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Flashcards in Lungs and respiratory system Deck (221):
1

Valsalva manoeuvre is

forced expiration against a closed glottis

2

4 phases of valsalva manoeuvre

initial pressure rise, reduced venous return and compensation, pressure release, return of cardiac output

3

3 types of cycles for ventilators

pressure cycled, time cycled, volume cycled

4

ventilators can be invasive or

non-invasive

5

2 types of pressure ventilator

positive or negative pressure ventilators

6

main mechanism of action of positive pressure ventilators

increased pressure within airways - air pushed into trachea

7

two types of positive pressure ventilators

flow generator, pressure generator

8

flow generator usually used on

adults

9

pressure generator usually used on (2)

children, adults when control of peak airway pressure is important

10

flow generator produces known pattern of gas flow during

inspiration

11

in flow generator, lungs fill at rate entirely controlled by

ventilator

12

pressure generator produces preset pressure in airway and rate of lung inflation depends on pressure generated by ventilator and on

respiratory resistance and compliance

13

negative pressure ventilation reduces ........ which sucks air into .......

ambient pressure around thorax..... lungs

14

negative pressure ventilation uses rigid chamber which encloses thorax or whole body below neck - pressure in tank is

reduced cyclically

15

negative pressure ventilation is used for

long term respiratory support or for overnight use on patients with respiratory muscle weakness

16

intermittent positive pressure ventilation is used during

surgical procedures that require muscle relaxation

17

intermittent positive pressure ventilation used in ICU when patient is ............. or ..............

sedated or paralysed, unable to make any respiratory movement

18

intermittent mandatory ventilation allows patient to

breath spontaneously

19

synchronised intermittent mandatory ventilation avoids

stacking of ventilator - delivering mandatory breath during period of spontaneous breath

20

mandatory minute ventilation monitors ........... in order to top up .....

exhaled volumes, patient's respiratory efforts

21

inspiratory pressure support = patient initiates breath and ventilator

raises airway pressure to a preset value

22

in inspiratory pressure support, at end of inspiration, positive airway pressure is removed to allow

unimpeded expiration

23

positive end expiratory pressure is particularly useful in patients who are ......... or ........... because there is a reduced .......... which leads to underventilation and a .........

anaesthetised or comatose; functional residual capacity; mismatched ventilation-perfusion balance

24

46000 non-smokers die from ... each year due to second hand smoke

CHD

25

second hand smoke causes more than ..... premature deaths per year

600 000

26

PULMONARY OEDEMA: excessive collection of watery fluid in lungs > collects in ..... > difficulty breathing

alveoli

27

PULMONARY OEDEMA: most common cause =

heart failure

28

PULMONARY OEDEMA: can be caused by

conditions affecting heart

29

PULMONARY OEDEMA: 7 causes

heart failure (increased pressure in pulmonary vessels), damage to lung capillaries, failure of lung lymphatics, kidney failure, lung damage, major injury, high altitude

30

PULMONARY OEDEMA: reduction in cardiac output > fall in effective circulating volume and arterial filling > activation of .....-......-..... system, non-osmotic release of ..., increased activity of renal sympathetic nerves > increased renal and ..... arteriolar resistance > water and .... retention > extracellular volume expansion and increased .... pressure > oedema

renin-angiotensin-aldosterone; ADH; peripheral; sodium ion; venous

31

8 respiratory system functions

O2/CO2 exchange, speech and vocalisation, pH and H+ control, smell, control of BP (angiotensin), pressure gradients promoting flow of venous blood and lymph, filtering of small blood clots, breath holding (expelling abdominal contents - Valalva Manoeuvre)

32

6 principal organs of respiratory system

nose, pharynx, larynx, trachea, bronchi, alveoli

33

Conducting division of respiratory system = from .... to ..... Only involved in ... not gas exchange

nostrils; bronchioles; airflow

34

respiratory division of respiratory system involved in airflow and ... ...../ components = .... and other gas exchange regions of distal airway

gas exchange; alveoli

35

upper respiratory tract = nostril > ...

