Chapter 1-5

Question 1

Pupil dilatation

2 mechanisms

Answer 1

Sympathetic nerves from superior cervical ganglion

Influx of circulating adrenaline (alpha-1 adrenoceptors)

Question 2

Iris muscles

Answer 2

Sphincter pupillae = constricts (parasympathetic)
Dilator pupillate = dilate (sympathetic)

Question 3

Dilator pupillae

Answer 3

Alpha-1 adrenoceptors

Question 4

Sphincter Pupillae

Answer 4

M3 - muscarinic acetylcholine receptors (lungs and eye)

Question 5

Pilocarpine eye drops

Answer 5

non selective muscarinic receptor agonist
treatment of glaucoma

Question 6

Ipratropium Bromide

Answer 6

Non selective muscarinic antagonist (M1-M5)

Lungs - acts on M3 receptors, opposing bronchoconstriction of smooth muscles + reduces mucus production of goblet cells

Question 7

Anisocoria

Answer 7

Difference in pupillary size

Red flags: ptosis, anhidrosis, impaired eye movements.

Question 8

Horner’s Syndrome

Answer 8

Disruption of sympathetic supply
- Mild ptosis
- constricted pupil (miosis)
- Anhidrosis

Ix: cocaine eyedrops - distinguish between Horner’s and physiological anisocoria

Question 9

GORD/ Recurrent aspiration

Answer 9

Vomiting
Poor weight gain
Recurrent chest infection

pH study
Bronchoscopy (lipid laden macrophages)
Contrast study

Question 10

Inhaled foreign body

Answer 10

Acute onset
Focal wheeze

CXR
Rigid bronch

Question 11

Cystic Fibrosis

Answer 11

Cough in first weeks
Poor weight gain (pancreatic insufficiency)

Sweat Test
D5 blood spot

Question 12

Primary Ciliary dyskinesia

Answer 12

Rhinorrhoea
Recurrent otitis Media

CXR for dextrocardia
Ciliary studies

Question 13

Immune deficiency

Answer 13

Recurrent, severe, persistent, unusual infection

Immunoglobulins
B and T cells
HIV test

Question 14

Post infectious bronchiolitis obliterans

Answer 14

Previous viral infection (adenovirus)

High resolution CT chest

Question 15

Episodic viral wheeze

Answer 15

Usually resolves by 6 years

Short, exclusively with colds/ URTI.

Question 16

Wheeze

Physiology

Answer 16

Airway obstruction
Small + mod airways inflammation + smooth muscle bronchoconstriction

Eosinophils, neutrophils, lymphocytes + mast cells fill airways causing epithelial damage
Proinflammatory cytokines (from Helper T) = IL4, IL5, IL13

Question 17

Montelukast

Answer 17

Severe episodes of viral wheeze
Blocks action of leukotriene D4 in lungs

Question 18

Diagnosis of Asthma

Answer 18

Bronchodilator responsiveness
PEFR
FeNO

Question 19

Bronchodilator responsiveness

Answer 19

> 9% is diagnositc

Question 20

Long acting beta agonists

Side effect

Answer 20

Sudden death (single agent use)

Question 21

Inhaled corticosteroids

Side effect

Answer 21

e.g. Budesonide
Height loss 1.2 cm overall
Decreased growth velocity

Question 22

Phosphodiesterase inhibitor

Answer 22

Theophylline

Tachycardia

Question 23

Leukotriene receptor antagonist

side effects

Answer 23

Montelukast

Night terrors
Increased thirst

Question 24

Oral steroids

Side Effects (8)

Answer 24

Weight gain
Muscle weakness
Striae
Acne
Osteoporosis
HTN
Glaucoma
Reduced growth velocity

Question 25

What is seretide

Answer 25

LABA + ICS

Question 26

Ciliated epithelial cells

Answer 26

Mucociliary clearance Motile or non-motile Frequency 5-10 Hz

Question 27

Diagnosis of PCD

Answer 27

NASAL FeNO levels Saccharin test replaced R/o CF with sweat test Check Immunoglobulins Confirm with nasal brushing + electron microscopy

Question 28

Blood from placenta to fetus

Answer 28

Umbilical Vein x1

Question 29

Volume of blood which bypasses liver | via what

Answer 29

50% via ductus venosus into IVC

Question 30

Blood from fetus to placenta

Answer 30

2x umbilical arteries arise from internal illiac arteries

Question 31

Fetal Haemoglobin HbF

Answer 31

two alpha chains + two gamma chains

Question 32

When is HbA made?

Answer 32

3rd trimester 2 alpha + 2 beta chains 80% HbF + 20% HbA at birth

Question 33

HbF oxyhaemoglobin dissociation curve

Answer 33

Shifted to Left Reduced levels of 2,3 DPG in gamma chains HbF saturated with O2 before HbA After birth shifts to Right

Question 34

Persistent pulmonary hypertension

Answer 34

Hypoxia in first hours causes pulmonary vasoconstriction and increased PVR Pervasive R to L shunt Acidosis + hypoglycaemia also trigger

Question 35

Causes of PPHN | 10

Answer 35

Perinatal asphyxia Meconium aspiration RDS Sepsis Polycythemia Hypoglycaemia Hypothermia Maternal NSAIDs SSRIs Diaphragmatic hernia (pulm hypoplasia)