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Nick's MD1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

At what vertebral level does the trachea begin?

A

C6

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1
Q

What is a typical tidal volume?

A

500 ml

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1
Q

What is a typical residual volume?

A

1200ml

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1
Q

If the lung is full of fluid, how will vocal resonance sound?

A

Louder

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1
Q

What is the majority of acute epiglottitis caused by?

A

Haemohpilus influenzae Type B

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1
Q

What do we call pus in the pleural space?

A

Empyema

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1
Q

HIgh pH and normal PaCO2 = what?

A

Metabolic alkalosis

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1
Q

Give a 2 word definition of asthma

A

Reversible bronchoconstriction

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1
Q

There is chemotaxis of which cell type in the delayed phase of asthma?

A

Mast cells

Lymphocytes

Eosinophils

Macrophages

Basophils

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1
Q

What is a Ghon’s complex comprised of?

A

Gohn focus + lymphadenopathy

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1
Q

Which lobe does secondary TB typically affect?

A

Upper lobe

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1
Q

What is Potts disease?

A

Single organ TB of the spine

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1
Q

What level must PaO2 drop below before it has an effect on ventilation?

A

~50mmHg

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1
Q

What information about cough must be obtained during history taking?

A

Site: throat vs deep chest

Quality: Dry vs wet; colour; thickness; pus; blood

Severity: volume of sputum (teaspoon vs cup)

Time course: duration

Context: Exertion; time of dayl time of year; smoking

Aggravating:

Relieving: medications

Associated features: pain while coughing

Vaccination Hx

Smoking Hx

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1
Q

What is haematemesis?

A

Vomited up blood

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1
Q

In which species is Type A influenza virus found?

A

Humans and other species

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2
Q

Which muscles may be contracted for forceful exhalation

A

Abdominal and internal intercostal muscles

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2
Q

Where does rotavirus replicate?

A

Rotavirus replicates in epithelial muscosa of GIT

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2
Q

What are the most common causes of otitis media?

A

Pneumococci,

H. influenzae

Moraxella catarrhalis

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2
Q

Hiow much oxygen is consumed at rest?

A

250ml/min

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2
Q

Define breathlessness

A

Pt’s recognition of an inappropriate relationship between respiratory work and total body work

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2
Q

What is corryza?

A

Runny nose

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4
Q

Name 4 features of airway remodelling in asthma that cause obstruction of the airways

A

Goblet cell hyperplasia with increased mucous production

Subepithelial collagen thickening

Increased airway smooth muscle volume

Increased mucosal vascularity

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4
Q

Define Gohn focus

A

Gohn focus = peripheral area of granulomatous inflammation and caseation

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5
Q

Which 3 factors determine fluid movement across pulmonary capillaries?

A

1 Hydrostatic pressure

2 Oncotic pressure

3 Capillary permeability

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6
Q

Define phlegm

A

Mucous + cell debris/bacteria/DNA etc

That is in the body

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6
Q

What is a medical way of saying “coughing up blood”

A

Haemoptysis

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7
Q

What is the most common cause of the common cold?

A

Rhinovirus

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8
Q

What influences the peripheral chemoreceptors involved in respiratory regulation?

A

PaO2, PaCO2, pH

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9
Q

What is the double fold of pleura inferior to the hilum called?

A

Pulmonary ligament

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9
Q

What is a normal PaCO2?

A

38-42 mmHg

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9
Q

On a CXR, what causes Kerley b lines?

A

Dilated lymphatics

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9
Q

What are 3 complications of emphysema?

A

1 hypoxia

2 pulmonary hypertension –> cor pulmonale

3 PTx

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9
Q

Define mucous

A

Physiological substance that is in the body

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10
Q

HIgh pH and low PaCO2 = what?

A

Respiratory alkalosis

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11
Q

What is on your list of differentials for haemoptysis?

A

Bronchitis

Pneumonia

Bronchiectasis

Pulmonary embolis

Tuberculosis

Lung cancer

Trauma

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12
Q

Inhaled foreign bodies tend to travel where?

A

Right main bronchus to right lung

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13
Q

What is a normal PaO2?

A

90-98 mmHg

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13
Q

What is the most viral common causes of croup?

A

Parainfluenza

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14
Q

What is the pressure of O2 at sea level?

A

160 mmHg

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14
Q

How does cigarette smoking lead to emphysema?

