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RESPIRATORY
PAR2012 - RESPIRATORY ANATOMY AND PHYSIOLOGY
| Question | Answer |
|---|---|
| WHAT ARE THE LOBES IN THE LUNG? | SUPERIOR, MIDDLE AND INFERIOR |
| WHAT COVERS THE TRACHEA WHEN FOOD IS PASSING? | EPIGLOTTIS |
| WHAT BONE IS THE BULGE IN YOUR NECK? | CARINA OF THE TRACHEA |
| WHAT BONE ANCHORS YOUR TONGUE TO YOUR MOUTH? | HYOID BONE |
| WHAT TYPE OF CARTILAGE LINES THE TRACHEA? | CRICOID |
| NOSE COMPONENTS: | NASAL CAVITY, NASAL CONCHAE, NASAL VESTIBULE |
| CORRECT PASSAGE OF AIR THROUGH PASSIVE BREATHING? | NARES, NASAL CAVITY, PHARYNX, LARYNX, VOCAL VOLDS, TRACHEA, BRONCHI, BROCNHIOLES, LUNGS, ALVEOLI, CAPILLARIES |
| CONDUCTIVE PARTS | where exchange of gas does not take place (nose, larynx, trachea and bronchi |
| RESPIRATORY PARTS | exchange of gases takes place (lungs) |
| GOBLET CELLS | secrete mucus in order to protect the mucous membranes |
| PSEUDO STRATIFIED EPITHELIAL CELLS | cilia and mucosa assist in removing foreign material |
| ALVEOLAR TYPE 2 CELLS | produce surfactant to reduce surface tension |
| PULMONARY VENTILATION | movement of air in and out of the lungs |
| EXTERNAL RESPIRATION | movement of oxygen from lungs to blood |
| INTERNAL RESPIRATION | movement of oxygen from blood to tissues |
| CONDUCTING ZONE | nose/bronchioles |
| RESPIRATORY ZONE | bronchiole, terminal bronchiole, alveolus |
| INSPIRATION | diaphragm, external intercostals, sternocleidomastoid |
| EXPIRATION | internal intercostals, abdominals |
| ANATOMICAL DEAD SPACE | upper respiratory tract and lower non-respiratory bronchioles |
| PHYSIOLOGICAL DEAD SPACE | anatomical dead space + volume of any non-functional alveoli |
| TIDAL VOLUME (TV) | volume of gas inhaled or exhaled during a normal breath 500-600mls |
| MINUTE VOLUME (MV) | amount of gas inhaled or exhaled in one minute TV x RR |
| EXPIRATORY RESERVE VOLUME (ERV) | amount of air that can be forcibly exhaled 1200mls |
| RESIDUAL VOLUME (RV) | remaining air left in alveoli after forcibly exhaling 1000-1200mls |
| INSPIRATORY CAPACITY (IC) | tidal volume + inspiratory reserve vol. This reflects the amount of gas a person can inspire maximally after a normal expiration = 3600 mls |
| FUNCTIONAL RESIDUAL CAPACITY (FRC) | xpiratory reserve vol + residual vol. Reflects the amount of gas remaining in the lung at the end of a normal expiration = 2400 mls |
| VITAL CAPACITY (VC) | inspiratory reserve volume + tidal volume + expiratory reserve volume. Reflects the vol of gas that can move on the deepest inspiration and expiration = 4800 mls |
| TOTAL LUNG CAPACITY (TLC) | sum of all the volumes = 6000 mls |
| DALTON'S LAW | the sum of partial pressures of each gas in a mixture is the same amount of partial pressure for the entire mixture |
| BOYLE'S LAW | the pressure of an ideal gas is inversely proportional to its volume, given a constant temperature doubling the volume = half the pressure |
| FICK'S LAW | diffusion of gases through liquid (blood) is determined by the pressure of the gas and its solubility |
| BOHR'S LAW | increases in the carbon dioxide partial pressure of blood or decreases in blood pH result in a lower affinity of haemoglobin for oxygen |
| HALDANE EFFECT | increases in arterial PO2 reduces the ability of the blood to store CO2, thereby increase the CO2 partial pressure |
| FACTORS THAT AFFECT DIFFSUION | lung disease, 02 concentration, altitude, loss of lung tissue, PEEP/CPAP/BIPAP, poor perfusion |
| LEFT SHIFT OF OXYHAEMOGLOBIN DISSOCIATION CURVE | INCREASES O2 AFFINITY FOR HAEMOGLOBIN lower CO2, higher pH, lower temp |
| RIGHT SHIFT OF OXYHEAMOGLOBIN DISSOCIATION CURVE | DECREASES O2 AFFINITY FOR HAEMOGLOBIN higher CO2, lower pH, higher temperature |
| REGULATION OF VENTILATION | CNS - BRAINSTEM, MEDULLAR RHYTHMICAL AREA, INSPIRATORY/EXPIRATORY AREA, PNEUMOTAXIC AREA, APNEUSTIC AREA, CERBRAL CORTEX, CHEMORECPETORS |
| ACID | a substance with a pH less than 7 and has more hydrogen ions in solution value below 7.35 produce acidosis |
| ALKALI | is a base or substance with a pH greater than 7 value above 7.45 produces alkalosis |
| PAEDIATRIC AIRWAY | large tongue, superior/anterior trachea and larynx, horizontal ribs, angled vocal cords, narrow trachea |
