RESP Flashcards
1
Q
What structure connects the middle ear with the nasopharynx?
A
Eustachian tube
2
Q
what does the eustacian tube do?
A
enabling pressure equalisation of the middle ear
3
Q
pain, associated hearing loss and fever is cause by what? (with a bulging tympanic membrane and fluid level)
A
otitis media
4
Q
what is a red flag referral for ENT ?
A
unexplained persistent hoarseness in a person over the age of 45
or
An unexplained lump in the neck
5
Q
causes of voice hoarseness?
A
voice overuse smoking viral illness hypothyroidism gastro-oesophageal reflux laryngeal cancer lung cancer
6
Q
which organisms which may colonise CF patients?
A
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
7
Q
Hypothyroidism cause what kinda of voice change?
A
Hypothyroidism is a known cause of hoarseness
The voice change is due to a thickening of vocal cords from mucopolysaccharide. Mucopolysaccharide, also known as glycosaminoglycans, is sugar molecules found throughout the body in mucus and in the fluid surrounding the joints. This buildup lowers the note produced by the voice box. The thyroid hormone helps prevent this build up.
8
Q
what is the likely consequence of a wrongly inseted NG tube?
A
The end of the tube ishould be below the diaphragm in the stomach.
serious consequences for a patient including aspiration pneumonia and death.
9
Q
Where does control and regulation of the respiratory centres occur
A
brain stem
upper/lower pon and medulla
The respiratory centres control the respiratory rate and the depth of respiration.
10
Q
what is the role of the thalamus?
A
The thalamus is involved in sensory, motor and cognitive functions, its axons connect with the cerebral cortex.
11
Q
what is the role of cerebellum?
A
The cerebellum coordinates voluntary movements and helps maintain balance and posture.
12
Q
what is the role of parietal lobe?
A
The parietal lobe processes information about sensory input, sensory discrimination and body orientation.
13
Q
what is the role of occipital lobe?
A
The occipital lobe contains the primary visual cortex.
14
Q
Lung cancer: paraneoplastic features of
Small cell?
A
ADH
ACTH - not typical, hypertension, hyperglycaemia (blurred vision), hypokalaemia (muscle weakness), alkalosis and muscle weakness are more common than buffalo hump etc
cushings syndrome
Lambert-Eaton syndrome
15
Q
Lung cancer: paraneoplastic features of squamous cell?
A
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
16
Q
Lung cancer: paraneoplastic features of Adenocarcinoma?
A
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
17
Q
Legionella pneumophila
A
Another one of the atypical pneumonias
Hyponatraemia and lymphopenia common
Classically seen secondary to infected air conditioning units
18
Q
Streptococcus pneumoniae
A
Accounts for 80% of cases
Particularly associated with high fever, rapid onset and herpes labialis
A vaccine to pneumococcus is available
19
Q
Haemophilus influenzae
A
Particularly common in patients with COPD
20
Q
Staphylococcus aureus
A
Often occurs in patient following influenza infection
21
Q
Pneumocystis jiroveci
A
typically only seen in HIV positive patients and presents with a dry cough and exercise-induced desaturation.
22
Q
Klebsiella pneumoniae
A
pneumonia Classically seen in alcoholics
also has a red currant jelly sputum
23
Q
Idiopathic interstitial pneumonia
A
a group of non-infective causes of pneumonia. Examples include cryptogenic organizing pneumonia which describes a form of bronchiolitis which may develop as a complication of rheumatoid arthritis or amiodarone therapy.
24
Q
pneumonia signs?
A
signs of systemic inflammatory response: fever, tachycardia
reduced oxygen saturations
ausculatation: reduced breath sounds, bronchial breathing
25
pneumonia symtpoms?
```
cough
sputum
dyspnoea
chest pain: may be pleuritic
fever
```
26
pneumonia xray?
the classical x-ray finding in pneumonia is consolidation
27
pneumonia blood results?
full blood count: would usually show a neutrophilia in bacterial infections
urea and electrolytes: check for dehydration (remember the 'U' for urea in CURB-65, see below) and also other changes seen with some atypical pneumonias
CRP: raised in response to infection
28
what is CURB-65?
The management of patients with community-acquired pneumonia
C Confusion (abbreviated mental test score <= 8/10)
U Urea >7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
Patients with a CURB-65 score of 0 should be managed in the community.
