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First Year Dundee Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Name the two forces that link the thorax and the lungs together

A

Intrapleural fluid cohesiveness

Negative intrapleural pressure

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2
Q

Name the muscles involved in passive inspiration and active inspiration

A 
External intercostal muscles
sternocleidomastoid
scalenus
diaphragm
pectoral
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3
Q

Pulmonary _________ is secreted by _____ ____ alveolar cells. this lowers the alveolar _______ ________.

A

surfacatant
Type II
Surface tension

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4
Q

What is a pneumothorax? Name two symptoms and two signs

A

A pneumothorax is air within the pleural space.
chest pain/SOB
Hyperresonant percussion note/ decreased/absent breath sounds

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5
Q

Respiratory distress of the newborn is caused by a lack of ________.

A

Surfactant

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6
Q

What is the tidal volume?

A

The volume of air entering or leaving the lungs during a single breath. (0.5L)

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7
Q

What is the residual volume?

A

the total volume of air remaining in the lungs after maximal expiration. (1.2L)

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8
Q

what is the Forced Vital Capacity (FVC)?

A

the total volume of air that can be expired after maximal inspiration.

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9
Q

What is the Forced Expiratory Volume (FEV1)?

A

the volume of air that is expired in the first second of expiration

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10
Q

how do restrictive diseases effect the FEV1/FVC ratio and the FVC?

A

the ratio remains the same

the FVC decreases

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11
Q

What is Pulmonary Compliance?

A

Pulmonary compliance is a measure of the amount of effort required in stretching/distending the lungs

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12
Q

What does it mean to have decreased/increased pulmonary compliance?

A

decreased-more effort to inspire

increased-less effort to inspire

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13
Q

Name the three classes of bronchi

A 
Main bronchi
Lobar bronchi (5 of them)
Segmental bronchi (10 of them- one for each bronchopulmonary segment)
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14
Q

which side of the lung has three lobes?

A

right side (upper/middle/lower)

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15
Q

Name the three cartilages which make up the larynx and the bone that is present

A

thyroid
Cricoid
arytenoid
hyoid bone

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16
Q

Which nasal structures are responsible for heating up entering air?

A

the inferior, middle and superior conchae

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17
Q

how many True/false/floating ribs are there?

A

True-7
False-3
Floating-2

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18
Q

Name the three sections of the sternum

A

Manubrium, body, xiphoid process

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19
Q

What is the diffusion coefficient?

A

A measure of the solubility of a gas in a membrane (mainly refering to CO2 diffusion)

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20
Q

What type of curve does Haemoglobin oxygen saturations provide?

A

A sigmoidal curve

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21
Q

Describe the Bohr effect.

A

Where the Oxygen saturation curve of haemoglobin shifts to the right due to:
increased CO2
increased temperature
increased [H+]

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22
Q

When stimulated M3 muscarinic receptors cause _________ _________.

A

Airway smooth muscle contraction

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23
Q

when stimulated Beta2 adrenoceptors cause ________ __________.

A

Airway smooth muscle relaxation

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24
Q

what are the main symptoms of bronchoconstriction?

A

SOB, cough, wheeze

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25
Q

Name the most common SABA and its main side effect

A

Salbutamol, Fine tremor

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26
Q

Name two LABAs and the combination necessary for their administration

A

Salmeterol, Formaterol

with a corticosteroid

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27
Q

What does symbicort consist of?

A

Budesonide and salmeterol

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28
Q

Name two CysLT1 receptors

A

Montelukast

Zafirlukast

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29
Q

Name three corticosteroids

A

Beclometasone
Fluticasone
Budesonide

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30
Q

What is the mode of action of corticosteroids?

A

They act on the nuclear receptors of cells and stimulate the production of anti-inflammatory proteins and decrease the production of inflammatory proteins

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31
Q

Name two Xanthines

A

Theophylline and aminophylline

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32
Q

what is omazilumab

A

Humanised Monoclonal IgE antibodies

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33
Q

what is the difference between Extrinsic and intrinsic asthma?

A

Extrinsic- immune overreaction to a innocuous substance e.g. animal dander/dust mites/pollen/funghi
Intrinsic- Not a response to an allergen but rather exercise/stress/cold air/infections

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34
Q

What form of inflammation is found in COPD and which is found in asthma?

