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Y3- Transition > Physiology > Flashcards

Physiology Flashcards

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1
Q

4 steps of respiration?

A

Ventilation
Gas exchange (alveoli and blood)
Gas transport
Gas exchange (at tissue)

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2
Q

What is Boyle’s Law?

A

As the volume of a gas increases the pressure exerted by the gas decreases

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3
Q

Structure of cardiac muscle?

A

Striated with gap junctions for communication and desmosomes for adhesion

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4
Q

How does ventilation occur?

A

Chest wall stretches
The Increase in the size of the lungs make the intra-alveolar pressure to fall
The air then enters the lungs down its pressure gradient

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5
Q

What is alveolar surface tension?

A

Attraction between water molecules at liquid air interface- present in alveoli- stop COLLAPSE

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6
Q

What produces surfactant, and why?

A

Produced by type 2 alveoli

Lowers alveolar surface tension- prevents collapse

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7
Q

What is alveolar interdependence?

A

If an alveolus start to collapse the surrounding alveoli are
stretched and then recoil exerting expanding forces in the
collapsing alveolus to open it

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8
Q

Major muscle of inspiration?

A

Diaphragm and external intercostals

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9
Q

Accessory muscles of inspiration?

A

Sternocleidomastoid, scalenus, pectoral

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10
Q

What does parasympathetic innervation cause the bronchus to do?

A

Constrict

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11
Q

What does sympathetic innervation cause the bronchus to do?

A

Dilate

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12
Q

What is tidal volume?

A

Volume of air entering or leaving lungs during a single breath

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13
Q

What is residual volume?

A

Minimum volume of air remaining in the lungs even after a maximal expiration

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14
Q

What is functional residual capacity?

A

Volume of air in lungs at end of normal passive expiration

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15
Q

What is vital capacity?

A

Maximum volume of air that can be moved out during a single breath following a maximal inspiration

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16
Q

What is total lung capacity and how is it calculated?

A

Maximum volume of air that the lungs can hold

Vital Capacity + Residual Volume

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17
Q

Is actin thick or thin?

A

Thin

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18
Q

Is myocyin thick or thin?

A

Thick

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19
Q

How is muscle tension produced?

A

By sliding of actin filaments on myocin filaments

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20
Q

In cardiac muscle, where is the calcium released from?

A

Sarcoplasmic reticulum

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21
Q

What does inotropic mean?

A

Increase force of contraction

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22
Q

What does chronotropic mean?

A

Increase heart rate

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23
Q

Why is alveolar ventilation less than pulmonary ventilation?

A

Anatomical dead space

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24
Q

Causes of metabolic acidosis?

