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BPT exams > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Neutrophils and alveolar macrophages are the predominant inflammatory cells in the small airways

A

Neutrophils and alveolar macrophages are the predominant inflammatory cells in the small airways

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2
Q

Name 5 path-physiological features of asthma:

A

Smooth muscle hyperplasia of bronchial and bronchiolar walls

  • Thick tenacious mucous plugs
  • Thickened basement membrane
  • Mucosal oedema → abnormal mucociliary clearance
  • Eosinophilia of the submucosa and secretions
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3
Q

In spirometry bronchodilator response is considered positive if FEV1 increase of at least ____ from baseline at 10minutes

A

FEV1 increase of at least 12% from baseline

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4
Q

What age do you transition to spacer with no mask?

A

2-4 years

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5
Q

What age group can manage turbuhaler?

A

5-7 years

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6
Q

Which LABA can you use for AIR/SMART therapy?

A

Eformoterol because it has rapid onset action

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7
Q

Choose AIR/SMART:

_____ more effective at Step 1 as reliever alone to prevent exacerbations

_______ more effective at Step 2 as reliever and preventer to prevent exacerbation

A

AIR therapy more effective at Step 1 as reliever alone to prevent exacerbations

SMART therapy more effective at Step 2 as reliever and preventer to prevent exacerbation

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8
Q

SMART ICS/formoterol reliever reduces the risk of an exacerbation by _____ % compared with ICS maintenance and SABA reliever therapy.

Reduces the risk of a severe exacerbation by at least _____% and ED visit by _______% compared to salbutamol alone

A

SMART ICS/formoterol reliever reduces the risk of an exacerbation by 32% compared with ICS maintenance and SABA reliever therapy.

Reduces the risk of a severe exacerbation by at least 60% and ED visit by 35% compared to salbutamol alone

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9
Q

What is Omalizumab?

A

Anti IgE antibody

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10
Q

What is Mepolizumab?

A

Anti-IL5 antibody - targets Eosinophils

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11
Q

One of the conditions for Mepolizumab therapy is that IgE levels must be greater than _____

A

0.5

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12
Q

What are two distinctive features of a normal thymus on CXR?

A

1) characteristic ‘sail’ shape

2) wavy margins resulting from the interdigitation of the soft thymic tissue in the intercostal spaces.

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13
Q

Where do you do a needle thorcentesis in emergency?

In controlled setting?

A

Emergency - mid clavicular line, 2nd intercostal space, right above the lower rib

Controlled setting - The 4th or 5th intercostal space just anterior to mid-axillary line

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14
Q

Do you go directly above or below rib for thoracentesis and why?

A

You go above the lower rib because the neurovascular structures are found right below the rib - vein, artery, nerve

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15
Q

Due to Boyle’s law, at higher altitude the ________ in the air is lower, and less ________ is breathed in with every breath. The partial pressure gradients for gas exchange are also decreased, along with the percentage of oxygen saturation in hemoglobin.

A

Due to Boyle’s law, at higher altitude the partial pressure of oxygen in the air is lower, and less oxygen is breathed in with every breath. The partial pressure gradients for gas exchange are also decreased, along with the percentage of oxygen saturation in hemoglobin.

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16
Q

Acclimatization to high altitude requires days, or even weeks. Gradually, the body compensates for the respiratory alkalosis by kidney excretion of ________, which allows adequate respiration to provide oxygen without risking _________

A

Kidneys can excrete bicarbonate and this prevents the risk of respiratory alkalosis.

Also can use Azetolamide for similar effect with high altitudes

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17
Q

What antibiotics would you use for severe pneumonia?

A

IV Ceftriaxone and Iv fluclox

Consider adding Vanc if MRSA suspected

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18
Q

Spasmodic croup is similar to ___________; however can be differentiated….

A

Similar to laryngobronchitis - normally presents with viral prodrome; whereas spasmodic croup is randomly bad

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19
Q

3 common bugs that cause bacterial tracheitis?

A

Staphylococcus aureus, Moraxella catarrhalis or Haemophilus influenza

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20
Q

How does RACP differentiate peritonsillar abscess and retropharyngeal abscess?

A

Retropharyngeal abscess is more common in children under 6 years old, has an insidious to sudden onset of symptoms, often presents with arching of the neck and dyspnoea.

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21
Q

Dry pleurisy is often associated with which condition?

