RESP RECAP Flashcards
Can a LABA (e.g. salmeterol) be used as mono-therapy
No
Has to be in a combination inhaler with ICS
Which enzyme does theophylline allegedly activate
histone deacetylase
What 2 classes of substances does the adrenal cortex produce
Glucocorticoids
Mineralocorticoids
What part of the adrenal cortex are Mineralocorticoids released from
Zona Glomerulosa
What part of the adrenal cortex are Glucocorticoids released from
Zona Fasciculata
Which genes do glucocorticoids affect and how
Increase transcription of genes encoding anti-inflammatory proteins
Decrease transcription of genes encoding inflammatory proteins
What are the major muscles of inspiration
External intercostal
Diaphragm
What are the muscles of active expiration
Internal intercostal
Abdominal muscles
What are the accessory muscles of inspiration
Sternocleidomastoid
Scalenus
What is the asthma triad
Airway Hyper-responsiveness
Airway inflammation
Reversible airflow obstruction
What is the pneumonic for causes of pulmonary fibrosis
BREAST I Bleomycin Radiation Extrinsic Allergic Alveolitis (EAA) Asbestosis/ Ankylosing Spondylitis Sarcoidosis TB Idiopathic
What are the 2 fibrogenic DPLD’s (diffuse parenchymal lung disease)
Asbestosis
Silicosis
What are the 3 non-fibrogenic DPLD’s (diffuse parenchymal lung disease)
Baritosis (barium)
Siderosis (Iron)
Stanosis (Tin)
What are the treatments for DPLD
PO Prednisolone
PO azathioprine
Anti-fibrotic (Pirfenidone)
Anti-oxidant (Acetylcysteine)
What is the neural sequence for normal breathing
Pre-Botzinger complex excites dorsal neurones
Dorsal neurones fire in bursts
Firing = Contraction of diaphragm + External intercostal
Firing stops = Passive expiration
What is the neural sequence for active expiration
Increased firing of Dorsal neurones excites Ventral neurones
Ventral firing = contraction of internal intercostal and abdominal muscles
What part of the brain is respiratory rhythm established in
Medulla
Where can the rhythm established in the medulla be modified from
Pons
More specifically the pneumotaxic centre
What does stimulation of the Pneumotaxic Centre (PC) cause
Termination of inspiration
When is the Pneumotaxic Centre (PC) stimulated to fire
When dorsal neurones fire
What is breathing like when the Pneumotaxic Centre (PC) is not active
Prolonged inspiration with brief expiration
Apneusis
Name 5 adaptations the body makes in response to chronic altitude hypoxia
Increased RBC production (polycythaemia)
Increased 2,3 DPG (easier to offload O2)
Increased number of capillaries
Increased number of mitochondria
Kidneys conserve acid -> decreased arterial pH
Which muscarinic receptor causes inhibition of Ach release
M2
Which muscarinic receptors does Ipratropium block
M1, M2, M3 (non-selective)
Which muscarinic receptors does Tiotropium block
M3 selective
Why is Tiotropium favourable to Ipratropium
asides from the fact that it is longer acting
It is M3 selective whereas Ipratropium blocks M1 and M2 also
Blocking of M2 is not desirable since it actually inhibits Ach transmission i.e decreased muscle contraction
What are the 3 types of Rhinitis
Allergic
Non-Allergic
Mixed
What are the 3 types of Allergic Rhinitis
Episodic, Seasonal (SAR) and Perennial (PAR)
What can cause onset of Non-Allergic Rhinitis
Infection Hormonal imbalance Vasomotor disturbance NARES (Non-Allergic Rhinitis with Eosinophilia Syndrome) Drug induced
What type of Rhinitis is linked to occupation
Mixed (Allergic & Non-Allergic)
What are the 4 aspects of rhinitis treatment
Anti-inflammatory
Mediator receptor blockers
Decreasing Nasal Blood flow
Anti-Allergic
Name the class of drug given as anti-inflammatory, method of administration and types of rhinitis used in
Glucocorticoids
Nasal Spray or Oral (Prednisolone)
Useful in SAR and PAR
Name the class of drugs given as mediator receptor blockers, method of administration and types of rhinitis used in
H1 receptor antagonists (block mast cell histamine)
SAR, PAR and episodic
Can be oral (Fexofenadine) or nasal (Azelastine)
CysLT1 receptor antagonists
PAR and SAR
Oral only - Montelukast
What is the aim of giving vasoconstrictors in rhinitis
To decrease nasal blood flow
Give an example of a vasoconstrictor given in rhinitis and its method of administration
Oxymetazoline (a-1 selective agonist)
Given intranasally for allergic rhinitis)
Why should vasoconstrictors not be given for long periods of time in rhinitis
When stopped can lead to rebound congestion
known as Rhinitis Medicamentosa
What is the anti-allergic drug given in allergic rhinitis and how does it work
Sodium Cromoglicate (cromone)
Mast cell stabiliser
Given nasally
Which Muscarinic receptor antagonist can be given in SAR and PAR to prevent Rhinorrhoea
Ipratropium
Given nasally
What is the treatment for atypical community-acquired pneumonia (E.g. Mycoplasma, Coxiella and Chlamydia)
Tetracycline + Macrolides
What is the causative organism of Q fever
Coxiella Burnetti
What is the location of the lesion in primary TB
BUZZWORD - Ghon focus
Mid zone of lung
Where is the lesion found in secondary TB
BUZZWORD - Assmann focus
Apical cavitating lesion
What are the 3 possible treatments for empyema
Drainage
IV broad spectrum antibiotics
Oral culture specific antibiotics (Takes 14days)
What is the treatment for croup (viral laryngotracheobronchitis )
Oral steroid (Prednisolone)
What is the investigation for a DVT
Ultrasound Doppler leg scan
What is the name of the ECG phenomenon rarely seen in a patient with a P.E
S1Q3T3
What is Virchow’s triad
Hypercoagulability (Post-MI, Cancer)
Endothelial Damage
Circulatory Stasis
What are the possible causes of a transudate effusion
Cardiac failure
Hypoproteinemia
What are the possible causes of an exudate effusion
Cancer, Pneumonia, TB, Connective tissue disease
What is stridor and what causes it
A predominantly inspiratory wheeze usually due to a large airway obstruction
What is the treatment for anaphylaxis
IM Adrenaline IV Corticosteroid IV Anti-histamine Nebulized bronchodilators High flow O2
What is the maximum score on the Epworth sleepiness scale and what is a normal score
Max score is 24
Normal score is <10
What are the consequences of Obstructive Sleep Apnoea
Excessive daytime sleepiness
Personality change
Cognitive impairment
Daytime function decreased
How is Obstructive Sleep Apnoea diagnosed
Epworth Sleepiness scale (score >10)
Polysomnography
What is the treatment of Obstructive Sleep Apnoea
CPAP
Continuous Positive Airway Pressure
What does MLCK stand for
Myosin Light Chain Kinase
What happens to MLC to cause muscle contraction and what must be present
MLC is phosphorylated in the presence of elevated intracellular Ca and ATP
How is muscle relaxation brought about
Dephosphorylation of MLC by myosin phosphatase
In the presence of elevated intracellular Ca will phosphorylation exceed dephosphorylation or vice versa
In the presence of intracellular Ca, the rate of MLC phosphorylation will exceed the rate of MLC dephosphorylation
