Mid-Term Exam - Part 1, Basics

Question 1

Sternal Angle

Answer 1

Level of the 2nd rib

Level of the carina

Question 2

Potential Mobility of the Chest

Answer 2

increases as you move inferior
increases as you move anterior
Sternum: mobility driven
Spine: stability driven
the most potential mobility lies along the xiphoid process and the inferior borders of the anterior and lateral ribs

Question 3

Movement of Ribs 1-7 (costo-transverse joints)

Answer 3

rotate increasing the thoracic dimensions primarily in the anterior and superior directions
upper ribs: primarily anterior and superior

Question 4

Movement of Ribs 8-10 (costo-transverse joints)

Answer 4

glide increasing thoracic dimensions primarily in a lateral and superior direction
lower ribs: primarily lateral and superior

Question 5

Spine:

a) Posterior Ligamentous Support
b) Anterior Ligamentous Support

Answer 5

a) three articulations, very stable (superior, lateral and posterior costo-transverse ligaments)
b) one flat articulating surface (ALL)

Question 6

Sequence of a Normal Breath

Answer 6

Easy onset and subtle rise of the upper abdomen
Lateral costal expansion of the lower chest
Gentle rise of the upper chest primarily in the superior and anterior planes.

Question 7

Lung Volumes / Capacities (8)

a) Tidal Volume

Answer 7

amount of air moved in and out of the lungs during quiet respiration

Question 8

Lung Volumes / Capacities (8)

b) Inspiratory Reserve Volume

Answer 8

amount of air moved into lungs above normal tidal inhalation

Question 9

Lung Volumes / Capacities (8)

c) Expiratory Reserve Volume

Answer 9

the amount of air that can be moved out of the lungs above normal tidal exhalation

Question 10

Lung Volumes / Capacities (8)

d) Residual Volume

Answer 10

the amount of air that remains in the lungs after forced exhalation

Question 11

Lung Volumes / Capacities (8)

e) Inspiratory Capacity

Answer 11

Tidal Volume + IRV

Question 12

Lung Volumes / Capacities (8)

f) Functional Residual Capacity

Answer 12

ERV + Residual Volume

Question 13

Lung Volumes / Capacities (8)

g) Vital Capacity

Answer 13

ERV + TV + IRV

Question 14

Lung Volumes / Capacities (8)

h) Total Lung Capacity

Answer 14

IRV + TV + ERV + RV

Question 15

Minute Ventilation

Answer 15

TV * # of breaths per minute

Question 16

Upper Airways

Answer 16

Nose, Mouth, Pharynx, Larynx
Cleanse, Head, Humidity
Resonance for Phonation

Question 17

Lower Airways

Answer 17

Conducting Airways: Trachea, Right Mainstem Bronchi (3), Left Mainstem Bronchi (2)
approximately 23 generations to reach the respiratory airways
Respiratory Airways: (gas exchange) alveoli

Question 18

Lung Landmarks

Answer 18

Upper lobes: mostly anterior thorax
Middle lobe & Left lingula: tip at mid-axillary line, larger part anterior around level of the nipple line
Lower lobes: mostly posterior thorax, beneath the spine of the scapulae.

Question 19

Respiratory Centers

Answer 19

Respiratory Center: medulla - not quite normal breathing
Apneustic Center: pons - inspiratory gasps
Pneumotaxic Center: pons - balances the above 2

Question 20

Cilia

Answer 20

Sol Layer: 90% water
Gel Layer: sticky, catches pollutants
mobilize secretions upward
present to the 12th generation of lung divisions
Hydration is key for bronchial hygiene and minimizing the risk of bacterial infection

Question 21

Chemoreceptors: CO2 sensitive

Answer 21

central: medulla, extremely sensitive
peripheral: carotid bodies, less sensitive

Question 22

Distribution of Gas

Answer 22

Upright: better ventilation of the lower lobes of the lungs
Supine: better ventilation of the posterior aspects of the lungs
Side-Lying: better ventilation of the side which is dependent (left side lying: left lung least resistance, gravity pulls blood to left side)
generally, greater air exchange occurs toward the gravity -dependent areas.

Question 23

Airway Resistance

Answer 23

High Airway Resistance: air cannot move in a unidirectional flow
Low Airway Resistance: below the level of cartilage support, small airways collapse at the end of inspiration

Question 24

Ventilation

Answer 24

the process by which air moves into the lungs.
the air that reaches the alveoli
the movement of air between the environment and the lungs via inhalation and exhalation
ventilation follows the direction of least resistance

Question 25

Perfusion

Answer 25

the blood flow of the pulmonary circulation available for gas exchange. the blood that reaches the alveoli position dependent, gravity dependent (in upright lungs, the bases are better perfused than the apices) the process of a body delivering blood to a capillary bed

Question 26

Ventilation / Perfusion Matching (V/Q)

Answer 26

the ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli. constitute the main determinants of the blood oxygen concentration. when V/Q mismatching occurs: Deadspace, ventilation in excess of perfusion Shunt: perfusion in excess of ventilation (atelectasis) V/Q should be about 1.

