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respiratory > need to know > Flashcards

need to know Flashcards

1
Q

what is ventilation

A

mechanical process of moving gas in and out of lungs

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2
Q

what must be right for ventilation to occur

A

intra alveolar pressure must be less then atmospheric pressure for air to flow into lungs during inspiration

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3
Q

what is boyles law

A

as volume of gas increases the pressure exerted by the gas decreases

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4
Q

what are the 2 forces holding the thoracic wall and lungs in close opposition

A
  • intra-pleural fluid cohesiveness

- the negative intra-pleural pressure

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5
Q

what are the 3 pressure important in ventilation

A
  • atmospheric
  • intra-alveolar
  • intra-pleural pressure
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6
Q

what are the inspiratory muscles used during normal resting breathing

A
  • diaphragm

- external intercostal muscle

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7
Q

how do lungs recoil during expiration

A

alveolar surface tension

- elastic connective tissue

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8
Q

what is the law of Laplace

A

the smaller alveoli have a higher tendency to collapse

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9
Q

what do pulmonary surfactant do to surface tension

A

lower the surface tension of smaller alveoli thus preventing them from collapsing

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10
Q

what is resp distress syndrome caused by in babies

A

not producing enough surfactant

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11
Q

what are the muscles of active expiration

A
  • internal intercostal muscle

- abdominal muscles

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12
Q

what is inspiratory capacity

A

Max volume of air inspired at end of normal quiet expiration

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13
Q

what is vital capacity

A

Max volume of air that can be moved out during single breath following Max inspiration

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14
Q

how to calculate inspiratory capacity

A

IC = IRV + TV

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15
Q

how to calculate vital capacity

A

VC = IRV + TV + ERV

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16
Q

how to calculate total lung capacity

A

vital capacity + residual volume

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17
Q

when does residual volume increase

A

when elastic recoil of lungs is lost

= emphysema

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18
Q

what is the FEV1/FVC ratio for airway obstruction

A

low

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19
Q

what is the FVC for lung restriction

A

low

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20
Q

what is the FVC for combination of obstruction and restriction

A

low

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21
Q

what is the FEV1/FVC ratio for combination of obstruction and restriction

A

low

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22
Q

what does peak flow meter estimates

A

the peak flow rate in patients with obstructive lung disease

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23
Q

what is the compliance of lungs

A

measure of effort that has to go into stretching or distending the lungs

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24
Q

what happens if the lungs are less compliant

A

more work required to give a degree of inflation

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25
Q

examples of when the lungs are less compliant

A
  • pulmonary fibrosis
  • oedema
  • collapse
  • pneumonia
  • absence of surfactant
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26
Q

what is increased compliance of lungs called

A

emphysema

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27
Q

what happens when the lungs have increases compliance

A

the lungs are hyper-inflated and patients have to work harder to get air out the lungs

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28
Q

what is pulmonary ventilation

A

volume of air breathed in and out per minute

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29
Q

what is ventilation perfusion matching dependent upon

A

the ventilation and perfusion

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30
Q

what is perfusion

A

the rate which blood is passing through the lungs

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31
Q

what is considered alveolar dead space

A

ventilated alveoli which are not adequately perfused with blood

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32
Q

what are 4 factors which influence gas transfer across the alveolar membrane

A
  • partial pressure gradient of O2 and CO2
  • diffusion coefficient
  • surface area of alveolar membrane
  • thickness of alveolar membrane
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33
Q

what is daltons law of pressure

A

total pressure = sum of each individual component in the gas mixture

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34
Q

what is PaO2

A

partial pressure of O2 in alveolar air

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35
Q

what is PiO2

A

partial pressure of O2 in inspired air

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36
Q

what is flicks law of diffusion

A

the amount of gas that moves across a tissue is proportional to the area of the sheet

thicker = less exchange

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37
Q

what is henrys law

A

the amount of a gas dissolved in a given type and volume of liquid at constant temperature is proportional to the partial pressure of the gas in equilibrium with the liquid

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38
Q

what is the Bohr effect

A

release of O2 by conditions of the tissue leads to shift of the curve to the right

more oxygen is released

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39
Q

where is myoglobin present

A

in skeletal and cardiac muscle cells

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40
Q

what is the Haldane effect

A

removing O2 from Hb increases ability of Hb to pick up Co2 and CO2 generated H+

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41
Q

what are the respiratory centre locations

A
  • pons
  • medulla
  • oblongata
  • spinal cord
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42
Q

what is the pre-botzinger

A

in the medulla and causes breathing rhythm

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43
Q

what do peripheral chemoreceptors sense

A

tension of oxygen and carbon dioxide and H+ in the blood

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44
Q

what do central chemo receptors respond to

A

H+ in cerebrospinal fluid

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45
Q

what does a rise in arterial PCO2 result in

A

increased ventilation

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46
Q

what does a fall in arterial PO2 stimulate

A

peripheral chemoreceptors

results in increased ventilation

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47
Q

what does a rise in H+ stimulate

A

peripheral chemoreceptors causes hyperventilation and increase elimination of CO2 from body

