Respiratory System Flashcards
(37 cards)
A 69-year-old asthmatic man has had a persistent cough and felt feverish for the last week. He is wheezy and having difficulty breathing, and his inhalers are not having any effect. Which of the following is the most consistent with a severe attack of asthma?
A. BP 90/60 mmHg
B. Inability to complete sentences
C. Inaudible air entry bilaterally
D. SaO2 < 75% on air
B. Inability to complete sentences
Running out of breath before the end of a sentence, together with a PEFR 33-50% of predicted and HR > 110/min is consistent with a severe attack of asthma.
A and C indicate hypotension; D suggests a life-threatening asthma attack which should prompt immediate referral to ITU.
A 21-year-old woman has had left-sided chest pain for a week, sharp in nature and worse on inspiration. The left medial border of her sternum is tender but her chest is otherwise clear. Temperature, heart rate, respiration rate and SaO2 are within normal range. Which is the most likely diagnosis?
A. Pneumonia
B. Myocardial infarction
C. Costochondritis
D. Pulmonary embolus
C. Costochondritis
A 30-year-old woman has had a severe acute episode of asthma, her first in ten years – she has a salbutamol inhaler for occasional use, and beclometasone for use twice daily. Which single measure is most likely to improve her long-term asthma control?
A. Add montelukast tablets to prescription
B. Add salmeterol inhaler
C. Ensure up-to-date spirometry and lung function tests
D. Write a plan of how and when to take the inhalers
D. Write a plan of how and when to take the inhalers
A 26-year-old man has a sudden pain over his lower sternum. He feels breathless and nauseous. On auscultation, there is decreased air entry at the right apex. Which is the most likely diagnosis?
A. Acute pericarditis
B. Pneumonia
C. Pneumothorax
D. Pulmonary embolus
C. Pneumothorax
The PO2 (mm Hg) inside skeletal muscle cells during exercise is closest to?
A. 3
B. 10
C. 20
D. 30
A. 3
Which of these is unlikely to be true for a normal, healthy individual?
A. Tidal volume = 0.5L
B. Respiratory rate = 13 breaths per minute
C. Partial pressure of oxygen in the arteries = 10.2kPa
D. Vital capacity = 3.9
E. Physiological dead space = 350ml
C. Partial pressure of oxygen in the arteries = 10.2kPa
Which of the following is untrue?
A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2
B. Respiratory neurons in the medulla have pacemaker activity
C. Peripheral chemoreceptors are found on the aortic arch and can respond to hypoxia, pCO2 and pH
D. Sensitivity to CO2 decreases in sleep
E. Pharyngeal resistance increases during sleep
B. Respiratory neurons in the medulla have pacemaker activity
The most important stimulus controlling the level of resting ventilation is:
A. PCO2 on peripheral chemoreceptors.
B. PCO2 on central chemoreceptors.
C. pH on peripheral chemoreceptors.
D. pH of CSF on central chemoreceptors.
D. pH of CSF on central chemoreceptors.
Match the following description of lung cells to the cell types given above
- These make up 95% of the surface area of the alveoli and are large and thin
- These are simple columnar epithelial cells which secrete mucin from granules into the bronchus and large bronchioles
- These are modified columnar epithelial cells in the upper airways, they move mucus towards the oropharynx
- These are found in the bronchioles, have microvilli, and secrete products that are protective to the bronchial epithelium
- These destroy foreign material in the alveoli
A. Goblet cells B. Astrocytes C. Paneth cells D. Type I pneumoncytes E. Schwann cells F. Macrophages G. Oligodendrocytes H. Basal cells I. Mesangial cells J. Clara cells K. Ciliated cells L. Type II pneumocytes
1 = D 2 = A 3 = K 4 = J 5 = F
A patient with asthma is prescribed inhaled corticosteroids – why?
A. To build smooth muscle in the conducting airways
B. Because studies have shown a positive correlation with good patient outcomes
C. To cause prolonged bronchodilation
D. To attenuate the underlying immune response
D. To attenuate the underlying immune response
Which of these is unlikely to be true for a normal, healthy individual?
