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Respiratory (P4) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the difference between type 1 and 2 respiratory failure? Give an example of each

A

T1: Hypoxemic + normocapnic
[Failure to Oxygenate] (“One for Oygenate”) e.g. Altitude, fibrosis, asthma.

T2: Hypoxemic + Hypercapnic
[Failure to Ventilate] e.g. Neuromuscular disorder, COPD, Obesity, Opiates.

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2
Q

What is the treatment for acute T1 respiratory failure?

A

Increase FiO2 via Oxygen (100%)

Increase mean airway pressure via CPAP (keeps alveoli open and maximises SA)

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3
Q

What is the treatment for Type 2 respiratory failure?

A

BiPAP to increase respiration rate (greater ventilation).

2 = Bi

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4
Q

Where is the VQ ratio lowest?

A

Lung bases

Perfusion increases dramatically in the bases due to gravity.

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5
Q

Where are the lungs best ventilated?

A

The apex

(Perfusion is relatively low in the apex thereofre V/Q ratio remains pretty high)

NB: TB tends to grow in the apex due to high level of ventilation.

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6
Q

What are the lobes of the lungs?

A

Right: Superior/Middle/Inferior
Left: Superior/Inferior

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7
Q

What neurotransmitters are at the pre and post synapses of the sympathetic nerves and parasympathetic nerves?

A

Sympathetic: [Short pre / Long post]

Pre = Acetylcholine @ Nictoninic receptors

Post = Noradrenaline @ Beta-adrenergic receptors.

[Therefore: Beta-adrenergic agonist –> bronchodilation]

Parasympathetic: [Long pre / Short post]

Pre = Acetylcholine @ Nicotinic

Post = Acetylcholine @ Muscarinic receptors

[Therefore: Muscarinic antagonist –> Bronchodilation]

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8
Q

What effect does sympathetic innervation have on the lungs?

A

Bronchodilation

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9
Q

What effect does parasympathetic innervation have on the lungs?

A

Bronchoconstriction

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10
Q

What causes smooth muscles to relax in the lungs following sympathetic stimulation?

A

Raised CAMP

Protein Kinase A inhibits Myosin Light Chain Kinase –> relaxation.

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11
Q

What causes smooth muscles in the lungs to constrict following parasympathetic innervation?

A

Raised Phospholipase C enzyme –> Protein Kinase C (C for calcium!) –> rasied intracellular calcium –> raised Myosin Light Chain Kinase –> Smooth muscle contraction

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12
Q

What type of B-adrenergic receptors are found in the lungs?

A

B2

[B1 = Heart]

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13
Q

What type of muscarinic receptors are found in the lungs?

A

M3

[M1 salivary glands / M2 Heart]

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14
Q

What is asthma?

A

Reversible airway obstruction caused by bronchospasm

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15
Q

True or false, asthma is typically worse at night?

A

True

{It is not known why. Possibly due to airways cooling, or circadian hormonal changes]

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16
Q

What is the test to determine if asthma is eosinophilic?

A

FeNO test.

Nitric Oxide level check as eosinophils produce NO.

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17
Q

How do you test the reversibility of asthma? What level is diagnostic?

A

Peak flow before and after B2 agonist e.g. salbutamol.

12% improvement = diagnostic.

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18
Q

What is the treatment for an acute asthma attack?

A 
Nebulised salbutamol (SABA)
Ipratropium bromide (SAMA)
Oxygen 
Hydrocortisone
[+Aminophylline IV]

[NB: MgSO4 IV bolus is a potent bronchodilator and can be used in severe attacks]

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19
Q

Give an example of a SABA, SAMA, LABA, LAMA and preventer

A 
SABA: Salbutamol
LABA: Salmeterol
SAMA: Ipratropium bromide
LAMA: Tiotropium 
Preventer: Beclomethasone
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20
Q

Give a cause of lobar collapse

A

Mucus plugs
Foreign body
Tumour

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21
Q

What is atelectasis?

A

Collapse or closure of part of a lung/lobe.

Can be obstructvie e.g. tumour or mucus plug or non-obstructive e.g. due to air pressure or general anaesthesia.

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22
Q

What is the difference between pneumothorax and atelectasis?

