1
Q
Airway function is facilitated by:
A
-Mechanical stability
- control of calibre
- filtering and cleansing
2
Q
many diseases are the effect of changes in what
A
calibre
3
Q
Order of airflow through the lungs
A
Nose/Mouth –> Pharynx –> Larynx –> Trachea –> Bronchi –> Bronchioles –> Alveoli.
4
Q
Calibre means
A
Width of the airways
5
Q
What does control of calibre allow
A
Can redirect ventilation, allows Coughing to be more effective
6
Q
Alveolar cell type 1 and 2 function
A
Type I alveolar cells (pneumocytes) are flat, thin cells covering most of the alveoli crucial for gas exchange, while Type II alveolar cells (pneumocytes) are cuboidal, more numerous cells that produce surfactant to reduce surface tension
7
Q
Cell type relation to function in respiratory tree
A
As you move down the bifurcations the composition of cells changes
Most of the gaseous exchange occurs in the smallest airways, the alveoli.
8
Q
immune cells in lungs
A
Mast cell, dendritic cell, lymphocyte, eosinophil, macrophage, neutrophil
9
Q
Disease where you create too much lung mucus
A
Bronchiectasis
10
Q
Mucins
A
major proteins in mucus, secretions from goblet cells and submucosal glands.
11
Q
what happens to mucin stores in COPD
A
increased mucin stores occur because of surface epithelial mucous hyperplasia, together with increases in the volume and number of the submucosal glands.
12
Q
Asthma vs COPD
A
COPD lots more bacteria compared to asthma
13
Q
Forced Vital Capacity (FVC).
A
The patient exhales as forcefully and rapidly as possible, beginning at maximal exhalation
14
Q
Main function of pores of kohn
A
small openings between adjacent alveoli. Their main function is to allow ventilation between alveoli, bypass blocked pathways
15
Q
Function of airway macrophages
A
- Induction of inflammation: pathogens.
- Inhibition of inflammation:
clearance of self cells and
extracellular matrix turnover
products
16
Q
How does lung regulate alveolar macrophages
A
Tissue specific, different macrophages have different thresholds for activation
17
Q
Why is there an optimum threshold for macrophage activation
A
18
Q
What happens when bacterial tollerence set too high
A
bacterial escape, diseases such as
19
Q
What dictates immune tolerance levels in the respiratory tract (3)
A
- hygiene
- Genetic polymorphisms
- infections
20
Q
how do abdominal contents effect diaphragm
A
pressure of abdominal contents on the diaphragm reduce lungs (ie. obesity)
21
Q
conditions such as asthma and COPD are associated with infiltration of what
A
Immune cells which reduce gaseous exchange
22
Q
Calibre is dictated by the actions of what type of muscle
A
smooth
23
Q
ASM dysfunction looks like
A
airways narrow, mucus accumulation, muscular layer thickening, inflammatory cell infiltration
24
Q
External causes for ASM dysfunction
A
smoke, environmental pollution, infection, chemicals, dust
25
Internal causes for ASM
heredity, airway hypersensitivity, maldevelopment
26
Relievers (therapy) action
Bronchodilators cause smooth muscle to relax.
Short-acting (1-2 hours) or long-acting (up to 12 hours) and usually used when asthma symptoms occur.
27
Preventers (therapy) action
Inhaled corticosteroids reduce inflammation in the airways.
Used daily even when there are no symptoms.
