaxation of bronchial smooth muscle, vasoconstriction of pulmonary vessels.
Visceral afferent: pain impulses to sensory ganglion of vagus
Trachea: recurrent laryngeal nerve

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11
Q

Lymphatic drainage of lung

A

Superficial (sub pleural): drains lung parenchyma

Deep: drains structures of lung root

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12
Q

Trachea structure

A

C-shaped cartilaginous rings
Lined with ciliated pseudo stratified columnar epithelium, interspersed with goblet cells. (forms functional mucociliary escalator)

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13
Q

Bronchi structure

A

Main: Cartilage rings completely encircle wall

Smaller lobar/segmental: crescent shaped cartilage

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14
Q

Bronchioles structure

A

No cartilage/mucus secreting goblet cells
Club cells produce surfactant lipoprotein.
Conducting bronchioles –>
terminal bronchioles –>
respiratory bronchioles –> alveoli

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15
Q

Alveoli structure

A

Thin wall of simple squamous epithelium

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16
Q

Muscles of inspiration

A

Inspiratory muscles: diaphragm, external intercostal muscles

Accessory muscles: scalene, sternocleidomastoid, pec major/minor, serratus anterior. lat doors

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17
Q

Muscles of expiration

A

Passive expiration requires only relaxation

Forced expiration: anterolateral abdominal wall, internal intercostal, innermost intercostal

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18
Q

Pressure changes in inspiration/expiration

A

Boyle’s law: volume of gas is inversely proportional to pressure (when temp constant)
Inspiration: volume of thorax increases, pressure decreases, air enters down pressure gradient
Expiration: volume of thorax decreases, pressure increases, air exits down pressure gradient

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19
Q

Determinants of airway resistance

A

Ohm’s law: flow = pressure gradient/resistance
Poiseuille’s law: resistance = resistance is inversely proportional to radius to power of 4.

Airway diameter

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20
Q

Determinants of airway resistance

A

Ohm’s law: flow = pressure gradient/resistance
Poiseuille’s law: resistance = resistance is inversely proportional to radius to power of 4.

Airway diameter

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21
Q

Control of airway diameter

A

Autonomic control:
Sympathetic: B2 relax bronchial smooth muscle
Parasympathetic: muscarinic (M3) constrict bronchial smooth muscle

Pressure: Large amount of elastic tissue in lung to allow expansion. Low intrathoracic pressure (inspiration) means pressure on airways reduced and airways expand. Inverse is true. Forced expiration can lead to pressure increases that collapse airways.

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22
Q

Surfactant and lung function

A

Produced by Type II alveolar cells
Hydrophilic & hydrophobic component
Disrupt hydrogen bonds between water molecules on surface overcoming surface tension.

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23
Q

Factors affecting gas exchange

Study These Flashcards
A

Fick’s law: factors affecting diffusion of gas through a liquid:

  1. Partial pressure difference across barrier
  2. solubility of gas
  3. cross-sectional area of fluid
  4. distance molecules need to travel
  5. Molecular weight of gas
  6. Temperature of fluid
24
Q

