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Week 1 Flashcards

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1
Q

EXACT anatomical description of where to auscultate for the middle lobe of the right lung

A

between ribs 4 and 6 in the midclavicular and midaxillary lines

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2
Q

EXACT anatomical description of where to auscultate for the lung base

A

scapular line at T11 vertebral level

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3
Q

How many bronchopulmonary segments does each lung have?

A

10

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4
Q

Where is bicarbonate formed and what is the enzyme involved?

A

Formed in RBCs, carbonic anhydrase is involved

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5
Q

What types of drugs are termed PREVENTERS in asthma treatment?

A

Act as anti-inflammatory drugs that reduce airway inflammation Glucocorticoids - beclometasone, fluticasone, prednisolone Cromones - sodium cromoglicate (mast cell stabiliser, but no direct anti-inflammatory action) Humanised monoclonal IgE antibodies

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6
Q

What does “fully saturated” mean when discussing haemoglobin?

A

All 4 Haem group in an Hb molecule is bound to oxygen. Affinity for O2 increases when a haem group binds to oxygen (think seats in a car and trying to sit with you friends) - known as cooperativity Partial Pressure of O2 is main determining factor.

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7
Q

Sympathetic stimulation in airways causes…

A

No innervation of bronchial smooth muscle in humans, but submucosal glands and smooth muscle of blood vessels are supplied. Stimulation causes bronchial smooth muscle relaxation via beta2-adrenoreceptors on airway smooth muscle cells activated by the release of adrenaline from the adrenal gland. Decreased mucous secretion. Increased mucociliary clearance Vascular smooth muscle contraction

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8
Q

What are the two forms that O2 is present in in the blood?

A

1) bound to haemoglobin (98.5%) 2) physically dissolved (1.5%)

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9
Q

Side effects associated with glucocorticoids?

A

dysphonia (hoarse and weak voice) oropharyngeal candidiasis (thrush)

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10
Q

Henry’s Law

A

the amount of a given GAS DISSOLVED in a given type and volume of a LIQUID at a constant temp is PROPORTIONAL TO THE PARTIAL PRESSURE OF THE GAS IN EQUILIBRIUM WITH THE LIQUID “The amount of O2 dissolved in blood is proportional to the partial pressure” - may increase up to 25 times during strenuous exercise

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11
Q

Tidal volume (TV)

A

Volume of air entering or leaving the lungs in a single breath

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12
Q

Inspiratory capacity

A

IRC + TV

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13
Q

Boyle’s Law

A

Pressure of a gas varies inversely with the volume of a gas I.e. As volume increases, pressure decreases

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14
Q

What is the diffusion coefficient of a gas? How does CO2 compare to O2?

A

Diffusion coefficient is the solubility of a gas in a membrane. CO2 has a diffusion coefficient 20x that of O2.

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15
Q

What effect does the Haldane Effect have on the CO2 Dissociation curve?

A

Shifts it to the right - decreased affinity

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16
Q

4 factors affecting rate of gas exchange across the alveolar membrane.

A

1) Partial pressure gradient between O2 and CO2 2) Diffusion coefficient of O2 and CO2 3) surface area of membrane 4) thickness of membrane

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17
Q

Types of hypersensitivity reaction in early and late phase asthma

A

Early - type I hypersensitivity (IgE-mediated) Late - type IV hypersensitivity (T-cell mediated), Th2 involved

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18
Q

Pulmonary compliance

A

Measure of the work required to stretch the lungs

More compliant = less work

Decreased compliance (stiffer lungs)

  • pulmonary fibrosis
  • PE
  • lung collapse
  • pneumonia.
  • Restrictive pattern in spirometry

Increased compliance

  • emphysema results in hyperinflation of the lungs
  • increasing age
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19
Q

Describe transport of O2 by myoglobin

A

Myoglobin is present in skeletal and cardiac muscles, presence in blood indicates muscle damage One haem group per molecule No cooperativity - dissociation curve is HYPERBOLIC, releases O2 at very low PO2 levels - short term storage for oxygen under anaerobic conditions

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20
Q

What is pulmonary ventilation?

A

Volume of air breathed in and out every minute Unaffected by how breathing is done

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21
Q

What is alveolar ventilation?

A

Volume of air exchanged between the atmosphere and alveoli each minute. Affected by how breathing is done

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22
Q

Why is pulmonary ventilation greater than alveolar ventilation?

