1002 1-5

Question 1

in pulmonary system, describe the bronchi

Answer 1

bronchi is conducting airways of lungs

• right main bronchus more vertical 

• progressive branching increases
• progressive thinner walls 


Question 2

describe alveoli

Answer 2

Alveoli is the primary gas exchange unit


• pores of Kohn : allow air to pass from alveolus to 
 alveolus

• approx. 300 million in adult

• 2 types of epithelial cells:
 Type I – structural
 Type II – secrete surfactant

Question 3

what is the main driver of breathing

Answer 3

CO2

Question 4

describe chest wall and pleura

Answer 4

ribs and intercostal muscles

Pleura 3 types
visceral pleura- the membrane covering the lungs
parietal pleura- membrane living the thoracic cavity
pleural cavity- thin or cavity allowing the two surfaces to slide with breathing.

Muscle
major- diaphragm and external intercostal muscles.
accessory- sternocleidomastoid and scalene muscles - increase A/P

Question 5

explain about respiratory physiology

Answer 5

respiration

central controller - pons, medulla other parts of brain 
- (output)
effectors 
respiratory muscles
- 
sensors 
chemoreceptors, lung and other receptors 
- (input)
central controller

Question 6

how brainstem is involved in control of breathing

Answer 6

complex process controlled from brainstem
- control centre+
afferent + efferent pathways

Respiratory centres in medulla : autonomic control regulated by afferents

• Medullary rhythmicity area
• Pontine respiratory centre

Question 7

what is afferent

Answer 7

chemoreceptors

Question 8

what are the 3 types of receptors of LUNG

Answer 8

3 type of receptors:

Irritant: proximal larger airways

Stretch: smooth muscle of airways

J-receptors: near capillaries, pressure sensitive

Question 9

what are the ions needed in breathing

Answer 9

CO2 - main driver of breathing
CO2 + H2O = H2CO3
H2CO3 = Carbonic Acid
H+ + HCO2 (Carbonate)

Question 10

describe how efferents are involved in breathing

Answer 10

Efferents:
respiratory centre to diaphragm, intercostal muscles + accessory muscles

phrenic nerve arise from spinal nerves, C3, 4 + 5

intercostal nerves leave spinal cord between T 1+ T 12

inspiration is active + expiration is passive

Question 11

what is the mechanic of breathing

Answer 11

Mechanics of breathing

1. Major and accessory muscles
2. Elastic properties of lung and chest
3. Resistance to airflow

Question 12

what is dead space

Answer 12

Dead Space is the parts of the airway that takes no part in gas exchange

Question 13

what is tidal volume

Answer 13

Tidal Volume is the amount of gas that is inhaled and then exhaled in one breath

Question 14

how to calculate minute ventilation

Answer 14

Minute Ventilation = (Tidal Volume – Dead Space) X Respiratory Rate

Question 15

describe Minute Ventilation

Answer 15

The amount of gas that is inspired and exhaled in one minute.

Question 16

what are the alterations in MV? (the causes of unconsciousness) and why they happen?

Answer 16

Causes of unconsciousness
A	- Anoxia or alcohol
E	- Epilepsy
I	- Insulin (diabetes mellitus)
O 	- Overdose
U	- Ureamia
T	- Trauma
I	- Infection
P	- Psychiatric/ psychosomatic
S	- Shock

Trauma to brainstem – brain death
Spinal cord injury
Nervous system 
MS, Guillain Barrè Syndrome, Myasthenia gravis
Airway – burns, trauma, tumors, foreign objects, inflammation
Thoracic chest wall injury
# ribs, flail chest
Pleural disease or injury
Pleural Effusion, pneumothorax, haemothorax
Lung disease or injury
Asthma
Chronic Obstructive Pulmonary Disease
Pneumonia
Pulmonary Oedema

Question 17

what is the subjective data of Health history and the examples?

Answer 17

the symptoms that can be seen, observed or gained from patients or their family.
Cough
Onset, how often, time of day, productive (sputum), Haemoptysis.
Shortness of breath – timing, on exertion
Orthopnoea – SOB whilst supine
Paroxysmal nocturnal dyspnoea – awakening at night with SOB
Chest pain with breathing
History of respiratory infections and lung disease
Smoking history
Environmental exposure

Question 18

what is the scale that can check measure breathlessness?

Answer 18

Borg category-ratio scale – How short of breath are you right now?

0 (nothing at all)- 10( maximal)

Question 19

what the normal chests look like?

Answer 19

posterior chest

• should be in a straight line
• Symmetrical (even) , in an elliptical shape with ribs in a 45o angle to spine.

anterior chest

Ribs are sloping downwards with symmetrical interspaces
Inspect
Airways – foreign object, swelling, signs of burns, tumors
Note:
facial expressions
Skin colour and condition – cyanosis is a late indication of low oxygen
Respirations
Accessory muscles
Bulging intercostals
Abdominal recession - paradoxical breathing

Question 20

what is palpation

Answer 20

Using fingers palpate the entire chest wall

-Palpate trachea for position – normally midline

The results are:

Crepitus

Course crackling sensation – subcutaneous emphysema
Caused by air in subcutaneous tissue

Fremitus

Vibration of the chest wall due to vocalization of “99”.
Increased fremitus – lungs become filled with fluid or more dense
Pneumonia, tumors & pleural effusions
Decreased – lung hyperinflated – barrel chest
Absent – Pneumothorax and lung alveolar collapse (Atelectasis)

Question 21

what are the assessment of respiration?

