Respiratory Flashcards
Name the two forces that link the thorax and the lungs together
Intrapleural fluid cohesiveness
Negative intrapleural pressure
Name the muscles involved in passive inspiration and active inspiration
External intercostal muscles sternocleidomastoid scalenus diaphragm pectoral
Pulmonary _________ is secreted by _____ ____ alveolar cells. this lowers the alveolar _______ ________.
surfacatant
Type II
Surface tension
What is a pneumothorax? Name two symptoms and two signs
A pneumothorax is air within the pleural space.
chest pain/SOB
Hyperresonant percussion note/ decreased/absent breath sounds
Respiratory distress of the newborn is caused by a lack of ________.
Surfactant
What is the tidal volume?
The volume of air entering or leaving the lungs during a single breath. (0.5L)
What is the residual volume?
the total volume of air remaining in the lungs after maximal expiration. (1.2L)
what is the Forced Vital Capacity (FVC)?
the total volume of air that can be expired after maximal inspiration.
What is the Forced Expiratory Volume (FEV1)?
the volume of air that is expired in the first second of expiration
how do restrictive diseases effect the FEV1/FVC ratio and the FVC?
the ratio remains the same
the FVC decreases
What is Pulmonary Compliance?
Pulmonary compliance is a measure of the amount of effort required in stretching/distending the lungs
What does it mean to have decreased/increased pulmonary compliance?
decreased-more effort to inspire
increased-less effort to inspire
Name the three classes of bronchi
Main bronchi Lobar bronchi (5 of them) Segmental bronchi (10 of them- one for each bronchopulmonary segment)
which side of the lung has three lobes?
right side (upper/middle/lower)
Name the three cartilages which make up the larynx and the bone that is present
thyroid
Cricoid
arytenoid
hyoid bone
Which nasal structures are responsible for heating up entering air?
the inferior, middle and superior conchae
how many True/false/floating ribs are there?
True-7
False-3
Floating-2
Name the three sections of the sternum
Manubrium, body, xiphoid process
What is the diffusion coefficient?
A measure of the solubility of a gas in a membrane (mainly refering to CO2 diffusion)
What type of curve does Haemoglobin oxygen saturations provide?
A sigmoidal curve
Describe the Bohr effect.
Where the Oxygen saturation curve of haemoglobin shifts to the right due to:
increased CO2
increased temperature
increased [H+]
When stimulated M3 muscarinic receptors cause _________ _________.
Airway smooth muscle contraction
when stimulated Beta2 adrenoceptors cause ________ __________.
Airway smooth muscle relaxation
what are the main symptoms of bronchoconstriction?
SOB, cough, wheeze
Name the most common SABA and its main side effect
Salbutamol, Fine tremor
Name two LABAs and the combination necessary for their administration
Salmeterol, Formaterol
with a corticosteroid
What does symbicort consist of?
Budesonide and salmeterol
Name two CysLT1 receptors
Montelukast
Zafirlukast
Name three corticosteroids
Beclometasone
Fluticasone
Budesonide
What is the mode of action of corticosteroids?
They act on the nuclear receptors of cells and stimulate the production of anti-inflammatory proteins and decrease the production of inflammatory proteins
Name two Xanthines
Theophylline and aminophylline
what is omazilumab
Humanised Monoclonal IgE antibodies
what is the difference between Extrinsic and intrinsic asthma?
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
What form of inflammation is found in COPD and which is found in asthma?
COPD-neutrophilic inflammation
Asthma-Eosinophilic inflammation
COPD pathogenesis: Smoking activates ________ __________ which subsequently release _________ causing mucus ____________ and _________ damage.
Alveolar macrophages
Proteases
Overproduction
Alveolar damage
What is chronic bronchitis?
It is chronic neutrophilic inflammation of the airways leading to mucus overproduction and mucocilliary dysfunction resulting in a productive cough.
What is emphysema?
The loss of alveolar elasticity because of alveolar destruction by proteases.
Why does COPD lead to recurrent infections?
The biome of the lung becomes altered thus infections are more likely to develop- they are the main cause of acute exacerbations of COPD
What three things should you do to treat an asthma attack?
Oral prednisolone
60% Oxygen
Nebulised Salbutamol
What is different about acute COPD treatment and Asthma treatment?
