Respiratory overview from UEMS tutors Flashcards
You are on placement and you are examining a patient with a respiratory problem. The doctor asks you to point out where the the trachea bifurcates (carina) on the patient. What landmark on the patient would you feel for?
Angle of Louis - T4/T5
vertebral level of sternal notch
T2/3
vertebral level of diploid process
T10
on the medial side of the left lung what in the indentation called
cardiac notch
what does the oblique fissure separate in the right lobe
the upper and middle lobes from the lower lobes
You are an F1 doctor and a patient presents to you with pleural effusion (fluid on the lung). Your consultant asks you to drain the fluid. Where do you stick your needle?
halfway between the 9th and 10th rib ( bottom of the lung in the intrapluerAL space)
thoracicentesis - mid axillary line
to avoid neurovascual bundles
where do you perform an intercostal nerve block
just below the rib
internal muscle are up towards the chest ad external muscle are like what
hands in your pockets
what is the major muscle of inspiration that has a central tendon and hemidomes lowered to the costal margin
diaphragm
what do the external intercostals do
elevate the ribs during forced inspiration
which accessory muscle of inspiration elevates and fixes the sternum
sternocleidomastoid
which accessory muscles of inspiration fix the 1st and 2nd ribs
scalenes
which accessory muscle of inspiration , when the scapula is stabilised fixes the 3-5th ribs
pec minor( MAJOR)
when the scapula is stablasied what access muscle of inspiration fixes the upper 8th and 9th ribs
serrates anterior
what is the process of expiration of how the ribs and chest wall move back into place
elastic recoil
do the internal and innermost intercostals depress the interosseous parts of ribs during forced expiration and elevate the interchondral parts of the ribs during forced expiration respectively
yes
what are the accessory muscles of expiration which increase the intra-abdominal pressure
rectus abdominus and transversus abdominus
Inspiratory muscles contract (external inter coastal muscles and diaphragm)
Intrapleural pressure (pip) becomes more negative
Increases difference between Palv and Pip = increases Ptp (trans pulmonary pressure- arbitrary)
Alveolar volume increases
Palv decreases
Difference in pressure between atm and alv
inspiration
Inspiratory muscles relax (usually passive but when active internal inter coastal muscles contract)
Pip becomes less negative
Decreases difference between Palv and Pip = decreases Ptp
Alveolar volume decreases (elastinnnnnn)
Palv increases
Difference in pressure between alv and atm
expiration
what is a pneumothorax
Sx ?
Air within the pleural space that can’t escape (so its like a one-way valve)
Presents with a sudden onset of SOB, chest pain, dyspnoea, dizziness. Usually young, tall, slim men.
what is a tension penuomothorax
A tension pneumothorax = rapidly getting worse (tracheal deviation, decreased BP, midline shift)
Your flatmate has a really productive cough. What cell in her lungs is producing all the mucous?
goblet cells
function of type 1 alveolar cells
surface coverage , alveolar capillary barrier formation , gas exchange and alveolar fluid clearance
function of type 2 alveolar cells
surfactant secretion, epithelial cell regeneration after injuries , barrier formation , inflammatory mediators production
function of endothelial cells
alveolar capillary barrier formation
gas exchange and nfalmamory mediators production
function of alveolar macrophages( known as dust cells)
danger associated molecular patterns recognition , immune response trigger , chemotactic and inflammatory mediators
function of surfactant r
reduce surface tension and increase compliance and contribution to lung stability
what is the hormone responsible for surfactant production
cortisol
if babies are born prematurely what problem can occur due to not enough sufacnta
repsriaotry distress syndrome
mothers are given prophylaxis ( corticosteroids) - trigger surfactant
given before it develops
You are walking down the street and come across a person who has collapsed. He is wheezing, is clammy, has a low pulse and has swollen lips and tongue. You recognize this as being an anaphylactic reaction. What would you give to treat him (assuming you are carrying a pharmacy lol)?