A

Cigarette smoke -> ROS -> alveolar damage

Smoke -> ROS –> neutrophil recruitment –> elastase -> alveolar septal degradation

Smoke -> inactivation of anti-proteases -> increased elastase -> alveolar septal degradation

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15
Q

What do people with chronic hypercapnoea have an increased dependence on for ventilatory regulation?

A

Respiratory drive

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16
Q

What does work of breathing include?

A

Elastic and resistive work

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17
Q

Which cell makes up most of the surface area of the alveolus?

A

Type 1 pneumocyte

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19
Q

What is stridor?

A

An audible breathing sound from the throat (often on inspiration)

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20
Q

What are the 4 most common viral causes of pneumonia?

A

Parainfluenza 3

Respiratory syncytial virus

Influenza virus

Adenovirus

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21
Q

What is a normal mixed venous PO2?

A

40mmHg

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21
Q

What causes excess mucus in chronic bronchitis?

A

Hypertrophy of mucus secreting glands

Increased goblet cells

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23
Q

What are the side effects of inhaled GCSs?

A

Oral candidiasis

Dysphonia

Decreased serum cortisol

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25
Q

What clinical feature particularly distinguishes influenza from other respiratory tract infections?

A

Muscle aches

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26
Q

What are 3 important DDx for peripheral oedema?

A

1 Left heart failure

2 Low serum protein

3 Fluid volume overload

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27
Q

What does Fick’s law determine?

A

Rate of diffusion of a gas

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28
Q

What are 2 unique features of the Mycobacterium tuberculosis cell wall?

A

Contains mucolic acid in the cell wall, giving it a waxy coating.

It is acid fast

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29
Q

What is a normal pulmonary artery sys/dias blood pressure?

A

25/8 mmHg

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30
Q

What is the role of neuraminidase in influenza infection?

A

NA (neuraminidase) cleaves the sialic acid off the epithelial receptor to prevent newly released virus particles from re-infecting that very cell

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31
Q

What are 2 conditions that can cause hypoventilation through neuropathy?

A

Polio virus

Guillain-Barre syndrome

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32
Q

What is the range of normal respiration rates for an adult person at rest?

A

12 to 16 breaths per minute

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33
Q

What is a normal mixed venous CO2?

A

46 mmHg

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34
Q

Where are peripheral chemoreceptors that contribute to respiratory regulation?

A

Carotid bodies and aortic arch

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35
Q

What percentage of acute sore throats are caused by viruses?

A

70%

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36
Q

What is a typical total lung capacity?

A

5.7L

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37
Q

Where are pulmonary veins always situated within the hilum?

A

Anterior and inferior

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38
Q

If the radius of a small airway is halved, by how much will resistance increase?

A

16 times

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40
Q

Define emphysema

A

Permanent and abnormal enlargement of the airways distal to the terminal bronchioles

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41
Q

What is the order of pharmacological agents used to treat COPD as disease severity increases?

A

1 Short acting bronchodilator if FEV1 >80?

2 Long acting bronchodilator if FEV1 = 50-80?

3 Inhaled GCS if FEV1 = 30-50%

4 Oxygen if FEV1

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42
Q

What are the most common bacterial causes of atypical pneumonia?

A

mycoplasma pneumonia,

Coxiella Burnetti,

Chlamydophila pneumoniae

Legionella spp

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44
Q

What is the normal range for arterial pH?

A

7.35 - 7.45

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45
Q

Alveolar pneumonia is characterised by what?

A

Consolidation (neutrophils) in the alveolar spaces

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47
Q

What is the best imaging modality for the lung parenchyma?

A

CT

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48
Q

Yellow sputum suggests what are present in the sputum?

A

Neutrophils

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50
Q

What does a CXR classically show in atypical pneumonia?

A

Reticulonodular infiltrate: “dots and dashes” throughout both lung fields

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51
Q

What are the most common causes of a flu-like sickness?

A

Influencza

Respiratory syncytial virus

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52
Q

In which species is Type B influenza virus found?

A

Humans only

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53
Q

How does consolidation of pneumonia appear on CXR?

A

Hyperdense = white

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54
Q

What is the most common viral cause of pharyngitis?

A

Adenovirus

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55
Q

What is the major cause of empyema?

A

Staph. aureus

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56
Q

What’s the most common bacterial cause of a sore throat?

