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Progress Test > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Which cells are involved in the acute phase of asthma?

A

Mast cells

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2
Q

Allergic rhinitis, urticaria and eczema precede which kind of asthma?

A

Atopic

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3
Q

Which three medications can induce asthma?

A

NSAIDs
Beta blockers
Aspirin

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4
Q

What would the lung function test of an asthmatic show?

A

Variable airflow obstruction

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5
Q

A patient presents with:

  • wheezing
  • cough
  • sputum production
  • chest tightness
  • shortness of breath

with symptoms worsening at night.

Which pathology could this be related to?

A

Asthma

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6
Q

Which lung function test is the gold standard for asthma diagnosis?

A

Spirometry

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7
Q

A blood test of an asthmatic could show:

Eosinophil count > ___%
____ IgE in serum

A

4

Increased

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8
Q

What is the mechanism of action of B-adrenergic receptor agonists?

A

Activate B2 receptor -> activate adenyl cyclase -> ultimately SM relaxation and inhibition of mediator release

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9
Q

What are two examples of SABAs?

A

Salbutamol and Albuterol

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10
Q

Epinephrine, Salmeterol and Formeterol belong to which class of asthma drugs?

A

LABAs

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11
Q

What is the mechanism of anticholinergic agents?

A

Non-selectively inhibit pathway where ACh stimulates submucosal glands

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12
Q

What is the mechanism of action of Xanthine drugs?

A
  • Non selective phosphodiesterase inhibitor
  • Anti-inflammatory effect
  • Non-selective antagonism of adenosine
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13
Q

What is the mechanism of action of mast cell stabilisers?

A

Inhibit IgE mediated release from mast cells

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14
Q

What class of asthma drugs do Cromolyn sodium and Nodocromyl sodium belong to?

A

Mast cell stabilisers

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15
Q

Which drugs are used for short term relief of asthma symptoms?

A

SABAs and anti-cholinergics

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16
Q

What are the side effects of SABAs?

A
  • Tremors
  • Tolerance
  • Increased HR
  • Arteriole vasodilation
  • Hypokalemia
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17
Q

Which anticholinergic agent has the least side effects and tachyphylaxis?

A

Ipatropium bromide

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18
Q

Which anti-cholinergic can cause dry mouth, constipation, blurred vision and urinary retention?

A

Tiotropium

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19
Q

____ and ____ are used for maintenance control of asthma

A

LABAs and inhaled corticosteroids

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20
Q

In which patients is use of Theophylline particularly dangerous?

A

Patients with heart disease (potential for serious cardiac side effects)

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21
Q

What is the most effective class of medication for asthma control?

A

Glucocorticoids

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22
Q

Why are glucocorticoids administered alongside LABAs?

A
  • Cause up regulation of B-adrenergic receptors

- Prevents tolerance of B-agonists

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23
Q

Which asthma drug is most suited to treat aspirin induced asthma?

A

Leukotrine receptor antagonists

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24
Q

What is the best method of administering asthma drugs to children?

A

Spacer

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25
Q

A ____ allows multiple asthma medications to be administered at once

A

Nebuliser

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26
Q

How are asthma drugs administered in an emergency?

A

Endotracheal instillation

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27
Q

____ and ____ are two types of inhalers

A

Metered dose

Dry powder dervice

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28
Q

What is the defining clinical feature of chronic bronchitis?

A

Productive cough

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29
Q

What is the biggest risk factor for COPD?

A

Smoking

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30
Q

Clinical findings for COPD:

__ FVC
__ FEV1.0
__ FEV1.0/FVC
__ TLC

A

Dec FVC
Dec FEV1.0
Dec FEV1.0/FVC
Inc TLC

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31
Q

Chronic bronchitis involves the hypertrophy and hyperplasia of ____ and ____

A

Mucinous glands and goblet cells

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32
Q

Why must patients with chronic bronchitis cough to get rid of mucus plugs?

A
  • Excess mucus

- Poorly functioning cilia

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33
Q

What are the signs and symptoms of chronic bronchitis?

A
  • Wheezing
  • Crackling
  • Hypoxemia
  • Hypercapnia
  • Cyanosis
  • RHS heart failure
34
Q

What is the main approach to treating COPD?

A
  • Reduce risk factors

- Manage associated illnesses

35
Q

What is the defining feature of emphysema?

A

Structural changes in the airways

36
Q

What is the pathogenesis of emphysema?

A

Irritants -> inflammatory reaction -> break down of structural proteins in CT -> weakened airway walls

37
Q

Which pattern of emphysema is most common in smokers?

A

Centriacinar (upper lobes)

38
Q

What are the symptoms of emphysema?

A
  • Dyspnea
  • Exhale slowly through pursed lips
  • Weight loss
  • Hypoxemia (chronic)
  • Cough will small amount of sputum
  • Barrel shaped chest
39
Q

What findings would there be on a CXR of a patient with emphysema?