Patients with a CURB-65 score of 1 should have their Sa02 assessed which should be >92% to be safely managed in the community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.
Patients with a CURB-65 score of 2 or more should be managed in hospital as this represents a severe community acquired pneumonia.
The CURB-65 score also correlates with an increased risk of mortality at 30 days with patients with a CURB-65 score of 4 approaching a 30% mortality rate at 30 days.
29
what is the action of Alpha-1 antitrypsin (A1AT) in COPD?
A1AT inhibits neutrophil elastase, so no elastase to cause destruction of aveolar walls (emphasema)
Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver.
30
What is a adverse consequence as a result of chest drain insertion?
winged scapula as a result of the long thoracic nerve being damaged. (paralysis of the serratus anterior muscle can also occur)
Failure to use aseptic technique during the procedure can result in hospital-acquired pleural infection as the drain is being inserted into this space,
31
Chest drain indications?
Chylothorax is a type of pleural effusion where lymphatic fluid accumulates in the pleural cavity, and pyothorax is a type of pleural effusion where pus accumulates in the pleural cavity. Chylothorax, pneumothorax and pyothorax are all indications for chest drain insertion and not known complications of the procedure.
32
which nerve is anterior to the lung root and which nerve is posterior to the lung root?
The vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.
33
the difference between cushings disease and symdrome?
Cushing's disease (a pituitary adenoma) and Cushing's syndrome (the symptoms associated with a high cortisol level, of any cause).
34
what is aminophlline?
Aminophylline is a shorter acting theophylline
35
what is the mechanism of action of aminophlline?
Aminophylline binds to adenosine receptors and blocks adenosine-mediated bronchoconstriction
36
what are xanthines?
theophylline or aminophylline
used in the management of acute asthma and chronic obstructive pulmonary disease (COPD).
37
what are COPD xray findings?
hyperinflation
bullae: if large, may sometimes mimic a pneumothorax
flat hemidiaphragm
also important to exclude lung cancer
38
what is the normal intracranial pressure?
The normal intracranial pressure is between 7 and 15 mm Hg.
The brain can accommodate increases up to 24 mm Hg, thereafter clinical features will become evident.
39
what is monre-kelly doctrine?
Pressure within the cranium is governed by the Monroe-Kelly doctrine. This considers the skull as a closed box. Increases in mass can be accommodated by loss of CSF.
Once a critical point is reached (usually 100- 120ml of CSF lost) there can be no further compensation and ICP rises sharply. The next step is that pressure will begin to equate with MAP and neuronal death will occur.
Other metabolic factors such as hypercapnia will also cause vasodilation, which is of importance in ventilating head injured patients.
The brain can only metabolise glucose, when glucose levels fall, consciousness will be impaired.
40
Webber and rennie hearing test?
Webbers test:
sensorineurial--> lound in good ear (no hearing in sensorineurial hearing loss ear)
conductive--> lound in bad ear
Rennie rest:
conductive hearing loss, better on the bone
sensorineural loss, the sound is heard better on air conduction, as in healthy individuals.
41
Which nerves pass through middle ear
chorda tympani, a branch of the facial nerve (CN7)
42
Chorda Tympani
chorda tympani is a branch of the facial nerve, the seventh cranial nerve. It arises from the mastoid segment of the facial nerve and carries parasympathetic fibres (destined for the submandibular and sublingual gland) and taste fibres (destined for the anterior two-thirds of the tongue). After it branches off the facial nerve, it passes through the middle ear before exiting via the petrotympanic fissure. It meets and joins with the lingual nerve (a branch of the mandibular nerve) to reach the tongue and two salivary glands.
43
vestibulochlear nerve
vestibulocochlear nerve is the eighth cranial nerve. It consists of a vestibular component that carries balance information from the labyrinths of the inner ear, and a cochlear component that carries hearing information from the cochlea of the inner ear.
44
maxillary nerve
maxillary nerve is the second division of the trigeminal nerve, the fifth cranial nerve. It carries sensation from the upper teeth and gingivae, the nasal cavity and skin across the lower eyelids and cheeks.
45
mandibular nerve
mandibular nerve is the third division of the trigeminal nerve, the fifth cranial nerve. It carries sensation from the lower teeth and gingivae, the anterior two-thirds of the tongue, the mandible, the skin across the chin and mandible. It also carries motor fibres to the muscles of mastication, mylohyoid, tensor veli palatini, tensor tympani and the anterior belly of digastric.
