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158 Cards in this Set
- Front
- Back
what type of cells line the alveoli?
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type I alveolar cells
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what is the thickness of the barrier to diffusion between air and blood?
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0.2 microns
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what is the name for the tissue between adjacent alveoli?
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interalveolar septum
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which are larger, type I or II alveolar cells?
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type I
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where do type II alveolar cells rest?
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where the interalveolar septa meet
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what type of cells line the alveoli?
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type I alveolar cells
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what is the thickness of the barrier to diffusion between air and blood?
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0.2 microns
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what is the name for the tissue between adjacent alveoli?
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interalveolar septum
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which are smaller, type I or II alveolar cells?
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type II
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where do type II alveolar cells rest?
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where the interalveolar septa meet
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t/f... type II cells can divide and differentiate to replace type I cells
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true
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what percentage of the alveolar area is comprised of type II alveolar cells?
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3%
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what structure allows ventilation to bypass a blocked alveolar duct?
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interalveolar pores of Kohn
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t/f... smooth muscle cells are found in the interalveolar interstitium
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false, fibroblast-like cells and myofibroblasts but not smooth muscle cells are found in the interalveolar interstitium
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which structures make up the pulmonary acinus?
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respoiratory bronchiole, alveolar ducts, alveolar sacs, alveoli
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what is asbestosis?
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diffuse interstitial pulmonary fibrosis resulting from inhalation of large doses of asbestos fibres
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what are the most dangerous forms of asbestos?
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crocidolite and amosite
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what is the least dangerous form of asbestos?
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chrysolite
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t/f... hilar lymphadenopathy is a feature of asbestosis
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false, it is a common sign in sarcoidosis
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what is the size of the most dangerous inhaled particles?
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1-5 microns
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what are the three ways for particles to be cleared from the airways?
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nasal clearance, tracheobronchial clearance (mucociliary raft), alveolar clearance (by alveolar macrophages)
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what percentage of cells in the lungs are inflammatory cells?
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less than 10%
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what type of cell accounts for over 90% of inflammatory cells in the lungs?
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macrophages
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which macrophage derived cytokines are chemotactic for neutrophils?
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IL-8 and LTB4
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what shifts the oxygen dissociation curve to the right?
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increases in temp, H+ concentration, PCO2 and 2,3-DPG concentration in RBCs
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what is the O2 saturation of Hb in normal arterial blood?
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97.5%
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what is the O2 saturation of Hb in mixed venous blood?
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75%
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t/f... CO has a greater affinity for Hb than O2
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true
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what catalyses the reaction between CO2 and water?
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carbonic anhydrase
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What is the FIO2 of room air?
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0.21
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what is the normal range for PaCO2?
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35-45 mmHg
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what is the normal range of PaO2?
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90-100 mmHg
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where is the vallecula?
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anterior to the epiglottis
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where are the palatine tonsils located?
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between the palatoglossal and palatopharyngeal arches
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what is the sensory supply to the nasopharynx?
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V2
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what is the sensory supply to the oropharynx?
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IX
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what is the sensory supply to the laryngopharynx?
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X
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which part of the pharynx receives sensory innervation from the maxillary nerve?
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nasopharynx
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which part of the pharynx receives sensory innervation from glossopharyngeal?
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oropharynx
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which part of the pharynx receives sensory innervation from vagus?
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laryngopharynx
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what is the parasympathetic supply to the nasopharynx?
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VII
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what is the parasympathetic supply to the oropharynx?
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IX
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what is the parasympathetic supply to the laryngopharynx?
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vagus
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which part of the pharynx receives parasympathetic supply via the facial nerve?
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nasopharynx
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which part of the pharynx receives parasympathetic innervation from the glossopharyngeal nerve?
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oropharynx
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which part of the pharynx receives parasympathetic supply via the vagus?
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laryngopharynx
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which pharyngeal muscle is innervated by IX?
