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medicine year 1 and 2 > case 6 > Flashcards

case 6 Flashcards

1
Q

what type of cells are type 1 glomus cells derived from embryologically?

A

nerve cells

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2
Q

what is the sternal notch also called?

A

the jugular notch

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3
Q

what are large cell carcinomas?

A

Epithelial tumours that lack the cytological features of small cell carcinoma and have no glandular or squamous differentiation.

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4
Q

what is the presentation of pneumothorax?

A

Unilateral pleuritic pain with increasing breathlessness and possible cyanosis.

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5
Q

what are the features of pneumothorax on exam?

A

↓ chest expansion
↓/absent breath sounds
Hyper-resonance on percussion

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6
Q

what is one way to treat a pneumothorax? (esp a big one where the patient’s struggling to breathe)

A

chest drain-a small plastic tube may be inserted into the pleural space to remove air-collapsed lung will reinflate as pressure on the lung decreases.

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7
Q

what is the criteria for pulsus paradoxicus?

A

drop in BP of >10mmHg on inspiration

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8
Q

what is frank blood?

A

when a blood vessel bleeds and the same blood is seen outside the body.

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9
Q

what is chylothorax?

A

Presence of lymphatic fluid in the pleural space

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10
Q

what is the annual incidence of PE?

A

around 3-4 per 10,000 people

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11
Q

what are crepitations?

A

crackles

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12
Q

what does GORD stand for?

A

gastro oesophageal reflux disease

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13
Q

why might the trachea deviate to the right?

A

left sided tension pneumothorax
right sided lobar collapse
right sided pneumonectomy
large left sided pleural effusion

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14
Q

what is a pneumonectomy?

A

surgery to remove a lung

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15
Q

what are the examination findings you would expect to find in a patient with a right lower lobe pneumonia?

A

Dullness to percussion right lower zone, crackles right lower zone, increased vocal resonance right lower zone, bronchial breathing

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16
Q

what are the unique symptoms of pancoast tumours?

A

shoulder pain

horners syndrome

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17
Q

What is horners syndrome?

A

unilateral:
ptosis- eyelid drooping
miosis- pupils constricted
anhidrosis - can’t sweat

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18
Q

what is the one bone in the body that isn’t connected to another bone?

A

hyoid bone (at the top of the larynx).

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19
Q

what is a crus?

A

a leg like structure (crus means leg in latin)

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20
Q

how many ribs do we have in total?

A

24

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21
Q

what does costal mean?

A

referring to the ribs

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22
Q

what does chondral refer to?

A

cartilage.

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23
Q

what is the thoracic wall?

A

the structure that surrounds and forms the boundaries of the thoracic cavity.

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24
Q

what are the openings of the thoracic wall?

A

1) superior thoracic aperture

2) inferior thoracic aperture.

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25
Q

what is the thoracic wall made up of?

A

thoracic cage
intercostal spaces + their contents
thoracic muscles

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26
Q

how many intercostal spaces on each side?

A

11

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27
Q

what are the 4 stages of physiological respiration?

A

pulmonary ventilation
external gaseous exchange (in alveoli)
gas transport
internal gas exchange (in capillaries)

28
Q

what do type 1 glomus cells do?

A

secretory sensory neuronal cells that release neurotransmitter in response to hypoxaemia. the neurotransmitter regulates the rate of firing of carotid body afferent fibres from cranial nerve 9 (glossopharyngeal).

29
Q

COPD is characterised by…

A

the obstruction of lung airflow which isn’t fully reversible.

30
Q

what are the 3 main types of joints?

A

cartilaginous-connect structures by cartilage
fibrous-by fibrous connective tissue
synovial-between structures that aren’t directly joined but surrounded by a joint capsule containing synovial fluid.

31
Q

what are the 3 classes of joint based on the degree of movement they allow?

A

synarthrosis-immovable
amphiarthrosis-slightly moveable
diarthrosis-freely moveable

32
Q

what are the 2 types of cartilaginous joints?

A 
primary cartilaginous (synchondrosis)-hyaline cartilage
secondary cartilaginous (symphysis)-fibrocartilage
33
Q

what is a1 antitrypsin defiency and its relevance?

A

genetic disorder, a cause of copd

a1 antitrypsin inhibits proteases, without it there is increased action of proteases which leads to copd.