46
glossopharyngeal nerve
glossopharyngeal nerve is the ninth cranial nerve. It carries taste and sensation from the posterior one-third of the tongue, as well as sensation from the pharyngeal wall, tonsils, pharyngotympanic tube, middle ear, tympanic membrane, external auditory canal and auricle. It also carries motor fibres to stylopharyngeus and parasympathetic fibres to the parotid gland. Information from the baroreceptors and chemoreceptors of the carotid sinus are carried via this nerve.
47
what si Trotters' triad?
Trotter's triad (diagnosis of nasopharyngeal carcinoma)
Unilateral conductive hearing loss
Ipsilateral facial & ear pain
Ipsilateral paralysis of soft palate
An association with previous Epstein Barr Virus is well established
48
what is Nasopharyngeal carcinoma?
Nasopharyngeal carcinoma
Basics
Squamous cell carcinoma of the nasopharynx
Rare in most parts of the world, apart from individuals from Southern China
Associated with Epstein Barr virus infection
Cervical lymphadenopathy
Tx: radiotherapy
49
what us Meniere's disease?
a disorder of the inner ear of unknown cause.
It is characterised by excessive pressure and progressive dilation of the endolymphatic system.
It is more common in middle-aged adults but may be seen at any age. Meniere's disease has a similar prevalence in both men and women.
"Vertigo, tinnitus, fluctuating sensorineural hearing loss - suspect Meniere's disease"
50
diseases of hearing loss causes? name 3
Meniere's disease: Vertigo, tinnitus, fluctuating sensorineural hearing loss. Painless rash?
Acoustic neuroma (vestibular schwannoma): unilateral sensorineural hearing loss, tinnitus, vertigo, facial numbness, loss of corneal reflex. a benign tumour of the 8th cranial nerve, also known as the vestibulocochlear nerve
Herpes Zoster Oticus (Ramsey Hunt syndrome) is a rare type of shingles: painful rash, vertigo, sensorineural hearing loss, facial palsy. sometimes a painful rash.
vestibular neuronitis: Long episodes of vertigo last for hours, it usually occurs after a recent viral illness, there is nausea and vomiting and hearing is not affected.
benign paroxysmal positional vertigo, vertigo occurs for seconds after sudden movement of the head.
51
parainfluenza causes what?
Parainfluenza virus is the most common cause of croup.
52
What is the normal function of the cystic fibrosis transmembrane regulator?
Chloride channel
53
What is mesothelioma risk factors?
f asbestos exposure through his occupation as a builder. As there a is latent period of 30 years and a complicated effusion,
54
what are the features of mesothelioma?
dyspnoea, weight loss, chest pain
clubbing
painless pleural effusion
55
investigation findings of mesothelioma?
suspicion is normally raised by a chest x-ray showing either a pleural effusion or pleural thickening
the next step is normally a pleural CT
fluid from pleural effusion should be sent to microscopy, culture and sensitivity (MC&S)
56
Malignant otitis externa causative agents?
pseudomonas aeruginosa (95%)
Staph Aureus, S epidermidis, aspergillus fumigatus
57
risk factors for malignant otitis externa?
old age
diabetes mellitus
immuno-compromised status
58
features of malignant otitis externa?
long standing otalgia
otorrhea
hearing loss
hallmarks:
granulation tissue in ear
canal
cranial nerve palsy
headache, neck stiffness
59
what is lung compliance?
Lung compliance is defined as change in lung volume per unit change in airway pressure.
compliance is inversely proportional to elastic recoil.
A high degree of compliance indicates a loss of elastic recoil of the lungs, as in old age or emphysema.
60
what are the causes of increased lung compliance?
old age
emphysema
61
what are the causes of low lung compliance?
pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis
atelectasis
pneumonia
lack of surfactant
a greater change in pressure is needed for a given change in volume
62
what histological findings are present in tuberculosis?
Epithelioid histiocytes is a histological finding in patients with granulomas resulting from a TB infection
a macrophage that has become an eoithelial cell.
63
what is Kartagener's syndrome?
Kartagener's syndrome (also known as primary ciliary dyskinesia)
defective dynein motor protein in cilia
```
Features
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
```
64
The recurrent nasal congestion, sinusitis and chronic ear infection are suggestive of what?
a diagnosis of a primary ciliary dyskinesia (also known as Kartagener syndrome) or cystic fibrosis
65
risk factor for developing TB?