A

COPD-neutrophilic inflammation

Asthma-Eosinophilic inflammation

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35
Q

COPD pathogenesis: Smoking activates ________ __________ which subsequently release _________ causing mucus ____________ and _________ damage.

A

Alveolar macrophages
Proteases
Overproduction
Alveolar damage

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36
Q

What is chronic bronchitis?

A

It is chronic neutrophilic inflammation of the airways leading to mucus overproduction and mucocilliary dysfunction resulting in a productive cough.

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37
Q

What is emphysema?

A

The loss of alveolar elasticity because of alveolar destruction by proteases.

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38
Q

Why does COPD lead to recurrent infections?

A

The biome of the lung becomes altered thus infections are more likely to develop- they are the main cause of acute exacerbations of COPD

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39
Q

What three things should you do to treat an asthma attack?

A

Oral prednisolone
60% Oxygen
Nebulised Salbutamol

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40
Q

What is different about acute COPD treatment and Asthma treatment?

A

Nebulised Salbutamol/ipratropium
Antibiotic if infection
O2-24-28%

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41
Q

Name two long term non-pharmological treatments of COPD.

A

Smoking cessation

Pulmonary rehab

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42
Q

Name one SAMA that is a non-selective blocker of Muscarinic receptors

A

Ipratropium

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43
Q

Name 4 LAMAs

A

aclidinium
umeclidinium
tiotropium
glycopyrronium

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44
Q

Name two ultra-LAMAs

A

Incadaterol

Olodaterol

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45
Q

what is the difference between sensitivity and specificity?

A

sensitivity- how good a test is at identifying disease

specificity- how good a test is at identifying health

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46
Q

How does respiratory acidosis occur?

A

Increased [H+] because increased [CO2]

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47
Q

How does the body compensate for Metabolic acidosis?

A

Breath out more CO2

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48
Q

How does the body compensate respiratory acidosis?

A

[H+] excretion from the kidneys

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49
Q

Name the three means by which carbon dioxide is carried in the blood?

A

In solution
carbamino compounds
bicarbonate

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50
Q

What is the Haldane effect?

A

Removing oxygen from haemoglobin increases its affinity for CO2 and H+. Helps to remove this waste at metabolically active tissue

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51
Q

What is the ‘pacemaker’ of the respiratory system and where is it located?

A

Pre-Botzinger Complex

Medulla Oblongata

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52
Q

The respiratory rhythm produced in the Pre-Botzinger complex is modified in the ______. what is the complex located there called?

A

Pons

Pneumotactic centre

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53
Q

What nerve stimulates the Diaphragm?

A

Phrenic nerve- C3,4,5

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54
Q

What is H+ drive?

A

H+ drive is the body’s compensatory response to respiratory acidosis- hyperventilation therefore increase C02 removal

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55
Q

What is the difference between Type 1 and Type 2 respiratory failure?

A

Type 1- decreased PO2 normal PCO2

Type 2- Decreased PO2 increased PCO2

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56
Q

Name four risk factors of Type 2 respiratory failure.

A

Kyphoscoliosis
Morbid obesity
CF
COPD

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57
Q

What O2 percentage is suitable for type 1 and type 2 resp failure

A

type 1- 90-94%

type 2- 88-92%

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58
Q

Name two symptoms of hypoxaemia

A

Tachypnoea, Dyspnoea

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59
Q

Where is a foreign body most likely to get lodged in the airways?

A

Right mainstem bronchus

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60
Q

Why does lung cancer lead to recurrent pneumonia?

A

The obstructed area causes areas downstream to have more stagnant air- more at risk of infection

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61
Q

Does stridor occur during inspiration or expiration?

A

It is an inspiratory wheeze

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62
Q

Name 5 signs/symptoms of lung cancer caused by local invasion

A

Pancoast tumour- invasion brachial plexus within delto-pectoral groove
Dysphagia- oesophageal invasion
atrial fibrilation/pericardial effusion- pericardium invasion
Distended jugular vein- invasion superior vena cava
pleural effusion- invade pleural space

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63
Q

What does HPOA stand for?