| PAEDIATRIC NUMBERS | oxygen consumption double (6ml/kg/min) tidal volume of 5-7ml/kg decreased respiratory reserve + increased 02 demand |
| Asthma | An episodic, reversible, inflammatory condition of the small airways, mediated by trigger factors, and characterised by bronchospasm, mucosal oedema and mucous plugging |
| trigger factors | allergens, respiratory infections, exercise, drugs, foods, smoking, air pollutants, temperature change |
| asthma pathophysiology | mast cells/eosinophils/neutrophils sit between the small airways, in response to a pathogen the inflammation response occurs smooth muscles constrict excess mucous secrete swelling of the airway walls |
| steps for asthma | bronchospasm, mucous oedema, mucous plugging |
| V/Q mismatch | mucous plugging - air can’t get into the alveoli can lead to hypoxemia and hypercapnia trying to match ventilation and perfusion |
| air trapping | failure to expire as much air as they have taken in, leads to a build up of pressure that reduces blood flow and blood pressure tension pneumothorax can occur (often bilateral) |
| asthma symptoms | dyspnoea, wheezing, chest tightness, prolonged expiratory phase, cough |
| status asthmatics | an acute severe asthma attack that does not improve with usual doses of inhaled bronchodilators and steroids |
| asthma plan | the development of a written asthma action plan by the person with asthma and/or their carer together with their doctor |
| ACIDOSIS | <7.35 hypoventilation, dizziness, dyspnea, lowered BP, hyperkalemia, rapid/shallow breathing |
| ALKALOSIS | >7.45 seizures, deep/rapid breathing, lethargy, decreased BP, tachycardia, hyperventilation |
| ACID | a substance with a pH less than 7 and has more hydrogen ions in solution |
| ALKALI/BASE | Is a base or substance with a pH greater than 7. |
| ALKALOSIS CAUSES | anxiety, hyperventilation |
| ACIDOSIS CAUSES | COPD, hypoventilation due to chest wall injury, head injury, drugs |
| COPD | airflow limitation, usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases |
| CHRONIC BRONCHITIS | principally the result of obstructive and inflammatory processoverweight, cyanotic, peripheral oedema and wheezing |
| EMPHYSEMA | walls of alveoli break down due to loss of elastin and replaced by collagen older and thin, quiet chest, severe dyspnea |
| COR PULMONALE | to improve oxygenation of the blood, pulmonary vessels adjacent to under-ventilated alveoli tend to constrict (hypoxic reflex pulmonary vasoconstriction), increasing both pulmonary vascular resistance and the work of right heart (CHRONIC STRAIN) |
| HYPOXIC DRIVE | Alveolar hypoxia leads to local capillary vasoconstriction – redirecting pulmonary blood to better ventilated alveoli Alveolar hyperoxia inhibits this important response, leading to worsening V/Q mismatch |
| UPPER RESPIRATORY TRACT INFECTION | illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx |
| EPIDEMIC | classification of a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is "expected," based on recent experience |
| PANDEMIC | is an epidemic that spreads across a large region (for example a continent), or even worldwide (EBOLA) |
| PNEUMONIA | Inflammatory process of functional lung tissue that is commonly caused by infectious agents |
| PNEUMONIA PATHOPHYSIOLOGY | Airborne pathogen released via sneezing/coughing, First line defence is coughing and mucocilliary clearance, Second line macrophage in alveoli, inflammatory mediators. This causes the terminal bronchioles to fill with debris and exudates (pus) |
| PNEUMONIA ASSESSMENT | unilateral coarse crackles, increased density of the lung, sough, sputum, SOB, fever, decreased SPO2 |
| WHOOPING COUGH | caused by the Bordetella pertussis bacterium, is an acute illness, involving the respiratory tract. |
| WHOOPING COUGH PATHOPHYSIOLOGY | catarrhal - sneezing, mild fever, occasional cough paroxysmal - rapid cough, trying to clear thick sputum convalescent - decreasing cough, recurring chest infections |
| PLEURISY | inflammation of the pleura, the thin membranes that line the chest wall and surround the lungs |
