Respiratory Flashcards
(194 cards)
1
Q
At what vertebral level does the trachea begin?
A
C6
1
Q
What is a typical tidal volume?
A
500 ml
1
Q
What is a typical residual volume?
A
1200ml
1
Q
If the lung is full of fluid, how will vocal resonance sound?
A
Louder
1
Q
What is the majority of acute epiglottitis caused by?
A
Haemohpilus influenzae Type B
1
Q
What do we call pus in the pleural space?
A
Empyema
1
Q
HIgh pH and normal PaCO2 = what?
A
Metabolic alkalosis
1
Q
Give a 2 word definition of asthma
A
Reversible bronchoconstriction
1
Q
There is chemotaxis of which cell type in the delayed phase of asthma?
A
Mast cells
Lymphocytes
Eosinophils
Macrophages
Basophils
1
Q
What is a Ghon’s complex comprised of?
A
Gohn focus + lymphadenopathy
1
Q
Which lobe does secondary TB typically affect?
A
Upper lobe
1
Q
What is Potts disease?
A
Single organ TB of the spine
1
Q
What level must PaO2 drop below before it has an effect on ventilation?
A
~50mmHg
1
Q
What information about cough must be obtained during history taking?
A
Site: throat vs deep chest
Quality: Dry vs wet; colour; thickness; pus; blood
Severity: volume of sputum (teaspoon vs cup)
Time course: duration
Context: Exertion; time of dayl time of year; smoking
Aggravating:
Relieving: medications
Associated features: pain while coughing
Vaccination Hx
Smoking Hx
1
Q
What is haematemesis?
A
Vomited up blood
1
Q
In which species is Type A influenza virus found?
A
Humans and other species
2
Q
Which muscles may be contracted for forceful exhalation
A
Abdominal and internal intercostal muscles
2
Q
Where does rotavirus replicate?
A
Rotavirus replicates in epithelial muscosa of GIT
2
Q
What are the most common causes of otitis media?
A
Pneumococci,
H. influenzae
Moraxella catarrhalis
2
Q
Hiow much oxygen is consumed at rest?
A
250ml/min
2
Q
Define breathlessness
A
Pt’s recognition of an inappropriate relationship between respiratory work and total body work
2
Q
What is corryza?
A
Runny nose
4
Q
Name 4 features of airway remodelling in asthma that cause obstruction of the airways
A
Goblet cell hyperplasia with increased mucous production
Subepithelial collagen thickening
Increased airway smooth muscle volume
Increased mucosal vascularity
4
Q
Define Gohn focus
A
Gohn focus = peripheral area of granulomatous inflammation and caseation
5
Which 3 factors determine fluid movement across pulmonary capillaries?
1 Hydrostatic pressure
2 Oncotic pressure
3 Capillary permeability
6
Define phlegm
Mucous + cell debris/bacteria/DNA etc
That is in the body
6
What is a medical way of saying "coughing up blood"
Haemoptysis
7
What is the most common cause of the common cold?
Rhinovirus
8
What influences the peripheral chemoreceptors involved in respiratory regulation?
PaO2, PaCO2, pH
9
What is the double fold of pleura inferior to the hilum called?
Pulmonary ligament
9
What is a normal PaCO2?
38-42 mmHg
9
On a CXR, what causes Kerley b lines?
Dilated lymphatics
9
What are 3 complications of emphysema?
1 hypoxia
2 pulmonary hypertension --\> cor pulmonale
3 PTx
9
Define mucous
Physiological substance that is in the body
10
HIgh pH and low PaCO2 = what?
Respiratory alkalosis
11
What is on your list of differentials for haemoptysis?
Bronchitis
Pneumonia
Bronchiectasis
Pulmonary embolis
Tuberculosis
Lung cancer
Trauma
12
Inhaled foreign bodies tend to travel where?
Right main bronchus to right lung
13
What is a normal PaO2?
90-98 mmHg
13
What is the most viral common causes of croup?
