Intern

Question 1

What is chronic bronchitis

Answer 1

Inflammation of bronchi. No spasm or contriction of muscle

Productive cough
Excessive bronchial secretion
Sob
Prolonged expiration
Wheeze or crackles

Question 2

What is emphysema

Answer 2

Loss of lung elasticity -destruction of the alveoli walls. Increased complience so air is trapped in the lungs. Alveoli are enlarged and capillaries are destroyed

Question 3

Why wheeze sound?

Answer 3

Friction and air turbulance from constriction

Moderate = wheeze
Severe = reduced air flow so no wheeze

Question 4

What is compliance?

Answer 4

A measure of the expansibility of the lungs and thorax

Increased = easier to inflate eg emphysema 
Decreased = harder eg pulmonary oedema and airway obstruction

Question 5

Lower resp tract?

Answer 5

Below epiglottis

Question 6

Inspiration muscles and pressure changes?

Answer 6

Quiet = diaphragm and external intercostals
Forced = sternocleidomastoid, serratus, scalene (accessory muscles)

Contraction of these muscles cause increase in volume of thoracic cavity and decrease of pressure

Question 7

Anaphylactis M16

Answer 7

1-protocol A2
2- is anaphylaxis suspected?
3- mild = no abcd s/s no systemic features = fexofenadine then tx
4- mod to severe = any abcd s/s or systemic features = IM adrenaline, hartmanns, urg tx

Question 8

Airway obstruction M2

Answer 8

1-protocol A2
Then
1- effective cough = encourage coughing, high flow O2, transport

2- inaffective cough
Conscious = 5 back blows then 5 chest thrusts, 100%o2 and continue with urg tx.
Unconscious = extricate with magils forceps, then CPR, urg tx

Question 9

Parts of respiratory tract

Answer 9

1 - External nares
2- Nasal conchae
3- Nasopharynx
4- Oropharynx
5- Laryngopharynx
6- Larynx
7- Trachea
8- Primary bronchus
9- Secondary bronchus
10- Tertiary bronchi
11- Bronchioles
12- Terminal bronchiole
13- Respiratory bronchiole 
14- Alveoli

Question 10

Cardiac output (volume of blood pumped by heart per min)=

Answer 10

Stroke volume (volume pumped out of ventrical each beat) x heart rate

Question 11

What is angiooedema

Answer 11

Inflammation of mucous membranes

Back up for adrenaline

Question 12

What is coronary sinus

Answer 12

Collection of veins joined together to form a large vessel that delivers deoxygenated blood to the right atrium

Question 13

What is frank starling law?

Answer 13

Stroke volume of heart increases in response to an increase in volume of blood filling the heart

Question 14

What is resp distress? Symptom or sign?

Answer 14

Sign

Clinically evident inability to adequately ventilate and/or oxygenate

Question 15

Vital capacity

Answer 15

Sum of tidal volume, inspiratory reserve volume, expiratory reserve volume

Question 16

Asthma M4

Answer 16

Protocol A2
Assess severity and Peak Expiratory Flow Rate (PEFR) for patients ≥ 8 years of age
Check for pneumothorax/tension pneumothorax
Treat according to severity:
Mild - Salbutamol
Moderate - Salbutamol and ipratropium bromide
Severe/life threatening - Adrenaline, salbutamol and ipratropium bromide
Expiratory assistance if indicated
Determine appropriate disposition for patient:
Urgent Transport - severe/life threatening
Non Transport Recommended P5 - mild, responsive to treatment with no generic exclusions to non-transport or protocol specific exclusions
Recommend transport for all other patients

Question 17

What is MAP

Answer 17

Mean arterial pressure =

dp + 1/3(sp-dp)

Question 18

Inspiratory reserve volume?

Answer 18

The amount of air that can be inspired forcefully after inspiration of the normal tidal volume

Question 19

Upper resp tract?

Answer 19

Above epiglottis

Question 20

What is CAL/COPD/COAD, whats the protocols treatments?

