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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

When would there be blunting of the costophrenic angle?

A

Pleural effusion

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2
Q

At what level is the carina?

A

T4 and T5 (second rib)

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3
Q

What is the division of the upper and lower respiratory tracts?

A

Vocal cords

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4
Q

Where do the intercostal nerves originate?

A

Anterior rami of spinal nerves T1 to T11

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5
Q

Which bronchus is shorter and fatter?

A

Right

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6
Q

Where would you place a chest drain?

A

Above the rib in the 5th intercostal space on the midaxillary line

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7
Q

What are the three layers of intercostal muscle?

A

External
Internal
Innermost

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8
Q

How many true ribs are there?

A

Seven

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9
Q

What are the three movements of normal ventilation?

A

Vertical
Anteroposterior
Lateral

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10
Q

What are the relationships of the structures in the hilum?

A

Bronchi behind
Arteries above
Veins and Phrenic nerve in front

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11
Q

Where do intercostal veins drain into?

A

Azygos system of veins or the internal thoracic veins, which connect to the brachiocephalic veins in the neck

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12
Q

What is transudate?

A

Excess tissue fluid leaking into the pleural space, as a result of fluid transmitting across the capillary membrane.
Has a low protein content.

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13
Q

Which nerve innervates the sternocleidomastoid muscle?

A

Spinal accessory nerve

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14
Q

What is the order of the intercostal nerves and vessels (top to bottom)?

A

Vein
Artery
Nerve

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15
Q

How long does a red blood cell spend in the capillary network of the lungs?

A

0.75 seconds

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16
Q

From which vessels do the intercostal arteries arise?

A

Aorta and internal thoracic arteries, which originate from the subclavian arteries

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17
Q

What is an empyema?

A

Pus in the pleural space

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18
Q

What is a chylothorax?

A

Lymph in the pleural space

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19
Q

Where is a tracheostomy performed?

A

On the thyroid gland (second/third tracheal ring)

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20
Q

Where does the thyroid gland sit?

A

On the second/third tracheal cartilages in a butterfly shape

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21
Q

What is the anatomical dead space?

And how large is it?

A

From the trachea to the terminal bronchioles, where no gas exchange takes place
About 150ml

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22
Q

What is the lateral movement of the ribs also known as?

What muscles does it use?

A

Bucket-handle action

Intercostal muscles

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23
Q

What would a lowered FEV1/FVC ratio (lower than 75%) with a normal FVC signify?

A

Obstructive lung disease

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24
Q

Between which two muscles do the intercostal nerves and vessels pass?

A

Internal and innermost

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25
Q

How many divisions of the bronchioles are there?

A

23

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26
Q

What is the mucociliary escalator?

A

Movement of cilia in the lung to remove mucus and bacteria

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27
Q

What are the muscles of expiration?

A

Rectus abdominis

Latissimus Dorsi

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28
Q

What are the forces of Starlings principle?

A

Hydrostatic pressure of blood
Hydrostatic pressure of interstitial fluid
Osmotic pressure of blood
Osmotic pressure of interstitial fluid

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29
Q

Which of the intercostal muscles are used during expiration?

A

Internal

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30
Q

What are the three parts of the rib?

A

Head
Neck
Body

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31
Q

Which tends to be bilateral: exudate or transudate?

A

Transudate, due to it usually being systematic

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32
Q

What level is the thyroid cartilage on?

A

C4 and C5

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33
Q

What are the four regions of the parietal pleura?

A

Apical
Mediastinal
Costal
Diaphragmatic

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34
Q

What can cause exudate in the pleural space?

A 
Result of inflammation:
Pneumonia
TB
Malignancy
Pulmonary Infarction
Collagen vascular disease
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35
Q

What is exudate?

A

Proteinaceous fluid with polymorphs and has a high level of protein.
Due to vessels becoming leaky and allowing fluid and contents through into pleural space

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36
Q

What is the pulmonary ligament?