28
What do current therapies for lung issues focus on
smooth muscle and inflammation
29
Autonomic nervous sytem (ANS) divisions
Sympathetic (fight or flight) parasympathetic (rest and digest)
30
Autonomic nervous systeem fucntion
acts at subconscious level. Regulates functions of most internal
organs/tissues. Homeostasis –
‘autonomic reflexes’
31
ANS control of blood pressure
Info from brain via Autonomic efferent (outgoing) pathway --> heart (cardiac output) --> Atrial blood pressure --> Arterial baroreceptor --> Sensory (afferent) nerve --> brain
32
‘Dysautonomia’
dysfunction of ANS
33
Why is it important to recognize ‘patterns’ of sympathetic / parasympathetic activation
Helps w correct interpretation of symptoms presentation in hospital
34
Autonomic nerves are in what
Peripheral nervous system
35
Autonomic efferents (outgoing) nerves structure
Usually two neurones + synapses/junctions
36
ANS "Afferent" nerves control what
INCOMING: signals from organs/tissues to the CNS
37
ANS "efferent" nerves control what
OUTGOING: From CNS to organs/tissues
38
What is the oxygen need of an average adult body at rest
250 ml/min at rest, but can chnage with exercise
39
Primary site of aerobic respiration
tissues
40
average Carbon dioxide production of body
200 ml/min at rest
41
Primary muscles of inspiration
mainly diaphragm and external intercostals
42
Primary muscles of active expiration
internal intercostals, abdominal muscles
43
Pleurae definiton
serous membranes that line the lungs and thoracic cavity. They permit efficient and effortless respiration
44
movement of air in and out fo the lungs requires
a pressure gradient
45
Alveolar pressure
the pressure of the air inside the alveolus
46
Alveolar pressure is controlled by
elastic recoil wants to close alveoli VS the surface tension forces at the air, liquid interface of the alveolus helps keep them open
47
what does it mean that the pleural space is a “potential space
in health there is no space there
48
how is the slightly negative pleural pressure created
A slight suction of fluid through lymphatics leads to a negative pressure (-5cm of water)
49
At rest (FRC) Palv =
Patm = No airflow
50
relationship between Palv and Patm for inspiration
Patm > Palv
51
When diaphragm contract what happens to pleaural space and pressure
Pleural space enlarges
Ppl decreases
52
relationship between Palv and Patm for expiration
Palv > Patm
53
When diaphragm is relaxed
No airflow
54
what happens when Ppl << Palv
Alveolar space enlarges
55
during inspiration to expiration intra alveolar pressure
changed from negative in inspiration, to positive in expiration
56
What is tidal volume
the amount of air that moves in or out of the lungs with each normal, resting breath
57
what is inspiratory reserve volume
The additional volume above the tidal volume that the lung can increase to
58
what is inspiratory capacity
Full inspiratory capacity of the lung including the tidal volume
59
Inspiratory vs tidal volumes
Inspiratory involves the use of accessory muscles
60
Expiratory reserve volume
Additional volume beyond tidal volume that the lung can expire
61
Residual volume
The volume of air within the lung that cannot be expired
62
Vital lung capacity
The total functional capacity of the lung including inspiratory and expiratory reserve volumes
63
Functional residual capacity
“The resting lung”. The volume of air present at the end of tidal breathing
64
Total lung capacity
The total volume of the lung including all reserve capacities and residual volume
65
Pneumothorax
air in the pleural space
66
Traumatic vs spontaneous pneumothroax
Traumatic pneumothorax results from physical injury (e.g., rib fractures, stabbing) or medical procedures, while spontaneous pneumothorax occurs without injury, often due to ruptured lung blisters (blebs).
67
Primary vs Secondary pneumothorax
no undelying lung diseass vs histroy fo underlying lung disease
68
Causes of secondary pneumothorax
emphysema or cystic lung disease
69
Simple pneumothorax
Pressures reach equilibrium
and Ppl = Palv
70
Tension pneumothorax
“One way valve”
Pleural pressure increases
Ppl > Palv
causes collapse of lung
71
Why is tension pneumothorax fatal?
Respiratory failure leading to insufficient oxygen or cardiac arrest due to the heart stopping pumping
72
Treatment of Pneumothorax
Insertion of a tube to remove the air and restore the negative pressure within the pleural space
Under water seal used to prevent air going back into the lung
73
why does the water column swing in chest drain
The water column in a chest drain swings (or "tides") due to pressure changes in the pleural cavity during breathing
74
What neural networks in the brainstem control respiration
Medulla oblongota and pons
75
What are the two medullary respiratory control centers
dorsal respiratory group (DRG) and the ventral respiratory group (VRG).
