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Flashcards in Respiratory Deck (194):
1

At what vertebral level does the trachea begin?

C6

1

What is a typical tidal volume?

500 ml

1

What is a typical residual volume?

1200ml

1

If the lung is full of fluid, how will vocal resonance sound?

Louder

1

What is the majority of acute epiglottitis caused by?

Haemohpilus influenzae Type B

1

What do we call pus in the pleural space?

Empyema

1

HIgh pH and normal PaCO2 = what?

Metabolic alkalosis

1

Give a 2 word definition of asthma

Reversible bronchoconstriction

 

1

There is chemotaxis of which cell type in the delayed phase of asthma?

Mast cells

Lymphocytes

Eosinophils

Macrophages

Basophils

1

What is a Ghon's complex comprised of?

Gohn focus + lymphadenopathy

1

Which lobe does secondary TB typically affect?

Upper lobe

1

What is Potts disease?

Single organ TB of the spine

1

What level must PaO2 drop below before it has an effect on ventilation?

~50mmHg

1

What information about cough must be obtained during history taking?

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

What is haematemesis?

Vomited up blood

1

In which species is Type A influenza virus found?

Humans and other species

2

Which muscles may be contracted for forceful exhalation

Abdominal and internal intercostal muscles

2

Where does rotavirus replicate?

Rotavirus replicates in epithelial muscosa of GIT

2

What are the most common causes of otitis media?

Pneumococci,

H. influenzae

Moraxella catarrhalis

2

Hiow much oxygen is consumed at rest?

250ml/min

2

Define breathlessness

Pt's recognition of an inappropriate relationship between respiratory work and total body work

2

What is corryza?

Runny nose

4

Name 4 features of airway remodelling in asthma that cause obstruction of the airways

Goblet cell hyperplasia with increased mucous production

Subepithelial collagen thickening

Increased airway smooth muscle volume

Increased mucosal vascularity

4

Define Gohn focus

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