1. Respiratory Flashcards
What is the most common infectious agent causing pneumonia in an adult?
Strep pneumonia
What are the classes of broad spectrum antibiotics to use in treatment?
Macrolides (Clindamycin)
Beta-lactams (amoxicillin)
What is an appropriate resp investigation you may have forgotten about?
Bronchoscopy
what is key to do when reading the exam questions?
Actually read the exam questions
Bring highlighter?
Describe the appearance of a normal alveoli?
Type I- squamous epithelium
Type II- Surfactant
Elastic fibres
Macropahges
What are the four main laws that drive respiration?
Boyles law- the pressure exerted by a gas is inversely proportionate to its volume
Daltons law- total pressure of gas mixture is the sum of the pressures of the individual gases
Charles law- volume of gas is directly related to temperature
Henry’s law- the amount of gas in a liquid is determined by the pressure of gas and its solubility in the liquid
What are the broad classes of lung diseases?
Restrictive (pneumothorax- fibrosis)- struggle to get air in
Obstructive (e.g. asthma and COPD) have problems on expiration
How do you differntiate between restrictive and obstructive lung diseases?
Spirometry Normal- 70%
Obstructive- below 70%
Restrictive- above 70%
What is the difference between alveolar and arterial dead space?
Anatomical dead space- conducting zone unable to participate
Alveolar dead space- ventilated but not perfused
Discuss the oxygen-dissociation curve
Oxygen is more likely to be held onto (move to the left) in certain situations:
Low temperature
Alkalotic pH
Low PCO2 (hyperventilation occurs to blow of CO2
How does respiration affect blood gas?
Carbon dioxide combines with water to cause a metabolic acidosis
Hyperventilation causing a blow off of hydrogen ions causing respiratory alkalosis
What are the different drivers of respiration?
Central chemoreceptors- primary driver found in medulla. Responds to H ions (carbon dioxide)
Peripheral chemoreceptors- carotid and aortic bodies. Primary drivers of respiration in chronic lung disease
What are the complications of pneumonia?
Pleurisy- inflammed pleura
Pleural effusion- fluid in the pleural cavity
Empyeme- pus in the pleural cavity
What type of lung cancer is caused by smoking?
Adenocarcinoma
Common metastisis points include bone, liver, brain and lung. Also lymph nodes and adrenals
What are the two main features that cause C.O.P.D.
Airflow obstruction and hyperinflation
What are some symptoms of COPD?
Pursed lip breathing
Shallow breathing
Weight loss
Cardiac disease
Loss of muscle mass
Wheeze
Barrel chest
How do you treat COPD?
Pulmonary rehab
Encourage smoking cessation
Inhalers to reduce breathlessness (SABA, SAMA, ICS)
Manage complciations (vaccines)
(AECOPD) CPAP
Nebulised bronchodilators,
corticosteroids,
antibiotics
What are the causes of asthma
Genes
Atopy -(moving away from)
Profession
Smoking
What is the pathway of inhalers in asthma?
SABA ICS LABA 4th agent (LTRA) (steroid tablet)
What level do the lungs bifurcate
T4 (yeah baby)
What level of pleura is vulnerable to pain?
parietal
What are the three haitus of the diaphragm?
T8- VENA CAVA
T10- OESOPHAGUS
T12- Abdomin Aorta
How do you treat pulmonary hypertension?
Treat underlying condition Oxyegn Anticoagulation Diuretics CCB (amlodopine) Prostacyclins
What are the top 3 interstitial lung diseases?
Sarcoidosis
Idiopathic pulmonary fibrosis
Hyeprstitium pneumonitits
What are the nodal stageings for lung cancer
N0 - no nodes
N1- ipsilateral hilar nodes
N2-Ipsilateral mediastinal nodes
N3- controlateral, suproclavicular
How do you investigate lung cancer?
Bronchoscopy EBUS Image guided biopsy FINA Bone biopsy Surgical biopsy
Tb treatment?
Rifampicin
Isoniazid
Ethambutol
Pyrzine
All four for two months
Two for further 4 months (isoniazid and rifampicin)
Tb treatment side effects?
Rifampicin (orange pee)
Isoniazid (hepatitis)
Ethambutol (optic damage)
Pyrzine (gout)
