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Flashcards

Respiratory

Phoebe Williams Medicine English 66 cards

Cards in this deck (66)

  1. 1Thoracic InletAKA superior thoracic aperture
    Bounded posteriorly by T1
    Bounded laterally by first pair of ribs
    Bounded anteriorly by costal cartilages of first pair of ribs and superior border of manubrium
  2. 2Inferior thoracic apertureBounded posteriorly by T12
    Bounded laterally by rib pairs 11 and 12
    Bounded anteriorly by xiphisternal joint and costal cartilages of rib pairs 7 to 10
    Diaphragm below separating from abdominal cavity
  3. 3Rib articulation/jointsRib head articulates with body of thoracic vertebrae at same level and one above
    Tubercle articulates with transverse process of thoracic vertebra at same level
    Both are synovial plane joints (costovertebral and costotransverse)
  4. 4Rib anatomyHead
    Neck
    Tubercle
    Subclavian artery groove (posterior)
    Scalene tubercle
    Subclavian vein groove (anterior)
  5. 5Lymphatic drainage of chestRight upper chest wall drains into right thoracic duct
    Rest of chest drains into lymphatic duct
    Both drain into brachiocephalic veins (right and left respectively)
  6. 6Diaphragm attachmentsPeripheral attachments at lumbar vertebrae and arcuate ligaments, costal cartilages of rib pairs 7 to 12 and xiphoid process
    Central attachment at central tendon
  7. 7Diaphragm cruraTendinous parts of diaphragm
    Arise from vertebral attachments
    Right crus arises from L1-L3
    Some parts around oesophageal opening prevent reflux
    Left crus arises from L1-L2
  8. 8Phrenic nerveRoots at C3, 4, 5
    Motor and sensory innervation
    Innervates diaphragm inferiorly for motor function
    Supplies central diaphragm for sensory function
  9. 9Diaphragmatic hiatusesT8: caval (inferior vena cava passes)
    T10: oesophageal hiatus (oesophagus and vagus nerves pass) through muscle of right crus
    T12: aortic hiatus (aorta, azygos and hemiazygos veins, thoracic duct pass) between left and right crura
  10. 10Upper respiratory tractEnds at larynx (usually)
    Defined as above cricoid cartilage (not including larynx) or above sternal angle (including larynx)
  11. 11Respiratory tree (conducting/non respiratory parts)Branching structure of airways
    Trachea
    Primary bronchi
    Lobar/secondary bronchi
    Segmental/tertiary bronchi
    Conducting bronchiole
    Terminal bronchiole
  12. 12Respiratory tree (respiratory/exchange sections)Respiratory bronchiole
    Alveolar duct
    Alveolar sac
    Alveoli
  13. 13LarynxC2/3-6
    Epiglottis to inferior border of cricoid cartilage
    Innervated by vagus nerve branches
  14. 14Parts and vertebral levels of larynxHyoid C2/3
    Thyrohydoid membrane C4
    Laryngeal prominence (Adam's Apple) C5
    Cricoid cartilage (start of trachea) C6
  15. 15Lobes and fissures of lungRight: 3 lobes (superior, middle, inferior)
    Left: 2 lobes (superior, inferior)
    Left has lingula (below cardiac notch)
    Oblique fissure spilts S and I lobes
    Horizontal splits S and M (in right)
  16. 16BordersAnterior border lies along superior lobe
    (and part of middle lobe in right)
    Posterior border lies along inferior lobe
    (and part of superior lobe)
    Inferior border lies at base of lung
  17. 17SurfacesCostal (outward facing)
    Mediastinal (medial)
    Diaphragmatic (inferior)
  18. 18Lung root structures in hilumBronchi (RL has extra bronchus above artery, eparterial)
    Pulmonary artery (anterior to bronchus)
    Superior pulmonary vein (most anterior)
    Inferior pulmonary vein (most inferior)
  19. 19Drawing of root in hilum for right lung(HB)
    B
    A
    S
    I
  20. 20PleuraVisceral on lung surface
    Parietal on chest wall
  21. 21Named parts of parietal pleuraCupular at apex
    Costal near ribs
    Diaphragmatic
    Mediastinal
