Respiratory Flashcards
1
Q
What cause a left shift of O2 Hb curve (increased affinity)?
A
Carbon Monoxide Poisoning Decreased Acid Decreased 2,3-DPG Decreased temp. Foetal Haemoglobin
2
Q
What causes a right shift of O2 Hb curve(decreased affinity)?
A
Increased CADET Increased CO2 Increased Acid Increased 2,3-DPG Increased Exercise Increased Temperature
3
Q
What is pulmonary shunting?
A
Alveoli is poorly ventilated but is well perfused.
4
Q
How does hypoxaemia cause hyperventilation?
A
By direct effect on the carotid and aortic body chemoreceptors (Peripheral Chemoreceptors)
5
Q
Which cells produce surfactant?
A
Type II Pneumocytes
6
Q
What does the Bohr effect refer to?
A
Loss of affinity of Hb for O2 when [H+] is increased
7
Q
What does the somatic mesoderm give rise to?
A
Parietal Pleura
8
Q
What does visceral mesoderm give rise to?
A
Visceral Pleura
9
Q
What respiratory group is involved in inspiration?
A
Dorsal Respiratory Group
10
Q
What respiratory group is involved in expiration?
A
Ventral Respiratory Group
11
Q
At which vertebral disc level does the oesophagus pass through the diagram?
A
T10
12
Q
What is the function of surfactant?
A
Prevent fluid accumulation
Decrease surface tension
13
Q
How many nasal conchae are there?
A
3, superior, middle and inferior conchae.
14
Q
What are the function of the nasal conchae?
A
To increase the surface area and increase the humidity.
15
Q
What are the nasal conchae lined by?
A
Ciliated mucous-secreting respiratory mucosa
16
Q
What number cranial nerve is the olfactory nerve?
A
CN I
17
Q
Where does the inferior constrictor muscle originate from?
A
Thyroid cartilage
18
Q
At which vertebral level is the cricoid cartilage?
A
C6
19
Q
Where does the trachea bifurcate?
A
T4
20
Q
Which bronchus is shorter?
A
The right bronchus is shorter and more vertical than the left
21
Q
At which vertebral level does the inferior vena cava pass through the diaphragm?
A
T8
22
Q
At what gestation does the foramen caecum regress?
A
Week 10
23
Q
What is the mechanism of action on Aminophylline?
A
Binds to adenosine receptors and blocks adenosine mediated bronchoconstriction
24
Q
What is lung complience?
A
A measure of the ease of expansion of the lungs and the thorax
25
What determines lung compliance?
Pulmonary volume and elasticity
26
What is palpable on the anterior chest wall, just inferior to the acromioclavicular joint?
Coracoid process
27
Where do we listen to auscultate the lung apex?
Sternal (medial) end of the clavicle
28
What interleukin does TH2 produce to activate B cells?
IL-4
29
What are goblet cells?
Glandular, modified simple columnar epithelial cells that produce mucins, the main component of mucus
30
What is the inspiratory capacity?
The sum of the inspiratory reserve volume and the tidal volume
31
What is the inspiratory reserve volume?
The max volume that can be inhaled from the end-respiratory level
32
What is the total lung capacity?
Max volume of air present in the lungs
33
What is the vital capacity?
Volume of air breathed out after the deepest inhalation of air
34
What is idiopathic pulmonary fibrosis?
Idiopathic inflammation of alveoli with thickening of alveolar walls
35
What is sarcoidosis?
Non-caseating granuloma formation
36
What hormone can squamous carcinomas produce?
PTH resulting in increased Ca2+
37
What is the most common causative pathogen of bronchiolitis?
Respiratory syncitial virus
38
Describe small cell lung cancer...
Normally central location and metastasise early
39
Describe squamous cell lung cancer...
Most common in smokers
40
Describe lymphoma...
Lymph node involvement
41
Describe mesothelioma...
Has to have previous exposure to asbestos
42
Describe adenocarcinoma...