A

Pneumothorax is a collapse of a whole lung. Drain this.

Atelectasis is a collapse of part of the lung. Don’t drain this.

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23
Q

What is poiseuille’s law?

A

Resistance in a tube is inversely proportional to the 4th power of the radius.

Doubling the radius decreases resistance 16 times.

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24
Q

Which type of cell makes up 90% of the SA of the lungs and is responsible for gas exchange?

A

Type 1 pneumocytes
Squamous epithelium
10% of the cells

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25
Q

What type of epithelium are Type 2 pneumocytes?

A

Cuboidal

90% of the cells but only around 10% of the surface area. Produce surfactant.

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26
Q

What does surfactant do in the lungs?

A

Decreases surface tension allowing lung expansion and contraction.

[Starts to be produced around 35 weeks gestation]

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27
Q

What enzyme catalyses the conversion of carbon dioxide + water to carbonic acid?

A

Carbonic Anhydrase

[Carbonic Acid Equation]

CO2 + H2O H2CO3 HCO3- + H+

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28
Q

What is the Henderson-Hasselbalch Equation?

A

pH (blood plasma) = 6.1 + Log[HCO3-]/[0.03 xpCO2]

[0.03 = solubility of CO2 in blood]

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29
Q

What is the normal pH range of blood?

A

7.35 - 7.45

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30
Q

How is the anion gap calculated? What does the anion gap indicate?

A

Positive cations (Na + K) - Negative anions (Cl + HCO3)

A large anion gap can indicate acidosis e.g. DKA as bicarbonate is used to compensate.

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31
Q

What happens to pH and Co2 in metabolic and respiratory acidosis/alkalosis?

A 
saMe = Metabolic
Reverse = Respiratory
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32
Q

In the oxygen dissociation curve, which direction does it move with higher pH and lower temperature?

A

Left = left on Hb
[Increased Hb affinity]

Right = Goes right into the tissues.
[Decreased affinity]

Therefore it shifts left

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33
Q

What is the diagnostic for obstructive and restrictiv lung disease?

A

Obstructive: FEV1:FVC ratio <70%

Restrictive: FEV1:FVC >80%
FVC reduced

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34
Q

What is the normal tidal volume?

A

500ml

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35
Q

What is the average total lung capacity?

A

5L

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36
Q

What is the residual volume?

A

The volume that remains in the lungs after VC (vital capacity) is breathed out.

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37
Q

What spirometry metric is used to stage COPD?

A

FEV1

1 = >80
2 = 50-80
3 = 30-50
4 = <30
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38
Q

What piece of patient information does the BODE index take into account when assessing patients with COPD?

A

Body mass

[This measure predicts how much the COPD will affect them]

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39
Q

Give two signs of chronic bronchitis and two signs of emphysema

A 
Chronic Bronchitis: 
[Blue Bloater]
- Cyanosis
- Obesity
- Peripheral oedema
- Crackles/Wheeze
Emphysema:
[Pink Puffer]
- Pink skin
- Cachetic appearance
- Decreased breath sounds
- Pursed lip breathing
- Barrel chest
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40
Q

What is the normal number of ribs (anterior + posterior) you should see on CXR?

A

No more than 6 anterior and 10 posterior.

More than this suggests hyperinflation.

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41
Q

Give a common causes of community and hospital acquired pneumonia

A 
Community: 
Strep pneumoniae
Mycoplasma pneumoniae
H influenzae
Viral
Hospital:
Staph aureus
Pseudomonas aeruginosa
Enterobacter
Virus
42
Q

What is the CURB65 score?

A

Indicates whether a patient with pneumonia requires hospital care

Confusion
Urea >7mmol/L
Resp Rate >30/min
BP <90 /<60
Age 65+ 
0-1 = Low risk
2 = Probably admit
3 = Admit
43
Q

True or false, Small Cell Lung Cancer [SCLC] is typically inoperable?

A

True

[Rare ~20% of lung cancers but much more aggressivethan than Non-small cell lung cancer]

44
Q

Which is the most common type of lung cancer Small Cell or Non-Small Cell?

