respiratory medicine

Question 1

what are the 2 components of respiration?

Answer 1

ventilation

gas exchange

Question 2

what is ventilation?

Answer 2

airway patency (how wide/narrow)

Question 3

what is essential for gas exchange?

Answer 3

adequate number of alveoli

no fibrosis of alveolar wall

Question 4

how will lungs appear on X-ray in health and with fluid?

Answer 4

appear black in health

fluid makes lungs appear white

fluid gathers at costal phrenic angles first

Question 5

how many lobes does the left lung have?

Answer 5

2 - superior and inferior

Question 6

how many lobes does the right lung have?

Answer 6

3- superior, middle and inferior

Question 7

what is a lobectomy?

Answer 7

removal of a lobe so a tumour for example won’t compromise other lobes

Question 8

what allows change in inter thoracic volume?

Answer 8

ribs

downwards contraction of diaphragm

Question 9

what is the function of the external intercostal muscles?

Answer 9

elevate ribs

Question 10

what is the function of the internal intercostal muscles?

Answer 10

depress ribs

Question 11

what other muscles are involved in respiration?

Answer 11

sternocleidomastoid
external and internal oblique
transverse abdominus
rectus abdominus
pectorals major and minor

Question 12

describe respiratory investigations.

Answer 12

sputum examination
CXR - chest radiograph
pulmonary function - spirometry
VQ scan - ventilation/perfusion mismatch
bronchoscopy 
CT
PET
MRI for soft tissue lesions

Question 13

what would green sputum suggest?

Answer 13

pus and infection

Question 14

what would yellow/white sputum suggest?

Answer 14

excess production of normal sputum

Question 15

what would blood speckled sputum suggest?

Answer 15

malignancy or inflammation

Question 16

how is pulmonary function measures?

Answer 16

PEFR - peak expiratory flow rate
FEV1 - forced expiratory volume
FEV1/VC - measures respiratory function

VC - vital capacity

Question 17

what does a VQ scan look for?

Answer 17

obstructions e.g. tumours or embolism of deep vein thrombosis

Question 18

when does type 2 respiratory failure occur?

Answer 18

type 2 occurs when ventilation is inadequate to deliver enough oxygen to blood and remove CO2

Question 19

when does type 1 respiratory failure occur?

Answer 19

type 1 occurs when gas exchange fails through either emphysema, thickening of alveolar wall or VQ mismatch

Question 20

what is gas exchange?

Answer 20

the ability of alveoli to get oxygen into and CO2 out of blood

Question 21

what is emphysema?

Answer 21

inadequate alveoli surface area

Question 22

what is VQ mismatch?

Answer 22

mismatch between where air goes into lungs and where blood goes into lungs

Question 23

how does thickening of alveolar wall affect gas exchange?

Answer 23

makes diffusion harder

Question 24

how will inadequate ventilation affect CO2 and O2 levels?

Answer 24

O2 levels fall, CO2 levels rise

Question 25

what is the airway ability to transfer gas proportionate to?

Answer 25

radius x10^8

Question 26

when are accessory muscles used?

Answer 26

times of stress/breathing difficulties

Question 27

what are the symptoms of respiratory failure?

Answer 27

cough
wheeze - expiratory noise
stridor - inspiratory noise
dyspnoea - difficult to breathe
pain - general/inspiratory

Question 28

what are the signs of respiratory failure?

Answer 28

• chest movement should be equal on side with breathing
• rate of respiration should be 12-15 breathes per min
• is air entry symmetrical/reduced?
• vocal resonance should be poor transmission of sound to stethoscope when patient speaks unless fluid or mass in lungs
• percussion note - resonant or dull

Question 29

what are some ventilation diseases?

Answer 29

• asthma
• chronic obstructive pulmonary disease
• bronchiectasis

Question 30

what are some gas exchange diseases?

Answer 30

• COPD - emphysema
• pulmonary fibrosis
• ventilation-perfusion mismatch

Question 31

examples of respiratory disease?

Answer 31

• ventilation disease
• gas exchange disease
• respiratory infection
• inflammatory disease- CF, sarcoidosis
• lung malignancy