The mass is peripheral or in the mid zone and most common LC in non-smokers
43
What is the treatment for non-severe hospital acquired pneumonia?
PO Amoxicillin and Metronidazole (Co-trimoxazole if penicillin allergic)
44
What is the treatment for severe hospital acquired pneumonia?
IV Amoxicillin, Metronidazole and Gentamicin (IV Co-trimoxazole if penicillin allergic)
45
What is Tiotropium?
LAMA
46
What are side effects of Rifampicin?
Red Secretions
47
What are side effects of Isoniazid?
Peripheral neuropathy in a sock and glove distribution
48
What are side effects of Pyrazinamide?
Arthralgia
49
What are side effects of Ethambutol?
Optic neuritis
50
What antibiotic should be used for Klebsiella Pneumonia?
Cefotaxime
51
What antibiotic should be used to treat Staphlococcal Pneumonia?
Flucloxacillin
52
What antibiotic should be used to treat Pneumocystis Jiroveci?
Co-trimoxazole
53
What antibiotic should be used to treat Legionella Pneumophilia?
Levofloxacin
54
What antibiotic should be used to treat Chlamydophilia Pneumoniae?
Doxycycline
55
What are signs of a severe asthma attack?
```
Heart rate above 110bpm
PEFR<50%
Cant complete sentences
Resp. Rate >25 bpm
Confusion
```
56
What are signs of a life threatening asthma attack?
```
Heart rate below 40bpm
Exhaustion
PEFR <33%
Confusion
Cyanosis
Silent Chest
```
57
What are the most likely causes of community aquired pneumonia?
Step. Pneumoniae
H. Influenza
Moraxella cattarrhallis
58
What do we use to treat atypical pneumoniae?
Macrolides
59
What are the most likely causes of hospital acquired pneumonia?
Pseudomonas aerginosa
Staph aureus
Legionella pneumoniae
60
Where is aspiration pneumonia most likely to occur?
Right middle lobe
| Right lower lobe
61
What are primary symptoms of pneumonia?
Chest pain
Dyspnoea - acute
Cough - haempotysis? Productivity?
Systemic symptoms - fever, night sweats, weight loss
62
What do we prescribe for mild pneumonia?
Oral amoxicillin/macrolide
63
What do we prescribe for moderate pneumonia?
Dual antibiotic therapy - amoxicillin and clarithromycin
64
What do we prescribe for sever pneumonia?
IV co-amoxiclav and clarithromycin
65
What is polycytheamia?
Increased number of RBC
66
What type of hypersensitivity is asthma?
Type 1 Hypersensitivity
67
What does FeNO measure?
Inflammation cells show airway inflammation
68
Where is adenocarcinoma located?
Periphery
69
Where is squamous cell carcinoma located?
Located centrally, close to the hilum
70
What are the paraneoplastic effects of squamous cell carcinoma?
Ectopic Parathyroid hormone
| causing hypercalcaemia
71
Where are large cell cancers located?
Periphery
72
What are the paraneoplastic effects of large cell carcinoma?
Increased B-HCG hormone
73
Where are small cell LC located?
Centrally around the hilum
74
What causes hoarseness in lung cancer?
Recurrent laryngeal nerve palsy
75
What is horners syndrome?
Pancoast tumour pressing on sympathetic ganglion - miosis, anhidrosis, ptosis
76
What type of lung cancer produces the most paraneoplastic effects?
Small cell lung cancer
77
What is pleurodhesis?
Talc is put in the pleural space to keep the pleura stuck together
78
What is a normal ABG for a pregnant woman?
Compensated respiratory alkalosis due to increased tidal volume causing decreased carbon dioxide.
79
What is the most anterior structure in the lung root?
Phrenic nerve
80
What is the most posterior structure in the lung root?
Vagus nerve
81
What is the function of the cystic fibrosis transmembrane regulator?
Cyclic AMP regulated chlorine channel
82
What is the name of the space between the vocal cords?
