Respiratory Science Flashcards
(125 cards)
1
Q
Is inspiration active or passive?
A
Active
2
Q
Is expiration active or passive?
A
Passive (can be active)
3
Q
What is the name of the two areas of the Pons? What are their functions?
A
Pneumotaxic (ends inspiration), apneustic excites dorsal group of medulla.
4
Q
What are the three areas of the Medulla? What are their functions?
A
Pre-Botzinger generates impulses for breathing. Dorsal is inspiratory. Ventral is forced expiration.
5
Q
Describe the law of LaPlace. Which factor is important?
A
2T/r, where radius is most significant
6
Q
Describe the concept of alveolar interdependance.
A
Surrounding alveoli exert a force on each other.
7
Q
Which substance reduces alveolar surface tension?
A
Surfactant
8
Q
Which are the major muscles of respiration?
A
Diaphragm and EXTERNAL intercostals
9
Q
Which muscles are used in forceful inspiration?
A
Sternocleidomastoid, scalanus, pectorals
10
Q
Which muscles are used in active expiration?
A
Abdominal, and internal intercostal muscles
11
Q
What is the term used to describe the volume of air circulated within one normal breath?
A
Tidal volume
12
Q
In terms of spirometry, what are the reserve volumes?
A
Volumes reached on maximal inspiration/expiration
13
Q
What is the residual volume?
A
Air that is always present in the lungs (dead space)
14
Q
Which three components is the vital capacity made out of?
A
Inspiratory reserve, tidal, expiratory reserve
15
Q
What does Boyle’s Law state?
A
Gas moves from higher to lower pressure.
16
Q
Dalton’s Partial Pressure Law states two things. What are these two formulae?
A
Pt = P1 + P2 + Pn, ventilation = TV x RR
17
Q
Describe the overall effect on the bronchi by autonomic innervation.
A
Parasympathetic - constricts, sympathetic - dilates.
18
Q
What is meant by pulmonary compliance?
A
Ability of the lungs to expand/retract.
19
Q
Which factors may decrease pulmonary compliance (make the lungs ‘stiffer’)?
A
Fibrosis, oedema, pneumonia, lung collapse, lack of surfactant.
20
Q
Which factors may increase compliance (making the lungs ‘less stiff’)?
A
Loss of recoil, emphysema
21
Q
What is meant by the V/Q ratio?
A
Ventilation/perfusion. Typically more oxygen in top of lungs (V) and less at the bottom (Q - due to CO2 and perfusion)
22
Q
Define partial pressure.
A
The pressure a gas would exert if it occupied the total volume of its mixture
23
Q
Define the diffusion coefficient concept. Explain how it differs in CO2 and O2.
A
Solubility of a gas - how easily it moves across the cell membrane. CO2 is non-polar so moves much more easily.
24
Q
State which two components affect diffusion in Fick’s Law and how they do so.
A
Area and thickness. Larger area means greater diffusion, larger thickness means less.
25
Give examples of some non-respiratory functions of the respiratory system.
Water loss, heat elimination, enhances venous return, acid-base balance, speech, singing, mucus and cilia, smell, etc
26
Define FEV1 and FVC.
FEV1 - forced expiratory volume after 1 second. FVC - forced vital capacity. Maximum inspiratory and expiratory volume.
27
State Henry's Law.
Gas solubility in blood is proportional to partial pressure.
28
State how much oxygen is held as bound (vs dissolved), and use Henry's Law to explain why.
98.5% - gas solubility is proportional to partial pressure, hence low solubility
29
State the composition (subunits) of haemoglobin
2 x alpha, beta (adult), gamma (foetus)
30
The haemoglobin curve is split into a smaller gradient section, and a larger gradient section. Explain why.
Smaller gradient - higher PO2 - oxygen loading isn't much affected at higher concentrations.
Higher gradient - lower PO2 - oxygen is released rapidly to tissue in hypoxia, buffering necrosis
31
What is the formula for the oxygen delivery index?
