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Respiratory for Finals > High Yield Exam Cram > Flashcards

High Yield Exam Cram Flashcards

1
Q

Which muscles are used during inspiration?

A

External intercostals and diaphragm

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2
Q

Is expiration active or passive at rest?

A

Passive

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3
Q

Which muscles are used in forced expiration?

A

Internal intercostal and abdominal muscles

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4
Q

What is meant by ‘lung compliance’?

A

The lung’s ability to stretch and expand

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5
Q

What is an average tidal volume?

A

500ml

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6
Q

What is the average volume of ‘dead space’?

A

150ml

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7
Q

What is ‘dead space’?

A

Places in the respiratory system where gas exchange cannot happen (e.g. trachea, bronchi, bronchioles)

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8
Q

What does residual volume prevent?

A

Alveolar collapse

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9
Q

Does breathing air in cause an increase or a decrease in pressure inside the chest?

A

decrease

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10
Q

how is pulmonary ventilation calculated?

A

respiration rate x tidal volume

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11
Q

What is the definition of pulmonary ventilation?

A

total air movement into/out of the lungs

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12
Q

What is the definition of alveolar ventilation?

A

the volume of fresh air getting to alveoli and therefore available for gas exchange

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13
Q

How is alveolar ventilation calculated?

A

{Tidal volume-dead space volume] x respiratory rate

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14
Q

Where in the lung is alveolar ventilation rate at it’s greatest and worst- why?

A

is greatest at the base of the lung and worst at the apex bc compliance is lowest at apex and highest at base

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15
Q

What is compliance?

A

The lung’s ability to stretch out when you breathe in?

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16
Q

What is elasticity?

A

The lung’s ability to recoil when you breathe out

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17
Q

Name the two different alveolar cells and their role

A

Type 1 - Gas exchange
Type 2 - Surfactant production

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18
Q

What is the function of surfactant?

A

reduces surface tension and makes alveoli less likely to collapse

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19
Q

At what stage in gestation does surfactant production begin and by what stage of gestation is production of surfactant adequate?

A

Production begins - 25 weeks

Surfactant levels adequate - 36 weeks

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20
Q

What is the ideal V/Q ratio in the lungs and what does that number mean?

A

V/Q= 1

this means that ventilation and perfusion match

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21
Q

Where in the lung would you find a V/Q <1?

A

in the lung base

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22
Q

Where in the lung would you find a V/Q >1?

A

In the lung apex

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23
Q

What is meant by the term ‘shunt’?

A

Shunt = alveoli are perfused but under ventilated

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24
Q

What is meant by the term ‘alveolar dead space’?

A

Alveolar dead space = alveoli that are well ventilated but under perfused

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25
Q

What is theme given to the natural arrhythmia that keeps the V/Q as close to 1 as possible?

A

Respiratory sinus arrhythmia

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26
Q

Describe how gas moves across a pressure gradient

A

From high pressure to low pressure

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27
Q

How is CO2 carried around the body?

A

70% carried as carbonic acid (which can dissolve to form bicarbonate and H+ driven by carbonic anhydrase)

23% carried as carboamino compounds inside erythrocytes

7% remains dissolved in plasma

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28
Q

describe the chemoreceptors involved in breathing control (where are they and what do they detect?

A

Central medullary chemoreceptors = detect CO2 in CSF

Carotid and aortic chemoreceptors = detect O2 and pH in arterial blood

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29
Q

Which parts of the brain process the information from chemoreceptors and send out signals to maintain homeostasis?

A

Medulla and pons

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30
Q

Describe the physiology of hypoxic drive

A

PaCO2 is chronically elevated in chronic lung disease.

Central chemoreceptors get desensitised and the individual instead begins to rely on changes in PaO2 to stimulate ventilation

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31
Q

Which lung diseases exhibit an obstructive pattern on spirometry?

A

Problems with the airway and COPD

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32
Q

Which lung diseases exhibit a restrictive pattern on spirometry?

A

Problems with the lung itself, neuromuscular disorders and obesity

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33
Q

What happens to the FEV1/FVC in obstructive lung diseases?

