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Pass Medicine notes > Respiratory knowledge tutor key points > Flashcards

Respiratory knowledge tutor key points Flashcards

1
Q

Thoracic duct perforates the diaphragm:

A

T12

  • aorta
  • thoracic duct
  • coeliac trunk leaves the aorta

T8
- inferior vena cava

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2
Q

What type of blood gas abnormality does altitude most commonly cause?

A

respiratory alkalosis

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3
Q

Fibrosis predominately affecting the upper zones

A

CHARTS

Coal worker pneumoconiosus 
Histocytosis 
Ankylosing Spondylitis 
Radiation 
Tuberculosis 
Silicosis / sarcoidosis
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4
Q

fibrosis predominantly affecting the lower zone

A
  • asbestosis
  • connective tissue disorders, SLE
  • idiopathic pulmonary fibrosis
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5
Q

Total lung capacity:

A

Equals vital capacity + residual volume

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6
Q

In a patient with:

  • pneumonia
  • dry cough
  • atypical chest signs
  • autoimmune haemolytic anaemia
  • erythema multiforme

is most associated with which organism?

A

mycoplasma pneumoniae

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7
Q

An 80-year-old man who used to work in ship building presents with progressive shortness-of-breath. A chest x-ray shows multiple pleural plaques and bilateral lower zone interstitial shadowing

A

asbestosis

- often affects lower zone

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8
Q

Summarise the key pathophysiology in asthma

A
  • chronic inflammation
  • many eosinophils release granules (histamine, leukotrienes etc.)

combined with environmental factors:

  • —-> 1. smooth muscle spasms
  • —-> 2. increased mucus secretion

-TH2 cells —> cytokines —> IL-5, attracts and activates more eosinophils
OR
- neutrophils —> IL8 more severe form

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9
Q

Irreversible changes seen in asthma

A
  1. Oedema
  2. Scarring
  3. Fibrosis
  • —-> thickened basement membrane
  • ———-> reduces airway diameter
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10
Q

COPD involves what two conditions

A
  1. Chronic bronchitis (productive cough)

2. Emphysema ( enlargement of airspaces)

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11
Q

Summarise type 1 respiratory failure

A
  1. Fluid in lungs
    - —> water (pulmonary oedema)
    - —> pus (pneumonia)
    - —> blood (haemorrhage)
  2. Oxygen diffusion impairment
  3. Hypoxemia as oxygen can’t diffuse
  4. Occurs with diseases and damage to lung tissues
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12
Q

Summarise type 2 respiratory failure

A
  1. Obstruction?
  2. asthma, COPD
  3. anything depressing respiratory drive
  4. neuromuscular conditions such as Guillain Barre or myasthenia gravis.
  5. CO2 collects leading to hypercapnia
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13
Q

Two classic clinical signs of idiopathic pulmonary fibrosis?

A
  1. dry cough

2. SOB

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14
Q

What occurs in the pathophysiology of idiopathic pulmonary fibrosis?

Early inflammatory stage

A
  1. repetitive exposure to unknown antigen leads to repetitive cycles of alveolitis
    - —-> type 1 pneuomocyte damage
  2. m.phages —cytokine—> IL-8, TNF
  3. chemotaxis of inflam cells : neutrophils, eosinophils and fibroblasts

LEADS TO

  • ——–> 1. Diffuse interstitial pulmonary fibrosis
  • ——–> 2. DILATION of prox. small airways

ALVEOLITIS

  • type 1 pneumocyte damage
  • capillary damage, leakage, leads to interstitial and alveolar oedema —> Hyaline membrane formation
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15
Q

pathophysiology of idiopathic pulmonary fibrosis?

Late inflammatory stage

A
  1. increased permeability of capillary and alveoli
  2. inflammatory cells reach alveoli
  3. fibrosis
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16
Q

Summarise diagnosis of Idiopathic pulmonary fibrosis?

