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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
Q

3 forms of CO2 carriage in the bloods

A

HCO3 (majoirty)
Carbamino Hb
Dissolved

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26
Q

Cause of left/right shift of CO2 curve

A

More HbO2, the less bound CO2 to Hb

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27
Q

Increment of HCO3 in acute respiratory acidosis

A

1 - 1.5 for every 10mmHg increase in CO2

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28
Q

Increment of HCO3 in chronic respiratory acidosis

A

3 - 4 for every 10mmHg increase in CO2

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29
Q

Normal A-a gradient age adjusted

A

Age/4 + 4

e.g. 60/4 + 4 = 19

30
Q

pAO2

A

150 - paCO2 / 0.8

31
Q

Increased A-a gradient

A

V/Q mismatch
Diffusion abnormality
Shunts
NOT pure hypoventilation

32
Q

Carbon monoxide poisoning

A

Lactic acidosis
Normal Sats and pO2
Smokers reach toxic level faster

33
Q

Anatomical shunt fraction

A

Ideal pO2 at 100% oxygen for 20 mins:
= (670 - pO2) / 20
= % shunt

34
Q

Effect on V/Q mismatch of bronchodilators

A

Vasodilation before bronchodilatation resulting in V/Q mismatch

35
Q

Indication for ICU in asthma

A

Hypercapnia

36
Q

the calculation to use when FiO2 >40% instead of A-a gradient

A

pO2 / FiO2 > 500 is normal

37
Q

Volume that may change on lying supine

A

Functional residual capacity

38
Q

Dyspnoea worse on standing

A

Atria-atria shunt

Hepatopulmonary syndrome causing a pulmonary shunt - dilation of the arteries

39
Q

Effect of PEEP

A

Reduces shunt
Increases FRC
Increase deadspace
Reduced CO due to decrease in venous return

40
Q

Lung volume parameter affected most in pregnancy

A

Decrease in ERV and RV, therefore, FRC most affected

41
Q

High DLCO

A

Alveolar haemorrhage

Asthma

42
Q

MIP

A

strength of inspiration musleca

43
Q

Gene mutation A1ATD

A

Serpina1
MM - normal
ZZ- common A1ATD levels 15%
MZ - vulnerability to smoking

No sex linkage

44
Q

Indications for O2 for COPD

A

PaO2 <55
PaO2 55-59 with PC or PHTN

Improves survival in these patients

45
Q

Indication for bipap COPD

A

pH <7.35

pCO2 >45

46
Q

COPD DECAF Score

A 
Dyspnoea 
Eisinopaenia 
Consolidation 
Acidaemia 
Atrial fibrillation

Worse outcomes

47
Q

Exhaled NO

A

Suggests steroid responsive asthma

48
Q

Anti IL5

A

Mepolizumab

Severe asthma with eosinophilia
Steroid sparing, reduces exacerbation

49
Q

IL4Ra inhibitor

A

Dupilumab

Eisinophilia and elevated FeNO

50
Q

Features of early aging
Family Ajax IPF
Short telemere

A

Familial interstitial pneumonia

51
Q

Pulmonary LAM

A

Women
Tuberous sclerosis complexes (seizures, cutaneous lesions, ID delay)
Autosomal dominant

52
Q

Birt Hogg Dube

A 
Multiple benign skin lesions
Pulmonary cysts 
Renal neoplasia 
Asymptomatic until PTx 
Lower zone
53
Q

Langerhans Cell histiocytosis

A

Smoking

Upper and mid zone cysts

54
Q

Hypersensitivity pneumonitis CT

A

Ground glass
Hypo dense on expiratory imaging
Gas trapping
Diffuse

Bird fanciers and farmers lung

55
Q

Silicosis

A

ILD
Stone Mason
Starry night on CT
Autoimmune features

56
Q

Best predictor of clinical response to treatment of OSA

A

Hypersomnolence

57
Q

IPF CT

A 
Honey combing 
Reticular changes 
Basal predominant 
Digital clubbing 
Older age
58
Q

Emphysema lower zones

A

A1ATD

59
Q

Gram-negative cocci that commonly causes respiratory infections in those with underlying lung disease

A

Morexella catarrhalis

60
Q

Indication for CPAP

A

T1RF

Benefit in APO

61
Q

Indications for BiPAP

A

T2RF/mixed

62
Q

In whihc COPD patients has long term O2 therapy shown benefit

A

paO2 <55 or SpO2 <88%

63
Q

Bronchiectasis on HRCT

A 
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
Q

Bronchiectasis clinical features

A

Sputum production
Clubbing
Coarse crackles

65
Q

Shape of flow-volume loop seen with tracheal stenosis

A

Box shaped

Flattening of inspiration amd exploratory limbs

66
Q

Treatment of aspergillosis

A

Voriconazole
Amphotericin
Caspofungin

67
Q

Diagnosis of OSA

A

AHI/RDA greater than 15 and asymptomatic

Or

> 5 and symptomatic

68
Q

NSIP CT

A 
Basal predominant
Ground glass opacity 
Subpleural sparing (most specific, distinguish from UIP)
69
Q

Organising pneumonia CT

A

Ground glass
Consolidation
Modular
Atoll sign (reverse halo)

Only small percentage with fibrosis

70
Q

Treatments for IPF

A

Nintedanib - tyrosine kinase blocker

Pirfendirone - TGF-b blocker

71
Q

Treatment of NSIP

A

Systemic glucocorticoid

Refractory-
Azathioprine 
Mycophenalate 
Cyclophosphamide 
Rutixumab
72
Q

Rapid score for empyema risk of mortality

A 
Renal 
Age 
Purulent fluid
Infection source (com good hosp bad)
Diet (albumin)

STEPH BPT 2021 (16 decks)

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