| PLEURAL EFFUSION - TRANSUDATIVE | contain fluid with a low protein concentration and arise from an increased hydrostatic pressure gradient or a low protein concentration in the blood, both of which will favour fluid transfer out of capillaries into the pleural space |
| PLEURAL EFFUSION - EXUDATIVE | have high protein content, are commonly unilateral, and arise because of increased permeability, usually caused by pathology involving the pleura such as malignancy, infection or following trauma or surgery |
| SPONTANEOUS PNEUMOTHORAX | a pneumothorax is defined as the presence of air or gas in the pleural space caused by a disruption in the visceral/parietal pleura and the chest wall. A spontaneous pneumothorax occurs with no obvious cause of trauma. |
| PRIMARY SPONTANEOUS PNEUMOTHORAX | occur without a recognised lung disease |
| SECONDARY SPONTANEOUS PNEUMOTHORAX | occur due to an underlying disease |
| BLEB | a small bubble in gas or fluid (in the lungs) |
| RISK FACTORS FOR SP | Tall, thin males COPD/asthma Smoking Family history Marfan syndrome Exposure to loud music |
| SIGNS OF SP | Sudden onset of pleuritic chest pain Sudden onset of dyspnea Exacerbation of COPD Reduced air entry into one lung Occurs at rest |
| PULMONARY EMBOLUS | Often caused by a blood clot in the vein Most common is one in a deep vein of the calf, thigh or pelvis (DVT) Clot breaks off and travels into the lungs |
| PULMONARY EMBOLUS OCCURS... | Childbirth Heart attack, surgery or stroke Severe injuries, burns or fractures of hips or thigh bone Long plane or car ride Cancer patients Long term bed rest |
| PULMONARY EMBOLUS RISK FACTORS | Varicose veins Oral contraceptive pill Oestrogen therapy Vasculitic syndromes (lupus) Pregnancy Haematological disease Age Atrial fibrillation |
| VIRCHOW'S TRIAD | stasis, vessel wall injury, hypercoagulability |
| PULMONARY EMBOLUS SIGNS | Chest pain (under breast bone) sharp/stabbing Worse with deep breathing Bluish skin, CPC Uneven calf size Dizziness Fast HR, RR sinus tachycardia, RBBB, right axis deviation |
| PE RULE OUT CRITERIA | HAD CLOTS (hormone, age, DVT, coughing blood, leg swelling, oxygen, tachycardia, surgery) |
| PLEURAL EFFUSION | collection of fluid abnormally present in the pleural space, usually resulting from excess fluid production and/or decreased lymphatic absorption. |
| NON-CARDIOGENIC PULMONARY OEDEMA | occurs secondary to accumulation of excess fluid and protein into the alveoli from factors other than increased pulmonary capillary pressure >18 mm Hg |
| CAUSES OF NON-CARDIOGENIC PULMONARY OEDEMA | sepsis, pneumonia, ARDS, smoke inhalation, non-thoracic trauma, high altitude, drowning, cocaine use |
| TREATMENT OF NON-CARDIOGENIC PULMONARY OEDEMA | o2 smoke - fluids, pain relief, MICA drowning - CPR, IPPV |
| SYMPTOMS OF NON-CARDIOGENIC PULMONARY OEDEMA | sob, hypoxia, fatigue, weakness, cough, pink/frothy sputum, lower extremity swelling, scattered ronchi and rales |
| DIFFERENCES WITH ACUTE PULMONARY OEDEMA | ECG changes, starlings forces, pressure (colloid/hydrostatic) |
| PATHOPHYSIOLOGY OF NON-CARDIOGENIC PULMONARY OEDEMA | Injury to endothelium - increased permeability and surfactant production disruption - movement of fluid to interstitial space and alveoli blockage of lymphatic vessels - inability to clear fluid - fluid accumulation |
| NEUROGENIC PULMONARY OEDEMA | occurs after a variety of neurologic disorders and procedures, including head injury, intracranial surgery, grand mal seizures, subarachnoid or intracerebral hemorrhage, and electroconvulsive therapy |
| CYSTIC FIBROSIS | caused by mutation of a gene that encodes a chloride-conducting transmembrane channel called the cystic fibrosis transmembrane conductance regulator (CFTR), which regulates anion transport and mucociliary clearance in the airways |
| CYSTIC FIBROSIS PATHOPHYSIOLOGY | mucous plugging chronic inflammation infection parenchymal involvement pulmonary vascular remodelling arterial vasoconstriction |
| CYSTIC FIBROSIS TREATMENT | Pulmonary health and nutrition Techniques to promote mucous clearing (chest pummelling) O2/bronchodilators |
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ZoDunk
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