A

Streptococcus pyogenese

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56
Q

What are the most common pathogenic agents for acute exacerbation of chronic bronchitis?

A

Haemophilius influenzae Streptococcus pneumoniae

56
Q

Koplick spots are diagnostic of what disease?

56
Q

What is a medical way of saying “vomited up blood”?

A

Haematemesis

57
Q

List 6 clinical features of atypical pneumonia

A

Malaise,

aches/pains,

HA,

diarrhoea

Dry non-productive cough

Patients often ambulant (walking pneumonia)

58
Q

What is the fancy way of saying “coughing up blood”?

A

Haemoptysis

59
Q

An unconscious supine patient who vomits will most likely have fluid in which lung segment?

A

Apical segment of the lower lobe of the right lung

61
Q

What is a normal PAO2?

62
Q

What type of respiratory disorder does pneumonia cause?

A

Restrictive

63
Q

What do we know about the receptor for influenza virus?

A

Terminal sialic acid bonded via alpha 2-6 linkage to galactose

64
Q

Name 4 features of congenital rubella syndrome

A

Microcephaly

Deafness

Cataracts

Congenital heart defects

65
Q

What type of cartilage is in the trachea?

66
Q

In what pattern of distribution is consolidation in bronchopneumonia?

A

Multifocal and patchy

67
Q

What kind of flow occurs in large airways?

68
Q

What is the definition of chronic bronchitis

A

Persistant cough, productive of sputum for at least 3 months in at least 2 consecutive years

Not due to another cause

69
Q

What does a wheeze imply?

A

Pathology in the airways

71
Q

What is a saddle pulmonary thrombo-embolism?

A

One that spans across the pulmonary trunk

72
Q

What is implied by crackles on ausculation of the lungs?

A

Fluid in alveoli or terminal bronchioles.

Could be pus, haemorrhage, oedema, salt water

73
Q

What is the most common pattern of bacterial pneumonia?

A

Bronchopneumonia

74
Q

What changes are there in ABG in Type 2 respiratory failure?

A

Low PaO2 and high PaCO2

75
Q

What are 3 pathological features of the immediate response in asthma?

A

Oedema,

mucous production and

bronchospasm

76
Q

What is the O2 saturation of venous blood?

77
Q

What are the most common pathogenic agents that cause an acute exacerbation of chronic bronchitis?

A

Pneumococcus

H. influenzae

79
Q

What is the pathophysiological definition of emphysema

A

Destruction of the alveolar wall without fibrosis

80
Q

What is the incubation period of influenza?

81
Q

What is empyema?

A

Pus in the pleura

83
Q

Define asthma (in more than 2 words)

A

Hyper-responsive airways…

…to various stimuli…

which leads to episodic bronchoconstriction

that is at least partly reversible

84
Q

What is the name of the active transporter that pumps Ca2+ into the SR in smooth muscle?

85
Q

How does emphysema cause airway obstruction?

A

There is a loss of elastic recoil,

leading to collapse of small airways

86
Q

Pleural friction suggests what type of pneumonia?

A

lobar pneumonia

87
Q

What is the mechanism of omalizumab in asthma treatment?

A

Blocks mast cell degranulation via steric hindrance of Fc portion of Ab, blocking IgE binding to mast cell

90
Q

Low pH and low PaCO2 = what?

A

Metabolic acidosis

91
Q

What is a typical minute ventialtion?

93
Q

What is haemoptysis?

A

The expectoration of blood or of blood-stained sputum

94
Q

What is the average number of deaths annually from influenza in Australia?

95
Q

What is the medical term for a sore throat?

A

Pharyngitis

96
Q

What is the role of haemagglutinin in the influenza virus?

A

Binds to sialic acid containing receptor → initiates entry

97
Q

The transition from bronchi to bronchioles is marked by which histological feature?

A

Disappearance of cartilage in the wall

99
Q

When are inhaled GCSs indicated in the treatment of asthma?

A

When the patient requires beta 2 agonists more than three times weekly

101
Q

Which pattern of pneumonia is more common in 20-50 years olds?

A

Lobar pneumonia

102
Q

What are the 3 most common viral causes of URTI?

A

Rhinovirus

Corona virus

Adenovirus

103
Q

What is the cut off for abnormal FEV1/FVC in a healthy young adult?

104
Q

What is the pathogensesis of chronic bronchitis?

