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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Nasal vestibule

A

Area just inside the nostril leading to nasal cavity

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2
Q

Defence to particulates in the vestibule

A

Hairs that catch large particulates

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3
Q

Turbinates of the nose

A

Outpouching of bone associated with epithelium in the vestibules of the nose to increase SA of nasal cavity to air condition

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4
Q

The paranasal sinuses and their role

A

Small hollow spaces in the bones around the nose
Frontal (lower forehead)
Maxillary (cheekbones)
Ethmoid (beside the upper nose)
Sphenoid (behind the nose)
All of which are paired
They’re evaginations of mucous membrane from the nasal cavity
They humidify air and resonate sound

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5
Q

Frontal sinuses

A

Within the frontal bone and the pair is separated by a midline septum
Found above orbit and across superciliary arch (where the eyebrows are found)

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6
Q

Nerve Supply of Frontal Sinuses

A

Ophthalmic division of V nerve (trigeminal nerve)

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7
Q

Maxillary Sinuses

A

Located within body of the maxilla
Pyramidal shape
Lateral wall of the nose is it’s base and it’s apex is the zygomatic process of the maxilla
Floor-alveolar process
Roof - floor of orbit

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8
Q

Maxillary sinuses open into the …. via the …

A

Open into the middle meatus
Via the hiatus semilunaris

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9
Q

Ethmoid Sinuses

A

Aero like appearance (labyrinthine structure)
Between the eyes

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10
Q

Ethmoid sinuses drain by the … into the …

A

Semilunar hiatus
Middle Meatus

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11
Q

What are meatuses of the nasal cavity?

A

Spaces created by the turbinates

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12
Q

What is the nerve supply of the Ethmoid Sinuses?

A

Ophthalmic and maxillary divisions of the V (trigeminal) nerve

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13
Q

Sphenoid Sinuses

A

Inferior to pituitary fossa and optic canal
Medial to cavernous sinus

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14
Q

Sphenoid sinuses empty into the…

A

Sphenoethmoidal recess

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15
Q

Nerve supply of sphenoid sinuses

A

ophthalmic divisions of the V (trigeminal) nerve

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16
Q

Eustachian tube

A

Connects middle ear to nasopharynx aerating middle ear system by clearing mucus into the nasopharynx

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17
Q

Folds of oropharynx

A

Palatoglossal then palatopharyngeal arches (on superior wall and into lateral walls)
Palatine tonsils on lateral walls

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18
Q

Larynx valvular function

A

Prevents liquid and food entering the lung

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19
Q

Single laryngeal cartilages

A

Epiglottis x1
Thyroid x1
Cricoid x1

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20
Q

Double laryngeal cartilages

A

Cuneiform x2
Corniculate x2
Arytenoid x2

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21
Q

Palpable slit in larynx is called…

A

The Cricothyroid Ligament
Access to trachea below level of blockage that doesn’t require you to go through bone (in an emergency)

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22
Q

Larynx innervation

A

By 2 branches of the Vagus Nerve:

Superior Laryngeal Nerve: Divides into internal branch which supplies sensation, and external branch which provides motor supply to cricothyroid muscle

Recurrent Laryngeal Nerve:
Provides motor supply to all muscles except the cricothyroid muscle (there is a R and L RLN)

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23
Q

Course of the Left RLN

A

Lateral to arch of aorta, loops under aorta, ascends between oesophagus and trachea

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24
Q

Approximate minute ventilation (air going in and out of lungs per minute)

A

5 litres

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25
Q

Carina

A

Bifurcation of the the trachea at the Sternal angle

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26
Q

What joins the incomplete C-ring cartilage of the trachea?

A

Trachealis muscle

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27
Q

What lines the internal trachea surface?

A

Ciliated, columnar, pseudostratified epithelium (goblet cells present)

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28
Q

Sensory Innervation of Trachea

A

Recurrent Laryngeal Nerve

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29
Q

Arterial Supply of Trachea

A

Inferior Thyroid Artery

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30
Q

Venous Drainage of Trachea

A

Brachiocephalic, accessory hemiazygos veins and azygos vein

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31
Q

Position of heart towards left of chest has what effect at the bifurcation point of the L and R main bronchus?

