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Respiratory medicine > L10 - HARC RESP 2 > Flashcards

L10 - HARC RESP 2 Flashcards

1
Q

Describe the lining of the airways?

A
  • Airways lined with epithelium containing ciliated and goblet cells.
  • Submucosa contains mucus secreting cells.
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2
Q

Describe the lining of the tracheobronchial tree

A

Endocrine cells

  1. APUD - amine precursor uptake and decarcaboxylation cells containing 5-ht
  2. Cells secrete hormones affecting smooth muscle
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3
Q

5-HT

A

5-Hydroxytryptamine receptors are

  • group of G protein coupled receptor and ligand gated ion channels
  • found in central and peripheral nervous systems.
  • Mediate both excitatory and inhibitory nerve transmission
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4
Q

Why might we hear crackles when listening to a patients chest?

A

May be caused by opening of previously closed airways.

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5
Q

Why might you hear early inspiratory crackles?

A

When there is diffuse airflow limitations, COPD

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6
Q

Why might you hear late inspiratory crackles? (3)

A
  • Pulmonary oedema
  • fibrosis
  • bronchiectasis
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7
Q

What epithelium lines the resp tract?

A

Ciliated columnar epithelial cells, contains alveolar macrophages

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8
Q

Describe clara cells?

A
  1. Found in distal conducting airways: terminal bronchioles, alveolar ducts
  2. Non-ciliated
  3. Short microvilli, large quantities of smooth endoplasmic reticulum
  4. Protruding apical gap with dense granules
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9
Q

What are the granules released by clara cells?

A
  1. Clara cell secretory protein.
  2. Detoxification of inhaled pollutants through secretion of cytochrome p450.

CCSP
- assist in mucocilliary clearance

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10
Q

Describe the cell types at alveolar level

A
  1. Type 1 pneumocytes
  2. Type 2 pneumocytes
  3. Capillary endothelial cells
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11
Q

Type 1 pneumocytes

A

Large, flat, squamous, few organelles, the cytoplasm.

Primary purpose is air to blood gas exhange

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12
Q

Type 2 pneumocytes

A

Domed, cuboidal, contain lamellar bodies that secrete surfactant.

Reduce surface tension

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13
Q

Role of surfactant

A

Reduce surface tension

  • prevent alveoli collapse
  • Aid increase pulmonary compliance
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14
Q

Describe what a butterfly shadow on CXR might show?

A
  • Pulmonary oedema

- pulmonary lymphatic channels engorged

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15
Q

What are Kerley B lines on CXR?

A
  • LHS pressure of heart high.
  • Causes thickening of interlobar septum.
  • May be visible as horizontal linear shadows on chest.
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16
Q

Compliance

A

How easily the lungs are distended.

Elastic properties of lungs tend to pull them away from thoracic wall, giving rise to intrapleural pressure

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17
Q

What are the two types of cyanosis?

A

Central

  • occurs when there is less than 50g/L of deoxyhaemoglobin present
  • seen in buccal mucosa, lips and tongue

Peripheral
- fingers and earlobes

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18
Q

Pneumonia

A
  • Inflammation of lung parenchyma secondary to infection.

- Purulent (fluid or pus) material within alveolar space.

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19
Q

How may you spot pneunomia on CXR?

A
  1. Airway opacification

2. Consolidation

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20
Q

Whats the difference between consolidation and pleural effusion?

A

Pleural effusion - collection of fluid in the space between your chest wall and lungs.

Lung consolidation may be fluid but it is inside lung so can’t move when you change positions.

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21
Q

Pulmonary vasculature:

Flow of deoxygenated blood

A
  1. Left pulomary artery
    - two lobar arteries
  2. Right pulmonary artery
    - Truncus anterior: supplies blood to upper lobe
    - Interlobar artery: supplies blood to middle and inferior lobe
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22
Q

Describe rib classifcation

A
  1. True (1-7)
  2. False (8-10)
  3. Floating (11-12)
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23
Q

True ribs

A

(1-7)

Articulate with sternum via costal cartilage.

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24
Q

False ribs

A

(8-10)

Articulate with costal cartilage only

25
Q

Floating ribs

A

(11-12)

Terminate in abdominal musculature

26
Q

Head of rib articulates with

A

Body

Transverse process

27
Q

Describe the costovertebral joints

A

T2-T9 - have superior and inferior facets at posterior aspect of vertebral body

T1 & t10-112 only have one facet

28
Q

Tension pneumothorax

A
  • Occurs when you have a one way valve forming.
  • Air drawn through chest wall and not let out.
  • Lung tissue progressively collapses with each inspiration.
29
Q

Treating tension pneumothorax

A

Canula through mid clavicular line to allow air to escape.