pharynx

36

lower respiratory tract = ..... > alveoli

larynx

37

3 parts of pharynx

nasopharynx, oropharynx, laryngoparynx

38

trachea and bronchi have what type of epithelium

pseudostratified columnar

39

trachea pseudostratified columnar epithelium mainly made up of which 3 cell types

goblet cells, ciliated cells, short basal stem cells

40

2 types of gland in connective tissue beneath tracheal epithelium

mucous glands, serous glands

41

bronchioles have what type of epithelium

ciliated columnar

42

alveolar ducts and smaller divisions have what type of epithelium

non-ciliated squamous

43

2 types of alveolar cell

squamous (type I) alveolar cells, cuboidal great (type II) alveolar cells

44

which type of alveolar cell are larger (thin and broad) and cover more surface area (~95%)

squamous (type I) alveolar cells

45

which type of alveolar cell are more numerous but smaller and occupy less surface area (~5%)

cuboidal great (type II) alveolar cells

46

2 functions of great alveolar cells

repair epithelium when squamous cells damaged, secrete pulmonary surfactant

47

what is pulmonary surfactant

mixture of phosopholipids and protein

48

where does pulmonary surfactant coat

alveoli and smallest bronchioles

49

pulmonary surfactant prevents collapse of alveoli upon ...

exhalation

50

what makes up respiratory membrane

1 squamous alveolar cell, squamous endothelial cell (capillary) and shared basement membrane

51

respiratory membrane is how thick?

0.5μm

52

3 functions of pleura and fluid (pleural cavity)

reduction of friction, creation of pressure gradient, compartmentalisation

53

accessory muscles of deep inspiration (7)

erector spinae, scalenes, sternocleidomastoids, pec minor, pec major, serratus anterior, internal intercostals (intercartilaginous part)

54

Muscles of quiet inspiration (3)

diaphragm, scalenes, external intercostals

55

Quiet expiration is

passive

56

Muscles of deep expiration (5)

internal intercostals (interosseous part), external and internal obliques, rectus abdominalis, transversus abdominis

57

Pneumothorax =

collection of air in pleural space

58

Latrogenic pneumothorax =

follows procedure e.g. biopsy, mechanical ventilation

59

Catamenial pneumothorax =

at time of menstruation - endometriosis

60

Traumatic pneumothorax =

follows chest trauma. can be open or closed

61

open traumatic pneumothorax =

damage to chest wall

62

closed traumatic pneumothorax =

chest wall undamaged

63

primary spontaneous pneumothorax =

no previous lung disease. Tiny blebs = foci of weakness > rupture

64

blebs of primary spontaneous pneumothorax =

small subpleural thin=walled air containing spaces

65

primary spontaneous pneumothorax most common in

young adults

66

secondary spontaneous pneumothorax more common in who

older people

67

people who develop secondary spontaneous pneumothorax usually have

underlying lung disease

68

secondary spontaneous pneumothorax usually follows rupture of

bulla/cyst of COPD

69

tension pneumothorax unique characteristic

engorged veins

70

tension pneumothorax has valve like mechanism where air can ..... pleural cavity but cannot ....

enter; leave

71

in tension pneumothorax, pleural pressure .... meaning ventilation and circulation are compromised

rises

72

safest place for chest drain

5th intercostal space, mid/anterior axillary line

73

oxygen given to people with pneumothorax to manage

hypoxia

74

eupnea =

relaxed, quiet breathing

75

apnoea =

temporary cessation of breathing

76

dyspnoea =

laboured, gasping, shortness of breath

77

hyperpnoea =

increased rate and depth of breathing

78

hyperventilation =

increased pulmonary ventilation - high blood pH

79

hypoventilation

reduced pulmonary ventilation - low blood pH

80

Kussmaul respiration =

deep rapid induced by ACIDOSIS

81

Orthopnoea =

dyspnoea when lying down

82

tachypnoea =

accelerated respiration

83

ventral respiratory group has .... and .... neurons - inhibitory fibres (only one fires at once) used for deep respiration

inspiratory and expiratory

84

neurons of dorsal respiratory group are to the integrating centres in the spinal cord > phrenic nerves to .....; intercostal nerves to ..... for inspiration

diaphragm; external intercostals

85

dorsal respiratory group controls ..... and .....

inspiration and respiratory rhyhm

86

dorsal respiratory group has ..... centre only

inspiratory

87

ventral respiratory group innervates lower motor neurons controlling ......

accessory muscles of respiration

88

pontine respiratory group receives input from

higher brain centres

89

pontine respiratory group hastens/delays transition from .... to ....

inspiration; expiration

90

pontine respiratory group adapts breathing to special circumstances such as (4)

sleep, exercise, vocalisation, emotional reponses

91

T1-.... power intercostals (inspiration)