76
What does the dorsal respiratory group control
basic inspiratory rhythm (diaphragm, external intercostals)
77
What does the ventral respiratory group control
controls active forced breathing. It stimulates the internal and innermost intercostal muscles to pull the ribs downward as well as abdominal muscles to increases intra abdominal pressure
78
Role of pons in control of respiration
plays a modulatory role by refining the respiratory rhythm generated by the medulla and ensuring smooth transitions between inspiration and expiration.
79
Where us the Apneustic center located
Lower pons
80
Where is the pneumotaxic center located
Upper pons
81
Strong stimulation of the pneumotaxic center would result in
Rapid shallow breathing
82
what does Apneustic Center do to DRG
provides continuous excitatory input to the DRG
83
Role of Apneustic center
Promote prolonged, deep inspirations and regulate the depth of breathing
84
Which respiratory center is crucial during hypoxia conditions
Apneustic center, because it helps maintain adequate oxygen levels
85
Physiological changes during lack of oxygen
Enhanced stimulation of the DRG leads to deeper and faster breathing, recruiting accessory muscles if necessary. Prolonged hypoxia may also increase sympathetic nervous system activity, raise heart rate, and alter breathing patterns to maximize oxygen uptake and delivery.
86
describe a simple pneumothorax
is when the lung collapses, but the pleural and alveolar pressures reach equilibrium and the tissue remains static.
87
Describe a tension pneumothorax
air cannot leave the pleural space, and a one-way valve is created with air coming in only. pleural pressures continue to increase, and the mediastinum gets pushed to the side
88
What does a deviated trachea shown on x-ray differentiate
Tension pneumothorax
89
triangle of safety anterior border
lateral edge of the pectoralis major muscle
90
Triangle of safety apical border
base of the axilla
91
Triangle of safety posterior border
anterior edge of the latissimus dorsi muscle
92
93
Triangle of safety apical border
border of axilla
94
What must be done for a tension pneumothorax before a chest tube is inserted
Needle decompression
95
Ganglion
group of cell bodies located outside the CNS
96
Where are central chemoreceptors located
medulla
97
Where are peripheral chemoreceptors located
the carotid bodies at the bifurcation of the common carotid arteries and in the aortic bodies near the aortic arch
98
When oxygen levels fall, what are the primary drivers of increased ventilation
Peripheral chemoreceptors
99
what is Cheyne–Stokes breathing is characterized by
cyclical periods of hyperventilation followed by apnea
100
what does cheyne-stokes breathing occur
impaired communication between respiratory centers and chemoreceptors
101
ventilation definition
mechanical process by which air is moved into and out of the lungs as a result of pressure changes produced by alterations in thoracic volume.
102
Define quiet (normal) inspiration
Quiet inspiration is an active process initiated by contraction of the diaphragm (flattens and descends) and external intercostal muscles (elevate ribs)
103
How to distinguish between the external and internal intercostal muscles on a cadaver
Internal intercostal muscles fibers direct outwards
External intercostal muscles fibers direct inwards
104
What diameters are changing during inspiration
vertical dimension of thoracic cavity and transverse diameter of the thorax
105
What does the increase in thoracic cavity dimensions do (in terms of pleura)
Causes the parietal pleura moves outward, it pulls on the visceral pleura, allowing the lungs to expand.
106
costodiaphragmatic recess
The sharp angles space located at the inferior-most edge of the pleural cavity
107
Describe the muscles involved in quiet expiration
Relaxation of the diaphragm and external intercostal muscles decreases thoracic volume
108
Forced expiration definition
Active process that occurs during activities such as exercise, coughing, or sneezing.
109
Describe the muscle action in forced expiration
contraction of the internal intercostal, innermost intercostal, and transverse thoracic muscles, which pull the ribs downward and inward. contraction of the abdominal muscles, including the rectus abdominis, internal and external obliques, and transversus abdominis, pushes abdominal contents upward against the diaphragm, further decreasing lung volume.
