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Phase 3 > Respiratory (Week 8) > Flashcards

Respiratory (Week 8) Flashcards

1
Q

Define ‘residual volume’ in terms of spirometry testing

A

Air in the lung which cannot be blown out

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2
Q

In relation to lung function, what term defines the measurement from being fully inspired to full expiration?

A

Vital capacity

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3
Q

What 2 results in reversibility testing spirometry suggest a diagnosis of asthma?

A

15% and 400ml reversibility in FEV1

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4
Q

What does an FEV1/FVC ration <70% indicate?

A

Obstructive disease

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5
Q

What FEV1/FVC ratio shows restrictive lung disease?

A

> 70%

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6
Q

Name three causes of hypoxaemia

A

Hypoventilation
Ventilation/perfusion mismatch
Shunting (e.g. congenital heart disease)

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7
Q

What PCO2 measurement would indicate type II respiratory failure?

A

PCO2>6

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8
Q

A PCO2 of <6 would indicate what?

A

Type I respiratory failure

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9
Q

Name 3 cell types associated with COPD?

A

CD8+ cells, macrophages and neutrophils

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10
Q

Which deficiency present in some COPD patients means they are unable to balance destructive enzymes in lungs?

A

Alpha 1 anti-trypsin deficiency

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11
Q

Define chronic bronchitis

A

Productive sputum most days for at least 3 months in at least 2 years

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12
Q

In chronic bronchitis, what causes loss of interstitial support in airways leading to inflammation?

A

Free radicals from neutrophils

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13
Q

Define emphysema

A

Permanent enlargement of airspaces distal to terminal bronchioles

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14
Q

Name 3 features of COPD on CXR

A

Hyperinflated lungs
Thin heart
Flattened hemi-diaphragm
Dark lungs

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15
Q

In COPD, what does <30% predicated FEV1 indicate?

A

Stage 4 (very severe) disease

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16
Q

Define pneumothorax

A

Air within pleural cavity causing collapse of elastic lung

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17
Q

Name three classifications of pneumothorax determined by cause

A

Traumatic
Iatrogenic
Spontaneous (primary/secondary)

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18
Q

If tension pneumothorax goes untreated, how does arrest occur?

A

Increased intra-pleural pressure leading to impaired venous return and BP fall

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19
Q

What measurement defines a ‘small’ pneumothorax

A

<2cm

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20
Q

Define talc pleurodesis in terms of pneumothorax management

A

Medicated talc applied to visceral pleura causes inflammatory response of adhesion of pleura to chest wall

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21
Q

Define the term allergy

A

Immune mediated intolerance of an external factor

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22
Q

Define the term intolerance

A

Inability to cope with normally acceptable conditions

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23
Q

What pathological mechanism causes a wheeze?

A

Turbulent airflow, a consequence of allergy

24
Q

What two injectable agents can be effective in asthma management?

A

Anti-IL5 and anti-IL13

25
Q

What disease is a result of allergy of the lung parenchyma caused by a trigger?

A

Extrinsic allergic alveolitis (EAA)

26
Q

In EAA, chronic exposure to triggers can lead to which 2 lung complications?

A

Fibrosis (interstitial scarring) and emphysema

27
Q

What fungus colonises keratinised areas?

A

Dermatophytes (ringworm)

28
Q

Fungal meningitis is caused by which fungus?

A

Cryptococcus neoformans

29
Q

Which fungal infection only occurs in immunocompromised patients?

A

Pneumocystis jiroveci

30
Q

What is the mechanism of action of the anti-fungal Amphotericin B

A

Exploits ergosterol by forming pore in fungal membrane = cell death

31
Q

What is the function of ergosterol?

A

An essential part of fungus plasma membranes

32
Q

Why would IV magnesium be given in life threatening asthma exacerbations?

A

To relax smooth muscle and block histamine release from mast cells

33
Q

What is the general MOA of corticosteroids?

A

Bind to glucocorticoid receptors to dampen pro-inflammatory genes by reversing histone acetylation

34
Q

How do anti-muscarinic drugs work?

A

Antagonist of M1 and M3 cholinergic receptors in lungs to counteract direct bronchoconstriction

35
Q

Give an example of

a) Short acting anti-muscarinic
b) Long-acting anti-muscarinic

A

a) Ipratropium bromide

b) Tiotropium

36
Q

Briefly define the MOA of methylxanthines

A

Non-selective phosphodiesterase inhibitor which increases cAMP to cause bronchial SM relaxation

37
Q

What is the function of the drug Carbocisteine in COPD?

A

Mucolytic to reduce sputum viscosity

38
Q

What is the function of the drug Roflumilast in COPD?

A

Phosphodiesterase-4 selective inhibitor to reduce pro-inflammatory cytokines

39
Q

Define pleural effusion

A

> 15ml fluid in pleural space

40
Q

What usually causes transudate pleural effusions?

A

Excess fluid being pushed into pleura bilaterally with no extra cause e.g. due to heart failure

41
Q

What usually causes exudate pleural effusions?

A

An additional causative pathology e.g. malignancy or empyema

42
Q

In pleural effusion, what does grey fluid on ultrasound usually indicate?

A

Exudate pleural effusion due to excess protein in fluid appearing grey

43
Q

In what circumstance should a pleural effusion NEVER be drained?

A

If the cause of the effusion is undiagnosed

44
Q

What would you expect the pH and glucose levels to be in a para-pneumonic pleural effusion? (arises as a result of pneumonia)

A

pH <7.2

Glucose <2.2

45
Q

What three symptoms occur in obstructive sleep apnoea?

A
  1. Upper airway obstruction during sleep
  2. Intermittent hypoxia
  3. Sleep fragmentation
46
Q

Name three treatments of sleep apnoea

A
  1. Continuous positive airways pressure (CPAP)
  2. Mandibular advancement device
  3. Sleep position trainers
47
Q

Name three non-metastatic effects of lung cancer

A
  1. Cushing’s (ACTH secreting tumour)
  2. SIADH (ADH secretion leading to water retention)
  3. Hypercalcaemia (parathyroid hormone related peptide secrtetion causing osteoclast activity)
48
Q

Which type of lung cancer occurs in the periphery of the lungs and more commonly in women?

A

Adenocarcinoma

49
Q

Which lung cancer type is the most aggressive and metastasises early in the disease process?

A

Small cell carcinoma

50
Q

Define mesothelioma

A

Pleural tumour almost always caused by asbestos exposure

51
Q

Define sarcoidosis

A

Multisystem inflammation of unknown cause, commonly affecting lungs and intrathoracic lymph nodes

52
Q

Name 2 signs of Idiopathic pulmonary fibrosis

A

Bibasilar crackles

Subpleural honeycombing

53
Q

Define pulmonary fibrosis

A

Scarring of the lungs with a specific cause such as smoking

54
Q

Give an example of an occupational cause of pulmonary fibrosis

A

Asbestos exposure

55
Q

Give two examples of a drug which can cause pulmonary fibrosis

A

Amiodarone

Methotrexate

56
Q

Give two examples of diseases which can cause pulmonary fibrosis

A

Lupus

Rheumatoid arthritis

57
Q

What imaging method is used to diagnose pulmonary fibrosis?

A

High resolution CT scan (HRCT)

Phase 3 (15 decks)

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