Respiratory Flashcards
1
Q
Name two things that lower lung compliance
A
Oedema and fibrosis
2
Q
What are the name of three conditions causing diaphragmatic muscle weakness ?
A
Muscular dystrophy, spinal muscle atrophy and myasthenia gravis
3
Q
What is the volume of dead space
A
2cc/kg
4
Q
Poiseuilles law
A
Flow = pressure x r4 x pi / 8 x viscosity x length
5
Q
Significant response in spiro to bronchodilator
A
12% increase fev1
6
Q
Ficks law
A
Flux is directly proportional to the steepness if the gradient (pressure difference both sides and area by which diffusion occurs) over thickness
7
Q
Two main causes of VQ mismatch and examples
A
- Shunt (cardio or pulm I.e AV malformation)
2. Dead space increased I.e in PE, mucous plug
8
Q
A-a gradient
A
Alveolar gas equation
9
Q
Body plethysmography utilises Boyles law
A
In a closed system pressure and volume change inversely when temperature is constant
10
Q
What is Niemann-Pick disease?
A
Types A,B,C1andC2 lysosomal storage disorder
11
Q
Most common virus causing croup
A
Parainfluenza Type 1
12
Q
How many mm at 2nd cervical vertebrae would be concerning for retropharyngeal abscess
A
7mm
13
Q
What does a displaced uvula in a teenager possibly represent?
A
Peritonsillar abscess
14
Q
What percentage of kids with tracheolaryngomalacia have cardiovasc abnormalities
A
60%
15
Q
Name four other odd causes of bronchi tasks
A
UC, Alpha antitripsan def, young syndrome, sawyer-James-Macleod syndrome
16
Q
Inheritance of primary ciliary dyskinesia
A
AD
17
Q
Vocal cord dysfunction spirometry change
A
Flattening of the inspiratory flow loop
18
Q
How does montelukast work
A
Block effects of cysLT1 receptor (leukotriene receptor antagonists)
19
Q
Cf newborn screen
A
Blood immunoreactive trypsinogen
20
Q
Falsely elevated saturation from
A
Methaemoglobimaemia
21
Q
Sickle cell and sats
A
Can be high or low
22
Q
Macrolide use in CF for
A
Anti inflammatory effect
23
Q
Narcolepsy test
A
Multiple sleep latency test
24
Q
Kartageners syndrome is
A
Primary ciliary dyskinesia
AR
Dextrocardia
25
Bradycardia with cabal stimulation treat
Atropine
26
Three most common mutations CF
F508
G451X
G551D
5, 12, 31
27
Pulmozyme
RhDNase
Synthetic enzyme reduces sputum viscosity
For FeV1 persistently below 70%
28
K complexes and spindles in which stage of sleep
N2 (3)
29
% with OSA and sleep disordered breathing
OSA 1-4%
| SDB 12-13%
30
Nasal steroids OSA
Halve score can cure mild
31
High CO2 indicates
Inadequate ventilation
32
Does dry air worsen asthma
Yes
33
Provocation asthma timing after intense exercise
6-8min (HR 85% of max)
34
Montelukast timing of action
2 hours and accelerates recovery
35
LABa not recommended isolated use in children because
Reduction in B2 density
36
Cytokines produced by Th2 in asthma
IL-4/5/13
37
Older child montelukast (blocks leukotreine receptors)
EIA if on ICS and no improvement with LABA
38
Over 12 with severe asthma can use
Omalizumab (humanised monoclonal anti-IgE antibody) sc
39
Wheeze persisting from viruses (name 2)
RSV
| Rhinovirus
40
CF screened for using
Immunor active trypsinogen level and genetics
41
Azithromycin in CF
Anti inflammatory
42
Ivacaftor used for
CF G551D mutation to improve transport of Cl through ion channel
43
Cataplexy is
Intense emotions cause sudd n loss of muscle tone
44
Periodic sleepiness syndrome
Klein-levin syndrome
45
Multiple sleep latency test in narcolepsy
Short latency (quick to sleep) and two periods of REM
46
Narcolepsy two special tests and results
HLA 95% positive for DQB1*0602
(Also positive in 20% normal)
Hypocretin-1 levels low or absent in CSF
47
What Does sleep deprivation lead to
Obesity (more time to eat and more hungry)
| Leads to inflam and insulin resistance
48
Slow sleep waves in
N3
49
R.E.M. With age
Decreases
50
Adolescent sleep duration in time
Has decreased
51
Percent of autism with sleep problem
44-83%
52
Parasomnia vs frontal lobe sz
In frontal lobe sz not related to stage of sleep, pointing and pelvic thrust stereotypical and looks same each time
53
Treat Periodic limb disorder with
Iron
54
Commonest cause of hypersomnia (excessive sleepiness)
Lack of sleep
55
Variation limit in spirometry performance
5%
56
Flow loop in obstruction
Concave
57
Spirometry flattened inspired curve causes
Vocal cord paralysis or dysfunction
58
Flat expiration curve spirometry cause
Tracheomalacia (variable intrathoracic obstruction)
59
Flat inspiration and expiration curve cause
Tracheal stenosis (fixed upper airway obstruction)
60
Loss of loop contour on spirometry due to
Poor effort
61
Jaggered expiration on spirometry
Coughing
62
Airway resistance highest..
