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1
Q

a) Why does PCO2 increase during sleep in healthy person? Give 2 reasons.

A
  1. The sensitivity to CO2 falls during sleep ventilation decreases CO2 goes up
  2. Minute ventilation and tidal volume fall by 10% (13% in REM). Alveolar ventilation falls due to fall in tidal volume. Frequency of breathing and oxygen saturation are same.
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2
Q

a) Why does PCO2 increase during sleep in healthy person? Give 2 reasons.

A
  1. The sensitivity to CO2 falls during sleep ventilation decreases CO2 goes up
  2. Minute ventilation and tidal volume fall by 10% (13% in REM). Alveolar ventilation falls due to fall in tidal volume. Frequency of breathing and oxygen saturation are same.
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3
Q

What muscles lose tone in Obstructive Sleep Apnoea? Give 2 reasons.

A

Genioglossus

Levator palatini

  1. These muscles stiffen the soft palate and prevent constriction. When they are not active the airway is prone to collapse.
  2. During sleep the pharyngeal resistance increases (relaxed muscles + resistance is the cause) more respiratory effort to breathe.
  3. The airway at the back of the throat does not contain cartilage distensible.
    (When lying down, effects of gravity)
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4
Q

What causes collapse of upper airway?

A

Reduced upper airway muscle activity during sleep,
extra luminal pressure (ELP) and negative intraluminal pressure (ILP) can result in occlusion of the phalangeal airway during sleep called: Obstructive sleep apnoea.

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5
Q

c) You are given an Oxygen Dissociation curve. Mark the following points:
i) level of normal wake person
ii) normal person in REM sleep
iii) COPD awake person
iv) COPD person in REM sleep.

A

i) level of normal wake person 97
ii) normal person in REM sleep 96
iii) COPD awake person 95
iv) COPD person in REM sleep. 70
(gradually goes down)

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6
Q

a) In what percentage of asthmatics do airborne allergens cause asthma attacks.

A

75% about

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7
Q

b) Two allergens that trigger asthma.

A 
House mite dust
Cats
Dogs
Alternaria
Cockroach
Horses
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8
Q

c) Two non-allergy factors that trigger an asthma attack.

A

Exercise
cold air/sudden temperature change
stress/emotional causes

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9
Q

d) Name 2 inflammatory mediators of Asthma.

A

IgE bound to mast cell when crosslinked mast cell releases:

histamine, leukotrienes,

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10
Q

e) 2 T cell cytokines that cause B Cell Proliferation.

A

IL-2, IL-4, IL-5

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11
Q

i) What is the PCO2 during non-REM sleep in normal people (1)

A

96.5% (check)

Josie: 5.3kPa

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12
Q

i) What is the PCO2 during non-REM sleep in normal people (1)

A

96.5% (check)

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13
Q

ii) PCO2 during non-REM sleep in patients with heart failure (1) ?

A
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14
Q

c) Explain how PCO2 is affected during wakefulness in patients with chronic heart failure (2)

A

Increased - failure of circulation to remove CO2 from blood due to pulmonary congestion caused by pulmonary oedema.

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15
Q

d) Explain how the use of diuretics relieves the problems of patients with heart failure (2)

A

Diuretics increase production of urine. Decrease blood volume and therefore BP. Reduce swelling (oedema) and water build up in lungs caused by HF.

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16
Q

What muscles lose tone in Obstructive Sleep Apnoea? Give 2 reasons.

A

Genioglossus

Levator palatini

  1. These muscles stiffen the soft palate and prevent constriction. When they are not active the airway is prone to collapse.
  2. During sleep the pharyngeal resistance increases (relaxed muscles + resistance is the cause) more respiratory effort to breathe.
  3. The airway at the back of the throat does not contain cartilage distensible.
    (When lying down, effects of gravity)
How well did you know this?
1
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17
Q

What causes collapse of upper airway?

A

Reduced upper airway muscle activity during sleep,
extra luminal pressure (ELP) and negative intraluminal pressure (ILP) can result in occlusion of the phalangeal airway during sleep called: Obstructive sleep apnoea.

How well did you know this?
1
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2
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18
Q

c) You are given an Oxygen Dissociation curve. Mark the following points:
i) level of normal wake person
ii) normal person in REM sleep
iii) COPD awake person
iv) COPD person in REM sleep.

