Respiratory

Question 0

Where is breathing controlled?

Answer 0

The medulla oblongata

Question 1

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

Answer 1

760mmHG.

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

Question 2

What effects lung compliance?

Answer 2

Elasticity- Thickening due to disease = reduced elasticity

Surface tension- reduced by surfactant

Question 3

What cells produce surfactant?

Answer 3

Type II pneumocytes

Question 4

What is most CO2 carried in the blood as?

Answer 4

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

Question 5

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

Answer 5

O2= ~100mmHg
CO2= ~ 40mmHG

Question 6

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

Answer 6

O2= ~40mmHg
CO2 = ~ $%mmHg

Question 7

What is the alveolar pp of O2?

Answer 7

105mmHg

Question 8

What is the chloride shift?

Answer 8

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

Question 9

What is a shunt and a dead zone?

Answer 9

Shunt= No ventilation
Deadzone= No bloodflow

Question 10

What nerves stimulate breathing?

Answer 10

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

Question 11

What does a low V/Q= ?

Answer 11

Impaired pulmonary gas exchange = decreased O2 & ^ CO2.

Question 12

What is the haldane effect?

Answer 12

Deoxygenation of blood ^ CO2 carrying capacity

Oxygenation of blood decreases CO2 carrying capacity

Question 13

What is the Bohr effect?

Answer 13

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

Question 14

What is COPD?

Answer 14

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

Question 15

What is the main immune cell in chronic bronchitis?

Answer 15

Neutrophil, the leukocyte infiltration is CD8+

Question 16

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

Answer 16

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

Question 17

What is emphysema?

Answer 17

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

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

Question 18

What are the types of respiratory failure?

Answer 18

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

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

Question 19

How is COPD diagnosed?

Answer 19

FEV1/FVC <80% predicted

Question 20

What pressure is the pleural space kept at?

Answer 20

Atmospheric pressure

Question 21

What is the 1st line treatment for COPD exacerbations?

Answer 21

Amoxicillin

Question 22

What is transudative pleural effusion and what can cause it?

Answer 22

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

Question 23

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

Answer 23

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

Question 24

What is asbestosis?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

What are the treatment options for asthma?

Answer 26

``` B-agonists - Salbutamol Inhaled corticosteroids - Beclamethasone LABAs - Salmeterol Leukotriene receptor agonists - Montelukast Xanthines - Theophylline ```

Question 27

What is pneumonia?

Answer 27

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

Question 28

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

Answer 28

Confusion, Urea >7mmol/L, Resp rate >30, BP 65y.o. Score >2 = IV ABx and higher = worse prognosis

Question 29

What investigations are performed to diagnose pneumonia?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

What is the treatment for uncomplicated pneumonia?

Answer 31

Oral amoxycilin and oral clarithromycin

Question 32

What are the ABx used to treat aspiration pneumonias?

Answer 32

IV cefuroxime and UV metronidazole

Question 33

What is acute respiratory distress syndrome?

Answer 33

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

Question 34

What is the ABx treatment in complicated pneumonia?

Answer 34

IV cefuroxime and oral clarithryomysin

Question 35

What type of pneumonia is more common in COPD patients?

Answer 35

Haemophillus influenza

Question 36

What 2 types of pneumonia are associated with aspiration?

Answer 36

Klebsiella and E.coli

Question 37

What type of pneumonia is most common in the immunocompromised?

Answer 37

Pseudomonas aeroginoas

Question 38

What is the treatment for TB?

Answer 38

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

Question 39

What caused TB and where is it most common?

Answer 39

Mycobacterium tuberculosis and most commonly affects the upper lobes

Question 40

How do inhaled corticosteroid work in asthma?

Answer 40

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

Question 41

What are some side effects of B2-agonists?

Answer 41

Tremor Tachycardia Oral candidiasis Tolerance