DO2I = CaCO2 x CO x 10
32
Which factors can affect how much oxygen is being delivered to tissue (DO2I)?
Respiratory disease, heart failure, anaemia
33
What may be indicated by presence of myoglobin in the blood?
Muscle wasting
34
In the blood, carbon dioxide is carried in three different forms. What are they, and what are their relative concentrations?
Solution (10%), bicarbonate (60%), carbamino compounds (30%).
35
Describe the main equilibrium which provides stasis for acidosis and alkalosis.
CO2 + H2O H3CO2 H+ + HCO3-
36
Apart from blood pressure, what else do the carotid baroreceptors detect?
Tensions of O2, CO2, [H+].
37
When oxygen levels drop below which level should they be rapidly corrected?
< 8kPa
38
Which chronic adaptations may be adopted in response to chronically low oxygen levels?
Polycythemia, increase in capillaries, increase in 2,3-BPG (more O2 offloaded), increase in mitochondria, and kidneys conserve acid.
39
What is the difference between the larynx and pharynx?
Larynx becomes trachea, pharynx becomes oesophagus
40
Name the three major areas of the pharynx.
Oropharynx, nasopharynx, laryngopharynx
41
Name the three cartilages in the nose.
Vomer, erthmoid, septal cartilage
42
Name the main cartilages in surrounding the epiglottis.
Thyroid, cricoid, hyoid, hyaline (trachea), carytenoids
43
What are the physiological purposes of the rima glottidis?
Control/pitch of voice, cough reflex
44
How many lobes does each lung have?
Left - 2, right - 3.
45
What is the purpose of hyaline cartilage in the trachea?
Minimises potency
46
Name the layers of the pleura, from innermost to outermost.
Visceral, pleural cavity, parietal pleura
47
Name the bony extension which is a landmark in cardiopulmonary resus.
Xiphoid process
48
Name the landmarks of the sternum. There are six.
Sternoclavicular joint, jugular notch, sternal angle, body, xiphoid process, manubrium
49
Name the three types of 'joint' in the ribcage. Which one is the true joint?
Sternocostal (true), costochondral, costovertebreal
50
Which four principles of breathing ensure correct breathing?
Alveolar diffusion, air moves into the lung, warm moist clean air, and protection of the lung.
51
Describe the mechanism of inspiration.
Diaphragm down and out; intercostals out; pleura moves lungs outwards
52
Describe the mechanism of expiration.
Diaphragm up and in; intercostals in; pleura in.
53
Does inspiration or expiration result in a decrease in pressure?
Inspiration
54
What three subcategories can pulmonary function tests be divided into?
Effort dependant, bronchial challenge, peak expiratory flow rate (PEFR)
55
Describe how FEV1 changes in asthma and COPD, obstructive and restrictive diseases?
All decrease.
56
Describe how FVC changes with asthma and COPD, obstructive and restrictive diseases?
Asthma remains the same. In all others, it decreases,
57
Describe and explain how FEV1/FVC changes in obstructive vs restrictive disease?
Obstructive - ratio decreases. Restrictive - ratio remains roughly constant.
58
In terms of pulmonary function tests, how may asthma and COPD be differentiated?
FVC is normal in asthma and lowered in COPD. Asthma has a >15% response to B2-ACRs, COPD < 15%
59
What is the normal blood value range of [H+]?
35 - 45 Mol/L
60
Define acidosis and alkalosis and the control mechanisms for each.
Increase/decrease of [H+] respectively. Getting rid of CO2 (lungs), and secreting HCO3- (hence H+) into the blood
61
What are the normal range values for pH, PaO2, PaCO2, and base excess (BE)?
7.35-7.45, 9.3-13.3 kPa, 4.7-6 kPa, (-2) - (+2) mM/L
62
Describe the compensatory mechanism for respiratory alkalosis.
