Week 6 - Asthma

Question 1

how many lobes does the right lung have?

Answer 1

3

Question 2

what are the fissures in the right lobe?

Answer 2

oblique fissure (between inferior lobe and superior + middle lobes)

horizontal fissure (between superior and middle lobes)

Question 3

what are the superficial markers of the oblique fissure of the right lung?

Answer 3

begins roughly at the spinous process of the vertebra TIV level of the spine, crosses the fifth interspace laterally, and then follows the contour of rib VI anteriorly

Question 4

what are the superficial markers of the horizontal fissure?

Answer 4

follows the fourth intercostal space from the sternum until it meets the oblique fissure as it crosses rib V.

Question 5

what is adjacent to the medial surface of the right lung?

Answer 5

heart,
▪ inferior vena cava,
▪ superior vena cava,
▪ azygos vein, and
▪ esophagus.

Question 6

how many lobes does the left lung have?

Answer 6

2

Question 7

what are the superficial markers of the oblique fissure of the left lung?

Answer 7

marked by a curved line on the thoracic wall that begins between the spinous processes of vertebrae TIII and TIV, crosses the fifth interspace laterally, and follows the contour of rib VI anteriorly

Question 8

what is the lingula in the lungs and where is it?

Answer 8

From the anterior border of the lower part of the superior lobe a tongue-like extension (the lingula of the left lung ) projects over the heart bulge.

Question 9

what spinal levels does the trachea run from and to?

Answer 9

C6-T4/5

Question 10

when does the trachea bifurcate?

Answer 10

C4/5

Question 11

what is the carina?

Answer 11

bifurcation of the trachea

Question 12

what are the shapes of the right and left main bronchi?

Answer 12

right = wider and more verticle
left = thinner and more horizontal

Question 13

which lung are inhaled foreign bodies found?

Answer 13

right

Question 14

what do the main bronchi branch into?

Answer 14

lobar bronchi

Question 15

what are secondary bronchi?

Answer 15

lobar bronchi

Question 16

what do the lobar bronchi branch into?

Answer 16

segmental bronchi

Question 17

what are segmental bronchi also known as?

Answer 17

tertiary bronchi

Question 18

how many bronchopulmonary segments are there in each lung?

Answer 18

10

Question 19

what cells line the trachea?

Answer 19

pseudostratifies columnar ciliated epithelium

Question 20

which part of the bronchial tree contains goblet cells?

Answer 20

trachea and upper bronchi

Question 21

what are the features of the terminal bronchioles?

Answer 21

simple columnar epithelium
initially cilliated
no goblet cwlls

Question 22

what are the features of the respiratory bronchiole?

Answer 22

ciliated cuboidal epithelium

Question 23

what are the features of the alveoli?

Answer 23

squamous epithelium
type 1 pneumocytes = thin diffsuion barrier for gas exchange
type 2 pneumocytes = secrete surfactant which decreases surface tension and stops alveolar collapsing

Question 24

what are type 1 pneumocytes?

Answer 24

involved in gas exchange in the alveolar
thin wall

Question 25

what are type 2 pneumocytes?

Answer 25

secrete surfactant whcih decreases the surface tension so alveolar dont collapse in exhalation

Question 26

what is the function of the conduction region in the lungs?

Answer 26

• Conducting portion (nose, pharynx, larynx, trachea, bronchi and bronchioles) → serve to humidify, warm and filter air
  ○ Humidification → requires serous and mucous secretions
  ○ Warming → relies on the extensive capillary network that lays within alveoli
  ○ Filtration → occurs by trapping mechanism of mucus secretions and ciliary beating
  § Goblet cells → columnar epithelial cells that secrete high molecular weight mucin glycoproteins into the lumen of the airway and provide moisture to epithelium while trapping incoming particulate and pathogens

Question 27

what is the blood gas barrier? name each step the O2 goes through to get to the blood

Answer 27

Type 1 alveolar cell -> basement membranes -> endothelial cells of capillary wall -> blood from pulmonary arteries

Question 28

where is the respiaratory centre of the brain? how does it send signals to the resp muscles

Answer 28

pons and medulla
send impulses to primary resp muscles via phrenic and intercostal nerves

Question 29

what do the ventral, dorsal and pontine areas control in ventilaiton?

Answer 29

• Ventral: expiration
• Dorsal: inspiration
  Pontine: rate and pattern of breathing

Question 30

what happens when
peripheral chemoreceptors detect low O2?

Answer 30

impulses travel through glossopharyngeal and vagus newver to medulla oblongata and pons
Brainstem then causes
1. Respiratory rate,tidal volume, and cardiac output to increase
2. Blood flow directed to kidneys and brain

Question 31

what do central chemoreceptors detect?

Answer 31

partial pressure of co2

Question 32

what medications are classed as relievers in asthma?

Answer 32

sabas
e.g. salbutamol

Question 33

what medications are classed as preventers in asthma?

Answer 33

ICSs
e.g. beclamethosone

Question 34

what are leukotrine receptor antagonists? give an example?

Answer 34

montelukast
Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and mucus secretion in the airways. Leukotriene receptor antagonists work by blocking the effects of leukotrienes

Question 35

what is theophylline?

Answer 35

This works by relaxing bronchial smooth muscle and reducing inflammation. Unfortunately it has a narrow therapeutic window and can be toxic in excess so monitoring plasma theophylline levels in the blood is required. This is done 5 days after starting treatment and 3 days after each dose changes.

Question 36

what are some side effectts of anti-inflammatory drugs?

Answer 36

· Dysphonia (effect of voice box, altered voice)
· Oropharyngeal candidiasis
· Adrenal suppression
· Osteoporosis
hyperglycaemia

Question 37

what is the aim of asthma treatment?

Answer 37

§ No daytime symptoms
§ No night-time awakening due to asthma
§ No need for rescue medication
§ No asthma attacks
§ No limitations on activity including exercise
§ Normal lung function (FEV and/or PEF >80%) predicted or best
Minimal side effects from medication

Question 38

what is the stepwise management of asthma?

Answer 38

SABA required at all steps

1. regular preventer (low dose ICS)
2. initial add-on therapy (add inhaled LABA to low dose ICS)
3. additional controller therapies (increase ICS to medium dose/add leukotrine receptor antagonist)
   if LABA isnt working from previous step them stop it
4. specialist therapies

Question 39

what is classed as a moderate acute asthma exacerbation?

Answer 39

increasing symptoms
* PEFR 50 – 75% predicted
Speaking full sentences

Question 40

what is classed as a severe asthma attack?

Answer 40

any one of these:
PEFR 33-50% predicted
Resp rate >25
Heart rate >110
Unable to complete sentences in one breath

Question 41

what is classed as a life-threatening asthma attack?

Answer 41

PEFR 33-50% predicted
Resp rate >25
Heart rate >110
Unable to complete sentences in one breath

Question 42

what is classed as a near fatal asthma attack?

Answer 42

raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Question 43

patient has PEFR of 50-75% of best? is this an asthma attack and if so what type?

Answer 43

moderate acute asthma attack

Question 44

what PEFR indicates a severe asthma attack?

Answer 44

33-50% of best

Question 45

what PEFR indicates a life threatening asthma attack?

Answer 45

<33% of best

Question 46

how is a moderate acute asthma attack treated?

Answer 46

Treated at home or in primary care

Admit people with a moderate asthma exacerbation with worsening symptoms despite initial bronchodilator treatment and/or who have had a previous near-fatal asthma attack.

SABA 2.5mg to be repeated x2 over 60mins if requires
nebulised ipratropium bromide (250-500ug 3-4 times a day)