A

hypertrophic pulmonary osteoarthropathy

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64
Q

What is the pneumonic for hypercalcaemia?

A

Stones, bones, thrones, groans, psychiatric overtones

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65
Q

Name the four types of lung cancer and the one with the poorest prognosis.

A

small cell, large cell, adenocarcinoma, squamous cell

poorest prognosis- small cell

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66
Q

What tests may be used in the staging of Lung cancer?

A

bronchoscopy, mediastinoscopy, PET scan, Ct brain and thorax

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67
Q

What is endobronchial therapy?

A

Placing a stent in the trachea to prevent stridor (a distressing symptom)

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68
Q

What does the respiratory epithelium consist of?

A

ciliated pseudostratified columnar epithelium

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69
Q

How does a pleural effusion present on a chest x-ray?

A

dense white consolidation in the costo-diaphragmatic recess

70
Q

name a suitable investigation for a pleural effusion

A

repeat thoracentesis

71
Q

What is mesothelioma?

A

Malignant tumour of the visceral/parietal pleura

72
Q

What cancers may metastasise to the mesothelium?

A

Lung/breast

73
Q

What is the most common presentation of mesothelioma?

A

Persistent chest wall pain and pleural effusion

74
Q

What is the treatment for a tension pneumothorax?

A

Immediate needle decompression

75
Q

What is the difference between a transudate and an exudate?

A

An transudate contains <30g protein

An exudate contains >30g protein

76
Q

Name two possible causes of a straw coloured pleural effusion

A

cardiac failure

Hypoalbuminaemia

77
Q

Name the two fissures between the lung lobes

A

Horizontal and oblique fissures

78
Q

In which order come the components of the intercostal neurovascular bundles from cranial end to caudal end

A

Vein
Artery
Nerve

79
Q

The vagus nerve runs _______ to the hilum and the Phrenic nerve ___________to the hilum.

A

posterior

anterior

80
Q

The _____ dome of the diaphragm sits higher than the _____ because of the ______.

A

right
left
liver

81
Q

name the three anatomical lines caudal to the axilla to the axilla

A

anterior, middle and posterior axillary lines

82
Q

What results in a winged scapula?

A

paralysis of the serratus anterior muscle due to damage to the long thoracic nerve

83
Q

what bacteria causes scarlet fever?

A

streptococcus pyrogenes

84
Q

What is quinsy?

A

It is a complication of tonsilitis. A peri-tonsilar abscess- needs drained + IV antibiotics

85
Q

What is epiglottitis?

A

A medical emergency often found in children- it is a complication of a bacterial infection

86
Q

Name three causes of coryza

A

RSV, rhinovirus, adenovirus

87
Q

Name two symptoms of sinusitis

A

maxillary sinus pain, Frontal headache

88
Q

What characterises Diphteria?

A

Pseudo membrane

89
Q

Name a nasal decongestant used in the treatment of sinusitis

A

Oxymetazoline

90
Q

What is the feverPAIN score used for?

A

to determine whether an upper respiratory tract infection is caused by streptococcus

91
Q

How does pneumonia present on a chest x-ray? What causes this appearance?

A

It presents as dense white consolidations

this is caused by the build up of pus

92
Q

How does a pneumonia lung present in pathology?

A

Red Hepatisation

93
Q

What latent virus may re-emerge as a result of pneumonia

A

Herpes simplex virus

94
Q

what is the CURB65 score used to determine?

A

The severity of community acquired pneumonia

95
Q

What colour is the sputum if the pneumonia is caused by Klebsiella Pneumonia?

A

‘Red current jelly’ sputum

96
Q

What is the most common form of lung cancer?

A

Adenocarcinoma

97
Q

What does each part of the curb65 score stand for?

A 
C-confusion
U-raised urea
R-high respiratory rate
B-low blood pressure
65-over 65
98
Q

How do you manage pneumonia?

A 
Amoxicillin/doxycycline
bed rest
oxygen
fluids
stop smoking
99
Q

What bacteria is the main cause of pneumonia?

A

Strep. pneumonia

100
Q

Which is more common in young pneumonia patients? Mycoplasma pneumonia or strep pneumonia?

A

mycoplasma

101
Q

which cranial nerves are involved in coughing and which are involved in sneezing?

