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Y1 Body system lecture notes year 1 > Respiratory > Flashcards

Respiratory Flashcards

(133 cards)

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1
Q

What are the functions of the respirator system

A

Gas exchange: O2 passes form air to blood; CO2 passes from blood into air
Speech
Smell

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2
Q

How can the function of respiratory be divided

A

Conducting portion: transports air; conditions air (warms, moistens, filters)
Respiratory portion: thin, moist, delicate membrane; site of caseous exchange

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3
Q

What are the paranasal sinuses and their role

A

Cavities within the skull sitting parallel to the nasal cavity

Produces mucus to protect from pathogens which trickles out when infected, to cause a runny nose

Frontal sinuses
Ethmoidal air cells
Sphenoid sinus
Maxillary sinus

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4
Q

What are the chonchae in the nasal cavity

A

Three ridges which create turbulence

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5
Q

What is a meatus

A

Hole which allows the air to pass from the chonchae into the sinuses

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6
Q

What is the mediastinum

A

Midline region which encloses the heart, major vessels, major nerves, trachea and oesophagus

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7
Q

What are the structures of left and right lungs

A

Right:
3 lobes: superior, inferior, middle
Fissure: oblique, horizontal

Left:
2 lobes: superior, inferior
Fissure: oblique

There are segments with their own venous drainage, arterial supply and nerve supply

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8
Q

What is on the medial surface of the lungs

A

Bronchi: most posteriorly
Pulmonary arteries: anterior to bronchi, superior to veins
Pulmonary veins: anterior and inferior

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9
Q

What is the upper vs lower respiratory tract

A

Everything above the larynx is upper and everything below the larynx is lower respiratory tract

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10
Q

What are the functions of the thoracic cage

A

Protection: bony cage around vital organs
Respiratory: Changes in thoracic volume underlie movement of fresh air into lungs and stale air out

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11
Q

What is in each intercostal space

A

3 thin muscle layers:
External intercostal
Internal intercostal
Innermost intercostal

Neurovascular bundle:
Intercostal vein
Intercostal artery
Intercostal nerve

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12
Q

What are the characteristics of the pleura

A

A membranous sac that encloses the lung and forms the pleural cavity

Visceral and parietal

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13
Q

What is breathing

A

The bodily function that leads to ventilation of the lungs

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14
Q

What are the pleural cavities

A

Two pleural cavities either side of the heart in the thoracic

Pleural cavity contains a thin film of fluid which help the lung to slide and creates surface tension between parietal and visceral layer to aid inspiration

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15
Q

What are the two types of disease that can affect ventilation and some examples

A 
Obstructive: 
Increased RV, FRC (emphysema)
Reduced TLC (COPD)
Examples: Asthma, COPD, lung cancer
Restrictive: 
Reduced RV, FRC, VC, TLC
Intrinsic: pulmonary fibrosis
Extrinsic: pneumothorax, disorders if the thoracic skeleton
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16
Q

How does pressure change in inspiration vs expiration

A

Inspiration: atmospheric pressure > alveoli pressure

Expiration: atmospheric pressure < alveoli pressure

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17
Q

What is the equation to determine how airway obstruction has a major effect on air flow

A

Flow= (k. change in pressure. r4)/ L

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18
Q

What inspiratory muscles are used for each type of breathing

A

Quiet: diaphragm, external intercostals stabilise rib cage
Increasing effort: diaphragm, external intercostal lift and expand rib cage, accessory muscles, neck muscles, shoulder girdle muscles

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19
Q

What expiratory muscles are used for each type of breathing

A

Quiet: elastic recoil of tissues

Increasing effort: internal intercostals, abdominal wall muscles

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20
Q

How are the respiratory muscles innervated

A

Diaphragm: phrenic nerve (C3, C4, C5)

