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Respiratory Flashcards

1
Q

What is primary ciliary dyskinesia

A

Autosomal recessive condition of impaired mucociliary clearance

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2
Q

Which mutations are seen in primary ciliary dyskinesia

A

DNAI1 and DNAH5

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3
Q

What is primary ciliary dyskinesia associated with

A

situs inversus - Kartager syndrome

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4
Q

Pathophysiology of primary ciliary dyskinesia

A

lack of dynein arms on cilia microtubule which leads to dyskinetic ciliary beat motion

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5
Q

Obstructive sleep apnoea - when is it most common

A

2- 8 year olds
More common in boys

Common cause - adenotonsillar hypertrophy

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6
Q

What is pathophysiology of OSA

A

partial or complete obstruction of upper respiratory during sleep

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7
Q

What is the gold standard test for OSA

A

Polysomnography - >5 apnoea episodes

ECG - right ventricular hypertrophy

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8
Q

What is vital capacity

A

Maximum volume of air that can be expired after a maximal inspiration

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9
Q

Definition of total lung capacity

A

total volume of air in lungs following maximal inspiration

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10
Q

Residual volume

A

volume of air remaining after maximal expiration

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11
Q

Four stages of pneumonia

A
  1. Vascular congestion and alveoli oedema
  2. Significant infiltration of RBCSfibrin and neutrophils
    3, Grey hepatisation - breakdown of fibrin and RBCcreate fibrinopurlent exudate
  3. Resoltion - macrophage clearing exudate
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12
Q

Classic triad of submucosal cleft palate

A

Bifid uvula
Absent or notched posterior nasal spine
Transulucent or blue area in midline of soft palate

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13
Q

What is the embryonic phase of resp. system?

A

respiratory bud arises from the ventral surface of foregut

3-5 weeks

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14
Q

What is the psudoglandular phase of respiratory system?

A

6-16 weeks

Bronchial tree is formed
Smooth muscle present in trachea and bronchi from 10 weeks
Cartilage develops from 6 weeks
Cilliated cells seen 12 weeks

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15
Q

What is the canalicular phase of respiratory system

A

17 - 24 weeks

Distal airways develop
Epithelial cells subdivide into type 1 pneumocytes for gas exchange and type 2 pneumocystis for surfactant production

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16
Q

What is saccular phase?

A

24 weeks to term

Terminal sacs, alveol ducts and alveoli form increasing surfactant production from 23/24 weeks

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17
Q

What controls breathing

A

Autonomic nervous system

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18
Q

What happens to breathing during REM

A

Automatic decrease in accessory muscle activity accompanied by an increase in upper airway resistance

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18
Q

Fetal Hb and 2,3 DBG

A

Fetal Hb doesn’t bind to 2,3DBG efficiently -> holds onto oxygen more -> oxygen less readily delivered to tissues