A

The R main bronchus is more vertically disposed, the L is more bent

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32
Q

Length of R and L main bronchi

A

R - 1-2.5cm (related to pulmonary artery)
L - 5cm (related to aortic arch)

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33
Q

Main Bronchi Bifurcate into…

A

Lobal Bronchi (3 for R lung: Upper, Middle, Lower and 2 for L: Upper (and lingula the remnant of middle), Lower)

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34
Q

Segmental bronchi divide into…

A

Terminal bronchioles into respiratory bronchioles

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35
Q

Acinus

A

Distal to terminal bronchiole comprising alveolar ducts, alveolar sacs and alveoli
Alveoli connected by pores of Kohn

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36
Q

Pleura

A

2 main layers of mesodermal origin
Parietal (has pain sensation) - attached to chest wall
Visceral (only has autonomic sensation)- attached to lung

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37
Q

Why is inflammation a “double-edged sword”?

A

It’s our defence against infection BUT many of us die of diseases caused by inflammatory processes

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38
Q

How is inflammation initiated?

A

In the tissues by epithelial production of H2O2 and release of cellular contents (provides stimulus for production of cytokines which recruit inflammatory cells)

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39
Q

How is inflammation amplified?

A

Tissue resident macrophages (alveolar macrophages in lungs) which coordinate what’s coming into the lung with rest of immune system (prevent large influx of neutrophils)

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40
Q

Toll-like (TLRs) and Nod-like (NLRs) receptors role and difference (innate response)

A

They’re signalling receptors in immune response
Toll-like receptors found on membrane (recognise common molecular patterns in pathogens)
Nod-like are found in cell cytoplasm

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41
Q

Endocytic/Phagocytic receptors (innate response)

A

Recognise common things on bacteria and engage in phagocytosis

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42
Q

PAMPs and DAMPs

A

Pathogen-associated molecular patterns
Damage-associated molecular patterns

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43
Q

Establishment of alveolar macrophages in the lung

A

Initial wave of foetal macrophages which are replaced by circulating foetal monocytes which colonise the lung and become tissue-resident alveolar macrophages (once exhausted by fighting infection, they are removed from lung and replaced by new monocyte-derived alveolar macrophages)

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44
Q

Macrophage plasticity

A

Macrophages can change behaviour to suit environment
During inflammation - host defence phenotype (activate immune system)
Post inflammation - Tissue-repair phenotype

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45
Q

Proportions of neutrophil location

A

Half free flowing in blood
Half adhere to endothelium in lungs and rest of body

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46
Q

What happens to neutrophils during resolution of inflammation? (after pathogen has been cleared)

A

They apoptose and are engulfed by macrophages and removed

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47
Q

Things receptors on neutrophils can recognise

A

-Bacterial structures
(cell walls, lipids,
peptides)

-Host mediators
(cytokines)

-Host opsonins

-Host adhesion
molecules (allow them
to stick to vessel walls)

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48
Q

Activation of neutrophils

A

By signalling transduction pathways (so neutrophils know the scale of the threat)

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49
Q

Adhesion of neutrophils to endothelium

A

Margination (initial contact by receptors called selectins on endothelium and neutrophils which interact)

Adhesion (firm adhesion and flattening of the neutrophil by receptors called integrins)

Neutrophils then migrate across endothelium into tissues

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50
Q

Neutrophil phagocytosis

A

Membrane pinching and invagination forming a phagosome
Which fuses with granules forming a phagolysosome

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51
Q

NAPDH Oxidase

A

An enzyme complex that exists on the membrane of a phagosome in a neutrophil which generates a ROS (toxic to bacteria)

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52
Q

Neutrophil apoptosis (post-inflammation)

A

Neutrophil advertises that it’s apoptopic using cell surface molecules which is recognised and engulfed by macrophages (changes macrophage role from attack to restoration of normal tissue function)

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53
Q

Nasopharynx lined by…

A

Pseudostratified columnar epithelium with goblet cells (respiratory epithelium)

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54
Q

Inferior portion of pharynx lined by…

A

Stratified squamous epithelium

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55
Q

Trachea lined by…

A

Pseudostratified columnar epithelium with goblet cells (respiratory epithelium)