Parainfluenza
14
What is the pressure of O2 at sea level?
160 mmHg
14
How does cigarette smoking lead to emphysema?
Cigarette smoke -\> ROS -\> alveolar damage
Smoke -\> ROS --\> neutrophil recruitment --\> elastase -\> alveolar septal degradation
Smoke -\> inactivation of anti-proteases -\> increased elastase -\> alveolar septal degradation
15
What do people with chronic hypercapnoea have an increased dependence on for ventilatory regulation?
Respiratory drive
16
What does work of breathing include?
Elastic and resistive work
17
Which cell makes up most of the surface area of the alveolus?
Type 1 pneumocyte
19
What is stridor?
An audible breathing sound from the throat (often on inspiration)
20
What are the 4 most common viral causes of pneumonia?
Parainfluenza 3
Respiratory syncytial virus
Influenza virus
Adenovirus
21
What is a normal mixed venous PO2?
40mmHg
21
What causes excess mucus in chronic bronchitis?
Hypertrophy of mucus secreting glands
Increased goblet cells
23
What are the side effects of inhaled GCSs?
Oral candidiasis
Dysphonia
Decreased serum cortisol
25
What clinical feature particularly distinguishes influenza from other respiratory tract infections?
Muscle aches
26
What are 3 important DDx for peripheral oedema?
1 Left heart failure
2 Low serum protein
3 Fluid volume overload
27
What does Fick's law determine?
Rate of diffusion of a gas
28
What are 2 unique features of the Mycobacterium tuberculosis cell wall?
Contains mucolic acid in the cell wall, giving it a waxy coating.
It is acid fast
29
What is a normal pulmonary artery sys/dias blood pressure?
25/8 mmHg
30
What is the role of neuraminidase in influenza infection?
NA (neuraminidase) cleaves the sialic acid off the epithelial receptor to prevent newly released virus particles from re-infecting that very cell
31
What are 2 conditions that can cause hypoventilation through neuropathy?
Polio virus
Guillain-Barre syndrome
32
What is the range of normal respiration rates for an adult person at rest?
12 to 16 breaths per minute
33
What is a normal mixed venous CO2?
46 mmHg
34
Where are peripheral chemoreceptors that contribute to respiratory regulation?
Carotid bodies and aortic arch
35
What percentage of acute sore throats are caused by viruses?
70%
36
What is a typical total lung capacity?
5.7L
37
Where are pulmonary veins always situated within the hilum?
Anterior and inferior
38
If the radius of a small airway is halved, by how much will resistance increase?
16 times
40
Define emphysema
Permanent and abnormal enlargement of the airways distal to the terminal bronchioles
41
What is the order of pharmacological agents used to treat COPD as disease severity increases?
1 Short acting bronchodilator if FEV1 \>80?
2 Long acting bronchodilator if FEV1 = 50-80?
3 Inhaled GCS if FEV1 = 30-50%
4 Oxygen if FEV1
42
What are the most common bacterial causes of atypical pneumonia?
mycoplasma pneumonia,
Coxiella Burnetti,
Chlamydophila pneumoniae
Legionella spp
44
What is the normal range for arterial pH?
7.35 - 7.45
45
Alveolar pneumonia is characterised by what?
Consolidation (neutrophils) in the alveolar spaces
47
What is the best imaging modality for the lung parenchyma?
CT
48
Yellow sputum suggests what are present in the sputum?
Neutrophils
50
What does a CXR classically show in atypical pneumonia?
Reticulonodular infiltrate: “dots and dashes” throughout both lung fields
51
What are the most common causes of a flu-like sickness?
Influencza
Respiratory syncytial virus
52
In which species is Type B influenza virus found?
Humans only
53
How does consolidation of pneumonia appear on CXR?
Hyperdense = white
54
What is the most common viral cause of pharyngitis?
Adenovirus
55
What is the major cause of empyema?
Staph. aureus
56
What's the most common bacterial cause of a sore throat?
