Respiratory Flashcards
Neutrophils and alveolar macrophages are the predominant inflammatory cells in the small airways
Neutrophils and alveolar macrophages are the predominant inflammatory cells in the small airways
Name 5 path-physiological features of asthma:
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
In spirometry bronchodilator response is considered positive if FEV1 increase of at least ____ from baseline at 10minutes
FEV1 increase of at least 12% from baseline
What age do you transition to spacer with no mask?
2-4 years
What age group can manage turbuhaler?
5-7 years
Which LABA can you use for AIR/SMART therapy?
Eformoterol because it has rapid onset action
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
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
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
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
What is Omalizumab?
Anti IgE antibody
What is Mepolizumab?
Anti-IL5 antibody - targets Eosinophils
One of the conditions for Mepolizumab therapy is that IgE levels must be greater than _____
0.5
What are two distinctive features of a normal thymus on CXR?
1) characteristic ‘sail’ shape
2) wavy margins resulting from the interdigitation of the soft thymic tissue in the intercostal spaces.
Where do you do a needle thorcentesis in emergency?
In controlled setting?
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
Do you go directly above or below rib for thoracentesis and why?
You go above the lower rib because the neurovascular structures are found right below the rib - vein, artery, nerve
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.
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.
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 _________
Kidneys can excrete bicarbonate and this prevents the risk of respiratory alkalosis.
Also can use Azetolamide for similar effect with high altitudes
What antibiotics would you use for severe pneumonia?
IV Ceftriaxone and Iv fluclox
Consider adding Vanc if MRSA suspected
Spasmodic croup is similar to ___________; however can be differentiated….
Similar to laryngobronchitis - normally presents with viral prodrome; whereas spasmodic croup is randomly bad
3 common bugs that cause bacterial tracheitis?
Staphylococcus aureus, Moraxella catarrhalis or Haemophilus influenza
How does RACP differentiate peritonsillar abscess and retropharyngeal abscess?
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.
Dry pleurisy is often associated with which condition?
TB - can be a delayed hypersensitivity reaction
In pleural fluid analysis: Glucose is usually <60 mg/dL in ________, ________, _______; the finding of many small lymphocytes and a pH < 7.20 suggest ________.
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
Most common bugs for Empyema
1) Strep Pneumonia and 2) Staph Aureus
Empyema has 3 stages: exudative, fibrinopurulent, and organizational. Describe them:
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
The pleural effusion is an empyema if bacteria are present on Gram staining, the pH is _____, and there are >_____ neutrophils
pH is <7.20, and there are >100,000 neutrophils
In Polysomnography you see sleep spindles and K complexes (wide QRS like); K complexes are associated with _____
K complex - REM sleep
Sleep spindles - Deep (NREM) sleep
______ % prevalence of snoring
________% prevalence of OSA
10-13% prevalence of snoring
1-3% prevalence of OSA
What is the success rate of Adenotonsillectomy in OSA?
80-85% “near or total cure” - no further treatment required
What are the RF for complications of adenotonsillectomy?
• Age < 3 years • Morbidly obese • Underlying syndrome • Severe OSA – (OAHI > 20/hr, SaO2 nadir < 80%) • Complications of OSA – FTT or cor pulmonale
How does Obesity contribute to OSA?
- Decreased lung volumes (pressing on chest)
- Results in decreased airway tension
- Fatty deposit around the pharynx narrowing airway
- Combined effect increased pharyngeal collapsibility
The definition of respiratory failure is PaO2 ________ or PaCO2 _______
The definition of respiratory failure is PaO2 <8 kPa
60mmHg) or PaCO2 >7 kPa (55mmHg
NIV indications in NMD:
1)
2)
3)
1) Symptoms of chronic nocturnal hypoventilation or daytime respiratory failure or hypercapnea
2) Recurrent chest infections
3) Respiratory acidosis
CCHS is related to _______ mutation; the increased the number of ________ repeats correlated to disease severity
Related to PHX0B2 mutation; number of polyalaline repeats correlates to disease severity
In congenital central hypoventilation syndrome; it typically presents in which age group?