110
Muscles involved in forced inspiration
Diaphragm and external intercostal muscles, sternocleidomastoid, scalene muscles, pectoralis major and minor, and serratus anterior.
111
Fight or flight stages
alarm, resistance, exhaustion
112
parasympathetic nerve pathways involve _____ preganglionic neurones and _____ postganglionic neurones
LONG preganglonic and very SHORT postganglionic
113
Describe the arrangement of the structures located in the intercostal spaces
external, internal and innermost intercostal muscles as well at the intercostal vein, artery and nerve
114
What are the two folds of the pleura called
Visceral (covers lungs) and Parietal (attached to chest wall)
115
What is the pleura made up of
serous membrane – a layer of simple squamous cells supported by connective tissue
116
Inter-pleural pressure is usually what in relation to atmospheric pressure
Negative in relation to atmospheric pressure to stop lungs from collapsing
117
Intrathoracic/alveolar pressure
Normally negative relative to atmospheric pressure
118
what are the two main receptors of chemical control of breathing
central chemoreceptors (medulla) and peripheral chemoreceptors (carotid and aortic bodies)
119
How do central chemoreceptors control breathing
sensitive to and increase in CO2 and a decrease in pH, stimulate ventilation
120
how do peripheral chemoreceptors control breathing
↓ O2 (< 60 mmHg), ↑ CO2, ↓ arterial pH → ↑ ventilation
121
Overall, breathing is regulated by
Brainstem rhythm
Blood gases (CO2 most important) Protective lung reflexes
122
What do stretch receptors in the lung do
detect over inflation
123
Negative inter-pleural pressure pulls the lungs...
outwards, promoting lung expansion
124
What occurs because of sympathetic activation due to stress
‘visible effects’ of stress ⟶ Adr release, sweat, pupil dilation etc
125
Effect of adrenaline
126
Residual volume
gas remaining in lungs after forced breath
127
Residual volume vs functional residual volume (FRV)
Residual volume = amount of air that remains in lungs after forced breath
Functional residual volume = amount of air that remains in lungs after normal passive expiration
128
Why do older people have larger residual volume
lungs harden as you age, more air trapped
129
which way does a tension pneumothorax shift the mediastinum
To the opposite side of the chest
130
The reduced venous return to the heart caused by
Tension pneumothorax causing high intrathoracic pressure and mediastinal shift
131
What happens to intrathoracic pressure during inspiration
the increase in thoracic volume causes the lungs to expand, leading to a decrease in intrapulmonary pressure below atmospheric pressure. Air flows from high pressure to low pressure (from atmosphere to alveoli)
132
Change in intrapleural pressure during inspiration
−5 cm H2O to −7 cm H2O (more negative)
133
Change in intrapleural pressure during expiration
-7 cm H2O to -5 cm H2O (less negative
134
why is it significant that intrapleural pressure is always negative relative to atmospheres
to prevent lungs from collapsing and maintain lung recoil
135
describe the resistance stage of Fight or flight
involves the body trying to adapt and cope with a continuing stressor. This is when alarm symptoms decrease but hormone levels remain elevated.