```
silicosis
chronic renal failure
HIV positive
solid organ transplantation with immunosuppression
intravenous drug use
haematological malignancy
anti-TNF treatment
previous gastrectomy
```
66
Which area of the brain stem coordinates the basic rhythm of breathing?
hythm of breathing is controlled by the medullary rhythmicity area in the medullary oblongata
67
what is the causative agent in bronchiectasis?
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
68
what is bronchiectasis?
a permanent dilatation of the airways secondary to chronic infection or inflammation.
69
Treatment of bronchiectasis?
physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)
70
what is TLCO? carbon monoxide transfer factor
The transfer factor describes the rate at which a gas will diffuse from alveoli into blood.
71
what causes a rise in TLCO?
```
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
```
72
what causes a decrease in TLCO?
```
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
```
73
what are the visceral and parietal pleural levels in terms of ribs?
Visceral pleura is strongly adherent to the lung tissue and can be considered one in the same.
Midclavicular line = 6th rib
Midaxillary line =8th rib
Scapular line = 10th rib
Parietal pleura is located more inferiorly compared to the visceral pleura.
Midclavicular line = 8th rib
Midaxillary line = 10th rib
Scapular line = 12th rib
74
what is Presbycusis?
loss of hearing that gradually occurs in most individuals as they grow older
It is a progressive and irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degeneration of the cochlea or associated structures of the inner ear or auditory nerves.
75
what is otosclerosis?
the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
Management
hearing aid
stapedectomy
76
what what level does the aorta and IVC cross the diaphram?
IVE= T8
Oesophagus=T10
Aorta=T12
77
what are the signs of pneumothorax?
hyper-resonance and diminished breath sounds
78
CF is an increased risk of developing what?
Cystic fibrosis is a key risk factor for pneumothorax. Patients have repeated chest infections, air trapping and lung remodelling as a result of the disease.
79
Pneumothorax risk factors?
CF
Tall
Male smoker
Marfan's syndrome (connective tissue disease)
80
what is warthin's tumour?
a benign cystic tumor of the salivary glands containing abundant lymphocytes
older patient, bilateral, and papillary folds composed of a double layer of oncocytic cells
81
tumour histology?
Acinic cell carcinoma Infiltrating groups of vacuolated epithelial cels
Adenocystic carcinoma Atypical cells forming cribriform and tubular patterns
Mucoepidermoid carcinoma
Mixture of squamous epithelial cells and mucus-secreting cells
Pleomorphic adenoma Mixture of epithelial structures and mesenchyme-like stroma
82
what is Eosinophilic granulomatosis with polyangiitis (EGPA)/Churg-Strauss?
It is an ANCA associated small-medium vessel vasculitis.
Features
```
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%
```
83
Features of GPA (granulomatosis with polyangiitis )?
Saddle-shaped nose deformity, haemoptysis, epistaxis,renal failure, +ve cANCA
84
what is empyema?
An empyema is a collection of pus in the pleural space. It is a potential complication of pneumonia
85
what is sarcoidosis?
a disease involving abnormal collections of inflammatory cells that form lumps known as granulomas
a neck lump, which is most likely to be an enlarged lymph node
tender nodules on the shin, which are called erythema nodosum
uveitis
-ray findings confirm the presence of bilateral lymphadenopathy
Angiotensin-converting enzyme levels are usually elevated in sarcoidosis
Hypercalcemia
findings:
Raised serum ACE levels - think sarcoidosis
erythema nodosum and bilateral hilar lymphadenopathy on CXR is pathognomonic of sarcoidosis
86
Ansa cervicalis innervates which muscles?
```
GenioHyoid
ThyroidHyoid
Superior Omohyoid
SternoThyroid
SternoHyoid
Inferior Omohyoid
```
GHost THought SOmeone Stupid Shot Irene
87
what factors causes the oxygen dissociation curve to shift?
The oxygen dissociation curve describes the relationship between the percentage of saturated haemoglobin and partial pressure of oxygen in the blood.
