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Resp Flashcards

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1
Q

how do lungs stick to thorax?

A

intrapleural fluid cohesiveness - water molecules in intrapleural fluid are attacted to eachother so reist being pulled apart

negative intrapleural pressure - transmural pressure gradient so lungs forced to expand outwards while chest squezes inwards

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2
Q

inspiration?

which muscles?

A

ACTIVE process

muscles = diaphragm (major inspiratory muscle) + external intercostal muscles (bucket handle)

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3
Q

expiration?

A

normal expiration is a passive process

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4
Q

pneumothorax?

complication?

s/s?

A

air in pleural space

complication = lung collapse due to abolished transmural pressure gradient

symptoms = SOB + chest pain

signs = hyperresonant percussion + decreased/absent breath sounds

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5
Q

pulmonary surfactant?

secreted by?

A

mixture of proteins that reduces alveolar surface tension preventing aveolar collapse

secreted by type II alveoli

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6
Q

pulmoary distress syndrome of the newborn?

A

premature babies = not enough surfactant

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7
Q

pre and postganglionic fibres of airways?

parasympathetic stimulation?

A

pre = brainstem

post = walls of bronchi and bronchioles

stimulation of cholingeric fibres = bronchial smooth muscle contraction (M3 muscarinic ACh receptors on ASM cells) + increased mucous secretion (M3 on goblet cells)

stimulation of noncholinergic fibres = bronchial smooth muscle relaxion (NO and VIP)

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8
Q

sympathetic stimulation airway?

A

No innervation to ASM so instead mediated by hormones

B2-adrenoceptors activated by adrenaline from adrenal gland = ASM relaxation + decreased mucous secretion + increased mucocilliary clearance

a1-adrenoceptors = vascular smooth muscle contraction

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9
Q

excitation contraction coupling in smooth muscle

A
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10
Q

Ca2+ in smooth muscle

A
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11
Q

relaxation of smooth muscle

A
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12
Q

activity of myosin light chain kinase and myosin phosphatase

A
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13
Q

asthma?

Ax?

A

recurrent reversible obstuction to airways

Ax = allergens, exercise (cold dry air), respiratory infections (e.g. viral), smoke, dust, pollutants

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14
Q

status asthmaticus?

A

MEDICAL EMERGENCY - acute severe asthma

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15
Q

s/s asthma?

chronic asthma changes

A

s/s = tight chest, wheezing, difficulty breathing, cough

chronic changes = SM hyperplasia/hypertrophy, oedema, increased mucous secretion, epithelial damage (exposing sensory nerve endings), sub-epithelial fibrosis

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16
Q

phases of asthma attack?

A

early phase = type 1 hypersensitivity reaction (mast cells)

late phase = type IV hypersensitivity reaction (TH2, eosinophils)

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17
Q

FEV1?

A

forced expiratory volume (litres) in 1 second

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18
Q

asthma immune reaction

non-atopic individual?

A

TH2 response involving IgE

non-atopic = TH1 response involving IgG and macrophages

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19
Q

learn pathway

A

TH2 cells also release IL-5 which activates eosinophils

IL-4 and IL-13 cause mast cells to express IgE receptors

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20
Q

activated mast cell?

releases?

A

mast cell activaed via binding of antigen to IgE receptors

releases:

  • chemokines - LTB4, PAF, PGD2 (attract eosinophils)
  • spasmogens - histamine + leukotrienes LTC4, LTD4 (ASM contraction)
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21
Q

muscles of respiration?

A
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22
Q

FVC?

A

forced vital capacity - maximum volume that can be foricbly expelled from lungs following mximal inspiration

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23
Q

FEV1/FVC ratio?

A

normally >70%

obstructive lung disease (asthma/COPD) = <70%

restrictive = >70%

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24
Q

autonomic NS airways?