A

Because some inspired air remains in the airways (anatomical dead space) where it is not available for gas exchange

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23
Q

Vital capacity (VC)

A

Max volume of air that can be moved out during a single breath following a maximal inspiration IRV + TV + ERV

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24
Q

What is the Haldane Effect?

A

Removal of O2 from haemoglobin increases Hb’s affinity for CO2 and CO2-generated H+. Works in tandem with the Bohr effect to facilitate O2 liberation and CO2 uptake

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25
Major muscles of inspiration
Diaphragm External intercostal muscles
26
What factors can impair oxygen delivery to tissues?
* decreased partial pressure of inspired O2 * respiratory disease * anaemia * heart failure
27
Inspiratory Reserve volume (IRV)
Extra volume of air that can be maximally inspired over and above the typical TV
28
What are the three peripheral attachments the muscular part of the diaphragm makes?
1. sternum 2. lower 6 ribs and costal cartilages 3. L1-L3 vertebral bodies
29
Muscles of active expiration
Internal intercostal muscles Abdominal muscles
30
External Respiration definition
Sequence of events that lead to the exchange of oxygen and carbon dioxide between the external environment and the cells of the body
31
Two forces allowing lungs to recoil at expiration
Elastic connective tissue Alveolar surface tension, resists the stretching of the lungs, lowered by surfactant.
32
What's the nerve supply for the intercostal spaces?
anterior ramus of intercostal spinal nerve
33
Dalton's Law?
Dalton's Law of Partial Pressures: Total pressure exerted by a gaseous mixture is the sum of the partial pressures of each individual component gas
34
What's the blood supply for the intercostal spaces? Think anterior and posterior
Anterior - internal thoracic artery and internal thoracic vein Posterior - thoracic aorta and azygous vein
35
What factors cause the oxygen haemoglobin dissociation curve to shift to the right (Bohr Effect)?
Anything that would make the body require more O2 - * increased CO2 * increased blood acidity * increased 2,3-BPG/DPG * increased exercise * increased temperature "CADET, FACE RIGHT!"
36
4 steps of external Respiration
1 - ventilation or gas exchange between the atmosphere and alveoli 2 - exchange of oxygen and carbon dioxide between air in the alveoli and the blood 3 - Transport of oxygen and carbon dioxide between lungs and tissues 4 - exchange of oxygen and carbon dioxide between lungs and tissues
37
Fick's Law of Diffusion
amount of gas moving across a membrane is... - directly proportional to the area of the sheet - inversely proportional to the thickness of the sheet
38
Obstructive vs restrictive spirometry results
Obstructive - FVC low/normal, FEV1 low, FEV1/FVC ratio is LOW Restrictive - FVC low, FEV1 low, FEV1/FVC ratio is NORMAL combo - everything is low
39
Accessory muscles of inspiration
Sternocleomastoid Scalenus (Also pec major, pec minor, serratus anterior and latisimus dorsi)
40
Is inspiration an active or an passive process?
Active, depends on contraction of the diaphragm (phrenic nerve 3,4 and 5) and the external intercostal muscles Increase in lung size = intra-alveolar pressure falls = air enters lungs down a pressure gradient until equal to atmospheric pressure (760 mm Hg)
41
Generally, how do glucocorticoids work?
Increase transcription of genes encoding anti-inflammatory proteins and decrease transcription of genes encoding inflammatory proteins. No direct bronchodilatory action and are ineffective in treating acute attacks, however are the mainstay in prophylactic treatment of asthma.
42
Name the lung lobes and the fissures separating them
Right - Superior - Middle - Inferior - Horizontal and Oblique fissures Left - Superior - Inferior - Oblique fissure
43
Where would you find the phrenic nerve in... - the neck - the chest
neck - surface of the scalenus anterior muscle chest - descending over the lateral aspects of the heart
44
What is respiratory distress of the newborn?
Foetal lungs are unable to synthesise surfactant, baby makes very strenuous inspiratory efforts to try to overcome higher surface tension and inflate the lungs. Sternal recession seen.
45
What are the two enzymes that act on myosin light chain (MLC) to mediate relaxation and contraction?
Contraction results from phosphorylation of MLC in the presence of elevated intracellular calcium. Done via MLC Kinase. Relaxation results from dephosphorylation via myosin phosphatase.
46
What are the three layers of intercostal muscle found between the ribs in the intercostal spaces?
* external intercostal muscles * internal intercostal muscles * innermost intercostal muscles
47