A

reduces (FEV1 tends to reduce more than FVC so the ratio gets thrown off)

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34
Q

What happens to the FEV1/FVC in restrictive lung diseases?

A

normal (both FEV1 & FVC reduces the ratio stays equal)

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35
Q

what is the difference between type 1 and type 2 respiratory failure?

A

Type 1 = O2 reduced

Type 2 = O2 reduced + CO2 increased (retained)

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36
Q

The presence of CO2 makes blood __________ (acidotic/alkalotic)

A

ACIDOTIC

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37
Q

Name 5 conditions that make patients acidotic

A

CCAPS

COPD + Compensation due to renal issues

Asthma

Pulmonary oedema

Sedative drugs (e.g. benzos and opiates)

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38
Q

Name 6 things that make you alkalotic

A

CHAPPS

CNS (e.g. stroke, encephalitis)

High altitudes

Anxiety

PE + Pregnancy

Salicylate poisioning

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39
Q

What is myoglobin and what does it indicate?

A

Myoglobin stores O2 in cardiac and skeletal muscle. it indicates tissue damage

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40
Q

What type of hypersensitivity reaction does asthma fall into?

A

Type 1

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41
Q

which tests can be used to diagnose asthma?

A

Spirometry with bronchodilator reversibility

FEV/FVC<70%

FENO >40 (adult) >35 (children)

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42
Q

What is the stepwise order of inhalers in asthma?

A

SABA + LOW DOSE ICS + LTRA + LABA

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43
Q

What is the PEFR in moderate asthma?

A

PEFR 50-75%

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44
Q

What is the PEFR in life threatening asthma?

A

PERF <33%

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45
Q

Name the other features of life threatening asthma

A

O2 SATS <92%
silent chest
hypotension
cyanosis
exhaustion
confusion
low CO2

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45
Q

What finding indicates near fatal asthma?

A

Raised or normal CO2

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46
Q

How should asthma be managed?

A

O2
Steroids (hydrocortisone), salbutamol
Ipatropium bromide
Magnesium sulphate aminophylline
ITU

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47
Q

What is the most common cause of bronchiectasis?

A

H. Influenzae

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48
Q

What is the gold standard test for diagnosing bronchiectasis?

A

High resolution CT

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49
Q

What CT sign indicates bronchiectasis?

A

Signet ring sign

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50
Q

What two conditions make up COPD?

A

Bronchitis and emphysema

51
Q

Does COPD cause clubbing?

A

NO

52
Q

How can the severity of COPD be graded?

A

MRCP breathlessness scale

53
Q

Describe the MRCP breathlessness scale

A

Grade 1: Breathless on strenuous exercise

Grade 2: Breathless on walking uphill

Grade 3: Breathlessness that slows walking on the flat

Grade 4: Breathlessness stops them from walking more than 100 meters on the flat

Grade 5: Unable to leave the house due to breathlessness

54
Q

State the FEV1 (%) in COPD stage 1-4

A

Stage 1 (mild)- >80%
Stage 2- (moderate)- 50-79%
Stage 3- (severe)- 30-49%
Stage 4-(very severe)-<30%

55
Q

What treatments should be given to manage an acute exacerbation of COPD

A

O2
Nebulised salbutamol & ipratropium
Hydrocortisone
ABX if indicated
Ventilation if indicated

56
Q

What are the indications for NIV in COPD?

A

< 7.35 or RR>30

57
Q

What are the indications for invasive ventilation in COPD?

A

pH < 7.25

58
Q

What are the chronic management options in COPD?

A

SABA/SAMA

then

LABA +ICS if asthatic features OR LABA + LAMA if no asthmatic features

59
Q

What are the indications of LTOT?

A

if PaO2 <7.3 KPa on 2 readings more than 3 weeks apart.

if PaO2 7.3 - 8 KPa with nocturnal hypoxia, polycythaemia, peripheral oedema, pulmonary hypertension.

60
Q

What is the inheritance pattern in cystic fibrosis?

A

Autosomal recessive

61
Q

On which chromosomes the mutated gene in cystic fibrosis?

