3.03 A Nasty Cough

Front 1

What is deconditioning in muscle?

Back 1

reduced oxidative enzymes, reduced capillaries, reduced number and density of mitochondria

Front 2

What happens to muscle after 10 days of low dose corticosteroids?

Back 2

chronic myopathy - generalised fibre atrophy

Front 3

What does pulmonary hypertension do to dead space?

Back 3

increases it

Front 4

How many people with COPD experience panic attacks?

Back 4

8-67%

Front 5

t/f... bronchodilators are effective for reducing FEV1 in COPD patients

Back 5

false. increases FEV1 by <10%

Front 6

how do bronchodilators help COPD sufferers do exercise?

Back 6

reduces dynamic hyperinflation: >25% in RV, FRC, tidal volume. ie. reduces exertional dyspnea

Front 7

What happens to Type I and Type II fibres in a normal person with exercise training?

Back 7

Type I fibres: hypertrophy, and increase in size and number of mitochondria

Type II fibres: IIb convert to IIa

Front 8

How soon is fitness lost after detraining?

Back 8

substantial loss after 2 weeks, with complete loss within 10 weeks to 8 months

Front 9

How much intensity is needed to acheive training affect with exercise?

Back 9

>50% VO2 max, >60% HR max

Front 10

What are three options for exercise training individuals with COPD?

Back 10

1. train small muscle groups in isolation (lower ventillation demand)
2. interval training (high intensity for brief periods)
3. weekly increments (within Borg 4-6 scale)

Front 11

What FEV1 % benefit do COPD patients receive after 6-8 week exercise program?

Back 11

20% FEV1 increase

Front 12

What is Heliox, and how does it help COPD?

Back 12

80% helium, 20% oxygen combo.

1/3 density of air, so reduces turbulent airflow, increases maximal flow rates, thus reducing hyperinflation

Front 13

What is the ATS criteria for bronchodilator reversibility?

Back 13

FEV1 > 12% or 200 mL

Front 14

What spirometry measurements with bronchodilator diagnose COPD?

Back 14

FEV1 < 80% predicted
FEV1/FVC < 70%

Front 15

How many patients can perform FEV6?

Back 15

80%

Front 16

What is the BODE index and what does it do?

Back 16

it's a measure of morbidity and mortality:

B - Body Mass Index
O - airflow Obstruction (FEV1)
D - Dypnea (MMRC dyspnea scale)
E - Exercise capacity (6 min walk test)

Front 17

What happens to RV, FRC, and TLC in COPD?

Back 17

increases

Front 18

What is the sensory and motor supply to the external nose?

Back 18

sensory: V1, V2
motor: VII

Front 19

Which sinus is worst affected by infection?

Back 19

maxillary

Front 20

What is the sensory and parasympathetic supply to the nasal cavity and sinuses?

Back 20

sensory: V1, V2, I
parasympathetic: VII-pterygopalatine ganglion (PpG)

Front 21

What constitutes the fauchial arches?

Back 21

palatoglossal and palatopharyngeal from the soft palate

Front 22

What are the functions of the palate?

Back 22

block nasal cavity and redirect air

Front 23

What is the function of the posterior 1/3 of tongue?

Back 23

lymph

Front 24

Where is the pharyngeal tonsil located?

Back 24

around nose, clsoe to auditory tube

Front 25

Where are the lingual tonsils located?

Back 25

posterior 1/3 of tongue

Front 26

Which muscles raise and tense the soft palate?

Back 26

levator veli palatini (raise)
tensor veli palatini (tense)

Front 27

What is the action of styloglossus?

Back 27

retracts tongue

Front 28

What is the action of hyoglossus?

Back 28

depresses tongue

Front 29

What is the action of palatoglossus?

Back 29

raises tongue

Front 30

What is the action of genioglossus?

Back 30

protrudes tongue

Front 31

What are the actions of the intrinsic glossal muscles?

Back 31

raise/depress tip
narrow, elongate
broaden, flatten

Front 32

What vessel does parotid gland contain?

Back 32

external carotid artery

Front 33

What are the three salivary glands in order of size from largest to smallest?

Back 33

parotid, submandibular, sublingual

Front 34

What is the motor supply to the palate?

Back 34

vagus, except tensor veli palatini, which is V3

Front 35

What is the sensory supply to the palate?

Back 35

V2

Front 36

What is the motor supply to the tongue?

Back 36

XII, except palatoglossus, which is X

Front 37

What is the parasympathetic supply to the tongue?

Back 37

VII-submandibular ganglion

Front 38

What nerves make the tongue detect taste?

Back 38

VII (anterior), IX (posterior)

Front 39

What is the sensory supply to the tongue?

Back 39

V3 (anterior), IX (posterior)

Front 40

What is the parasympathetic supply to the palate?

Back 40

VII-Pterygopalatine ganglion

Front 41

What nerve gives parasympathetic activity to the JUICY parotid gland?

Back 41

IX-otic ganglion

Front 42

What nerve supplies parasympathetic activity to the submandibular and sublingual glands?

Back 42

VII- submandibular ganglion

Front 43

Where is nicotine most readily absorbed?

Back 43

lung alveoli

Front 44

Why isn't nictotine well absorbed in the stomach?

Back 44

it is a strong base

Front 45

After inhalation of nicotine, when are peak concentrations reached?

Back 45

10 minutes

Front 46

What is the stable metabolite of nicotine?

Back 46

cotinine

Front 47

What is the mechanism of action of nicotine?

Back 47

binds to cholinergic receptors in autonomic ganglia, adrenal medulla, NMJ, and brain (readily crosses blood-brain barrier)

Front 48

How does nicotine stimulate respiration?

Back 48

directly affects medulla and activates peripheral chemoreceptors (ie. in carotid body)

Front 49

How does nicotine relax skeletal muscle?

Back 49

causes discharge of Renshaw cells from the spinal cord, which inhibit motor neurones

Front 50

What specific parts of the body should be exercised trained in COPD?

Back 50

lower limb

Front 51

What happens to myoglobin after exercise training?

Back 51

increases

Front 52

How much does relative risk of CVD drop after one year of smoking cessation?

Back 52

50%

Front 53

What are the six key strategies of tobacco control in Australia?

Back 53

1. strengthen community action
2. promote cessation of smoking use
3. reducing availability and supply of tobacco
4. reducing tobacco promotion
5. regulating tobacco
6. reduce exposure to tobacco smoke

Front 54

What is the normal ratio of FEV1/FVC?

Back 54

80%

Front 55

What is the FEV1/FVC in obstructive lung disease?

Back 55

decreased (FEV1 and FVC both fall, but FVC falls more)

Front 56

What is the FEV1/FVC in restrictive lung disease?

Back 56

maintained or increased, as decreased lung compliance prevents dynamic airway exposure

Front 57

Which spirometric values are elevated in obstructive lung disease?

Back 57

TLC, RV

Front 58

How close do the two best results have to be in spirometry for FVC and FEV1 to be valid?

Back 58

within 5% or 0.1L

Front 59

What FEV1/FVC % is classically seen in COPD?

Back 59

<70%