Left shift: more oxygen is bound to haemoglobin so less oxygen is delivered to tissues
Right shift: for a given partial pressure less oxygen is bound to haemoglobin, so more oxygen is available to be delivered to tissue
Left shift factors:alkali
High pH (low CO2)
Low DPG
Low temperature
(Everything Low)
```
Right shift factors: acidic
Low pH(high CO2)
high DPG
Hight temperature
Exercise
```
(2,3 DPG helps haemoglobin release oxygen)
88
what resp manifestations are there in rheumatoid arthritis?
pulmonary fibrosis
pleural effusion
pulmonary nodules
bronchiolitis obliterans
complications of drug therapy e.g. methotrexate pneumonitis
pleurisy
Caplan's syndrome - massive fibrotic nodules with occupational coal dust exposure
infection (possibly atypical) secondary to immunosuppression
89
what is caplan syndrome?
pneumoconiosis and rheumatoid arthritis
90
does the chest xray of someone with asthma look normal?
A normal chest-ray with no significant findings can be
Yes in asthma Chest xray can look normal.
present in a range of respiratory diseases. If the clinical suspicion of an underlying respiratory disease is high, further investigation should be undertaken to rule in or out these diagnoses. One common example is asthma, where patients can have normal chest X-ray but further investigation such as the use of peak flow meter or spirometry will show airflow obstruction.
91
what does a hyperinflated chest x ray tell you?
obstructive lung disease known as chronic obstructive respiratory disease. This condition comprises chronic bronchitis and emphysema.
The destruction of the alveoli causes the lung to lose its elastic recoil ability.
92
what does egg shell calcification of hilar lymph nodes tell you?
restrictive lung disease, common in people with silicosis
93
what does a central bronchial opacity around the hilar region tell you? (xray)
squamous cell carcinoma of the lungs
94
whats the impact of high altitude on oxygen dissociation curve?
a right shift of the hemoglobin dissociation curve. This means that for the same partial pressure of oxygen, the hemoglobin saturation will be less.
95
whats the impact of anaerobic metabolism on oxygen dissociation curve?
Anaerobic metabolism will result in the production of lactic acid. Lactic acid will shift the haemoglobin saturation curve to the right and tissues will, therefore, be able to extract more oxygen from the blood, resulting in a lower hemoglobin saturation of the blood leaving the body tissues.
96
How is the majority of carbon dioxide transported in the blood?
bound to haemoglobin as bicarbonate ions (60%)
bound to the globin portion of haemoglobin in carbamino compounds (whilst oxygen is bound to the haem portion) 30%
dissolved in blood 10%
97
causes of metabolic acidosis?
Reduction in plasma bicarbonate levels.
1. Gain of strong acid (e.g. diabetic ketoacidosis)
2. Loss of base (e.g. from bowel in diarrhoea)
98
causes of metabolic alkalosis?
caused by a rise in plasma bicarbonate levels, or loss of H+
```
Vomiting / aspiration (e.g. Peptic ulcer leading to pyloric stenosis, nasogastric suction)
Diuretics
Liquorice, carbenoxolone
Hypokalaemia
Primary hyperaldosteronism
Cushing's syndrome
Bartter's syndrome
Congenital adrenal hyperplasia
```
99
causes of respiratory acidosis?
Rise in carbon dioxide levels usually as a result of alveolar hypoventilation
Renal compensation may occur leading to Compensated respiratory acidosis
COPD
Decompensation in other respiratory conditions e.g. Life-threatening asthma / pulmonary oedema
Sedative drugs: benzodiazepines, opiate overdose
100
causes of respiratory alkalosis?
Hyperventilation resulting in excess loss of carbon dioxide
This will result in increasing pH
Psychogenic: anxiety leading to hyperventilation
Hypoxia causing a subsequent hyperventilation: pulmonary embolism, high altitude
Early salicylate poisoning*
CNS stimulation: stroke, subarachnoid haemorrhage, encephalitis
Pregnancy
101
arterial gas interpretation
1. How is the patient?
2. Is the patient hypoxaemic?
the Pa02 on air should be >10 kPa
3. Is the patient acidaemic (pH <7.35) or alkalaemic (pH >7.45)
4. Respiratory component: What has happened to the PaCO2?
PaCO2 > 6.0 kPa suggests a respiratory acidosis (or respiratory compensation for a metabolic alkalosis)
PaCO2 < 4.7 kPa suggests a respiratory alkalosis (or respiratory compensation for a metabolic acidosis)
5. Metabolic component: What is the bicarbonate level/base excess?
bicarbonate < 22 mmol/l (or a base excess < - 2mmol/l) suggests a metabolic acidosis (or renal compensation for a respiratory alkalosis)
bicarbonate > 26 mmol/l (or a base excess > + 2mmol/l) suggests a metabolic alkalosis (or renal compensation for a respiratory acidosis)
ROME
Respiratory = Opposite
low pH + high PaCO2 i.e. acidosis, or
high pH + low PaCO2 i.e. alkalosis
Metabolic = Equal
low pH + low bicarbonate i.e. acidosis, or
high pH + high bicarbonate i.e. akalosis
102
what causes acute tonsillitis? (quinsy)
Streptococcus pyogenes
103
in pneumothorax what happens to intrapleural pressure?
