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Respiratory Flashcards

0
Q

Where is breathing controlled?

A

The medulla oblongata

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1
Q

What is the atmospheric pressure at sea level and why is this important?

A

760mmHG.

If alveolar pressure = < then air moves in
If alveolar pressure = > then air moves out

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2
Q

What effects lung compliance?

A

Elasticity- Thickening due to disease = reduced elasticity

Surface tension- reduced by surfactant

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3
Q

What cells produce surfactant?

A

Type II pneumocytes

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4
Q

What is most CO2 carried in the blood as?

A

HCO3- –> when it enters the pulmonary capillaries it –> CO2 + H2O

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5
Q

What is the pp of O2 and CO2 in oxygenated blood?

A 
O2= ~100mmHg
CO2= ~ 40mmHG
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6
Q

What is the PP of O2 and CO2 in deoxygenated blood?

A 
O2= ~40mmHg
CO2 = ~ $%mmHg
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7
Q

What is the alveolar pp of O2?

A

105mmHg

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8
Q

What is the chloride shift?

A

HCO3- and Cl- exchange in RBCd to allow more CO2 to diffuse in whilst maintaining neutrality

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9
Q

What is a shunt and a dead zone?

A 
Shunt= No ventilation
Deadzone= No bloodflow
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10
Q

What nerves stimulate breathing?

A 
Voluntary = Cerebral cortex
Autonomic = Medulla oblongata --> Phrenic nerve (C3, 4 & 5)
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11
Q

What does a low V/Q= ?

A

Impaired pulmonary gas exchange = decreased O2 & ^ CO2.

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12
Q

What is the haldane effect?

A

Deoxygenation of blood ^ CO2 carrying capacity

Oxygenation of blood decreases CO2 carrying capacity

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13
Q

What is the Bohr effect?

A

Haemoglobins O2 binding affinity is inversely related to acidity and Conc. of CO2

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14
Q

What is COPD?

A

Umbrella term for: Chronic bronchitis, emphysema and small airways disease.

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15
Q

What is the main immune cell in chronic bronchitis?

A

Neutrophil, the leukocyte infiltration is CD8+

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16
Q

What is the normal epithelial lining of the bronchioles and what does it change to in chronic bronchtis?

A

Pseudostratified, cilliated, columnar epithelium that metaplases to squamou epithelium –> loss of cilia

17
Q

What is emphysema?

A

Destruction of lung tissue. –> terminal bronchiole and alveoli = loss of elasticity.

Collagen and elastin broken down –> airways “snap shut” trapping air = hyperinflation

18
Q

What are the types of respiratory failure?

A

Type 1- ‘pink puffers’ = low O2 normal Co2

Type 2- ‘blue bloaters’ low o2, high co2

19
Q

How is COPD diagnosed?

A

FEV1/FVC <80% predicted

20
Q

What pressure is the pleural space kept at?

A

Atmospheric pressure

21
Q

What is the 1st line treatment for COPD exacerbations?

A

Amoxicillin

22
Q

What is transudative pleural effusion and what can cause it?

A

Clear, low protein fluid, can be caused by:
Heart failure,
Liver failure
Renal failure

23
Q

What is exudative pleural effusion and what can it be caused by?

A 
Empyema- pus and is from inflammation. Can be caused by:
Malignancy,
Trauma
Infection
TB
P.E.
24
Q

What is asbestosis?

A

Long-term exposure to asbestos –> ‘holly leaf’ plaques. Inflammation and fibrosis caused by macrophages attempting to phagocytose asbestos fibres

25
Q

What is the pathophysiology in the early response to an asthma attack?

A

IgE mediated Type 1 hypersensitivity. It’s reversible with B2 agonists and subsides w/in 2 hrs.

26
Q

What are the treatment options for asthma?

A 
B-agonists - Salbutamol
Inhaled corticosteroids - Beclamethasone
LABAs - Salmeterol
Leukotriene receptor agonists - Montelukast
Xanthines - Theophylline
27
Q

What is pneumonia?

A

Acute, lower respiratory tract infection usually with fever symptoms, chest signs and an abnormal CXR

28
Q

What are the criteria in the CURB-65 score and what is it used for?

A

Confusion, Urea >7mmol/L, Resp rate >30, BP 65y.o.

Score >2 = IV ABx and higher = worse prognosis

29
Q

What investigations are performed to diagnose pneumonia?

A 
SUBEX:
Sputum- AFB, culture, gram stain
Urine- Output is reduced in sepsis
Blood- cultures, WBC, urea, serology
ECG
X-ray
30
Q

What is the most common cause of pneumonia and what are its symptoms?

A

Strep pneumoniae-
Abrupt onset, rust coloured sputum, lobar, pleural rub –> rapid, shallow breathing.

-Medical emergency

31
Q

What is the treatment for uncomplicated pneumonia?

A

Oral amoxycilin and oral clarithromycin

32
Q

What are the ABx used to treat aspiration pneumonias?

A

IV cefuroxime and UV metronidazole

33
Q

What is acute respiratory distress syndrome?

A

PaO2 <20mmHg
Bilateral infiltrates on CXR
Massive inflammatory response
High mortality

34
Q

What is the ABx treatment in complicated pneumonia?

A

IV cefuroxime and oral clarithryomysin

35
Q

What type of pneumonia is more common in COPD patients?

A

Haemophillus influenza

36
Q

What 2 types of pneumonia are associated with aspiration?

A

Klebsiella and E.coli

37
Q

What type of pneumonia is most common in the immunocompromised?

A

Pseudomonas aeroginoas

38
Q

What is the treatment for TB?

A 
RIPE:
Rifampicin- orange secretions
Isoniazid- N&V, hepatitis, neuropathy
Pyrazinamide- hepatotoxicity
Ethambutol- colourblindness
39
Q

What caused TB and where is it most common?

A

Mycobacterium tuberculosis and most commonly affects the upper lobes

40
Q

How do inhaled corticosteroid work in asthma?

A

Anti-inflammatory –> reduce TH2 cytokines & vasodilators PGe2 and PGE1 by inhibiting COX-2 –> lowers eosinophils

41
Q

What are some side effects of B2-agonists?

A

Tremor
Tachycardia
Oral candidiasis
Tolerance

Revision (12 decks)

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