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stylopharyngeus
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what is the parasympathetic supply to the laryngopharynx?
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vagus
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which part of the pharynx receives parasympathetic supply via the facial nerve?
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nasopharynx
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which part of the pharynx receives parasympathetic innervation from the glossopharyngeal nerve?
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oropharynx
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which part of the pharynx receives parasympathetic supply via the vagus?
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laryngopharynx
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which pharyngeal muscle is innervated by IX?
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stylopharyngeus
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what muscles make up the inferior constrictor?
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thyropharyngeus and cricopharyngeus
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which constrictor goes from the hyoid bone to the pharyngeal raphe?
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middle constrictor
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where is the superior constrictor?
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pterygomandibular raphe to pharyngeal raphe
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name the levators of the pharynx
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palatopharyngeus, stylopharyngeus, salpingopharyngeus
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where is the larynx?
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C3-6
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what is the name for the space between the vestibular folds?
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rima vestibuli
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what colour are the vocal folds?
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white
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what type of epithelium lines the larynx?
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columnar and squamous
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what muscle abducts the vocal cords?
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posterior cricoarytenoideus
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which muscle adducts the vocal cords?
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lateral cricoarytenoideus
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what is the sensory supply to the vocal folds?
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SLX
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which muscle of the larynx is innervated by SLX?
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cricothyroideus
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what is the action of thyroarytenoideus?
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relaxes vocal cords
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which laryngeal muscle is active during forced respiration?
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posterior cricoarytenoideus
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what determines the pitch of phonation?
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length of vocal cords
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in airways obstruction, what happens to FEV1, FVC and FEV1/FVC?
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FEV1 decreased (more than FVC)
FVC decreased FEV1/FVC decreased |
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in lung restriction, what happens to FEV1, FVC and FEV1/FVC?
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FEV1 decreased
FVC decreased (more than FEV1) FEV1/FVC normal or increased |
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what happens to total lung capacity in obstruction?
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increased
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in obstruction, what increases more, RV or FRC?
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RV
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what is the definition of restriction?
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TLC<80%
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how is oxygen transported through the smaller airways?
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diffusion
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how is oxygen transported through the major airways?
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convection
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what is the most important site for a diffusion impairment?
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across membrane
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what are the mediators of matrix degradation?
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matrix metalloproteinases
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how many members are in the gene family of tissue inhibitors of metalloproteinases (TIMPs)?
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4
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who is mainly affected by usual interstitial pneumonia?
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middle aged adults
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t/f... the prognosis for desquamative interstitial pneumonia is better than for usual interstitial pneumonia
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true
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what is the mortality from desquamative interstitial pneumonia?
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30%
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what type of pneumonia involves lymphocytes, plasma cells and type II hyperplasia?
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non-specific interstitial pneumonia
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what is the FEV1/FVC in interstitial lung disease?
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normal or high
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t/f... reduced compliance is a feature of interstitial lung disease
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true
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what are the pathological features of sarcoidosis?
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mononuclear cell alveolitis, non-caseating granulomas, interstitial fibrosis
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hat are some causes of alveolar haemorrhage?
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idiopathic pulmonary haemosiderosis, Goodpasture's syndrome, SLE, Wegener's gramulomatosis, vasculitis associated with connective tissue disorders
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What are the characteristic symptoms of ILD?
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dry cough and dyspnoea
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What is base excess?
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calculation of base required to bring the measured pH back to 7.4 after correcting the PCO2 to 40 mmHg
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What is occupational lung disease?
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an abnormality of the lower respiratory system resulting from work place exposure to an offending substance/s
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What is the latency period for mesothelioma?
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up to 30 years
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t/f... mesothelioma requires a large amount of exposure
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false, small amount is sufficient
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t/f... asbestosis requires a large amount of exposure
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true
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What is the % loss of longevity due to smoking in survivors at 75 years?
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10%
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What % of lip, oral cavity and pharynx cancer is linked to smoking?