Nebulised Salbutamol/ipratropium
Antibiotic if infection
O2-24-28%
Name two long term non-pharmological treatments of COPD.
Smoking cessation
Pulmonary rehab
Name one SAMA that is a non-selective blocker of Muscarinic receptors
Ipratropium
Name 4 LAMAs
aclidinium
umeclidinium
tiotropium
glycopyrronium
Name two ultra-LAMAs
Incadaterol
Olodaterol
what is the difference between sensitivity and specificity?
sensitivity- how good a test is at identifying disease
specificity- how good a test is at identifying health
How does respiratory acidosis occur?
Increased [H+] because increased [CO2]
How does the body compensate for Metabolic acidosis?
Breath out more CO2
How does the body compensate respiratory acidosis?
[H+] excretion from the kidneys
Name the three means by which carbon dioxide is carried in the blood?
In solution
carbamino compounds
bicarbonate
What is the Haldane effect?
Removing oxygen from haemoglobin increases its affinity for CO2 and H+. Helps to remove this waste at metabolically active tissue
What is the ‘pacemaker’ of the respiratory system and where is it located?
Pre-Botzinger Complex
Medulla Oblongata
The respiratory rhythm produced in the Pre-Botzinger complex is modified in the ______. what is the complex located there called?
Pons
Pneumotactic centre
What nerve stimulates the Diaphragm?
Phrenic nerve- C3,4,5
What is H+ drive?
H+ drive is the body’s compensatory response to respiratory acidosis- hyperventilation therefore increase C02 removal
What is the difference between Type 1 and Type 2 respiratory failure?
Type 1- decreased PO2 normal PCO2
Type 2- Decreased PO2 increased PCO2
Name four risk factors of Type 2 respiratory failure.
Kyphoscoliosis
Morbid obesity
CF
COPD
What O2 percentage is suitable for type 1 and type 2 resp failure
type 1- 90-94%
type 2- 88-92%
Name two symptoms of hypoxaemia
Tachypnoea, Dyspnoea
Where is a foreign body most likely to get lodged in the airways?
Right mainstem bronchus
Why does lung cancer lead to recurrent pneumonia?
The obstructed area causes areas downstream to have more stagnant air- more at risk of infection
Does stridor occur during inspiration or expiration?
It is an inspiratory wheeze
Name 5 signs/symptoms of lung cancer caused by local invasion
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
What does HPOA stand for?
hypertrophic pulmonary osteoarthropathy
What is the pneumonic for hypercalcaemia?
Stones, bones, thrones, groans, psychiatric overtones
Name the four types of lung cancer and the one with the poorest prognosis.
small cell, large cell, adenocarcinoma, squamous cell
poorest prognosis- small cell
What tests may be used in the staging of Lung cancer?
bronchoscopy, mediastinoscopy, PET scan, Ct brain and thorax
What is endobronchial therapy?
Placing a stent in the trachea to prevent stridor (a distressing symptom)
What does the respiratory epithelium consist of?
ciliated pseudostratified columnar epithelium
How does a pleural effusion present on a chest x-ray?
dense white consolidation in the costo-diaphragmatic recess
name a suitable investigation for a pleural effusion
repeat thoracentesis
What is mesothelioma?
Malignant tumour of the visceral/parietal pleura
What cancers may metastasise to the mesothelium?
Lung/breast
What is the most common presentation of mesothelioma?
Persistent chest wall pain and pleural effusion
What is the treatment for a tension pneumothorax?
Immediate needle decompression
What is the difference between a transudate and an exudate?
An transudate contains <30g protein
An exudate contains >30g protein
Name two possible causes of a straw coloured pleural effusion
cardiac failure
Hypoalbuminaemia
Name the two fissures between the lung lobes
Horizontal and oblique fissures
In which order come the components of the intercostal neurovascular bundles from cranial end to caudal end
Vein
Artery
Nerve
The vagus nerve runs _______ to the hilum and the Phrenic nerve ___________to the hilum.
posterior
anterior
The _____ dome of the diaphragm sits higher than the _____ because of the ______.
right
left
liver
name the three anatomical lines caudal to the axilla to the axilla
anterior, middle and posterior axillary lines
What results in a winged scapula?
paralysis of the serratus anterior muscle due to damage to the long thoracic nerve
what bacteria causes scarlet fever?
streptococcus pyrogenes
What is quinsy?
