Respiratory Flashcards
1
Q
what is boyles law
A
pressure is inversely related to volume
2
Q
functional residual capacity
A
volume of air in lungs after quiet expiration
3
Q
vital capacity
A
inspiratory capacity plus expiratory reserve volume
4
Q
total lung capacitt
A
vital capacity plus residual volume
5
Q
anatomical dead space
A
air inside lung apart from alveoli that doesn’t take part in gas exchange
6
Q
alveolar dead space
A
alveolar air that doesn’t get perfused
7
Q
physiological dead space
A
anatomical plus alveolar
8
Q
alveolar ventilation rate =
A
(tidal volume-dead space) - resp rate
9
Q
muscles of forced inspiration
A
scalene, serrates anterior, teres m/m
10
Q
muscles. quiet inspiration
A
diaphragm, external intercostals
11
Q
muscles forced expiration
A
internal intercostals and abdo wall muscles
12
Q
7 causes of interstitial lung disease
A
occupational, treatment, connective tissue, immunological, idiopathic
13
Q
atelectasis definition and 3 causes
A
lobar collapse, compression/absorption
14
Q
anatomical dead space vs physiological dead space vs alveolar dead space
A
- Anatomical deadspace is the volume of air which is inhaled that does not take part in the gas exchange because it remains in the conducting airways
- alveolar deadspace involves air reaching the lungs that is not perfused or poorly perfused due to dead/damaged alveoli (0.12 L)
Physiological dead space = anatomical + alveolar
15
Q
How can one calculate the dead space ventilation rate?
A
DSVR = Dead space volume x respiration rate
16
Q
How can one calculate alveolar ventilation rate?
A
AVR = (tidal volume - dead space volume) x respiration rate
17
Q
How can one calculate lung perfusion?
A
- Lung perfusion (Q) = RV output
- It is the same as cardiac output (approx. 5 litres/min)
18
Q
value of atmospheric pressure and water vapour pressure(SVP)
A
atmospheric- 101 kPa
water vapour- 6.28kPa
19
Q
how to calculate partial pressure
A
gas % x atmospheric pressure
20
Q
solubility coefficient for o2
A
0.01mmol/L
21
Q
give values of alveolar and arterial pCo2 and pO2
A
pCO2- 5.3kPa
pO2- 13.3kPa
22
Q
concentration of blood on Hb
A
8.935mmol/L
23
Q
how to calculate partial pressure of oxygen in URT
A
(101-6.28) x 0.209
24
Q
Henrys law
A
concentration of gas (mmol/L) = Kh x partial pressure of gas above liquid
25
what causes curve to shift to right and left
right-
lowered affinity, more o2 released
-increased temperature
-increased 2,3BPG
-increases H+
left-
increased affinity, less o2 released
-reduced temperature
-lowered 2,3BPG
-lowered H+
-CO
26
give atmospheric pressures for co2, o2 and n2
co2- 101x0.3 = 0.03kPa
o2- 101x0.29 = 21.109kPa
n2- 101x0.78 = 78.7kPa
27
give venous pressures for co2 and o2
both 6kPa
28
what is the most important stimulus's in the minute to minute control of ventilation in a healthy person
effect of change in arterial pO2 at central chemoreceptors
29
how to calculate co2 dissolved
pco2 x 0.23 = 1.2mmol/L
30
Henderson hasselbachs equation
pH= pk + log (HCO3)/(CO2)
31
reaction of co2 and red blood cells in tissues and in lungs
in tissues:
co2 diffuses into rbc, reacts to form hco3- and h+
rbc in t state so H+ binds to it, shifting reaction to right
in lungs:
hco3- and h+ converted to co2. co2 diffuses out. rbc in r state so H+ cannot bind. increases h+ pushes reaction to left.
