Respiratory Flashcards
What is primary ciliary dyskinesia
Autosomal recessive condition of impaired mucociliary clearance
Which mutations are seen in primary ciliary dyskinesia
DNAI1 and DNAH5
What is primary ciliary dyskinesia associated with
situs inversus - Kartager syndrome
Pathophysiology of primary ciliary dyskinesia
lack of dynein arms on cilia microtubule which leads to dyskinetic ciliary beat motion
Obstructive sleep apnoea - when is it most common
2- 8 year olds
More common in boys
Common cause - adenotonsillar hypertrophy
What is pathophysiology of OSA
partial or complete obstruction of upper respiratory during sleep
What is the gold standard test for OSA
Polysomnography - >5 apnoea episodes
ECG - right ventricular hypertrophy
What is vital capacity
Maximum volume of air that can be expired after a maximal inspiration
Definition of total lung capacity
total volume of air in lungs following maximal inspiration
Residual volume
volume of air remaining after maximal expiration
Four stages of pneumonia
- Vascular congestion and alveoli oedema
- Significant infiltration of RBCSfibrin and neutrophils
3, Grey hepatisation - breakdown of fibrin and RBCcreate fibrinopurlent exudate - Resoltion - macrophage clearing exudate
Classic triad of submucosal cleft palate
Bifid uvula
Absent or notched posterior nasal spine
Transulucent or blue area in midline of soft palate
What is the embryonic phase of resp. system?
respiratory bud arises from the ventral surface of foregut
3-5 weeks
What is the psudoglandular phase of respiratory system?
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
What is the canalicular phase of respiratory system
17 - 24 weeks
Distal airways develop
Epithelial cells subdivide into type 1 pneumocytes for gas exchange and type 2 pneumocystis for surfactant production
What is saccular phase?
24 weeks to term
Terminal sacs, alveol ducts and alveoli form increasing surfactant production from 23/24 weeks
What controls breathing
Autonomic nervous system
What happens to breathing during REM
Automatic decrease in accessory muscle activity accompanied by an increase in upper airway resistance
Fetal Hb and 2,3 DBG
Fetal Hb doesn’t bind to 2,3DBG efficiently -> holds onto oxygen more -> oxygen less readily delivered to tissues
Dissociative curve
If Hb binds to oxygen more strongly, dissociation curve shifted to left
What shifts dissociate curve to right
Increase in hydogen ions, 2-3-diphosphoglycerate and carbon dioxide
What is forced expieroatory flow
Mean maximal flow in the middle 50% of FVC
more sensitive but more variable than FEV1 in assessing obstruction
Peak expiratory flow rate
maximal flow able to be generate in litres per minute
What is most sensitive marker of small to moderate airway obstruction
forced expiratory flow
Chronic obliterative bronchiolitis - symptoms
Cough
Wheeze
pyrexi a
Tachypnoea - all fail to resolve
Chronic obliterative bronchiolitis - causes
Infection - adenovirus and chronic aspiration
CT changes for chronic obliterative bronchiolitis
High resolution CT scan
pATCHY HYPERINFLATION WITH MOSAIC ATTENUATION APPEARANVE OF THE LUNGS
What is bronchiectasis
Abnormal dilatation of bronchi - from chronic airway inflammation (neutrophilic)
Persisten moist cough, clubbing and local chest signs
Causes of bronchiectasis
Post infamous - measles, pertussis, severe pneumonia
Immune dysfunction - hypogammaglobulinaemia, neutrophil dysfunction, HIV
Impaired mucocillary clearance - PCD, CF
Systemic disorders - RA, IBD
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
Where is mucus produced
Goblet cells
SABA
B2 receptors found in throat and down to terminal airways
beta agonists
Hydrophilic
LABA’s
B2 receptors
binding to beta adrenergic receptor -> stimulation of adenylate cyclase and cyclic AMP formation
Hydrophobic
Anticholinergics
Muscarinic receptor antagonist -> prevent cholinergic nerve-induced bronchial constriction
Ipratropium bromide
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
Leukotriene receptor antagonists
High levels of leukotrienes in asthma
Cysteinyl leukotrienes are derived frim arachidonic acid using enzyme 5-lipooxygenase
What do leukotrienes do
Increase mucus production
Bronchoconstriction
Eosinophil recruitment
Exudation of plasma
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
Theophyllines MoA
inhibition of phosphodiesterase -> increase in intracellular cyclic AMP -> bronco dilatation
What treatment is for pseudomonas infections
Colomycin
How does colomycin work
Cationitc agent that damages bacterial cell membrane
How does tobramycin work
It is an aminoglycoside
Bactericidal
What results in low fractional excretion of nitric oxide
Katagener syndrome
What is alveolar capillary dysplasia
Misalignment of pulmonary veins
Pulmonary arteries are hypertrophied
What histological features would you see in alveolar capillary dysplasia
Defiencet alveolar capillaries in alveolar walls
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)
Triad of Pierre-Robin sequence
Small jaw
Glossoptosis (posterior replacement of tongue to pharynx)
Airway obstruction
-Inverted U Shape cleft palate
Oligohydamnios
obstructive picture of respiratory disease in spirometry
Decreased FEV1: FVC
Increased RV : TLC
Restrictive picture in spirometry
Normal FEV1 : fvc
Increased RV : TLC
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
What type of reaction is allergic rhinitis
Type 1 hypersensitivity
common cause of pneumonia
mycoplasma pneumonia
strep pneumonia
Obstructive picture in spirometry
Reduced FEV1
FEVz/ FVC ratio <70%
Restrictive picture in spirometry
FEV1:FVC > 70%
Both FEV1 and FVC are reduced
What type of bacteria is pseudomonas
gram negative rod
What settings do you change on a ventilator if you want to decrease CO2 levels
increase tidal volume
increase RR
increase PIP
decrease PEEP
What settings do you change on a ventilator in you need to improve oxygen saturation levels
increase PEEP
Increase Fi01
Increase Map
TB Mantoux test results
> 5mm with no BCG = positive
10mm if had BCG = postive
Sensoroneural loss
damage to inner ear (Cochlear damage), nerve or auditory processing part of brain )
Irreversible
Conductive loss
unable to pass from outer ear to inner ear
temporary
Rhinnes test
bone conduction vs air conduction
normal - air conduction > bone conduction
Webers test
Conduction loss - localise to affected side
Sensorineural loss - localise to good ear
Group A strep bacteria
postive cocci
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
Results of asthma
FEV1 reduced
FEVC/FVC <70%
FeNo >35
Bronchodilator reversibility >12%
Peak variability >20% in one week
Severe asthma attack
SpO2 <92%
Unable to talk in full sentences
HR >140, >125
RR >40 >30
PEF 33-50%