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~90%
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What % of bladder cancer is linked to smoking?
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50%
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What percentage of stomach, cervix and pancreatic cancers are related to smoking?
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20-30%
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What are the risks to the foetus in maternal smoking?
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LBW, prematurity, increased miscarriage, premature membrane rupture, placenta praevia, abruptio placentae, SIDS, lowered immune capacity
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What can children get as a result of passive smoking?
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SIDS, URTI, Middle ear infections, asthma
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What is the effect of cigarette smoke acutely?
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increase sympathetic tone, lung inflammation, decreased PO2
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What is the effect of cigarette smoke, pathophysiologically?
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endothelial dysfunction, atherosclerosis from inflammation (MI)
decreased mucocilliary clearance (emphysema) |
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What are the chronic pharmacological effects?
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Induce liver enzymes, increasing break down of drugs e.g. theophyliines
Nicotinic receptor function altered ie downregulated/desensitised |
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Emphysema and bronchiole asthma difference?
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emphysema - hyperinflation, decreased surface area as opposed to musclular contraction in asthma, use DCO to test for surface area in lung (if less = emphysema)
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Dental issues associated with tobacco?
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Staining, gum inflammation, black hairy tongue, oral cancer, delayed healing of gums, bad with chewing too.
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What blood vessels are especially effected in smoking?
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carotid, cardiac, aortic peripheral vasculature
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What are the features of a post op MI in a patient who is a smoker?
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less chance of chest pain, 3 days post op, and not much ST elevation
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What is the increase in risk of posoperative pulmonary complications in smokers?
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6 fold due to sensitised bronchioles to bronchospasm
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How long should you be a non-smoker for before an operation?
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at least 6 weeks, for immune function to be restored
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Why do smokers get DVT/PE/thrombosis post surgically more than others?
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Low O2 = EPO release in kidney = increased RBC, increased viscosity leads to increased chance of coagulation, in surgery stasis can lead to an increase chance of thrombotic events
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How many times more is the risk of infection in smokers post op?
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3 times
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How does smoking impair immune function?
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Decrease IG and IgM, impaired NK activity, worsened by surgery and anaesthetic
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Why does smoking decrease wound healing post -op?
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Poor microcirculation, local thromobisis, reduce O2, Cyanide impaires mitochondiral oxidative phosphorylation, inhibits collagen producing enzymes
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What adjuvant drugs are used in Nicotine replacement therapy?
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Bupropion - an antidepressant
Conidine - dampen sympathetic overdrive, a2 agonist Varenicline/Champix - partial Ach-R agonist |
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What occurs with smoking cessation in the first 12 weeks?
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Decreased CO and nicotine in 1 day, cHB and ciliary function improve in 2 days, 1-2 weeks - sputum production decreased, 4-6 wks - pulmonary function improves, 6 wks, immune fn improves, 12 wks, decreased mortality and morbidity
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How long does it take for MI risk to be reduced by 50% in a person quitting smoking?
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5 years
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How long does it take for risk of lung cancer to be halved after quitting smoking?
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10 years
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Chronic bronchitis and emphysema difference clinically?
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cyanosis, cor-pulmonale, heart failure - blue bloaters
pink, accessory muscle use - emphysema |
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What lung measurement is restrictive lung disease characterised by?
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<80% TLC
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t/f... compliance is increased in fibrosis/restrictive lung disease
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false, compliance is decreased. That is, your ability to change volume with changes in pressure, or ability to 'expand' is deminished
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What is sarcoidosis?
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Multisystem disease, featuring bilateral hilar lymph node iand airway involvement, interstitial fibrosis, hypercalcaemia/uria, cardio/neuro/skin
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What is the pattern of inflammation seen in CT diseases associated with interstitial lung disease?
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Non-specific interstitial penumonia (NSIP) pattern is most common
(sometimes see usual intersitial penumonia (UIP) pattern or lymphocytic interstitial pneumonia (lip) pattern) |
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What is IPF? How gets it? how common is it? what is the survival after diagnosis?