Metabolic acidosis - equation is shifted so H+ and HCO3- are favoured. Negative base excess
63
Describe the compensatory mechanism for respiratory acidosis.
Metabolic alkalosis - equation shifts to H2CO3 (hence taking in H+). Positive BE
64
What is the purpose of the nasal cavity in regard to air?
Warms, moistens, filters
65
Describe the structure of the nasal epithelium.
Keratinised stratified sqaumous epithelium
66
Describe the structure of the respiratory epithelium.
Pseudostratified columnar and goblet cells, with basal cells, lamina propria, and cilia.
67
Describe the structure of the vocal folds.
Rima glottidis. A flat surface with stratified squamous epithelium
68
Describe the function of bronchiole club cells.
Stem cells, immune modification, detoxification
69
What is the name of the cartilage around the trachea?
Hyaline
70
What is the name of the arteries that supply the lung itself?
Bronchial arteries
71
Describe the differences between respiratory and terminal endothelium.
Terminal - cartilage, psuedostratified columnar, decreases to cuboidal with club cells and contains smooth muscle.
72
Describe the two types of alveolar cell.
Type 1 - simple squamous epithelium
| Type 2 - surfactant production
73
Describe the location and composition of the neurovascular bundle and its collateral.
Inferior surface of rib is NVB. Contains (posterior - thoracic aorta and azygous vein), (anterior - internal thoracic artery and vein) and nerve from anterior ramus
74
Which nerve innervates the diaphragm?
Cervical spine nerves 3, 4, 5 (phrenic) keep the diaphragm alive.
75
Name the three main accessory muscles of respiration (and the vein that seperates them)
Deltoid, pectoralis major, serratus anterior and lattissmus dorsi. Cephalic vein.
76
Name the location where fluid may accumulate and cause pleural effusion.
Costodiaphragmatic recess/angle
77
What are the four sections of the breast?
Superomedial, superolateral, inferomedial, inferolateral
78
Which vessels supply the breast?
Internal thoracic, subclavian (both arteries and veins)
79
Describe lymphatic drainage from the breast.
Unilateral from axillary nodes, bilateral from parasternal nodes
80
Describe the anatomy of the hilum.
Pulmonary veins inferior, bronchi superomedial, pulmonary artery superior, lymph nodes central
81
What is the purpose of the phrenic nerve?
Innervates the diaphragm (breathing)
82
Where does the phrenic nerve originate?
C3,4,5
83
Where specifically can the apex of the lung be auscultated?
Superior to the medial 1/3rd of the clavicle
84
Where can the middle and base of the lung be auscultated?
Ribs 4-6, T11
85
What is contained within the carotid sheath?
Internal and common carotid arteries, jugular vein, and vagus nerve
86
What is the name of the intertwining of nerves in front of the carina?
Pulmonary plexus
87
Describe the two steps which occur to allow deep inspiration.
Diaphragm descends maximally. Accessory muscles are recruited.
88
Name the (four) muscles involved in active expiration, and how they move to achieve this.
Vocal folds adduct. External oblique, internal oblique, and transverse abdominus contract.
89
Name the main consequence of cough and why this is the case.
Rupture of the visceral pleura, buildup of pressure.
90
Where should a chest drain for tension pneumothorax be inserted?
5th intercostal space, mid axillary line.
91
What is Fick's Law of oxygen uptake?
VO2 = CO x (CaO2 - CvO2)
92
What is the term for a diagnosis of exclusion regarding dyspnoea?
Dysfunctional breathing.
93
Define immunocompromisation, and some causes.
Decreased T cell function. Steroids, chemotherapy, immunosupression.
94
During embryonic development, give the name of the structure of the pre-lung bud.
Respiratory diverticulum.
95
What is the name of the structure that, in embryology, seperates the trachea and oesophagus?
Tracheoesophagel ridge.
96
Name the two main malformations that may occur between the trachea and oesophagus in embryo.
Atresia or fistula.
