breathing Flashcards
(253 cards)
1
Q
boyle’s law
A
states that the pressure exerted by a gas is inversely proportional to to its volume (P a 1/V).
Note that gases (singly or in mixtures) move from areas of high pressure to areas of low pressure.
2
Q
Dalton’s law
A
states that the total pressure of a gas mixture is the sum of the pressures of the individual gases.
3
Q
Charles law
A
states that the volume occupied by a gas is directly related to the absolute temperature (v a T)
4
Q
henry’s law
A
states that the amount of gas dissolved in a liquid is determined by the pressure of the gas and it’s solubility in the liquid.
5
Q
expiratory reserve volume
A
1100 mL
6
Q
what is the vital capacity volume
A
4600 mL
7
Q
inspiratory reserve volume
A
3000 mL
8
Q
dead space volume
A
150 mL
9
Q
what is the alveolar ventilation pressure for o2
A
13.3 kPa - 100mm hg
10
Q
what is the alveolar ventilation pressure for Co2
A
5.3 kPa - 40 mm hg
11
Q
during inspiration diaphragm does
A
contract and the volume increases
12
Q
during expiration the diaphragm does
A
relax and the volume decreases
13
Q
intra thoracic alveolar pressure is
A
negative or positive in comparison to atmospheric pressure
14
Q
intra pleural pressure
A
always negative
15
Q
trans pulmonary pressure
A
always positive
16
Q
the pulmonary circulation is an example of what system?
A
high flow, low pressure system
17
Q
tissue values partial pressure of oxygen and carbon dioxide
A
02 - 40 mmHg (5.3kPa)
C02- 46 mmHg (6.2kPa)
18
Q
factors that affect gas exchange are
A
partial pressure gradient
gas solubility
surface area
thickness of membrane
19
Q
what is the perfect ventilation: perfusion ratio
A
1
20
Q
alveolar dead space causes
A
pulmonary vasodilation in response in increase oygen and bronchial constriction in response to alveolar decreases carbon dioxide levels
21
Q
anatomical dead space refers to
A
air in the conducting zone of the respiratory tract
22
Q
Type 2 alveolar cells produce what which does what?
A
surfactant increases lung compliance reduces recoil makes breathing easier effective in small alveoli relaxes water tension
23
Q
equation of LaPlace
A
P=2T/r
24
Q
high compliance refers to
A
large increase in lung volume in response to a small decrease in ip pressure
25
compliance represents
stretch ability
26
examples of obstructive lung disorders
asthma
| COPD (bronchitis or emphysema (loss of elasticity) - very low FEV1, slightly low FVC (low ratio)
27
examples of restrictive lung disorders
fibrosis
infant respiratory distress syndrome (no surfactant)
oedema
Pneumothorax
normal or elevated FEV1/FVC ratio, but severely decreased lung capacity. use FEF.
28
what is the test for breathing?
spirometry
29
haemoglobin increases oxygen carrying in RBC to how much?
200ml
30
02 solubility in water is
0.03ml/L/mmHg
31
what is the oxygen demand of resting tissues?
250ml/min
32
Haemoglobin A consists of
2 alpha and two beta strands with each having a heme group with an iron centre
33
each gram of haemoglobin can bind to
1.34ml of oxygen
34
how long does oxygen saturation with haemoglobin take?
0.25 seconds
35
at resting cell partial pressure of 40mm Hg o2 what is the saturation of haemoglobin
75%
36
what factors effect haemoglobin saturation
2,3-DPG, pH, PCO2, and temperature
37
how many more times stronger is carbon monoxide's affinity for haemoglobin
250x
38
a PCO of what is sufficient for causing carboxyl haemoglobin formation
0.4mmHg
39
how is carbon dioxide transported?