A

A loose fold of pleura that hangs down from the hilum

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37
Q

What is the normal FEV1/FVC ratio?

A

Between 75 and 80%

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38
Q

What are the three common COPD?

A

Asthma
Emphysema
Chronic bronchitis

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39
Q

Name three causes of transudate in the pleural space.

A

Cardiac failure
Nephrotic syndrome
Hepatic failure

40
Q

How large is the respiratory zone and what does it consist of?

A

2.5-3 litres

From terminal bronchioles to distal alveolus

41
Q

Which of the intercostal muscles are used during inspiration?

A

External

42
Q

How would a restrictive disorder be shown in spirometry?

A

A normal FEV1/FVC ratio, but dramatically reduced FVC

43
Q

What is bronchiectasis?

A

Long term condition where the airways become abnormally widened, leading to a build up of excess mucus, making lungs vulnerable to infection

44
Q

What is an acinus?

A

An anatomical unit that is a portion of the lung distal to a terminal bronchiole

45
Q

By which mechanism does inspired air travel down to the terminal bronchioles?

A

Through bulk flow

46
Q

What is the dominant mechanism of ventilation in the respiratory zone?

A

Diffusion of gas, due to forward velocity of gas being so small by the time it gets to the respiratory zone

47
Q

Which cells of the lung produce surfactant?

A

Type II pneumocytes (cells)

48
Q

What does Fick’s Law of Diffusion state?

A

The amount of gas that moves across a sheet of tissue is proportional to the area of the sheet, but inversely proportional to its thickness

49
Q

How does Bohr’s equation measure physiological dead space?

A

By measuring the volume of lung that doesn’t eliminate carbon dioxide

50
Q

How does Fowler’s method measure anatomical dead space?

A

By measuring the volume of the conducting airways

51
Q

Do anatomical and physiological dead space vary?

A

Not in normal subjects, though in some lung diseases physiological dead space will be increased

52
Q

What are the regional differences in ventilation?

A

Lower regions of the lungs ventilate better than the upper zones

53
Q

What causes the difference in regional ventilation of the lungs?

A

Gravity

54
Q

What is the difference in pressure between the pulmonary circulation and the systemic circulation?

A

The pulmonary circulation is much lower.
Mean pressure in pulmonary artery = 15mmHg
Mean pressure in aorta = 100mmHg

55
Q

What is the difference in overall distribution of pressure between the pulmonary and systemic circulation?

A

The distribution of pressure is more even throughout the pulmonary circulation.
In the systemic circulation there is a rapid drop between arteries and veins

56
Q

What is the difference between pulmonary vascular resistance and systemic vascular resistance?

A

Pulmonary vascular resistance is 1/10th that of systemic.

Compatible with distributing blood in a thin film

57
Q

What two mechanisms cause a decrease in pulmonary vascular resistance in response to a slight rise in pressure? (which is principle)

A

Recruitment (Principle mechanism)

Distension

58
Q

What is recruitment of vessels?

A

Blood vessels not normally collecting blood open and begin conducting blood

59
Q

What is distension of vessels?

A

Changes in shape of the capillaries from near flattened to a more circular shape

60
Q

At what lung volumes is pulmonary vascular resistance low?

A

After passive expiration, at the level of FRC

61
Q

At what lung volume do the large vessels of the pulmonary circulation have the lowest vascular resistance?

A

At large lung volumes, due to the lungs expanding and pulling them open

62
Q

At which part of the lungs is blood flow the lowest?

A

The apex

63
Q

What causes the uneven distribution of blood flow in the lungs?

A

Hydrostatic pressure differences in the blood vessels

64
Q

At what part of the lungs is vascular resistance lowest?

A

The base

65
Q

What does the Windkessel effect do to the cardiac cycle?

A

Dampens the fluctuation in blood pressure and assist in the maintenance of organ perfusion during diastole when cardiac ejection ceases

66
Q

In which blood vessels is the Windkessel effect seen the greatest?

