hh1606

Question 1

define COPD

Answer 1

a disease characterised by airflow obstruction resulting from chronic bronchitis or emphysema

Question 2

briefly describe clinical features of chronic bronchitis

Answer 2

a persistent productive cough for 3 months of the year for 2 consecutive years. - airway disease - insidious onset with morning cough

Question 3

state the aetiology of chronic bronchitis

Answer 3

smoking is primary aetiological factor
recurring bronchial infections
environmental pollution

Question 4

list secondary effects of chronic bronchitis

Answer 4

V/Q mismatch
increased airway resistance so reduced airflow
airway obstruction
increased WOB
impaired gas exchange

Question 5

define lung parenchyma

Answer 5

the portion of lung involved in gas transfer - alveoli, alveolar duct, capillary bed and respiratory bronchioles

Question 6

define cor pulmonale

Answer 6

widespread hypoxic vasoconstriction within lungs with increased vascular resistance and right ventricular failure

Question 7

define polycythaemia

Answer 7

body’s response to chronic hypoxia, increasing total volume of red blood cells hence increasing blood viscosity with plethoric appearance (red face)

Question 8

define respiratory failure

Answer 8

the inability to maintain the partial pressures in arterial blood of carbon dioxide and oxygen within normal physiological limits where PaO2<8kPa and CO2 >6.7 kPa

Question 9

define atelectasis

Answer 9

the collapse of a lung resulting in reduced gas exchange

Question 10

what is absorption atelectasis

Answer 10

when gases other than oxygen is required to keep the alveolar sacs open e.g. nitrogen

Question 11

interstitial fibrosis

Answer 11

a chronic relentless progressive fibrotic disorder of the lungs of unknown aetiology affecting adults >40years males

Question 12

what is innervated by the phrenic nerve?

Answer 12

C3,4,5 KEEPS THE DIAPHRAGM ALIVE!

Question 13

what factors generate the pleural pressure gradient?

Answer 13

the force acting to inflate the lung within the thorax, is generated by the opposing elastic recoils of the lung and chest wall and the forces generated by respiratory muscles. this tug of war creates pleural pressure gradient.

Question 14

describe process of quiet inspiration

Answer 14

respiratory muscles contract (diaphragm and external intercostals)
increases thoracic lung volume
causing decreased intrapulmonary pressure
airflow into lungs down pressure gradient
airflow stops when intrapulmonary pressure equals atmospheric pressure

Question 15

describe the process of quiet expiration

Answer 15

passive process
inspiratory muscles relax
air flow out of the lungs into atmosphere
thoracic volume decreases
which cause intrapulmonary pressure to increase
lungs recoil
airflows out of lung down pressure gradient until intrapulmonary pressure 0

Question 16

what happens to pleural pressure in a pneuomothorax

Answer 16

becomes positive, colour in x-ray is black

Question 17

what are the two types of dead space?

Answer 17

anatomical and alveolar dead space

Question 18

if air is missing during v/q it is

Answer 18

shunt (alveolar dead space)

Question 19

in anatomical dead space what are you missing

Answer 19

blood

Question 20

respiratory assessment: what symptoms do you want to know about the pt?

Answer 20

cough
wheeze
sputum
dyspnoea
breathing pattern
exercise tolerance

Question 21

what do you want to know about the pt’s current symptoms

Answer 21

have they changed from the normal

Question 22

what causes a wheeze?

Answer 22

air being pushed through a narrowed airway

Question 23

what causes chest pain? whats innervated in thorax?

Answer 23

the parietal pleura therefore parietal pain

Question 24

name 3 chest wall deformities

Answer 24

scoliosis
kyphosis
sternal - pectus cavinatum
or pectus excivatum

Question 25

how will a breathless patient change their breathing pattern?

Answer 25

``` apical breathing pattern rapid breathing fixed upper limb use of accessory muscle scalenes and scm pursed lip breathing ```

Question 26

name 5 criteria associated with fick's law

Answer 26

``` gas solubility surface area diffusion gradient thickness of alveolar membrane V/Q coupling ```

Question 27

what is hypoxic pulmonary vasoconstriction?