A

Cigarettes -> inflammation:
–> mucous production in larger airways

–> scarring and narrowing of smaller airways

105
Q

What must happen to the influenza virus for it to be activated once it leaves a respiratory eptithelial cell?

A

Must be cleaved by tryptase clara

106
Q

What coloured phlegm do viruses tend to cause?

107
Q

Give an example of a virus that causes a latent infection

A

Herpesvirus

108
Q

What does central cyanosis imply?

A

Hypoxaemia (low PaO2)

109
Q

What are 5 potential respiratory system causes of dyspnoea?

A

1 Airways

2 Alveoli

3 Pleura/chest wall

4 Pulmonary vasculature

5 Respiratory muscle

111
Q

What does pruritus mean?

112
Q

What are 5 classes of causes of inadequte ventilation?

A

1 Central

2 Neuromuscular eg MND

3 Obesity

4 Chest wall deformities

5 Sleep disordered breathing

113
Q

What are complications of chronic bronchitis

A

Superimposed infective exacerbations

Hypoxia

Pulmonary hypertension

Squamous metaplasia and dysplasia leading to malignancy

115
Q

Where would painful irritation of the costal parietal pleura be experienced?

A

Thoracic wall (because parietal pleura is innervated by branches from intercostal nerves)

116
Q

Where does the respiratory virus replicate in humans?

A

Virus replicates in respiratory epithelium, esp in large airways such as bronch

119
Q

What is the first level of the airways where gas exchange may occur?

A

Respiratory bronchioles

120
Q

What are the most common pathogenic agents for low severity index community-acquired pneumonia?

A

Streptococcus pneumoniae

Mycoplasma pneumoniae

Chlamydophila pneumoniae

122
Q

What is the defining histopatholgoical feature of idiopathic pulmonary fibrosis

A

Interstitial inflammation with firbosis at varying stages of development

123
Q

What is the most common preventable cause of death in hospitalised patients?

A

Venous thrombo-embolism

124
Q

Which type of pneumonia is more common at extremes of age?

A

Bronchopneumonia

126
Q

What is the GPCR downstream effect of salbutamol leading to bronchodilation

A

Increases activity of SERCA, which takes up Ca2+ into SR, decreasing ASM contractility –> bronchodilation

127
Q

What is the most common cause of aortic stenosis?

A

Dysrtrophic calcification

128
Q

How may someone with PE present?

A

Dyspnoea

Haemoptysis

Cough

Syncope

Pleuritic pain

129
Q

Which influenza type has many subtypes?

130
Q

What stimulates central chemoreceptors involved in respiratory regulation?

131
Q

What are the 4 stages of lobar pneumonia?

A

1 Congestion

2 Red hepatisation
3 Grey hepatisation
4 Resolution

132
Q

What is the pathogenic agent in typhus?

A

Rickettsia

133
Q

What type of respiratory disease does emphysema cause?

A

Obstructive

134
Q

What causes antigenic drift in influenza virus?

A

RNA-dependent RNA polymerase errors during replication lead to single amino acid changes in HA or NA sites that reduce affinity of neutralising antibodies.

These viruses will be selected for, and a new strain will emerge

135
Q

What is the defining feature of the histopathology of restrictive lung diseases?

A

Inflammation and fibrosis of inter-alveolar septa (interstitium)

136
Q

Low pH and high PaCO2 = what?

A

Respiratory acidosis

138
Q

What type of respiratory disease does asthma cause?

A

Obstructive

140
Q

What percentage of people have viridans streptococci in their URT?

141
Q

What kind of flow occurs in small airways?

142
Q

What information about sputum must be obtained during history taking?

A

Colour

Volume

Thickness

Pus

Blood

144
Q

What type of breathing pattern would be adopted by a person with stiff lungs?

A

Rapid shallow breaths

145
Q

The transition from terminal bronchioles to respiratory bronchioles is marked by which histological feature?

A

Breaks in the continuity of the walls

146
Q

What is haemoptysis?

A

Coughed up blood

147
Q

What is the most common valvular disease in Western world?

A

Aortic stenosis

148
Q

What are the side effects of short acting beta 2 agonits?

A

tachycardia,

tremor and

hypokalemia

149
Q

Which lung volumes are reduced in restrictive respiratory diseases?

