At what vertebral level is the carina?
T4 and T5 (2nd rib)
Where would a chest drain be placed?
5th intercostal space, above rib, MAL
What is the transit time of a RBC in the capillaries of the lungs?
A reduced FEV1/FCV ratio with a normal FVC signifies what?
Obstructive disease of the lungs
What is a normal FEV1/FVC ratio?
Between 75% and 80%
A normal FEV1/FVC ratio with a dramatically reduced FVS signifies what?
Restrictive disease of lungs
What is bronchiectasis?
Abnormally widened lumen of the airways which accumulate excess mucous -> these make the lungs vulnerable to infections
Which cells of the lungs produce surfactant?
Type II pneumocytes
What is Fick's law of diffusion?
The amount of gas that moves across a membrane is proportional to the area and inversly proportional to the thickness
Which portion of the lungs are better ventilated?
What is the mean pressure in the pulmonary artery?
What is the mean pressure in the aorta?
Name 2 mechanisms which cause reduction in pulmonary vascular resistance (in response to slight rise in pressure)
Recruitment and distension
When is the pulmonary vascular resistance at its lowest?
On deep inspiration - expansion of the vessels by the lung parenchyma
Which part of the lungs have the lowest vascular resistance?
What is the Windkessel effect?
Elastic expansion of the large elastic arteries in systole - maintains constant pressure for perfusion of the organs during diastole
What is cor pulmonale?
Enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs
Name 2 SABAs
Name a drug which is a ß2 agonist and acts on the bronchioles. Name a long term SE of this drug
Causes tremor due to its affect on the muscles, hypokalaemia when it acts on the cell membrane
What class of drug is ipratripium? Explain its MOA and SEs
Muscarinic receptor antagonist --> competes with ACh at the muscarinic receptors to prevent bronchoconstriction SE: dry mouth, blurred vision, GIT disturbances
Which receptors does tiotropium act on specifically?
Which bond in the mucous do mucolytics break?
Disulphide bonds - makes the mucous viscous
What is α1-antitrypsin?
Glycoprotein produced by the liver. It's a serine protease inhibitor - balances the action of e.g. neutrophil elastase which is present in inflammation
Where is the respiratory centre found?
In the medulla and pons
Name some signs of a 'blue bloater'
- Bounding pulse
- CO2 flap
- Increased JVP
- Ankle swelling
- Tricuspid regurge
Which lobes are damaged in α1-antitrypsin deficiency?
What is Hamman's sign?
Mediastinal crunch precordially associated with cardiac systole - cardiac contraction forcing air through the pleural folds
What is Hippocratic succussion?
Sound of splashing in the chest which is sometimes audible without a stethoscope - signifies a very large pleural effusion
What would cause a young, tall, healthy male to have a pneumothorax?
Congenital pleural bleb
Where would a thoracocentesis be sited?
2nd ICS mid clavicular line on the affected side. Converts a tensiion PnTx int o a simple PnTx with a 14g venflon.