A

Large elastic arteries, such as aorta, common carotid, subclavian and pulmonary arteries

67
Q

During a history, what factors would point you towards a diagnosis of asthma, as opposed to COPD?

A 
Never smokes
Diurnal variation
Exacerbating factors
Nasal symptoms
Family history
Childhood atopy (allergies)
68
Q

What is cor pulmonale?

A

Enlargement and failure of the right ventricle of the heart in response to increased vascular resistance or high blood pressure in the lungs

69
Q

What are the two subgroups of lung cancer?

A

Small cell carcinoma

Non-small cell carcinoma

70
Q

What are the subclassifications of non-small cell lung cancer?

A

Squamous cell cancer
Adenocarcinoma
Large cell (undifferentiated) carcinoma

71
Q

What is the most common type of lung cancer in UK?

A

Squamous cell lung cancer

72
Q

Where does small cell lung cancer arise from and what can this result in?

A

Neuroendocrine cells of bronchial tree

Can result in ectopic hormone production

73
Q

What are the common local effects/symptoms of lung cancer?

A 
Cough
Breathlessness
Haemoptysis
Wheeze
Hoarse voice
Recurrent infections
74
Q

What is the result of a bronchial carcinoma invading a phrenic nerve?

A

Ipsilateral paralysis of the hemidiaphragm

75
Q

What is the common metastatic nodal spread of lung cancer?

A

Mediastinal
Cervical
Axillary
Intra-abdominal

76
Q

Which organs does lung cancer commonly metastasise to?

A

Liver
Bone
Adrenal glands
Brain

77
Q

When conducting a CT to determine the extent of lung cancer, which organs should be included in the investigation?

A

Liver

Adrenal glands

78
Q

How would you obtain a biopsy for a central lung cancer?

A

Fibre optic bronchoscopy

79
Q

How would you obtain a biopsy for a peripheral lung cancer/lesion?

A

Percutaneous aspiration under CT guidance

80
Q

What investigation is used in staging of lung cancer to visualise mediastinal nodes?

A

Endobronchial ultrasound

81
Q

In which lung cancer type and stage can surgery be considered with curative intent?

A

Non-small cell lung cancer - stages I, II and in selected IIIa

82
Q

What investigation is used to determine extent of nodal involvement and highlighting distant metastases?

A

PET scan

83
Q

In healthy individuals what is the main drive for respiration?

A

Arterial pH

84
Q

What is the rate of oxygen flow to the tissues?

A

250mL/min

85
Q

What do the central and peripheral chemoreceptors detect?

A 
Arterial PCO2 and pH (Central and peripheral)
Arterial PO2 (peripheral)
86
Q

What is the most important factor in chemical control of ventilation?

A

PCO2

87
Q

How much does respiration increase for a rise in alveolar PCO2?

A

15-25L/min for each kPa rise in alveolar PCO2

88
Q

What is normal alveolar PCO2?

A

5.3kPa

89
Q

What is normal alveolar PO2?

A

13kPa

90
Q

Which chemoreceptor is thought to control the majority of the respond to CO2 in humans?

A

Central chemoreceptor near the ventrolateral surface of medulla

91
Q

What two types of cells does the carotid body contain?

A

Glomus (type I) cells

Sheath (type II) cells

92
Q

What is the function of glomus cells?

A

Responsible for peripheral chemoreception

93
Q

What is the function of sheath cells?

A

Protect and support glomus cells

94
Q

Where is the central pattern generator (for breathing) and what does it contain?

A

Pons and medulla

Contains inspiratory and expiratory neurons

95
Q

What part of the respiratory centre is in the pons and what is it involved in?

A

Pneumotaxic centre - eupnoea and mediating responses to lung receptor stimulation

96
Q

What is thought to be the probable source of rhythm of breathing?

A

Cycling or switching due to reciprocal inhibition and ‘off switches’ within networks of central respiratory centre in pons and medulla

Medicine (19 decks)

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