Answer 20

Problem in bronchi and alveoli

Protocol A2
Salbutamol and ipratropium bromide
Urgent transport
Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration

Question 21

Epistaxis M17 protocol

Answer 21

1- protocol A2

2- apply compression 15 mins

Question 22

Why sal and atrovent for asthma?

Answer 22

Sal = b2 sympathetic to relax muscles
Atrovent = blocks vagas stim that causes the muscle spasm or tone

Both work on the same thing but have different adverse effects so can use little of both decreasing the amount of adverse effects

Question 23

Hyperventilation s/s

Answer 23

Alkalosis
Absence of other physical prob
Anxiety
Tingling hands and feet
dyspnoea 
Carpo-pedal spasms 
Increased resp rate

Question 24

Principles of ventilation?

Answer 24

Boyles law = the volume of gas is inversely proportional to the pressure at a constant temperature

Air flows along a pressure gradient

Question 25

Croup vs epiglottis

Answer 25

Croup - slow, sitting, barking cough, no drool | Epiglottis- fast, sitting, no barking, drool

Question 26

What is dyspnoea? Symptom of sign?

Answer 26

Symptom Pt feels SOB - feels awareness of their breathing and it feels obstructed/labored

Question 27

CO2 transport

Answer 27

7% dissolved in plasma Rbc = 93% 23% haemoglobin 70% transformed to bicarbonate form CO2 + h2o with carbonic anhydrase enzyme = carbonic acid H2CO3 = Bicarbonate ion HCO3 + H

Question 28

Difference between cardio / membrane leak pulmonary oedema

Answer 28

Cardiogenic = increased hydrostatic - look for JVP and hypertension Membrane leak = fluid leaking due to decrease COP

Question 29

Lung capacity

Answer 29

Tidal volume Inspiratory and expiratory reserve volume Residual volume

Question 30

What is asthma?

Answer 30

Hypersensitive reaction 1- bronchoconstriction or muscle spasm 2-inflammation and swelling of bronchiole 3- increased mucous secretion

Question 31

Expiratory muscles and pressure changes?

Answer 31

``` Quiet = passive relaxation of inspiration muscles Forced = internal intercostals, abdominal muscles - active process (not as much force as inspiratory muscles) ``` Volume of thorax is decreased caused increased pressure

Question 32

What does the atrial natriuretic hormone do?

Answer 32

Blood pressure rises stretching atria | ANH shuts off RAAS thus stabilizing blood volume and pressure

Question 33

Differences between left and right respiratory system

Answer 33

Right bronchus is straighter, shorter and wider. Right lung has 3 x lobes Left lung has 2 x lobes

Question 34

Residual volume

Answer 34

Air remaining in the lungs after the most complete expiration possible

Question 35

What is tidal volume?

Answer 35

Volume of air inspired or expired during normal inspiration or expiration

Question 36

Expiratory reserve volume

Answer 36

Air that can be forcefully expired after normal tidal expiration

Question 37

Moderate asthma s/s

Answer 37

``` Use of accessory muscles Expiration wheeze mod to loud Diaphoresis Tachy 100-120 Anxiety Speaks in short sentances ```

Question 38

Severe asthma s/s

Answer 38

``` Decreased breath sounds Hypoventilation Cyanosis Speaks words or not at all Chest hyperinflation Accessory muscles Tachy >120 or brady (pre arrest) Intercostal retraction Reduced LOC Resp arrest ```

Question 39

At completion of expiration - forces opposing and facilitating collapse

Answer 39

Facilitating = 1- elastic recoil - elastic fibres in alveoli walls 2- surface tension - droplets at boundary between water and air Opposing = 1- intrapleural pressure 2- surfactant - decreases surface tension

Question 40

What is the respiratory membrane? Or external respiration

Answer 40

Alveolar epithelial cells Interstitial layer Endothelial capillary cells Where gas exchange occurs

Question 41

Mild asthma s/s

Answer 41

``` Chest tight Dyspnoea Tachypnoea with prolonged expiration Expiratory wheeze Cough Mild tachy <100 ```

Question 42

Oxygen transport %

Answer 42

98. 5% with hemoglobin | 1. 5% dissolved in plasma