Answer 21

Respiratory Rate- Number of full inspiration/expirations in one minute (adult: 12-20 infant: 30-50)

Ventilatory Depth - Observing the degree of excursion or movement in the chest wall
Deep respiration, full expansion of the lungs with full exhalation
etc

Ventilatory Rhythm - Breathing pattern – regular or irregular
Men & children – diaphragmatic breathing, seen in lower chest and abdomen
Women – thoracic muscle, seen in upper chest

Ventilatory Sound - Audible by ear,
Stertor – snoring sound when secretions block the trachea or large bronchi
Stridor – inspiratory wheeze indicating upper airway obstruction
Wheezing – high pitch musical sound occurring on inspiration, indicating partial obstruction of small (lower) airways
Inspiratory grunt – babies – occluded airway

Question 22

what can you check though auscultation?

Answer 22

breath sounds

normal:
Bronchial: loud, high pitched

Bronchovesicular: medium pitched

Vesicular: soft, low pitched, gentle, rustling sounds

abnormal:
Nil

Wet – Crackles or Rales = pulmonary oedema

Noisy - Rhonchi: air passing past sputum = pneumonia

Wheeze: narrow airways = asthma

Question 23

how to do percussion?

Answer 23

Starting over the apices, percuss the interspaces at 5cm intervals moving from side to side for comparison.
Avoid dampening effect of bone (scapula and ribs)
Resonance – normal low-pitched, clear hollow sound over lungs
Hyperresonance – lower-pitched, booming sound – too much air as in Pneumothorax and Emphysema
Dull – abnormal density in lung as with pneumonia, pleural effusion, atelectasis or tumour
Percussion has a 5-7cm depth limit

Question 24

what is the pulmonary function test?

Answer 24

Peak expiratory flow meters :
Is the point of highest flow during maximal expiration
Serial monitoring
Intra-individual accuracy
Limited assessment of respiratory diseases
Peak expiratory flow (trend of lung function)

spirometry:
Gold standard
Diagnostic
High reliability

Question 25

what are the things to be checked in lung function tests?

Answer 25

``` Four volumes: tidal volume (VT): volume of inspired or expired air per breath ``` inspiratory reserve volume (IRV): volume that can be inspired above TV expiratory reserve volume (ERV): volume that can be expelled at end of TV residual volume (RV): volume of gas remaining in the lungs after maximal expiration ``` Four capacities: inspiratory capacity (IC) functional residual capacity (FRC) vital capacity (VC) total lung capacity (TLC):volume of gas in lungs after maximal inspiration ```

Question 26

what is use of pulse oximetry

Answer 26

pulse oximetry is for Relative measure of percentage of bound oxygen to haemoglobin - COPD patients n=64 - Acute exacerbation - Comparison of oximeters - Significant hypoxia PaO2 < 60 mmHg

Question 27

describe Capnography

Answer 27

it is to confirm endotracheal tube placement during emergency airway management - > 2000 intubations.

Question 28

what are the 4 major components of respiratoration

Answer 28

Mechanical movement of gases into and out of lungs – (mechanism of breathing) – last week’s lecture Gas exchange across alveolar membrane Carriage of gasses to and from tissues Metabolic processes of the cell to produce energy

Question 29

explain use of oxygen in cells?

Answer 29

Production of Adenosine Triphosphate (ATP) for energy requires delivery adequate level of Oxygen (O2) to cells Electron transport system in mitochondria supplies 95% of cellular energy but uses 90% of DO2 This delivery of oxygen (DO2) is dependent on cardio-vascular sufficiency, the focus of future lectures Without oxygen, cells die.

Question 30

why DO2 important ? (dissolved oxygen)

Answer 30

Inadequate DO2 will cause: Pyruvic acid converts to lactic acid Drop in intracellular pH Diminished protein synthesis, denaturing of existing proteins Free fatty acid accumulation, swelling of intracellular organelles Sodium-potassium pump dysfunction Tissue/organ failure Without oxygen, cells die.

Question 31

what is the alteration of PaO2

Answer 31

``` Decreased partial pressure of inspired oxygen Altitude Suffocation Increase in other gasses in air eg carbon monoxide Ventilation/perfusion (V/Q) mismatch Decreased Ventilation - Shunting Airway occlusion eg COPD Fluid in lungs eg pulmonary oedema Alveolar collapse Decreased Perfusion – Dead Space Decreased cardiac function Decreased BP Pulmonary emboli ```

Question 32

oxygen transport, why oxygen is carried in blood?