A. Tidal volume = 0.5L
B. Respiratory rate = 13 breaths per minute
C. Partial pressure of oxygen in the arteries = 10.2kPa
D. Vital capacity = 3.9
E. Physiological dead space = 350ml
E. Physiological dead space = 350ml
Which of the following is untrue?
A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2
B. Respiratory neurons in the medulla have pacemaker activity
C. Peripheral chemoreceptors are found on the aortic arch and can respond to hypoxia, pCO2 and pH
D. Sensitivity to CO2 decreases in sleep
E. Pharyngeal resistance increases during sleep
A. Central chemoreceptors are found on the medulla, they respond to pH and pCO2
Central chemoreceptors respond only to pCO2
The CXR shows a patient who has had contrast injected and then had a CXR straight away. What do the arrows show?
A. Pulmonary Arteries
B. L and R Main Bronchi
C. The Azygous Vein System
D. The aortic bifurcation
A. Pulmonary Arteries
Pulmonary surfactant is produced by:
A. Alveolar macrophages. B. Goblet cells. C. Leukocytes. D. Type I alveolar cells. E. Type II alveolar cells.
E. Type II alveolar cells.
The basal regions of the upright human lung are normally better ventilated than
the upper regions because:
A. Airway resistance to the upper regions is higher than to the lower regions.
B. There is less surfactant in the upper regions.
C. The blood flow to the lower regions is higher.
D. The lower regions have a small resting volume and a relatively large increase in
volume.
E. The PCO2 of the lower regions is relatively high.
C. The blood flow to the lower regions is higher.
Pulmonary surfactant:
A. Increases the surface tension of the alveolar lining liquid.
B. Is secreted by type I alveolar epithelial cells.
C. Is a protein.
D. Increases the work required to expand the lung.
E. Helps to prevent transudation of fluid from the capillaries into the alveolar spaces.
A. Increases the surface tension of the alveolar lining liquid.
Do the following all affect airway resistance?
A. Bronchial smooth muscle contraction B. Mucus plugging C. Oedema D. Foreign bodies E. Left ventricular ejection fraction
A. Bronchial smooth muscle contraction - YES
B. Mucus plugging - YES
C. Oedema - YES
D. Foreign bodies - YES
E. Left ventricular ejection fraction - NO
Is air flow limitation in COPD fully reversible?
A. Yes, always
B. Yes, with LABAs therapy
C. Sometimes
D. No
D. No
Match the following to either
A. Asthma or B. COPD
- CD4 T Cells
- CD8 T Cells
- Mast Cells
- Neutrophils
- Reduced gas transfer ability
- No change in gas transfer ability
- Hyperinflated chest -
- Alpha 1 Anti-trypsin deficiency in about 1%
- Pulmonary rehabilitation
- CD4 T Cells –> Asthma
- CD8 T Cells –> COPD
- Mast Cells –> Asthma
- Neutrophils –> COPD
- Reduced gas transfer ability –> COPD
- No change in gas transfer ability –> Asthma
- Hyperinflated chest –> COPD
- Alpha 1 Anti-trypsin deficiency in about 1% –> COPD
- Pulmonary rehabilitation –> COPD
Match the appropriate pathogen with the descriptions provided in the question:
A. Coronavirus B. Rhinoviruses C. Rotavirus D. Staphylococcus epidermidis E. Influenza A family viruses F. Hantavirus
- Causes Severe Respiratory Distress Syndrome (SARS). No drug has been proven effective against the pathogen. Management is supportive. First discovered in 2003.
- Can cause rapidly- progressive pneumonia ± ARDS. The most common types which infect humans are designated as H1N1 and H3N2. Oseltamivir (Tamiflu) and zanamivir (Relenza) can be used to reduce morbidity.
- Pulmonary oedema and ARDS are present in 80-90% of patients. Cough and upper respiratory symptoms are uncommon. Renal syndrome is also presentable. No drug has been proven effective against the pathogen. Management is supportive. First discovered in 1950s.