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48
Q

what does patient have if ABGs show high PaO2 and low PaCO2 and high pH

A

respiratory alkalosis with no metabolic compensation

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49
Q

what is type I resp failure

A

hypoxia + normal or low CO2

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50
Q

what is type 2 resp failure

A

hypoxia + hypercapnia

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51
Q

what is the nasal cavity lined by

A

respiratory epithelium (pseudo stratified ciliated columnar)

underneath there is lamina propriety and connective tissue

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52
Q

what does the oropharynx transmit

A

both air and swallowed food so is lined by non-keratinised stratified squamous epithelium

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53
Q

what are the larynx walls made up of

A

cartilage and muscle except the vocal folds

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54
Q

what are the larynx walls covered in

A

stratified squamous epithelium

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55
Q

what is the trachea made up of

A
  • RE
  • basal lamina
  • lamina propria of connective tissue
  • submucosa of loose connective tissue
  • cartilaginous rings
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56
Q

what is the bronchi made up fo

A
  • RE
  • lamina propria
  • irregular shaped cartilage
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57
Q

do the bronchioles have cartilage

A

no

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58
Q

what the bronchioles made up of

A
  • cuboidal epithelium

- lamina propria

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59
Q

what do terminal bronchioles contain

A

Clara cells

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60
Q

what are type 1 alveolar cells

A

simple squamous epithelium blood-air barrier

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61
Q

what are type 2 alveolar cells

A

polygonal shape with microvilli, contains surfactant

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62
Q

what is endoderm

A

lining of the trachea and bronchial tree

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63
Q

what is visceral mesoderm

A

all other lung tissue

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64
Q

mnemonic for lung maturation

A

ELEPHANTS PLAY CHESS in SUNNY AFRICA

  • embryonic
  • pseudoglandular
  • canalicular
  • saccular
  • alveolar
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65
Q

what does stimulation of cholinergic fibres cause

A

bronchial smooth muscle contraction

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66
Q

what does stimulation of postganglionic non-cholingeric fibres cause

A

relaxation

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67
Q

what does stimulation cause

A

bronchial smooth muscle relaxation via B2-adrenoreceptors on airway smooth muscle cells activated by adrenaline released from the adrenal gland

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68
Q

what does mild asthma display

A

hypersensitivity and mild hyper reactivity

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69
Q

what is one major cause of asthma

A

due to an immune imbalance between Th1 and Th2 lymphocyte mediated response

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70
Q

what is Th2 lymphocyte activation

A

allergen through airway epithelium > CD4+ expresses t to THO cells that mature to Th2 cells

these activate B cells that mature to IgE secreting P cells

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71
Q

what else can Th2 lymphocytes release

A

IL4 and IL13 which cause mast cells to express IgE receptors

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72
Q

asthma treatments

A
  • SABA
  • LABA
  • CystLT1 receptor antagonist
  • methylxanthines
  • glucocorticoids
  • monoclonal antibodies directed against IgE
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73
Q

example of SABA

A

salbutamol

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74
Q

example of LABA

A

salmeterol, formoterol

must be co-administered with glucocorticoid

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75
Q

example of CysLT1 receptor antagonist

A

monteleukast

  • blocks cysLT1 receptor for LTs from mast cells - bronchodilator
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76
Q

examples of methylxanthines

A
  • theophylline

- aminophylline

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77
Q

how do methylxanhtines work

A

inhibits PDE3

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78
Q

examples of mild/moderate glucocorticoids

A
  • beclometasone
  • budesonide
  • fluticasone
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79
Q

side effect of fluticasone

A

hoarse voice

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80
Q

example of severe glucocorticoid

A

prednisolone

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81
Q

example of monoclonal antibodies directed against IgE

A

omalizumab

82
Q

what does blockage of M3 prevent

A

contraction of airway smooth muscle

83
Q

what are the treatments used for COPD

A
  • SAMA
  • LAMA
  • SABA
  • LABA
  • ultra LABA
  • PDE4 inhibitor
84
Q

example of SAMA

A

ipatropium

85
Q

example of LAMA

A

tiotropium

86
Q

example of ultra LABA

A

indacaterol

87
Q

example of PDE4 inhibitor

A

rofumilast

88
Q

what is the FVC in asthma

A

normal

89
Q

what is FVC ini COPD

A

reduced

90
Q

what is FEV1 response to beat agonist in asthma

A

> 15%

91
Q

what is FEV1 response to beta agonist in COPD

A

<15%

92
Q

what is the triad for asthma

A
  • reversible airflow obstruction
  • airway hyper responsiveness
  • airway inflammation
93
Q