56
Q

Epithelium goes from … to … in the finer bronchioles and then down to … in the alveoli

A

Columnar -> Cuboidal -> Squamous

57
Q

Molecules in epithelium of respiratory tract that are secreted to play a role in passive host defence

A

Antiproteases
Anti-fungal peptides
Anti-microbial peptides
Antiviral proteins
Opsins

58
Q

AT1 cells vs AT2 cells

A

AT1 - cover >95% of alveolar surface and are essential for air-blood barrier function of lungs

AT2 - Produce host defence proteins to protect alveolar space
(AT2 cells can also differentiate into AT1 cells)

59
Q

Mucus in respiratory tract

A

Produced by goblet cells and submucosal glands

Contain water, carbohydrates, lipids and proteins

Removes foreign material and reduces fluid loss (reduces evaporation across respiratory epithelium)

60
Q

Mucociliary Escalator

A

Rhythmic beating of ciliated cells in respiratory epithelium moving mucus from the lower respiratory tract into the pharynx

61
Q

Cough as a non-immune defence

A

Expulsive reflux protecting lungs from foreign bodies (involuntary or voluntary) (irritation in lower respiratory tract)

62
Q

Sneeze as a non-immune defence

A

Involuntary expulsion of air (irritation in upper respiratory tract)

63
Q

Following injury to airway apithelium…

A

Basal cell layer is a stem/progenitor cell pool that can migrate to the surface that proliferate and redifferentiate

64
Q

Mucus plugs

A

Prevent airflow through airways

65
Q

What innervates the diaphragm?

A

C3, C4, C5 (phrenic nerve)
Sensory afferents leave via Vagus (X) nerve

66
Q

Dead space in ventilation

A

Volume of air not contributing to ventilation
Anatomical - 150mls
Alveolar - 25mls
(175mls total)
So breathing in 500mls, only 350mls enters alveoli

67
Q

Bronchial Circulation

A

Arteries arise from descending Aorta
Bronchial veins drain into SVC
Systemic Pressure - 120mm/80mm

68
Q

Pulmonary Circulation

A

L and R Pulmonary Arteries
Lower pressure - 24mm/10mm

69
Q

Broncho-vascular bundle

A

Pulmonary artery and bronchus run alongside each other (artery not running alongside a vein)

70
Q

Normal PaCO2

A

4-6kPa

71
Q

Alveolar Gas Equation

A

PAO2 = PaO2 - PaCO2/R

72
Q

Normal pH of arterial blood

A

7.4 (7.36-7.44)

73
Q

Carbonic acid / bicarbonate buffers to control pH

A

CO2 + H2O <-(carbonic anhydrase)-> H2CO3 + H+ + HCO3-
CO2 under respiratory control (rapid)
HCO3- under renal control (less rapid)

74
Q

Response to respiratory acidosis

A

Often caused by reduced alveolar ventilation (CO2 build up)
This is corrected by reducing CO2 back down again or increasing HCO3-

75
Q

Respiratory acidosis (hypoventilation)

A

Increased PaCO2, decreased pH, mild increased HCO3-

76
Q

Respiratory alkalosis (hyperventilation)

A

Decreased PaCO2, increased pH, mild decreased HCO3-

77
Q

Metabolic acidosis

A

Reduced HCO3- and decreased pH

78
Q

Metabolic alkalosis

A

Increased HCO3- and increased pH

79
Q

FEV1

A

Forced Expiratory Volume in 1 second (normal if above 80% of predicted value)

80
Q

FVC

A

Forced Vital Capacity (normal if above 80% of predicted value)

81
Q

PEF

A

Peak Expiratory Flow (rate)
Single measure of the highest flow during expiration (very effort dependent) (measured using peak flow meter)

82
Q

Measuring lung volume by gas dilution

A

Measures air in lungs + all communicating airways
Gas breathed in from box
Change in conc once the gas is returned to box is a result of the distribution relative to the volume of the airways
(areas of lungs blocked by cysts etc. can’t be considered)

