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Respiratory complaints Flashcards

1
Q

What is a normal breathing frequency?

A

8 - 12 breaths/minute.
12 - 20 breaths/minute.

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2
Q

What is a normal breathing frequency during exercise?

(A) 18 - 25 breaths/minute.
(B) 30 - 40 breaths/minute.
(C) 20 - 50 breaths/minute.

A

(C) 20 - 50 breaths/minute.

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3
Q

What is a normal tidal volume?

(A) 0.2 - 0.4 L/min
(B) 0.4 - 0.5 L/min
(C) 0.4 - 0.6 L/min

A

(B) 0.4 - 0.5 L/min

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4
Q

What is a normal tidal volume during exercise?

(A) 1 - 3.5 L/min
(B) 2 - 3.5 L/min
(C) 3.5 - 5 L/min

A

(B) 2 - 3.5 L/min

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5
Q

Give examples of anatomical pathologies that limit ventilation:

A

(A) Emphysema.
(B) Fibrosis.

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6
Q

Explain: EMPHYSEMA

A
  • Damage to the walls of the alveoli.
  • Decreases surface area.
  • Decreased gas exchange.
  • Decreased elastic recoil.
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7
Q

Explain: LUNG FIBROSIS

A
  • The tissue around the air sacs of the lungs (alveoli) becomes damaged, thickened, and scarred. As the lungs scar and stiffen, breathing becomes more difficult. It can mean that not enough oxygen enters your blood.
  • Thickened wall = Decreased gas exchange.
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8
Q

What is a considered a normal breathing reserve?

(A)10%.
(B) 20%.
(C) 30%.

A

(B) 20%.

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9
Q

What are the factors that can limit ventilation?

A
  • Age.
  • Sex.
  • Chest deformities.
  • Chest surgery (loss of elastic recoil, deformities in the thorax, atelectasis).
  • Lung disease.
  • Breathing muscle weakness.
  • Breathing disorders.
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10
Q

Give examples of conditions that limit ventilation and increase the wall thickness of the lungs:

A

Fibrosis.

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11
Q

Give examples of conditions that limit ventilation and reduces the surface area of the lung:

A
  • COPD.
  • Restrictive lung disease.
  • Emphysema.
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12
Q

Give examples of conditions/factors that limit ventilation and reduces the pressure gradient of the lung:

A
  • Altitude.
  • COPD.
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13
Q

Explain: EXERCISE-INDUCED ARTERIAL HYPOXEMIA

A
  • Drop in arterial oxygen saturation during exercise.
  • Often occur in highly trained endurance athletes CO > 40 L/min / VO2max > 70 - 75 L/min).
  • The primary cause of EIAH is a mismatch between ventilation (air movement into and out of the lungs) and perfusion (blood flow in pulmonary capillaries).
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14
Q

What are the clinical signs of EXERCISE-INDUCED PULMONARY OEDEMA?

A
  • Worsening of dyspnea.
  • Coughing up blood.
  • Pink (frothy) sputum.
  • Fatigue.
  • Cough.
  • LOW SAO2.
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15
Q

Explain: EXERCISE-INDUCED PULMONARY OEDEMA

A

Pulmonary edema is the abnormal accumulation of fluid in the lungs, and exercise-induced pulmonary edema (EIPE) specifically refers to this condition triggered by physical activity.

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16
Q

What is the MEAN ARTERIAL PRESSURE of the pulmonary circulation?

(A) MAP 15.
(B) MAP 20.
(C) MAP 100.

A

(A) MAP 15.

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17
Q

What is the MEAN ARTERIAL PRESSURE of the systemic circulation?

(A) MAP 15.
(B) MAP 20.
(C) MAP 100.

A

(C) MAP 100.

18
Q

Explain: ASTHMA

A
  • Chronic condition.
  • Airway inflammation and reversible bronchoconstriction, which may eventually result in airway remodelling.
  • May be triggered by exercise, airborne allergens (pollens, per hair), respiratory irritants (pollen, or pet dander), respiratory irritants (vehicular air pollution or tobacco smoke), environmental factors (e.g. dry air), infectious disease, psychological events, various behaviours and other stimuli.
19
Q

What are the clinical signs of ASTHMA in athletes?

A
  • Cough.
  • Wheezing.
  • Dyspnea.
  • Poor performance or “feeling out of shape”.
  • Abdominal pain.
  • Headaches.
  • Muscle cramps.
  • Fatigue.
  • Dizziness.
20
Q

What are the common causes of EIB

A
  • Air pollution.
  • Allergens.
  • Cold dry air.
  • Breathing air containing chloramines.
  • Asthma.
21
Q

Why might cold, dry air lead to Exercise-Induced Bronchoconstriction (EIB)?

A

Exercising vigorously in a cold environment will increase the injury to the airway epithelium because of both, the increases need to heat and humidify the inspired air, and the potential to the increase the area of the airway surface becoming dehydrated.

22
Q

Why might breathing air containing chloramines lead to Exercise-Induced Bronchoconstriction (EIB)?

A

BY-PRODUCTS OF CHLORINATION:
- The reaction of chlorine-containing agents with organic nitrogen-containing compounds (dirt, sweat, urine) brought into the pool water by users leads to the formation of several by-products (chloramines).
- Nitrogen trichloride (NCI3) is a well-known by-product of chlorination that causes acute disruption of the airway epithelium.

23
Q

Why might allergens lead to Exercise-Induced Bronchoconstriction (EIB)?