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Idiopathic pulmonary fibrosis, more likely in men >50 years, `10/100 000, 3-5 year median survival post diagnosis (no cure)
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How is interstitial pulmonary fibrosis diagnosed?
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Exclusion of other known ILD causes AND presence of UIP on CT AND surgical biopsy pattern
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Who is more likely to get NSIP?
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Women 40-50 years
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t/f... NSIP is a rapdly progressive fibrotic lung disease which causes death in 3-5 years
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false, Non-specific interstitial pneumonia is a slowly progressive disease, Idiopathic pulmonary fibrosis is a rapidly progressive lung disease causing death in 3-5 years, as a median.
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How do you treat:IPF? NSIP?
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IPF - antifibrotic therapy,
NSIP - antiinflammatory therapy +/- antifibrotic therapy |
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What will you find on the physical examination of someone with ILD?
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inspiratory crackles at bases, inspiratory squeaks, clubbing, pulmonary HT, extrapulmonary features of underlying disorders
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How are pulmonary function tests used in ILD?
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used to assess disease severity.
TLC<80% reduced FVC elevated FEV1/FVC ratio low DLco, preserved KCO |
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What are the features of a usual intersitital pneumonia pattern on CT?
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lower zone reticulation, honeycombing, patchy distribution, distortion, traction bronchiectasis. (usually indicates IPF, but can also be found in RA etc)
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What are the features of a non-specific intersitital pneumonia pattern on CT?
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Lower zone, ofter symmetrical, ground glass opacity (predominant), reticular changes, traction bronchiectasis, no honeycombing
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What are the histological feathures of Unusual Iinterstitial Pneumonia pattern?
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Temporarl and geographical heterogeneity, establish fibrosis, fibroblastic foci, normal lung, peripheral and subpleural accentuation of fibrosis
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What are the histological feathures of Non Specific Interstitial Pneumonia pattern?
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temporally uniform, absence of honeycombing, minimal or no fibroblastic foci, cellular or fibrotic
|
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What is pH?
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-log10[H+], measurement of H+
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What is the bicarbonate buffer system?
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H2CO3 <-> HCO3- + H+
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What is the Henderson Hasselbach equation?
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pH = pK + log10([HCO]/[H2CO3])
Tells you the pH when half dissociation of acid has occurred |
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What is K?
What is pK? |
K = [H+][HCO3]/[H2CO3]
pK = pH at half dissociation = 6.1 |
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t/f... blood gas measurements are related back to 37 degrees, even if febrile
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true
|
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What is base excess?
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The amount of excess base (+) or acid (-) in the blood, having removed abnormal influence of the lung by bringing PCO2 back to 40mmHg.
|
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What is the scheme for ABG interpretation?
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pH?
If acid and paCO2 high = respiratory If acid, is BE low = metabolic If alkaline, is PaCO2 low = respiratory If alkaline is BE/HCO3 high = metabolic Haas the other variable moved in the opposite direction? (compensation) Is compensation partial or complete? If ischaemic, is it due to lung disease - Ideal PAO2 = 150-paO2 - (1.25 x PaCO2) |
|
Sample ABG
pH = 7.35 PCO2 = 67 mmHg BE = +10mml/L PaO2 = 44mmHg |
Primary respiratory acidosis with complete metabolic compensation and a wide A-a gradient indicating V/Q mismatch - lung disease present, possible chronic obstructive lung disease with compensated repiratory acidosis
|
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How long does it take for kidney to make changes to acid-base system?
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~48 hours
|
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sample ABG
pH = 7.38 PaCO2 = 19mmHg BE = -13mmol/L PaO2 = 82mmHg |
Primary metabolic acidosis with complete respiratory compensation. O2 is too low for CO2 level(should be 120 if normal) therefore there is a lung disease present. Consistent with sepsis and lactic acidosis
|
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sample ABG
pH = 7.5 PaCO2 = 44mmHg BE = +10 mmol/L PaO2 = 56 mmHg |
Primary metabolic alkalosis with no respiratory compensation, wide A-a gradient indicating lung disease.
