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FRACP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

When and where does the lung bud develop from
What are the stages of lung development and when do they occur
When is surfactant formed

A 
Week 4 from the endoderm 
Embryonic- 
Pseudoglandular- from 6 weeks
Canalicular- from 16 weeks
Saccular- from 24 weeks 
Alveolar- from 36 weeks
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2
Q

What forms at each stage of lung development

A 
Embryonic- bronchial buds
Pseudoglandular- bronchioles
Canalicular- terminal sacs 
Saccular- surfactant 
Alveolar- alveoli
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3
Q

What shifts the o2 affinity curve left?

What does this do to oxygen affinity Examples?

A

Increased affinity for o2
Fetal hb
LESS h, temp,co and 2,3 DPG

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4
Q

What shifts the o2 dissociation curve right
What does it indicate
2 examples

A

Increased affinity to o2
Raised H, CO 2,3 DPG and temp
Adult hb and sickle cell

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5
Q

What is the role of 2,3 DPG
when it increases what does it do
How does it correlate to the o2 binding curve?

A

Controls o2 release from hb
Lowers affinity to o2
Increases- reduces affinity- shifts curve right
Lowered- increases affinity- shifts curve left

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6
Q

What process causes most toxic effects from carbon monoxide poisoning?

A

Reversible binding to cytochrome A3

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7
Q

From bottom to top what 4 volumes are seen in the spirometry curve
What capacity do all 4 make up?

A 
Reserve vol 
Exp reserve
Tidal vol 
Insp reserve 
Total lung capacity
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8
Q

What makes up the forced vital capacity (3 volumes)

A

IRV
TV
ERV

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9
Q

What makes up the functional residual capacity?

What does it signify?

A

Reserve vol
Exp reserve vol
Everything left after a normal breath out

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10
Q

What is changed more in obstructive disease; Inspiration or expiration
How do the volumes and capacities change
How does FEV1 change. How and why does this change the ratio?

A 
Expiration becomes poor- air trapping 
Increased RV and ERV
increased FRC and TLC 
Reduced FEV1 
FEV1 reduces more than fvc therefore ratio decreases
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11
Q

Why can spirometry not diagnose restrictive disease reliably?

A

Cannot measure the RV therefore can’t measure TLC

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12
Q

How does the spirometry flow loop change in obstructive disease

A

Concave curve in exp.
normal curve in insp.
moves slightly left

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13
Q

What changes in restrictive disease

How does the ratio change

A

All volumes decrease

Increased or normal as all volumes and FEV1 reduce in proportion

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14
Q

In central/small airways obstruction how does a fixed obstruction look

How would a variable extrathoracic defect change the curve and why? Give an example

How would a variable intrathoracic curve look and why? Give an example

A

Boxed shaped curve- both insp and exp change

Extrathoracic airways have the smallest lumen in inspiration- flattening of the insp curve.
Vocal cord dysfunction

Intrathoracic have the smallest volume on exp- flattening of the exp curve.
Tracheomalacia

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15
Q

What is FEF 25-75
What does it indicate
What value is abnormal

A

Average flow rate in the middle of the FVC
Medium airway disease
<66%

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16
Q

What two shapes will you see in a normal flow volume curve

Will the upper or lower bit be inspiratory or expiratory

A

Triangle above a semi circle

Upper- exp
Lower- Insp

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17
Q

How does the spirometry flow loop change in obstructive disease
How does it change in restrictive disease

A

Moves left, scalloped exp portion

Generally smaller

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18
Q

What object does fixed upper airway dysfunction look like on a flow volume curve. What causes it

A

Post box

Tracheal stenosis

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19
Q

How does a variable intrathoracic obstruction look on a flow volume loop?
What causes it

A

Flattening of the exp curve

Tracheomalacia or foreign body

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20
Q

How does a variable extrathoracic obstruction look on flow volume loop?
Give an example

A

Flattened insp curve

Laryngomalcia or vocal cord palsy

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21
Q

What 2 volumes make up the inspiratory capacity

A

Reserve volume

Insp reserve volume

22
Q

What happens FEV1:FVC ratios in obstructive disease and restrictive disease

A

Obstructive- FEV1 reduces more than fvc therefore ratio reduces

Restrictive- both reduce so ratio is normal or increased

23
Q

What would be seen on spirometry with poor technique

A

Everything reduces in proportion

24
Q

Which gene in CF is potentially treated
What class of defect is it
What is the medication

A

G5116D
Class 3
Ivacaftor

25
Q

Where are the central chemoreceptors found. What do they sense?
Where are the two peripheral ones found? What do they sense?