It is a complication of tonsilitis. A peri-tonsilar abscess- needs drained + IV antibiotics
What is epiglottitis?
A medical emergency often found in children- it is a complication of a bacterial infection
Name three causes of coryza
RSV, rhinovirus, adenovirus
Name two symptoms of sinusitis
maxillary sinus pain, Frontal headache
What characterises Diphteria?
Pseudo membrane
Name a nasal decongestant used in the treatment of sinusitis
Oxymetazoline
What is the feverPAIN score used for?
to determine whether an upper respiratory tract infection is caused by streptococcus
How does pneumonia present on a chest x-ray? What causes this appearance?
It presents as dense white consolidations
this is caused by the build up of pus
How does a pneumonia lung present in pathology?
Red Hepatisation
What latent virus may re-emerge as a result of pneumonia
Herpes simplex virus
what is the CURB65 score used to determine?
The severity of community acquired pneumonia
What colour is the sputum if the pneumonia is caused by Klebsiella Pneumonia?
‘Red current jelly’ sputum
What is the most common form of lung cancer?
Adenocarcinoma
What does each part of the curb65 score stand for?
C-confusion U-raised urea R-high respiratory rate B-low blood pressure 65-over 65
How do you manage pneumonia?
Amoxicillin/doxycycline bed rest oxygen fluids stop smoking
What bacteria is the main cause of pneumonia?
Strep. pneumonia
Which is more common in young pneumonia patients? Mycoplasma pneumonia or strep pneumonia?
mycoplasma
which cranial nerves are involved in coughing and which are involved in sneezing?
sneezing- CNV CNIX
coughing- CNIX CNX
Name three symptoms of Influenza
Fever
headache
Myalgia
Malaise
Name a common cause of secondary bacterial pneumonia following influenza
Haemophilius influenza
How is Influenza detected?
PCR of nasopharyngeal swabs
tuberculosis is caused by what pathogen?
Mycobacterium Tuberculosis
TB pathogenesis: bacteria are ingested by _______ _________ and an immune ____________ is triggered leading to the formation of ____________ leading to _________ necrosis
alveolar macrophages
overreaction
granuloma
caseous necrosis
the caseated areas of the lung in TB become ________ forming ______ ______.
calcified
ghon foci
how does TB appear on an x-ray?
patchy consolidation
name four symptoms of TB.
Haemoptysis Productive cough fevers night sweats weight loss
what stain is used to detect for mycobacterium tuberculosis?
Ziehl- Neelsen stain
What is the second most common organ in which to find TB?
Lymph nodes
What bodily fluid is used in testing for TB?
sputum
What are the four drugs used in the ‘Quadruple therapy’ of TB?
rifampacin
Isoniazid
Pyrazinamide
ethambutol
What virus is associated with TB?
Human Immunodeficiency Virus
What is bronchiolitis? When does it usually occur? What virus usually causes it?
Inflammation of the bronchioles due to viral infection. Usually occurs in infants. Respiratory Syncytial Virus
What secondary bacterial infection may occur in children after influenza?
Otitis media
What type of hypersensitivity does Tuberculosis exhibit?
Delayed (type IV)
What is bronchiectasis?
Abnormally and permenantly dilated airways
Bronchiectasis is characterised by _________ inflammation, _________ infection and airway _______. These combined impair mucocilliary clearance
Neutrophilic
Recurrent
damage
Name five symptoms of bronchiectasis
Persistent cough haemoptysis purulent sputum finger clubbing crackles chest pain SOB
What is the Gold standard investigation for bronchiectasis?
HRCT scanning- show signet ring pattern of bronchi wall thickening
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.
CFTR Cl- Na+ Water mucus
What does CFTR stand for?
Cystic fibrosis Transmembrane conductance regulator
How many classes of cystic fibrosis are there and which is the most serious?
5 classes
Class I
Which two organs are mainly effected by CF?
Lungs and Pancreas
What long-term anti-inflammatory drug is given to bronchiectasis and CF patients?
Azithromycin
How is CF treated?
Airway clearance techniques
Nebulized therapy
Azithromycin
What type of hypersensitivity does asthma exhibit?