A
  • Increased A-P diameter
  • Increased lung field lucency
  • Flattened diaphragm
40
Q

What is the most common mutation in CF?

A

DeltaF508

41
Q

How may CF manifest in a newborn?

A

Meconium ileus

  • First still thick and sticky so becomes stuck in intestines
42
Q

What is the most prominent effect of CF in early childhood?

A

Pancreatic insufficiency

43
Q

What are symptoms of CF in early childhood?

A
  • Poor weight gain
  • Failure to thrive
  • Steatorrhea
44
Q

What is CF exacerbation?

A

Defective mucociliary action -> bacteria colonisation -> cough + fever

45
Q

Which two bacteria are most commonly implicated in CF exacerbation?

A

S. Aureus + P. Aeruginosa

46
Q

What is the leading cause of death in CF?

A

Respiratory failure

47
Q

How are newborns screened for CF?

A
  • Detection of IRT

- Sweat test

48
Q

Which medications are available to treat the symptoms of CF?

A

N-acetylcystine and dornase alfa

49
Q

Why are antibiotics ineffective for mycoplasmic pneumonia?

A

Mycoplasma have no cell wall

50
Q

Which two organisms are problematic in causing hospital acquired pneumonia?

A

MRSA and Pseudomonas Aeruginosa

51
Q

What happens following aspiration of stomach contents?

A

Chemical burn -> inflammatory reaction -> chemical pneumonitis -> weakened airways -> pneumonia

52
Q

A patient’s CXR shows patch areas of consolidation in the lower + right middle lobes.

What kind of pneumonia is this due to?

A

Bronchopneumonia

53
Q

What is the main causative organism of lobar pneumonia?

A

Streptococcus Pneumoniae

54
Q

What are the four stages of lobar pneumonia?

A

Congestion -> red hepatization -> grey hepatization -> resolution

55
Q

Which symptoms are associated with interstitial pneumonia?

A

Mild symptoms

  • Low fever
  • Minimal mucus
  • Non productive cough
  • Chest pains
56
Q

Histologically how does interstitial pneumonia differ to the other kinds of pneumonia?

A
  • No exudate/fluid

- Mononuclear infiltrate

57
Q

Which non-small cell carcinoma of the lung is associated with smoking?

A

SqCC

58
Q

SqCC of the lungs tend to arise in the ____ of the lung whereas AdenoCa arise in the ____

A

Major airways

Periphery

59
Q

Which type of x-ray gives the most accurate dimensions of the heart?

A

P-A

60
Q

In what instances would it be preferable to take an exhalation film?

A

Pneumothorax and atelectasis

61
Q

What steps comprise the A-F of CXR analysis?

A 
A - TracheA
B - Bones
C - Cardiac silhouette 
D - diaphragm
E F - Equal lung Fields
62
Q

Pleural effusion will cause tracheal deviation to the _____ side

A

Opposite

63
Q

How would you observe compression fractures in a CXR?

A

Disruption of regular intervals between vertebrae

64
Q

Which lung lobe does the RA abut?

A

Right middle lobe

65
Q

Which division of the heart does the lingula abut?

A

The left border

66
Q

What would be indicative of a bowel perforation in a CXR?

A

Any areas of density just underneath the diaphragm

67
Q

What is the meniscus sign?

A

Loss of the sharp costophrenic angle

68
Q

What is Westermark sign?

A

Pulmonary embolism -> blood shunted from affected to opposite side -> opposite side hyperaemic

69
Q

Upon examination of a patient’s CXR, you observe multiple calcified nodules in both upper lobes.

What is this indicative of?

A

Tuberculosis (until proven otherwise)

70
Q

What are the most important symptoms associated with pulmonary oedema?

A

Orthopnia and ankle oedema (CHF)

71
Q

What vascular changes are observed in a CXR of a patient with CHF?

A

Cephalisation -> vessels become engorged, upper lobe vessels more visible

72
Q

What are air bronchograms?

A

Where the outline of smaller bronchi are observed on the background of fluid

-> water density in the lungs but not in the airways

73
Q

What is the primary clinical indication for spirometry?

A

To establish or confirm diagnosis of an obstructive ventilatory defect

74
Q

Which clinical measurement is essential in diagnosing a restrictive lung disease?

A

Total Lung Capacity

75
Q

Which test is used for evaluation and follow up for parenchymal lung disease?

A

DLCO (alveolar-capillary diffusion assessment)

76
Q

Inhalation/exhalation in a flow volume diagram would be abnormal in a patient with COPD

A

Exhalation

77
Q

Inhalation/exhalation in a flow volume diagram would be abnormal in a patient with goitre

A

Inhalation

78
Q

Which long volume cannot be measured clinically?

A

Residual volume

79
Q

Architectural destruction and extrinsic constriction can be measured by which lung function test?

A

DLCO

80
Q

Which lung function test can distinguish between COPD and asthma?

A

DLCO

Progress Test (5 decks)

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