83
Q

Airways restriction if…

A

FVC is below 80% of predicted value

84
Q

Airways obstruction if…

A

FEV1/FVC is <0.70

85
Q

Alveolar ventilation is inversely proportional to…

A

PaCO2 (low alveolar ventilation = build up of CO2)

86
Q

Locations of centre in brain that control basic breathing rhythm

A

Pons - pneumotaxic centre and apneustic centre
Medulla - dorsal respiratory group (DRG) and ventral respiratory group (VRG)

87
Q

Difference between DRG and VRG

A

DRG - primarily inspiration focused
VRG - primarily expiration focused

88
Q

Expiration muscle activity

A

1st part - passive elastic recoil of thoracic wall + some contraction of inspiration muscle to slow down expiration
2nd part - Expiration muscle contraction

89
Q

Central chemoreceptors sensitive to CO2

A

Located in brainstem and pontomedullary junction but not the DRG/VRG complex
They’re sensitive to PaCO2 perfusing the brain
PaCO2 diffuses into the CSF shifting equation to make more H+ which binds to a chemoreceptor increasing the stimulus to breathe

90
Q

Why do central chemoreceptors go off PaCO2 and not [H+]?

A

The blood brain barrier is impermeable to H+ and HCO3- (at cerebral capillaries)

91
Q

Peripheral Chemoreceptors (responsible for all response to hypoxia due to reduced PaO2 but also respond partly to PaCO2) location and afferents

A

Carotid bodies - at bifurcation of common carotid, IX cranial nerve afferents
Aortic bodies - ascending aorta, vagus (X) nerve afferents
(fire in response to hypoxia to increase PAO2)

92
Q

Response to PaCO2 comes from…

A

60% central chemoreceptors
40% peripheral chemoreceptors

93
Q

Pulmonary CO

A

4.5-8L/min

94
Q

2 differences between pulmonary and systemic arteries

A

Thicker walls in systemic
More significant muscularization in systemic

95
Q

Pressure in a vessel =

A

CO x Resistance

96
Q

Pressure in pulmonary circulation =

A

mPAP - PAWP (pulmonary arterial pressure, left atrial pressure)
(= CO x PVR)

97
Q

V/Q mismatch explained

A

Due to gravity, perfusion is greater in the lower parts of the lung resulting in a lower V/Q ratio resulting in lower oxygen saturation of Hb (ventilation is the limiting factor so could be caused by other things like pulmonary oedema)

98
Q

Measuring exhaled nitric oxide (eNO)

A

Simple machines that measure nitric oxide in exhaled breathe
Measured in ppb
Normal = <25ppb
High (>50ppb) = eosinophilic airways inflammation (so could potentially indicate asthma)

99
Q

Cystic fibrosis inheritance

A

1:25 are carriers so 1:2500 births have CF

100
Q

What does the CFTR protein channel do?

A

Transport protein on membrane of epithelial cells that transport Cl- in and out (mutation = disregulated epithelial fluid transport)
80% of cases - Lung and GI
15% - just lung

101
Q

1 atmosphere of pressure is equivalent to…

A

1 bar - 1000 millibars
760 mmHg / torr
10m sea water
101.3 kPa

102
Q

Boyle’s Law

A

At constant temperature, absolute pressure of a fixed mass of gas is inversely proportional to its volume
P1V1 = P2V2

103
Q

Dalton’s Law

A

Total exerted by a mixture of gases is equal to the sum of the pressures that would be exerted by each of the gases if it alone occupied the total volume

104
Q

PiGas =

A

Patm x FiGas

105
Q

PAO2 =

A

PiO2 - PaCO2/R

106
Q

Death zone for breathing

A

Above 8000m it’s difficult to sustain life without supplemental O2

107
Q

R = Respiratory Quotient =

A

Normally 0.8 (drops closer to 0.7 with a fat rich diet)

108
Q

Pressure at top of everest (8848m)