Type I
What is the most common cause of occupational asthma?
Isocyanates
On which chromosome is the CFTR gene located?
Chromosome 7
What type of hypersensitivity does Sarcoidosis exhibit?
Type IV- granulomatous
name three typical signs of sarcoidosis
Bilateral Hilar Lymphadenopathy
Pulmonary infiltration
Skin/Eye lesions
What Four symptoms combined are known as Lofgren’s syndrome?
BHL
Erythema nodosum
arthralgia
fatigue
What is the end stage of Sarcoidosis?
Pulmonary fibrosis
How would sarcoidosis exhibit on a CXR and an HRCT scan?
CXR- BHL
HRCT- Nodular infiltrate
The blood test of a sarcoidosis patient may present with ____________ and raised _______ levels.
hypercalcaemia
ACE
State three signs of idiopathic pulmonary fibrosis
Cough
Basal crackles
Finger clubbing
What characterises IPF on a HRCT scan?
Honeycombing pattern of fibrosis
Name two drugs used in the treatment of IPF.
Nintedanib
Pirfenidone
What is Croup?
Paediatric condition- narrowing of the trachea at the level of the larynx leading to stridor and barking cough.
Type I hypersensitivity is Ig___ mediated and involves _____ cells and ____________.
IgE
Mast cells
Eosinophils
Name the four types of hypersensitivity
Type I- IgE mediated
Type II- cytotoxic
Type III- Immune complex mediated
Type IV- Delayed
What is rhinitis?
Inflammation of the nasal passages
what is Rhinorrohea?
watery mucus in the nasal cavity
What is oxymetazoline used to treat?
nasal congestion- it is a Nasal decongestant
What are the main signs of Deep Vein thrombosis?
Swollen, red, hot, tender leg/calf
What are arterial and venous clots called?
Arterial- white thrombi
Venous- red thrombi
what makes up Virchow’s triad?
Hypercoagulable blood
Abnormal blood flow (turbulence/stasis)
Endothelial Damage
In arterial thrombosis what are the two main contributing factors? What about in Venous thrombi?
Arterial- Turbulence and vessel wall damage
Venous- Hypercoagulability and stasis
Where is a distal and proximal DVT found?
Distal- calf veins
Proximal- Popliteal veins
Name three ‘strong’ risk factors of DVT
Major surgery
Trauma
Absolute bed rest
What scoring system is used in DVT/PE diagnosis?
Wells criteria
What is the gold standard test for DVT?
Ultrasonography
Which two imaging techniques are used to identify a PE?
CTPA- CT Pulmonary Angiogram
V/Q isotope lung scan
Name three oral anti-coagulants used in the treatment of DVTs.
Apixaban
dabigatran
rivaroxaban
what does DOAC stand for?
Direct Oral Anticoagulant
What is CTEPH?
Chronic Thromboembolic Pulmonary Hypertension
Raised JVP, left parasternal heave and tricuspid regurgitation are all signs of what condition?
Pulmonary hypertension
The relaxation of which muscles cause snoring?
Pharyngeal dilator muscles
What diagnostic scale is used for Obstructive sleep apnoea?
Epworth Sleepiness score
What is Cor pulmonale?
Right ventricle enlargement due to excessive pressure loading caused by lung or pulmonary artery diseases
How does COPD typically present on a chest x-ray?
Flattened diaphragm
What condition can be caused by a deficiency of Alpha-1 Antitrypsin?
COPD
How does Lung collapse present?
Trachea deviated to side of lung that is damaged, dull to percuss, reduced breath sounds
What receptors do Xanthines act upon?
Adenosine receptors
Identify a complication of streptococcus pyrogenes infection
Acute Rheumatic fever
How do Mycobacterium tuberculosis appear on a Ziehl Neelson stain?
Bright red acid-fast bacilli
Where does TB predominate in the lung? Why?
Upper lobes
because they are strict aerobes- highest O2 in upper lobes
Identify a drug used to stabilise mast cells.
Sodium cromoglicate
What antibiotic combination is used for hospital acquired pneumonia?
Amoxicillin and metronidazole
What bacteria causes epiglottitis?
H. influenzae
Which influenza virus A/B is associated with pandemics?
Influenza A