Rima Glottidis
83
What is a common sign of COPD on CXR?
Flattened diaphragm
84
What pathogen id the main cause of bronchiolitis?
Respiratory Syncytial Virus
85
What is the vertebral location of the trachea?
C6 - T5
86
What type of hypersensitivity is commonly associated with asthma?
Type 1 Hypersensitivity
87
What type of cells does adenocarcinoma affect?
Mucus-Secreting Cells
88
What type of cells does small cell lung cancer affect?
APUD cells
89
What are APUD cells?
A type of neuroendocrine cell found in the lung
90
What is a pancoast tumour?
This is a tumour of the pulmonary apex
91
What are paraneoplastic syndromes associated with lung cancers?
```
Hypercalcaemia
SIADH
Cushing's Syndrome
Lambert-Eaton Syndrome
Hypertrophic Osteoarthropathy
```
92
What vertebral level is the larynx located?
C3-C6
93
What vertebral level is the thyroid cartilage located?
C5
94
What vertebral level is the pulmomary hilum located?
T5-T7
95
What are the three paired cartilaginous segments of the larynx?
Artenoid, Corniculate and Cuniform
96
What are the three single cartilaginous segments of the larynx?
Thyroid, Cricoid and Epiglottic
97
What protein can a patient have a deficiency in that would normally protect that lungs from neutrophil elastase?
Alpha-1 Antitrypsin
98
What is emphysema?
A form of chronic obstructive airways disease in which damage to the alveolar walls causes many alveoli to fuse forming large air sacs called bullae.
99
What is the piriform recess?
A recess on either side of the laryngeal oriface
100
What is the most common causative organism of aspiration pneumonia?
Klebsiella pneumonia - red currant jelly like sputum
101
What is the causitive organism for meliodosis?
Burkholderia pseudomallei
102
What is an opportunistic fungus that can infect immunocompromised patients?
Pneumocystis jiroveci
103
What is the oxygen cascade (high to low pressure)?
```
Atmospheric air
Humidification in upper airways
Mixing with dead space gas
Alveolar gas mixing
Right to left shunting
Capillary diffusion
Mitochondria
(slight increase again) Venous blood
```
104
Why is the O2 Hb curve sigmoid shape?
There is co-operativity between the four subunits of the Hb molecule. as O2 is bound, this leads to an increased affinity hence creating the sigmoid curve
105
What is the equation for tissue oxygen delivery?
Arterial oxygen content ((1.34 x Hb x SpO2) + (PaO2 x 0.23)) x cardiac output
106
How is the majority of CO2 in the blood carried?
In bicarbonate
107
What is the haldane effect?
The increased affinity of deoxygenated haemoglobin for carbon dioxide
108
What is the bohr effect?
The reduced affinity of haemoglobin for oxygen in high carbon dioxide environments
109
What do the peripheral chemoreceptors detect?
pO2
pH
CO2
110
What do the central chemoreceptors detect?
pH
| CO2
111
What cannot be measured by spirometry?
Residual volume
Functional residual capacity
Total lung capacity
112
What is the equation for lung compliance?
Change in volume/change in pressure
113
What is la place's law?
The pressure inside an inflated alveoli is inversely proportional to the radius as long as the surface tension is presumed to change little.
114
How is the pressure within the alveoli kept the same no matter the size?
Smaller alveoli have more surfactant to reduce the surface tension
115
What lobes are most commonly affected by aspiration pneumonia?
Right middle and lower lobes
116
Why may males with cystic fibrosis be infertile?
Absence of a Vas Deferens
117
What are the three centre that control different aspects of respiration?
Upper pons
Lower pons
Medulla oblongata
118
What is normal intracranial pressure?
<15mm Hg
119
Which nerve supplies the percardium?
Phrenic Nerve
120
What chromosome is the CFTR gene on?
Chromosome 7
121
What are the common sites of lung tumour metastases?