what are the signs and symptoms of asthma

A
  • episodic
  • non-productive cough
  • wheeze
  • triggers
  • family history
94
Q

what is the diagnosis of asthma

A
  • diurnal variation of peak flow rate
  • reduced forced expiratory ratio (FEV1/FVC <75%)
  • bronchospasm
95
Q

diagnosis of severe asthma

A
  • peak flow <50%
  • tachycardia >110bpm
  • > 25 resp/min
  • cant complete sentences
96
Q

what does cigarette smoke do

A

activate macrophages and airway epithelial cells in the respiratory tract which release neutrophil chemotactic factors (IL-8 and leukotriene B4)

97
Q

what do neutrophils and macrophages release

A

proteases that break down connective tissue in the lung parenchyma and also stimulate mucus hyper secretion

98
Q

what is the pathology in COPD

A

imbalance between proteases and antiproteases which lead to inflammatory changes in the airways including damage of the respiratory mucosa

99
Q

what are the features of chronic bronchitis

A
  • chronic neutrophilic inflammation
  • mucus hyper secretion
  • mucociliary dysfunction
  • altered lung microbiome
  • smooth muscle spasm and hypertrophy
  • partially reversible
100
Q

features of emphysema

A
  • impaired gas exchange
  • loss of bronchial support
  • irreversible
101
Q

what are the clinical syndromes of restrictive thoracic disease

A
  • breathless on exertion
  • cough but no wheeze
  • finger clubbing
  • inspiratory lung crackles
  • central cyanosis
  • pulmonary fibrosis
102
Q

how to diagnose restrictive thoracic disease

A
  • history
  • reduced lung volumes: reduced FEV1 and FVC)
  • reduced gas diffusion
  • arterial oxygen desaturation
103
Q

what are the early clinical features of lung cancer

A
  • cough
  • breathes for no reason
  • chest infection doesn’t clear up
  • coughing blood
  • weight loss
  • chest or shoulder pain
  • tiredness
  • hoarse voice
104
Q

what are the 4 common smoking associated types of lung tumours

A
  • adenocarcinoma
  • squamous carcinoma
  • small cell carcinoma
  • large cell carcinoma
105
Q

what is the worst cancer of the lung

A

small cell

106
Q

how is small cell lung cancer treated

A

chemotherapy

107
Q

what is the treatment of choice for non-small cell lung cancer

A

surgery

108
Q

what does squamous cell cancer express

A

p63 and high molecular

109
Q

what is carcinoid lung neoplasm

A

neuroendocrine system (low grade malignancy)

110
Q

what his bronchial gland neoplasm

A

most often seen in salivary glands

111
Q

what are the investigations done for lung cancer

A
  • bronchoscopy (vocal cord palsy)
  • medisatinoscopy
  • CT scan of brain
  • CT scan of thorax (tumour size)
  • PET scan (mets)
112
Q

what to percent in lung cancer

A
  • tobacco smoking
  • asbestos
  • radon
113
Q

when can transudate pleural effusion occur

A
  • cardiac failure
  • cirrhosis
  • renal failure
114
Q

when can exudate pleural effusion occur

A
  • pneumonia
  • TB
  • abscess
  • malignancy
115
Q

what is mesothelioma

A

uncommon malignant tumour of lining of tumour or abdominal cavity

exposure to ASBESTOS

116
Q

what are the symptoms of mesothelioma

A
  • breathlessness
  • chest pain
  • weight loss
  • fever
  • sweating
  • cough
117
Q

what is the treatment for mesothelioma

A
  • pleurodese effusion
  • radiotherapy
  • surgery
  • chemo
  • palliative
118
Q

examples of upper tract infections

A
  • coryza
  • pharyngitis
  • sinusitis
  • epiglottis
  • diphtheria
119
Q

examples of lower tract infection

A
  • acute bronchitis
  • acute exacerbation of COPD
  • resp distress
  • pneumonia
  • influenza
120
Q

what is the main infection of TB

A

mycobacterial infection

121
Q

what are the symptoms of TB

A
  • persistent productive cough
  • occasional haemoptysis
  • pleuritic pain
  • hoarseness
  • upper zone crackles
  • night sweats fever
  • weight loss
122
Q