A

All lung volumes are decreased

150
Q

List 4 histological featrues of interstitial pneumonia

A

1 Lymphocytes, macrophages and plasma cells present in the alveolar septa (ie interstitium)
2 Alveolar septa are widened
3 No inflammatory cells in the alveoli
4 Bronchiolitis

151
Q

Define cor pulmonale

A

Right sided heart failure caused by pulmonary hypertension

152
Q

What type of respiratory disease does COPD cause?

A

Obstructive

153
Q

What is the medical way of saying runny nose?

156
Q

What type of respiratory disorder does pulmonary oedema cause?

A

Restrictive

158
Q

What are 3 distinguishing features of the right main bronchus compared with the left main bronchus?

A

Shorter, wider and more vertical

160
Q

What is the most numerous cell in the alveolus?

A

Type 2 pneumocyte

161
Q

How much CO2 is produced at rest?

162
Q

What is the most common cause of pneumonia?

A

Pneumococcus

163
Q

How would you distinguish haemoptysis from haematemesis on history taking?

A

Prodome: (irriation in chest or desire to cough)

Colour: bright red = haemoptysis; dark red = haematemesis

Frothiness: frothy = haemoptysis; not frothy = haematemesis

Pain: localised to URT, chest, or epigastric

164
Q

If there is a pneumothorax, how will vocal resonance sound?

A

Duller/softer

166
Q

An abnormally low FEV1/FVC implies what type of respiratory dysfunction?

A

Obstructive

167
Q

Is gas diffusion across the A-C membrane perfusion- or diffusion-limited

168
Q

Define sputum

A

Expectorated product

169
Q

At what level of the respiratory system do airways lose cartilage in their walls?

A

Bronchioles

170
Q

What percentage of pneumonia is due to bacteria?

171
Q

How many people out of 100,000 in Australia have tuberculosis?

172
Q

How is TB transmitted between people?

A

Infected aerosolised droplets

173
Q

What is under nervous control within the lungs?

A

Mucous production and diameter of bronchi

174
Q

What are the 3 broad causes of pulmonary HT?

A

Increased left atrial pressure (eg mitral stenosis)

Increased pulmonary blood flow (eg excess central volume)

Increased pulmonary vascular resistance (eg emphysema, embolism)

175
Q

What are the 2 most common causes of the common cold?

A

Rhinovirus and coronavirus

176
Q

How is Type 1 respiratory failure diagnosed?

A

PaO2 less than 50 mmHg, with evidence of respiratory compensation.

177
Q

Where would painful irritation of the diaphragmatic pleura be experienced?

A

Pain in the lateral neck and supraclavicular region of the shoulder (C3-C5 dermatomes)

178
Q

How could you assess whether alveolar ventilation is adequate?

179
Q

What is miliary TB?

A

Mycobacterium TB that has spread through blood to infect other organs

180
Q

What is a normal PACO2?

181
Q

List 5 clinical features of pneumonia

A

1 Intractible cough

2 that is productive of green/yellow sputum

3 fever and chills

4 Chest pain (if pleural inflamed)

5 Impaired gas exchange –> dyspnoea and tachypnoea

182
Q

Sleep deprivation of how long will result in cognitive performance equivalent to BAC of 0.05?

A

18-24 hours

183
Q

What happens to PaCO2 during sleep?

A

Increases from 40 to 45mmHg

184
Q

How many sleep cycles are there in a night typically?

185
Q

What is a typical length of a sleep cycle?

A

90-120 mins

186
Q

Where does the suprachiasmatic nucleus project to?

A

Paraventricular nucleus

187
Q

Which nucleus in the brain releases histamine?

A

Tuberomammilary nucleus

188
Q

Which nucleus in the brain is activated by adenosin and depleted ATP and inhibits ascending cholinergic and monoaminergic neurones to promote sleep?

A

Ventro-lateral preoptic nucleus

189
Q

Do you get fibrosis in emphysema?

190
Q

In percussion of the chest, how will different tisuues sound from dullest to most resonant

A

Fluid -> Solid organs -> Lung -> Air

191
Q

What type of noradrinergic receptors are found in the lungs?

A

Beta 2 (because you have 2 lungs)

192
Q

Which nerve passes in front of the lung root?

A

Phrenic nerve

193
Q

Which nerve passes behind the lung root?

A

Vagus nerve

Nick's MD1 (28 decks)

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