Then put chest drain when patients more stable.

30
Q

How might tension pneumothorax affect venous return?

A
  • Mediastinum compressed.
  • Reduced venous return from vena cava.
  • BP falls.
  • Cardiac output reduced.
  • Patient loses consciousness.
  • Possibly becomes hypoxic.
31
Q

Describe bronchopulmonary segments

A

Area of lung supplied by a segmental (tertiary) bronchus and accompanying pulmonary artery branch.

32
Q

Pulmonary artery does not supply lung tissue so what does?

A

Bronchial arteries supply oxygenated blood to lung tissue.

33
Q

Bronchial artery, vein and nerve come off…

A

Thoracic aorta at level of T5

Supplies blood to:
Lung
Visceral peritoneum
Lung parenchyma

34
Q

What classification is used in Pneumonia?

A

CURB-65

Score for pneumonia severity

35
Q

Bronchial arteries supply

A

Lung tissue
Hilum
Visceral Pleura
Parenchyma

36
Q

How many bronchial arteries branch on the left and how many on the right?

A

2 to Left

1 to Right

37
Q

How many planes of movement do synovial joints allow?

A

Synovial joints allow movement in a single plane.

38
Q

Why is there a minimum of two facets on the ribs?

A

Allows hinge

Allows articular movement around plane between costovertebral and costotransverse joints.

Permits up and down movement.

39
Q

Describe the bucket handle effect?

A

Upper ribs firmer costovertebral joint .

Hence there is limited lateral movement of upper ribs, so increases in anterior posterior diameter.

40
Q

Superior thoracic aperture

A

Upper part of thoracic cage.

Anterior: manubrium of sternum
Laterally: First ribs
Posteriorly - T1 veterbral booy

41
Q

Describe the branch of the aorta?

A

Brachiocephalic artery
Left common carotid
Left subclavian

42
Q

Where is the mediastinum divided into superior and inferior?

A

By a line between between sternal angle and T4 vertebra

43
Q

State the tributaries of the SVC

A
  1. Brachiocephalic veins
  2. Left superior intercostal vein
  3. Supreme intercostal vein
  4. Azygous vein
44
Q

Brachiocephalic veins

A

Draining blood from the upper body.

45
Q

Left superior intercostal vein

A

Collects blood from the left 2nd and 3rd intercostal vein

46
Q

Supreme intercostal vein

A

Drains the vein from first intercostal space directly into the brachiocephalic veins.

47
Q

Azygos vein

A

Receiving blood from the right posterior intercostal veins.

48
Q

Where does the left intercostal vein drain into first?

A

Hemiazygos first and accessory hemiazygos bveins before joining the azygos vein around t7-t9.

49
Q

Right hilum of lung sits posterior to:

A

SVC

Right atrium

50
Q

Right hilum of lung sits inferior to:

A

Azygos vein

51
Q

Left hilum of lung passes…

A

Underneath arch and anterior to descending aorta

52
Q

Phrenic nerve passes….to hila

A

Phrenic nerve passes anterior to hila

53
Q

Vagus nerve passes….to hila

A

Phrenic nerve passes posterior to hila

54
Q

Contents of Right lung Hilum (4)

A
  1. Right superior lobe bronchus (Eparterial bronchus)
  2. Pulmonary artery
  3. Hypaterial bronchus (any branches below pulmonary artery)
  4. Inferior pulmonary vein
55
Q

Contents of Left lung Hilum (3)

A
  1. Pulmonary artery
  2. Bronchus
  3. Inferior pulmonary vein
56
Q

Role of pulmonary ligament

A

Helps anchor lungs to diaphragm.

57
Q

Cough

A

Forced expulsive manoeuvre.

Usually against closed glottis which is then forced open.

58
Q

Cough Reflex

DAGAV-C

A
  1. Diaphragm contracts, with external intercostals (inhalation)
  2. Air enters lungs to equalise pressure
  3. Glottis closes, vocal cords contract
  4. Abdominal muscles contract. Diaphragm relaxes, increases pressure within lungs.
  5. Vocal cords and glottis opens. Air released
  6. Collapse of bronchi and non-cartilaginous parts of trachea. Forms a slit to force air through clearing any irritants.

Respiratory medicine (16 decks)

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