34
Q

what are splanchnic nerves?

A

paired visceral nerves carrying fibres of the autonomic nervous system and sensory fibres. all sympathetic apart from pelvic (parasympathetic).

35
Q

what makes up the upper respiratory tract?

A

nose, nasal cavity, pharynx, larynx (larynx sometimes called lower respiratory)

36
Q

what makes up the lower respiratory tract?

A

trachea, bronchi, lungs

37
Q

what is the trachea held open by?

A

c shaped cartilage rings

38
Q

what happens to cartilage as you go down the RT?

A

trachea-c shaped, bronchi, cartilage rings, cartilage reduces as bronchi branch further, no cartilage in bronchioles.

39
Q

what nerves innervate the parietal pleura?

A

phrenic and intercostal nerves

40
Q

what nerves innervate the visceral pleura?

A

pulmonary plexus (sympathetic trunk and vagus nerve)

41
Q

what can each of the pleura sense?

A

parietal- pressure, pain, temperature

visceral-stretch

42
Q

what arteries supply the pleura?

A

visceral-bronchial

parietal-intercostal

43
Q

about how many degrees is the sternal angle?

A

163

44
Q

how can you remember what structures are under the sternal angle?

A 
RAT PLANT:
rib 2
aortic arch
tracheal bifurcation
pulmonary trunk
ligamentum arteriosum
azygous vein
nerves
thoracic duct
45
Q

what pattern of breathlessness does pulmonary fibrosis cause?

A

a slow insidious increase in breathlessness

46
Q

what is it called when u have too many platelets?

A

thrombocytosis

47
Q

what do you have to remember when testing for lung cancer using a CXR?

A

they miss 1/5!! if u strongly suspect lung cancer, do a CT.

48
Q

what are the 2 theories underpinning neuronal control of ventilation?

A

neuronal network theory

pacemaker theory

49
Q

what is pacemaker theory and its support?

A

pacemaker cells which fire and discharge rhythmically in the brain control ventilation
supported by rhythmic firing of cells in pre-botzinger complex.

50
Q

what are some of the cons of pacemaker theory?

A

if it was correct, how would it respond to metabolic changes?
raises issues about how to integrate with other functions like speech-too simple

51
Q

what happens in asbestosis?

A

breathe in asbestos-can cause scarring and thickening of alveoli-lungs shrink and harden-lower lung capacity-dyspnoea+can cause cough, wheeze, fatigue, chest pain.

52
Q

what are pain receptors called?

A

nociceptors

53
Q

in obstructive lung disease what happens to the FEV1 and the FVC and the ratio?

A

both decrease but FEV decreases more

lower FEV1/FVC ratio

54
Q

you’re 3x more likely to stop smoking if…

A

u use a combination of stop smoking treatment and specialist help

55
Q

what are 3 examples of stop smoking treatment?

A

nicotine replacement therapy eg gums, sprays
stop smoking medication eg varenidine (champix-stops pleasurable effects of nicotine on the brain)
e cigarettes

56
Q

what is paraneoplastic syndrome?

A

set of symptoms that occur with cancer due to substances a tumour secretes or to the body’s response to the tumour.

57
Q

what is a pancoast tumour?

A

tumour growth (typically squamous carcinoma) in apical region of lungs. unique set of symptoms.

58
Q

how do you treat tension pneumothorax?

A

wide bore cannula into 2nd intercostal space at midclavicular line-needle thoracentesis

59
Q

what are the clinical features of tension penumothorax?

A 
severe signs and symptoms of respiratory distress and mediastinal shift:
tracheal deviation (away from site)
tachycardia >135bpm
pulsus paradoxicus
hypotension
increased jvp
60
Q

what is pulsus paradoxicus?

A

abnormally large decrease in stroke volume, bp, and pulse wave amplitude on inspiration.

61
Q

what are some of the causes of haemothorax?

A

chest trauma, cancer, PE (less common)

62
Q

what is empyema?

A

presence of pus in the intrapleural space

63
Q

what causes empyema?

A

it’s secondary to an infection-usually pneumonia.

64
Q

what is stridor?

A

high pitches breathing sound resulting from a narrow or blocked airway heard on inspiration

65
Q

what is FEV1?

A

measure of how much air a patient can breathe out forcefully in one second.

medicine year 1 and 2 (29 decks)

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