Intercostals: segmental thoracic nerves

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21
Q

What is tidal volume

A

The volume of air move in or out of the lungs during normal breathing

at rest 6-7 ml/kg
during exercise 15ml/kg

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22
Q

What is inspiratory reserve volume

A

As deep a breath in as possible

typical: 430 ml/kg

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23
Q

What is expiratory reserve volume

A

as deep a breath out as possible

typical: 22ml/kg

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24
Q

What is the residual volume

A

air remaining in lungs even after a maximal expiration

typical: 14.5 ml/kg

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25
What is total lung capacity
Tidal volume + inspiratory reserve volume + expiratory reserve volume + residual volume
26
What is vital capacity
Tidal volume + inspiratory reserve volume + expiratory reserve volume
27
What is functional residual capacity
Expiratory reserve volume + residual volume
28
What is measured by vitalograph
Forced vital capacity (FVC) | Forced expiratory volume in 1 second (FEV1)
29
What is measured by a peak flow meter
Peak expiratory flow rate (PEFR)
30
What is compliance
The change in lung volume pre unit change in intrathoracic pressure
31
What is the surfactant layer
``` Reduces surface tension by acting as a detergent Produced by type II alveolar cells 90% phospholipid 10% protein Increases pulmonary compliance Prevents atelectasis Aids alveolar recruitment Minimises alveolar fluid Deficient in infant respiratory distress syndrome ```
32
What is the equation of proportion for rate of diffusion
Rate of diffusion @ surface area @ pressure gradient | @ = proportional to
33
What is the pressure gradient
The difference in partial pressure of the respective gases in the alveolus and the blood
34
What is the partial pressure of a gas in mixture of gases
The pressure that it would exert if it was the only gas in the container
35
What is the universal gas equation
PV =nRT | Pressure x volume = number of moles x the gas constant x temperature (kelvins)
36
How can the partial pressure of a gas be calculated?
Fractional conc x pressure of full mixture of gas
37
What are the characteristics of partial pressure of oxygen in alveoli
Lower than in room air because: inspired air is humidified in the upper airway o2 and co2 mixed more O2 molecules consumed than CO2 molecules produced
38
How is oxygen diffusing capacity measured
Oxygen uptake/ (alveolar PO2 -mean pulmonary capillary PO2)
39
How is carbon monoxide diffusing capacity measured
carbon monoxide uptake/ alveolar PCO
40
What are problems which can occur within alveoli and how do these look
Alveolar fibrosis: thickening of alveolar wall Pneumonia: alveolar consolidation Pulmonary edema: frothy secretions Interstitial edema Emphysema: alveolar-capillary destruction (COPD) Atelectasis: alveolar collapse
41
What is the process of pharyngeal dilator reflex
Pressure receptors -> brainstem -> pharyngeal muscle contraction
42
What are afferent and efferent signals
Afferent are going towards brain Efferent are going away from brain
43
What are the characteristics of the upper airway
Continuous muscle activity is needed to keep the airway patent Reflex control of the muscles is rapid and critical Control of the muscles is often poor such as during sleep or with sedative drugs
44
What are the types of epithelial cells
Pseudostratified: nose and pharynx, long and thin Columnar: trachea and bronchi, quite tall Cuboidal: bronchioles, as tall as they are high
45
What are goblet cells
Secrete mucin in granules | Sit in epithelia cells
46
What are the two layers above the epithelial cells
Periciliary layer: Salty and watery | Mucous layer: sticky and mucousy
47
What inhibits cilia function
Tobacco smoke Inhaled anaesthetics Air pollution Infection
48
What are the function of the airway lining fluid
Humidification | Airway defence
49
Where are inhaled particles deposited
Very large: nose and pharynx Large: large airways Small: bronchioles Very small: exhaled again
50
What are the non-immunological pulmonary defences
Physical barrier and removal Chemical inactivation: lysozyme, protease enzymes e.g. elastase, antimicrobial peptides e.g. human B defensins Alveolar macrophages