A

TB - can be a delayed hypersensitivity reaction

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22
Q

In pleural fluid analysis: Glucose is usually <60 mg/dL in ________, ________, _______; the finding of many small lymphocytes and a pH < 7.20 suggest ________.

A

Malignancy, rheumatoid disease, and tuberculosis

The finding of many small lymphocytes and a pH < 7.20 suggest TB

Generally exudate has high protein, high LDH (above 200) and pH <7.2

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23
Q

Most common bugs for Empyema

A

1) Strep Pneumonia and 2) Staph Aureus

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24
Q

Empyema has 3 stages: exudative, fibrinopurulent, and organizational. Describe them:

A

1) Exudative - fibrinous exudate forms on the pleural surfaces
2) In fibrinopurulent - fibrinous septa form, causing loculation of the fluid and thickening of the parietal pleura.
3) Organisational - organizational stage, there is fibroblast proliferation; pockets of loculated pus may develop into thick-walled abscess cavities

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25
Q

The pleural effusion is an empyema if bacteria are present on Gram staining, the pH is _____, and there are >_____ neutrophils

A

pH is <7.20, and there are >100,000 neutrophils

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26
Q

In Polysomnography you see sleep spindles and K complexes (wide QRS like); K complexes are associated with _____

A

K complex - REM sleep

Sleep spindles - Deep (NREM) sleep

27
Q

______ % prevalence of snoring

________% prevalence of OSA

A

10-13% prevalence of snoring

1-3% prevalence of OSA

28
Q

What is the success rate of Adenotonsillectomy in OSA?

A

80-85% “near or total cure” - no further treatment required

29
Q

What are the RF for complications of adenotonsillectomy?

A 
• Age < 3 years
• Morbidly obese
• Underlying syndrome
• Severe OSA
– (OAHI > 20/hr, SaO2 nadir < 80%)
• Complications of OSA
– FTT or cor pulmonale
30
Q

How does Obesity contribute to OSA?

A
  • Decreased lung volumes (pressing on chest)
  • Results in decreased airway tension
  • Fatty deposit around the pharynx narrowing airway
  • Combined effect increased pharyngeal collapsibility
31
Q

The definition of respiratory failure is PaO2 ________ or PaCO2 _______

A

The definition of respiratory failure is PaO2 <8 kPa

60mmHg) or PaCO2 >7 kPa (55mmHg

32
Q

NIV indications in NMD:
1)
2)
3)

A

1) Symptoms of chronic nocturnal hypoventilation or daytime respiratory failure or hypercapnea
2) Recurrent chest infections
3) Respiratory acidosis

33
Q

CCHS is related to _______ mutation; the increased the number of ________ repeats correlated to disease severity

A

Related to PHX0B2 mutation; number of polyalaline repeats correlates to disease severity

34
Q

In congenital central hypoventilation syndrome; it typically presents in which age group?

Which stage of sleep is ventilation better in?

A

Presents in infancy with apneas and cyanosis.

Ventilation is better awake and in REM sleep due to corticol outputs. Worst sleep in Stage N3

35
Q

Which other antenatal syndromes is CCHS related to?

A

CCHS is associated with:

  • Sudden death
  • Hirschsprungs disease
  • Neural crest tumours
  • iris problems
36
Q

Children is CCHS are at risk of developing ______ tumours

A

Autonomic tumours - phaeochromocytoma, ganglioneuroma and neuroblastoma

37
Q

Children with Prader Willi Syndrome have a _____% rate of deaths related to respiratory problems

A

61% rate of death related to respiratory issues

44% mainly infection though

38
Q

  • -
A
  • Hypotonia
  • Kyphosis
  • Decreased Co2 responsiveness

Other factors include OSA, obesity (also they get treated with GH which can improve tone but cause adenotonsillar hypertrophy - through IGF-1)

39
Q

Narcolepsy is caused by deficiency of which hormone?

A

Hypocretin

40
Q

CFTR gene is found on which chromosome?

A

Chromosome 7

41
Q

In CF spirometry studies; ______ is a good prognostic measure

A

FEV1

42
Q

What type mutation is a processing mutation vs a gating mutation

A

Processing mutation is a type II mutation - folding error

Gating mutation is a type III mutation - protein present at membrane but does not open properly

43
Q

What are the 6 scenarios you can get a false positive sweat chloride test?

A 
Adrenal insufficiency
Hypothyroidism or Hypoparathyroidism
Glycogen storage disease
G6PD deficiency
Diabetes insipidus
Klinefelters syndrome
44
Q

What are the 3 scenarios you can get a false negative sweat chloride test?