Answer 27

in areas of lung with poor gas exchange hypoxia is sensed by baroreceptors in arterioles the arterioles constrict to reduce wasted perfusion to areas of low ventilation in an attempt to reduce v/q mismatch. blood flow is redirected to areas of lung with good gas exchange therefore effective

Question 28

what is poisseuille's law?

Answer 28

flow of gas through an airway is directly proportional to the 4th power of its internal radius

Question 29

what is type 1 respiratory failure?

Answer 29

when oxygen is low and carbon dioxide is normal or low. oxygen is below 8, caused by V/Q mismatch within the lung

Question 30

what is type 2 respiratory failure?

Answer 30

when oxygen is low below 8 and co2 is high above 6kPa. caused by alveolar hypoventilation and failure of the respiratory muscles to generate pressure therefore respiratory pump fails

Question 31

what is the hilum

Answer 31

pulmonary arteries, pulmonary veins and lymph nodes

Question 32

why does pursed lips breathing occur?

Answer 32

exhaling via pursed lips increases resistance to expiratory airflow, which generates back pressure within airways, to help splint them open during expiration, more open when they breathe out (ppl with floppy airways like emphysema will use pursed lip breathing)

Question 33

whats normal inspiration/expiration ratio?

Answer 33

1:2

Question 34

signs of respiratory distress in COPD pt

Answer 34

``` tachypnoea pursed lip breathing prolonged expiration cah obstructive active expiration fixed ULs - use pec minor for insp use of acc mm scl nd scm soft tissue recession ```

Question 35

what happens to static lung volumes with COPD pts?

Answer 35

``` they are high as gas trap occurs higher RV, higher TLC, unaccessed trapped air higher FRC reduced diffusing capacity ```

Question 36

management of COPD

Answer 36

``` steroids diuretics anti-inflammatory drugs flu vaccine long term oxygen therapy lung volume reduction surgery - remove bullae ```

Question 37

physio management COPD

Answer 37

education- smoking cessation, inhaler technique sputum clearance technique when appropriate breathlessness management at rest pulmonary rehab

Question 38

acute type 2 respiratory failure

Answer 38

low pao2 high paco2 normal hco3 decreased pH - respiratory alkylosis

Question 39

chronic type 2 respiratory failure

Answer 39

``` low pao2 high paco2 high hco3 levels normal pH eg copd ```

Question 40

acute on chronic type 2 resp failure

Answer 40

low pao2 high paco2 increased hco3 but not enough so resp acidosis decreased pH deterioration of kidneys so co2 rised further

Question 41

Why can't we give people with chronically high co2 levels lots of O2 to breathe?

Answer 41

reversed HPVC - increasing V/Q mismatch Haldane effect Loss of hypoxic drive

Question 42

factors that affect haemoglobin's affinity for O2

Answer 42

``` primarily PO2 DPG (diphosophoglycerate) temperature PCO2 pH ```

Question 43

pulmonary rehabilitation

Answer 43

educate patient on ways to breathe functional exs prescribe group exs

Question 44

Radial traction

Answer 44

The elastic recoil in the alveoli surrounding airways helps to hold them open.

Question 45

define bronchiectasis

Answer 45

Chronic dilation and distortion of proximal and medium sized bronchi due to excessive inflammation

Question 46

define cystic fibrosis

Answer 46

inherited condition caused by defective chromosome 7 mutating CFTR altering Cl channel, resulting in thick dehydrated intraluminal mucus.

Question 47

aims of breathing retraining

Answer 47

• Restore and maintain normal diaphragmatic breathing pattern • Re-programme respiratory centre to trigger inspiration at a higher level of CO2

Question 48

respiratory compliance

Answer 48

distensibility of lung elastic tissue, the change in pulmonary volume per unit of pressure change

Question 49

pulmonary surfactant

Answer 49

surface acting lipoprotein complex secreted by type 2 alveolar cells reduces surface tension, improves alveolar expansion prevents lung collapsing at end of expiration increase lung compliance

Question 50

main component of pulmonary surfactant

Answer 50

dipalmitoglyphosphatidylcholine

Question 51

what happens if FRC drops to below closing volume?

Answer 51

lung collapses (dynamic compression of small airways and alveoli)

Question 52

describe the clinical relevance of reduced pulmonary surfactant

Answer 52

reduced pulmonary surfactant production-> increased surface tension-> decreased lung compliance-> atelectasis-> increased WOB/O2 consumption

Question 53

how is co2 transported

Answer 53

10% in plasma, 20% in hb, 70% as bicarbonate

Question 54

consequences of reduced lung volume

Answer 54