A

NSMLC = 80%

  • Adenocarcinoma (40%)
  • Squamous (30%)
  • Large cell (10%)
45
Q

What is the most common type of lung cancer among smokers?

A

Squamous cell (30% of all lung cancers)

[Adenocarcinoma is the most common generally and is the most common in non-smokers]

46
Q

Where does lung cancer typically spread?

A

Typically via blood

In order…

Liver
Adrenal glands
Bones
Brain 
Kidneys
47
Q

Where would you find a pancoast tumour? What is it associated with?

A 
Lung cancer (mostly NSCLC)
Occurs in the apex of the lungs.

Can cause Pancoast syndrome when it impinges on the brachial plexus –> pain in the inner arm and shoulder swelling.

48
Q

Give two complications of lung cancer

A

Horner’s Syndrome: Ptosis, Miosis, Anhydrosis.

Pancoast syndrome: Brachial plexus impingement with pain and swelling in the arm.

Hoarse voice: Impingement on the laryngeal nerve.

Hiccoughing/Breathing difficulty: Impingement on the phrenic nerve.

Paraneoplastic syndrome: Neurological or hormonal effects due to cancer.

49
Q

What investigations would you do in a patient you suspect of having lung cancer?

A 
CXR
Chest CT
Bronchoscopy 
CT guided biopsy
PET (Staging)
Spirometry
LFT
50
Q

If you suspect a patient as having a neuroendocrine tumour with carcinoid syndrome (paraneoplastic), what test would you do?

A

Urine test for 5-HIAA

51
Q

Which part of the lung is most affected by mesothelioma?

A

Pleura

52
Q

What investigations do you do for mesothelioma?

A

CXR

Thoracentesis + pleural biopsy

53
Q

After the lungs, where does mesothelioma tend to spread?

A

To the pritoneum

Pleura –> lungs –> hilar lymph nodes –> peritoneum

54
Q

Name two professions at risk of asbestosis

A

Engineers
Boiler makers
Construction workers

55
Q

Give two signs of TB

A

Weight loss
Night sweats
Cough
Haemoptysis

56
Q

True or false, the Interferon Gamma Release Assay (IGRA) and Tuberculin (Mantoux) test can differentiated between active and latent TB?

A

False. Neither can.

CXR is used to determine if active.

57
Q

Which TB test is most specific?

A

Interferon Gamma Release Assay [IGRA] - Blood test.

[Better than Mantoux]

58
Q

How many sputum samples must be taken to diagnose TB? What test is run on it?

A

At least 3 samples!

Acid Fast Bacilli
[Ziehl Neelsen stain]

59
Q

What is the treatment regimen for active TB?

A

[RI-PE]
Rifampicin + Isoniazid [6M]
Pyrazinamide + Ethambutol [First 2M]

60
Q

What is the treatment regimen for latent TB?

A

[RI]

Rifampicin + Isoniazid [3M]

61
Q

True or false, TB patients should be in positive pressure room?

A

False. They should be in a negative pressure room.

62
Q

Which TB drug causes red/orange urine?

A

Rifampicin

[Red pissin]

63
Q

Which TB drug causes optic neuritis and colour blindness?

A

Ethambutol

[E for Eyes!]

64
Q

Give a side effect of Isoniazid

A

Neuropathy

Constipation

65
Q

True or false Pyrazinamide can cause anaemia?

A

True

66
Q

What is bronchiectasis? Give a common cause

A

Irreversible dilation of the bronchial tree caused by a bronchial obstruction e.g. Cystic fibrosis or TB

67
Q

What tests would you do for cystic fibrosis?

A

Sweat electrolyte test (1st line)
Sputum sample
CXR
Gene testing (CFTR)

68
Q

Which ion is assessed in a sweat test for cystic fibrosis?

A

Chloride ion concentration

69
Q

What is a mycetoma? What is the most common cause?

A

A fungus or bacterial ball in a pre-existing lung cavity.

Aspergillus is the most common cause. The cavity is often the result of a previous TB infection.

70
Q

True or false, if you have had the BCG vaccination, this may cause the tuberculin skin test to read a false positive?

A

True

71
Q

What are the 4 types of hypersensitivity reaction?

A

1) “Allergic” IgE mediated <1hr.
Anaphylaxis, drug allergy.