51
What are the immunological pulmonary defences
Humoral: IgA (nose and large airways) IgG (small airways) IgE (allergic disease Cell-mediated: Epithelial cells Macrophages
52
How is oxygen carried
Dissolved in blood | Combined with haemoglobin
53
What is the volume of O2 in blood
0.0232 x PO2(12.5) = 0.29ml.dl-1
54
How is O2 saturation calculated
HbO2/ HHb+HbO2 | Oxygenated Haemoglobin/ De-oxygenated haemoglobin + oxygenated haemoglobin
55
What is the Hufner constant
1.39ml.g-1 Number of ml of O2 that one g go Hb can bind
56
What is a buffer
A solution that can minimise changes in the free H+ conc and therefore in pH
57
What are some buffer systems in blood
Bicarbonate Plasma proteins Haemoglobin Phosphate
58
What is the blood pH
7.35-7.45
59
How is CO2 carried
Dissolved in blood Carbamino compounds Bicarbonate/carbonic acid
60
What is the equalibrium equation of CO2 and HCO3- and what acts as a catalyst on this
CO2 + H2O H2CO3 H+ + HCO3- Carbonica anydrase
61
What is the Henderson-Hasselbalch equation
pH = pK + log10 [HCO3-] / [CO2]
62
What is the difference of respiratory and metabolic acidosis and alkalosis
R acidosis: Low pH, High PCO2, High HCO3- M acidosis: Low pH, Low PCO2, Low HCO3- R alkalosis: High pH, low PCO2, normal HCO3- M alkalosis: High pH, normal PCO2, high HCO3-
63
What part of the respiratory tract is formed by endoderm and mesoderm
Endoderm: Inner lining of respiratory tract Mesoderm: Vasculature and connective structures
64
How and when does the lung bud form
Grows ventrocaudally Tracheo-oesophageal ridges separate the respiratory diverticulum from the foregut Dorsally oesophagus Ventrally trachea and lung bud which has now divided to form lung buds
65
How can formation of the lung bud go wrong
Tracheo-oesophageal fistulas Result from incomplete division of foregut into oesophageal and respiratory portions Most commonly associated with oesophageal atresia (closed or absent) resulting in abdomen rabidly distending as stomach fills with air
66
What is a fistula
Abnormal communication
67
What are congenital abnormalities which are often found together
``` Vertebral defects Anal atresia Cardiac defects Tracheo-oesophageal fistulas Oesophageal atresia Renal abnormalities Limb defects ``` VACTERL
68
What is pulmonary agenesis
Occurs when lung bud fails to split Complete absence of bronchi and vasculature Can be unilateral or bilateral Bilateral genesis is incompatible with life
69
What is pulmonary hypoplasia
All components are present but incompletely developed Severity determines the degree of respiratory compromise May be found in association with congenital diaphragmatic hernia
70
What four parts can maturation of the lungs be divided into and what happens in each stage and at what time
Pseudoglandular: branching of respiratory tree to form terminal bronchioles; 5-17 weeks Canalicular: Terminal bronchioles give rise to respiratory bronchioles, mesodermal tissue becomes highly vascularised; 16-25 weeks Saccula/terminal sac: further terminal sacs (primitive alveoli), epithelium thins and differentiates, blood-air barrier; 26 weeks- birth Alveolar period: Increase number of respiratory bronchioles and alveoli; 36 weeks - 8years old
71
What are the two types of epithelium in the terminal sac period
Type I pnuemocytes: across which gaseous exchange takes place Type II pneumocytes: which secrete surfactant
72
What is ventilation, where does it occur and how is it measured
Movement of gases in and out of the lungs Occurs through airways Measured as change in volume per unit time
73
What is perfusion, where does it occur and how is it measured
Blood flow through any organ Occurs through blood vessels Measured as flow of blood per unit time
74
What is emphysema
Widespread destruction and dilation of distal airway Regional destruction of vascular beds Poor gas exchange and hypoxia
75
What is hydrostatic oressure
Force exerted by weight of a fluid due to gravity
76
What is a shunt
Deoxygenated blood reaching left side of the heart either bypassing lungs or failing to get oxygenated when in the lungs
77
What are the steps in the oxygen cascade
1: humidification 2: alveolar gas 3: alveolar-capillary diffusion 4: ventilation-perfusion mismatch and shunt 5: tissue diffusion 6: diffusion within cell
78
