Anatomy
In the intercostal bundle there are 3 structures.
Which structure is located superior to the other 2?
Intercostal Vein
Describe the difference between an obstructive and restrictive disorder using spirometry.
Obstructive Disorders → FEV1 decreases, FVC minimal change, FEV1/FVC decreases.
Restrictive Disorders → FEV1 decreases, FVC decreases, FEV1/FVC minimal change.
Explain why some COPD patients are referred to as blue bloaters.
- Chronic Bronchitis
- Bronchiolar Inflammation => Airway obstruction => Ventilation/Perfusion Mismatch => Poorly oxygenated blood => Tissue Hypoxia (Cyanosis)
- Bronchiolar Inflammation/Obstruction => Increased workload on right side of heart to provide pulmonary circulation => Pulmonary HT => Right sided HF => Systemic Oedema (Bloating)
What is the commonest treatment for asthma and what is its broad drug class and function?
Salbutamol
Beta-2 adrenergic agonist
Dilates bronchiolar smooth muscle
What is the largest planet in our solar system?
Jupiter
Which muscle forms the anterior faucial pillar in the oropharyngeal cavity?
Palatoglossus
List the 3 factors that affect pulmonary ventilation and determine whether they increase or decrease ventilation.
Airway Resistance → Reduces ventilation.
Alveolar Surface Tension → Reduces ventilation. ∵Causes the lungs to collapse (decreased area for gas exchange)
Lung Compliance → Increases/allows ventilation
What are the 4 types of asthma?
Atopic Asthma
Non-atopic Asthma
Drug/aspirin induced Asthma
Occupational Asthma
What is the most effective first-line management for a patient with COPD.
Smoking Cessation.
Which country won the first ever World Cup (football)?
Uruguay
What sign on an X-ray helps differentiate right upper lobe atelectasis from lobar pneumonia?
Golden S line/sign
An overweight 65-year-old man presents with excessive thirst, frequent urination and nausea.
On examination, he is dehydrated and has deep, rapid breathing. His breath has a fruity odour.
His arterial blood gas results are:
pH: 7.18
PaCO₂: 22 mmHg
HCO₃⁻: 8 mmol/L
Identify the acid-base disturbance.
Metabolic acidosis with respiratory compensation
List 1 histopathological feature of a small cell lung carcinoma.
Either:
- Fragile cell appearance
- Neuroendocrine granules
What drug class are known to suppress dry coughs?
Opioids
What is the fastest animal in the world?
Peregrine Falcon (389km/hr)
In the thorax, lymph drains to the mediastinal lymphatic vessels FROM both the right and left surfaces of the lungs.
Describe the lymphatic drainage from the left lung to the venous system AFTER lymph reaches the mediastinal lymphatic vessels.
Thoracic Duct → Left Jugulo-Subclavian Venous Angle → Systemic Circulation
Describe the autonomic cough reflex.
1. Receptors detect irritation.
2. Afferent impulses from vagus nerve to medulla
3. Reflex:
a. Rapid and deep inspiration
b. Closing of epiglottis and vocal cords.
c. Expiratory muscles contract and cause a forceful expulsion of air that suddenly opens the epiglottis and forces air + foreign material out.
Sensitisation is the first stage in the pathogenesis of atopic asthma.
Explain the immune mediated pathway of sensitisation.
1. Forgein body presents antigen to dendritic cell.
2. Dendritic cell presents antigen to immature T cell which matures into Th2 cell.
3. Th2 cell sends interleukins to recruit eosinphils and promote B cell activation.
4. B cell undergoes class-switching to produce antigen-specific IgE antibody
5. Mast cell is sensitised to antigen and releases histamines and granules in response to allergen
Tumour Lysis Syndrome involves the breakdown of tumour cells and release of intracellular metabolites.
Name a drug that is used to manage a common clinical consequence of Tumour Lysis Syndrome?
Allopurinol (treats hyperuricaemia)
How many chairs are there in this room?
Which structure is thought to lubricate the true vocal folds?
Laryngeal Saccules
There are 2 main inibitory NANC chemicals that cause bronchoconstriction. One is histamine.
What is the other one?
Vasoactive Intestinal Peptide
Which type of asbestos fibre is more dangerous and why?
- Amphibole
- Straight, sharp => Damage to deeper lung tissue
- More carcinogenic than Serpentine fibres
Omalizumab
What is Vaibhav’s favourite Travis Scott song?
Hint: Think pharmacology
Antidote