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New 1st year medicine > Resp > Flashcards

Resp Flashcards

1
Q

how do lungs stick to thorax?

A

intrapleural fluid cohesiveness - water molecules in intrapleural fluid are attacted to eachother so reist being pulled apart

negative intrapleural pressure - transmural pressure gradient so lungs forced to expand outwards while chest squezes inwards

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2
Q

inspiration?

which muscles?

A

ACTIVE process

muscles = diaphragm (major inspiratory muscle) + external intercostal muscles (bucket handle)

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3
Q

expiration?

A

normal expiration is a passive process

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4
Q

pneumothorax?

complication?

s/s?

A

air in pleural space

complication = lung collapse due to abolished transmural pressure gradient

symptoms = SOB + chest pain

signs = hyperresonant percussion + decreased/absent breath sounds

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5
Q

pulmonary surfactant?

secreted by?

A

mixture of proteins that reduces alveolar surface tension preventing aveolar collapse

secreted by type II alveoli

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6
Q

pulmoary distress syndrome of the newborn?

A

premature babies = not enough surfactant

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7
Q

pre and postganglionic fibres of airways?

parasympathetic stimulation?

A

pre = brainstem

post = walls of bronchi and bronchioles

stimulation of cholingeric fibres = bronchial smooth muscle contraction (M3 muscarinic ACh receptors on ASM cells) + increased mucous secretion (M3 on goblet cells)

stimulation of noncholinergic fibres = bronchial smooth muscle relaxion (NO and VIP)

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8
Q

sympathetic stimulation airway?

A

No innervation to ASM so instead mediated by hormones

B2-adrenoceptors activated by adrenaline from adrenal gland = ASM relaxation + decreased mucous secretion + increased mucocilliary clearance

a1-adrenoceptors = vascular smooth muscle contraction

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9
Q

excitation contraction coupling in smooth muscle

A
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10
Q

Ca2+ in smooth muscle

A
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11
Q

relaxation of smooth muscle

A
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12
Q

activity of myosin light chain kinase and myosin phosphatase

A
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13
Q

asthma?

Ax?

A

recurrent reversible obstuction to airways

Ax = allergens, exercise (cold dry air), respiratory infections (e.g. viral), smoke, dust, pollutants

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14
Q

status asthmaticus?

A

MEDICAL EMERGENCY - acute severe asthma

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15
Q

s/s asthma?

chronic asthma changes

A

s/s = tight chest, wheezing, difficulty breathing, cough

chronic changes = SM hyperplasia/hypertrophy, oedema, increased mucous secretion, epithelial damage (exposing sensory nerve endings), sub-epithelial fibrosis

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16
Q

phases of asthma attack?

A

early phase = type 1 hypersensitivity reaction (mast cells)

late phase = type IV hypersensitivity reaction (TH2, eosinophils)

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17
Q

FEV1?

A

forced expiratory volume (litres) in 1 second

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18
Q

asthma immune reaction

non-atopic individual?

A

TH2 response involving IgE

non-atopic = TH1 response involving IgG and macrophages

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19
Q

learn pathway

A

TH2 cells also release IL-5 which activates eosinophils

IL-4 and IL-13 cause mast cells to express IgE receptors

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20
Q

activated mast cell?

releases?

A

mast cell activaed via binding of antigen to IgE receptors

releases:

  • chemokines - LTB4, PAF, PGD2 (attract eosinophils)
  • spasmogens - histamine + leukotrienes LTC4, LTD4 (ASM contraction)
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21
Q

muscles of respiration?

A
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22
Q

FVC?

A

forced vital capacity - maximum volume that can be foricbly expelled from lungs following mximal inspiration

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23
Q

FEV1/FVC ratio?

A

normally >70%

obstructive lung disease (asthma/COPD) = <70%

restrictive = >70%

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24
Q

autonomic NS airways?

A

parasymp = bronchoconstriction

sympathetic = bronchodilation

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25
Q

when is peak flow used?

A

obstructive lung disease - asthma or COPD

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26
Q

restrictive airway disease?

FEV1/FVC ratio?

A

pulmonry fibrosis

pulomary oedema

lung collapse

pneumonia

absence of surfactant

restrictive = >70%

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27
Q

emphysema?