``` decreased frc decreased lung compliance increased WOB increased o2 consumption airway closure atelectasis ```

Question 55

list all respiratory system sensors

Answer 55

``` central chemoreceptors peripheral chemoreceptors juxta-capillary receptors stretch receptors irritant receptors proprioceptors mechanoreceptors ```

Question 56

central chemoreceptors

Answer 56

located on ventral surface of medulla bilaterally bathed in cerebral spinal fluid sensitive to arterial hypercapnia at BBB, pCO2 = paCO2 feedback responsible for 70% of drive to breathe

Question 57

what is the target saturation range for acutely ill patients who are not at risk of hypercapnic respiratory failure?

Answer 57

94-98%

Question 58

target saturation range for acutely ill patient who is at risk of hypercapnic respiratory failure?

Answer 58

88-92%

Question 59

where is the apex of the lung located?

Answer 59

2.5cm above the medial 1/3 of the clavicle

Question 60

o2 delivery devices

Answer 60

``` nasal canaliculae (variable) simple facemask (variable) reservoir masks (variable) venturi mask (fixed) ```

Question 61

benefits of pulmonary rehab

Answer 61

``` increased exs capacity reduced dyspnoea improved health status increased muscle strength reduced anxiety and depression ```

Question 62

explain loss of hypoxic drive if you give too high o2 to chronic hypercapnic pt with copd

Answer 62

COPD pt with chronic hypercapnia rely on peripheral chemoreceptors that sense arterial hypoxaemia if given too high o2 arterial hypoxaemia reversed, hence only remaining drive to breathe reversed

Question 63

explain worsed V/Q mismatch due to reversed hpv

Answer 63

COPD pt has areas of lung destruction with poor ventilation leading to hypoxia therefore vq mm compensatory hypoxic vasoconstriction occurs if given high o2 good lung tissue reversed hpv reversed so perfusion of non ventilating lung causes increased vq mismatch

Question 64

explain haldane effect as a reason not give high o2 to a COPD pt

Answer 64

Hb has high affinity for o2 in tissue hb lowers affinity for o2 as o2 low at tissues so unloading dissociation occurs for hb deox of hb increase co2 affinity increasing po2 brakes hb off co2 to bind with the o2 co2 dissolves in plasma, unable to be exchanged at lung thereby raising paco2 decreasing the ph thereby causing respiratory acidosis

Question 65

what are the 6 main symptoms of cardiorespiratory disease

Answer 65

``` sputum haemoptysis breathlessness (dyspnoea) chest pain cough wheeze ```

Question 66

what is a wheeze?

Answer 66

a whistling or musical sound produced by turbulent airflow through narrowed airways

Question 67

ventilatory pump

Answer 67

the ability to sustain spontaneous ventilation depending on the triad of CNS drive, respiratory mm capacity, and load that is imposed upon them

Question 68

emphysema

Answer 68

abnormal permanent enlargement of the alveolar septa distal to the terminal bronchioles, accompanied by wall destruction without obvious fibrosis

Question 69

asthma pathophys

Answer 69

``` narrowing of airway due to: mucosal oedema constriction bronchial smooth muscle lumen secretions thickening of bronchial wall increased airflow resistance decreased airflow breathlessness ```

Question 70

shape of thorax in copd

Answer 70

barrel shaped

Question 71

Pulmonary rehabilitation

Answer 71

``` • Education • Breathlessness management – at rest and on exertion • Sputum clearance techniques if appropriate • Exercise • Smoking cessation ```

Question 72

why do we use collateral channel ventilation?

Answer 72

- to re-inflate lung tissue | - remove sputum

Question 73

how does PEP work?

Answer 73

The PEP device creates pressure in the lungs and keeps your airways from closing. The air flowing through the PEP device helps move the mucus into the larger airway. for CF.