7% directly in plasma
23% as deoxyhaemoglobin
70% as bicarbonate ions
40
hypoventilation will result in respiratory..
acidosis
41
hyperventilation will result in respiratory..
alkalosis
42
the DRG controls
the dorsal respiratory group controls the inspiratory muscles
43
the VRG controls
the ventral respiratory group controls expiratory muscles and inspiratory pharynx, larynx and tongue muscles
44
the central chemoreceptor in the medulla is driven by
hypercapnea - raised partial pressure of carbon dioxide
45
during acidosis ventilation is
stimulated
46
during alkalosis ventilation is
inhibited and vomiting
47
FEV1/FVC <70%
obstructive lung disease
48
FEV1 > 80%
normal
49
FEV1 < 80%
restrictive lung disease
50
what are the possible complications of CODP
```
Pneumonia
macro nutrient deficiency
muscle wasting
polycythaemia
pulmonary hypertension
Cor pulmonale
depression
pneumothorax
```
51
examples of short acting bronchodilators
SABA (salbutomal) or SAMA (ipratropium)
52
examples of long acting bronchodilators for worsening FEV1
LAMA ( long acting anti-muscarinic agents) or LABA (long acting beta 2 agonist)
53
high dose inhaled corticosteroids for even worse FEV1 examples
Relvar, fostair MDI, LABA
54
list the COPD management value pyramid from top to bottom
telehealth for chronic disease, triple therapy, LABA, tiotropium, pulmonary rehabilitation, stop smoking wit pharmacotherapy, flu vaccinations
55
oxygen treatment of 7.3 to 8 kPa should be given for COPD if
polycythaemia
nocturnal hypoxia
peripheral oedema
pulmonary hypertension
56
asthma definition
Episodic wheeze and/or cough in a clinical setting where asthma is likely and other rarer conditions have been excluded”
57
what percentage of kids in the uk are on inhaled steroids
5%
58
is a cough predominant or cough variant asthma possible?
must have a wheeze, cough predominant common no such thing as cough variant asthma
59
what are the mechanisms for a wheeze in asthma
bronchoconstriction
airwall thickening
luminal secretions
60
what is the treatment for responsiveness' in asthma
ics for two months
61
ideally for asthma there should be
response to treatment
shortness of breath at rest
wheeze
parental asthma
62
Acute epiglottitis is caused by
group A beta haemolytic streptococci
63
what are the three main components of the respiratory tract defence mechanism
alveolar macrophages
mucociliary escalator
cough reflex
64
bronchopneumonia appears on a x ray as
bilateral patchy opacification due to the consolidation of pus in the alveoli
65
what percentage of bronchiectasis starts in childhood
75%
66
what are the clinical features of bronchiectasis
cough, abundant foul sputum, chronic infection, coarse crackles, haemoptysis
67
what are some of the potential causes of aspiration pneumonia
```
vomiting
oesophageal lesion
obstetric anaesthesia
neuromuscular disorders
sedation
```
68
what is type 1 respiratory failure characterized by
PaO2 <8kPa
69
how is type 2 respiratory failure characterized by
PaCO2 >6.5kPa
70
what are the four abnormal states associated with hypoxaemia
ventilation/perfusion imbalance
diffusion impairment
alveolar hypoventilation
shunt
71
embryonic phase of lung morphogenesis lasts for
3-8 weeks
72
the pseudo glandular phase of lung morphogenesis lasts for
5-17 weeks
73
canalicular phase of lung morphogenesis lasts for
16-26 weeks, at this point extra uterine life is possible at end of this stage
74
saccular phase of lung morphogenesis lasts for
24-38 weeks
75
alveolar phase of lung morphogenesis lasts for
36 weeks ~ 2-3 years
76
what are some common lung developmental diseases
```
airway stenosis
airway malacia
pulmonary agenesis
trachea-oesophageal fistula
bronchogenic cyst
congenital pulmonary anomalies
```
77
when is a patient most likely to present features
fetus - ultrasound - 75%
newborn - 10%
childhood 15%
78
what are the characteristics of trachea bronchomalacia
seal like cough
early onset
breathlessness
stridor/wheeze
79
what treatment do you avoid with bronchomalacia
asthma treatments such as bronchodilators
80
how long does diaphragm development take
18 weeks
81
what are the fetal origins of COPD
```
utero nicotine exposure
fetal infection
malnutrition
premature birth
genetic
```
82
what are the paediatric origins of COPD
```
infection
ETS (A1 AT deficiency)
environmental
lack off nutrients
genetic
```
83
COPD is the
3rd leading cause of death in the world
84
normal FEV1 is about
4 litres
85
normal FVC is about
5 litres
86
COPD can also be measured by
PEFR: Peak expiratory flow rate
87
normal PERF rate
400-600L/min, 80-100% pass rate
88
chronic bronchitis is clinically defined as
productive cough for 3 consecutive months, or 2 or more consecutive years.