What is oxygen delivery
Amount of oxygen leaving the heart in one minute | DO2
79
How is oxygen delivery calculated
Amount of oxygen in blood (O2 carried by haemoglobin + dissolved O2) x amount of blood leaving heart (cardiac output)
80
What is oxygen consumption
Amount of oxygen used by the body in one minute (VO2)
81
How is VO2 measured
Direct calorimetry | Indirect calorimetry
82
What are factors that affect VO2
Age: peak at age 0-2 years, then falls for rest of life Temperature: metabolic rate doubles with every 10 degrees C Exercise
83
What is the respiratory exchange ratio (respiratory quotient)
The ratio of carbon dioxide production (VCO2) to oxygen comsumption (VO2) RER
84
How is the respiratory exchange ratio affected
Acid-base balance Hyperventilation Metabolic fuel
85
How is energy generated
Glycolysis Tricarboxylic acid cycle Oxidative phosphorylation
86
What are the characteristics of glycolysis
Occurs in cytoplasm Glucose to pyruvate or lactate No oxygen required 2 ATP molecules per glucose
87
What are the characteristics of tricarboxylic acid cycle
Occurs mostly in mitochondria Acetyl CoA (from glycyolysis) to CO2 38 ATP molecules per glucose
88
What are the characteristics of oxidative phosphorylation
Occurs in mitochondria NADH provides H+ H+ combines with O2 to produce water ATP produced
89
What are the causes of cellular hypoxia
Anoxic: lack of O2 in blood Anaemic: lack of haemoglobin Stagnant: lack of blood supply
90
What is the ventral respiratory group (VRG)
Contains mixed neurones, some fire during inspiration, some during expiration
91
What is the dorsal respiratory group (DRG)
Contains neurones which fire during inspiration
92
What does the bpneustic centre do
Stimulates inspiratory neurones
93
What does the pneuomotaxic centre do
Inhibits inspiratory neurones
94
What are pulmonary stretch receptors
Afferent fibres from smooth muscle of bronchi and trachea | Run in the vagus nerve to the respiratory centre (medulla)
95
What generates a cough
Receptors throughout the airways which when stimulated initiate an explosive expiration
96
What are baroreceptors
Sense blood pressure, can also influence ventilation | Increase in BP leads to decrease in ventilation and vice versa
97
What are J-receptors
Juxtacapillary Lie close to capillaries around the alveolar walls Activated by trauma such as pulmonary oedema, inflammatory agents, pneumonia Activation triggers increased ventilation
98
What do chemoreceptors do
The chemical regulation of breathing
99
What are central chemoreceptors
Specialised regions close to medulla respiratory centres but also close to a rich blood supply Sensitive to O2, CO2 and H+
100
How does the body respond to altitude
Hyperventilation and respiratory alkalosis Increased 2,3-DPG causes better unloading of oxygen Polycythaemia-slow to develop Bicarbonate excretion from CSF and kidneys Diuresis Hyponatraemia Acetazolamide
101
What is surface pressure
1 atmosphere | 100 kPa
102
How does pressure change in the sea
10m depth increases pressure by 1 atmosphere
103
What is the mechanism of a cough
Cough receptors or lung irritant receptors -> cough centre in medulla -> vagal stimulation leading to cough
104
What do expectorants do
Increase volume of secretion in a productive cough
105
What do mucolytics do
Decrease the viscosity of mucus in a productive cough
106
What is useful vs useless cough
Useless: persistent and unproductive, dry cough Useful: expels secretions, productive cough
107
How is a dry cough suppressed
Afferent side: reduce stimuli Efferent side: medullary cough centre
108
What are the most common causes of chronic cough
Upper airways cough syndrome Bronchial asthma Chronic obstructive pulmonary disease (COPD) Gastroesophageal reflux disease
109
What does chronic lung disease do
Inflammation Bronchoconstriction Secretions
110
What are types of bronchial asthma
Asthma associated with allergic reactions Asthma not associated with specific allergen Exercise induced asthma Asthma associated with chronic obstructive pulmonary disease
111
How is asthma treated
Non specific reduction of bronchial hyperactivity: life style, corticosteroids Dilation of narrowed bronchi: Mimicking dilator neurotransmitter: sympathomimetics Direct acting bronchodilators: methylxanthines Blockade of constrictor transmitter: anticholinergics Prevention of release of transmitter: mast cell stabilisers Antagonism of released transmitter: leukotriene receptor antagonists