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19
Q

Dissociative curve

A

If Hb binds to oxygen more strongly, dissociation curve shifted to left

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20
Q

What shifts dissociate curve to right

A

Increase in hydogen ions, 2-3-diphosphoglycerate and carbon dioxide

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21
Q

What is forced expieroatory flow

A

Mean maximal flow in the middle 50% of FVC

more sensitive but more variable than FEV1 in assessing obstruction

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21
Q

Peak expiratory flow rate

A

maximal flow able to be generate in litres per minute

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22
Q

What is most sensitive marker of small to moderate airway obstruction

A

forced expiratory flow

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23
Chronic obliterative bronchiolitis - symptoms
Cough Wheeze pyrexi a Tachypnoea - all fail to resolve
24
Chronic obliterative bronchiolitis - causes
Infection - adenovirus and chronic aspiration
25
CT changes for chronic obliterative bronchiolitis
High resolution CT scan pATCHY HYPERINFLATION WITH MOSAIC ATTENUATION APPEARANVE OF THE LUNGS
26
What is bronchiectasis
Abnormal dilatation of bronchi - from chronic airway inflammation (neutrophilic) Persisten moist cough, clubbing and local chest signs
27
Causes of bronchiectasis
Post infamous - measles, pertussis, severe pneumonia Immune dysfunction - hypogammaglobulinaemia, neutrophil dysfunction, HIV Impaired mucocillary clearance - PCD, CF Systemic disorders - RA, IBD
28
Where is CTFR found
Found in epithelial cells - allows chlorides to move out into mucus which covers it Na ions will follow passively increasing mucus electrolyte concentration
29
Where is mucus produced
Goblet cells
30
SABA
B2 receptors found in throat and down to terminal airways beta agonists Hydrophilic
31
LABA's
B2 receptors binding to beta adrenergic receptor -> stimulation of adenylate cyclase and cyclic AMP formation Hydrophobic
32
Anticholinergics
Muscarinic receptor antagonist -> prevent cholinergic nerve-induced bronchial constriction Ipratropium bromide
33
Pharamcology of corticosteroids
Pass through cell membrane of inflammatory cells - including cells in lung In cytoplasm - they attach themselves to glucocorticoid receptors Increase transcription of the genes that suppress inflammation and reduce transcription o those which enhance inflammation
34
Leukotriene receptor antagonists
High levels of leukotrienes in asthma Cysteinyl leukotrienes are derived frim arachidonic acid using enzyme 5-lipooxygenase
35
What do leukotrienes do
Increase mucus production Bronchoconstriction Eosinophil recruitment Exudation of plasma
36
What is omalizumab
Recombinant humanized monoclonal antibody which bings to circulating IgE This binding prevents IgE from activating IgE receptors on inflammatory cells (mast cells) and blocks response to specific aeroallergens
37
Theophyllines MoA
inhibition of phosphodiesterase -> increase in intracellular cyclic AMP -> bronco dilatation
38
What treatment is for pseudomonas infections
Colomycin
39
How does colomycin work
Cationitc agent that damages bacterial cell membrane
39
How does tobramycin work
It is an aminoglycoside Bactericidal
40
What results in low fractional excretion of nitric oxide
Katagener syndrome
41
What is alveolar capillary dysplasia
Misalignment of pulmonary veins Pulmonary arteries are hypertrophied
42
What histological features would you see in alveolar capillary dysplasia
Defiencet alveolar capillaries in alveolar walls
43
Features of alveolar capillary dysplasia
Couple of hours after both to days - response distress and pulmonary HTN Resistant to pulmonary hypertension treatment (NO and extracopeal membranE oxygenation)
44
Triad of Pierre-Robin sequence
Small jaw Glossoptosis (posterior replacement of tongue to pharynx) Airway obstruction -Inverted U Shape cleft palate Oligohydamnios
45
obstructive picture of respiratory disease in spirometry
Decreased FEV1: FVC Increased RV : TLC
46
Restrictive picture in spirometry
Normal FEV1 : fvc Increased RV : TLC
47
High risk determinates of pulmonary hypertension
systemic venous saturation <60% echo findings right artery / right ventricular enlargement reduced left ventricular size increased RV/LVratio pericardial effusion mean right atrial pressure >10
48
What type of reaction is allergic rhinitis
Type 1 hypersensitivity
49
common cause of pneumonia
mycoplasma pneumonia strep pneumonia
50
Obstructive picture in spirometry
Reduced FEV1 FEVz/ FVC ratio <70%
51
Restrictive picture in spirometry
FEV1:FVC > 70% Both FEV1 and FVC are reduced
52
What type of bacteria is pseudomonas
gram negative rod
53
What settings do you change on a ventilator if you want to decrease CO2 levels
increase tidal volume increase RR increase PIP decrease PEEP
54
What settings do you change on a ventilator in you need to improve oxygen saturation levels
increase PEEP Increase Fi01 Increase Map
55
TB Mantoux test results
>5mm with no BCG = positive >10mm if had BCG = postive
56
Sensoroneural loss
damage to inner ear (Cochlear damage), nerve or auditory processing part of brain ) Irreversible
57
Conductive loss
unable to pass from outer ear to inner ear temporary
58
Rhinnes test
bone conduction vs air conduction normal - air conduction > bone conduction
59
Webers test
Conduction loss - localise to affected side Sensorineural loss - localise to good ear
60
Group A strep bacteria
postive cocci
61
Spirometry results - mild, moderate, severe, very severe
mild - Z score <-2 , FEV1:FVC ratio <70% moderation Z -2 - -2.5 Severe Z score -2.5- -3 Very severe <35%, -3 - -4
62
Results of asthma
FEV1 reduced FEVC/FVC <70% FeNo >35 Bronchodilator reversibility >12% Peak variability >20% in one week
63
Severe asthma attack
SpO2 <92% Unable to talk in full sentences HR >140, >125 RR >40 >30 PEF 33-50%

TAS (18 decks)

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