Session 1-4 Review

Question 1

A patient has methotrexate induce pulmonary fibrosis

What will happen to functional residual capacity

Answer 1

Decreased secondary to increased elastic recoil

Increased compliance and elastic recoil due to increased CT

Decreased lung volumes as stiff and hard to expand, less FRC as elastic recoil pulls lung walls in

Question 2

Lung auscultation with pulmonary fibrosis

Answer 2

Fine Velcro crackles best heard in dependent lung fields

Question 3

Lung foreign body aspiration can be complicated by

Answer 3

Reabsorption atelectasis and pneumonia

Question 4

Dysphagia, diploplia, muscle fatigue and and hypoventilation most likely cause

Presentation and spirometry

Answer 4

Myasthenia gravis

Hypoventilation, restrictive pattern on spirometry

Question 5

Adaptation of a woman at high atmospheric pressure

Answer 5

Increased 2,3-DPG levels with right shift of o2-Hb dissociation curve

Reduced affinity, more readily release oxygen

Question 6

Mechanical ventilator has 450ml dead space, rate of 20

Patients anatomical dead space is 150ml

Which volume to deliver 6000 ml/minute?

Answer 6

Total volume = alveolar and dead space

150 + 450 = 600

6000/20 = 300ml per breath

300 + 600 = 900ml

Question 7

Partial pressure of oxygen =

Answer 7

O.209 x (atmospheric pressure - saturated vapour pressure)

Question 8

What will happen to a person with partial pressure of oxygen 5.2kPa

Answer 8

Alveolar pO2 will be lower, will become hypoxaemic and rapidly lose consciousness

Question 9

Why is carbon monoxide poisoning more dangerous than iron deficiency anaemia

Answer 9

CO causes decrease in P50 of Hb for O2

Shift curve to left

Question 10

Iron deficiency anaemia lab findings

Answer 10

Tissue hypoxia, Hb saturation and PaO2 normal

Question 11

Effects of hypophosphataemia and associated lower 2,3-DPG levels

Answer 11

Shifts curve to left, Hb has an increased oxygen affinity

Question 12

HOC would have what impact on patient (hyperbaric oxygen chamber)

Answer 12

Increased PAO2, would shift oxygen haemoglobin dissociation curve to right

Question 13

Fetus starts producing surfactant from week

Answer 13

25

Question 14

SVP =

Answer 14

6.28

Question 15

Atmospheric pressure =

Answer 15

31.1

Question 16

Pp of oxygen

Answer 16

0.209

Question 17

What is partial pressure of oxygen and the partial pressure of carbon dioxide in mixed venous blood

Answer 17

6 kPa

Question 18

Oxygen haemaglobin dissociation curve is shifted to the right when

Answer 18

Low pH
High partial pressure of CO2
High temp
High concs of 2,3-BPG

Question 19

High concentrations of 2,3-BPG shift curve to

Answer 19

Right

Question 20

What 2 factors affect the partial pressure of oxygen within alveolus

Answer 20

Rate of oxygen diffusion into blood
Rate at which oxygen is replenished

Question 21

partial pressure of oxygen in 33.7 atmospheric pressure

Answer 21

7.04

33.7 x 0.209

Question 22

What is the function of clara cells

Answer 22

Goblet cells replaced by clara cells from bronchioles onwards

Clara cells produce surfactant

Question 23

What are conchae

Answer 23

Outgrowths of medial surface of nasal cavity to increase surface area for inspired air to be humidified whilst cooling expired air to recover water

Question 24

The parasympathetic supply to the lungs is derived from

Answer 24

Vagus nerve

Question 25

Pleural membranes are comprised of what type of epithelium

Answer 25

Simple squamous

Question 26

Which muscle forms the inferior border of the middle mediastinum

Answer 26

Diaphragm

Question 27

Mediastinum is divided into superior and inferior by an imaginary line at what level

Answer 27

T4

Question 28

What forms the posterior border of the superior mediastinum

Answer 28

Vertebral bodies T1-T4

Question 29

Which part of each rib articulates with the sternal articular facets

Answer 29

Costal cartilage associated with ribs 1- articulates with sternum

Question 30

Tubercle at the neck of each rib articulates with the

Answer 30

Transverse process of thoracic vertebrae

Question 31

Weird thing about second rib

Answer 31

Roughened area for attachment of Serratus anterior

Question 32

Which structure does the central tendon of the diaphragm fuse with

Answer 32

Pericardium

Question 33

Which ligament is unique to thoracic spine

Answer 33

Costotransverse ligament

Question 34

Which part of the ribs do the thoracic vertebral bodies articulate with

Answer 34

Head

Question 35

The pH of the plasma is 7.4 which is alkaline, why

Answer 35

High conc of hydrogen carbonate ions in the plasma preventing carbon dioxide in the plasma reacting with water

Question 36

In the cells of the proximal tubule of the nephrons, what amino acid is used to produce ammonium ions

Answer 36

Glutamine

Question 37

Reference range for oxygen on arterial blood gas

Answer 37

11-13kPa

Question 38

Vomiting causes

Answer 38

Metabolic alkalosis

Question 39

What are central chemoreceptors sensitive to

Answer 39

Changes in pH of CSF

Question 40

Oxygen saturation of Hb begins to reduce at pO2 of

Answer 40

8kPa

Question 41

What value of pCO2 would be hypercapnia on ABG

Answer 41

6.5 Range is 4.7-6

Question 42

What electrolyte disturbance is most likely to be seen in a patient with metabolic acidosis

Answer 42

More H+ ions means H+ moved into cells Potassium is moved out Causes hyperkalaemia

Question 43

Which physiological dysfunction is the most common cause of hypercapnia

Answer 43

Alterations in respiratory rate- decrease minute ventilation volume

Question 44

Causes of hypercapnia in order of most to least common

Answer 44

Alterations in respiratory rate Disturbance in gas exchange Abnormalities in function of chest wall Abnormalities of neural control

Question 45

What is the most important mechanism by which carbon dioxide is transported in the lungs

Answer 45

Bicarbonate in serum (Dissolved is 10% and carbamino Hb is 20-30%)

Question 46

High pH leads to

Answer 46

Left shift of oxygen dissociation curve P50 lower

Question 47

Hyperventilation level of PaCO2

Answer 47

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