Passmed Respiratory Flashcards
Which part of the brain inhibits insipiration?
Pneumotaxic centre, found in upper pons
Which part of the brain stimulates insipiration?
Apneustic centre in lower pons, which activates and prolongs inspiration.
What is the role of the ventral group?
Located in the medulla for forced vnoounary expiration.
-> it can be depressed by opiates
What is the role of the dorsal group?
Located in the nucleus tractus solitaris to initiate respiration
-> can be depressed by opiates
What do the peripheral chemoreceptors respond to?
Increased pCO2 and H+ in arterial blood
What do central chemoreceptors respond to?
Levels of H+ in the rain interstitial fluid
What do the stretch receptors initiate?
Reduced respiratory rate
What do irritant receptors stimulate?
They cause bronchospasm
How does smoke inhalation affect the lungs?
Inactivates alpha-1 antitrypsin which increases breakdown of elastic tissue, leading to emphysema.
There is mucous gland hyperplasia, basal cell metaplasia and basement membrane thickeinng
When is oral theophylline used?
It is used following trials of short and long-acting bronchodilators. It competitively inhibits phosphoesterae, which breaks down cyclic aMP in smooth muscle to promote bronchodilation.
What is the first line treatment for COPD?
SABA or SAMA
What is the second line treatment for COPD?
LABA and LAMA, where everyday symptoms adversely affect quality of life
-> consider adding inhale corticosteoid for frequent infective exacerbations
What medication regime is reccomended for those with day-to-day symptoms and asthmatic features?
LABA and inhaled corticosteroid
What medication regime should be considered for those with COPD that have frequent exacerbations or previous treatments have not relieved breathlessness?
LABA and LAMA and ICS
What is the physical features of cystic fibrosis?
Short stature, delayed puberty, rectal prolapse, male infertility, female infertility and recurrent chest infection with diabetes mellitus.
What is Caplan syndrome?
Restrictive lung disease where there are intrapulmonary nodules due to rheumatoid arthritis along with pneumonicosis.
Which pneumonicosis are associated with Caplan syndrome?
Silicosis
Coal worker’s pneumonicosis
What is the cause of central bronchial opacity around hilar region of lungs?
Squamous cell carcinoma
How does acute pulmonary distress affect spirometry?
Causes restrictive pattern
What does the oxygen disassociation cure shifting to the left mean?
Decreased release of oxygen tissues because of Increased oxygen affinity of haemoglobin
What does the oxygen disassociation cure becoming steep mean?
Increased oxygen release to tissues as there is reduced affinity to haemoglobin. This occurs with factors that shift the disassociation curve to the right.
What does a shallow oxygen curve indicate?
Reducing oxygen release to tissues, as there is increased oxygen affinity to haemoglobin. This occurs with factors that shift the disassociation curve to the left.
What causes the curve to shift to the right?
More acidity, raised pCO2 and temperature
What causes the curve to shift to the left?
Methaemoglobin, carboxyhaemoglobin
Alkali
Low temperature
Low 2,3 DPG and pCO2
What causes transfer factor to increase?
Asthma: reduced expiration and hyperinflation increase gas exchange
haemorrhage
left-to-right shunt: increases blood flow to the lungs for more gas exchange
Pulmonary haemorrhage: blood in alveoli will interfere with results
Polycythaemia : higher levels of haemoglobin to participate
Exercise
Male gender
Kyphosis
Neuromuscular weakness
Lobectomy
What causes transfor to decrease?
Pulmoanry oedema, because fluid in pleural space increases the time for gas exchange.
Pneumonia
Emphysema
Anaemia
Low cardiac output
Which organisms are common in COPD?
Haemophilius influenzae
Pseudomonas aeruginosa
Klebisella
Streptococcus pneumoniae
What are the causes of respiratory alkalosis?
Pulmonary embolism
CNS disorder
Pregnancy
Salicylate (aspirin) poisoning
Anxiety
How is functional residual capacity calculated?
Expiratory reserve volume + Residual volume
Which gene causes cystic fibrosis?
F508
Which cell is increased wih asthma?
Eosinophils: correlates with the severity of asthma
What is the first line drug for asthma?
SABA
Which medication should be added for asthma not controlled y SABA?
Inhaled corticosteroids
What is MART?
A single inhaler contains both ICS and a fast-acting LABA such as formoterol, which includes Maintanenace and reliever therapy,
What cauases increased lung compliance?
Age
Emphysema
What causes decreased lung compliance?
Pulmonary oedema
Pulmonary fibrosis
Pneumonectomy
Kyphosis
What does FEV1 and VC both reduced indicate?
Restrictive lung disease
What indicates obstructive lung disease with spirometry?
FEV1/VC ratio less than 70%
What paraneoplastic syndrome is squamous cell carcinoma associated with?
Clubbing
PTH-rp secretion causing hypercalcaemia
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism
What paraneoplastic syndrome is adenocarcinoma associated with?
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
What paraneoplastic syndrome is small cell associated with?
Lambert Eaton syndrome
Cushing’s syndrkme
SIADH
How does asbestos affect the lungs?
Diffuse interstitial fibrosis tell reticular shadowing and causes reduced lung volumes.
How does mesothelioma affect the lungs?
Unilateral pleural effusion localised to the tumour due to inflammatory adhesions in the pleural space.
What causes the trache to deviate in the opposite direction?
Pleural effusion
Diaphragmatic hernia
Large thoracic mass
What causes the trachea to deviate to the same side of the pathology?
Pneumonectomy
Complete lung collapse
Pulmonary hypoplasia
What are the clinical features of complete lung collapse?
Dullness and absent breath sounds throughout the lung field and the decrease in pressure on the affected side will cause the mediastinum and trachea to shift towards the affected side.
Which side does the trachea deviate in lobectomy?
How does sarcoidosis affect the heart?
Causes systolic dysfunction of the heart and results in reduced ejection fraction
This is due to dilated cardiomyoapthy
1200+ 4400=5,600
What is the mot common cause of aspiration pneumonia
Kliebsella pneumonia, which is part of the normal gut flora that is a cause of aspirational pneumonia. It results in a red-currant jelly sputum and typically affects the upper lobes.
It typically causes empyema.
How does mycoplasma pneumonia present?
Non productive cough, clear asucultation of lungs and more common in younger individuals
Which area of the lungs is most likely affected in aspirational pneumonia?
Right mddle and lower lobe, due to te force of gravity
What is the risk factor for pneumothorax?
Cystic fibrosis due to repeated chest infections with air trapping and lung remodelling
Marfan’s syndrome
What cancer is associated with gynaecomastia?
Adenocarcinoma
-> hypertrophic pulmonary osteoarthropy also occurs
Wha is squamous carcinoma associated with?
PTH-rip secretion
Clubbing
Hyperthyroidism
Hypertrophic pulmonary osteoarthropathy
What does widened mediastinum indicate?
Aortic dissection
