Respiratory

Question 1

Define Ventilation

Answer 1

Inspiration/Expiration

Movement of air in and out of the lungs. Movement is created by changes in pressures within the lungs.

Question 2

Inspiration

Answer 2

Moving air into the lungs.

The muscles of inspiration contract, expanding lungs.. Lungs expand, increasing volume, decreasing pressure.
Muscles involved.
-Diaphragm – 80% of work of breathing, pushes down viscera and displaced the abdomen outwards.
-External intercostals – elevate the ribs and expand the chest cage outwards
-Scalene, Serratus anterior & Sternocleidomastoid (accessory muscles)

Question 3

Expiration

Answer 3

Air leaving the lungs.
End of inspiratory phase
Diaphragm relaxes. Intercostal muscles relax. Volume reduced, increases pressure in the lungs.
Passive event.

Question 4

Regulation and Control

Answer 4

Respiratory Centre:
Medulla Oblongata - Respiratory Centre
-- Ventricle Group - Rhythmicity
-- Dorsal Group - Inspiration with diaphragm 
Pons - Pontine Respiratory Group
   -- Apneustic 
   -- Pneumotaxic 

Cortical Influences:
Voluntary override of automatic responses.

Inflation Reflex:
Stretch receptors in bronchi and bronchioles. Overstretched signals Vagus nerve to apeustic and inspiration area.

Chemical Regulation:
Arterial and central chemoreceptors. Deter changes in blood pH and pp(CO2) in the blood.

Proprioceptors:
Movement in the muscles and joints stimulates inspiration centre to increase rate and depth.

Other:
Temperature
Pain
Stretching of anal sphincter

Question 5

Internal Respiration

Answer 5

Exchange between blood and tissues

Question 6

External Respiration

Answer 6

Exchange between alveoli and blood

Question 7

Tidal Volume

Answer 7

Volume inhaled and exhaled during normal breathing – (500ml)

1/3 remains in dead space (150ml) – not involved in gas exchange

Question 8

Residual Volume

Answer 8

Volume of gas left in the lungs after forced expiration due to alveoli and the non collapsible airways (1200ml)

Question 9

Inspiratory Reverse Volume

Answer 9

Volume that can be forcibly inhaled above TV (3100ml)Volume that can be forcibly inhaled above tidal volume (3100ml)

Question 10

Expiratory Reserve Volume

Answer 10

Volume which can be forcibly exhaled beyond that of tidal volume (1200ml)

Question 11

Vital Capacity

Answer 11

This is inspiratory reserve volume + tidal volume + expiratory reserve volume (4800ml)

Question 12

Total Lung Capactiy

Answer 12

Total Volume of the lungs. (6000ml)

Vital Capacity and residual volume.

Question 13

Minute Volume

Answer 13

Tidal Volume x breaths per minute (500x16= 8L)

Question 14

Respiratory Distress Assessment

Answer 14

Exertional SoB
Cough
Pain on coughing
Able to swallow
Drooling
Sleeping Position
Nocturnal Dyspnoea
Previous hospital or intubation
Recent med changes
Meds compliance
Frequency of use
Clot risks (calf pain, surgery, prolonged stasis)

Question 15

Ausc Sounds - Course Crackles

Answer 15

More low pitched and longer lasting.

Chest Infection
Phlegm, pus, large bronchi

Question 16

Ausc Sounds - Fine Crackles

Answer 16

Soft, high-pitched, and very brief. (Rubbing hair sound)

Alveoli (terminal bronchioles)- opening of alveoli causing pop sound (after surfactant has been washed away

Question 17

Ausc Sounds - Stridor

Answer 17

High pitched crowing sounds

Larynx narrowing
Croup

Question 18

Ausc Sounds - Wheeze

Answer 18

A high-pitched whistling sound.

Terminal bronchioles, respiratory bronchioles, portion of alveoli.
Asthma

Question 19

Diseases of COPD

Answer 19

Asthma
Emphasema
Chronic Bronchitis

Question 20

Define Asthma

Answer 20

Asthma is a chronic reversible disease that involves inflammation of the lower airways.

The gross pathology of asthmatic airways is hyperinflation, bronchoconstriction, mucosal oedema, mucous gland hypersecretion and cilia cell disruption.

Question 21

Asthma Pathophys

Answer 21

Trigger factors affect the airway
↓
Local antigen/antibody reaction on mast cells lining the respiratory tract
↓
Mast cells rupture releasing histamine and other inflammatory substances
↓
Bronchospasm Mucosal oedema Mucus plugging
↓
Small airways obstruction
↓
Air continues to enter the lungs with decreased air expired
↓
Hypoxia and CO2 retention
↓
Gas trapping hyperinflation TnPnTx
↓
Decreased venous return
↓
Decreased CO
↓
Decreased cerebral perfusion
↓
Coma/death

Question 22

Asthma: 4 trigger factors

Answer 22

PIDE

Pollution/preservatives
Infection
Drugs/dust
Exercise/emotion

Question 23

Define: Chronic Bronchitis

Answer 23

The inflammation of the bronchis caused by irritants.
This causes a thickening of the bronchial wall and an increase in mucous production. The increase in number and size of mucous glands makes them more susceptible to infections. Combined with impaired ciliary function, respiratory infections are common.