89
the definition of emphysema is
Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls and without obvious fibrosis
90
centri-acinar
```
begins with bronchiolar definition
measured by number
related to inflammation
not everywhere
still alveolar damage
closer to the bronchioles
```
91
pan-acinar
```
stems from alpha 1 antitrypsin deficiency
found everywhere
measured by area
towards the ends of the bronchioles
more alveolar damage
```
92
peri-acinar
airpsaces are larger than 1 cm in space, can cause the lung to collapse and pulmonary distress. singularly a bulla if >1cm. bleb describes a bulla just underneath the pleura
93
what part of COPD can be targeted pharmacologically
small airway inflammation and muscle tone
94
what is an important aspect of emphysema
loss of alveolar attachments
95
how many patients present with late stage lung cancer
2/3rd's
96
order of systematic review of a chest x-ray
```
name
lines/metal
heart
mediastinum
lungs zones
bones
diaphragm
soft tissue
```
97
how long before you should be concerned for a lobar lung collapse
2 to 3 weeks
98
a pulmonary mass is
an opacity over 3cm
99
a pulmonary nodule is
a mass up to 3cm
100
tests to determine T in a TNM
CT PET or bronchoscopy
101
tests to determine N in TNM
PET CT mediastinoscopy
| EBUS/ECHO
102
tests to determine M in TNM
PET CT, bone scan
103
what is the analogue used in a PET CT scan
18F-FDG glucose
104
T1
<3cm
105
T 2
3-5cm or involves main bronchus, visceral pleura or obstruction
106
T5
5-7cm invading chest wall, phrenic nerve or parietal pericardium
107
T4
larger than 7cm and invading vertebral body, trachea, heart, laryngeal nerve, diaphragm etc, or tumours in separate lobe
108
N1
ipsilateral nodes or intrapulmonary nodes
109
N2
ipsilateral mediastinal and sub carinal
110
N3
contralateral mediastinal, hilar or supraclavicular.
111
what percentage of lung cancer is attributable to smoking
>85%
112
in the lung periphery a tumour is likely to be
an adenocarcinoma, due to bronchi alveolar stem cell transformation
113
in central airways a tumour is likely to be
squamous cell carcinoma as bronchial epithelial stem cells transform - strongly associated with smoking
114
what oncogene is most smoking induced in adenocarcinogensis
KRAS then EGFR
115
what are the local effects of lung cancer
bronchial collapse, lipid pneumonia, infection/abcess or bronchiectasis
pleural inflammation
chest wall invasion
invasion of the phrenic, laryngeal nerve, brachial plexus, cervical sympathetic, and mediastinum.
lymph node metastasis
116
bronchiectasis refers to
permanent enlargement of the airways
117
distant effects of lung cancer
metastases of liver, adrenal, bone, brain and skin, neural and vascular problems
paraneoplastic syndromes
finger clubbing
hypertrophic pulmonary osteoarthropathy
118
increase in ACTH and siADH indicates what type of carcinoma
small cell
119
increase in PTH indicates
squamous cell
120
what is the 5yr prognosis for lung cancer
9.8%
| 4% for small cell carcinoma
121
what are the predictive biomarkers for adenocarcinoma
EGFR, KRAS, HER 2 BRAF
| ALK translocations and ROS 1 translocations
122
in non-small cell carcinoma what is the immune checkpoint target and biomarker
PD1/PDL1, CTLA4
123
what is the 5 year prognosis for a T1 stage
70%
124
what is a 5 year prognosis for a N2 stage
16%
125
what is the medication for a pulmonary embolism
```
Low molecular weight heparin e.g. dalteparin
Warfarin
Direct Oral Anticoagulants (DOAC)
rivaroxaban, apixaban
Thrombolysis
Alteplase (rt-PA)
```
126
pulmonary hypertension is defined as
pulmonary artery pressure above 25mm Hg
127
what is the specific treatments for pulmonary hypertension
```
Calcium channel antagonist e.g. amlodipine
Prostacyclin
Endothelin receptor antagonists
bosentan
ambrisentan
Phosphodiesterase inhibitors
sildenafil
tadalafil
```
128
what are the infective agents that are viral for upper respiratory tract infections
```
Viral
Adenovirus
Influenza A, B
Para’flu I, III
RSV
Rhinovirus
```
129
bacterial agents for upper respiratory infections
```
Bacterial
H influenzae
M catarrhalis
(Mycoplasma)
(S aureus)
Streptococci
B haemolytic, S pyogenes
Non haemolytic, S pneumoniae
```
130
how long should a runny nose go for?
