Respiratory overview from UEMS tutors

Question 1

You are on placement and you are examining a patient with a respiratory problem. The doctor asks you to point out where the the trachea bifurcates (carina) on the patient. What landmark on the patient would you feel for?

Answer 1

Angle of Louis - T4/T5

Question 2

vertebral level of sternal notch

Answer 2

T2/3

Question 3

vertebral level of diploid process

Answer 3

T10

Question 4

on the medial side of the left lung what in the indentation called

Answer 4

cardiac notch

Question 5

what does the oblique fissure separate in the right lobe

Answer 5

the upper and middle lobes from the lower lobes

Question 6

You are an F1 doctor and a patient presents to you with pleural effusion (fluid on the lung). Your consultant asks you to drain the fluid. Where do you stick your needle?

Answer 6

halfway between the 9th and 10th rib ( bottom of the lung in the intrapluerAL space)

thoracicentesis - mid axillary line
to avoid neurovascual bundles

Question 7

where do you perform an intercostal nerve block

Answer 7

just below the rib

Question 8

internal muscle are up towards the chest ad external muscle are like what

Answer 8

hands in your pockets

Question 9

what is the major muscle of inspiration that has a central tendon and hemidomes lowered to the costal margin

Answer 9

diaphragm

Question 10

what do the external intercostals do

Answer 10

elevate the ribs during forced inspiration

Question 11

which accessory muscle of inspiration elevates and fixes the sternum

Answer 11

sternocleidomastoid

Question 12

which accessory muscles of inspiration fix the 1st and 2nd ribs

Answer 12

scalenes

Question 13

which accessory muscle of inspiration , when the scapula is stabilised fixes the 3-5th ribs

Answer 13

pec minor( MAJOR)

Question 14

when the scapula is stablasied what access muscle of inspiration fixes the upper 8th and 9th ribs

Answer 14

serrates anterior

Question 15

what is the process of expiration of how the ribs and chest wall move back into place

Answer 15

elastic recoil

Question 16

do the internal and innermost intercostals depress the interosseous parts of ribs during forced expiration and elevate the interchondral parts of the ribs during forced expiration respectively

Answer 16

yes

Question 17

what are the accessory muscles of expiration which increase the intra-abdominal pressure

Answer 17

rectus abdominus and transversus abdominus

Question 18

Inspiratory muscles contract (external inter coastal muscles and diaphragm)
Intrapleural pressure (pip) becomes more negative
Increases difference between Palv and Pip = increases Ptp (trans pulmonary pressure- arbitrary)
Alveolar volume increases
Palv decreases
Difference in pressure between atm and alv

Answer 18

inspiration

Question 19

Inspiratory muscles relax (usually passive but when active internal inter coastal muscles contract)
Pip becomes less negative
Decreases difference between Palv and Pip = decreases Ptp
Alveolar volume decreases (elastinnnnnn)
Palv increases
Difference in pressure between alv and atm

Answer 19

expiration

Question 20

what is a pneumothorax

Sx ?

Answer 20

Air within the pleural space that can’t escape (so its like a one-way valve)
Presents with a sudden onset of SOB, chest pain, dyspnoea, dizziness. Usually young, tall, slim men.

Question 21

what is a tension penuomothorax

Answer 21

A tension pneumothorax = rapidly getting worse (tracheal deviation, decreased BP, midline shift)

Question 22

Your flatmate has a really productive cough. What cell in her lungs is producing all the mucous?

Answer 22

goblet cells

Question 23

function of type 1 alveolar cells

Answer 23

surface coverage , alveolar capillary barrier formation , gas exchange and alveolar fluid clearance

Question 24

function of type 2 alveolar cells

Answer 24

surfactant secretion, epithelial cell regeneration after injuries , barrier formation , inflammatory mediators production

Question 25

function of endothelial cells

Answer 25

alveolar capillary barrier formation | gas exchange and nfalmamory mediators production

Question 26

function of alveolar macrophages( known as dust cells)

Answer 26

danger associated molecular patterns recognition , immune response trigger , chemotactic and inflammatory mediators

Question 27

function of surfactant r

Answer 27

reduce surface tension and increase compliance and contribution to lung stability

Question 28

what is the hormone responsible for surfactant production

Answer 28

cortisol

Question 29

if babies are born prematurely what problem can occur due to not enough sufacnta

Answer 29

repsriaotry distress syndrome mothers are given prophylaxis ( corticosteroids) - trigger surfactant given before it develops

Question 30

You are walking down the street and come across a person who has collapsed. He is wheezing, is clammy, has a low pulse and has swollen lips and tongue. You recognize this as being an anaphylactic reaction. What would you give to treat him (assuming you are carrying a pharmacy lol)?