Streptococcus pyogenese
56
What are the most common pathogenic agents for acute exacerbation of chronic bronchitis?
Haemophilius influenzae Streptococcus pneumoniae
56
Koplick spots are diagnostic of what disease?
Measles
56
What is a medical way of saying "vomited up blood"?
Haematemesis
57
List 6 clinical features of atypical pneumonia
Malaise,
aches/pains,
HA,
diarrhoea
Dry non-productive cough
Patients often ambulant (walking pneumonia)
58
What is the fancy way of saying "coughing up blood"?
Haemoptysis
59
An unconscious supine patient who vomits will most likely have fluid in which lung segment?
Apical segment of the lower lobe of the right lung
61
What is a normal PAO2?
100mmHg
62
What type of respiratory disorder does pneumonia cause?
Restrictive
63
What do we know about the receptor for influenza virus?
Terminal sialic acid bonded via alpha 2-6 linkage to galactose
64
Name 4 features of congenital rubella syndrome
Microcephaly
Deafness
Cataracts
Congenital heart defects
65
What type of cartilage is in the trachea?
Hyaline
66
In what pattern of distribution is consolidation in bronchopneumonia?
Multifocal and patchy
67
What kind of flow occurs in large airways?
Turbulent
68
What is the definition of chronic bronchitis
Persistant cough, productive of sputum for at least 3 months in at least 2 consecutive years
Not due to another cause
69
What does a wheeze imply?
Pathology in the airways
71
What is a saddle pulmonary thrombo-embolism?
One that spans across the pulmonary trunk
72
What is implied by crackles on ausculation of the lungs?
Fluid in alveoli or terminal bronchioles.
Could be pus, haemorrhage, oedema, salt water
73
What is the most common pattern of bacterial pneumonia?
Bronchopneumonia
74
What changes are there in ABG in Type 2 respiratory failure?
Low PaO2 and high PaCO2
75
What are 3 pathological features of the immediate response in asthma?
Oedema,
mucous production and
bronchospasm
76
What is the O2 saturation of venous blood?
75%
77
What are the most common pathogenic agents that cause an acute exacerbation of chronic bronchitis?
Pneumococcus
H. influenzae
79
What is the pathophysiological definition of emphysema
Destruction of the alveolar wall without fibrosis
80
What is the incubation period of influenza?
1-5 days
81
What is empyema?
Pus in the pleura
83
Define asthma (in more than 2 words)
Hyper-responsive airways...
...to various stimuli...
which leads to episodic bronchoconstriction
that is at least partly reversible
84
What is the name of the active transporter that pumps Ca2+ into the SR in smooth muscle?
SERCA
85
How does emphysema cause airway obstruction?
There is a loss of elastic recoil,
leading to collapse of small airways
86
Pleural friction suggests what type of pneumonia?
lobar pneumonia
87
What is the mechanism of omalizumab in asthma treatment?
Blocks mast cell degranulation via steric hindrance of Fc portion of Ab, blocking IgE binding to mast cell
90
Low pH and low PaCO2 = what?
Metabolic acidosis
91
What is a typical minute ventialtion?
7-8 L/min
93
What is haemoptysis?
The expectoration of blood or of blood-stained sputum
94
What is the average number of deaths annually from influenza in Australia?
1,500
95
What is the medical term for a sore throat?
Pharyngitis
96
What is the role of haemagglutinin in the influenza virus?
Binds to sialic acid containing receptor → initiates entry
97
The transition from bronchi to bronchioles is marked by which histological feature?
Disappearance of cartilage in the wall
99
When are inhaled GCSs indicated in the treatment of asthma?
When the patient requires beta 2 agonists more than three times weekly
101
Which pattern of pneumonia is more common in 20-50 years olds?
Lobar pneumonia
102
What are the 3 most common viral causes of URTI?
Rhinovirus
Corona virus
Adenovirus
103
What is the cut off for abnormal FEV1/FVC in a healthy young adult?
80%
104
What is the pathogensesis of chronic bronchitis?
