Resp Flashcards
Pulmonary oedema may be associated with which heart murmur?
MR
What is another name for Farmer’s lung?
Hypersensitivity pneumonitis
What is the ratio for pleural protein: serum protein for an exudate?
> 0.5
Describe Atoll’s sign
A region of ground glass opacity surrounded by denser lung tissue
In which disease is Atoll’s sign most commonly seen?
Cryptogenic organising pneumonia
In what class of patients is Pickwickian syndrome most commonly seen?
Obese patients
What improves Pickwickian syndrome?
CPAP
What is the immediate treatment for a tension pneumothorax?
Immediate needle thoracocentesis
When would needle aspiration be contraindicated?
In trauma
How is pericarditis treated?
NSAIDs
What is the first and second line treatments in diabetic ketoacidosis?
1st = rapid rehydration with saline 2nd = insulin
Which disease can aspergillosis present like?
Allergic asthma
What can colorectal cancer predispose to?
DVT or PE
At what position is a chest drain inserted?
5th ICS mid-axillary line
Which syndrome develops secondary to an upper respiratory tract infection?
Guillain-Barre
Patients with SLE may experience recurrent what?
Thromboembolisms
Do the lungs receive a single or dual blood supply?
Dual
In which types of worker’s lungs are giant cells found?
Those who work in the hard metal industry eg magnesium
What can predispose epiglottitis?
Lack of childhood vaccinations
How do pleural plaques present on CXR?
Holly leaf
What disease causes an artificially high KCO?
Pulmonary haemorrhage
How is chronic type II respiratory failure compensated?
Permanent increased HCO3-
How can squamous cell carcinomas be described?
Cavitating
How does silicosis present on CXR?
Egg-shell calcification
Which radiological sign is associated with aspergillosis?
Air-crescent sign
Hyponatraemia is associated with which lung cancer?
Small cell
Which type of sensitivity reaction is Grave’s disease?
Type II
Which type of pleural effusion may constrictive pericarditis cause?
Transudative
Which type of cell is COPD associated with?
CD8+
Which two things are increased in SLE?
ANA antibodies and double-strand DNA
Which is the most common lung cancer?
Adenocarcinoma
Which bacteria most commonly causes acute epiglottitis?
Haemophilus Infleunzae B
What is a normal FEV1/FVC?
80%
What is a normal tidal volume?
500ml
Describe Fick’s law
The amount of gas that moves across a sheet of tissue in unit time is proportional to the area of the sheet, but inversely proportional to its thickness
Describe Henry’s law
The amount of given gas dissolved in a given type and volume of liquid is proportional to the partial pressure of the gas in equilibrium with the liquid
Describe Boyle’s law
The pressure exerted by a gas varies inversely with container volume
What is the LENT score used for?
To estimate survival rate of malignant pleural effusions
What does LENT stand for?
Lactate dehydrogenase (estimates tissue damage)
ECOG performance score (patient’s ability to look after themself)
Neutrophil:lymphocyte ratio in serum
Tumour type
What is the most common cause of CAP?
Strep pneumoniae
What is the total lung capacity?
5.7l
What effect does emphysema have on breath sounds?
Decreased
What is the pH of intrapleural fluid?
7.6
Which TB drug can render the contraceptive pill useless?
Rifampicin
What is the treatment for latent TB?
3 months of isoniazid and rifampicin
OR
6 months of isoniazid
What is the most common cause of glandular fever?
EBV
What bacteria is related to blindness in the developing world?
Chlamydia trachomatis
How does acute bronchitis present on a CXR?
Usually clear
What are the major causes of HAP?
Pseudomonas aeruginosa, E.coli, klebsiella
What is the commonest cause of empyema?
Strep. pneumoniae
Post-infection, how many months will it take a patient to fully recover?
6 months
What shape is the myoglobin dissociation curve?
Hyperbolic
What shape is the haemoglobin dissociation curve?
Sigmoidal
What happens if the rhythm of breathing comes from below the medulla?
Ventilation caeses
What is the value of residual volume?
1.2l
During inspiration, what happens to intrapleural pressure?
It falls
In which direction does the Bohr effect move the graph?
To the right
What does surfactant decrease?
Alveolar surface tension
What role do the kidneys play in altitude hypoxia?
Preserve acid
What does the Pre-Botzinger complex do?
Controls basic breathing rhythm
Where is myoglobin found?
In muscle tissue
Does compliance change with age?
No
What impact does dorsal neuron activation have on inspiratory muscles?
Causes contraction
Impulses from where prolong inspiration?