A

33.5kPa

109
Q

Approximate alveolar oxygen pressure difference

A

1kPa higher in alveoli

110
Q

Normal blood pH

A

7.36-7.44

111
Q

Normal PaCO2

A

4.5-6kPa

112
Q

Normal PaO2

A

10.5-13.5kPa

113
Q

Normal response to hypoxia

A

Increased ventilation
CO2 drops (alkalosis)
Tachycardia

114
Q

In response to falling, PaO2, peripheral chemoreceptors…

A

Fire (carotid and aortic bodies) activating increased ventilation reducing PaCO2

115
Q

4 stages of lung development

A

Embryonic (0-5 weeks)
Pseudoglandular (5-17 weeks)
Cannalicular (16-25 weeks)
Alveolar (25 weeks - term)

116
Q

Embryonic stage of lung development

A

Lungs derived from foregut
They’re an outpouching of the oesophagus

117
Q

Pseudoglandular stage of lung development

A

Angiogenesis
Mucous glands form
Lungs full of fluid at this point

118
Q

Pseudoglandular stage of lung development

A

Angiogenesis
Mucous glands form
Lungs full of fluid at this point

119
Q

Cannalicular stage of lung development

A

Vascularisation (formation of capillary bed)
Respiratory bronchioles, alveolar ducts, terminal sacs

120
Q

Alveolar stage of lung development

A

Type 1 and 2 pneumocytes
Alveolar sacs

121
Q

Changes in alveoli from birth to 3-5 years

A

Thinning alveolar membrane and interstitium (increased alveolar complexity)

122
Q

Systemic vessels vasoconstrictors and vasodilators

A

Vasoconstrictor - O2

Vasodilator - hypoxia/acidosis/CO2

123
Q

Pulmonary vessels vasoconstrictors and vasodilators

A

Vasoconstrictors - hypoxia/acidosis/CO2

Vasodilator - O2

124
Q

Physiology of foetal circulation

A

Shunting of blood from R->L
High pulmonary vascular resistance (hypoxia)
Low systemic resistance (placenta)

125
Q

What occurs in alveoli of a foetus?

A

Foetal airways distended with fluid through active pumping in

126
Q

Role of ductus venosus

A

Shunt allowing oxygenated blood in umbilical vein to bypass the liver to the IVC (as blood is oxygenated in placenta)
Shunts about 30% of umbilical blood directly to IVC

127
Q

Shunts of blood in foetus heart

A

Ductus arteriosus (between pulmonary trunk and arch of aorta)
Foramen ovale (between the 2 atria)

128
Q

Fate of ductus arteriosus after birth

A

Muscular wall contracts to close after birth (mediated by bradykinin) becoming ligamentum arteriosum

129
Q

Adaptive changes of circulation at birth

A

Fluid squeezed out of lungs through birth process (tight gap)

Adrenaline stress = increased surfactant release

Gas is inhaled = O2 vasodilates pulmonary arteries, pulmonary vascular resistance falls, RA pressure falls = closed foramen ovale

Umbilical arteries constrict

Ductus arteriosus constricts

130
Q

Change in pressures pre and post birth

A

Pre birth - Pulmonary artery (pulmonary) higher

Post birth - Aorta (systemic) higher

131
Q

Laplace’s Law

A

P = 2T / r

132
Q

Surfactant is…

A

A phospholipid formed by type 2 pneumocytes
Abolishes surface tension
Dramatic increase 2 weeks before birth (so premature babies are deficient)

133
Q

Regulation of airways tone (diameter) controlled by…

A

ANS - Contractile signals cause increased intracellular Ca in smooth muscle activating actin-myosin contraction

Smooth muscle can tighten up due to inflammation

134
Q

Parasmypathetic bronchoconstriction

A

Vagus nerve neurons terminate in parasympathetic ganglia in airway cell

Short post-synaptic nerve fibres reach muscle releasing ACh which acts on muscarinic receptors (M3) on muscle cells

Stimulates airway smooth muscle contraction

135
Q

Sympathetic bronchodilation

A

Nerve fibres release noradrenaline activating alpha/beta adrenergic receptors

Activation of beta2 receptors on airway smooth muscle causes muscle relaxation

136
Q

Phagocytes vs Lymphocytes

A

Phagocytes - (monocytes and neutrophils) phagocytose

Lymphocytes - make and release antibodies and kill diseased cells

137
Q

Antibodies

A

Produced by B-lymphocytes (plasma cells)
Neutralise/elimijate pathogens

Medicine (14 decks)

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