A

hyperinflation of lungs

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28
Q

different effects of O2 on pulmonary vs systemic arterioles?

A
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29
Q

binding of one O2 to Hb?

A

increases affinity of Hb for O2 (co-operativity)

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30
Q

Bohr effect?

A

shift of sigmoid curve to the right

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31
Q

foetal Hb?

benefit?

A

has higher affinity for O2 compared to HbA

this is because it interacts less with 2,3-biphosphoglycerate

allows O2 transfer from mother to foetus even if Po2 is low

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32
Q

myoglobin found?

purpose?

significance?

A

in skeletal and cardiac muscles - only one haem group per myoglobin molecule

provides short term storage of O2 for anaerobic conditions

prescence of myoglobin in blood indicates muscle damage

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33
Q

influenza clinical presentation?

A

fever - high, asrupt onset

malaise

myalgia

headache

cough

prostration - unable to leave bed

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34
Q

Ax flu?

flu-like illnesses?

not to be confused with….

A

influenza A + B

flu-like illnesses caused by: parainfluenza viruses

do not get confused with haemopilus influenzae - it is a bacterium and not a primary cause of flu (may be a secondary invader)

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35
Q

flu complications?

A

primary influenzal pneumonia

  • high mortality!
  • seen in young adults

secondary bacterial pneumonia (haemophilus)

  • elderly, co-morbs
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36
Q

flu Tx?

A

symptomatic

  • bed rest
  • fluids
  • paracetamol

antivirals

  • oseltamivir
  • zanamivir
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37
Q

epidemiology flu

A

winter epidemics (antigenic drift - minor mutations in surface proteins)

pandemics - rare, influenza A (antigenic shift)

(can be from animal reservoir/mixing vessel)

38
Q

CO2 transport in blood?

A

solution - 10%

bicarbonate - 60%

carbamino compounds - 30%

39
Q

carbon dioxide solubility?

A

20 times more soluble than oxygen

40
Q

most Co2 trasported in blood as?

how is this formed?

A

bicarbonate

formed in blood by:-

41
Q

carbamino compounds?

A

combines with Hb to produce carbamino-haemoglobin

42
Q

the haldane effect?

A

removing O2 from Hb increases ability of Hb to pick up CO2

(the bohr effect and haldane affect work in conjunction)

i.e. O2 liberation and uptake of CO2 at tissues

43
Q

bohr effect purpose?

A

facilitates removal of O2 from Hb at tissues by shifting dissociation curve to the right

44
Q

CO2 dissociation curve

A
45
Q
A

SOB - loss of elstic recoil (emphysema), dynamic airway compression

Lung volume - increased RV due to hyperinflation, increased FRC

Blood oxygenation - emphysema reduces surface area for gas exchange as it destroys alveoli (patient may have low PO2)

46
Q

densities on CXR

A
47
Q

USS densities?

A
48
Q

when is AP used rather than PA?

disadantages of this?

A

when patient cannot stand i.e. very unwell or bed bound

heart shadow magnified so heart size cannot be assessed accurately

scapulae partially obscure lungs

can be difficult to achieve adequate inspiration

49
Q

how to determine CXR inspiration and rotation

A

if CXR adequately inspired - anterior ends of at least 6 ribs should be visible

if CXR correctly centred - medial ends of clavicls should be equidistant from spinal processes of throaic vertebrae

50
Q

mediastinal borders CXR

A
51
Q

mediastinal lymph node locations + names

A
52
Q
A

…

53
Q

lung lobes radiograph

A
54
Q
A

…

55
Q
A

…

56
Q
A

right superior lobe (above right horizontal fissure)

57
Q

60 y/o smoker

2 stone weight loss

haemoptysis + cough

what is the abnormality?

A

right lower lobe collapse

58
Q

where is the abnormality?

A

left lower lobe collapse

59
Q

60 y/o smoker

afrebrile

haemoptysis + cough

what is the abnormality?

A

left upper lobe collapse

60
Q

60 y/o smoker

febrile

haemoptysis + cough

what is the abnormality?

A

left upper lobe consolidation

61
Q
A

large left pleural effusion

62
Q
A

….

63
Q
A

dilated bronchi

thickened bronchial walls

64
Q
A

bilateral hilar enlargement

(probs sarcoid)

65
Q

features suggestive of cardiac pain?

