Respiratory Medicine [10&11]

Question 1

3 main reasons for respiratory issues

Answer 1

1. Ventilation - airway obstruction
2. Perfusion - circulation problems
3. Diffusion - thick scar tissue

Question 2

What is affected by fibrosis (scarring)

Answer 2

Interstitium - tissue between air sacs

Question 3

What are type 1 cells in the lungs for

Answer 3

Gas exchange - thin surface

Question 4

What are type 2 cells in the lungs for

Answer 4

Secreting surfactant
- resist surface tension so alveoli don’t collapse

Question 5

What are fibroblasts in the lungs for

Answer 5

They lay down collagen & elastin in fibrosis

Question 6

What is the perinuclear zone in type 1 cells

Answer 6

Clustered organelles & nucleus
Synthesises products that diffuse into cytoplasmic flaps

Question 7

Can type 1 cells regenerate

Answer 7

No
The have no mitosis potential

Question 8

Can type 2 cells regenerate

Answer 8

Yes
They can replace type 1 cells after injury

Question 9

What to macrophages in the lungs target

Answer 9

Particulate material that escapes tracheobronchial filters

Question 10

How do macrophages leave the lungs

Answer 10

Migrate to nearest bronchiole & exit via mucociliary escalator
Or pass into interstitium & exit via blood or lymph

Question 11

What mechanisms lead to bronchoconstriction

Answer 11

Inflammation
Obstruction
Mucus overproduction

Question 12

What happens to extra-cellular matrix in lung disease

Answer 12

Excessive ECM accumulation and reduced degradation of ECM
- scar tissue

Question 13

3 types of bronchodilator

Answer 13

Beta 2 agonist
Anticholinergic
Theophylline

Question 14

2 diseases that require bronchodilators

Answer 14

Asthma
COPD

Question 15

Bronchoconstriction reflex

Answer 15

Ach binds M3 Muscarinic receptors in muscle
Intracellular calcium release
Contraction

Question 16

What are anticholinergics

Answer 16

Competitive antagonists of Muscarinic ach receptors

Question 17

Example of short acting cholinergic

Answer 17

Ipratropium bromide

Question 18

Example of long acting anticholinergic

Answer 18

Tiotropium bromide

Question 19

Why are anticholinergics not helpful in asthma

Answer 19

They only reduced vagal my mediated bronchoconstriction
- not inflammatory mediated constriction

Question 20

Side effects of anticholinergics

Answer 20

Dry mouth
Urinary retention
Constipation

Question 21

How much inhaled ipratopium is absorbed

Answer 21

1-2%

Question 22

How is ipratropium eliminated

Answer 22

Unchanged in faeces or urine

Question 23

What could form a precipitate with ipratropium bromide

Answer 23

Eromolyn sodium

Question 24

Mechanism of beta 2 agonists

Answer 24

Bind G protein coupled beta 2 receptors
Activate adenylyl cyclase
Catalyses formation of cAMP
Activates PKA
Phosphorylates protein targets leading to muscle relaxation

Question 25

Beta 2 agonists - Pathways downstream of PKA lead to

Answer 25

Decreased Ca2+ - sliding filament theory -> contraction needs high Ca2+

Question 26

2 examples of short acting beta 2 agonists

Answer 26

Salbutamol Terbutaline

Question 27

2 examples of long acting beta 2 agonists

Answer 27

Salmeterol Formoterol

Question 28

Side effects of beta 2 agonists

Answer 28

Non-selective ones have non-specificity problems Tachycardia Tremor

Question 29

When is salbutamol used

Answer 29

Premature labour to prevent uterine muscle contraction

Question 30

What do theophylline’s do

Answer 30

Inhibit phosphodiesterase which breaks down camp - promotes lowering of Ca2+ levels - bronchodilation

Question 31

What causes decreased clearance of theophyllines

Answer 31

Heart failure Viral infections

Question 32

What causes increased clearance of theophyllines

Answer 32

Smoking Alcohol

Question 33

What do glucocorticosteroids do

Answer 33

Downregulate proinflammatory cytokines

Question 34

Example of oral steroid

Answer 34

Prednisolone

Question 35

Example of inhaled steroid & side effect

Answer 35

Beclomerhasone Can cause oral candidiasis

Question 36

What happened when histamine binds the H1 receptor

Answer 36

Increased calcium Contraction

Question 37

What happens when histamine binds the H2 receptor

Answer 37

Increased camp Gastric acid secretion Vasodilation

Question 38

What happens when histamine binds the H3 receptor

Answer 38

Decreased camp Decreased histamine release

Question 39

Example of an anti histamine

Answer 39

Loratidine for allergic inflammation

Question 40

Which generation of histamines can cross the blood brain barrier

Answer 40

First generation

Question 41

Which generation of histamines is non-sedating

Answer 41

Second generation

Question 42

What is an expectorant

Answer 42

Hypertonic saline Increases secretion and hydration of mucus

Question 43

What is a mucoregulator

Answer 43

Anticholinergic agents Decreases secretion volume

Question 44

What is a mucolytic

Answer 44

N-acetylcysteine Breaks disulphide bonds linking mucin polymers

Question 45

What is a mucokinetic

Answer 45

Bronchodilator Improves cough clearance

Question 46

What is the cough reflex

Answer 46

Vocal chords close Abdominals contract & intercostals brace Pressure in thorax Vocal chords open Expel air

Question 47

What drug class suppresses cough

Answer 47

Antitussive

Question 48

2 examples of antitussives

Answer 48

Dextromethorphan Codeine

Question 49

What is IPF and how is it treated

Answer 49

Idiopathic pulmonary fibrosis Treatments only reduce decline

Question 50

3 IPF treatments

Answer 50

Perfinidone Nintedamib Simtuzumab