Cigarettes -\> inflammation:
--\> mucous production in larger airways
--\> scarring and narrowing of smaller airways
105
What must happen to the influenza virus for it to be activated once it leaves a respiratory eptithelial cell?
Must be cleaved by tryptase clara
106
What coloured phlegm do viruses tend to cause?
White
107
Give an example of a virus that causes a latent infection
Herpesvirus
108
What does central cyanosis imply?
Hypoxaemia (low PaO2)
109
What are 5 potential respiratory system causes of dyspnoea?
1 Airways
2 Alveoli
3 Pleura/chest wall
4 Pulmonary vasculature
5 Respiratory muscle
111
What does pruritus mean?
Itchy
112
What are 5 classes of causes of inadequte ventilation?
1 Central
2 Neuromuscular eg MND
3 Obesity
4 Chest wall deformities
5 Sleep disordered breathing
113
What are complications of chronic bronchitis
Superimposed infective exacerbations
Hypoxia
Pulmonary hypertension
Squamous metaplasia and dysplasia leading to malignancy
115
Where would painful irritation of the costal parietal pleura be experienced?
Thoracic wall (because parietal pleura is innervated by branches from intercostal nerves)
116
Where does the respiratory virus replicate in humans?
Virus replicates in respiratory epithelium, esp in large airways such as bronch
119
What is the first level of the airways where gas exchange may occur?
Respiratory bronchioles
120
What are the most common pathogenic agents for low severity index community-acquired pneumonia?
Streptococcus pneumoniae
Mycoplasma pneumoniae
Chlamydophila pneumoniae
122
What is the defining histopatholgoical feature of idiopathic pulmonary fibrosis
Interstitial inflammation with firbosis at varying stages of development
123
What is the most common preventable cause of death in hospitalised patients?
Venous thrombo-embolism
124
Which type of pneumonia is more common at extremes of age?
Bronchopneumonia
126
What is the GPCR downstream effect of salbutamol leading to bronchodilation
Increases activity of SERCA, which takes up Ca2+ into SR, decreasing ASM contractility --\> bronchodilation
127
What is the most common cause of aortic stenosis?
Dysrtrophic calcification
128
How may someone with PE present?
Dyspnoea
Haemoptysis
Cough
Syncope
Pleuritic pain
129
Which influenza type has many subtypes?
Type A
130
What stimulates central chemoreceptors involved in respiratory regulation?
[H+]
131
What are the 4 stages of lobar pneumonia?
1 Congestion
2 Red hepatisation
3 Grey hepatisation
4 Resolution
132
What is the pathogenic agent in typhus?
Rickettsia
133
What type of respiratory disease does emphysema cause?
Obstructive
134
What causes antigenic drift in influenza virus?
RNA-dependent RNA polymerase errors during replication lead to single amino acid changes in HA or NA sites that reduce affinity of neutralising antibodies.
These viruses will be selected for, and a new strain will emerge
135
What is the defining feature of the histopathology of restrictive lung diseases?
Inflammation and fibrosis of inter-alveolar septa (interstitium)
136
Low pH and high PaCO2 = what?
Respiratory acidosis
138
What type of respiratory disease does asthma cause?
Obstructive
140
What percentage of people have viridans streptococci in their URT?
100%
141
What kind of flow occurs in small airways?
Laminar
142
What information about sputum must be obtained during history taking?
Colour
Volume
Thickness
Pus
Blood
144
What type of breathing pattern would be adopted by a person with stiff lungs?
Rapid shallow breaths
145
The transition from terminal bronchioles to respiratory bronchioles is marked by which histological feature?
Breaks in the continuity of the walls
146
What is haemoptysis?
Coughed up blood
147
What is the most common valvular disease in Western world?
Aortic stenosis
148
What are the side effects of short acting beta 2 agonits?
tachycardia,
tremor and
hypokalemia
149
Which lung volumes are reduced in restrictive respiratory diseases?