A

parasymp = bronchoconstriction

sympathetic = bronchodilation

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25
when is peak flow used?
obstructive lung disease - asthma or COPD
26
restrictive airway disease? FEV1/FVC ratio?
pulmonry fibrosis pulomary oedema lung collapse pneumonia absence of surfactant restrictive = \>70%
27
emphysema?
hyperinflation of lungs
28
different effects of O2 on pulmonary vs systemic arterioles?
29
binding of one O2 to Hb?
increases affinity of Hb for O2 (co-operativity)
30
Bohr effect?
shift of sigmoid curve to the right
31
foetal Hb? benefit?
has higher affinity for O2 compared to HbA this is because it interacts less with 2,3-biphosphoglycerate allows O2 transfer from mother to foetus even if Po2 is low
32
myoglobin found? purpose? significance?
in skeletal and cardiac muscles - only one haem group per myoglobin molecule provides short term storage of O2 for anaerobic conditions prescence of myoglobin in blood indicates muscle damage
33
influenza clinical presentation?
fever - high, asrupt onset malaise myalgia headache cough prostration - unable to leave bed
34
Ax flu? flu-like illnesses? not to be confused with....
influenza A + B flu-like illnesses caused by: parainfluenza viruses do not get confused with haemopilus influenzae - it is a bacterium and not a primary cause of flu (may be a secondary invader)
35
flu complications?
primary influenzal pneumonia * high mortality! * seen in young adults secondary bacterial pneumonia (haemophilus) * elderly, co-morbs
36
flu Tx?
symptomatic * bed rest * fluids * paracetamol antivirals * oseltamivir * zanamivir
37
epidemiology flu
winter epidemics (antigenic drift - minor mutations in surface proteins) pandemics - rare, influenza A (antigenic shift) (can be from animal reservoir/mixing vessel)
38
CO2 transport in blood?
solution - 10% bicarbonate - 60% carbamino compounds - 30%
39
carbon dioxide solubility?
20 times more soluble than oxygen
40
most Co2 trasported in blood as? how is this formed?
bicarbonate formed in blood by:-
41
carbamino compounds?
combines with Hb to produce carbamino-haemoglobin
42
the haldane effect?
removing O2 from Hb increases ability of Hb to pick up CO2 (the bohr effect and haldane affect work in conjunction) i.e. O2 liberation and uptake of CO2 at tissues
43
bohr effect purpose?
facilitates removal of O2 from Hb at tissues by shifting dissociation curve to the right
44
CO2 dissociation curve
45
SOB - loss of elstic recoil (emphysema), dynamic airway compression Lung volume - increased RV due to hyperinflation, increased FRC Blood oxygenation - emphysema reduces surface area for gas exchange as it destroys alveoli (patient may have low PO2)
46
densities on CXR
47
USS densities?
48
when is AP used rather than PA? disadantages of this?
when patient cannot stand i.e. very unwell or bed bound heart shadow magnified so heart size cannot be assessed accurately scapulae partially obscure lungs can be difficult to achieve adequate inspiration
49
how to determine CXR inspiration and rotation
if CXR adequately inspired - anterior ends of at least 6 ribs should be visible if CXR correctly centred - medial ends of clavicls should be equidistant from spinal processes of throaic vertebrae
50
mediastinal borders CXR
51
mediastinal lymph node locations + names
52
...
53
lung lobes radiograph
54
...
55
...
56
right superior lobe (above right horizontal fissure)
57
60 y/o smoker 2 stone weight loss haemoptysis + cough what is the abnormality?
right lower lobe collapse
58
where is the abnormality?
left lower lobe collapse
59
60 y/o smoker afrebrile haemoptysis + cough what is the abnormality?
left upper lobe collapse
60
60 y/o smoker febrile haemoptysis + cough what is the abnormality?
left upper lobe consolidation
61
large left pleural effusion
62
....
63
dilated bronchi thickened bronchial walls
64
bilateral hilar enlargement | (probs sarcoid)
65
features suggestive of cardiac pain?
**referred pain!!** central, crushing, heavy, tight band usually left sided (can be epigastric) often radiates: left arm, neck, jaw/teeth
66
lung pain?
contain no pain receptors do contain J receptors = cough pleurisy is if pathology reaches the pleura pleuritic pain = sharp, worse on inspiration
67
GI chest pain?
oseophageal spasm trapped wind reflux oesophagitis
68
MSK pain chest?
usualy worse on moveent reproducible (touch)
69
which systems could be respondible for chest pain? (and so should be covered in history)
cardiac resp GI MSK
70
breathlessness questions
"what do you mean by breathless?" cant breathe in or out? doing what? orthopnoea? paroxysmal nocturnal dyspnoea? associated symptoms - wheeze, stridor, cough?
71
acute Ax breathlessness? subacute? chronic?
acute - PE, pneumothorax, pulmonary oedema subacute - pneumonia, pulmonary oedema, pleural effusion, asthma/COPD chronic - COPD, pulmonary fibrosis, PE
72
acute dry cough? most common Ax?
\<8 weeks almost always viral
73
Ax dry cough?
viral sinsister: lung cancer, mesothelioma, pulmonary metastases pulmonayr fibrosis sarcoidosis pneumonitis (EAA)
74
chronic dry cough Ax?
GORD ACE-I upper airway disease smoking allergens
75
massive vs non-massive haemoptysis?
massive \>500ml in 24 hours non-massive \<500ml in 24 hours
76
Ax haemoptysis?
big four: infection, carcinoma, PE, bronchiectasis others: cardiac, AVM, anticoagulation
77
PMH resp?
ask about... childhood infection PE TB
78
drug history resp?
ILD - **nitrofurantoin, methotrexate, amiodarone**, ACEI, bleomycin, B-blockers airways - **B-blokers**, contrast, **ACEI**, penicillamine vascular - phenytoin (PE), **dexfenfluramine**
79
social history resp?
occupation/hobbies - asbestos, coal mining, farming, pigeons/birds tobacco!!!!!! cannabis foreign travel pets
80
CO2 flap Ax? what actually is it? other s/s?
due to hypercapnic encephalopathy irregular flapping of hand when wrist hyperectended (asterixis) S/s: confusion + peripheral vasodilation
81
what are these?
82
Ax finger clubbing?
bronchial carcinoma fibrosing alveolitis lung suppuration (bronchiectasis, lung abscess, empyema) cyonatic congenital heart disease infective endocarditis malabsorption states (UC, Crohn's, liver cirrhosis) congenital Idiopathic
83
horner's syndrome s/s? Ax?
small pupils ptosis enopthalmos unilateral loss of sweating due to disruption of cervical chain Ax: pancoast tumour, cervical lymphadenopathy, carotid dissection
84
sarcoidosis/TB eyes? chronically raised CO2 eyes?
sarcoid/TB = uveitis chronically raised pCO2 = dilated retinal veins/papilloedema
85
lymph nodes in the neck?
86
cor pulmonale s/s? what is it?
cyanosis raised JVP pitting oedema parasternal heave loud P2 right heart failure due to chronic lung disease
87
superior vena cava obstruction s/s?
distention of axillary, subclavian and jugular veins oedema of face, neck and upper chest
88
whats this? s/s?
pectus excavatum s/s: pulmonary artery flow murmur, right lower lobe CXR changes mimicking pulmonary infiltrate, diminished lung sounds
89
tracheal deviation direction?
towards collapse towards consolidation away from effusion
90
crepitation lungs Ax?
(sign that air is leaking out of the lungs) surgical emphysema chest wall trauma iatrogenic (chest drains) ruptured oesophagus

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