A

sneezing- CNV CNIX

coughing- CNIX CNX

102
Q

Name three symptoms of Influenza

A

Fever
headache
Myalgia
Malaise

103
Q

Name a common cause of secondary bacterial pneumonia following influenza

A

Haemophilius influenza

104
Q

How is Influenza detected?

A

PCR of nasopharyngeal swabs

105
Q

tuberculosis is caused by what pathogen?

A

Mycobacterium Tuberculosis

106
Q

TB pathogenesis: bacteria are ingested by _______ _________ and an immune ____________ is triggered leading to the formation of ____________ leading to _________ necrosis

A

alveolar macrophages
overreaction
granuloma
caseous necrosis

107
Q

the caseated areas of the lung in TB become ________ forming ______ ______.

A

calcified

ghon foci

108
Q

how does TB appear on an x-ray?

A

patchy consolidation

109
Q

name four symptoms of TB.

A 
Haemoptysis
Productive cough
fevers
night sweats
weight loss
110
Q

what stain is used to detect for mycobacterium tuberculosis?

A

Ziehl- Neelsen stain

111
Q

What is the second most common organ in which to find TB?

A

Lymph nodes

112
Q

What bodily fluid is used in testing for TB?

A

sputum

113
Q

What are the four drugs used in the ‘Quadruple therapy’ of TB?

A

rifampacin
Isoniazid
Pyrazinamide
ethambutol

114
Q

What virus is associated with TB?

A

Human Immunodeficiency Virus

115
Q

What is bronchiolitis? When does it usually occur? What virus usually causes it?

A

Inflammation of the bronchioles due to viral infection. Usually occurs in infants. Respiratory Syncytial Virus

116
Q

What secondary bacterial infection may occur in children after influenza?

A

Otitis media

117
Q

What type of hypersensitivity does Tuberculosis exhibit?

A

Delayed (type IV)

118
Q

What is bronchiectasis?

A

Abnormally and permenantly dilated airways

119
Q

Bronchiectasis is characterised by _________ inflammation, _________ infection and airway _______. These combined impair mucocilliary clearance

A

Neutrophilic
Recurrent
damage

120
Q

Name five symptoms of bronchiectasis

A 
Persistent cough
haemoptysis
purulent sputum
finger clubbing 
crackles
chest pain
SOB
121
Q

What is the Gold standard investigation for bronchiectasis?

A

HRCT scanning- show signet ring pattern of bronchi wall thickening

122
Q

Cystic fibrosis occurs because the ______ doesn’t work correctly/is absent and the _____ ions are not there to counter the ___ movement. _____ therefore moves away from the lumen into the cells and the _______ thickens, becoming difficult to move.

A 
CFTR
Cl-
Na+
Water
mucus
123
Q

What does CFTR stand for?

A

Cystic fibrosis Transmembrane conductance regulator

124
Q

How many classes of cystic fibrosis are there and which is the most serious?

A

5 classes

Class I

125
Q

Which two organs are mainly effected by CF?

A

Lungs and Pancreas

126
Q

What long-term anti-inflammatory drug is given to bronchiectasis and CF patients?

A

Azithromycin

127
Q

How is CF treated?

A

Airway clearance techniques
Nebulized therapy
Azithromycin

128
Q

What type of hypersensitivity does asthma exhibit?

A

Type I

129
Q

What is the most common cause of occupational asthma?

A

Isocyanates

130
Q

On which chromosome is the CFTR gene located?

A

Chromosome 7

131
Q

What type of hypersensitivity does Sarcoidosis exhibit?

A

Type IV- granulomatous

132
Q

name three typical signs of sarcoidosis

A

Bilateral Hilar Lymphadenopathy
Pulmonary infiltration
Skin/Eye lesions

133
Q

What Four symptoms combined are known as Lofgren’s syndrome?

A

BHL
Erythema nodosum
arthralgia
fatigue

134
Q

What is the end stage of Sarcoidosis?

A

Pulmonary fibrosis

135
Q

How would sarcoidosis exhibit on a CXR and an HRCT scan?

A

CXR- BHL

HRCT- Nodular infiltrate

136
Q

The blood test of a sarcoidosis patient may present with ____________ and raised _______ levels.