A
  1. Serum Acute phase reactant (lung inflammation)
    a) Anti-nuclear antibodies (ANA)
    b) rheumatoid factor (RF)
  2. increased m.phage and neutrophils
  3. restrictive thus lung volumes decreased, low FVC but FEV1/FVC ratio should be normal or slightly high
  4. Aa gradient increased
  5. DLCO decreased
17
Q

ABG of a patient with idiopathic pulmonary fibrosis may show?

A

Respiratory alkalosis due to dysponea

18
Q

What might be characteristically seen on CXR of patient with idiopathic pulmonary fibrosis?

A

Early
- bilateral, diffuse infiltrates

Late
- honeycomb lung, cysts surrounded by fibrosis

19
Q

Define sarcoidosis?

A
  1. chronic immune related
  2. multisystem granulomatous disease
  3. non-infectious, non ceasating granulomas
20
Q

Summarise the pathophysiology of sarcoidosis?

A
  • unknown antigen
  • CD4+ T-helper cells —–release—–> cytokines
  • non infectious, noncaseating granuloma, epitheloid histocytes (m.phages)
  • m.phages in granuloma release 1-a-hydroxylase enzyme
  • converts vitamin D to active form
  • hypervitaminosis D —–> Hypercalcaemia —-> calcium kidney stones, Very severe pain
  • increased Ca2+ absorption from small intestine and reabsorption from DCT via principle cells
21
Q

which intrinsic muscles of larynx open up the airway by separating the vocal folds?

A

posterior cricoarytenoid muscles

22
Q

All intrinsic muscles of the larynx are supplied by which nerve?

who’s the only exception?

A

recurrent laryngeal nerve of the vagus

only exception are cricothyroid which are supplied by external branch of superior laryngeal nerve.

23
Q

true vocal folds are lined by what mucosa?

A
  • stratified squamous mucosa , protective as vocal folds exposed to wear and tear.
  • not the typical resp epithelium that lines the rest of the tract.
  • epiglottis also lined by protective stratified squamous epithelium. largely composed of elastic cartilage.
24
Q

in embryology the thyroid gland descends from the …

A

foramen caecum

25
Q

describe the blood supply of the thyroid gland

A
  • superior thyroid artery which is a branch of the external thyroid artery.
  • inferior thyroid artery which is a branch of the thyrocervial trunk of first part of subclavian artery
26
Q

venous drainage of thyroid

A
  • superior and middle thyroid veins
  • to internal jugular veins
  • via inferior thyroid veins
  • to brachiocephalic vein
27
Q

what muscle causes tongue to protrude?

A
  • genioglossus muscle
  • tongue has squamous epithelium
  • thus tumours arising from tongue are typically squamus cell carcinomas
28
Q

all muscles of tongue are supplied by which nerve?

what is the only exception?

A
  • muscle of the tongue are supplied by hypoglossal nerve

- exception of palatoglossus muscle which is supplied by pharyngeal plexus of nerves

29
Q

what nerve may be injured during submandibular gland procedures?

A

hypoglossal nerve

30
Q

parathyroid gland are all usually supplied by which artery?

A

inferior thyroid artery

31
Q

calcitonin secreted from

A

parafollicular cells of thyroid glands

32
Q

why are salivary stones more commonly encountered in submandibular gland and less commonly found in parotid gland?

A
  • parotid mainly serous gland

- few scattered mucinous acini

33
Q

pes anserinus

A

five terminal branches of facial nerve

34
Q

four muscles of mastication are…

A
  1. Temporalis
  2. Masseter
  3. Medial pterygoid
  4. lateral pterygoid
35
Q

buccinator muscle innervated by

A

facial nerve

not a muscle of mastication

36
Q

muscles of mastication are innervated by the …

A

mandibular division of the trigeminal nerve

37
Q

describe the dual blood supply of the lungs?

A
  • via pulmonary artery and the bronchial arteries
  • thus obstruction of a small pulmonary arteriole by pulmonary embolus will have no minor effect if patient has intact bronchial circulation
38
Q

describe the differences in innervation of pleura covering the lungs?

A
  • visceral is poorly innervated, autonomic
  • parietal, rich innervation from intercostal nerves and phrenic nerve.
  • so in lung disease when disease crosses visceral to parietal pleura, pain becomes an important factor

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