A

Chromosome 7

62
Q

What molecular structure is affected in cystic fibrosis sufferers?

A

transmembrane cAMP-activated chloride channel.

63
Q

What is the most common type of lung cancer?

A

Adenocarcinoma

64
Q

What are the 3 most common types of lung cancer?

A

Adenocarcinoma (60%)
Squamous cell (20%)
Small cell (20%)

65
Q

Which type of lung cancer is seen more commonly in non-smokers?

A

Adenocarcinoma

66
Q

What are the additional features seen in adenocarcinoma?

A

Gynaecomastia and HPOA

67
Q

What are the additional features seen in squamous cell carcinoma?

A

PTHRP, Ectopic TSH, HPOA, Clubbing

68
Q

What are the additional features seen in small cell carcinoma?

A

Labert Eaton, SIADH, ectopic ADH release

69
Q

Which type of lung cancer carries the worst prognosis?

A

Small cell lung cancer

70
Q

What is the first line treatment for lung cancer?

A

Lobectomy

71
Q

When is lobectomy contraindicated?

A

stage 3/4
FEV1<1.5L
SVCO
pleural effusion
tumor near hilum
vocal cord affected

72
Q

What is the second line treatment in lung cancer if lobectomy is not possible?

A

Curative radiotherapy

73
Q

What is the treatment in metastatic small cell lung cancer?

A

Palliative chemotherapy

74
Q

What is the most common cause of pulmonary fibrosis?

A

Idiopathic

75
Q

What are the names of the 2 medications licences to slow the progression of idiopathic pulmonary fibrosis?

A

Pirfenidone and nintedanib

76
Q

What sign on CT is indicative of pulmonary fibrosis?

A

Ground glass appearance

77
Q

Name the causes upper and lower zone pulmonary fibrosis

A

Upper zone: CHARTS

  • Coal worker’s pneumoconiosis
  • Histiocytosis/
    hypersensitivity pneumonitis
  • Ankylosing spondylitis,
  • Radiation
  • Tuberculosis
  • Silicosis/sarcoidosis

Lower zone: RAIDS

  • Rheumatoid
  • Asbestosis
  • Idiopathic
  • Drugs
  • Sarcoidosis
78
Q

How do you differentiate between a transudate and an exudate

A

< 25g/L = transudate

25-30g/L = light’s criteria

> 30g/L = Exudate

79
Q

Describe light’s criteria

A

Light’s Criteria

The effusion is exudative if protein is 25-30g/L and one of the following is present:

Pleural fluid/Serum protein >0.5
Pleural fluid LDH/Serum LDH >0.6
Pleural fluid LDH > 2/3rds upper limit of normal serum LDH

80
Q

Is an exudative effusion usually unilateral or bilateral?

A

Unilateral

81
Q

Is a transudative effusion usually unilateral or bilateral?

A

Bilateral

82
Q

List the causes of an exudative effusion

A

Infection (put in chest drain!!)
Pulmonary issues
Inflammation
Malignancy
Dressler’s yellow nail

83
Q

List the causes of a transudative effusion

A

Increased hydrostatic or decreased oncotic pressure

Meig’s syndrome (benign ovarian tumour, pleural effusion & ascites. Pleural effusion & ascites resolve once tumour is removed)

84
Q

How are the following managed:

Primary pneumothorax (no lung disease)

<2cm and stable =
<2cm & breathless =
>2cm =

A

<2cm and stable = discharge

<2cm & breathless = aspiration

> 2cm = chest drain

85
Q

How are the following managed:

Secondary pneumothorax (lung disease)

<1cm =
1-2cm =
>2cm =

A

<1cm = admit
1-2cm = aspiration
>2cm = chest drain

86
Q

How should a tension pneumothorax be managed?

A

needle decompression THEN chest drain (once pressure is relieved)

87
Q

How should a bilateral pneumothorax be managed?

A

chest drain

88
Q

What are the boundaries of the ‘safe triangle’ for chest drain insertion?

A

5th intercostal space, edge of latissimus dorsi and edge of pectoralis major

89
Q

Where should the needle the placed in needle decompression of a pneumothorax?