there is a loss of negative intrapleural pressure and hence the lung is unable to fully reflate itself
so there is increased intrapleural pressure (less negative)
104
what is cholesteatoma?
on-cancerous growth of squamous epithelium in ear, in the middle section of your ear, behind the eardrum
Main features
foul-smelling, non-resolving discharge
hearing loss
Other features are determined by local invasion:
vertigo
facial nerve palsy
cerebellopontine angle syndrome
Otoscopy
'attic crust' - seen in the uppermost part of the ear drum
Management
patients are referred to ENT for consideration of surgical removal
105
What is the definition of chronic bronchitis?
The definition of chronic bronchitis is a chronic productive (with sputum) cough for at least 3 months in 2 consecutive years in a patient in whom other causes of chronic cough have been excluded.
Enlargement of air spaces distal to the terminal bronchioles is a component of the definition of emphysema, rather than chronic bronchitis.
106
what does elevated neutrophil mean?
acute bacterial infection
107
what does elevated eosinophils mean?
allergy and parasitic infection
108
what does elevated lymphocytes mean?
chronic inflammation and acute viral infections
109
what does elevated IgE mean?
allergic asthema,
alaria
thype 1 hypersensitivity
110
what does elevated anti-ccp mean?
rheumatoid arthritis
111
what increase functional residual capacity?
Increased FRC:
Erect position
Emphysema
Asthma
when you are sitting upright the diaphragm and other organs place less pressure on the lung bases.
112
what decrease functional residual capacity?
Abdominal swelling
Pulmonary oedema
Reduced muscle tone of the diaphragm
Age
113
name 2 antihistamine antiemetics?
cyclizine and promethazine
114
what are 5-HT3?
ondansetron and granisetron
they block serotonin receptors in the central nervous system and gastrointestinal tract.
115
what are antimuscarinic antiemetics?
Antimuscarinic antiemetics are anticholinergic drugs.
e.g.: Hyoscine (scopolamine) i
116
which organisms commonly cause respiratory diseases in CF patients?
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
117
what are the common causes of occupational asthma?
```
isocyanates - the most common cause. Example occupations include spray painting and foam moulding using adhesives
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes
```
118
define vertigo?
Vertigo is the perception of movement in the absence of movement and requires a clear history to establish its presence
Vertigo can be seen to have peripheral causes which are due to derangements of the inner ear or vestibular system and central nervous system causes like stroke or tumours. BPPV is a vestibular cause of vertigo and is treated with the Epley manoeuver, however this may not always be the case and it is important to consider other differentials of vertigo.
119
what is pleural pressure?
Pleural pressure is the pressure surrounding the lung, within the pleural space. During quiet breathing, the pleural pressure is negative; that is, it is below atmospheric pressure.
During a Valsalva manoeuvre, the intra pleural pressure rises owing to extrinsic compression.
120
lung malignancy increases the risk of developing what?
pneumothorax
121
what antibiotics can inhibit the hepatic metabolism of theophylline?
Ciprofloxacin inhibits hepatic metabolism of theophylline - increased risk of theophylline toxicity
122
what are the features of theophylline poisoning?
acidosis, hypokalaemia
vomiting
tachycardia, arrhythmias
seizures
123
TLC reduced meaning obstructive or restrictive?
The TLC is reduced confirming this is restrictive
124
Pulmonary hypertension would present with a decreased TLCO and KCO.
Total lung coefficient (TLCO)
Transfer coefficient (KCO)
125
TLC reduced meaning obstructive or restrictive?
The TLC is reduced (total lung capacity)confirming this is restrictive
126
Pulmonary hypertension would present with a decreased TLCO and KCO.
Total lung coefficient (TLCO)
Transfer coefficient (KCO)
127
cyctic fibrosis can delay pubity, is this true?
yes
128
name some caues of dely in puberty?
Chronic illness - eg, kidney disease, Crohn's disease.