16 days
131
average duration of an earache
9 days
132
should you offer antibiotics to treat otitis media
not really, doesn't offer immediate relief and by the time action is effective there is no point.
133
what should you give for tonsillitis
not amoxycillin
| 10 days penicillin.
134
how long should a sore throat last for
7 days
135
croup signs
stridor, barking cough, hoarse throat
136
croup treatment
oral dexamethasone
137
epiglottis signs
stridor, drooling
138
epiglottis treatment
intubation and antibiotics
139
croup duration
3 days
140
what are the antenatal causes of COPD predisposition
```
nicotine exposure
infection
maternal nutrition
premature
micronutrients
```
141
what are the post natal causes of COPD disposition
```
infection
growth
alpha tyrosin deficiency
environmental pollution
micro nutrients
```
142
human development pre-embryonic phase
0-3 weeks
143
embryonic phase of foetal development
4-8 weeks
144
foetal phase lasts for
9-40 weeks
145
after several replications the zygote forms
a morula
146
a fetus inherits mitochondrial diseases form
the mother
147
a morula develops into
a blastocyst, containing a blastocystic cavity, inner cell mass and trophoblast
148
how long does it take the blastocyst to reach the uterus?
5 days
149
abnormal uterine ciliary function could result in
an ectopic pregnancy
150
implantation occurs
day 7
151
the trophoblast forms what, and what is its function?
the chorion, and it implants, forming a part of the placenta and secretes chorionic gonadotropin
152
the chorion fuses with
the decidua basalis
153
the inner mass of cells in the blastocyst forms
a bilaminar disc the epiblast with the amniotic sac above, and the hypoblast with the yolk sac below.
154
the function of the placenta?
foetal nutrition, transport of waste and gases, immunity
155
what is the order of events for the trilaminar disc formation
primitive steak in the epiblast, axis formation, cell proliferation, displacement of hypoblast and formation of ectoderm, mesoderm, endoderm. cells now specialised.
156
the ectoderm forms
the notochord which lies between the mesoderm/endoderm, neural plate, which then forms the neural tube through invagination between the ectoderm/mesoderm
157
the mesoderm splits into
paraxial plate, intermediate plate, and the lateral plate
158
the lateral plate forms the
somatic and splanchnic mesoderm space in between the intraembryonic coelom
to form the body cavity and coverings
159
the intermediate plate forms the
urogenital system
160
the paraxial mesoderm forms
somites
161
the heart starts to beat on the
24th day
162
how any pairs of somites form
43
163
the endoderm folds to form
the gut
164
somites divide to form
dermatome, myotome and sclerotomes
165
what weeks is the greatest sensitivity to teratogens?
weeks 3-8
166
the tracheal budding begins at what week?
4rth week
167
the protruding foregut is coated in what?
splanchnic mesoderm
168
a fistula is
an abnormal passage between two organs
169
an atresia is
orifice being abnormally sealed
170
the parietal pleura develops from
the somatic mesoderm
171
what are some embryonic congenital conditions
accessory lobe
lobe of azygos vein
agenesis of lung
172
the septum transversum forms the
central tendon of the diaphragm
173
the pleuroperitoneal membranes form the
primitive diaphragm
174
the dorsal mesentery of the oesophagus forms the
median portion and crura of the diaphragm.
175
muscular ingrowth from the lateral walls from what aspect of the diaphragm
the peripheral parts.
