29/3/22

Question 1

What is meant by ‘lung compliance’?

Answer 1

Compliance is a measure of effort that has to go into stretching or distending the lungs - GETTING AIR IN

If you DECREASE COMPLIANCE you INCREASE how much WORK it takes to inflate the lungs

Question 2

How is FEV1/FVC affected in COPD and pulmonary fibrosis?

Answer 2

FEV - functional expiratory vol.
FVC - functional vital capacity

COPD - decreased
Fibrorsis - same or increased (problem with getting air in rather than out)

Question 3

What is a normal FEV1/FVC?

Answer 3

75%

Question 4

What impact does bronchodilators have on FEV1/FVC in COPD?

How does this differ in asthma?

Answer 4

Remains below 70%

Improves by about 15% in asthma

Question 5

Hyperventilation leads to what ABG?

What causes tingling around the mouth?

Answer 5

Respiratory alkalosis

Ca+ travels round the body bound to albumin or free in the blood
Alkalosis of the blood means more is bound to albumin which leads to reduced free Ca2+ and symptoms of hypocalcaemia

Question 6

A low PO2 leads to pulmonary vasoconstriction or dilation?

Answer 6

Constriction because want to direct blood to alveoli which are better ventilated

(opposite of what happens in rest of body)

Question 7

Match:

• parasympathetic
• sympathetic
• bronchodilation
• bronchoconstriction

Answer 7

Dilate - symapthetic

Constrict - parasympathetic

Question 8

Is compliance increased or decreased in emphysema?

Answer 8

Increased

- elastic recoil is lost so lungs can inflate very easily but struggle to get air out

Question 9

What way does the trachea deviate in tension pneumothorax?

Answer 9

Away from the side

- increase in pressure in side of pneumothorax pushes trachea to opposing side

Question 10

Does pneumothorax cause hypo or hypertension and why?

Answer 10

Hypotension as increase in pleural pressure causes an decrease in venous return (as blood returns into the thorax via the vena cavas they have to work against an increase in pressure) and as a result less preload

Question 11

Does the spinal accessory enter or exit through the foramen magnum?

Answer 11

Enter

Question 12

Describe how saturation and PO2 (O2 concentration in the blood) changes with anaemia:

Answer 12

Sats. will remain high because Hb that is there is fully oxygenated

PO2 will remain normal as PO2 only changes if respiratory problem (PO2 is not dependant on Hb at all) - simply how much O2 is dissolved in the blood

• (remember PO2 is like conc. in air and then moves to area of lower PO2)

Question 13

What impact does COPD have on total lung capacity.

With emphysema what would you hear on percussion?

Answer 13

Increases total lung capacity because alveoli are destroyed

Hyper-resonant

Question 14

What is the mnemonic for treatment of pulmonary oedema?

Answer 14

POND

Position
O2
Nitrates
Diuretics

Nitrates because they cause venous dilation and reduce the preload on the heart

And morphine

Question 15

What murmur is most closely associated with AF?

Answer 15

Mitral stenosis

Question 16

In an acute setting what impact will there be on the HCO3?

Answer 16

None - takes a long time for there to be an impact on HCO3

Question 17

What are your next investigations in a patient that presents with headache?

Answer 17

cranial nerve exam
upper and lower neuro exam
fundoscopy
FBC + CRP
~ CT scan

Question 18

In what kind of palsy would you see a uvula deviation?

If the palsy is in the right side which way does the uvula deviate?

Answer 18

Vagus palsy

Left side

Question 19

What clinical sign is common in optic neuritis?

Answer 19

Red desaturation - reds appearing less red

Question 20

If someone wishes to commence pharma therapy after understanding that there is no pathology in an essential tremor. What do you use?

Answer 20

Propanalol and primidone

Question 21

We know MND is a clinical diagnosis. However what can support the diagnosis?

Answer 21

Electromyograph revealing diffuse denervation

Question 22

Write out the GCS

A GCS below what indicates the need for ventilation?

Answer 22

Eyes
4 - open 
3 - open to words
2 - open to pain 
1 - do not open

Voice
5 - respond and orientated
4 - confused
3 - inappropraite words
2 - inappropriate sounds
1 - nothing 

Motor 
6 - obeys command
5 - localises pain 
4 - withdraws from pain 
3 - abnormal flexion 
2 - abnormal extension 
1 - nothing 

<8 = intubation

Question 23

What 10 questions could you ask a patient with delirium/dementia to assess their current cognition?

Answer 23

• Name
• DOB
• Where they live?
• Where they are right now?
• Recognition of 2 people
• What year is it
• Name of the monarch
• Name of prime minister
• Dates of WW2
• Count backward from 20-1

Question 24

Smear/smudge cells = ?

Answer 24

Chronic lymphoid leukaemia

Question 25

Middle aged patient with cancer symptoms and massive splenomegaly?

Answer 25

CML

Question 26

What is the first line management for autoimmune haemolytic anaemia?>

Answer 26

Steroids

Question 27

The pre and postcentral gyrus are found where and are responsible for what?

Answer 27

Pre - frontal lobe pre the central sulcus
- motor area

Post - parietal lobe post the central sulcus
- sensory area

Question 28

What is the name of the fissure between the two hemispheres and between the frontal/parietal lobe and the temporal lobe?

Answer 28

Two hemispheres - longitudinal fissure

Temporal lobe etc. - lateral fissure

Question 29

What is the name of the dura mater found between the two hemispheres?

Answer 29

Falx cerebri