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STEPH BPT 2021 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Stimulators of central chemoreceptors

A

High CO2, Low pH

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2
Q

Stimulators of peripheral chemoreceptors (carotid bodies>aortic bodies)

A

Low oxygen
High Co2
Low pH

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3
Q

Group of neurons most important for inspiration

A

Dorsal inspiratory group neurons in the medulla

Communicates with somatic neurons working of the diaphragm

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4
Q

Arterial baroceptors action

A

Increase in arterial blood pressure can cause refle hypoventilation

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5
Q

Conducting airway dead space volume

A

150ml

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6
Q

First site of diffusion of oxygen

A

Respiratory bronchioles

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7
Q

Muscles important for active expiration

A

abdominal muscles

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8
Q

Total lung capacity

A

6L

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9
Q

Residual volume

A

20% TLC

Volume post forced expiration

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10
Q

Functional residual volume

A

40% of TLC

Volume after passive expiration

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11
Q

Major site of airway resistance

A

medium-sized bronchi

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12
Q

Lowest point of PVR

A

At FRC

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13
Q

Tidal volume

A

7ml/kg ~700mls

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14
Q

Elderly LFTs

A

Lvel of obstruction with increased residual volumes

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15
Q

Lung volume that cannot be measured with a spirometer

A

Residual volume
Therefore TLC and functional residual capacity
Measures with body plethysmograph

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16
Q

FEV1 / FVC ratio for obstruction

A

< 0.7

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17
Q

Reduction in TLC

Reduction in RV

A

Intrinsic RLD (ILD)

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18
Q

TLC decrease

RV normal

A

Extrinsic RLD

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19
Q

Mixed obstruction/restriction

A

Decreased TLC

FEV1/FVC <0.7

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20
Q

Indicator of gas trapping in COPD

A

Functional residual capacity

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21
Q

Increased RV/TLC

A

Consistent with extrinsic restriction
Mild increase with morbid obesity
Marked with NMD

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22
Q

The partial pressure of oxygen

A

Amount of oxygen dissolved in the blood

Not affected by Hb

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23
Q

Right shift of oxygen dissociation curve

A 
Causes a reduced affinity of O2 to Hb 
Increase in Temp 
Increased pCO2
decreased pH
Increased 2,3- DBG
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24
Q

Left shift of oxygen dissociation curve

A

Carbon Monoxide
High HbF
Met-Hb
Decreased temp, high pH, low pCO2

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25
3 forms of CO2 carriage in the bloods
HCO3 (majoirty) Carbamino Hb Dissolved
26
Cause of left/right shift of CO2 curve
More HbO2, the less bound CO2 to Hb
27
Increment of HCO3 in acute respiratory acidosis
1 - 1.5 for every 10mmHg increase in CO2
28
Increment of HCO3 in chronic respiratory acidosis
3 - 4 for every 10mmHg increase in CO2
29
Normal A-a gradient age adjusted
Age/4 + 4 | e.g. 60/4 + 4 = 19
30
pAO2
150 - paCO2 / 0.8
31
Increased A-a gradient
V/Q mismatch Diffusion abnormality Shunts NOT pure hypoventilation
32
Carbon monoxide poisoning
Lactic acidosis Normal Sats and pO2 Smokers reach toxic level faster
33
Anatomical shunt fraction
Ideal pO2 at 100% oxygen for 20 mins: = (670 - pO2) / 20 = % shunt
34
Effect on V/Q mismatch of bronchodilators
Vasodilation before bronchodilatation resulting in V/Q mismatch
35
Indication for ICU in asthma
Hypercapnia
36
the calculation to use when FiO2 >40% instead of A-a gradient
pO2 / FiO2 > 500 is normal
37
Volume that may change on lying supine
Functional residual capacity
38
Dyspnoea worse on standing
Atria-atria shunt | Hepatopulmonary syndrome causing a pulmonary shunt - dilation of the arteries
39
Effect of PEEP
Reduces shunt Increases FRC Increase deadspace Reduced CO due to decrease in venous return
40
Lung volume parameter affected most in pregnancy
Decrease in ERV and RV, therefore, FRC most affected
41
High DLCO
Alveolar haemorrhage | Asthma
42
MIP
strength of inspiration musleca
43
Gene mutation A1ATD
Serpina1 MM - normal ZZ- common A1ATD levels 15% MZ - vulnerability to smoking No sex linkage
44
Indications for O2 for COPD
PaO2 <55 PaO2 55-59 with PC or PHTN Improves survival in these patients
45
Indication for bipap COPD
pH <7.35 | pCO2 >45
46
COPD DECAF Score
``` Dyspnoea Eisinopaenia Consolidation Acidaemia Atrial fibrillation ``` Worse outcomes
47
Exhaled NO
Suggests steroid responsive asthma
48
Anti IL5
Mepolizumab Severe asthma with eosinophilia Steroid sparing, reduces exacerbation
49
IL4Ra inhibitor
Dupilumab Eisinophilia and elevated FeNO
50
Features of early aging Family Ajax IPF Short telemere
Familial interstitial pneumonia
51
Pulmonary LAM
Women Tuberous sclerosis complexes (seizures, cutaneous lesions, ID delay) Autosomal dominant
52
Birt Hogg Dube
``` Multiple benign skin lesions Pulmonary cysts Renal neoplasia Asymptomatic until PTx Lower zone ```
53
Langerhans Cell histiocytosis
Smoking | Upper and mid zone cysts
54
Hypersensitivity pneumonitis CT
Ground glass Hypo dense on expiratory imaging Gas trapping Diffuse Bird fanciers and farmers lung
55
Silicosis
ILD Stone Mason Starry night on CT Autoimmune features
56
Best predictor of clinical response to treatment of OSA
Hypersomnolence
57
IPF CT
``` Honey combing Reticular changes Basal predominant Digital clubbing Older age ```
58
Emphysema lower zones
A1ATD
59
Gram-negative cocci that commonly causes respiratory infections in those with underlying lung disease
Morexella catarrhalis
60
Indication for CPAP
T1RF | Benefit in APO
61
Indications for BiPAP
T2RF/mixed
62
In whihc COPD patients has long term O2 therapy shown benefit
paO2 <55 or SpO2 <88%
63
Bronchiectasis on HRCT
``` Dilatation of the lumen of airway more than the nearest blood vessel (signet ring sign) Varicose construction of airways Balloons cysts (bunch of grapes sign) ```
64
Bronchiectasis clinical features
Sputum production Clubbing Coarse crackles
65
Shape of flow-volume loop seen with tracheal stenosis
Box shaped | Flattening of inspiration amd exploratory limbs
66
Treatment of aspergillosis
Voriconazole Amphotericin Caspofungin
67
Diagnosis of OSA
AHI/RDA greater than 15 and asymptomatic Or >5 and symptomatic
68
NSIP CT
``` Basal predominant Ground glass opacity Subpleural sparing (most specific, distinguish from UIP) ```
69
Organising pneumonia CT
Ground glass Consolidation Modular Atoll sign (reverse halo) Only small percentage with fibrosis
70
Treatments for IPF
Nintedanib - tyrosine kinase blocker | Pirfendirone - TGF-b blocker
71
Treatment of NSIP
Systemic glucocorticoid ``` Refractory- Azathioprine Mycophenalate Cyclophosphamide Rutixumab ```
72
Rapid score for empyema risk of mortality
``` Renal Age Purulent fluid Infection source (com good hosp bad) Diet (albumin) ```

STEPH BPT 2021 (17 decks)

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