Which stage of sleep is ventilation better in?
Presents in infancy with apneas and cyanosis.
Ventilation is better awake and in REM sleep due to corticol outputs. Worst sleep in Stage N3
Which other antenatal syndromes is CCHS related to?
CCHS is associated with:
- Sudden death
- Hirschsprungs disease
- Neural crest tumours
- iris problems
Children is CCHS are at risk of developing ______ tumours
Autonomic tumours - phaeochromocytoma, ganglioneuroma and neuroblastoma
Children with Prader Willi Syndrome have a _____% rate of deaths related to respiratory problems
61% rate of death related to respiratory issues
44% mainly infection though
- -
- 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)
Narcolepsy is caused by deficiency of which hormone?
Hypocretin
CFTR gene is found on which chromosome?
Chromosome 7
In CF spirometry studies; ______ is a good prognostic measure
FEV1
What type mutation is a processing mutation vs a gating mutation
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
What are the 6 scenarios you can get a false positive sweat chloride test?
Adrenal insufficiency Hypothyroidism or Hypoparathyroidism Glycogen storage disease G6PD deficiency Diabetes insipidus Klinefelters syndrome
What are the 3 scenarios you can get a false negative sweat chloride test?
Malnutrition
Skin oedema
Mineralocorticosteroid use
When Pseudomonas Aerginosa is seen in CF you aim to eradicate. How do you do this?
‐ If well – usually oral ciprofloxacin, inhaled tobramycin
‐ If unwell – iv antibiotics (ceftazidime or meropenum & tobramycin)
True or False?
Pseudoman Aeruginosa infection are worse than Burkholderia cepacia
Chronic infection with Burkholderia cepacia syndrome organisms results in a 10 year reduction in median survival compared to chronic Pseudomonas aeruginosa infection.
Non Tuberculosis Mycobactrerium is found in approximately ______ of cystic fibrosis (CF) patients
10%
Does CF related DM affects males or females more?
More common in female
What is the pathophysiology regarding CF related diabetes?
Decreased insulin production, insulin resistance and
normal anabolic effect of insulin is reduced
How does Pulmozyme work?
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
What are the four most common causes of non-CF related bronchiectasis?
1) Post infection
2) Primary immunodeficiency
3) Aspiration/foreign body
4) Primary ciliary dyskinesia
What is the most common bacteria in non-CF bronchiectasis?
Haemophilus influenzae
Then Moxarella and Strep Pneumonia
If Staph A - check for CF
What are the treatment modalities recommended for non-CF bronchiectasis and what are the indications?
- Macrolide therapy - Azithromycin
- recommended if more than 3 exacerbations or more than 2 hospitalisations (12-24mo) - Nebulised antibiotics
- especially if frequent PsA infections
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
Induration of 15mm or greater
Induration of 10mm or greater in high risk groups
Extrapulmonary sequestration is much more common in _____ (boys./girls) and almost always involves the _____ lung
Extrapulmonary sequestration is much more common in boys and almost always involves the left lung
Extrapulmonary sequestration is associated with …
Diaphragmatic hernia and other abnormalities such as colonic duplication, vertebral abnormalities, and pulmonary hypoplasia
Refractory chylothorax in the fetus has been associated with a missense mutation in integrin ______ gene
α9β1 gene
The volume of the lung that does not eliminate CO2?
Anatomic dead space
Anatomic dead space - conducting airways
Physiological dead space - conducting airways + bronchioles/alveoli not eliminating CO2 (atelectasis)
what is the definition of residual volume?
Volume left in the lungs after expiration
In acute respiratory acidosis - what is the ratio of HCO3 correction
What would be the rate in chronic acidosis?
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
What is the order of the four stages of lung development?
Hint: (PCSA)
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
Congenital methhaemoglobinaemia is due an abnormality in which enzyme?
Cytochrome B5 reduction (methhaemoglobin reductase)
Methhaemoglobinaemia is basically a ________ version of normal haemoglobin
Oxidised
How does congenital lobar emphysema present on chest XRAY?
Presents as a hyperlucent lobe of lung on chest XRAY