T12

92

T6-... power abdominals - cough, expel, balance and posture

T12

93

Boyles law =

pressure of gas irreversibly proportional to volume

94

Charles's law =

volume of gas proportional to temperature

95

Dalton's law =

total pressure of gas mixture = sum of all partial pressures

96

Henry's law =

at air water interface ,amount of dissolved gas is determined by solubility and partial pressure in air

97

INSPIRATION: ribs swing up > parietal pleura follows > visceral pleura follows > alveoli stretched > lung expands > pressure .... > inflow of air

drops

98

intrapulmonary pressure =

pressure inside respiratory tract at alveoli

99

On quiet inhalation, intrapulmonary pressure =

-1mmHg

100

On quiet exhalation, intrapulmonary pressure =

+1mmHg

101

Intrapleural pressure usually

-4mmHg

102

Intrapleural pressure drops to .... during inspiration (quiet)

-6mmHg

103

Intrapleural pressure rises to .... during expiration (quiet)

-3mmHg

104

Pneumothorax develops because without negative interpleural presure, ......... leads to collapsed lung

elastic recoil

105

3 factors affecting resistance to airflow

diameter of bronchioles, pulmonary compliance, surface tension of alveoli and distal bronchioles

106

bronchodilation stimulated by (2)

epinephrine and norepinephrine

107

bronchoconstriction stimulated by (4)

histamine, acetylcholine, cold air, chemical irritants

108

pulmonary compliance =

stiffness of lungs

109

pulmonary surfactant disrupts .... > resists compression due to water and ..... components

hydrogen bonds; hydrophobic

110

hypoxia =

deficiency of oxygen to tissue/ inability to use oxygen

111

hypoxaemic hypoxia =

low arterial PO2 > usually due to inadequate pulmonary gas exchange

112

Ischaemic hypoxia =

inadequate blood circulation

113

Anaemic hypoxia =

anaemia > oxygen carrying capacity of blood

114

Histotoxic hypoxia =

metabolic poison prevents tissue using oxygen

115

hypoxia often marked by

cyanosis

116

5 factors that effect gas exchange in lungs

pressure gradients of gases, solubility of gases, membrane thickness, membrane area, ventilation-perfusion coupling

117

tidal volume =

air inhaled/exhaled normal breathing

118

minute volume =

air exhaled per minute

119

vital capacity =

exhaled after maximum inspiration

120

functional residual capacity =

remaining in lungs after normal expiration

121

total lung capacity =

volume of lungs when maximally inflated

122

forced vital capacity =

forcibly and quickly exhaled after maximum inspiration

123

forced expiratory volume =

exhaled during 1st 2nd 3rd second etc of FVC

124

forced expiratory flow =

average rate of flow during middle half FVC test

125

Peak expiratory flow rate =

maximum volume during forced expiration

126

BRUCE protocol -

exercise tolerance testing - 20 minutes can be modified

127

patients with obstructive lung disease have

narrowed airways

128

examples of obstructive lung disease (2)

COPD, asthma

129

in obstructive lung disease FEV1/FVC ratio appears

low

130

obstructive lung disease if FEV1 less than or ration or less

80%; 0.7

131

GOLD criteria COPD: mild COPD > FEV1 = ...% or more and has ... spirometry after bronchodilator

80%; normal

132

GOLD criteria COPD: moderate COPD > FEV1 = ...-....% after ....

50-79%; bronchodilator

133

GOLD criteria COPD: severe COPD > FEV1 = ...-....% after ....

30-49%; bronchodilator

134

GOLD criteria COPD: moderate COPD > FEV1 = less than ....% after ......

30%; bronchodilator

135

patients with restrictive lung disease cannot

fully expand lungs

136

patients with restrictive lung disease have FEV1/FVC ratio that appears

normal

137

example of restrictive lung disease

pulmonary fibrosis

138

type I respiratory failure is hy....... and is due to ...........

hypoxaemic; ventilation-perfusion mismatch

139

type I respiratory failure has PaO2 less than .... with ...... PaCO2

60mmHg; normal/low

140

In type I respiratory failure, hyperventilation increased carbon dioxide removal but does not increase

oxygenation

141

Type I respiratory failure can be seen in (3)

pulmonary oedema, pneumonia, acute asthma

142

type II respiratory failure is hy.....