2) “Cytotoxic”. IgG/M hrs-days
Goodpastures, Haemolytic reaction.

3) “Immune Complex”. IgG/M + Complement activation.
SLE, Serum sickness, hypersensitivity pneumonitis (aka extrinsic allergic alveolitis)

4) “Delayed”. T-Cell mediated + cytokines e.g. contact dermatitis (nickel, latex etc).

[ACID]

72
Q

True or false, Byssinosis is a hypersensitivity reaction?

A

False. It is just lung irritation cause by exposure to dust.

73
Q

Extrinsic Allergic Alveolitis is what kind of hypersensitivity reaction?

A

Type 3 (Immune complex, IgM/G + complement activation).

It can progress in chronic form to Type 4 (delayed T cell mediated)

74
Q

What would you see on CXR in a case of Extrinsic Allergic Alveolitis?

A

Honeycombing/Ground glass appearance.

75
Q

Name a scoring tool for breathlessness

A

MRC Breathlessness Scale
Borg Scale
NYHA
WHO Functional Class

76
Q

What inheritance pattern does cystic fibrosis follow?

A

Autosomal Recessive

77
Q

What is the treatment for cystic fibrosis?

A

Nebulised saline
Antibiotics
PPI
Pancreatic enzyme replacement

78
Q

What does a faecal elastase test assess?

A

Pancreatic insufficiency
(May be a sign of cystic fibrosis)

[Guthrie screening looks for CF too]

79
Q

Which two organs are most affected by Alpha-1 antitrypsin deficiency?

A

Lungs and liver

Lack of A1AT results in increased protease enzyme activity. Made worse by smoking. Presents like COPD.

80
Q

True or false, patients who smoke who have alpha 1 antitrypsin deficiency still have a normal life expectancy?

A

False.

Smoking reduces it.
Non-smokers it is normal.

81
Q

What causes pneumoconiosis?

A

Dust exposure

82
Q

True or false, amiodarone can cause pulmonary fibrosis?

A

True

83
Q

Name two drugs used for smoking cessation.

A

Varenicline (Champix)
[Most effective] Only 18+
Not in pregnancy.

Bupropion (Zyban)
Not if history of seizures. Start while smoking.

Nicotine Replacement Therapy. Safe from 12 years old and in pregnancy.

84
Q

True or false, Nicotine Replacement Therapy is safe during pregnancy?

A

True

85
Q

What ECG changes do you observe in a PE?

A

S1Q3T3

S waves lead I
Q wave lead 3
T inverted lead 3

Sinus tachycardia is the most common sign!

86
Q

What is the first line investigation for PE?

A

D-Dimer to rule out
If high then CTPA

VQ perfusion if allergic to contrast

87
Q

What is it called when 3 or more ribs are broken in at least 2 places?

A

Flail chest

High risk of pneumothorax

88
Q

In a tension pneumothorax does the trachea move away or towards it?

A

Pushed away

89
Q

What is it called when there is air in the subcutaneous tissues surrounding the lungs?

A

Surgical emphysema

90
Q

What is the first line treatment for pulmonary embolism?

A

LMWH or Fondaparinux

91
Q

What is the test for legionella?

A

Urine antigen test

92
Q

What is the treatment for legionella?

A

IV Abx + O2

Azithromicin (macrolides), Cephalosporins

93
Q

What are the target O2 sats for a patient with type 2 respiratory failure?

A

88-92%

94
Q

True or false, sarcoidosis is more common in women?

A

True

95
Q

How is sarcoidosis diagnosed?

A

CXR
Chest CT
Bronchoscopy + biopsy

96
Q

How is sarcoidosis treated?

A

NSAIDs/Paracetamol for flareup pain

Corticosteroids to reduce autoimmune response

97
Q

What further test would you perform in a patient presenting with PCP?

A

Pneumocystis Pneumonia

HIV test

98
Q

What is carbocysteine used for in the treatment of COPD?

A

Mucolytic

99
Q

True or false, ACE is raised in 2/3rds of patients with sarcoidosis?

A

True

100
Q

True or false, E-cigarettes are available on the NHS?

A

False

Respiratory (P4) (1 decks)

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