Complete set of notes for this element in the Bristol A100 Pre-clinical course. This is everything you need to know to achieve 90% marks. It is presented in a simple question, simple answer layout. If you have any questions or if anything doesn’t make sense, email me at mh14782@my.bristol.ac.uk
Table of Contents
Respiratory System 2
Lecture 1: Clinical Introduction to the Respiratory System 2
Lecture 2: Introduction to Respiratory Physiology: Lung Volumes 3
Lectures 3&4: Pathology of Major Clinical Conditions 7
Lecture 5: Ventilation & Airway Resistance 9
Lecture 6: Compliance and Pulmonary Circulation 11
Lecture 7: Gas Exchange 14
Lecture 8: Carriage of O2 in the Blood 17
Lecture 9: Carriage of CO2 in the Blood 20
Lecture 10: Control of Respiration 23
Lecture 11: Microbiology of Lower Respiratory Tract Infections 26
Lecture 13: Airways Pharmacology 1 30
Lecture 14: Pathology and Immunology of Tuberculosis 32
Cystic Fibrosis Symposium 34
Lecture 15: Respiratory Embryology 37
Lecture 16: Epidemiology of Asthma 41
Lecture 17: Airways Pharmacology 2 43
, Respiratory System
Lecture 1: Clinical Introduction to the Respiratory System
• What are small lung diseases? Diseases of the very small airways and interstitial tissues
between alveoli and other structures. There are over 200 types.
• Why is history-taking important in diagnosing small lung disorders? The diseases are often
related to the patients’ activities/hobbies (e.g. bird fanciers’ lung – see later), so history is
important.
• Compare restrictive versus obstructive airways diseases, giving examples.
Restrictive Obstructive
A class of lung diseases where the lungs A class of lung diseases where the airways
cannot expand properly. The lungs are are narrow/obstructed, and hence it is hard
restricted from fully expanding to pass air through them, making it very hard
to breathe (air must be forced out)
- Obesity (extra weight makes it hard to - Tuberculosis
move chest up and down) - Bronchitis
- Scoliosis (deformations make it hard to - Asthma
breathe) - Cystic fibrosis
- Pleural diseases (inflammation/cancers of - COPD
the pleura leaves less space for the lungs
to expand)
- Lung fibrosis (lungs cannot stretch out as
they expand)
• What is pneumonia? Inflammation of the lungs, usually caused by an infection
• What are the potential complications of pneumonia?
1. Pleural effusion – excess fluid that accumulates in
the pleural cavity
2. Empyema – collection of pus in the pleural cavity
3. Abscess – a pus-filled cavity lined with granulation
tissue
• What can cause a localised pleural effusion? Infection,
malignancy or a pulmonary embolism (i.e. localised
causes)
• What can cause bilateral pleural effusion? Blood
disorders
• What’s the difference between pulmonary oedema and
a pleural effusion? An effusion is fluid in the pleural
cavity, outside of the lung, whereas a pulmonary oedema
is fluid inside the lung.
• What is a pneumothorax? When the airtight pleura is
compromised so there is an air leak and the lung can therefore deflate.
• What is a secondary pneumothorax? A pneumothorax caused by another lung problem or
by iatrogenic causes (caused by doctors)
• What is a pack year? A unit to quantify how much someone has smoked. 1 pack year = 20 a
day for a year. So for example, 10 a day for 3 years is 1.5 pack years.
• What is lung reduction surgery? LVRS can improve the quality of life for certain COPD and
emphysema patients. Parts of the lung that are particularly damaged by emphysema are
removed, allowing the remaining, relatively good lung to expand and work better.
Marc Huttman 2
,• What is a lung bulla? When there is tissue destruction of the lung parenchyma, many alveoli
may merge together, forming a large air-filled cavity. This is very inefficient for gas exchange
as it has a much lower surface area than all the alveoli did.
Lecture 2: Introduction to Respiratory Physiology: Lung Volumes
• What is respiration? The process by which oxygen from the atmosphere is delivered to cells
of the body and enables them to produce energy by oxidative reactions. The by-product
carbon dioxide is removed to the atmosphere.
• Define the following types of respiration commonly talked about:
Respiration type Definition
External respiration Getting gas in and out of your lungs (i.e. breathing)
Internal respiration Getting the gases in the blood to the tissues of the body and the
gases in the tissues of the body back into the blood
Cellular respiration Biochemical reactions using oxygen to produce energy (i.e.
glycolysis, link, Krebs, ETC)
• What does compliance mean when talking about the lungs? How stretchy they are
• Where does gas exchange take place in
the lungs?
o Respiratory bronchioles (NOT
terminal bronchioles or anything
more proximal)
o Alveolar ducts
o Alveolar sacs
o Alveoli
• What happens to the gas you breathe
in as it travels down to the alveoli?
Humidified and warmed by the walls of
the airways
• Why is this important for the alveoli?
So the gas won’t dry them out
• How do the airways protect us from invasive foreign materials?
1. Hairs in nose act as a filter
2. Trachea and main bronchi have sticky mucus to trap any particulate matter that
does get this far. It is then removed by the muco-ciliary escalator and then
swallowed.
3. Alveolar macrophages
• What is dead space? The volume of gas in the lungs that does not take part in gas exchange,
which in a normal healthy individual is the volume of gas in the conducting airways.
• What happens to the cross-sectional area of the individual airways as branching increases?
Each individual airways has a smaller diameter
• What happens to the TOTAL cross-sectional area of each branching level? It gets bigger, as
the total cross-sectional area at the alveolar level is much higher than at the trachea
because there are many more alveoli, despite each individual one being much smaller than
the trachea in diameter.
• What do goblet cells in the main airways secrete? Mucin, which is a precursor to mucus
Marc Huttman 3
, • Why do the trachea and main
bronchi have cartilage? For support,
to keep them open.
• How to bronchioles stay open if they
have no cartilage? There is
supportive, elastic connective tissue
between them (a.k.a. lung
parenchyma provides radial traction)
• How thin are the walls between the
alveoli and capillary? 0.5μm
• What are the 3 cell types in the
alveolus and what do they do?
Cell Type Description
Macrophage Scavenger cells that engulf and dissolves any foreign material
Type I alveolar cells - The cells that line the alveoli
- Gas exchange occurs across them
- Makes up 90% of SA of alveoli
- Tight junctions
- Fused with capillary endothelium
Type II (septal) - Secretes surfactant, which is very important in lung function in
alveolar cells decreasing the surface tension
• When are type II pneumocytes first made in an embryo? At 24 weeks
• What happens if they are not made? Respiratory distress of the newborn
• Roughly how many branches are there before you get to the alveoli? 24
• Be comfortable with all of the following symbols:
Marc Huttman 4
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