1 = A 2 = E 3 = F
25) Which of the following about oseltamivir (Tamiflu) is INCORRECT? (More than one option might be correct)
A. It can be used in prophylaxis for influenza A infection
B. Resistance has been reported for H1N1 strain
C. It is administered in oral, intravenous and inhaled routes
D. It is a neuraminidase inhibitor
E. It can be used to treat Haemophilus influenzae infection
A - Oseltamivir is used for prophylaxis of influenza A and B once the infection has been circulating. It is contra-indicated in children <1 YO and >48h post-exposure.
B - Rare cases of oseltamivir-resistant H1N1 strain were reported in 2009 (and possibly earlier). Zanamivir, where no resistance has been reported by far, is believed to be a more effective treatment option.
C - CORRECT: Oseltamivir is only available in oral form. European Medicines Agency (EMA) holds a positive stance towards Tamiflu IV, which is the intravenous form of oseltamivir. However by January 2010 it has yet to be approved. Zanamivir is available in inhaled form but not oseltamivir.
D - Oseltamivir inhibits neuraminidase expressed by the influenza virus, which the enzyme is crucial for viral budding. It is a competitive inhibitor for neuraminidase, by binding to sialic acid expressed on normal cells.
E - CORRECT: Oseltamivir is only used to treat influenza A and B infections. It has no efficacy in treating Gram- positive bacterial infection in the case of H. influenzae.
26) Which of the following about FiO2 is INCORRECT?
A. It is defined as the fraction of oxygen in inspired air in a gas mixture
B. It can be increased by artificial ventilation
C. It has a maximum value of 1.0
D. It may cause lung injury when >0.50
E. It is always positively related with SaO2
A. It is defined as the fraction of oxygen in inspired air in a gas mixture
CORRECT - FiO2 = fraction (F) of inspired (i) oxygen (O2); normal value in the atmosphere = 0.21 (21%); does not vary with altitude, unlike partial pressure of inspired oxygen (PiO2).
B. It can be increased by artificial ventilation
CORRECT - FiO2 can be manipulated by altering oxygen content in the gas mixture, to a maximum of 1.0 (100%).
C. It has a maximum value of 1.0
CORRECT - Expressed as a number w/o unit from 0.0-1.0
D. It may cause lung injury when >0.50
CORRECT
E. It is always positively related with SaO2
INCORRECT - At the presence of right-to-left shunting (V/Q mismatch), SaO2 might not respond to an increasing FiO2
A 65-year old male presents FiO2 = 0.40, PaO2 = 8.0, reduced HCO3-, elevated urea and creatinine levels. PH indicates he had no pre-existing renal conditions. Which of the following is the most likely diagnosis? (ARDS: Acute Respiratory Distress Syndrome; ALI: Acute Lung Injury; ARF: Acute Renal Failure; CRF: Chronic Renal Failure)
A. Acute Respiratory Distress Syndrome
B. Acute Respiratory Distress Syndrome with Acute Renal Failure
C. Acute Lung Injury with Acute Renal Failure
D. Acute Respiratory Distress Syndrome with Chronic Renal Failure
E. Acute Lung Injury
A. Acute Respiratory Distress Syndrome
NO - Patient presents elevated urea and creatinine, which is a sign of renal failure instead of ARDS alone.
B. Acute Respiratory Distress Syndrome with Acute Renal Failure
YES - PaO2:FiO2 ratio = 20, which falls within the cut-off of ARDS (26.6kPa). Patient presents renal failure w/o pre-existing renal conditions –> acute –> Likely diagnosis = ARDS with ARF.
C. Acute Lung Injury with Acute Renal Failure
NO - PaO2:FiO2 cut-off for ALI is 40kPa –> Patient therefore experiences ARDS but not ALI.
D. Acute Respiratory Distress Syndrome with Chronic Renal Failure
NO - Renal failure in this case is acute, but CRF refers to deterioration of renal fxn over >3 months.
E. Acute Lung Injury
NO - Same as C
Concerning the pressure-volume behaviour of the lung:
A. Compliance decreases with age.
B. Filling an animal lung with saline decreases compliance.
C. Removing a lobe reduces total pulmonary compliance.
D. Absence of surfactant increases compliance.
E. In the upright lung at FRC, for a given change in intrapleural pressure, the alveoli
near the base of the lung expand less than those near the apex.
C. Removing a lobe reduces total pulmonary compliance.