A

i) level of normal wake person 97
ii) normal person in REM sleep 96
iii) COPD awake person 95
iv) COPD person in REM sleep. 70
(gradually goes down)

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19
Q

a) In what percentage of asthmatics do airborne allergens cause asthma attacks.

A

75% about

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20
Q

b) Two allergens that trigger asthma.

A 
House mite dust
Cats
Dogs
Alternaria
Cockroach
Horses
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21
Q

c) Two non-allergy factors that trigger an asthma attack.

A

Exercise
cold air/sudden temperature change
stress/emotional causes

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22
Q

d) Name 2 inflammatory mediators of Asthma.

A

IgE bound to mast cell when crosslinked mast cell releases:

histamine, leukotrienes,

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23
Q

e) 2 T cell cytokines that cause B Cell Proliferation.

A

IL-2, IL-4, IL-5

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24
Q

f) What drug type can be used to treat asthma?

A

Bronchodilator containing corticosteroids or B2-agonist. (Dilates the bronchial airways).

— Corticosteroids and B2 agonist

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25
Q

i) What is the PCO2 during non-REM sleep in normal people (1)

A

96.5% (check)

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26
Q

ii) PCO2 during non-REM sleep in patients with heart failure (1) ?

A
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27
Q

c) Explain how PCO2 is affected during wakefulness in patients with chronic heart failure (2)

A

Increased - failure of circulation to remove CO2 from blood due to pulmonary congestion caused by pulmonary oedema.

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28
Q

d) Explain how the use of diuretics relieves the problems of patients with heart failure (2)

A

Diuretics increase production of urine. Decrease blood volume and therefore BP. Reduce swelling (oedema) and water build up in lungs caused by HF.

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29
Q

a) Under a light microscope, how would you distinguish between a cross-section of human trachea and respiratory bronchioles (4)

A

Trachea: bigger lumen, wall has hyaline C-shaped rings of cartilage (smooth muscle only posteriorly); epithelium is PSEUDOSTRATIFIED CILIATED columnar. Sero-mucous glands + goblet cells.

Bronchioles: do not contain any cartilage, only smooth muscle in the wall, smaller lumen, epithelium is SIMPLE columnar + non-ciliated. CLARA cells.

30
Q

a) Describe 3 light microscopic changes that can be seen with patients undergoing an asthma attack (3)

A

From practical: Bronchoconstriction and mucus inside where air should be

Airway epithelium is very constricted, wavy surfaces

  • Enlarged submucosal glands
  • Mucus hypersecretion
  • Goblet cell hyperplasia
  • Gaps in epithelium fragility
  • Thickening of BM
  • Constricted bronchioles/hypertrophy of smooth muscle– smaller lumen
  • Mucus plugs blocking the airways; greater production of neutrophils
  • Vasodilation
  • Plasma leak edema in mucous membranes + inflammation by infiltration of eosinophils
31
Q

c) Explain how the above 3 changes contribute to the symptoms of asthma (3)

A

Cough, shortness of breath, wheezing, chest tightness bronchoconstriction narrows the airways + oedema swelling

Swelling of submucosal glands and hypersecretion of mucus from goblet cells can form mucus plugs in the airways, increasing resistance to passage of air into lungs SOB.

Hypersecretion of mucus leads to cough reflex to clear mucus build up to back of throat.

32
Q

a) Which type of cell would be most abundant in someone who is a healthy non-smoker?

A

Macrophages

33
Q

a) Which type of cell would be most abundant in someone who is a smoker?

A

Neutrophils

34
Q

5) Which cell secretes surfactant?

A

Type 2 epithelial

35
Q

d) What is the main histological feature of emphysema?

A
  • Weakened alveoli walls rupture to form large pores (fewer, bigger alveoli)
  • Tissue destruction
  • Increased type II epithelial cells
  • Increased number of fibroblasts
  • Increased collagen deposition
36
Q

a) Explain how the cell types from a, b and c lead to the development of emphysema

A

Caused by secretion of protease enzymes from macrophages and neutrophils - serine proteinases and metalloproteinases; enzymes that destroy lung tissue. Loss of surface area, decrease in gas exchange in capillaries -breathlessness

37
Q

a) Give two treatments for emphysema and explain their mechanism

A
  1. Dual protease inhibitor: inhibit the proteases produced by phagocytes in lung tissue (NE+MMP) which are destroying lung tissue.