A

AIR POLLUANTS:
- Air polluted by combustion engines (PM), is highly injurious to the airways.
- Dehydrated and damaged airways are more vulnerable to the deleterious effects of PM, particles penetrate deeper into the lungs.
- High ventilation during intense exercise results in greater deposition of PMN in the lungs and in higher concentrations of O3 and NOx entering the airways, hence increasing the risk of airway injury.

24
Q

Explain the clinical presentation of EIB:

A
  • Wheezing, cough, shortness of breath and/or chest tightness.
  • Often occurring within 5 to 30 minutes after intense exercise.
  • Gradual spontaneous improvement is common after ending exercise.
  • Athletes may not suffer from the obvious symptoms as regular asthmatic patients do rather
    - Cough
    - Poor performance.
    - Feeling out of shape.
    - Abdominal pain.
    - Headaches.
    - Muscle cramps.
    - Fatigue.
    - Dizziness.
25
Q

Explain: EIB

A

A transient (reversible) airway narrowing occurring during physical exertion. It is caused by an acute large increase in the amount of air entering the airways that require heating and humidifying.

26
Q

What is the diagnostic protocol of EIB?

A

A positive bronchodilation test (reversibility of 16%): Test two times, before and after medication. If there is an increase of 16% in FEV1 when using the medication, the test is considered positive, reversible obstruction.

27
Q

Explain: EILO

A
  • Exercise-induced laryngeal obstruction (EILO).
  • Condition in which there is an inappropriate narrowing of the larynx (voice box) during physical activity.
  • Caused by a temporary and inappropriate closure of the vocal cords during exertion.
28
Q

Clinical signs of EILO

A
  • Shortness of breath (dyspnea).
  • Increased inspiratory effort.
  • Inspiratory stridor (a harsh inspiratory sound due to turbulent airflow through a narrow laryngeal opening).
  • Breathing sounds, high pitched, grating (harsh).
  • A feeling of tightness in the throat and chest.
29
Q

How long does intense endurance exercise impairs the immune system?

(A) 2 - 24 hours.
(B) 2 - 48 hours.
(C) 2 - 72 hours.

A

(A) 2 - 24 hours.

30
Q

What are the common symptoms in RHINITIS?

A
  • Sneezing.
  • Anterior rhinorrhea (flow out of the nose).
  • Post-nasal drip.
  • Chronic cough.
  • Nasal obstruction
31
Q

What are the less obvious symptoms of rhinitis that athletes might experience?

A
  • Reduced exercise performance.
  • Fatigue.
  • Poor-quality sleep.
  • Difficulty to recover after more demanding exercise sessions.
32
Q

Explain: DYSFUNCTIONAL BREATHING

A

Chronic or recurrent changes in breathing pattern that cannot be attributed to a specific medical diagnosis.

33
Q

Clinical signs of DYSFUNCTIONAL BREATHING

A
  • More thoracic than abdominal breathing.
  • Irregular breathing, deep sip followed by shallow breathing.
  • Exercise-induced breathlessness,
  • Variety of other asthma-like symptoms such as dyspnea with normal lung function, chest tightness, chest pain, deep sighing, frequent yawning and hyperventilation.
  • Decreases in end-tidal CO2 during exercise can be associated with chest discomfort perceived as dyspnea.
34
Q

Explain: DECONDITIONING

A
  • Poor physical fitness is a very frequent cause of exercise-induced breathlessness.
  • May occur when returning too fast to previous performance levels, which could lead to dysfunctional breathing.
  • Leads to an increased ventilatory drive.
  • Lower lactate threshold, accumulating lactate and increasing minute ventilation with less exercise.
  • Excess lactate buildup results ultimately in hypocapnia (reduced blood levels of CO2; alkalosis).
  • Respiratory alkalosis = CO2 in the blood is too low + pH is too high.
35
Q

Why is IRON important to exercise?

A

Iron is essential for the production of hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body. Without sufficient iron, the body can’t produce enough healthy red blood cells to effectively transport oxygen, leading to anemia.

36
Q

Clinical signs of IRON DEFICIENCY

A
  • Syncope.
  • Dyspnea.
  • Fatigue.
  • Cardiac issues.
37
Q

What are the 3 factors that make someone prone to EIB?

A
  1. Increased levels of exhaled nitric oxide (elevated NO levels are associated with inflammation).
  2. Increase levels of leukotrienes (inflammatory mediators).
  3. Increased airway epithelial shedding.
38
Q

What is the role of the mechanoreceptors in the control of respiration?

A
  • Found in the airways, trachea, lung, and pulmonary vessels.
  • Provide sensory information with regards to lung volume, airway stretch, and vascular congestion.
  • Adapting stretch spindles (conveys only volume information) and rapid adapting irritant receptors.
  • The mechanoreceptors transmit information to the respiratory center via cranial nerve X (the vagus nerve) to increase the breathing rate, the volume of breathing, or to stimulate cough.
39
Q

What is the role of the central chemoreceptors in the control of respiration?

A
  • Sense pH changes, O2 and CO2 concentrations, in the central nervous system.
  • Chemoreceptors, in turn, respond to pH changes as they become more acidic and send sensory input to the brain to stimulate hyperventilation.
40
Q

What is the role of the peripheral chemoreceptors in the control of respiration?

A
  • Found in the carotid and aortic bodies.
  • Sense the arterial O2 levels in the blood.
  • Responds to hypercapnia or acidosis (higher levels on CO2 in the blood).

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