Malnutrition - eg, anorexia nervosa, cystic fibrosis, coeliac disease.
Excessive physical exercise, particularly athletes or gymnasts.
Psychosocial deprivation.
Steroid therapy.
Hypothyroidism.
Tumours adjacent to the hypothalamo-pituitary axis
Congenital anomalies - eg, septo-optic dysplasia, congenital panhypopituitarism.
Irradiation treatment
Trauma: surgery, head injury
129
cyctic fibrosis can cause what other conditions?
neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease
```
short stature
diabetes mellitus
delayed puberty
rectal prolapse (due to bulky stools)
nasal polyps
male infertility, female subfertility
```
130
what are the causes of normal anion gap acidosis?
```
H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - Renal tubular acidosis
D - Diarrhoea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline
```
131
In asthma, and other obstructive airway diseases, the parameter most affected?
forced expiratory volume
132
Pain from the middle ear is transmitted via which nerve?
glossopharyngeal nerve
It carries taste and sensation from the posterior one-third of the tongue, as well as sensation from the pharyngeal wall, tonsils, pharyngotympanic tube, middle ear, tympanic membrane, external auditory canal and auricle. It also carries motor fibres to stylopharyngeus and parasympathetic fibres to the parotid gland. Information from the baroreceptors and chemoreceptors of the carotid sinus are carried via this nerve.
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A cervical rib may produce an absent radial pulse due to compression of the subclavian artery
Cervical ribs may cause neurological and vascular signs and symptoms in the upper limb due to compression of nerves and blood vessels causing thoracic outlet syndrome. Compression of the subclavian artery may cause an absent radial pulse, and can be tested for using Adson's test. Thoracic outlet syndrome can present similarly to cervical radiculopathy but the absent radial pulse suggests compression of a structure other than a nerve root.
Flapping tremors are more commonly seen in encephalopathic patients, usually as a result of liver failure or carbon dioxide retention.
An irregular pulse is a sign of an arrhythmia such as atrial fibrillation or a heart block.
An ejection systolic murmur is a sign of aortic stenosis, which usually presents with loss of consciousness on exertion in older patients.
A bounding pulse is a sign of forceful myocardial contractions, which may be caused by heart failure, arrhythmias, pregnancy, and thyroid disease.
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pericarditis?
The pain radiates to the back, neck, and left shoulder (phrenic nerve). The pain is relieved by sitting forward and worsened by lying down, and he feels feverish.
135
nerve damage and their symptoms?
The axillary nerve innervates the teres minor and deltoid muscles and dysfunction of this nerve usually presents with loss of movement or sensation to the shoulder area.
While the accessory nerve does innervate muscles in the neck that attach to the shoulder (the sternocleidomastoid and trapezius muscles), this nerve has a purely motor function to those muscles not sensory. Also, this shoulder pain is referred pain from pericarditis, and is not a typical history of musculoskeletal pain.
Injuries involving the long thoracic nerve are usually associated with winging of the scapula, and are commonly caused by axillary surgery.
While the vagus nerve supplies parasympathetic innervation to the heart, this is a history of pericarditis and the pericardium is innervated by the phrenic nerve not the vagus nerve
136
what is Kartagener's syndrome?
Kartagener's syndrome is caused by a defect in the cilia which reduces the ability of the lungs to clear mucus. This progresses to bronchiectasis as repeated infections and inflammation cause the airways to become widened and oedematous.
also known as primary ciliary dyskinesia
137
what does a silent chest indicate?
A silent chest indicates a life-threatening feature of an asthma attack which requires urgent intervention. The airways are so constricted that even a wheeze will not be heard.
138
causes of polyuria?
hyperprarthryoidsm
Diabeties insipidus
diabeties mellitus
139
hypercalcaemia symtpoms?
These are best remembered by: stones (renal/biliary), bones (pain), groans (abdominal pain, nausea, and vomiting) and moans (depression, anxiety).
140
residual volume and vital capacity changes in emphysema?
Emphysema increased the residual volume and therefore reduces the vital capacity
141
type 2 pneumocytes and their production of surfactants in babies?
Type 2 pneumocytes produce pulmonary surfactant from week 24, but does not reach sufficient levels until week 35. Respiratory distress syndrome is often prevented by administering steroids prior to labour.
Type 1 pneumocytes are adapted for gas exchange within the alveoli.
142
Which hypersensitivity is asthma associated with?
