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Mattias - Respiratory > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is internal respiration

A

Intracellular mechanism which consumes O2 and produces CO2

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2
Q

What is external respiration

A

Sequence of events tha tlead to the exchange of O2 and CO2 between the external environment and the cells of the body

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3
Q

Steps of external respiration

A
  • Gas exchange between atmosphere and alveoli
  • Exchange of O2 and CO2 between alveoli air and blood
  • Transport of O2 and CO2 between lung and tissue
  • Exchange of O2 and CO2 between blood and tissue
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4
Q

What is ventilation

A

Mechanical process of moving air between the atmosphere and alveolar sacs

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5
Q

What is Boyle’s law

A

At any constant temp the pressure exerted by a gas varies inversely with the volume of the gas

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6
Q

What forces hold the thoracic wall and the lungs in close opposition

A
  • Intrapleural fluid cohesiveness

- Negative intrapleural pressure

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7
Q

Diaphragm is innervated by what nerve

A

Phrenic nerve

C3,C4,C5

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8
Q

What muscles lifts the ribs to create inhalation

A

External intercostal muscles

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9
Q

What way does the external intercostal muscles run in

A

Anterio-inferiorally

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10
Q

What is pneumothorax

A

Air in the pleural space

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11
Q

Difference between traumatic and spontaneous pneumothorax

A

Traumatic - Puncture in chest wall

Spontaneous - Hole in lung

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12
Q

What are the forces that aid lung recoil during expiration

A

Elastic connective tissue in the lungs

Alveolar surface tension

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13
Q

What prevents alveoli from collapsing

A

Pulmonary surfactant

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14
Q

What secretes pulmonary surfactant

A

Type 2 alveoli

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15
Q

What is pulmonary surfactant

A

Mixture of lipids and proteins

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16
Q

What is the alveolar interdependence

A

Alveoli are interconnected and when one alveolus start collapsing the other alveoli recoil and excerts expanding forces on the collapsing one

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17
Q

What are the accessory muscles of inspiration

A

Sternocleidomastoid

Scalenus

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18
Q

What are the muscles of active inspiration in order of contribution

A

Diaphragm
External intercostal muscles
Internal intercostal muscles

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19
Q

What is Inspiratory reserve volume

A

Available room left in lungs after tidal volume is inspired

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20
Q

What is residual volume

A

Air left in airway after maximum expiration

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21
Q

What is tidal volume

A

Volume of a normal breath

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22
Q

What is vital capacity

A

Maximum amount of air that can be expired after a maximum inhalation

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23
Q

What is Total lung capacity

A

Total volume

Vital capacity + Residual volume

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24
Q

What is Functional residual capacity

A

Total volume left in airway after tidal volume expired

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25
Q

What is Expiratory reserve volume

A

Available air for further expiration after tidal volume is expired (NOT inculding residual volume)

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26
Q

What is inspiratory capacity

A

Volume that can be inhaled after a normal tidal volume expiration

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27
Q

What volume can not be measured by spirpmetry

A

Residual volume and Total lung volume

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28
Q

What is FEV1

A

Forced expiratory volume in one second

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29
Q

What is FVC

A

Forced Vital capacity

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30
Q

What is the useful spriometry ratio

A

FEV1/FVC

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31
Q

What does FEV1/FVC normal value

A

> 70%

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32
Q

What does FEV1/FVC below 70% indicate

A

Obstructive lung disease

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33
Q

What happens to FEV1/FVC in restrictive lung disease. Why

A

Stays the same or may increase. Because both FVC and FEV1 decreases

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34
Q

Parasympathetic stimulation causes what to the broncho tree

A

Bronchoconstriction

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35
Q

Sympathetic stimulation causes what to the broncho tree

A

Bronchodilation

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36
Q

Why is expiration more difficult hat inhalation in asthma

A

Airways are pulled open by the decrease in intrapleural pressure in inhalation but airways collapse in expiration

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37
Q

How is Peak Flow meter used

A

Maximum short sharp expiration by patient. Three attempts and best one is recorded. Compare with normalized chart

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38
Q

What is pulmonary compliance

A

a measure of effort that has to go into stretching or distending the lungs

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39
Q

What causes decreased compliance

A 
Pulmonary fibrosis
Pulmonary edema
Lung collapse
Pneumonia
Absence of surfactant
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40
Q

Decreased pulmonary compliance can cause what pattern in spirometry and FEV1/FVC ratio

A

Restrictive pattern

>70% FEV1/FVC ratio

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41
Q

What may increase the pulmonary compliance

A

Emphysema

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42
Q

Difference of innervation by the parasympathetic and the sympathetic on bronchial smooth muscles

A

Parasympathetic is direct.