136
What are the two kinds of neurons in the sympathetic nervous system
pre-ganglionic and post-ganglionic
137
Preganglionic neurons have their cell bodies where
spinal chord
138
Where is acetylcholine released from
acetylcholine is released from the presynaptic neurons and into the synaptic cleft
139
where does acetylcholine bind
binds to nicotinic receptors on tissue
140
what are the receptors for Adrenaline and noradrenaline
Adrenergic receptors are split into two classes (alpha and beta)
141
what are the two divisons of the peripheral nervous system
somatic (voluntary)
Autonomic (involuntary)
142
Divisions of the autonomic nervous system
Parasympathetic and sympathetic
143
Why are pre ganglionic neurons called cholinergic neurons
because they release acetylcholine
144
What does activation of nicotinic receptors do
Allows Na+ and Ca2+ to flow into cells (Post ganglionic neurons)
145
What do activated post-ganglionic neurons release
they release noradrenaline
146
What are adrenergic neurons
nerves in sympathetic nervous system that release noradrenaline
147
What do adrenergic receptors respond to
binding of noradrenaline, these receptors are found on target tissue
148
Alpha-1 andrenergic receptors
stimulate smooth muscle contraction in blood vessels to cause vasoconstriction, which leads to higher blood pressure
149
Alpha-2 andrenergic receptors
act as auto-receptors on sympathetic nerve terminals and inhibit the further release of hormones to prevent overstimulation;
150
Beta-1 adrenergic receptors
primarily found in the heart and kidneys and increase cardiac output by increasing cardiac contractility and heart rate
151
Beta- 2 adrenergic receptors
relax bronchial smooth muscle to cause bronchodilation
152
Beta-3 adrenergic receptors
primarily found in adipose tissue and increase lipolysis.
153
What type are adrenergic receptors
G-protein-coupled receptors responding to adrenaline (epinephrine) and noradrenaline (norepinephrine
154
Physiological what is changing during fight or flight
blood is redirected to muscle and brain. Cardiac output is increased
155
Where does a needle decompression insert
2nd intercostal space in the mid-clavicular line or in the fifth intercostal space in the mid axillary line
156
Local anesthetic use
To numb a specific area, usually for a minor surgery such as tooth extraction, wound stitching, or mole removal.
157
How do local anesthetics work
they work by blocking the action potentials along neurons which transmit pain sensations (ex. by binding to voltage gated channels)
158
Lidocaine mechanism of action
bind to voltage gated sodium ion (Na+) channels on the cell membranes of these neurones and inhibit them to prevent the influx of sodium ions. Stops action potential
159
Key anatomical landmarks on a chest x-ray
ribs, clavicles, vertebral column, Costophrenic Recesses
160
In a normal chest x-ray the lungs appear
DARK, air filled. Dense things appear white.
161
Hila of lungs mean
the root of the lungs
162
A viable pleural line represents
the lungs have been shifted, the edge of a collapsed lung
163
What is Tidal Volume
the volume of air inhaled or exhaled during a single, normal, resting breath
164
How to measure Tidal volume
165
Respirtory rate
Number of breaths taken in a minute
166
What is vital capacity
The maximum amount of air a person can normally exhale after a maximum inhalation, typically ranging from 3 to 5 liters in healthy adults
167
What is Functional vital capacity
Total volume of air forcibly exhaled after maximum inhalation
168
what is forced expiratory volume 1 (FEV1)
the maximum volume of air a person can forcefully exhale in one second
169
How is PEFR measured
forcefully exhaling into a handheld meter, record the best of three attempts
170
Define cognitive behavioral therapy
talking therapy aimed at discovery and analyzing negative autonomic thoughts with the goal of replacing them with more realistic thoughts to develop better coping strategies for both mental health conditions and chronic pain.
171
Explain the role of classical conditioning in CBT
classical conditioning - patient learns to link a stimulus to a consequence, exposure therapy can expose the stimuli to patient without the feared consequence occurring --> help break learned association
172
Explain the role of operant conditioning in CBT
Operant conditioning involves learning by consequences, such as rewards and punishments for voluntary behaviors. Encouraging patients to engage in behaviors with positive outcomes or rewards rather than negative outcomes helps to reinforce positive behavior.
173
Name the hierarchy of evidence
- systematic reviews
- randomized control trials
- cohort studies
- case-control studies
- case series and case report studies
- Editorial and expert opinions
174
Small pneumothorax
1-2cm gap between lung margins and chest wall
175
Large pneumothroax
1-2cm gap between lung margins and chest wall
176
Causes of pneumothorax
asthma, pneumonia, COPD, CF, emphysema, etc, injuries, lifestyle factors like drinking smoking or scuba diving
177
Adult dosage of lidocaine
1 mg/kg
178
Common side effects of lidocaine
headache, dizziness, confusion
179
How does tension pneumothorax cause a cardiac arrest
compression of venous return to heart which reduced preload. No matter how hard you contract heart you cannot generate a high stroke volume
180
When would you use the descriptions increased density vs lucency
as seen on an X-ray, increase density can occur when a space if filled, lucency means it gets less dense/ is filled with air
181
How does changing kVp in X-rays effect the image
182
what positioning is best for taking a chest xray
PA erect. Supine imaging changes the penetration and size of structure like heart
183
Diagram is made of what kind of muscle?