what is the pathology of TB

A

type IV hypersensitivity reaction

123
Q

what are the reasons for TB reactivation

A
  • decreased T cell function

- reinfection at high dose or more virulent organism

124
Q

what is the investigation for TB

A

broncho alveolar lavage

  • Ziehl Neilsen stain
  • CXR
125
Q

side effects of rifampicin

A

orange fluids

126
Q

side effect of isoniazid

A

neuropathy

127
Q

side effect of pyrazinamide

A

joint pain

128
Q

side effects of ethambutol

A

colour blindness

129
Q

what therapy can reactivate latent TB

A

anti TNF therapy

130
Q

pneumonia

A

inflammation of one or both lungs due to infection

131
Q

what is the pathology of pneumonia

A

classical acute inflammatory response

132
Q

what are the symptoms of pneumonia

A
  • malaise
  • anorexia
  • sweats
  • rigors
  • myalgia
  • arthralgia
  • headache
  • confusion
  • cough
  • pleurisy
  • haemoptysis
  • dyspnoea
  • abdominal pain
  • diarrhoea
133
Q

what are the signs of pneumonia

A
  • fever
  • rigors
  • herpes
  • tachypnoea
  • crackles
  • rub
  • cyanosis
  • hypotension
134
Q

investigation for pneumonia

A
  • blood culture
  • serology
  • ABGs
  • FBC
  • urea
  • liver funciton
  • CXR
135
Q

what is the most common cause pneumonia

A

strep pneumonia

136
Q

what are the causative organisms of pneumonia

A
  • herpes labials
  • haem influenza (common in COPD patients)
  • staph aureus

atypicals

  • mycoplasma pneumonia
  • chlamydophila
  • legionella pneumophilia (water tanks, Spain)
  • klebsiella (alcoholics)
  • pneumocystis
137
Q

what is lobar pneumonia

A

confluent consolidation of a complete lung lobe

138
Q

what is broncho pneumonia

A

infection arising in bronchi or bronchioles

139
Q

when does bronchiolitis usually occur

A

1st or 2nd year of life

140
Q

what is are the early symptoms of bronchiolitis

A
  • fever
  • coryza
  • cough
  • wheeze
141
Q

what are the severe symptoms of bronchiolitis

A
  • grunting
  • decrease O2
  • intercostal/sternal drawing
142
Q

what are the complications fo bronchiolitis

A

resp and cardiac failure

143
Q

investigation for bronchiolitis

A

PCR

144
Q

what is the epidemiology for bronchiolitis

A

every winter

no vaccine

145
Q

what are the signs and symptoms of chronic pulmonary infection

A
  • shadow on CXRR indicates cancer or infection
  • weight loss s
  • persistent sputum production
  • chest pain
  • increasing shortness of breath
146
Q

what are the differential diagnosis of chronic pulmonary infection

A
  • lung cancer
  • intrapulmonary abscess
  • empyema
  • bronchiectasis
  • cystic fibrosis
147
Q

what are the risk factors of chronic pulmonary infection

A
  • immunodeficiency
  • immunosuppression
  • abnormal innate host defence
  • repeated insult
148
Q

what are the ways a patient could be immunodeficient

A
  • IgA deficiency
  • hypo-splenism
  • myeloma
  • lymphoma
  • HIV
149
Q

what are the ways a patient could be immunosuppressant

A
  • drugs (steroids, azathioprine, methotrexate, infliximab, chemo)
  • malignancy
150
Q

what are the 4 forms of chronic infection

A
  • intrapulmonary absces
  • empyema
  • bronchiectasis
  • cystic fibrosis
151
Q

what are the symptoms of intrapulmonary abscess

A
  • weight loss
  • lethargy
  • cough
  • preceding an illness
152
Q

what is the CT of intrapulmonary abscess

A

orange

153
Q

what is intrapulmonary abscess caused by

A

septic emboli

154
Q

what is empyema

A

pus in pleural space

155
Q

what is the treatment of empyema

A
  • IV abs

large = chest drain

156
Q

what is the CT of bronchiectasis

A

signet ring

157
Q

what is the cough like in bronchiectasis

A
  • sputum
  • chest pain
  • recurrent LRTIs
158
Q

what is the treatment of bronchiectasis

A
  • stop smoking
  • flu vaccine
  • pneumococcal vaccine
  • Abs (prophylaxis)
  • anti-inflammatory
159
Q

what is the defect in cystic fibrosis

A

CFTR channel defect so lose inhibition of sodium channel so cells fill with Na+ and increase in H2O so this leads to dryness at airways