hypercapnic

143

type II respiratory failure has ... CO2 (...... 50mmHg)

high; more than

144

type II respiratory failure often due to

ventilation-perfusion mismatch

145

acute type II respiratory failure usually has pH less than

7.3

146

chronic type II respiratory failure usually has pH ..... due to renal compensation and increase in .....

only slightly decreased; bicarbonate

147

People with COPD often have ...... respiration

pursed lip

148

Chest x ray COPD often normal but 4 things which could be seen

bullae, overinflation, flattened diaphragm, deficiency of blood vessels in peripheral half of lung fields

149

COPD can be caused by ..... deficiency

alpha1- antitripsin

150

alpha1 antitripsin is a glycoprotein usually produced in the ..... that inhibits ........

liver; neutrophil elastase

151

gene for alpha 1 antitripsin is on chromosome ...

14

152

hereditary alpha 1 antitripsin deficiency accounts for ~....% of emphysema cases

2

153

3 main phenotypes for alpha1 antitripsin

MM (normal), MZ (Heterozygous deficiency), ZZ (homozygous deficiency)

154

1 in how many people are homozygous for alpha1 antitripsin deficiency?

1/5000

155

homozygotes for alpha1 antitripsin deficiency who develop breathlessness under 40 have radiographic evidence of ...... and are usually ....

basal emphysema; cigarette smokers

156

pneumonia = infection of lung ......, alveoli and airways - usually with virus or ....

interstitium; bacterium

157

3 classifications of pneumonia by locality

CAP (community acquired), HAP (hospital acquired), VAP (ventilator acquired)

158

2 classifications of pneumonia by localisation

bronchopneumonia, lobar pneumonia

159

3 classifications of pneumonia by mechanism/pathogen

bacterial pneumonia, viral pneumonia, aspiration pneumonia

160

6 symptoms of pneumonia

cough (dry/phlegm), rapid HB, fever, breathlessness, fatigue, headaches

161

4 risk factors for pneumonia

babies/very young children, elderly, smokers, health conditions/weakened immune system

162

incidence of pneumonia =

5/1000

163

pneumonia makes up for ...-...% of all lower respiratory tract infections with 1/.... requiring hospitalisation

5-10%; 1/3

164

COPD is characterised by

airway obstruction which is usually progressive and not fully reversible

165

COPD = chronic bronchitis +

emphysema

166

6 risk factors for COPD

tobacco smoke, indoor air pollution, outdoor air pollution, occupational dusts and chemicals, cannabis use, frequent lower respiratory tract infections during childhood

167

percentage of adult population with COPD

10%

168

....% of people with COPD die within 5 years of diagnosis

25%

169

COPD causes how many deaths per year?

30 000

170

121 symptoms of COPD

smoker/exsmoker 35+; exertional breathlessness; chronic cough; regular sputum production; tachypnoea; palpable liver edge; wheeze; winter exacerbations; tar staining of fingers; central cyanosis; FEV1/FVC ration less than 0.7; barrel chest

171

3 types of pulmonary fibrosis

replacement fibrosis, focal fibrosis, diffuse parenchymal lung disease

172

replacement fibrosis =

secondary to lung damage

173

focal fibrosis =

response to irritants

174

diffuse parenchymal lung disease =

in fibrosing alveolitis (idiopathic pulmonary fibrosis) + extrinsic allergic alveolitis

175

3 distributions of pulmonary fibrosis

localised (unresolved pneumonia), bilateral (TB), widespread (drug use)

176

most common cause of pulmonary fibrosis

idiopathic

177

3 presentations of pulmonary fibrosis

acute, subacute, chronic

178

acute pulmonary fibrosis =

fulminant, progressive, remitting, resolving course

179

subacute pulmonary fibrosis =

resolving, remitting, relapsing, progressive course

180

chronic pulmonary fibrosis =

insidious and slowly progressive

181

PROCESS OF PULMONARY FIBROSIS: (1) macrophages and alveolar epithelial cells are activated by several mechanisms > produce growth factors including (4)

fibronectin, platelet-derived growth factor, transforming growth factor beta and IGF-I

182

PROCESS OF PULMONARY FIBROSIS: (2) fibronectin, platelet-derived growth factor, transforming growth factor beta and IGF-I stimulate the deposition of type I and type II ....

collagens

183

PROCESS OF PULMONARY FIBROSIS: (3) there are two main features of pulmonary fibrosis: (1) cellular infiltration with ......... and plasma cells > thickening and fibrosis of alveolar walls