Skeletal muscle, which is why we can control diaphragmatic breathing well
184
pectus excavatum
Pectus excavatum, or "sunken chest," is a congenital deformity where the breastbone (sternum) and ribs grow inward, creating a caved-in appearance can be seen on Xrays
185
two approaches for assessing a chest radiograph
inside out VS outside in approaches
186
Afferent nerves vs efferent nerves
Afferent are the incoming nerves, from organs to CNS. Efferent are the outgoing nerves form CNS to organs
187
Signs of damage to autonomic nervous system
188
Limited anatomical distribution is a feature of
parasympathetic nervous system, no supply to limbs, skin, blood vessels muscles.
189
Where are the preganglionic neurons of the sympathetic division located
In the thoracic spinal chord and upper 2-3 lumbar spinal chord segments
190
Where are the post-ganglionic neurons of the sympathetic division located
usually in sympathetic chain either side of the spinal column
191
describe the general distribution patterns of parasympathetic and sympathetic nervous system
Some organs will receives only sympathetic supply and some will receive supply from both (parasympathetic doesn't go everywhere)
192
Example of body part that only have sympathetic control
diameter of your arterial blood vessels (BP depends on this!)
193
Neurotransmitters in sympathetic pathways
acetylcholine and noradrenaline
194
Neurotransmitters in parasympathetic pathways
just acetylcholine
195
Effect on target tissue from the ANS depends largely on what
which receptors are present on the target tissue
196
Varicosities
sympathetic nerve endings, a collection of nerve endings strung across tissue in order to supply a larger area
197
Acetylcholinesterase mechanism of action
terminates neuronal signaling by rapidly breaking down the neurotransmitter acetylcholine (ACh) into choline and acetate.
198
Monoamine oxidase mechanism of action
after norepinepherine is up-taken into sympathetic nerve terminals, Monoamine oxidase destroys it terminating signal
199
Year 1
flashcards
Decks in class (28)
# Cards
-
Terms Relating to Position and Movement27
-
1A ILOS: Early Embryology167
-
1B ILOS: Pregnancy171
-
2 ILOS: Chromosomal Abnormalities162
-
3 ILOS: Innate Immune system and Medelian Genetics137
-
4 ILOS: Post Natal Growth and Puberty169
-
5 ILOS: Adaptive immune system and viruses202
-
6 ILOS: Cell cycle, cancer genetics and malignancy162
-
7 ILOS: Aging, Fragility, and Polypharmacy161
-
Introduction to Medicine 1 Anatomy45
-
Introduction to Medicine 2 Anatomy54
-
Anatomy 1: Female Reproductive System 188
-
Anatomy 2: Female reproductive System 281
-
Anatomy 3: Introduction to the GI and Respiratory systems84
-
Anatomy 4: Male rep. system and imaging of the upper limb76
-
Anatomy 5: Lymphatic System and Muscles of the Forearm & Hand118
-
Anatomy 6: Breast, Axilla, and Muscles of the Shoulder and Arm111
-
Anatomy 7: Neurovascular supply of upper limb + Vertebral column57
-
Evidence Based medicine39
-
ILO Theme 8: Phneumothroax199
-
ILO Theme 9: Asthma191
-
ILO Theme 10: COPD130
-
ILO Theme 11: Heart Valve Dysfunction151
-
ILO Theme 12: Ischemic heart disease133
-
ILO Theme 13: Hypertension74
-
ILO Theme 14: Anaemia101
-
ILO Theme 15: DVT and PE18
-
ILO Theme 16: Shock35