A

hypercalcaemia

ACE

137
Q

State three signs of idiopathic pulmonary fibrosis

A

Cough
Basal crackles
Finger clubbing

138
Q

What characterises IPF on a HRCT scan?

A

Honeycombing pattern of fibrosis

139
Q

Name two drugs used in the treatment of IPF.

A

Nintedanib

Pirfenidone

140
Q

What is Croup?

A

Paediatric condition- narrowing of the trachea at the level of the larynx leading to stridor and barking cough.

141
Q

Type I hypersensitivity is Ig___ mediated and involves _____ cells and ____________.

A

IgE
Mast cells
Eosinophils

142
Q

Name the four types of hypersensitivity

A

Type I- IgE mediated
Type II- cytotoxic
Type III- Immune complex mediated
Type IV- Delayed

143
Q

What is rhinitis?

A

Inflammation of the nasal passages

144
Q

what is Rhinorrohea?

A

watery mucus in the nasal cavity

145
Q

What is oxymetazoline used to treat?

A

nasal congestion- it is a Nasal decongestant

146
Q

What are the main signs of Deep Vein thrombosis?

A

Swollen, red, hot, tender leg/calf

147
Q

What are arterial and venous clots called?

A

Arterial- white thrombi

Venous- red thrombi

148
Q

what makes up Virchow’s triad?

A

Hypercoagulable blood
Abnormal blood flow (turbulence/stasis)
Endothelial Damage

149
Q

In arterial thrombosis what are the two main contributing factors? What about in Venous thrombi?

A

Arterial- Turbulence and vessel wall damage

Venous- Hypercoagulability and stasis

150
Q

Where is a distal and proximal DVT found?

A

Distal- calf veins

Proximal- Popliteal veins

151
Q

Name three ‘strong’ risk factors of DVT

A

Major surgery
Trauma
Absolute bed rest

152
Q

What scoring system is used in DVT/PE diagnosis?

A

Wells criteria

153
Q

What is the gold standard test for DVT?

A

Ultrasonography

154
Q

Which two imaging techniques are used to identify a PE?

A

CTPA- CT Pulmonary Angiogram

V/Q isotope lung scan

155
Q

Name three oral anti-coagulants used in the treatment of DVTs.

A

Apixaban
dabigatran
rivaroxaban

156
Q

what does DOAC stand for?

A

Direct Oral Anticoagulant

157
Q

What is CTEPH?

A

Chronic Thromboembolic Pulmonary Hypertension

158
Q

Raised JVP, left parasternal heave and tricuspid regurgitation are all signs of what condition?

A

Pulmonary hypertension

159
Q

The relaxation of which muscles cause snoring?

A

Pharyngeal dilator muscles

160
Q

What diagnostic scale is used for Obstructive sleep apnoea?

A

Epworth Sleepiness score

161
Q

What is Cor pulmonale?

A

Right ventricle enlargement due to excessive pressure loading caused by lung or pulmonary artery diseases

162
Q

How does COPD typically present on a chest x-ray?

A

Flattened diaphragm

163
Q

What condition can be caused by a deficiency of Alpha-1 Antitrypsin?

A

COPD

164
Q

How does Lung collapse present?

A

Trachea deviated to side of lung that is damaged, dull to percuss, reduced breath sounds

165
Q

What receptors do Xanthines act upon?

A

Adenosine receptors

166
Q

Identify a complication of streptococcus pyrogenes infection

A

Acute Rheumatic fever

167
Q

How do Mycobacterium tuberculosis appear on a Ziehl Neelson stain?

A

Bright red acid-fast bacilli

168
Q

Where does TB predominate in the lung? Why?

A

Upper lobes

because they are strict aerobes- highest O2 in upper lobes

169
Q

Identify a drug used to stabilise mast cells.

A

Sodium cromoglicate

170
Q

What antibiotic combination is used for hospital acquired pneumonia?

A

Amoxicillin and metronidazole

171
Q

What bacteria causes epiglottitis?

A

H. influenzae

172
Q

Which influenza virus A/B is associated with pandemics?

A

Influenza A

First Year Dundee Medicine (4 decks)

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