Question 27

Diffusion

Answer 27

the movement of oxygen from the capillaries to the mitochondria. determined by: metabolic rate, vascular resistance, capillary recruitment and tissue oxygen consumption and extraction. can be effected by the ability of the oxygen to be transported or the pulmonary-capillary membrane wall thickness

Question 28

Oxyhemoglobin Dissociation Curve

Answer 28

Y-Axis: % Saturation X-Axis: partial pressure of O2 increases in temp, H+, PCO2 moves curve to the right and more apt to release oxygen. Hgb holds 4 oxygen, more bound, greater affinity, less likely to give up.

Question 29

Diaphragm

Answer 29

Phrenic Nerve: C3-5 2/3 - 3/4 of TV effort and volume thoracic (neg), abdominal (pos) uses positive pressure of the abdominal cavity to "stabilize" the central tendon. Once stable, the peripheral fibers of the diaphragm can produce lateral and superior expansion. Concentric Contractions: quiet and forceful inhalation Eccentric Contractions: controlled exhalation and speech

Question 30

Intercostals

Answer 30

T1-T12 stabilize the rib cage during inhalation to prevent chest wall collapse toward the negative pressure generated in the thoracic cavity.

Question 31

Abdominals

Answer 31

T6-L1 stabilizes the inferior border of the rib cage as it interlaces the lower rib cage onto the abdomen. visceral support positive pressure support

Question 32

Innervation: a) Erector Spinae b) Pecs c) Serratus Anterior

Answer 32

a) T1-S3 b) C5-T1 - used in reverse, provide upper chest anterior and lateral expansion. c) C5-C7 - posterior expansion of the rib cage. only inspiratory muscle that is paired with trunk flexion movements rather than extension

Question 33

Innervation: a) Scalenes b) SCM c) Traps

Answer 33

a) C3-C8 b) C2-C3 & accessory cranial nerve c) C2-C4 (least energy efficient accessory muscle)

Question 34

Hilum

Answer 34

point at which the nerves, vessels, and primary bronchi penetrate the parenchyma of each lung.

Question 35

Root

Answer 35

``` comprised of the structures entering the hila of each lung: principle bronchus pulmonary artery pulmonary vein pulmonary nerve plexus lymph vessels ```

Question 36

Compliance

Answer 36

ease at which the lungs expand too much: can't return to baseline effectively, resulting in air trapping too little: can't expand easily, resulting in decreased inspiratory capacity

Question 37

Newborn: Shape, Size, Breathing Patterns

Answer 37

triangular in the frontal plane and circular in the horizontal plane. occupies ~ 1/3 of trunk. narrow intercostal spacing and horizontal ribs. obligatory diaphragm breathers. no accessory muslces and no pulmonary reserves. RR of 40-60bpm

Question 38

3-6 months: shape, size, breathing patterns

Answer 38

more rectangular, but still not elongated log-rolling upper chest expansion is possible, still primarily diaphragmatic breathers, RR is decreasing.

Question 39

6-12 months: shape, size, breathing patterns

Answer 39

more rectangular, now elongating and ribs begin to rotate downward, lung size has increased 4x since birth. greater O2 demands: creeping to walking breathing patterns: all patterns available.

Question 40

Over 12 Months

Answer 40

trends continue but at a less dramatic rate | flaring of the ribs becomes less apparent as the abdominals and intercostals become stronger

Question 41

Trends with Aging

Answer 41

increased lung compliance (decreased elastic recoil) decreased chest wall compliance (stiff) decreased lung volumes and expiratory flow rates (except residual volume which increases)

Question 42

Cheyne-Stokes:

Answer 42

consists of alternating crescendos to hyperpnea and decrescendos to apnea. associated with lesions deep inside the cerebellum and the basal ganglia.

Question 43

Central Neurogenic Hyperventilation

Answer 43

respirations that are rapid (>24), continual, regular and deep. associated with lesions in the lower midbrain to middle pons area.

Question 44

Apneusis

Answer 44

prolonged inspiration with a pause at the inspiratory peak and sometimes the expiratory peak. associated with lesions in the middle to lower pons area with extensive brain stem damage.

Question 45

Cluster Breathing

Answer 45

irregular spurts of breathing interspersed with period of apnea. associated with lesions in the upper medulla.

Question 46

Biot's Respirations

Answer 46

completely irregular, unpredictable patterns with deep and shallow random breaths and pauses. associated with lesions in the medulla.

Question 47

Central Apnea

Answer 47

All respiratory centers of the CNS are impaired resulting in complete apnea. associated with severe increased intracranial pressure and patient's often require long term mechanical ventilation

Question 48

Paradoxical Breathing

Answer 48

paralyzed intercostals &/or abdominals - upper chest collapses during inspiration - belly rises excessively, diaphragm does not encounter any resistance as the central tendon descends. paralyzed diaphragm (phrenic C3-C5) - lower chest and abdomen collapse during inspiration - upper chest rises excessively Diaphragm and Upper Accessory Muscles only (paralyzed intercostals) Isolated Diaphragm (eg SCI) Upper Accessory muscles only (eg. high SCI) lateral breathers: weakness, not paralysis of the trunk muscles Asymmetrical breathers: eg. hemiplegia, post surgical patients Shallow breathers: eg high tone patients Altered speech support patterns: poor breath support or poor eccentric control