A

2nd intercostal space, midclavicular line

90
Q

When is a pneumonia classed as ‘community acquired’ vs ‘hospital acquired’

A

Within 48hrs of admission = community admission

> 48 hours after admission = hospital acquired

91
Q

Explain how CURB-65 helps guide where a patient is treated

A
  • 0-1- home
  • 2- hospital
  • 3-5-ITU
92
Q

What are the parameters of CURB-65

A

C - confusion
U - Urea >7
R - RR>30
B - BP <90 systolic or <60 diastolic
65 - >65 years old

93
Q

Which type of pneumonia is associated with herpes labialis?

A

Strep pneumoniae

94
Q

What is the most common cause of pneumonia?

A

strep pneumonia

95
Q

Which type of pneumonia is associated with cystic fibrosis and bronchiectasis?

A

pseudomonas

96
Q

Which type of pneumonia is associated with COPD and immunocompromisation

A

Moraxella

97
Q

Which type of pneumonia is associated with bilateral diseases in IV drug users, cystic fibrosis suffered, the elderly and those who have recently received their influenza vaccine?

A

Klebsiella

98
Q

What are patients with klebsiella pneumonia at risk of developing?

A

Empyema and lung abscess

99
Q

Which type of pneumonia is associated with poor air conditioning or water sources?

A

Legionella

100
Q

What electrolyte derangement is seen in patients with legionella pneumonia?

A

Hyponatraemia

101
Q

How can legionella pneumonia be detected?

A

Urinary antigens

102
Q

Which type of pneumonia can be acquired from birds?

A

Chlamydophila Psittaci

103
Q

Which type of pneumonia is known as Q fever and is acquired from the bodily fluids of animals (often affects farmers)

A

Coxiella Burnetti

104
Q

Which type of pneumonia is common in young children and causes headache, cold autoimmune anaemia and erythema multiform?

A

Mycoplasma

105
Q

Which scores are used to assess the likelihood of a PE?

A

PERC then WELLS

106
Q

How should a PE be managed if provoked?

A

3 months of DOAC

107
Q

How should a PE be managed if unprovoked?

A

3 months of DOAC

108
Q

If a patient with cancer develops a PE, how long should they receive treatment for?

A

6 months

109
Q

Which patient’s shouldn’t have their PE treated with a DOAC? What should be given instead?

A

Renal impaired patients (eGFR,15ml/min) or those with antiphospholipid syndrome - give LMWH instead

110
Q

What are the most common causes of pulmonary hypertension?

A

idiopathic, L heart failure, chronic lung/vascular disease

111
Q

What medications do you give in pulmonary hypertension? (3)

A

CCBs
IV prostaglandins
endothelin receptor antagonists

112
Q

What ECG changes do you see in pulmonary hypertension?

A

peaked P, R axis deviation, RBBB

113
Q

What is the gold standard test for diagnosing TB?

A

Sputum culture

114
Q

How is acute TB treated?

A

RIPE for first 2 months
RI for next 4 months

115
Q

How is latent TB managed?

A

pyridoxine
3 months of IR
6 months of I

116
Q

What are the side effects associated with rifampicin?

A

hepatitis
orange secretions
flu like symptoms

117
Q

What are the side effects associated with Isoniazid?

A

hepatitis
agranulocytosis
peripheral neuropathy

118
Q

What are the side effects associated with Pyrazinamide?

A

hepatitis
gout due to hyperuricemia
Arthralgia
myalgia

119
Q

What are the side effects associated with Ethambutol?

A

optic neuritis

(E for Eyes)

120
Q

What is the composition of a sarcoid lesion?

A

granuloma (macrophage driven)

121
Q

Name three major clinical features of sarcoidosis

A

Hilar lymphadenopathy
Erythema nodosum
Calcium derangement

122
Q

How can sarcoidosis be screened for?

A

Serum ACE

123
Q

How is sarcoidosis managed?

A

Conservative management (if no symptoms), long term steroids, methotrexate

124
Q

What respiratory conditions can untreated sarcoidosis cause?

A

pulmonary fibrosis and pulmonary hypertension

Respiratory for Finals (1 decks)

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