Answer 30

adrenaline Type 1 hypersensitivity too allergy and autoimmune

Question 31

what is an allergy

Answer 31

Allergy – abnormal immunological response to otherwise harmless environmental stimulus

Question 32

what is an autoimmune disease

Answer 32

Autoimmune disease – abnormal immunological response directed against an antigen within the body ``` Types 1- Anaphylactic 2- cytotoxic 3- immune complex 4- delayed type ```

Question 33

types of hypersensitivity

Answer 33

Type 1: Allergic or immediate hypersensitivity, onset within minutes, involves development of IgE antibodies in response to harmless antigens, eg asthma, anaphylaxis Type 2: is called cytotoxic as it causes antibody mediated destruction of healthy cells, onset within minutes to hours, involves IgM or IgG antibodies, eg Graves disease, myasthenia gravis Type 3: immune complex hypersensitivity, onset usually 2-6 hours, eg Farmer’s / Pigeon Fanciers lung and serum hypersensitivity Type 4: delayed hypersensitivity reaction, inflammation by 2-6 hours and peaks by 24-48 hours. Results from interaction of T cell-initiated inflammation and does not involve antibodies. Eg contact dermatitis, rheumatoid arthritis, multiple sclerosis, drug reactions (eg Stevens-Johnson syndrome).

Question 34

FEV1

Answer 34

FEV1 – amount of air you can force out in 1 second

Question 35

FVC

Answer 35

FVC – all the air you can breathe out of your lungs after a nig breath in

Question 36

PEFR

Answer 36

PEFR/PEF (peak expiratory flow rate) – highest rate of expiration (as soon as you breath out) These are influenced by: Resistance = ease with which gas flows through conducting airways Compliance = expandability of lungs and chest wall obstructive disease resistance goes up in restrictive disease compliance decreases

Question 37

symptoms of asthma

Answer 37

``` Wheeze (expiration) Dyspnoea Cough (maybe with sputum) (often at night as airway resistance tends to be higher at night for asthmatics) Tachypnoea Tachycardia Hyperinflated chest ``` ``` vasodialtion hyperplasia desquamation odema hypertorphy thickenign collagen deposition partial occlusion of brocnhial lumen by mucus plug ```

Question 38

what is the asthma allergy mechanism

Answer 38

Immunological mechanism: Mediated by IgE- formed in response to intial exposure to allergen. In the 2nd exposure the IgE antibodies, now bound to the mast cells via their fc binding region will then form a complex with the antigen. This causes degranulation of mast cells. Smooth muscle contraction- spasmogens Inflammation of lung lining- inflammatory cytokines. Mucous is released into airways- narrow.

Question 39

asthma is an obstructive disease what would results show

Answer 39

Decreased FEV1 FVC is the same FEV1/FVC decreases treated with SABA and corticosteroids

Question 40

An old man presents to clinic with barrel chest, sob, history of smoking and cyanosis in his extremities. This is his CXR. What pathology can you identify

Answer 40

COPD ``` Types Emphysema Long term exposure to irritant Immune destruction of alveolar sacs Decreases elasticity Air retained in lung= hyper inflation ``` pink puffer ``` Chronic bronchitis Long term exposure to irritant Inflammatory response in bronchi CHRONIC INFLAMMATION Build up of mucus Chronic narrowing of air ways. Treatment- symptomatic treatments NO CURE. ``` blue bloater

Question 41

recurrent laryngeal nerve injury symptoms

Answer 41

Hoarse weak voice | Bovine cough

Question 42

what is penetrance

Answer 42

how likely it is the genotype will be expressed in the phenotype

Question 43

anticipation

Answer 43

severity of the mutation increase down the generations ``` Autosomal dominance- Males= Female MULTIPLE generations Autosomal recessive Males= Female SINGLE generation X- linked Recessive ONLY males (basically) Transmitted through FEMALEZ X link dominant Females less severely effected No male to male transmission ```

Question 44

antibiotics therapy

Answer 44

``` beta lactams of cell wall - penicillin cell membrane - polymyxins 30S subunit - ahminoglycosides 50S - macrocodes RNA polymerase - rifampin DNA gyrate - quinolone folate synthesis - sulphonamides ```

Question 45

where are the most ROS produced from

Answer 45

complex 1 and 3

Question 46

60 year old man presents to ED after he is caught in a fire in the plastic bottle factory where he works . He says he feels dizzy and you notice his cheeks are cherry red and his lips are cyanotic. What do you suspect?

Answer 46

cyanide poisoning ``` block ETC by binding to cytochrome oxidase. N & V Headache Altered mental state Seizures Tachypnoea Tachy cardia ``` histotoixc hypoxia

Question 47

example of hypoxic hypoxia

Answer 47

COPD

Question 48

example of circulatory hypoxia

Answer 48

cardiac failure and hypotensive shot