A

Lactic acidosis
Renal failure
Sepsis

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25
Cause of metabolic alkalosis?
Vomiting
26
Causes of respiratory alkalosis?
Hyperventilation: Anxiety Pain early sepsis
27
What is partial pressure?
The pressure that gas would exert if it occupied the total volume for the mixture in the absence of other components
28
Which part of the brainstem modifies respiration?
Pons
29
Which part of the brainstem generates the rhythm of respiration?
Medulla
30
What do central chemoreceptors respond to?
H+ level of CSF (increased H+ causes hypercapnia)
31
3 important pressures in ventilation?
Atmospheric Intra-alveolar Intrapleural
32
What is lung compliance?
Compliance is measure of effort that has to go into stretching or distending the lungs
33
When might lung compliance decrease?
pulmonary fibrosis, pulmonary oedema, lung collapse, pneumonia, absence of surfactant (restrictive)
34
When might lung compliance increase?
COPD- hyperinflation of lungs | obstructive
35
How do emphysema and pneumothorax affect gas exchange?
Decreased surface area
36
How do pulmonary fibrosis, pulmonary oedema and pneumonia affect gas exchange?
Increased thickness
37
How does pulmonary embolism affect gas exchange?
Decreased perfusion
38
What does left-sided heart failure cause?
Pulmonary capillary congestion and pulmonary oedema (SOB, orthopnea, PND)
39
What shifts oxygen dissociation curve to the right (Bohr effect)?
Increase PCO2 Increase H+ conc Increase temp Increase 2,3-biphosphoglycerate
40
In anaemia, what would be the arterial PO2 sensed by peripheral chemoreceptors?
Normal!
41
Examples of investigations for SOB?
``` CXR ECG FBC ABG Troponin T + many others (e.g. spirometry, ECHO, VQ scan etc.) ```
42
What is FVC?
Forces vital capacity- maximum volume that can be forcibly expelled from the lungs following a maximum inspiration
43
What is FEV1?
Forced expiratory volume in one second
44
In obstructive disease, what are the results of FVC, FEV1 and FEV1/FVC?
FVC- normal FEV1- low FEV1/FVC- low
45
In restrictive disease, what are the results of FVC, FEV1 and FEV1/FVC?
FVC- low FEV1- low FEV1/FVC- normal
46
Mechanism of AF?
Multiple wavelets of re-entry
47
What is paroxysmal AF?
Paroxysmal and lasting less than 48 hours
48
What is persistent AF?
An episode of AF lasting greater than 48 hours, which can still be cardioverted to NSR
49
What is permanent AF?
Inability of pharmacologic or non-pharmacologic methods to restore NSR
50
Causes of AF?
``` Hypertension Heart Failure Obesity Familial Valve disease Alcohol abuse COPD Pericarditis etc. ```
51
What is idiopathic AF?
Absence of any heart disease and no evidence of ventricular dysfunction
52
Symptoms of AF?
``` Palpitations Pre-syncope Chest pain Dyspnea Sweatiness Fatigue ```
53
ECG features of AF?
Irregularly irregular atrial rate >300 ABSENT P WAVE
54
What does a ventricular rate of >60bpm suggest in AF?
AV conduction disease
55
Principles of AF treatment?
Rate or rhythm control + Anti-coagulation
56
Name some drugs to control rate in AF?
Digoxin Beta blockers Verapamil
57
How can normal sinus rhythm be restored in AF?
Direct current cardioversion or pharmacologically
58
How can normal sinus rhythm be maintained in AF?
Anti-arrhythmic drugs Catheter ablation Radiofrequency ablation
59
What is used to assess stroke risk in AF?
CHA2DS2-VASc score
60
Criteria of CHA2DS2-VASc score?
``` Heart failure Hypertension >75 years Diabetes Stroke Vascular disease Female ```
61
Name some anti-arrhythmic drugs used in AF?
``` Lignocaine Flecainide Propranolol Amiodarone Dronedaron Verapamil ```
62
Name some anti-coagulants used in AF?
Warfarin Rivaroxaban Apixaban
63
What can be used to assess major bleeding risk when on anti-coagulation?
HAS-BLED
64
What is atrial flutter?
Rapid and regular form of atrial tachycardia
65
Mechanism of atrial flutter?
Macro-reentrant signals in right atrium ONLY
66
ECG features of atrial flutter?
SAW-TOOTH
67
What can atrial flutter cause?
Progression to AF | Thromboembolism
68
Treatment of atrial flutter?
RF ablation Cardioversion Warfarin
69
62 year old smoker with SOB. Barrel shaped chest and hyper-resonant percussion note. What will happen to his total lung capacity, lung diffusion capacity and FEV1/FVC ratio?
Increased total lung capacity Decreased lung diffusion capacity Decreased FEV1/FVC ratio
70
Man in hospital post MI. Wakes up at night with SOB. He's now sitting with high flow O2 but has mild tachycardia and chest crackles posteriorly. What do you prescribe?
Probably got pulmonary oedema IV furosemide + start nitrate infusion (venous dilation to reduce preload- decrease work of heart and backload on lungs)
71
Longterm treatment of heart failure?
Diuretics ACE inhibitor Beta blockers
72
74 year old woman with SOB on exertion for weeks. Weight loss, irregularly irregular pulse at 110bpm, tremor and normal cardiac auscultation. What investigation is diagnostic?
Thyroid function tests
73
28 yo tall thin woman with sudden right sided chest pain, worse on breathing. Has insomnia + taking diazepam at night. On oral contraceptive. RR 20, HR 90, no added sounds in chest. What is the mechanism of her shortness of breath?: A- loss of transmural pressure gradient across the lung wall B- ventilation perfusion mismatch C- respiratory muscle paralysis
B- ventilation perfusion mismatch
74
pH 7.34 pCO2 6.5 HCO3 38 pO2 6.1- what is this ABG classic of?
Compensated resp acidosis- in COPD (longterm CO2 retention)
75
56 yo farmer with SOB on exertion. History of hypertension. What will happen to his total lung capacity, lung diffusion capacity and FEV1/FVC ratio?
Decreased total lung capacity Decreased lung diffusion capacity Normal/increased FEV1/FVC ratio
76
pH 7.06 pCO2 2.9 pO2 12.8 HCO3 9.2 What are these results suggestive of?
Metabolic acidosis with respiratory compensation E.g. diabetics with DKA
77
65 yo with SOB after prescribed painkiller for knee. Stool black and tarry. Tired, chest and heart sound normal. Mechanism of SOB?
Reduced oxygen carrying capacity of the blood | could have been prescribed NSAIDs- cause gastric ulcer and bleeding
78
What is transmural pressure?
The transmural pressure gradient is the difference between intrathoracic (or ‘intrapleural’) and alveolar pressure (P in alveolus > P surrounding interstitial tissue)
79
How can DKA be compensated?
With Kussmaul breathing (deep, signing breaths)

Y3- Transition (9 decks)

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