176
the septum transversum migrating brings what nerves
C3,4,5,
177
three defects of diaphragmatic hernia
posterolateral, anterior and central
178
what are the two types of hiatus hernia
parasophageal hernia (rolling) and sliding hiatus hernia
179
what causes acute epiglottis?
group A beta haemolytic streptococci or haemophilus influenza type B
180
what are the aetiological types of pneumonia
```
Community Acquired Pneumonia
Hospital Acquired (Nosocomial) Pneumonia
Pneumonia in the Immunocompromised
Atypical Pneumonia
Aspiration Pneumonia
Recurrent Pneumonia
```
181
what are the patterns of pneumonia
Bronchopneumonia
Segmental
Lobar
Hypostatic
Aspiration
Obstructive, Retention, Endogenous Lipid
182
what are the complications of pneumonia
```
Pleurisy, Pleural Effusion and Empyema
Organisation
mass lesion
COP(cryptogenic organising pneumonia (BOOP))
Constrictive bronchiolitis
Lung Abscess
Bronchiectasis
```
183
why does pneumonia cause hypoxemia
Ventilation / Perfusion abnormality (mismatch)
Bronchitis / Bronchopneumonia
Shunt
Severe bronchopneumonia
Lobar pattern with large areas of consolidation
184
what are the symptoms of lung cancer
```
chronic coughing
difficulty swallowing
wheezing
chest/bone pain
chest infection
haemoptysis
weight loss
SOB
raspy voice
```
185
what are the clinical signs of lung cancer
* Chest signs
* Clubbing
* Lymphadenopathy
* Horner’s syndrome
* Pancoast tumour
* Superior vena cava obstruction
* Lymphadenopathy
* Hepatomegaly
* Skin nodules (metastases)
186
what is the dynamic turnover of pleural fluid in an hour
30-75%
187
what is the negative pressure of the pleura
-0.66kPa
188
a transudate is characterized by and caused by??
imbalance of hydrostatic forces, normally bilateral <30g/L proteins. range of conditions such as liver cirrhosis, peritoneal dialysis and left ventricular failure.
189
an exudate is characterized by and caused by?
increased permeability and unilateral. >30g/L proteins. caused by inflammation in response to malignancy, embolism or autoimmune disease.
190
how large a volume for the effusion before it is visible on a cxr
200ml
191
what needle is used for a pleural biopsy and how many samples?
Abram's needle.
| at least 4
192
a non-iatrogenic pneumothorax means
penetrating chest injury or blunt chest injury
193
a iatrogenic pneumothorax examples are
biopsy acupuncture, cannulation.
194
what's a large pneumothorax defined as
rim of air >2cm
195
what's the management for a pneumothorax?
cannula inserted in the 2nd intercostal space along the mid clavicular line then insert intercostal chest drain.
196
what is asbestos?
highly fibrous naturally occurring mineral
197
what is the most dangerous form of asbestos
crocidolite
198
how does CF effect fertility in men
blocked/absent vas deferens
199
when is a patient considered for lung transplant
once FEV1 <30%/predicted to be soon
200
what is the genetic prevalence of CF
1:25
201
that is the function of the CFTR
active transport of chloride regulating liquid volume, its compromise results in cilia dysfunction
202
what is the accepted sweat chloride values
>60 is CF
| <30 normal if over the age of 6 months
203
what is the treatment for pancreatic insufficiency
fat soluble vitamins, Proton pump inhibitors, high energy diet and enteric enzyme pellets
204
common pathogens for CF
Staphylococcus aureus and Haemophilus influenzae in early years
Pseudomonas aeruginosa later
uncommonly there is atypical mycobacteria e.g. m abscessus
205
restrictive lung disease is associated with
reduced compliance
low FEV 1 and low FCV but normal ratio
reduced gas transfer
V/Q imbalance.
206
restrictive lung disease often results in
type 1 respiratory failure.
207
diffuse alveolar damage results from
type 2 cell necrosis, has an exudative phase, hyaline membrane formation phase. can be fatal or progress to fibrosis.
208
sarcoidosis is
multisystem granulomatous disorder
209
sarcoidosis presents with
arthralgia, erythema nodosum and bilateral hilar lymphadenopathy, shortness of breath and cough with abnormal x ray.
210
hypersensitivity pneumonia is an example of
type 3 and type 4 hypersensitivity reactions.
211
usual interstitial pneumonia demonstrates
temporal and spatial heterogeneity - patches of recent and old trauma.
212
how many people are infected with tuberculosis world wide?
2 billion
213
what bacteria is responsible for tuberculosis?
mycobacterium
214
mycobacteria are
```
non-motile bacillus
slow growing
aerobic
thick cell wall
resistant to acid, alkalis, detergents, neutrophils and macrophages
```
215
name of the stain for mycobacterium
zhiel neilson stain
216
what is the immunopathology of tuberculosis
activated macrophages then epithelioid cells then langhans cells. accumulation, the granuloma formation. it then forms a central caseating necrosis which may calcify.