160
Q

where is gene located in cystic fibrosis

A

chromosome 7

161
Q

what can cystic fibrosis cause

A
  • bronchiectasis
  • sputum
  • biliary obstruction
  • internal obstruction
  • pancreas
  • dysfunction
  • infertility for males
  • SALTY SWEAT
  • failure to thrive
162
Q

what is the genetic of cystic fibrosis

A

Del508 inherited by one of each parent

163
Q

what is exacerbation management of cystic fibrosis

A
  • antibiotics
  • physiotherapy
  • adequate hydration
  • increase dietary input
164
Q

what is interstitial lung disease

A

any disease process affecting lung interstitial

165
Q

symptoms of interstitial lung disease

A
  • breathlessness

- dry cough

166
Q

what are the biopsies done for interstitial lung disease

A
  • trans bronchial

- thoracoscopic

167
Q

what type of hypersensitivity is sarcoidosis

A
  • type 4
168
Q

what is the diagnosis for sarcoidosis

A
  • CXR (peripheral nodular infiltrate)
  • tissue biopsy
  • pulmonary function test
  • blood test (ACE, raised Ca, increased inflammatory markers)
169
Q

treatment for sarcoidosis

A

acute
- self-limiting (steroids)

chronic
- oral steroids
+ immunosuppression

170
Q

what hypersensitivity is pneumonitis

A

type III

171
Q

what is the aetiology of hypersensitivity pneumonitis

A
  • farmers lung
  • malt workers
  • mushroom workers
  • bird fancier
172
Q

what are the symptoms of acute hypersensitivity pneumonitis

A
  • cough
  • breathless
  • fever
  • myalgia
173
Q

what are the signs of hypersensitivity pneumonitis

A
  • crackles
  • hypoxia
  • CXR = widespread pulmonary infiltrates
174
Q

what is the treatment of acute hypersensitivity pneumonitis

A
  • oxygen
  • steroid
  • antigen avoidance
175
Q

clinical features of pulmonary embolism

A
  • tachycardia
  • tachypnoea
  • cyanosis
  • fever
  • low BP
  • crackles
  • rub
  • pleural effusion
  • ABGs
  • CXR = consolidation, pleural effusion
176
Q

treatment of pulmonary embolism

A

anticoagulation (low heparin) + warfarin

177
Q

signs of pulmonary hypertension

A
  • central cyanosis
  • dependent oedema
  • raised JVP with v waves
  • right ventricular heave at left parasternal edge
  • murmur of tricuspid regurgitation
  • enlarged liver
178
Q

what is stridor

A

inspiratory wheeze due to large airways obstruction

179
Q

what is Gillian barre syndrome

A

rapid-onset of muscle weakness caused by immune system damaging the peripheral nervous system

180
Q

what is symptoms of Gillian barre syndrome

A
  • changes in sensation start at feet and hands

- develop over hours to few weeks

181
Q

what do to do diagnose DVT

A

ultrasound

182
Q

what to do if massive PE suspected and CXR abnormal

A

CT pulmonary angiogram

183
Q

what do goblet cells secrete

A

mucus

184
Q

what do club cells secrete

A

are found in bronchioles and secrete glycosaminoglycans

185
Q

what is the level of the male nipple

A

T4

186
Q

histology of the respiratory epithelium

A

pseudostratified columnar epithelium with goblet cells and cilia

187
Q

what supplies the upper respiratory tract

A

vagus nerve

188
Q

what controls the trapezius

A

spinal accessory

189
Q

where is a pleural effusion first seen

A

at chostodiaphragmatic recess

190
Q

what is Horner syndrome

A

neuropathy compression of sympathetic nerve

191
Q

what causes horners syndrome

A

ipsilateral Pancoast tumour

ipsilateral = same side

192
Q

what is tenecteplase

A

thrombolytic drug

193
Q

what does squamous cell carcinoma release

A

PTH

194
Q

what does PTH do

A

is causes hypercalcaemia

195
Q

what are symptoms of hypercalcaemia

A

‘moans, bones, groans and kidney stones’

- diarrhoea etc

196
Q

what are the difference in symptoms between asbestosis and mesothelioma

A 
asbestosis = cough and chest pain 
mesothelioma = no cough, pleural effusion
197
Q

what does stony dull to percuss mean

A

pleural effusion

198
Q

what disease causes pleural thickening

A

asbestosis

199
Q

what disease causes cavitation on CT

A

TB

fungal

200
Q

what disease causes consolidation on CT

A

pneumonia

201
Q

what kind of joints are all symphysis

A

secondary cartilaginous

202
Q

when you aspirate food where does it usually end up

A

right lower lobe

respiratory (20 decks)

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