A

referred pain!!

central, crushing, heavy, tight band

usually left sided (can be epigastric)

often radiates: left arm, neck, jaw/teeth

66
Q

lung pain?

A

contain no pain receptors

do contain J receptors = cough

pleurisy is if pathology reaches the pleura

pleuritic pain = sharp, worse on inspiration

67
Q

GI chest pain?

A

oseophageal spasm

trapped wind

reflux oesophagitis

68
Q

MSK pain chest?

A

usualy worse on moveent

reproducible (touch)

69
Q

which systems could be respondible for chest pain?

(and so should be covered in history)

A

cardiac

resp

GI

MSK

70
Q

breathlessness questions

A

“what do you mean by breathless?”

cant breathe in or out?

doing what?

orthopnoea?

paroxysmal nocturnal dyspnoea?

associated symptoms - wheeze, stridor, cough?

71
Q

acute Ax breathlessness?

subacute?

chronic?

A

acute - PE, pneumothorax, pulmonary oedema

subacute - pneumonia, pulmonary oedema, pleural effusion, asthma/COPD

chronic - COPD, pulmonary fibrosis, PE

72
Q

acute dry cough?

most common Ax?

A

<8 weeks

almost always viral

73
Q

Ax dry cough?

A

viral

sinsister: lung cancer, mesothelioma, pulmonary metastases

pulmonayr fibrosis

sarcoidosis

pneumonitis (EAA)

74
Q

chronic dry cough Ax?

A

GORD

ACE-I

upper airway disease

smoking

allergens

75
Q

massive vs non-massive haemoptysis?

A

massive >500ml in 24 hours

non-massive <500ml in 24 hours

76
Q

Ax haemoptysis?

A

big four: infection, carcinoma, PE, bronchiectasis

others: cardiac, AVM, anticoagulation

77
Q

PMH resp?

A

ask about…

childhood infection

PE

TB

78
Q

drug history resp?

A

ILD - nitrofurantoin, methotrexate, amiodarone, ACEI, bleomycin, B-blockers

airways - B-blokers, contrast, ACEI, penicillamine

vascular - phenytoin (PE), dexfenfluramine

79
Q

social history resp?

A

occupation/hobbies - asbestos, coal mining, farming, pigeons/birds

tobacco!!!!!!

cannabis

foreign travel

pets

80
Q

CO2 flap Ax?

what actually is it?

other s/s?

A

due to hypercapnic encephalopathy

irregular flapping of hand when wrist hyperectended (asterixis)

S/s: confusion + peripheral vasodilation

81
Q

what are these?

A
82
Q

Ax finger clubbing?

A

bronchial carcinoma

fibrosing alveolitis

lung suppuration (bronchiectasis, lung abscess, empyema)

cyonatic congenital heart disease

infective endocarditis

malabsorption states (UC, Crohn’s, liver cirrhosis)

congenital

Idiopathic

83
Q

horner’s syndrome s/s?

Ax?

A

small pupils

ptosis

enopthalmos

unilateral loss of sweating

due to disruption of cervical chain

Ax: pancoast tumour, cervical lymphadenopathy, carotid dissection

84
Q

sarcoidosis/TB eyes?

chronically raised CO2 eyes?

A

sarcoid/TB = uveitis

chronically raised pCO2 = dilated retinal veins/papilloedema

85
Q

lymph nodes in the neck?

A
86
Q

cor pulmonale s/s?

what is it?

A

cyanosis

raised JVP

pitting oedema

parasternal heave

loud P2

right heart failure due to chronic lung disease

87
Q

superior vena cava obstruction s/s?

A

distention of axillary, subclavian and jugular veins

oedema of face, neck and upper chest

88
Q

whats this?

s/s?

A

pectus excavatum

s/s: pulmonary artery flow murmur, right lower lobe CXR changes mimicking pulmonary infiltrate, diminished lung sounds

89
Q

tracheal deviation direction?

A

towards collapse

towards consolidation

away from effusion

90
Q

crepitation lungs Ax?

A

(sign that air is leaking out of the lungs)

surgical emphysema

chest wall trauma

iatrogenic (chest drains)

ruptured oesophagus

New 1st year medicine (2 decks)

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