A

Medulla- high co2

Carotid and aortic bodies- low o2

26
Q

On spirometry testing how much variation is allowed?

A

5%

27
Q

What will increase DLCO

A

Pulmonary haemorrhage

28
Q

How will a lateral neck X-ray differentiate between bacterial tracheitis and retro pharyngeal abscess

What is seen on presentation with the 2

A

Bacterial tracheitis- toxic with hoarse voice. Steeple sign and indentations along the trachea

Retropharyngeal abscess- widened RP space. Sick with sore neck and unable to open mouth

29
Q 
Which chromosome is involved in developing CF 
What are the three most common gene  defects and what class of mutations are each
A

Chromosome 7
1-G542X. Non sense mutation- no protein
2- delta F508- missense mutation- deletion of phenylalanine- trafficking defect. Single phenylalanine deletion.
3- G551D- gating defect

30
Q

How is screening carried out for CF
what happens next
How is a definitive diagnosis made

A

Look for IRT and genetic testing
Sweat test and stool test
Positive sweat test- cl >60 and/ or two positive genes

31
Q

What can cause a false negative sweat test

What 3 things can cause a false positive

A

Oedema

DI, adrenal al insufficiency, dermatitis

32
Q

What is the pattern of infection seen over time in CF

A

Staph and haemophillus
Pseudomonas and stenoprophomonas
Burkholderia
Non TB mycobacterium

33
Q

What defines a transudate?
What are 4 examples

What defines an exudate?
Give 4 examples

A

Exudate: Low protein and high glucose
Heart failure, cirrhosis, nephrotic syndrome, dialysis

Transudate: High protein and low glucose
Pneumonia, TB, chylothorax, cancer

34
Q

What happens to the cilia mostly in primary ciliary dyskinesia
What will exhaled NO show

A

Absent dyenin arms

Low NO- diagnostic

35
Q

What 2 tests in spirometry help a diagnosis of asthma.

How much and how does the FEV1 change?

A

Bronchodilator response- should increase by>12%

Histamine- should reduce by 20%

36
Q

When should a mask be used in asthma

A

All under 2s

37
Q

What are the steps in managing asthma- under 5s

Over 5s

A

Under 5s 1) preventer 2) add low ICS 3) add monteleukast 4) refer

Over 5s 1&2 same 3) consider LABA/ICS combo 4) add minteleukast 5) increase dose of combined and refer

38
Q

Why are LABAS never used alone

Which age group should they never be given to

A

Increases mortality by down regulating the beta 2 receptors

Under 5s

39
Q

What is a low dose and standard dose of

  • beclomethasone
  • beclomethasone ultra fine
  • fluticasone
  • budesonide

What makes up a high dose

A
  • 200/400
  • 100/200
  • 100/200
  • 200/400

Twice a standard dose

40
Q

What do SMART and air therapy use

What is the regime?

A

Symbicort- eformoterol and budesonide
(Rapid onset LABA) and ICS

AIR- use it PRN
SMART- use it BD

41
Q

How does omalizumab work
What is the caveat
What is the alternative and how does it work?

A

Binds to free igE
IgE needs to be less than 1300
Mepolizumab- binds to IL5

42
Q

What may a bronchial cast show

A

Underlying asthma or CF

43
Q

What happens REM sleep during the sleep cycle

A

More towards the end so more in the mornings

44
Q

What is the genetic association with narcolepsy

What is deficient

A

HLADQ1B

Orexin neuropeptide

45
Q

What is congenital central hypoventilation syndrome associated with (2 things)

A

Increased neural crest tumours and hirschsprungs

46
Q

When is BIPAP use in neuromuscular weakness- at night? Day and night?

A

FVC <60%

FVC <20%

47
Q

Which test in TB can be affected by the vaccine

Which is more specific

A

TST

IGRA

48
Q

If a less than 5 year old is exposed to TB what should be done
If results are negative what should be done
If results are positive what should be done

A

Treat for 3 months, do IGRA and CXR
Stop treatment and give vaccine
If symptoms and positive cxr- samples and treat for active disease
If no symptoms and negative cxr- treat for latent TB

49
Q

What two waves are seen in non REM sleep

What owe wave is seen on REM sleep

A

Sleep spindles and k complexes

Delta waves

50
Q

What percentage of kids snore?

How many have OSA

A

10-20

3%

FRACP (23 decks)

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