Mediastinum
Hilar Lymph Nodes
Lung Pleura
Heart etc.
122
What type of cell does SCLC arise from?
Small, immature neuroendocrine cells
123
What is the condition when SCLC secretes inappropriate hormones?
Paraneoplastic syndrome
124
What type of cancer causes cushings syndrome?
SCLC
125
What do mesothelial plaques express?
Calretinin that regulates calcium in the cell
126
What is a pleural effusion?
This is the presence of excess fluid in the pleural space
127
What medications could be given to patients with pleural effusion as a result of heart failure?
Diuretics and sodium restriction.
128
At what level does the aorta pass through the diaphragm?
T12
129
What passes through aortic opening of the diaphragm?
Aorta
Azygous vein
Thoracic duct
130
What level does the oesophagus pass through the diaphragm?
T10
131
What passes through the oseophageal opening of the diaphragm?
Left Gastric Veins
Vagal Trunk
Oesophagus
132
What nerve lies anterior to the root of the lung?
Phrenic Nerve
133
What is the most common pathogen causing bronchiectasis exacerbation?
Haemophilus Influenzae
134
What is the most common pathogen causing bronchiolitis?
Respiratory Syncytial Viras
135
What is the most common pathogen causing croup?
Parainfluenza virus
136
What is a ghon focus?
This is a granuloma formation in TB with caseous necrosis in the centre
137
What is the treatment of active TB?
```
RIPE
Rifampicin
Isoniazide
Pyrazinamide
Ethambutol
```
138
What type of hypersensitivity is tuberculosis?
Type 4
139
What type of epithelium lines the trachea?
Pseudo-stratified ciliated columnar cells and goblet cells
140
What is the muscle between the oesophagus and the trachea?
Trachealis muscle
141
What is the most common cystic fibrosis mutation?
Delta F508 mutation of the CFTR gene
142
What is the newborn screening test for cystic fibrosis?
Pancreatic Enzyme IRT
143
What is used for the diagnosis of PE?
CT Pulmonary Angiogram
144
What is stridor?
Predominantly inspiratory wheeze due to obstruction of the large airways
145
What is the transmural pressure gradient?
The difference between intrathoracic pressure and alveolar pressure
146
What two factors allow the lungs to adhere to the chest wall?
Transmural Pressure Gradient
| Intrapleural Fluid Cohesiveness
147
Why is alveolar ventilation lower than pulmonary ventilation?
Due to anatomical dead space
148
What is alveolar dead space?
The sum total of all the alveoli that have little or no blood flowing through their adjacent pulmonary capillaries
149
What are the paraneoplastic features associated with small cell lung cancer?
ADH
ACTH
Lambert-Eaton Syndrome
150
What are the paraneoplastic features of squamous cell carcinoma?
Parathyroid Hormone Relates Protein Release
Clubbing
Hypertrophic Pulmonary Osteoarthropathy
Hyperthyroidism due to ectopic TSH
151
What are the paraneoplastic features of adenocarcinoma?
Gynaecomastia
| Hypertrophic Pulmonary Osteoarthropathy
152
What organism is associated with red-currant jelly sputum?
Klebsiella Pneumoniae
153
What is the most common cause of pneumonia in immunocomporomised individuals?
Pneumoncyctis jiroveci
154
Invasion into which nerve causes hoarseness?
Recurrent laryngeal nerve
155
What is the test for tuberculosis?
Interferon gamma release assay
156
What occurs in the embryonic phase of lung development?
Respiratory diverticulum forms, initial-branching to give lungs, lobes and segments
157
What happens in the pseudoglandular phase?
Branching of terminal bronchioles
158
What happens in the canalicular phase?
Terminal bronchioles → respiratory bronchioles → alveolar ducts
159
What happens in the saccular phase?
Terminal sacs form and capillaries establish close contact
160
What happens in the alveolar phase?
Alveoli mature.
161
What is closed when the vocal cords addict?
Glottis
