Multisystem Review

Greys

100

What is the functional unit of the respiratory system? How many does each lung contain?

Bronchopulmonary Segment

Right: 10

Left: 8-10

200

List the pathway from trachea to the end of the resp tract and what each segment supplies?

Primary Bronchus>Secondary Bronchus (Lobes)>Tertiary Bronchus (BPS)> Lobular Bronchiole (Secondary Lobule)>Terminal Bronchiole (Acinus)>Respiratory Bronchiole (Primary Bronchiole)>Alveolar Duct> Alveolar Sac, Alveolus

300

What are the muscles of inspiration and expiration (passive and/or active)? Name the nerve supply?

Inspiration:

-Diaphragm (Phrenic Nerve C3,4,5)

-External Intercostal Muscles (Intercostal Nerves)

Expiration

-Abdominals (Lots)

-Internal Intercostals (Intercostal Nerves)

400

What are the two factors that influence pulmonary ventilation? What other factors influence these?

1) Lung Compliance

-Elasticity

-Surfactant

2) Resistance

- Radius

- Velocity of flow

500

What are the two autonomic influences on the resp system? Name receptors, nerve, NT and function.

Give an example of a drug that affects each one.

Parasympathetic: Vagus Nerve, M3 muscarinic receptor, acetylcholine, bronchoconstriction.

Sympathetic: No direct nerve, B2 metabotropic, adrenaline, bronchodilation.

Crescendo-Decrescendo

100

List the 3 main classes of carcinogens in smoking?

• Contains three major classes of carcinogens: 
  1. Polycyclic hydrocarbons (including benzo(a)pyrene)
  2. Nitrosamines 
  3. Aromatic amines

200

List the different types of cancers that occur in the lungs? Which one is the most common?

• Two groups: 
  • Small Cell Carcinoma
  • Non-Small Cell Carcinoma: 
    • Squamous Cell Carcinoma  
    • Adenocarcinoma  
    • Large Cell Undifferentiated       Carcinoma  
    • Other:  
      • Mixed Types of above

300

What is the name of the cancer condition in the lungs that has spread to the lymphatics causing severe dyspnoe and resp symptoms?

• Lymphangitis Carcinomatosa

400

List 3 common genetic mutations that occur in cancer and which one is the most common?

KRAS: most common 

others: WT, EGFR, ALK, heaps

500

List the pathophysiological 'steps' of differentiation of an adenocarcinoma?

• Pre-invasive lesions: 
  • AAH: Atypical Adenomatous      Hyperplasia
  • AIS: Adenocarcinoma In Situ
• Invasive Lesions 
  • MIA: Minimally Invasive      Adenocarcinoma
  • Invasive Adenocarcinoma

'Have you done this before Doctor...?'

100

What is a common risk of occuring following a fine needle aspiration or biopsy of the lung?

Pneumothorax

200

What can small muscle wasting of the hand indicate in a resp exam?

T1 nerve root compression (potentially due to lung ca).

300

Explain the central and peripheral chemoreceptors and the drive to breathe?

Central: In medulla: detect CO2 and H+

Peripheral: In carotid bodies: Detect O2, CO2 and H+

Inout via sensory vagus to Resp Centre in Medulla Oblongata then output via Vagus (CN10) and Glossopharyngeal Nerve (CN9).

400

List the ABC... protocol for a chest Xray?

1. Airway: 
   • Midline? Obvious deformities, paratracheal masses 
2. Bones and soft tissue 
   • No obvious fractures, subcutaneous emphysema 
3. Cardiac size 
   • <50% of width of chest, silhouette, density
   •  Aorto-pulmonary window just under the aortic window 
     • Important area: if there is any shadow may indicate enlargement of lymph nodes 
4. Diaphragm 
   • Right higher than the left 1-3cm 
   • Costophrenic angles, border of hemidiaphragms sharp? 
5. Equal Volume 
   • Count ribs 
   • Look for mediastinal shift 
6. Fine Detail 
   • Pleura, lung fields 
   • Masses 
   • Consolidation  
   • Pneumothoraces 
7. Gastric Bubble 
   • No more than 0.5cm opacity above bubble 
8. Hilum/ Hardware 
   • Left above right up to 3cm 
   • Widened? (wider than a thumb) 
   • Hardware: tubes, catheters,      pacemakers, monitors

500

List the features in 'Horner's Syndrome' and what nerves and/or muscles are involved?

-Partial ptosis (Superior tarsal muscle)

-Miosis (Dilator pupillae)

-Anhidrosis

You are feeling very sleepy

100

What are the two broad categories of aneasthetic agents?

IV Agents

Volatile Inhalational Agents

200

Explain the process of an action potential in a neuron and the release of a NT and further stimulation at the synapse?

What are the two types of receptors in a synapse? 

What is the main excitatory and main inhibitory receptors and neurotransmitters?

AP - Ca2+ influx: triggers vesicles of NT to be exocytosed out at synapse. Main excitatory: glutamate. Will trigger influx of Na+ causing depolarisation.

Ionotropic (Ligand-gated), Metabotropic

Excitatory: Glutamate (NMDA, Kainate, AMPA mGlu)

Inhibitory: GABA (GABA-A, GABA-B)

300

What is the MOA of Propofol?

Binds to the Beta-subunit of the GABA-A receptor

400

Define 'Minimum Alveolar Concentration' in relationship to Volatile Inhalational Anaesthetics?

• A measure of relative potency (and standard for experimental studies)  
• MAC is based on the fat solubility of the anaesthetic or more appropriately its ability to cross the lipid bilayer  
• Anaesthetic dosage is expressed in multiples of MAC
• Minimum Alveolar Concentration = 
  • How much of an agent does it take to prevent 50% of a test population moving in response to a standard surgical incision 
  • MAC = 50% population = 1.0 MAC 
  • Each agent has its own MAC 50%

500

What is the MOA of Ketamine?

Antagonist at the NMDA receptor for glutamate. 

You Spin Me Right Round Baby

100

Define 'Atopy'?

Type 1 Hypersensitivity

Encompasses: Allergic rhinitis, asthma, contact dermatitis (eczema)

200

What is the treatment for Tuberculosis?

Which ones can give a)Orange mucous/ liquid, b)Cause ototoxicity c)peripheral neuropathy?

• Isoniazid (INH or H)
• Rifampicin (RIF or R)
• Pyrazinamide (PZA or Z)
• Ethambutol (EMB orE)

Orange: Rifampicin

Ototoxicity: Ethambutol

Peripheral Neuropathy: Isoniazid (If deficient in Vit B6)

300

Explain what is FVC and what are you assessing for to assist in diagnosing Obstructive vs Restrictive Pulmonary Disease?

FEV1/FVC

Obstructive: FEV1/FVC <0.7

Restrictive: FEV1/FVC >0.7

400

What are the two types of respiratory failure and give the parameters for these definitions?

Type 1: Low O2 (below pO2 60mmHg)

Type 2: Low O2 and High CO2 (O2 below 80mmHg, CO2 above 45mmHg)

500

What are the four types of emphysema and which one is the most common?

Which one is caused by alpha-1-antitrypsin deficiency?

1) Centriacinar: most common. Usually due to smoking

2) Panacinar: Whole alveolus. Most commonly from Alpha-1 Antitrypsin Deficiency

3) Distal Acinar

4) Irregular