32
describe neuronal control of breathing
afferent-
glossopharyngeal from carotid codes, vagus from lung stretch and aortic bodies
receptor- RPG
efferent-
diaphragm phrenic nerve (c3450
internal intercostals intercostal nerve
33
where are peripheral chemoreceptors located and what are they sensitive to
aortic and carotid bodies
changes in pO2 and H+
34
where are central chemoreceptors located and what are they sensitive to
ventral surface of medulla
changes in co2 and h+
35
2 types imaging PE
pulmonar angiography, ventilation perfusion lung scintigraphy
36
5 causes hypovolaemia
low inspired o2, VQ mismatch, diffusion defect intra lung shunt, hypoventillaiton
37
most common cause of pulmonary embolism in young people w no risk factors, and 2 other causes
protein c resistance secondary to factor V Leiden mutation
- protein c resistance
- antithrombin III resistance
38
what medical conditions are hypercoaguable
lupus anticoagulant, homocystinuria. occult neoplasm
39
3 outcomes of PE
RV failure, pulmonary infarction due to haemoptysis, pleuritis and pleural effusion, and resp failure
40
main investigations PE
blood gas shows hyperaemia and hypocapoa, CXR shows wedge shape, ECG shows RV strain or SI, QIII, TIII, raised D dimers
41
what is SI, QIII, TIII
deep S wave lead 1, q wave lead 3, inverted t wave lead 3
42
immediate treatment PE and why used
immediate heparisation
- stops thrombus propogation in pulmonary arteries and embolic source
- allows fibronolyssis of embolus
43
how to treat high risk PE patient
haemodynamic and resp support, exogenous fibrinolytic, percutaneous catheter directed thrombectomy, surgical pulmonary embelectomy
44
2 long term treatments PE
oral warfarin, DOAC- direct oral anticoagulant
45
describe immediate and late phase response asthma
immediate-
TH2 cell
IgA interacts with allergen. causes mast cell degranulation and bronchocontriction
late phase
inflammatory cells cause airway inflammation
46
5 hallmarks of asthma
chronic inflammatory, variable airflow obstruction, susceptibility, reversibility, hyperresponsiveness
47
effects of inflammation asthma
Mucosal swelling ,
Thickening of bronchial walls
Mucous over production
Smooth muscle contraction
The epithelium is shed
48
3 effects of airway remodelling asthma
hypertrophy of smooth muscle, mucus glands and basememt membrane
49
describe VQ mismatch asthma
early- vasconstricton and hyperventilation can account for Co2 but not o2. type 1 resp failure
late- exhaustion and complete airway closure mean co2 rises. type 2
50
signs and symptoms COPD
tachypnoea, barrel chest, cough, dyspnoea, hyperressonance wheezing.
cor pulmonale, co2 flap, cyanosis
51
symptoms bronchiectasis
fever, fine crackles, sputum, inspiratory squeak
52
draw a flow volume loop marking PEF and FVC
53
draw a volume time loop marking FEV1 and FVC
54
55
how to calculate CURB-65
Confusion
- Urea \> 7 mmol/l
- RR \> 30
- BP \<90/60
- Age \> 65 years
Score 2-5 = manage as severe
56
4 drugs to treat TB
rifampicin, isoniazid, ethambutol, pyranzinamide
57
signs pneumonia
tachypnoea, crackles, wheeze, dull percussion, increases breath sounds
58
causes of CAP
common- S. pneumoniae
uncommon- H influenza, mycoplasma pneumoniae
59
cause of HAP
pseudomonas aurginosa
60
cause aspiration pneumonia
flora and anaerobes
61
casue immunocompromised pneumonia
cytomegalovirus
62
what to look for on xray
Rotation
- clavicle equidistant from spinous processes and spinous processes vertical
I- inspiration
5-6 anterior ribs, the lung apices, both costophrenic angles and lateral rib edges should be visible
P- projection
AP vs PA film
E- exposure
vertebra visible through heart
63
what test is positive for latent TB vs active TB
latent- quantiferon and mantoux
active- sputum smear (ziehl-nielsen)
64
what is miliary tb
secondary TB returns to lungs
65
what is the gohn complex
primary focus and draining lymph node
66
4 concequences of post primary TB
pleural effusion, cavitation, haemorraage, infection of lung apex
67
symptoms TB
fever
night sweats
weightloss
cough
dyspnea
haemoptysis
68
signs TB
crackles, consolidation on CXR
69
cause of primary sponteneous pneumothorax and who does it occur in
in young, talll, male, smokers
spontaneous- rupture of pleuritic bleb
70
cause secondary spontaneous pneumothorax
COPD, asthma, bronchiectasis, marfans
71
where to insert needle for in needle thoracocentesis for tension pneumothorax
2 ICS, mid clavicular line. just above 3rd rib
72
signs and symptoms tension pneumothorax
symptoms- pleuritic chest pain, SOB, severe respiratory distress, tachypnoea, tracheal shift, elevated JVP, tachycardia and hypotension
signs- reduced vocal resonance and chest movements, hyper ressonance
73
safe triangle
L pec major, L latissimus dorsi, 6th rib, axilla
74
how to treat pneumothorax
tension-
emergency insert needle into 2nd ICS, midclavicular line
simple-
chest drain into safe triangle, inserted to the pleural space and connected to an underwater seal, allowing the air to be drained out and the lung to expand.