A

Malnutrition
Skin oedema
Mineralocorticosteroid use

45
Q

When Pseudomonas Aerginosa is seen in CF you aim to eradicate. How do you do this?

A

‐ If well – usually oral ciprofloxacin, inhaled tobramycin

‐ If unwell – iv antibiotics (ceftazidime or meropenum & tobramycin)

46
Q

True or False?

Pseudoman Aeruginosa infection are worse than Burkholderia cepacia

A

Chronic infection with Burkholderia cepacia syndrome organisms results in a 10 year reduction in median survival compared to chronic Pseudomonas aeruginosa infection.

47
Q

Non Tuberculosis Mycobactrerium is found in approximately ______ of cystic fibrosis (CF) patients

A

10%

48
Q

Does CF related DM affects males or females more?

A

More common in female

49
Q

What is the pathophysiology regarding CF related diabetes?

A

Decreased insulin production, insulin resistance and

normal anabolic effect of insulin is reduced

50
Q

How does Pulmozyme work?

A

It is recombinant human deoxyribonuclease I ‐ an enzyme which selectively cleaves DNA – hydrolysing DNA in sputum reduces sputumviscoelasticity

This increases lung function and decreases exacerbation

51
Q

What are the four most common causes of non-CF related bronchiectasis?

A

1) Post infection
2) Primary immunodeficiency
3) Aspiration/foreign body
4) Primary ciliary dyskinesia

52
Q

What is the most common bacteria in non-CF bronchiectasis?

A

Haemophilus influenzae

Then Moxarella and Strep Pneumonia

If Staph A - check for CF

53
Q

What are the treatment modalities recommended for non-CF bronchiectasis and what are the indications?

A
  1. Macrolide therapy - Azithromycin
    - recommended if more than 3 exacerbations or more than 2 hospitalisations (12-24mo)
  2. Nebulised antibiotics
    - especially if frequent PsA infections
54
Q

An induration of ___ in a mantoux test is considered in everyone

An induration of ___ in a mantoux test is considered positive in

  • Recent immigrants (<5 years) from high prevalence countries
  • Children <4 years old
  • Infants, children and adolescents who are exposed to adults in high risk categories
A

Induration of 15mm or greater

Induration of 10mm or greater in high risk groups

55
Q

Extrapulmonary sequestration is much more common in _____ (boys./girls) and almost always involves the _____ lung

A

Extrapulmonary sequestration is much more common in boys and almost always involves the left lung

56
Q

Extrapulmonary sequestration is associated with …

A

Diaphragmatic hernia and other abnormalities such as colonic duplication, vertebral abnormalities, and pulmonary hypoplasia

57
Q

Refractory chylothorax in the fetus has been associated with a missense mutation in integrin ______ gene

A

α9β1 gene

58
Q

The volume of the lung that does not eliminate CO2?

A

Anatomic dead space

Anatomic dead space - conducting airways

Physiological dead space - conducting airways + bronchioles/alveoli not eliminating CO2 (atelectasis)

59
Q

what is the definition of residual volume?

A

Volume left in the lungs after expiration

60
Q

In acute respiratory acidosis - what is the ratio of HCO3 correction

What would be the rate in chronic acidosis?

A

In acute respiratory acidosis - the rate of correction would be 1mmol HCO3 for every 10mmHg rise in CO2

In chronic respiratory acidosis - the rate of correction would be 4mmol HCO3 for every 10mmHg rise in CO2

61
Q

What is the order of the four stages of lung development?

Hint: (PCSA)

A

1) Pseudoglandular - week 5-16 -> formation of bronchi and bronchioles
2) Cannicular stage - Week 15-26->Formation of bronchioles and alveolar ducts (immature alveoli with cuboidal cells in week 24)
3) Saccular - Terminal sac stage - Week 26 -> birth - Formation of Alveoli and Type I and II pneumocytes
4) Alveolar stage - week 36 till 8 years - Septa divide the alveoli even further

62
Q

Congenital methhaemoglobinaemia is due an abnormality in which enzyme?

A

Cytochrome B5 reduction (methhaemoglobin reductase)

63
Q

Methhaemoglobinaemia is basically a ________ version of normal haemoglobin

A

Oxidised

64
Q

How does congenital lobar emphysema present on chest XRAY?

A

Presents as a hyperlucent lobe of lung on chest XRAY

BPT exams (24 decks)

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