217
primary infection of tuberculosis may present with
erythema nodosum
| cough, fever, but often asymptomatic
218
post primary infection often involves the
skeletal system, the meninges, pleural effusion and most the tissues.
219
what is the Tb regime
```
4 drugs for two months
Rifampicin
Isoniazid
Ethambutol
Pyrazinamide
```
then two drugs for 4 months
rifampicin
isoniazid
220
side effects of the Tb multi drug therapy?
Rifampicin Orange ‘Irn Bru’ urine, tears
Induces liver enzymes, prednisolone, anticonvulsants
Oral contraceptive pill ineffective
Hepatitis
```
Isoniazid Hepatitis
Peripheral neuropathy (pyridoxine B6)
```
Ethambutol Optic neuropathy (check visual acuity)
Pyrazinamide Gout
221
screening test for an under 16 year old for tb
no immunity to tuberculinprotein so the mantoux or heaf test
222
older then 16 screening test for tb
chest x-ray
223
what does a right heart catheter measure?
wedge pressure, cardiac output and the blood pressure of the artery.
224
what hormone secretion is associated with small cell cancer lung
ACTH siADH
225
what hormone secretion is associated with large cell carcinoma lung
PTH
226
asthma is the result of IgE antibodies inappropriately reacting to inert antigens, causing mast cells to release.
microthrombins , prostaglandins, histamine and lysosomal enzymes in a exaggerated inflammatory response. Spasmogens such as histamine also trigger an immediate response
227
```
you perform aspiration and perform a look and sniff, what do this signs indicate
foul smelling
pus
food particles
milky
blood stained
blood
```
```
foul smelling - anaerobic empyema
pus - empyema
food particles – oesophageal rupture
milky – chylothorax (usually lymphoma)
blood stained - ?malignancy
blood – haemothorax, trauma
```
228
name some chemotactic released in asthma
NCF
LTB4
PAF
ECF-A
229
name some spasmogens released in asthma
histamine
SRS
PG
PAF
230
CURB 1 pneumonia treatment
amoxicillin or clarithromycin
231
CURB 2 pneumonia treatment
amoxicillin and clarithromycin
232
CURB 3-5 pneumonia treatment
co-amoxiclav and clarithromycin
233
how quickly does small cell lung carcinoma double
every 29 days
234
what is the response rate of small cell lung cancer to therapy
90%
235
how many cycles of chemotherapy for lung cancer are undertaken
4 cycles
236
what Is the dosage of radiation for stage 3 lung cancer
55Gy+
237
what drugs are used for stage 1-2 adjuvant therapy for lung cancer
cisplatin and vinorelbine
238
how long does non small cell lung cancer take to double
129 days
239
what are the drugs of choice for small cell lung carcinoma
cisplatin and etoposide with early thoracic radiotherapy and prophylactic cranial radiation
240
how prevalent is asthma in the population
10%
241
what drugs to avoid with asthma managing
beta blockers
NSAIDS
asparin
sedative/opiates
242
what drugs to give during an acute asthma attack
beta 2 agonists, steroids, leukotriene receptor antagonist, monoclonal antibodies
theophyllines
magnesium
oxygen
243
adverse effects of beta 2 stimulants
tremor, cramp, headache, flushing, palpitations, angina
244
side effects of long term inhaled steroidal use
oropharyngeal candidiasis
| dysphonia
245
acute asthma signs
PEF 33%-50%
respiratory rate of more than 25/min
heart rate above 110 min
inability to complete a sentence in a breath
246
life threatening asthma signs
```
altered consciousness
exhaustion
hypotension
cyanosis
silent chest
poor respiratory rate
raised PCO2
```
247
what is the duration of a cough associated with bronchiolitis
25 days
248
duration of bronchiolitis
16 days
249
would you treat tracheitis with antibiotics?
yes, Augmentin
250
bronchitis antibiotics?
no
251
LRTI/pneumonia antibiotics?
oral amoxicillin
252
bronchiolitis, antibiotics?
no
253
empyema, antibiotics?
yes, IV