Antioxidants can also reduce the effects of oxidants

Other answers:

  1. Bronchodilator B2 agonist that relaxes smooth muscle in the bronchioles, dilating them, reducing resistance to airflow and making it easier to breathe.
  2. Inhaled corticosteroids: they work by blocking the late-phase immune reaction, decreasing inflammation and reducing inflammatory cells (neutrophils, macrophages).
  3. Dual protease inhibitor: inhibit the proteases produced by phagocytes in lung tissue (NE+MMP) which are destroying lung tissue.
  4. Mucolytic drugs, antibiotics, supplemental oxygen clear mucus from airways, clear infection if there is one, increase oxygen partial pressure.
38
Q

1) How does regional ventilation change from the base of the lung to the apex? (1/2)
2) Why is this?

A

Regional ventilation is higher at the base of the lung than the apex.

  • Inside the lungs the pressure is atmospheric (=0)
  • Inside the pleural cavity the pressure is subatmospheric (-ve).
  • Due to lung weight (effect of gravity acting on lungs) the lungs are pulled away from the chest wall in the apex, squashing the basal regions.
  • The pressure in the pleural cavity near the apex is therefore more negative than at the base.
  • The pressure difference is therefore smaller at top than bottom.
  • The base of the lung sits lower down on the pressure volume curve than the top of the lung. This means that for a given pressure, the base of the lung will increase in volume more than the apex.
  • *Base has a smaller resting volume so can increase in volume more.
  • Better perfused
39
Q

1) Someone is tested with spirometer and it is found that their inspiratory reserve volume and vital capacity is lower than would be predicted. What can you interpret from this and explain why? (3)

A

The person may have a restrictive lung disorder e.g. pulmonary fibrosis
There is reduced lung compliance and elastic recoil which means that the lungs are STIFF, and cannot expand as much as healthy lungs large volumes of air cannot be inspired as the lungs cannot stretch as far low VC + IRV.

40
Q

) A young healthy male wants to be tested for his lung capacities (how interesting) he is tested with spirometry and it is found that his expiratory reserve volume is disproportional to his inspiratory reserve volume. What can you interpret from this and what is the course of action? (2)

A

??

41
Q

3) Some in a GP has an asthma attack and the take a bronchodilator, state the changes of some lung capacities, does anyone know these? (2)

A

Asthma increases the residual volume due to bronchoconstriction and mucus plugging in the lower airways which causes gas trapping. The person can still breathe in but inspiratory volumes (inspiratory reserve volume, tidal volume) decreased due to gas trapping.

42
Q

4) The asthmatic take a b2-agonist inhaler, state two ways in which this increases lung function (2)

A

Relax the bronchioles smooth muscle, open up the airways, increase airflow to lungs. Dilate the airways, decreasing resistance to airflow. Reduces resistance. Less air trapping.

43
Q

3) State which volume that can’t be expelled from the lung?

A

Residual volume

44
Q

1) What cell synthesises and secretes lysozyme

A

Clara

45
Q

2) Which cell is involved in xenobiotics?

A

Clara cell

46
Q

3) Which cell clears derbies out of the large airways?

A

Ciliated cells

47
Q

4) Which cell facilitates gas exchange?

A

Type 1 epithelial

48
Q

5) Which cell secretes surfactant?

A

Type 2 epithelial

49
Q

Which lung volume would increase with someone suffering obstructive disease?

A

RV, TLC, FRC, TV

50
Q

FEV1 / FVC = 37.5% (ie 1.5/3.8)

On the basis of these results, indicate whether the patient has a restrictive or obstructive lung disorder.

Give two justifications for your diagnosis based on the lung function data.

A

This is an OBSTRUCTIVE disorder. (1 mark)

(i ) The FEV1 / FVC ratio is below the normal range (or put another way, the FEV1 is low but the FVC is normal). (1 mark)
(ii) The FRC is above the normal range (or hyperinflation). (1 mark)

51
Q

Which lung volume would decease if you had an increased tidal volume?