  22. 22Pleural nerve supplyParietal:
    Somatic nerves (intercostal nerves, phrenic)
    Sensitive to pain
    Visceral:
    Autonomic nerves (T2-5)
    Insensitive
  23. 23Reflections and recessesReflection: where parietal pleura changes direction (doesn't follow lung shape and visceral pleura)
    Recess: increased space between pleura at reflection
    Costomediastinal
    Costophrenic (costodiaphragmatic)
  24. 24Inferior margins of lung and parietal pleuraMidclavicular line - 6th rib
    Midaxillary line - 8th rib
    Midscapular line - 10th rib
    Pleural margin is 2 ribs below
  25. 25Fissure levelsHorizontal fissure (right lung) follows 4th rib anteriorly
    Oblique fissures begin at spine of T3 and follows 6th rib anteriorly
  26. 26Histology of trachea (and large bronchi)Respiratory epithelium
    Mucosa
    Lamina propria
    Submucosa
    Tracheal cartilage
  27. 27Bronchiole histologyNo cartilage
    No glands
    No goblet cells
    Columnar to cuboidal to squamous
    from trachea to bronchioles to alveoli
  28. 28Anatomical dead space~150ml
    Volume of gas in conducting airways
    NOT available for gas exchange
  29. 29Tidal volumeAir breathed in or out per breath
  30. 30Expiratory reserve volume (ERV)Maximum volume exhaled after normal expiration
  31. 31Inspiratory reserve volume (IRV)Maximum volume of air inhaled after normal inspiration
  32. 32Residual volumeAir leftover after maximal expiration (stops lungs collapsing)
  33. 33Vital capacityTidal volume + ERV + IRV
    Fit, young, healthy, adult male: 5L
  34. 34Total lung capacityMaximum volume held by lungs
    VC + residual volume
  35. 35Inspiratory capacityTidal volume + IRV
  36. 36Functioal residual capacityAir typically leftover after a normal breath
    Residual volume + ERV
  37. 37FEV1Forced expired volume in one second
    Fast, hard expiration
    Fit, healthy, young adult male: 4L
  38. 38FEV1/FVCFraction of forced vital capacity
    expired in a second
    Usually 80%
  39. 39VentilationSplit into two types, both L/min
    Pumonary (minute) ventilation (total air moved in and out of lungs, usually insignificant functionally)
    Alveolar (fresh air reaching alveoli, so available for gas exchange)
  40. 40Changing partial pressure with hyper/hypoventilationUsually alveolar PO2 and PCO2 are relatively constant (100mmHg and 40mmHg respectively)
    During hyperventilation, PO2 rises to 120mmHg, PCO2 falls to 20mmHg
    During hypoventilation, PO2 falls to 30mmHg, PCO2 rises to 100mmHg
  41. 41Types of cell in alveolar wallsThin Type 1 cells for gas exchange
    Specialised Type 2 cells secreting surfactant to reduce surface tension and prevent recoil/collapse of alveoli
  42. 42Surfactant in small vs large alveoliEven better effect in smaller alveoli as surfactant is concentrated
    Law of Laplace P=2T/pi
  43. 43In utero surfactantStarts production around 25 weeks
    Complete around 36 weeks
    Stimulated by thyroid hormones and cortisol (more around third trimester)
    Lack of surfactant e..g. premature babies causes infant respiratory distress syndrome
  44. 44ComplianceHow does volume change for associated pressure change
    Stretchability of lungs
    Highly compliant: large volume increase for small intrapleural pressure decrease
  45. 45Obstructive vs restrictive lung diseaseObstruction of airflow, due to increased resistant, especially during expiration
    Restriction of lung expansion, lost compliance (stiffness), affects inspiration
  46. 46Why is expiration passive?Work done during expiration is recovered due to elastic recoil
  47. 47Obstructive diseasesAsthma
    COPD, including emphysema (decreased elastic tissue, no recoil, expiration not passive) and chronic bronchitis (inflammation of bronchi)
  48. 48Restrictive diseasesFibrosis, excess connective tissue, idiopathic or occupational hazard (asbestosis, coal dust)
    IRDS
    Oedema
    Pneumothorax