97
Which gene mutation (of which there are x varieties) causes cystic fibrosis?
CFTR (x = 5)
98
Describe how the thicker secretions of cystic fibrosis occur.
Elevated number of Cl and Na ions
99
Describe the two major hallmarks of primary immunodeficiency.
Recurrent infection, SPUR (serious, persistant, unusual, recurrent)
100
To which main cells do primary immunodeficiencies (an umbrella term) occur?
Antibodies (SPAD), Neutrophil, T cells, or combined (SCID)
101
Describe the cause and diagnosis of specific antibody IgA immunodeficiency.
B cell deficiency, asymptomatic and often diagnosed after a transfusion.
102
Describe the cause and treatment of common variable immune deficiency (CVID).
Low IgA, IgE, IgG. Ig Replacement, and stem cell therapy.
103
Describe hypogammaglobulinaemia.
Full name - Bruton's X-linked hypogammaglobulinaemia. Body can't produce mature B cells. Bacterial infection common.
104
What is hereditary angiodema? What causes it?
Swelling of the face due to genetic influences. A complement system defect.
105
Leukocyte adhesion deficiency is a SCID. Describe its cause and consequence.
Neutrophils can't leave the blood. Combined T and B cell defect. Common bacterial infection.
106
Describe Kostmann's syndrome (a SPID).
Neutropenia. Autosomal recessive abnormality. Medication, stem cell transplant, or G-CSF (growth factor) required to treat.
107
Describe the cause and mechanism of chronic granulatomous disease.
Phagocytes can't kill, but instead form granulomas. This is because they lack reactive oxygen/nitrogen species.
108
Describe Chediak-Higashi syndrome (a SPID).
Albino. A mutation on the LYST gene which results in lack of lymphocytes.
109
For reticular dysgenesis (a SCID), describe the cause, effects, and treatment.
Neutrophils can't be produced. Infection, fatal sepsis. Bone marrow transplant.
110
Describe the cause of DiGeorge syndrome.
Low T cell count as no maturation, lack of/underdeveloped thymus, microdeletion of 22q11
111
Which drugs may cause immunosupression (IMPORTANT)?
Azathioprine, methotrexate, cyclophosphamide
112
Describe the four levels of epidemilogical outbreak.
Sporadic, endemic, epidemic, pandemic
113
Describe how, in the context of autoimmunity, central / peripheral tolerance may be achieved?
Central - T cells destroyed in the thymus itself. Peripheral - T(reg) cells destroy rogue T cells in periphery.
114
Which three factors lead to autoimmunity?
Genetic factors, immune regulation, environment
115
Describe the difference between the terms immunisation and vaccination.
Immunisation - process within self to gain protection. Vaccination - iatrogenic administration.
116
Which two immune components cause type 1 hypersensitivity? In asthma, which additional cell is activated?
IgE (which attaches to) mast cells (causing degranulation). Eosinophils
117
Which three mechanisms does type 1 hypersensitivity activate?
Muscle spasm (bronchoconstriction, wheeze), infiltration (of lymphocytes/eosinophils - yellow sputum) and inflammation (odema)
118
Which three main components does type 2 hypersensitivity involve?
Cell surface receptors, IgG, IgM
119
Which three main receptors cause type 2 hypersensitivty?
Self, foreign, penicillin (blood)
120
Which immune components does type 3 sensitivity involve?
Immune complexes (complement and neutrophils), IgG and antigens
121
Which immune components does type 4 sensitivity involve?
T cells. Th1, Th2, Tfh, Treg, Th17.
122
Define the four hypersensitivities in terms of A, B, C, D.
Allergic, antibodies, anaphylaxis, antiBodies, Complex, Delayed
123
Which type of embolus causes pulmonary embolism?
A venous (red) embolus.
124
Which three factors make up Virchow's Triad?
Vessel wall factors, hypercoaguability, abnormal blood flow
125
Which scale is used to determine sleepiness?
Epworth Sleepiness Scale