Corticosteroid therapy in COPD. Diuretic therapy in pulmonary oedema Vomiting and aspiration |
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t/f... alkalosis is almost always compensated for
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false, paCO2 drives ventilation, not only acid, so that if CO2 is normal it will not generally increase respiration in a metabolic alkalosis, and respiratory alkalosis is usually short term so not enough time for compensation in rby metabolism
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sample ABG
pH = 7.55 PaCO2 = 21mmHg BE = -4 mmol/L PaO2 = 117mmHg |
Primary respiratory alkalosis without metabolic compensation, and with normal lung function. Perhaps hyperventilation from anxiety
|
|
sample ABG
pH = 7.49 PaCO2 = 41mmHg BE = +7 mmol/L paO2 = 68mmHg |
Primary metabolic alkalosis, not compensated by respiratory system, wide Aa gradient so lung disease
|
|
sample ABG
pH = 7.22 PaCO2 = 63mmHg BE = -2mmol/L PaO2 = 64mmHg |
Acute primary respiratory acidosis with no compensation, normal lung function.
Could be head injury, drug overdose, acute hypoventilation |
|
sample ABG
pH = 7.05 paCO2 = 59mmHg BE=13mmol/L PaO2 = 56mmHg |
Combined respiratory and metabolic acidosis, with a wide Aa gradient indicating disease
Shock, severe sepsis, ruptured spleen |
|
What is the negative impact of giving high oxygen to premature babies?
|
Retinopathy - loss of placental maternal growth factors, loss of retinal vessels, suppress local growth factor production e.g. VEGF
|
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What are oxygen sensors?
|
prolul hydroxylases, stabilise HIFS
Haeme oxygenase putative sensor in the carotid body cytochorme oxidase key in o2 binding to mitochondira |
|
What is the biochemical reason for death in low oxygen?
|
can't generate AP for cellular machinery
|
|
What are some ROS?
|
superoxide, hydrogen peroxide, hydroxyl radicals, peroxynitrite
|
|
What are some anti-ROS defence substances?
|
Glutathione
REdox proteins - thioredoxin and peroxiredoxin |
|
How does glutathione protect from proxidants?
|
converts from GSH to GSSG, oxidising
|
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What is the antioxidant response to hyperoxia toxicity?
|
high o2 = metabolism byNADPH oxidase = ROS = EGFR-dependent signal pathway = activation of NRf2 (TF) = interacts with AntioxidantResponseElements (genes)
|
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How does our body defend against ROS induced carcinogenesis?
|
Induces apoptosis when there are high levels of ROS.
ROS oxidises TRX-ASK1, removing TRX and allowing ASK1 to activate p38-MAPK, which induces growth arrest and apoptosis. If p38 is impaired, then ROS can induce cancer? |
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What does high/normal oxygen levels in the body do to HIF?
|
causes Hypoxia Induced Factor proteosomal degradation in the cytosol
|
|
What are the downstream effects of HIF production?
|
EPO production
Metabolism change (glycolysis) angiogenesis cell survival O2 delivery |
|
How does low O2 promote glycolysis?
|
Low O2 = HIF stabilisation = enhanced PDK expression = inhibition of PDH = Puruvate does not enter citric acid cycle, but is instead retained in the cytoplasm to be converted into lactate
|
|
How do hydrogen sulfide levels rise in hypoxia?
|
CSE synthesises Hydrogen sulfide.
Low oxygen = decreased activity of Haeme oxygenase, that breaks down haem into bilirubin. this process has a by product of CO. CO inhibits CSE, so in low O2, normally suppressed CSE is allowed to produce hydrogen sulfide |