Sympathetic is indirect. Adrenaline from adrenal gland relaxes airway smooth muscle

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43
Q

Bronchial smooth muscles contract due to which receptor

A

M3 Muscarinic ACh receptor

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44
Q

Which cells cause mucus secretion in the airway

A

Goblet cells

45
Q

Which receptor is activated for bronchial smooth muscle relaxation

A

B2-adrenoreceptors

46
Q

Vascular smooth muscle contraction is mediated by which receptor

A

alpha-1 adrenoreceptor

47
Q

What does Myosin Light chain kinase do

A

Phosphorylates Myosin light chain and cause contraction of smooth muscle

48
Q

What does Myosin phosphatase do

A

Dephosphorylates Myosin Light chain and cause smooth muscle relaxation

49
Q

What can cause an asthmatic attack

A 
Allergens
Cold/dry air
Exercise
Respiratory infections
Smoke, dust, pollutants
And more
50
Q

Chronic asthma cause what pathological changes

A 
Smooth muscle hyperplasia and hypertrophy
Pulmonary edema
Increased mucus
epithelial damage
Sub-epithelial fibrosis
51
Q

Immediate and delayed phase of asthma attack is due to which hypersensitivity

A

Type 1 - Immediate

Type 4 - Delayed phase

52
Q

Allergic asthma is mediated by which cells

A

T-CD4+ cells mature into Th2 cells which bind B lymphocytes and therafter matures into Plasma cells

53
Q

What is anatomical deadspace

A

the air that remains in the airway and is not available for gas exchange

54
Q

What is pulmonary ventilation

A

Tidal volume x RR

55
Q

What is alveolar ventilation

A

(Tidal volume - Anatomical dead space) x RR

56
Q

The transfer of gases between the body and atmosphere depends upon

A

Ventilation

Perfusion

57
Q

What is alveolar dead space

A

Ventilated alveoli which are not adequately perfused with blood

58
Q

What is the physiological dead space

A

Alveolar dead space + Anatomical dead space

59
Q

CO2 has what effect on airway smooth muscles

A 
Increase = Relaxation
Decrease = Contraction
60
Q

O2 has what effect on pulmonary arteriolar smooth muscle

A 
Increase = Relaxation
Decrease = Contraction
61
Q

O2 has what affect on systemic arteriolar smooth muscle

A 
Increase = Contraction
Decrease = Vasodilation
62
Q

What influences gas exchange across alveolar membrane

A

Partial pressure gradient
Diffusion coefficient
Surface area
Thickness of membrane

63
Q

How do you convert between mmHg and kPa

A

7.5 mmHg = 1 kPa

64
Q

What type of alveolar cells does gas exchange occur over

A

Type 1

65
Q

Example of short acting beta2-adrenoceptor agonist

A

Salbutamol (albuterol, terbutaline)

66
Q

Example of long acting beta2-adrenoceptor agonist

A

Salmeterol

Formoterol

67
Q

Side effects of Salbutamol

A

fine tremor

Tachycardia, cardiac dysthytmia, hypokalemia

68
Q

What does CysLT1 receptor antagonists block

A

Cysteinyl leukotrienes derieved from mast cells and infiltrating inflammatory cells from causing smooth muscle contraction, mucus secretion and edema

69
Q

Example of CysLT1 receptor antagonist

A

Montelukast

Zafirlukast

70
Q

Example of Methylzanthines

A

Theophylline

Aminophylline

71
Q

Main Glucocorticoid

A

Cortisol (hydrocortisone)

72
Q

Where is Cortisol released from

A

Adrenal cortex

Zona Fasiciculata

73
Q

Main Mineralocorticoids

A

Aldosterone

74
Q

Which steroids are used in asthma treatment

A

Beclometasone, Budenoside, Fluticasone

75
Q

MOA of glucocorticoids

A

enter cell plasma by diffusion
Combine with GRalpha and translocates to nucleus
Create homodimers and bind to Glucocorticoid response elements

