ILA 4 - Respiratory SBA Flashcards
A 67 year old patient is being investigated for shortness of breath.
Which of the following conditions would normally lead to Type 2 Respiratory Failure?
A. Chronic Obstructive Pulmonary Disease
B. Pneumonia
C. Pulmonary embolism
D. Right middle lobe collapse
E. Small Pneumothorax
A. Chronic Obstructive Pulmonary Disease Type 2 respiratory failure - Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build-up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
Increased airways resistance - chronic obstructive pulmonary disease
Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
Neuromuscular problems
Smoking is known to adversely affect the clearance of mucus from the airways.
Which of the following provides cilia for the mucociliary escalator?
A. Columnar Epithelial Cells
B. Goblet Cells
C. Macrophages
D. Mast cells
E. Vascular Endothelial Cells
A. Columnar Epithelial Cells
The diaphragm plays a major role in breathing.
Which nerve supplies motor function to the diaphragm?
A. Accessory Nerve
B. Intercostal Nerves
C. Lateral Thoracic Nerves
D. Phrenic Nerve
E. Vagus Nerve
D. Phrenic Nerve
The central chemoreceptors, located in the ventral medulla help regulate the internal environment.
What do they respond to?
A. CSF bicarbonate
B. CSF carbon dioxide
C. CSF haemoglobin
D. CSF oxygen
E. CSF pH
E. CSF pH
The body uses a variety of chemoreceptors to regulate the internal environment.
Where are the main peripheral chemoreceptors located?
A. Carotid arteries and aortic arch
B. Jugular veins and vena cava
C. Pulmonary veins and left atrium
D. Skeletal muscle
E. Trachea and main bronchi
A. Carotid arteries and aortic arch
An 20 year old patient is admitted with shortness of breath and is diagnosed with Type 1 respiratory failure.
Which of these conditions would normally lead to Type 1 Respiratory Failure?
A. Chronic Obstructive Pulmonary Disease
B. Pulmonary Embolism
C. Pulmonary Hypertension
D. Severe Motor Neurone Disease
E. Widespread pulmonary tuberculosis
B. Pulmonary Embolism
Type 1 respiratory failure is defined as a low level of oxygen in the blood (hypoxaemia) without an increased level of carbon dioxide in the blood (hypercapnia), and indeed the PaCO2 may be normal or low.
This type of respiratory failure is caused by conditions that affect oxygenation such as:
Low ambient oxygen (e.g. at high altitude)
Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism)
Alveolar hypoventilation due to reduced respiratory muscle activity, e.g. in acute neuromuscular disease (this form can also cause type 2 respiratory failure if severe)
Diffusion problem (oxygen cannot enter the capillaries due to parenchymal disease, e.g. in pneumonia)
Shunt (oxygenated blood mixes with non-oxygenated blood from the venous system, e.g. right to left shunt)
Chemoreceptors regulate the internal environment by monitoring changes to various substances.
Changes in which of these substances stimulate the carotid chemoreceptors?
A. Carbon dioxide and H+ ions
B. Carbon dioxide and HCO3- ions
C. Carbon dioxide only
D. Oxygen and HCO3- ions
E. Oxygen, carbon dioxide and H+ ions
E. Oxygen, carbon dioxide and H+ ions
A 23 year old patient is admitted with shortness of breath and a severe wheeze.
Which of these factors will cause bronchodilation?
A. Adrenaline
B. Beta-Blockers
C. Cold dry air
D. Histamine release
E. Parasympathetic stimulation
A. Adrenaline
Adrenaline causes bronchodilation, by binding to β 2 -receptors in the smooth muscle of the bronchioles and causing their relaxation.
All the other factors are associated with causing brochoconstriction
A 67 year old patient is being investigated for shortness of breath.
Which of the following arterial blood gas results is typical of chronic Type 2 Respiratory Failure?
A. low pO2, high pCO2, low HCO3
B. low pO2, high pCO2, normal-high HCO3
C. low pO2, low pCO2, low HCO3
D. low pO2, low pCO2, normal HCO3
E. normal pO2, low pCO2, low-normal HCO3
B. low pO2, high pCO2, normal-high HCO3
A 70 year old has an X-ray to investigate their shortness of breath. It reveals a suspicious lesion associated with the pleura.
What is the term used to describe a malignant tumour of the pleural membranes?
A. Mesodermocarcinoma
B. Mesotheliocarcinoma
C. Mesothelioma
D. Pleurocarcinoma
E. Pleuroma
C. Mesothelioma
The Vagus Nerve and its branches have both motor and sensory functions.
Which of the following structures receives its voluntary motor function from the vagus nerve and its branches?
A. Bronchiole
B. Larynx
C. Main bronchus
D. Nostril
E. Trachea
B. Larynx
Motor - recurrent laryngeal nerve (but cricothyroid muscle is supplied by the superior laryngeal nerve)
Sensory - internal laryngeal nerve
An 83 year old patient is admitted with shortness of breath and is diagnosed with Type 1 respiratory failure.
Which of the following arterial blood gas results characterizes Type 1 Respiratory Failure?
A. high pO2, high pCO2
B. high pO2, normal/low pCO2
C. low pO2, high pCO2
D. low pO2, normal/low pCO2
E. normal pO2, low pCO2
D. low pO2, normal/low pCO2
A 5 year old is scheduled for theatre to remove an inhaled peanut.
Where is the inhaled peanut most likely to become lodged in their airway?
A. Alveoli
B. Left Main Bronchus
C. Right main bronchus
D. Terminal bronchiole
E. Trachea
C. Right main bronchus
Trachea too large
Terminal bronchiole and alveoli too small
Bronchus just right. Preferentially goes down Right main bronchus due to the angle it comes off trachea.