All lung volumes are decreased
150
List 4 histological featrues of interstitial pneumonia
1 Lymphocytes, macrophages and plasma cells present in the alveolar septa (ie interstitium)
2 Alveolar septa are widened
3 No inflammatory cells in the alveoli
4 Bronchiolitis
151
Define cor pulmonale
Right sided heart failure caused by pulmonary hypertension
152
What type of respiratory disease does COPD cause?
Obstructive
153
What is the medical way of saying runny nose?
Corryza
156
What type of respiratory disorder does pulmonary oedema cause?
Restrictive
158
What are 3 distinguishing features of the right main bronchus compared with the left main bronchus?
Shorter, wider and more vertical
160
What is the most numerous cell in the alveolus?
Type 2 pneumocyte
161
How much CO2 is produced at rest?
200ml/min
162
What is the most common cause of pneumonia?
Pneumococcus
163
How would you distinguish haemoptysis from haematemesis on history taking?
Prodome: (irriation in chest or desire to cough)
Colour: bright red = haemoptysis; dark red = haematemesis
Frothiness: frothy = haemoptysis; not frothy = haematemesis
Pain: localised to URT, chest, or epigastric
164
If there is a pneumothorax, how will vocal resonance sound?
Duller/softer
166
An abnormally low FEV1/FVC implies what type of respiratory dysfunction?
Obstructive
167
Is gas diffusion across the A-C membrane perfusion- or diffusion-limited
Perfusion
168
Define sputum
Expectorated product
169
At what level of the respiratory system do airways lose cartilage in their walls?
Bronchioles
170
What percentage of pneumonia is due to bacteria?
85%
171
How many people out of 100,000 in Australia have tuberculosis?
4
172
How is TB transmitted between people?
Infected aerosolised droplets
173
What is under nervous control within the lungs?
Mucous production and diameter of bronchi
174
What are the 3 broad causes of pulmonary HT?
Increased left atrial pressure (eg mitral stenosis)
Increased pulmonary blood flow (eg excess central volume)
Increased pulmonary vascular resistance (eg emphysema, embolism)
175
What are the 2 most common causes of the common cold?
Rhinovirus and coronavirus
176
How is Type 1 respiratory failure diagnosed?
PaO2 less than 50 mmHg, with evidence of respiratory compensation.
177
Where would painful irritation of the diaphragmatic pleura be experienced?
Pain in the lateral neck and supraclavicular region of the shoulder (C3-C5 dermatomes)
178
How could you assess whether alveolar ventilation is adequate?
PaCO2
179
What is miliary TB?
Mycobacterium TB that has spread through blood to infect other organs
180
What is a normal PACO2?
40mmHg
181
List 5 clinical features of pneumonia
1 Intractible cough
2 that is productive of green/yellow sputum
3 fever and chills
4 Chest pain (if pleural inflamed)
5 Impaired gas exchange --\> dyspnoea and tachypnoea
182
Sleep deprivation of how long will result in cognitive performance equivalent to BAC of 0.05?
18-24 hours
183
What happens to PaCO2 during sleep?
Increases from 40 to 45mmHg
184
How many sleep cycles are there in a night typically?
4-6
185
What is a typical length of a sleep cycle?
90-120 mins
186
Where does the suprachiasmatic nucleus project to?
Paraventricular nucleus
187
Which nucleus in the brain releases histamine?
Tuberomammilary nucleus
188
Which nucleus in the brain is activated by adenosin and depleted ATP and inhibits ascending cholinergic and monoaminergic neurones to promote sleep?
Ventro-lateral preoptic nucleus
189
Do you get fibrosis in emphysema?
No
190
In percussion of the chest, how will different tisuues sound from dullest to most resonant
Fluid -\> Solid organs -\> Lung -\> Air
191
What type of noradrinergic receptors are found in the lungs?
Beta 2 (because you have 2 lungs)
192
Which nerve passes in front of the lung root?
Phrenic nerve
193
Which nerve passes behind the lung root?
Vagus nerve
