Anatomy
How many lobes are on the right lung, their names, and what fissures are there?
3 lobes
Superior lobe
Middle lobe
Inferior lobe
- Horizontal and oblique fissure.
What is the spirometry measure/ reading of quiet breathing?
Tidal volume
Which nerve passes anterior to the root of the lung, and whats its origin?
The phrenic nerve, origin: spinal nerves from level C3-5.
Any 2 histology changes seen in chronic asthma.
- Smooth muscle hypertrophy of bronchial smooth muscle
- Inflammation and edema within the bronchial walls - the presence of eosinophils/ mixed chronic inflammatory cells (non-allergic asthma).
- Thickened basement membrane
- Hyperplasia of submucosal glands
- Thick mucus plus in bronchi
What is the effect on the uvula and soft palate during obstructive sleep apnoea?
Uvula and soft palate get sucked down, they become erythematous and edematous and create a severely narrowed airway.
When this spirometry value is decreased it is indicative of an obstructive airway disease.
Reduced FEV1
A patient presents with HR of 130, hemoptysis, chest pain, and a history of previous left hip arthroplasty 2 weeks ago. What scoring system is used to determine PE risk, what risk category is this patient in, and what is the next step in this patient's care?
High risk of DVT (wells score >6 (10)).
The next step in this patient's care is to do a CTPA to determine the site and severity of PE.
What are 2 ways Beta-2 receptor agonists like salbutamol decrease airway resistance?
- Induce airway smooth muscle relaxation - bronchodilation.
- Inhibit stimuli that induce bronchoconstriction
- Decrease mast cell mediator release (histamine)
- Decrease mucus secretion
- Decrease endothelial cell permeability to prevent edema.
What is the position of the pulmonary veins in the hilum of the lung?
The most anterior and posterior structure in the hilum of the lung.
What are the three components of Virchow's triad and give an example of risk factors/ examples of these relating to the development of DVT.
Stasis of flow (venous stasis)
- Surgery, trauma, immobility, plaster casts, air travel.
Endothelial damage
- Trauma, shock, cardiovascular catheterization
Hypercoagulable state / acquired hypercoagulability
- Factor V Leyden mutation, prothrombin gene mutation, antithrombin III deficiency, protein C and S deficiency, and dysfibrinogenaemia.
- Acquired: cancer, pregnancy, OCP, HRT, polycythemia, smoking, antiphospholipid syndrome.
In which component of a pulmonary lobule do pulmonary veins and pulmonary lymphatics exist?
Interlobular septa
The phospholipase released from eosinophils that crystalizes and is seen in sputum cytology as Charcot-Leyden crystals.
Galactin-10
What two sinuses drain through the semilunar hiatus?
Frontal and maxillary sinus.
A patient has a tiffeneau-pinelli index of 65%, does this patient have a restrictive or obstructive lung disease?
Obstructive lung disease. This index represents the ratio of FEV1/FVC, and it represents the proportion of their vital capacity that can expire in the first second of forced expiration. A normal tiffeneau-pinelli index is (70-80%). Since it is less, it implies there is excessive expiratory obstruction, most likely from narrowing, or loss of elastic recoil.
What type of emphysema typically results from an alpha-1 antitrypsin deficiency, and what parts of the acinus are affected in this type? What is a life-threatening complication that can occur with this type of emphysema?
Panacinar emphysema, affects the entire acinus, the respiratory bronchiole, the alveolar duct, and the alveoli. Because of this, the para septal end can balloon forming an emphysematous bullae or bleb. These can rupture leading to a pneumothorax.
What are the role/s do IL-13, IL-15, and IL-4 play in the sensitization phase of asthma?
IL-13: activates B cells and increases mucus production.
IL-15: recruits eosinophils
IL-4: Activates B cells and B cell differentiation to secrete IgE
What intrinsic laryngeal muscle is active during forceful respiration, and what is its innervation?
Posterior cricoarytenoid, innervated by the recurrent laryngeal nerve.
What lung disease results from a decrease in radial traction?
Emphysema. Radial traction is the force that results from the tethering of alveoli to smaller airways. It relies on the elasticity of the lung. Lungs with high elasticity have high radial traction which allows the smaller airways to remain patent, especially respiratory bronchioles which solely rely on radial traction to remain patent.
What structure does the right recurrent laryngeal nerve loop under?
Right subclavian artery, the left loops under the arch of aorta.
What are the benefits of using glucocorticoids and beta-2 adrenoreceptor agonists in synergy?
When these drugs are used together they prevent desensitization of each other.
- Glucocorticoids prevent the downregulation of beta-2 adrenoreceptors (decrease SABA desensitization)
- Beta-2 agonists extend glucocorticoid responsiveness (GR priming through phosphorylation of GR).