76
Q

Glucocorticoid effect relevant to asthma treatment

A

prevent IgE production
Decrease formation of Th2 cytokines and cause apoptosis
Prevent Eosinophil action
Redcuce number of mast cells

77
Q

Side effects of inhaled steroids

A

Dysphonia (hoarse and weak voice)

Oropharyngeal candidiasis

78
Q

Which oral steroid is available in asthma treatment

A

Prednisolone

Only in chronic severe asthma

79
Q

Omalizumab is

A

Monoclonal antibodies directed against IgE

80
Q

Upper respiratory tract is

A

Right and Left nasal cavities
Oral cavity
Naso- Oro- and Laryngo- pharynx
Larynx

81
Q

Lower respiratory tract is

A 
Trachea
R&L main bronchi
Lobar bronchi
Segmental bronchi
Bronchioles
Alveoli
82
Q

At what level does the larynx become the trachea and pharynx becomes the esophagus

A

C6

83
Q

Difference between parietal and visceral pleura

A

Parietal is external and Visceral is attached to the lungs

84
Q

How man Lung lobes are there, what are they

A
  1. Right and Left Superior Lobe
    Right and Left Inferior Lobe
    Right middle lobe
85
Q

The area of lung lobe that each one of the segmental bronchi supply with air is called

A

Bronchopulmonary segment

86
Q

How many pair of ribs are there?

A

12

87
Q

What are the types of ribs

A

True ribs: 1-7
False ribs: 8-10
Floating ribs: 11 & 12

88
Q

Difference between true and false ribs

A

True attach via their costal cartilage directly to the sternum
False attach via the costal cartilage indirectly to the sternum

89
Q

Parts of the Sternum (4)

A

Manubrium
Body
Ziphoid
Sternal angle

90
Q

Head of the rib articulates with what bone

A

Body of the vertebra of the same number and the body of the vertebra superiorly

91
Q

Other than the head of the rib, what other parts articulate with bone and where?

A

Rib tubercle

Articulates with transverse process of the vertebrae of the same number

92
Q

Blood supply to the intercostal spaces

A

Posteriorly - Thoracic aorta

Anteriorly - Internal thoracic artery

93
Q

Blood drainage of the intercostal space

A

Posteriorly - Azygous vein

Anteriorly - Internal thoracic vein

94
Q

What is the nerve supply to the Diaphragm

A

Phrenic nerve

C3-5

95
Q

What does the Phrenic nerve supply

A

Somatic sensory and sympathetic axons to the diaphragm and fibrous pericardium
Somatic motor to the diaphragm

96
Q

Lympathic draingage of the breast

A

Lateral quadrants - Axillary nodes

Medial quadrants - Parasternal nodes

97
Q

What nerve supply serratus anterior. Role of muscle

A

Long thoracic nerve

Anchor scapula to ribs

98
Q

Attachments of pectoralis minor

A

Coracoid process of the scapula

Ribs 3-5

99
Q

Amount of gas dissolved in a given type and volume of liquid is proportional to the partial pressure of the gas.

A

Henry’s Law

100
Q

Each Hemoglobin molecule contains __ heme groups

A

4

101
Q

What is the Bohr effect

A

Shift of the oxygen dissociation curve with changes in PCo2, [H+], Temp, 2,3-Bisphosphoglycerate

102
Q

If [H+] increases, what happens to the oxygen dissociation curve

A

It shifts to the right, making oxygen more avaliable to tissue

103
Q

Difference between Fetal hemoglobin and adult hemoglobin structure

A

HbF - 2 alpha 2 gamma subunits

HbA - 2 alpha 2 beta subunits

104
Q

What is the role of Myoglobin

A

Provide short-term storage of O2 for anaerobic conditions. Present in Skeletal and cardiac muscles

105
Q

What does presence of Myoglobin in the blood indicate

A

Muscle damage

106
Q

How is CO2 transported in the blood

A

10% - Dissolved
60% - As Bicarbonate
30% - Carbamino compounds

107
Q

How is CO2 converted into bicarbonate

A

CO2 + H2O –> H2CO3 –> H+ + HCO3-

108
Q

What is the Haldane effect

A

Removing O2 from Hb increases the ability of Hb to pick up CO2 and CO2 generated H+

Mattias - Respiratory (2 decks)

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