  49. 49Spirometry in diseaseObstructive: reduced FEV1 and FVC, much longer to reach FVC, not proportional, reduced ratio
    Restrictive: reduced FEV1 and FVC in proportion, normal timescale for expiration, normal/high ratio
  50. 50Compliance and alveolar ventilationDecrease as you move from base to apex
    Diaphragm compresses lungs at base so more compliant on inspiration
  51. 51Blood supply to lungsBronchial circulation (nutritive) via bronchial arteries (systemic circulation) supplies airway smooth muscle, lung tissue and nerves with oxygen
    Pulmonary circulation (gas exchange) via left and right pulmonary arteries from right ventricle back to left atrium (high flow, low pressure: 25mmHg around a fifth of systemic pressure at 120mmHg)
  52. 52Conversion between mmHg and kPa100 mmHg = 13.3 kPa
    40 mmHg = 5.3 kPa
    46 mmHg = 6.2 kPa
  53. 53Partial pressures of O2 and CO2 in tissues, arterial blood and alveolar air mmHgAlveolar: O2=100, CO2=40
    Arterial (systemic) : O2=100, CO2=40
    NOT pulmonary artery
    Venous=Tissues: O2=40, CO2=46
    same as pulmonary artery
  54. 54Gradients and volumes of gas moved per minuteAlveoli: O2=100, CO2=40
    Pulmonary artery: O2=40, C02=46
    O2: 250ml/min (higher grad)
    CO2: 200ml/min
  55. 55Emphysema and changes to gas exchangeObstructive
    More work done to expire
    Destroys alveoli, reduced surface area
    Reduced or normal alveolar O2
    Reduced arterial O2
  56. 56Fibrotic lung disease and changes to gas exchangeRestrictive lung disease
    Reduced compliance
    Thickened alveolar membrane slows exchange and lost compliance decreases ventilation
    Reduced or normal alveolar O2
    Reduced arterial O2
  57. 57Pulmonary oedema and effect on gas exchangeIncreased diffusion distance due to fluid in interstitial space
    CO2 is more soluble in water so arterial CO2 usually normal
    Alveolar O2 normal
    Arterial O2 reduced
  58. 58Asthma and effect on gas exchangeObstructive disease
    Harder expiration
    Constricted bronchioles
    Increased airway resistance
    Decreased ventilation
    Low alveolar and arterial O2
  59. 59Ventilation-PerfusionVentilation: breathing (air reaching alveoli)
    Perfusion: blood flow to area
    Should compliment each other
  60. 60How is blood flow distribution in lungs affected?Hydrostatic (blood) pressure
    Alveolar pressure
    At base of lungs: high blood flow
    (blood pressure>alveolar pressure
    so low resistance)
    At apices: low flow
    (blood pressure
  61. 61Where is ventilation and perfusion best matched?Around 3rd rib
  62. 62Mismatched ventilation-perfusion Type 1: ventilationIf ventilation decreases in alveoli, partial pressure of CO2 increases and pp of O2 decreases
    Blood not oxygenated
  63. 63What is a shunt?Passage of blood through poorly ventilated areas: no gas exchange occurs
    Oxygenated blood from better ventilated areas is diluted by deoxygenated blood that has arrived from poorly-ventilated areas (i.e. restricted alveoli)
  64. 64How is mismatch controlled?Blood flow diverted to better ventilated alveoli by constricting arterioles near 'bad' alveoli (triggered by reduced O2, hypoxia)
    Increased CO2 also does this
    Only happens in pumonary vessels (systemic vessels do the opposite and dilate)
  65. 65Mismatched ventilation-perfusion Type 2: ventilation>blood flowAlveolar dead space
    Opposite to shunt, where blood vessels constrict
    Increased alveolar O2: vessels dilate
    Decreased alveolar CO2: bronchioles constrict
  66. 66Physiological dead spaceAlveolar dead space (from ventilated but not perfused alveoli)
    +
    Anatomical dead space

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Description
Medicine Flashcards on Respiratory, created by Phoebe Williams on 09/04/2018.
Created by
Phoebe Williams · Apr 2018
Updated
Apr 16, 2018
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