75
triggers for asthma
cold, exercise, alllergy, emotional distress, fumes
76
2 types of treatment for asthma
B2 agonists eg. salbutamol
muscarinic antagonists- ipratroprium
77
what type of immunity follows post exposure to TB bacillus
cell mediated
78
what cell in granuloma
langhans giant cell
79
compare latent and active TB
in latent TB bacili are not multiplying in active they are
patient is asymptomatic in latent
patient has negative sputum/smear in latent TB and has a normal CXR
80
2 things that increase risk for reactivation latent tb
HIV, malignancy, malnutrition, substance abuse, long term steroids
81
3 investigations TB
TB bacilli on sputum smear, Tb bacilli on sputum culture, NAAT on sputum sample
82
location of peripheral chemoreceptroa
aortic and carotid bodies
83
what causes hypoxaemia in respiratory distresss syndrome newborn
VQ mismatch. partially collapsed alveoli are still perfused. Q\>V
84
how to calculate pack years
number of years x number of packs a day
85
how does bronchial carcinoma cause left vocal cord paralysis
left recurrent laryngeal nerve travels down thorax, loops arund arch aorta amd back up larynx. damaged by carcinoma. causes paralysis
86
cough reflex
deep inspiration, closure of glottis, contraction expiratory muscles, glottis opens, forceful expulsion of air
87
2 complications from spread of bronchial carcinoma
paralysis of left hemidiaphragm causes breathlessness
pericardial effusion causes pleurtic chest pain
88
why does pco2 increase after oxygen therapy is started
- oxygen reduces pulmonary hypoxia induced vasoconstriction in poorly ventillated alveoli. reduces VQ as blood diverted from better ventillated alveoli.
oxygenated Hb cannot carry as much co2 and so less is removed from tissues
89
90
Causes interstitial lung disease
Idiopathic- pulmonary fibrosis Immunological- sarcoidosis Connective tissue disease- RA Treatment related- radiation/chemotherapy Occupational- asbestosis and coal worker pneumoconiosis
91
How to calculate pack years
Years of smoking x (cigarette number/20)
92
Compare SCC and NSCC
SCC is aggressive and lots of metastatic growth NSCC is slower growing and treated with surgery
93
Which cancer associated with aspestos
Mesothelioma
94
Parameoplastic symptoms cancer
SIADH and cushings - SCC Hypercalcaeima- squamous cell carcinoma
95
4 drugs and side effects TB
rifampicin- orange secretions
isoniazad- peripheral neuropathy
pyranimide- hepatotoxicity
ethambutol- visual distrubances
96
exudate vs transudate
if the patient's serum total protein is normal and the pleural fluid protein is less than 25g/L the fluid is a transudate. If the pleural fluid protein is greater than 35g/L the fluid is an exudate.
“Transudate” is fluid buildup caused by systemic conditions that alter the pressure in blood vessels, causing fluid to leave the vascular system. “Exudate” is fluid buildup caused by tissue leakage due to inflammation or local cellular damage.18 Jun 2020