Diffusion barrier for gas exchange

Study These Flashcards
A 
Alveolar epithelium
Tissue fluid
Capillary endothelium
Plasma
Red cell membrane
25
Factors affecting rate of diffusion in the lung
Membrane thickness (Fluid: pulmonary oedema. Thickening of alveolar membrane: Pulmonary fibrosis). Membrane surface area (Destruction go alveolar architecture: emphysema)
26
V-Q (ventilation perfusion ratio)
Ventilation: volume of gas inhaled and exhaled in a given time (tidal volume x RR. Approx 6L/min) Perfusion: total volume of blood reaching pulmonary capillaries in a given time
27
V-Q mismatch
If ventilation decreases capillary partial pressure of O2 falls and CO2 rises. Hypoxic vasoconstriction causes diversion of blood to better ventilated parts. Causes of reduced ventilation: primary lung condition (pneumonia, COPD, asthma etc) Causes of reduced perfusion: PE
28
Transport of oxygen in the blood
Dissolved in blood (1.5%) | Bound to haemoglobin (98.5%)
29
Haemoglobin
Protein. 2 alpha, 2 beta subunits. | Haem + O2 = oxyhaemoglobin
30
Oxygen binding curve
When no O2 bound: Tense state (T-state) with low affinity for O2 When 1 O2 bound Hb alters shape: Relaxed state (R-state). Higher affinity for O2. When Oxyhaemoglobin reaches tissues with Low O2 it will dissociate to O2 + Hb.
31
Factors affecting Oxygen affinity
Increase in O2 affinity moves curve to left. Decrease moved curve to right. pH/CO2: When pCO2 increases/pH decreases Hb enters T state and its affinity for O2 decreases (Bohr effect). Inversely when pCO2 decreases and pH increases affinity of O2 increases 2,3-diphosphoglycerate (2,3-DPG): chemical found in RBCs from glucose metabolic pathway. 2,3-DPG binds to Hb and decreased affinity for O2. Temp: at increased temperature decreased affinity of Hb for O2.
32
Lung cancers
``` Non-small cell carcinoma (80-85%) - Squamous cell carcinoma - Adenocarcoma - Carcinoid - Large cell Small cell carcinoma (15%) ```
33
Squamous cell carcinoma of the lung
Form from square shaped cells that produce keratin. Develop centrally. Strong associated with smoking. Can produce parathyroid hormone-related peptide (PHTrP)
34
Adenocarcinoma of the lung
Originate from glandular structures that produce mucin Develop peripherally in bronchial or alveolar wall. Strongly associated with smoking Can cause hypertrophic osteoarthropathy and can present with clubbing, joint pain, bone pain
35
Carcinoid tumours of the lung
Rare (1-2%) Develop from mature neuroendocrine cells. Can present as carcinoid syndrome
36
Large cell tumours of the lung
5-10% Lack glandular and squamous differentiation Most common in peripheries.
37
Small cell carcinoma of the lung
``` Originate from neuroendocrine cells Develop centrally near main bronchus. Strong associated with smoking Rapidly growing and metastasise early. Strong associated with smoking. Paraneoplastic syndromes: SIADH (ADH), Cushing's syndrome (ACTH). Lambert-Eaton Syndrome (Antibodies against presynaptic calcium channel of neuromuscular junction) ```
38
Investigations for lung cancer
Contrast CT chest Staging PET-CT or CT-AP +/- Head Biopsy: transbronchial, US guided endoscopic, CT-guided, video-assisted thoracoscopic
39
Management of Lung cancer
Medical: Metastatic: Chemo +/- radio Small cell: often metastasised to brain (prophylactic radiotherapy) Non-small cell: immunotherapy agents ``` Surgical: Lobectomy Pneumonectomy Wedge resection Sleeve resection VATS (video-assisted thoracoscopic surgery) ```
40
Tidal volume
Volume that enters and leaves with each breath from normal quiet inspiration to normal quiet expiration Average: 0.5L Increased in pregnancy
41
Inspiratory reserve volume
Extra volume that can be inspired above tidal volume, from normal quiet inspiration to maximum inspiration Average: 2.5L Relies on muscle strength, lung compliance and normal starting point (end of tidal volume)
42
Expiratory reserve volume
Extra volume that can be expired below tidal volume, from normal quiet expiration to maximum expiration Average: 1.5L Relies on muscle strength and low airway resistance. Reduced in pregnancy, obesity, severe obstruction
43
Residual volume/reserve volume
Volume remaining after maximum expiration Average: 1.5L Cannot by measured by spirometry
44
Vital capacity/forced vital capacity
Volume that can be exhaled after maximum inspiration Inspiratory reserve volume + tidal volume + expiratory reserve volume Average: 4.5L Requires adequate compliance, muscle strength, low airway resistance
45
Inspiratory capacity
Volume breathed in from quiet expiration to maximum inspiration Tidal volume + inspiratory reserve volume Average: 3L
46
Functional residual capacity
Volume remaining after quiet expiration Expiratory reserve volume + residual volume Average: 3L Affected by height, gender, posture, lung compliance
47
Total lung capacity
Volume of air in lungs after maximum inspiration Residual volume + expiratory reserve volume + tidal volume + inspiratory reserve volume Average: 6L Restriction <80% predicted Hyperinflation >120% predicted Measure by helium dilution
48
Anatomical dead space
Volume of air that never reaches alveoli and so never participates in respiration. Includes upper and lower Respiratory tract up to and including terminal bronchioles
49
Alveolar (distributive) dead space
Volume of air that reaches alveoli but never participates in respiration. This can reflect alveoli that are ventilated but not perfused E.g. PE
50
Simple spirometry
Measures: tidal volume, inspiratory reserve volume, expiratory reserve volume
51
Helium dilution
Measures total lung capacity
52
Nitrogen washout
Method for calculating serial/anatomical dead space
53
Forced vital capacity (FVC)
Maximal volume of air expelled in one maximal expiration from a point of maximal inspiration Obstructive: reduced Restrictive: <80% predicted
54
Forced expiratory volume in 1 second (FEV1)
Maximal volume of air that a subject can expel in one second from a point of maximal inspiration Obstructive: <80% predicted Restrictive: <80% predicted
55
FEV1/FVC ratio
Obstructive: <0.7 Restrictive: >0.7

X. MRCS: Pathophysiology (13 decks)

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