adrenaline
Type 1 hypersensitivity too
allergy and autoimmune
what is an allergy
Allergy – abnormal immunological response to otherwise harmless environmental stimulus
what is an autoimmune disease
Autoimmune disease – abnormal immunological response directed against an antigen within the body
Types 1- Anaphylactic 2- cytotoxic 3- immune complex 4- delayed type
types of hypersensitivity
Type 1: Allergic or immediate hypersensitivity, onset within minutes, involves development of IgE antibodies in response to harmless antigens, eg asthma, anaphylaxis
Type 2: is called cytotoxic as it causes antibody mediated destruction of healthy cells, onset within minutes to hours, involves IgM or IgG antibodies, eg Graves disease, myasthenia gravis
Type 3: immune complex hypersensitivity, onset usually 2-6 hours, eg Farmer’s / Pigeon Fanciers lung and serum hypersensitivity
Type 4: delayed hypersensitivity reaction, inflammation by 2-6 hours and peaks by 24-48 hours. Results from interaction of T cell-initiated inflammation and does not involve antibodies. Eg contact dermatitis, rheumatoid arthritis, multiple sclerosis, drug reactions (eg Stevens-Johnson syndrome).
FEV1
FEV1 – amount of air you can force out in 1 second
FVC
FVC – all the air you can breathe out of your lungs after a nig breath in
PEFR
PEFR/PEF (peak expiratory flow rate) – highest rate of expiration (as soon as you breath out)
These are influenced by:
Resistance = ease with which gas flows through conducting airways
Compliance = expandability of lungs and chest wall
obstructive disease resistance goes up
in restrictive disease compliance decreases
symptoms of asthma
Wheeze (expiration) Dyspnoea Cough (maybe with sputum) (often at night as airway resistance tends to be higher at night for asthmatics) Tachypnoea Tachycardia Hyperinflated chest
vasodialtion hyperplasia desquamation odema hypertorphy thickenign collagen deposition partial occlusion of brocnhial lumen by mucus plug
what is the asthma allergy mechanism
Immunological mechanism:
Mediated by IgE- formed in response to intial exposure to allergen.
In the 2nd exposure the IgE antibodies, now bound to the mast cells via their fc binding region will then form a complex with the antigen.
This causes degranulation of mast cells.
Smooth muscle contraction- spasmogens
Inflammation of lung lining- inflammatory cytokines.
Mucous is released into airways- narrow.
asthma is an obstructive disease what would results show
Decreased FEV1
FVC is the same
FEV1/FVC decreases
treated with SABA and corticosteroids
An old man presents to clinic with barrel chest, sob, history of smoking and cyanosis in his extremities. This is his CXR. What pathology can you identify
COPD
Types Emphysema Long term exposure to irritant Immune destruction of alveolar sacs Decreases elasticity Air retained in lung= hyper inflation
pink puffer
Chronic bronchitis Long term exposure to irritant Inflammatory response in bronchi CHRONIC INFLAMMATION Build up of mucus Chronic narrowing of air ways. Treatment- symptomatic treatments NO CURE.
blue bloater
recurrent laryngeal nerve injury symptoms
Hoarse weak voice
Bovine cough
what is penetrance
how likely it is the genotype will be expressed in the phenotype
anticipation
severity of the mutation increase down the generations
Autosomal dominance- Males= Female MULTIPLE generations Autosomal recessive Males= Female SINGLE generation X- linked Recessive ONLY males (basically) Transmitted through FEMALEZ X link dominant Females less severely effected No male to male transmission
antibiotics therapy
beta lactams of cell wall - penicillin cell membrane - polymyxins 30S subunit - ahminoglycosides 50S - macrocodes RNA polymerase - rifampin DNA gyrate - quinolone folate synthesis - sulphonamides
where are the most ROS produced from
complex 1 and 3
60 year old man presents to ED after he is caught in a fire in the plastic bottle factory where he works . He says he feels dizzy and you notice his cheeks are cherry red and his lips are cyanotic. What do you suspect?
cyanide poisoning
block ETC by binding to cytochrome oxidase. N & V Headache Altered mental state Seizures Tachypnoea Tachy cardia
histotoixc hypoxia
example of hypoxic hypoxia
COPD
example of circulatory hypoxia
cardiac failure and hypotensive shot