A

Inspiratory, expiratory, FRC

52
Q

the type and location of receptors that give rise to cough

A

Irritant receptors (rapidly adapting stretch receptors ) located in the pharynx down to the bronchi including larynx, trachea, carina, main bronchi, smaller bronchi

53
Q

the afferent pathways by which this information is relayed to the central nervous system (CNS)

A

Afferent information is relayed by the vagus nerve and via the superior laryngeal nerve (a branch of the vagus) from the larynx

54
Q

structures within the CNS that integrate afferent information to generate a “motor programme” for cough

A

Afferent information synapses first at the nucleus of the solitary tract and is then integrated within networks in the medulla oblongata/brainstem/cough centre. The nucleus ambiguus and nucleus retoambigualis supply the appropriate efferent nerves

55
Q

the efferent nerves and muscles whose co-ordinated innervation gives rise to the mechanical events that comprise a cough

A

Efferent nerves: Laryngeal, phrenic, spinal nerves

Muscles: Laryngeal (glottic), Diaphragm, Expiratory muscles (abdominal, internal intercostals)

56
Q

Define the term FEV1 [1]

A

Forced expired volume in the first second of expiration

57
Q

Define the term FVC [1]

A

Forced vital capacity

total amount of air exhaled during the FEV test.

58
Q

Draw on the graph a line representing the result of the test performed in two patients, one with severe obstructive lung disease and one with restrictive lung disease. Both patients have an FVC of 4 litres. Clearly identify which line represents which patient. [2]

A

Obstructive lung disease should have a flat gradient with an FEV1 clearly less than 3.2 litres (80%). Restrictive lung disease should have a normal or steeper gradient with an FEV1 greater than 3.2 litres. As stated, both should have an FVC of 4 litres. [1 mark per line, 2 total]

59
Q

Identify two respiratory diseases in which you would expect to observe an obstructive breathing pattern (please note: the answer chronic obstructive pulmonary disease will not gain a mark!) [2]

A

Asthma, emphysema or chronic bronchitis

60
Q

Identify one respiratory disease in which you would expect to observe a restrictive breathing pattern. [1]

A

Pulmonary fibrosis, interstitial lung disease, sarcoidosis, kyphoscoliosis.

61
Q

Identify a test that is useful for determining day to day variability in lung function in a patient’s home. [1]

A

Peak expiratory flow measurement, “Peak flow” 1 mark

62
Q

What do the terms FEV1 , FVC and FRC stand for? [3]

A 
FEV1 = Forced Expired (or Expiratory) Volume in 1 second.
FVC = Forced Vital Capacity
FRC = Functional Residual Capacity
63
Q

Calculate the ratio of FEV1 / FVC for this patient. [1]

A

FEV1 / FVC = 37.5% (ie 1.5/3.8)

64
Q

FEV1 / FVC = 37.5% (ie 1.5/3.8)

On the basis of these results, indicate whether the patient has a restrictive or obstructive lung disorder.

Give two justifications for your diagnosis based on the lung function data.

A

This is an OBSTRUCTIVE disorder. (1 mark)

(i ) The FEV1 / FVC ratio is below the normal range (or put another way, the FEV1 is low but the FVC is normal). (1 mark)
(ii) The FRC is above the normal range (or hyperinflation). (1 mark)

65
Q

(a) Define Henry’s law. [3]

A

At constant temp, the amount of given gas that dissolves in a given type and volume of liquid is DIRECTLY PROPORTIONAL to the partial pressure of that gas in equilibrium with that liquid

66
Q

(b) What globin chains are present in HbA2? [1]

A

2 alpha and two delta

HbA = 2 alpha and two beta

67
Q

(d) Give the three main functions of haemoglobin. [3]

A

carry 02, carry Co2, buffering

68
Q

(a) What is the relationship between P(alv) and P(atm) at the end of a tidal expiration? (>, = or

A

..

69
Q

(b) What happens to the interpleural pressure during a forced expiration? (large increase, no change or large decrease) [1]

A

..

70
Q

(c) Define lung compliance. [1]

A

..

71
Q

(d) What are three changes that occur to air as it passes from the atmosphere to the alveoli? [3]

A

warmed, humidified, slowed, mixed

72
Q

(e) Draw the flow rate-volume loops for a person with (i) COPD and (ii) a restrictive lung disease. [4]

A

coving, top, restrictive move to ?

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