Asthma is associated with type 1 hypersensitivity
Type 1 hypersensitivity is mediated by IgE binding to Mast cells. This leads to an inflammatory response.
(Type 2 hypersensitivity occurs when IgG or IgM binds to an antigen on the cell surface. Type 3 hypersensitivity is immune complex-mediated - here free antigens and antibodies form immune complexes and deposit into specific tissues. Type 4 hypersensitivity is T-cell mediated. Type 5 hypersensitivity occurs when an antibody binds to cell surface receptors, either activating or inhibiting them.)
143
what is Acute respiratory distress syndrome?
Acute respiratory distress syndrome (ARDS) is caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli, i.e. non-cardiogenic pulmonary oedema. It is a serious condition that has a mortality of around 40% and is associated with significant morbidity in those who survive.
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Causes
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass
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Clinical features are typically of an acute onset and severe:
dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations
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A chest x-ray and arterial blood gases are the key investigations.
144
Exposure to whar results in pigeon fancier's lung?
Avian proteins from bird droppings cause bird fanciers’ lung
145
Mycobacterium avium is responsible for what?
hot tub lung
146
what is sialolithiasis?
The stones most commonly form in the submandibular gland and therefore may occlude Whartons duct. Stensens duct drains the parotid gland.
147
intrapulmonary nodules are a sign of what pulmonary disease?
pneumoconiosis
148
hyperinflated lungs are a sign of what pulmonary disease?
obstructive lung disease.
chronic obstructive respiratory disease. This condition comprises chronic bronchitis and emphysema. The destruction of the alveoli causes the lung to lose its elastic recoil ability. Together with the airway obstruction due to inflammation of the bronchi, this results in hyperinflated lungs put pressure on the diaphragm giving it the flattened appearance on chest X-ray.
149
egg shell calcification of the hilar lymph nodes are a sign of what?
silicosis. This is a restrictive lung disease which develops in individuals exposed to silica, due to occupational exposure such as sandblasters and in silica mines.
150
A central bronchial opacity around the hilar region is seen in which pulmonary disease?
squamous cell carcinoma of the lungs.
The risk of developing squamous cell carcinoma of the lungs is higher in smokers and the disease is associated with hypercalcemia as a paraneoplastic syndrome.
151
a tracheostomy causes what changes?
1. alveolar ventilation is increased
2. anatomical dead space is reduced by 50%
3. working of breathing is reduced
4proportion of ciliated epithelial cells in the trachea may decrease
5. splinting of the larynx may lead to swallowing difficulties
152
laryngeal nerve can be compressed can cause what?
hoarseness of voice or aphonia
153
causes of anion gap acidosis?
Causes of increased anion acidosis: MUDPILES
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M - Methanol
U - Uraemia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates
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154
Pleural effusion: causes?
Pleural effusions may be classified as being either a transudate or exudate according to the protein concentration.
Transudate (< 30g/L protein): too much fluid leaves the capillaries.
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs' syndrome
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Exudate (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
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Features
dyspnoea, non-productive cough or chest pain are possible presenting symptoms
classic examination findings include dullness to percussion, reduced breath sounds and reduced chest expansion
155
explain the physiology in transudate plural effusion
too much pleural fluid leaves the capillaries into the plural space, either due to increases hydrostatic pressure or oncotic pressure
>>hydrostatic pressure the pressure exerted onto the vessel (like blood pressure). A common cause of increased hydrostatic pressure is heart failure. due to a backup of pressure into the pulmonary vessels.
>>oncotic pressure is s a form of osmotic pressure, where fluid move from area of low to high solute concentration.
so fluid leak into the pleural space when there is a decreased oncotic pressure in the capillary (low albumin)
two causes are cirrhosis, where the liver makes too few albumin, or nephrotic syndrome (where proteins are lost in urine)
156
explain the physiology of exudate plural effusion?
due to inflammation of pulmonary capillarys
causes: trauma, malignancy, Lupus, infection (pneumonia)/
157
explain the lymphatic pleural effusion? (chylothorax)
the thoracic duck is disrupted and the lymphatic fluid accumates in the pleural space.
causes: tumour in the mediastinum, ioatronic
158
what is pleurisy?
pain when inhaling, common in pleural effusion
159
features of quinsy (peritonsillar abscess)?
severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility
A peritonsillar abscess typically develops as a complication of bacterial tonsillitis.