How does foetal haemoglobin differ from adult haemoglobin?
Structure - adult has 2 alpha and 2 beta subunits, foetal has 2 alpha and 2 GAMMA subunits Foetal haemoglobin has a higher affinity for O2 - shifts oxygen haemoglobin dissociation curve to the left
48
Generally, what are the two pathways that lead to calcium being released from the sarcoplasmic reticulum to prompt airway contraction?
Activation of G-protein coupled receptor via transmitter or hormone (M3 ACh receptors activated by parasympathetic stimulation). Calcium released via IP3 receptor Depolarisation activating calcium channels, resulting in calcium influx. Calcium released via calcium-activated calcium channel
49
Residual volume (RV)
Minimum volume of air remaining in the lungs even after maximal expiration Cannot be measured by spirometry. Increases when compliance is increased/elastic properties of lung are lost e.g. COPD
50
What is the transmural pressure gradient?
Gradient between the intra-alveolar and Intrapleural pressure. Abolished by pneumothorax
51
What types of drugs are termed RELIEVERS in asthma treatment?
All act as bronchodilators and relax airway smooth muscle. Act as physiological antagonists of all spasmogens. * SABAs - salbutamol, terbutaline * LABAs - salmeterol, formeterol (NEVER use as monotherapy!) * CysLT receptor antagonists - montelukast, zafirlukast * Methylxanthines - theophylline, aminophylline
52
Expiratory Reserve volume (ERV)
Extra volume that can be actively expired after maximal contraction beyond the normal volume of air after resting TV
53
Total lung capacity
Max volume of air the lungs can hold Vital capacity + residual volume Cannot be measured by spirometry
54
Effect of DECREASING local O2 on... 1) Pulmonary arterioles 2) Systemic arterioles
1) vasoconstriction 2) vasodilation
55
What are the 3 ways CO2 is transported in blood? Give %s
- as bicarbonate (60%) - as carbamino compounds (30%) - in solution (10%)
56
Parasympathetic stimulation of postganglionic CHOLINERGIC fibres (embedded in the bronchi and bronchioles) causes...
**Smooth muscle contraction**, mediated by **M3** muscarinic ACh receptors in airway smooth muscle cells **Increased mucous production**, also mediated by **M3** muscarinic ACh receptors but this time on goblet cells
57
EXACT anatomical description of where to auscultate for the apex of the lung
In the root of the neck, superior to the medial 1/3rd of the clavicle
58
Parasympathetic stimulation of postganglionic NON-CHOLINERGIC fibres (embedded in the bronchi and bronchioles) causes...
Bronchial smooth muscle relaxation mediated by NO and vasoactive intestinal peptide (VIP)
59
Is normal expiration an active or passive process?
Passive, brought about by relaxation of muscles Recoil of lungs = intra-alveolar pressure rises = air leaves the lungs down a pressure gradient
60
Nerve stimulation on airways
* Parasympathetic - bronchoconstriction (M3 receptors) * Sympathetic - bronchodilation (beta 2 receptors)
61
Effect of INCREASING local O2 on... 1) Pulmonary arterioles 2) Systemic arterioles
1) vasodilation 2) vasoconstriction
62
EXACT anatomical description of where to auscultate for the oblique fissures
bilaterally at the levels of rib 6 anteriorly rising to T3 vertebral level posteriorly
63
What is alveolar dead space?
Ventilated alveoli that are not adequately perfused (imperfect matching of ventilation and perfusion). Can increase significantly in disease
64
Where do the upper resp tract and lower resp tract meet?
Where the larynx becomes the trachea and the pharynx becomes the oesophagus (C6)
65
What is the name of the recess in the pleural cavity that appears "blunted" in the abnormal presence of fluid?
Costodiaphragmatic recess
66
Law of LaPlace. Effect of surfactant
Smaller alveoli (with smaller radius) have a higher tendency to collapse. Surfactant lowers surface tension of smaller alveoli more than larger alveoli, preventing collapse. Inward collapsing pressure =2 x surface tension/radius
67
What are ventilation and perfusion?
* Ventilation - the rate at which gas is passing through the lungs * Perfusion - the rate at which blood is passing through the lungs
68
What structures are present in the root of the lung?
* 1 main bronchus * 1 pulmonary artery * 2 pulmonary veins * also lymphatics and nerves (symp., parasymp., and visceral afferents)
69
Dynamic airway compression
Makes active expiration more difficult in patients with obstruction. Rising pleural pressure during active expiration compresses alveoli and airways, causes no problem in healthy individuals.
70
Functional residual capacity (FRC)
ERV + RV
71
Internal Respiration definition
Intracellular Mechanisms that consume oxygen and produce carbon dioxide

Respiratory (11 decks)

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