Answer 32

``` O2 considerably less soluble than CO2 Due to ability to form carbonic acid where as O2 has no ability Carbonic Acid (H2CO3) = H2O + CO2 Therefore most O2 carried attached to haemoglobin (about 97% of total) Measured as SpO2 (peripheral monitor) or SaO2 (arterial gas analysis) The remainder 3% is dissolved in plasma Measures as PaO2 ```

Question 33

oxygen saturation?

Answer 33

% of oxyhaemoglobin in total (saturated and unsaturated) haemoglobin Normal SaO2 = 98% Normal SvO2 = 75% Difference is a reasonable estimate of oxygen extraction by cells

Question 34

what is the oxygen consumption and oxygen extraction ration

Answer 34

Volume of oxygen consumed by the tissues per minute (VO2) Reflects body cellular metabolism Norm 3.5 ml/min/kg resting At rest 250 ml/min Exercise 3600 ml/min \ Estimate of the balance between oxygen usage by cells and oxygen delivery -VO2: DO2 - OER = 22-32%

Question 35

describe arterial blood gases

Answer 35

``` Using an arterial blood sample we can measure: pH – acidity or alkalinity normally 7.35 – 7.45 <7.35 acid >7.45 alkaline PaO2 – partial pressure of oxygen in arterial blood Normally 80-100 mmHg PaCO2 – partial pressure of oxygen in arterial blood Normally 35-45 mmHg > 45 acid < 35 alkaline Bicarbinate - normal 21-26mmol Base Excess - -2 to +2 mmol/L ```

Question 36

describe the blood gas analysis

Answer 36

Simple steps 1. Determine whether the blood is acidic or alkaline by examining pH 2. Determine the primary cause of the pH - Examine PaCO2 to determine respiratory cause of acidosis or alkalosis - Examine Bicarbonate and 3. Base Excess to determine renal cause of acidosis or alkalosis 4. Determine if there is respiratory/renal compensation Determine oxygen status by examining PaO2 and SaO2

Question 37

describe pulse oximetry (finger thing)

Answer 37

Relative measure of percentage of bound oxygen to haemoglobin SaO2 = HbO2 / Total Hb Two wavelengths – visible and infrared beams Measure absorption in pulsatile element of blood flow between Hb and Hb02 ``` Use of pulse oximetry COPD patients n=64 Acute exacerbation Comparison of oximeters Significant hypoxia PaO2 < 60 mmHg ```

Question 38

simply explain respiratory physiology

Answer 38

Three steps in the process of oxygenation: 1. Ventilation (gas in and out of lungs) 2. Diffusion (o2 and Co2 in the alveoli and capillaries of body tissue) 3. Perfusion of lungs (move blood to and from the alveolocapillary membrane for gas exchange to occur) * The respiratory centre lies in the brainstem and controls respiration * Chemoreceptors respond to change in the chemical composition • Central – detects changes in pH (adjust inspiration rate and depth) • Peripheral – detect arterial O2 and CO2 Predominantly o2 therefore adjust respiration in response to hypoxaemia (Craft, et al 2015)

Question 39

what are the factors effecting oxygenation

Answer 39

1. Physiological 2. Developmental 3. Behavioural 4. Environmental

Question 40

the alternations in respiratory functioning | and they contribute-

Answer 40

Alveolar hyperventilation • Ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism • Alveolar hypoventilation • Ventilation inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide • Atelectasis • Collapse of the alveoli, preventing normal diffusion of oxygen and carbon dioxide and they contribute - Ventilation/perfusion mismatch • Diffusion impairment • Alteration in membrane thickness and/or surface area which results in impaired gas exchange • Hypoxia • Inadequate tissue oxygenation at the cellular level • Cyanosis • Blue discoloration of the skin and mucous membranes, caused by the presence of desaturated haemoglobin in capillaries, is a late sign of hypoxia

Question 41

what are the signs and symptoms?

Answer 41

``` CNS Unexplained apprehension Unexplained restlessness or irritability Unexplained confusion or lethargy Combativeness Coma Respiratory Tachypnoea Dyspnoea on exertion Dyspnoea at rest Use of accessary muscles Retraction of interspaces on inspiration Pause for breath between sentences, words Cardiovascular Tachycardia Mild hypertension Dysrhythmia’s (pre mature ventricular contraction) Hypotension Cyanosis Cool clammy skin Other Diaphoresis Decreased urinary output Unexplained fatigue ```

Question 42

respiratory assessment diagnostic test for different 4 parts?

Answer 42

Ventilation and oxygenation studies - Pulmonary function test spirometry - Peak expiratory flow - Arterial blood gas - Oximetry Viewing structures of the respiratory system - Chest X-ray examination - Bronchoscopy - Lung scan (CT)

Question 43

what are the common asthmatic symptoms or signs? triggers? and risk?

Answer 43

* Bronchoconstriction * Oedema of airways * Mucous hypersecretion ``` triggers: allergens drugs aspirin cold air stress ``` risks: family history history of allergies age