112
How do corticosteroids work and how can they be taken
Anti-inflammatory Reduced bronchial reactivity Inhaled and orally
113
What are the characteristics of leukotriene receptor antagonists
Uses: allergen induced asthma, exercise induced asthma, reduced frequency of exacerbations Given orally Not effective in acute asthma Minor adverse effects: headaches, gastritis, flu-like symptoms, CS syndrome
114
What are some sympathomimetic agents
B2 agonist agents: Short acting: salbutamol, terbutaline Long acting: salmeterol, formetrol Non-selective: adrenaline
115
What are the characteristics of COPD
``` Slowly progressive Airflow obstruction Little or no reversibility Does not change much over several months Predominantly caused by smoking Symptoms improve in 90% if stop smoking Reduced FEV1/FVC ratio ```
116
What is FEV1
Forced expiratory volume in 1 second Volume of air that can be expelled from maximum inspiration in the first second Time dependent and reflects airway caliber
117
What is FVC
The forced vital capacity of the lung The volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum expiration Volume dependent and reflects lung volume
118
What are the symptoms of COPD
Breathlessness Wheezing Phlegm Cough
119
How are pack years calculated
(Number of cigarettes per day/ 20) x number of years
120
What is asthma
A chronic inflammatory disorder of the airways Airway hyper-responsiveness Recurrent episodes of wheezing and breathlessness Chest tightness, Coughing particularly at night or in the early morning Variable airflow obstruction that is often reversible, either spontaneously or with treatment Investigated using peak flow meter
121
What are the differences between intrinsic and extrinsic asthma
Extrinsic: Family history, starts in childhood, eczema/rhinitis, percipitating factors, positive skin tests, episodic Intrinsic: Adulthood, negative skin tests, persistent symptoms, no clear percipitating factors, exacerbated by infections
122
What are the symptoms of lung cancer
``` Cough Breathlessness Wheeze Stridor Dysphagia Hoarse voice Chest pain Bone pain Neurology Anorexia Weight loss Clubbing ```
123
What investigations are done in lung cancer patients
``` Chest X-ray CT scan Bronchoscopy Percutaneous fine needle aspiration/biopsy Mediastinoscopy VATS Bone scan Endobronchial ultrasound ```
124
What are the symptoms of Cystic Fibrosis
``` Weight loss Increase cough Thich green sputum Haemoptysis Fatty stools Reduced vision Clubbing ```
125
What is bronchiectasis
Chronic dilation of one or more bronchi Poor mucous clearance Predisposition to bacterial infection
126
What are the symptoms of bronchiectasis
``` Persistent purulent sputum Haemoptysis Breathlessness Wheeze Sinustitis nasal symptoms Weight loss Pleurisy Nasal polyps ```
127
What investigations are done for bronchiectasis
``` History Genetics Sweat test Faecal elastase Ciliary beat frequency Sperm analysis Autoantibody screen Sputum analysis Aspergillus antibodies Lung function ```
128
What treatment is given for bronchiectasis
``` Physiotherapy Prompt antibiotics Intravenous antibiotics Nebulised antibiotics Annual influenza vaccination ```
129
What are the symptoms of pneumonia
Progressive breathlessness Fever with shivering attacks Left sided sharp chest pain General lathargy
130
What are the treatments of pneumonia
``` Antibiotics Oxygen Analgesia Fluids Physiotherapy Nutrition Stop smoking ```
131
What is type 2 vs type 1 respiratory failure
Type 1: Low level of oxygen in the blood without an increased level of CO2 in the blood, so PaCO2 may be normal or low Type 2: Buildup of CO2 levels (PaCO2) that has been generated by the body but cannot be eliminated
132
What is a tension pneumothorax
The tissue forms a one way valve allowing air to enter the pleural space and preventing its escape, pushing the mediastinum to the opposite side resulting in obstruction of venous return to the heart
133
What are the symptoms of a tension pneumothorax
Very bruised Excrutiating pain in his left chest which is tender to touch Very short of breath

Y1 Body system lecture notes year 1 (5 decks)

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