Physiology

Question 1

Do the lungs recoil in inspiration or expiration?

Answer 1

Expriation

Question 2

What is the nerve supply to the diaphragm?

Answer 2

Phrenic C3, C4, C5 keeps the diaphragm alive

Question 3

When does the upper respiratory tract become the lower respiratory tract? At what vertebral level?

Answer 3

Larynx to trachea at C6

Question 4

Where is the best place to auscultate the apex, middle lobe and lung base?

Answer 4

Apex: superior to medial 1/3 of the clavicle
Middle lobe: between ribs 4-6 in mid-axillary/mid-clavicular line
Base: scapular line at T11

Question 5

Total lung capacity = X + X

Answer 5

Total lung capacity = residual volume + vital capacity

Question 6

What is tidal volume?

Answer 6

Volume entering / leaving lungs in one breath

Question 7

What is vital capacity?

Answer 7

Max volume breathed out in 1 breath

Question 8

What is residual volume?

Answer 8

Minimum volume after expiration

Question 9

What is FEV1?

Answer 9

Volume expired in 1st second of expiration

Question 10

What is pulmonary compliance?

Answer 10

Effort to stretch lungs in inspiration

Question 11

Does less pulmonary compliance = more or less work?

Answer 11

More work

Question 12

Define ventilation and perfusion? What is shunting?

Answer 12

Ventilation rate of gas passing through lungs
Perfusion rate of blood passing through lungs
Shunting is perfusion but no ventilation

Question 13

How is FVC, FEV1 and FEV1/FVC ratio effected in obstructive lung disease?

Answer 13

FVC: normal
FEV1: reduced
FEV1/FVC ratio: reduced

Question 14

How is FVC, FEV1 and FEV1/FVC ratio effected in restrictive lung disease?

Answer 14

FVC: reduced
FEV1: reduced
FEV1/FVC ratio: normal

Question 15

What is respiratory epithelium?

Answer 15

Psuedostratified ciliated columnar epithelium

Question 16

Bicarbonate is produced by what enzyme in what cell?

Answer 16

Bicarbonate carries CO2 and is produced by carbonic anhydrase in RBCs

Question 17

Define wheeze

Answer 17

Expiratory
High pitched whistling sound arising from smaller airways

(Polyphonic wheeze in inspiration + expiration, seen in severe COPD/ asthma)

Question 18

Are crepitations inspiratory or expiratory

Answer 18

Inspiratory

Question 19

Define stridor

Answer 19

Large airway obstruction

Inspiratory

Question 20

First line investigation for stridor

Answer 20

Laryngoscopy

Question 21

What is normal oxygen saturation targets? What are saturation targets in patients at risk of hypercapnic respiratory failure?

Answer 21

94-98%

88-92%

Question 22

What patients are at risk of hypercapnic respiratory failure?

Answer 22

COPD

Opiate/benzo OD

Question 23

What type of oxygen delivery should you use in COPD patients?

Answer 23

24-28% Venturi mask

carry a oxygen alert card

Question 24

Name the 2 types of non-invasive ventilation NIV?

Answer 24

CPAP and BiPAP

Question 25

What type of NIV is used for acute pulmonary edema?

Answer 25

CPAP

Question 26

What type of NIV is used for type 2 respiratory failure?

Answer 26

BiPAP

Question 27

What type of NIV is used for acute pulmonary edema?

Answer 27

CPAP

Question 28

How do you assess that a CXR is properly inspired?

Answer 28

Anterior ends of at least 6 ribs visible

Question 29

How do you assess that a CXR is properly penetrated?

Answer 29

Can see spinous processes behind the heart

Question 30

How do you assess that a CXR is properly rotated?

Answer 30

Medial ends of clavicles equidistant from spinous processes of upper thoracic vertebrae

Question 31

What % of oxygen delivery is high flow oxygen?

Answer 31

> 60%

double check this

Question 32

What is the management of acute pulmonary edema?

Answer 32

High flow O2
Sit upright
IV furosemide
If remain hypotensive IV inotrope