```
Nasal airway (50% total)
Intermediate bronchi (4-8th generation)
```
63
Inspiration and expiration muscles (NMD)
Insp (diaphragm)
Exp (intercostal and abdominal
)
64
Aspirin overdose ABG
Respiratory alkalosis
65
Age can use dry powder inhaler
6
66
Montelukast
CysLT1 receptor on bronchial sm antagonist (leukotriene 4 blocked)
67
DMD thresholds in FVC
<60% is SDB
| <20% daytime respiratory failure
68
CF FEV1 0% survival perfect in 2 years
50%
| Lung transplant
69
Most useful spirometry measurement in obstructive lung disease progression
FEV1
70
NMD respiratory test to detect early failure
Polysomnography
71
FEV1 severity
>70% mild
>50% moderate
35% severe
72
I NO short duration of action due to
Binding to hb
73
iNO near tracheal tube due to
Minimise risk of NO2 which is toxic
74
Virus associated with brochiolitis obliterans
Adenovirus
75
L atrial enlargement compresses what
L main bronchus
76
Most common pathogen in CF
SA
77
Max fluticasone under 12y
Usually 200mcg but can go up to 400mcg if >4y
| 90% of effectiveness achieve at dose of 125mcg/day or 250mcg/day budesonide
78
PaO2 at 70%, 80%, 90%
40' 50, 60
79
More sensitive in small airway disease
Recent research suggests that FEF25-75% or FEF25-50% may be a more sensitive
parameter than FEV1 in the detection of obstructive small airway disease
current practice guidelines
recommend using FEV1, FVC, and FEV1/FVC as indicators of obstructive disease.
Low FEV1 indicates current obstruction (impairment) and risk for future exacerbations
(risk). For children, the ratio of the FEVI/forced vital capacity (FVC) appears to be a
more sensitive measure of severity and control in the impairment domain. FEV1 is a
useful measure of risk for exacerbations,
80
serum periostin
a protein secreted by airway epithelial cells and lung fibroblasts in response to IL-4 and IL-13
81
What to us in asthma if all avenues exhausted
Omalizumab is a humanized, monoclonal anti‐IgE
antibody that binds specifically to circulating IgE
molecules, thus interrupting the allergic cascade.
Consider > 12 years for severe allergic asthma when all
other avenues exhausted.
Given by a subcut injection – may get site reactions
Well tolerated, but occasional anaphylaxis (medical
supervion needed)
Costly. NZ$500
82
Which viruses are associated with
increased risk of wheezing
persisting at age 6 years?
Think of 2 viruses
RSV
| rhinovirus
83
Most common CF genetic mutations (3)
delta F 508, G451X and G551D
84
Sweat test not reliable when
<75g sweat (false if <60 Cl)
1. Malnutrition
2. Mineralocorticoid use
3.Adrenal insufficiency
4.Fucosidosis
5. G6PD deficiency
85
Azithromycin action in CF
Anti inflammatory
86
ivacaftor use for
Class III mutations in CF gene
87
Scimitar syndrome, or pulmonary venolobar syndrome , is...
a rare congenital heart defect characterized by anomalous venous return from the right lung
88
Surfactant def accounts for 10% ILD what are the four genetic def
Protein B (SPB)
Protein C
ABCA3
Thyroid transcription factor related disease
89
Ventilator tidal volume in relatively normal lungs
7-10ml\kg
90
Ground glass on CT indicates
Neuroendocrine cell hyperplasia of infancy
91
Long history of SOB on exertion and bay wing appearance on CXR with bronchopulmonary lovage milky coloured
Pulmonary alveolar proteinosis (increased surfactant)
92
Oxygen index equation
Oxygen index = (FiO2 x MAP)/PaO2
93
Is flow curve doesn't meet the
Poor technique
94
Main component of surfactant
Phosphatidycholine
95
What virus can cause obliterative bronchiolitis
Adenovirus can cause obliterative bronchiolitis.
96
Round pneumonia under 8y most commonly due to
Strep pneumoniae
| Proposed underdevelopment of pores of kohn and canals of lambert
97
Xray for suspected inhaled FB
Insp and exp films (air trapping)
98
Incidence CF
1/3,500
99
Types of CF mutations
5 main classes:
I: Lack of/no protein production.
Eg: Stop codons (eg. Trp1282X, Gly542X) and splicing defects
with no protein production.
II: CFTR not processed correctly, so no protein gets to the cell
membrane.
Eg: Phe508del.
III: Defective regulation; but transfer of CFTR occurs.
IV: Reduced chloride transport/current through CFTR at the apical
membrane.
V: Synthesis of CFTR abnormal but is transferred.
100
DMD study to review early respiratory failure
Polysomnography (sleep study)
101
Fractional exhaled NO associated with eosinophilic airway inflammation therefore high value predicts ? And low value what two conditions
High - atopy (asthma)
| Low - CF/ciliary dyskinesia
102
Peak of bronchoconstriction how many minutes after start exercise
10
103
Long acting beta agonist not safe alone because
Reduction of beta two density
104
Virus associated with increased risk of wheeze persisting at 6y
Rhinovirus
| RSV but gone by 11y
105
Ivacaftor for class?
Three
106
Another test for restrictive and asthma
Plethysmography
| Exercise test
107
Best lung test in restrictive?
FVC
108
Inert gas washout actually can measure
Rv and FRC
109
Two test to review FRC
Plethysmography
| Inert had washout test
110
Gas transfer test?
Diffusing capacity of lung to carbon monoxide
