Additional notes

Question 1

What is bronchial breathing?

Answer 1

Consolidated alveoli (which being solid, are excellent at conducting sounds) - which conduct breath sounds from larger airways.

Question 2

• List two conditions which will cause a mediastinal displacement towards the affected side and explain why.

Answer 2

Localised fibrosis – fibrous tissue contracts, pulling the trachea & mediastinum
towards the affected side

Lung collapse from central airway obstruction –
With complete obstruction of the bronchus, no air enters the airways & alveoli distal to the obstruction.
Over time, the air distal to the obstruction is gradually absorbed into the blood, and the alveoli distal to the obstruction collapse and shrink, pulling trachea and mediastinum towards the affected side

Question 3

• List one other condition which will cause a mediastinal displacement away from the affected side and explain why.

Answer 3

Large effusion
Increased pressure in right pleural cavity due to the large effusion pushing entire mediastinum (including trachea) to the opposite (left) side

Question 4

Outline the symptoms of acute bronchitis

Answer 4

Acute Bronchitis is an acute viral or bacterial infection of the respiratory tract.
• Usually begins 3 -4 days after an upper respiratory tract infection
• Cough may initially be dry, then productive of sputum ( white, yellow, or green)
• May have breathless & wheezing
• Symptoms do not vary during the day

• Mild fever may be present. (High fever suggests pneumonia)
• Central chest discomfort on coughing may be present
• No past history of recurrent similar episodes

Question 5

Outline symptoms of asthma

Answer 5

Not an infection, though episodse may be triggered by respiratory tract infection
• No preceding URTI (unless trigger)

• Dry cough, tenacious, scanty white sputum
• Chest tightness
• Breathlessness and wheeze,
• Symptoms show variability – worse at night & early morning,
• Past history of similar episodes, with trigger factors
• History of atopy (Hay fever, urticaria, exzema)?
• Family history of asthma/atopy

Question 6

What causes narrowing of large airways?

Answer 6

Compression (eg by Lymph nodes outside airways),
Narrowing of lumen by tumour
inhaled foreign bodies

Question 7

What causes narrowing of the small airways?

Answer 7

bronchoconstriction, mucus in lumen, mucosal edema, bronchial wall thickening due to hypergrophy of submucosal glands, loss of radial traction (eg emphysema)

Question 8

What is the difference between vesicular and bronchial sounds?

Answer 8

Vesicular sounds – these are the normal breath hsounds
They have a quality suggestive of ‘rustling leaves’; heard on inspiration and first part of expiration with no gap between the inspiratory & expiratory components.

Bronchial breathing – Characteristic blowing sound, present in both inspiration and expiration with gap between the inspiratory & expiratory components.

Question 9

Give two main effects of chronic respiratory failure

Answer 9

CO2 retention
o	CSF acidic corrected by choroid plexus
o	Initial acidosis corrected by the kidney
o	Reduction of respiratory drive
o	Persisting hypoxia

Right Heart Failure (Cor pulmonare)
o Effect of hypoxia on pulmonary arteries  Pulmonary hypertension
o Chronic respiratory failure is severely disabling

Question 10

What is the management of respiratory failure? (4)

Answer 10

o Oxygen therapy
o Removal of secretions
o Assisted ventilation
o Treat acute exacerbations