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Respiratory > Respiratory overview from UEMS tutors > Flashcards

Respiratory overview from UEMS tutors Flashcards

1
Q

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?

A

Angle of Louis - T4/T5

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2
Q

vertebral level of sternal notch

A

T2/3

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3
Q

vertebral level of diploid process

A

T10

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4
Q

on the medial side of the left lung what in the indentation called

A

cardiac notch

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5
Q

what does the oblique fissure separate in the right lobe

A

the upper and middle lobes from the lower lobes

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6
Q

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?

A

halfway between the 9th and 10th rib ( bottom of the lung in the intrapluerAL space)

thoracicentesis - mid axillary line
to avoid neurovascual bundles

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7
Q

where do you perform an intercostal nerve block

A

just below the rib

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8
Q

internal muscle are up towards the chest ad external muscle are like what

A

hands in your pockets

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9
Q

what is the major muscle of inspiration that has a central tendon and hemidomes lowered to the costal margin

A

diaphragm

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10
Q

what do the external intercostals do

A

elevate the ribs during forced inspiration

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11
Q

which accessory muscle of inspiration elevates and fixes the sternum

A

sternocleidomastoid

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12
Q

which accessory muscles of inspiration fix the 1st and 2nd ribs

A

scalenes

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13
Q

which accessory muscle of inspiration , when the scapula is stabilised fixes the 3-5th ribs

A

pec minor( MAJOR)

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14
Q

when the scapula is stablasied what access muscle of inspiration fixes the upper 8th and 9th ribs

A

serrates anterior

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15
Q

what is the process of expiration of how the ribs and chest wall move back into place

A

elastic recoil

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16
Q

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

A

yes

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17
Q

what are the accessory muscles of expiration which increase the intra-abdominal pressure

A

rectus abdominus and transversus abdominus

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18
Q

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

A

inspiration

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19
Q

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

A

expiration

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20
Q

what is a pneumothorax

Sx ?

A

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.

21
Q

what is a tension penuomothorax

A

A tension pneumothorax = rapidly getting worse (tracheal deviation, decreased BP, midline shift)

22
Q

Your flatmate has a really productive cough. What cell in her lungs is producing all the mucous?

A

goblet cells

23
Q

function of type 1 alveolar cells

A

surface coverage , alveolar capillary barrier formation , gas exchange and alveolar fluid clearance

24
Q

function of type 2 alveolar cells

A

surfactant secretion, epithelial cell regeneration after injuries , barrier formation , inflammatory mediators production

25
Q

function of endothelial cells

A

alveolar capillary barrier formation

gas exchange and nfalmamory mediators production

26
Q

function of alveolar macrophages( known as dust cells)

A

danger associated molecular patterns recognition , immune response trigger , chemotactic and inflammatory mediators

27
Q

function of surfactant r

A

reduce surface tension and increase compliance and contribution to lung stability

28
Q

what is the hormone responsible for surfactant production

A

cortisol

29
Q

if babies are born prematurely what problem can occur due to not enough sufacnta

A

repsriaotry distress syndrome

mothers are given prophylaxis ( corticosteroids) - trigger surfactant
given before it develops

30
Q

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)?

A

adrenaline

Type 1 hypersensitivity too
allergy and autoimmune

31
Q

what is an allergy

A

Allergy – abnormal immunological response to otherwise harmless environmental stimulus

32
Q

what is an autoimmune disease

A

Autoimmune disease – abnormal immunological response directed against an antigen within the body

Types
1- Anaphylactic 
2- cytotoxic 
3- immune complex
4- delayed type
33
Q

types of hypersensitivity

A

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).

34
Q

FEV1

A

FEV1 – amount of air you can force out in 1 second

35
Q

FVC

A

FVC – all the air you can breathe out of your lungs after a nig breath in

36
Q

PEFR

A

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

37
Q

symptoms of asthma

A 
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
38
Q

what is the asthma allergy mechanism

A

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.

39
Q

asthma is an obstructive disease what would results show

A

Decreased FEV1
FVC is the same
FEV1/FVC decreases

treated with SABA and corticosteroids

40
Q

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

A

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

41
Q

recurrent laryngeal nerve injury symptoms

A

Hoarse weak voice

Bovine cough

42
Q

what is penetrance

A

how likely it is the genotype will be expressed in the phenotype

43
Q

anticipation

A

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
44
Q

antibiotics therapy

A 
beta lactams of cell wall - penicillin 
cell membrane - polymyxins 
30S subunit - ahminoglycosides 
50S - macrocodes 
RNA polymerase - rifampin 
DNA gyrate - quinolone 
folate synthesis - sulphonamides
45
Q

where are the most ROS produced from

A

complex 1 and 3

46
Q

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?

A

cyanide poisoning

block ETC by binding to cytochrome oxidase.
N & V
Headache 
Altered mental state
Seizures
Tachypnoea
Tachy cardia

histotoixc hypoxia

47
Q

example of hypoxic hypoxia

A

COPD

48
Q

example of circulatory hypoxia

A

cardiac failure and hypotensive shot

Respiratory (22 decks)

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