Apneustic centre
Hypoxia stimulates what kind of chemoreceptors?
Peripheral
When does hypoxia stimulate chemoreceptors?
When saturations fall below 8kPa
What two structures innervate peripheral chemoreceptors?
Carotid sinus then glossopharyngeal nerve
Where is rhythm generated (and where can it be modified)?
Generated in the medulla and modified in the pons
Which reflex is a good preventor of hyperinflation?
Hering-Breur
Which type of cancer can cause lobar pneumonia?
Squamous cell carcinoma
Where in the lungs are adenocarcinomas usually found?
Peripherally
Where in the lungs are small cell cancers usually found?
Centrally
What are the three main symptoms of Horner’s syndrome?
Ptosis (droopy eyelid)
Anhydrosis (ipsilateral sweating loss)
Miosis (pupil constriction)
What hormone is secreted by squamous cell carcinomas (and what does this cause)?
PTH causes hypercalcaemia
Which type of small cell cancer causes Horner’s syndrome?
ACTH secreting
At which stage in pregnancy is surfactant produced?
30-32 weeks
What are the 4 most common causes of pneumonia in neonates?
Group B Strep.
E.coli
Klebsiella pneumoniae
Staph. aureus
What are the 2 most common causes of pneumonia in infants?
Chlamydophila pneumoniae
Strep. pneumoniae
Describe the Haldane effect
Removal of oxygen from haemoglobin increases the affinity of Hb for CO2
Do the Haldane and Bohr effects work together or against each other?
Together
What name is given to difficulty in expiration in obstructive disease?
Dynamic airway compression
In what order (from most to least) is CO2 carried in the blood?
Bicarbonate>carbamino compounds>solution
What is apneusis?
Prolonged inspiration with brief expiration
What is alveolar dead space?
Alveoli which are not adequately perfused
What is the most common cause of COPD exacerbations?
Haemophilus influenzae
What compound is naturally present in tea, coffee and chocolate?
Methylxanthine
What size of airways are defined as ‘large’?
2mm
How many levels of branching are there within the respiratory tree?
23
What is non-atopic asthma mediated by? (2)
Macrophages and IgG
Contraction in smooth muscle involves what?
Ca2+ binding to calmodulin
Neutrophils in airways due to smoking cause what?
Mucous hypersecretion
Through what does mucous hypersecretion occur?
Neutrophil elastase
Which two types of drugs may cause asthma?
NSAIDs and beta blockers
What is breakdown of connective tissue in alveoli?
Emphysema
Calcium entry to mast cells causes release of what (2)?
Preformed histamine
Production of leukotrines
Asthma-COPD overlap syndrome can be described how?
COPD with >3% blood eosinophilia
Which IL causes TH2 to activate and differentiate eosinophils?
IL5
Which IL causes TH2 cells to active B cells?
IL4
Which receptors do SAMAs block?
M1, M2, M3
Are cromones strong or weak?
Weak
Which two types of cells produce Cys-leukotrines?
Mast cells and inflammatory cells
What feature of muscarinic antagonists cause them to have low systemic absorption?
Their quaternary ammonium group
How long do SABAs work for?
3-5 hours
What % risk of pneumothorax is associated with CT guided biopsy?
10%
What causes Horner’s syndrome?
Sympathetic chain disruption
What are 3 symptoms associated with squamous cell carcinoma?
Headache, thirst, confusion
Which type of cancer comes from the spread of neoplastic cells along the alveolar wall?
Adenocarcinoma
What are 3 symptoms of SVC invasion?
Headache
Distended external jugular vein
Puffy eyelids
Where are bronchial gland carcinomas most commonly seen?
Salivary glands
What type of cancer is bronchial cancer (usually)?
Squamous
What condition are cancer patients predisposed to, due to having hypercoaguable blood?
Thrombophlebitis
Describe the incidence and prevalence of lung cancer
High incidence but low prevalence
Invasion of the brachial plexus gives hand weakness due to which root infiltration?
T1
How close to the carina must a tumour be to be inoperable?
2cm
What are the thee components of the asthma triad?
Airway hyper-responsiveness
Airway inflammation
Reversible airflow obstruction
Which bacteria will only grow on lysed blood agar?
Haemophilus influenzae
Out of asthma and COPD, which is reversible?
Asthma
What is the treatment for severe CAP?
Doxycycline + co-amoxiclav
How many times per day is amoxicllin usually taken?
3
Which antibiotic can you not drink whilst taking?
Metronidazole
Gentamicin is only used against gram (negative/positive)?
Negative
With which antibiotic should renal function be monitored?
Gentamicin