T lymphocytes

184

PROCESS OF PULMONARY FIBROSIS: (3) there are two main features of pulmonary fibrosis: (2) .... > increased cells within alveolar space (mainly macrophages and type II ...... shed from alveolar walls)

ALVEOLITIS; pneumocytes

185

cigarette smoke contains plycyclic aromatic hydrocarbons and nicosamines which are potent carcinogens and mutagens > release enzymes from ....... and ..... > destroy elastin > lung damage

neutrophil granulocytes and macrophages

186

smoking and asbestos are .... in promoting bronchial carcinoma

synergists

187

4 effects of smoking on large airways

increase in submucosal gland volume, increase in number of goblet cells, chronic inflammation, metaplasia and dysplasia of surface epithelium

188

4 effects of smoking on small airways

increase number and distribution of goblet cells, airway inflammation and fibrosis, epithelial metaplasia/dysplasia, carcinoma

189

3 effects of smoking on parenchyma

proximal acinar scarring, increase in alveolar macrophage numbers, emphysema (centri-acinar/ pan-acinar)

190

11 cancer causing chemicals in tobacco smoke

tar, arsenic, benzene, cadmium, formaldehyde, chromium, polonium-210, 1,3-butadiene, polycyclic aromatic hydrocarbons, nitrosamines, acrolein

191

cytokines involved in systemic inflammation in COPD (4)

IL-I(beta), IL-6, IL-18, TNF alpha

192

acute phase proteins involved in systemic inflammation in COPD

CRP, SAA

193

smokers have ...... within lumen which are capable of releasing .... and proteases > increase emphysema

neutrophil granulocytes; elastases

194

Imbalance between protease and .... can cause damage in airways

antiprotease

195

major serum antiprotease example

alpha-1 antitripsin

196

alpha1 antitripsin can be inactivated by

cigarette smoke

197

smoke has adverse effect on surfactant which causes .... of lungs

overdistension

198

CHRONIC BRONCHITIS: hypertrophy of mucus secreting .... in bronchial tree; increased number of ... cells; increased .... production

glands; goblet; mucus

199

CHRONIC BRONCHITIS: infiltration of inflammatory cells - mainly

CD8+

200

CHRONIC BRONCHITIS: ulcers may form as squamous epithelium replaces

columnar cells

201

CHRONIC BRONCHITIS: progression of disease = progressive squamous cell .... and ..... of bronchial wall

metaplasia; fibrosis

202

EMPHYSEMA: classified according to site of damage - 3 types

centri-acinar emphysema, pan-acinar emphysema, irregular emphysema

203

EMPHYSEMA: centri-acinar emphysema = concentrated around respiratory bronchioles and .... alveolar ducts therefore alveoli are .....

distal; well-preserved

204

EMPHYSEMA: most common type =

centri-acinar

205

EMPHYSEMA: pan-acinar emphysema = distension and destruction involve

whole acinus

206

EMPHYSEMA: pan-acinar emphysema = in extreme form, lungs become mass of

bullae

207

EMPHYSEMA: pan-acinar emphysema = ventilation-perfusion ....

mismatch

208

EMPHYSEMA: pan-acinar emphysema = occurs in alpha1 ....... deficiency

antitripsin

209

EMPHYSEMA: pan-acinar emphysema = shows ........ shadowing

right lung base

210

EMPHYSEMA: irregular emphysema = scarring and damage affecting lung ..... patchily without regard for acinar structure

parenchyma

211

Long term, patients with emphysema become .... and respiration becomes ...... driven

hypoxaemic; hypoxic

212

EMPHYSEMA: destruction of elastin > loss of lung elasticity > loss of pressure > .......

hyperinflation

213

2012, percentage of men who smoke

22%

214

2012, percentage of women who smoke

19%

215

2012, overall percentage of population who smoke

20%

216

nicotine = highly toxic .... and agonist of ...... cholinergic receptors

alkaloid; nicotinic

217

nicotine stimulates neurons of autonomic ganglia and blocks ........

synaptic transmission

218

nicotine induces peripheral vasoconstriction, tachycardia and therefore .... blood pressure

raises

219

nicotine in the brain binds to ..... neurons

dopaminergic

220

in adrenal medulla, nicotine binds to receptors on .... cells and ultimately causes release of .... into bloodstream

chromaffin; adrenaline

221

nicotine replacement therapy increases rate of smoking cessation by

70%