Cardioresp - General

Question 1

Name the 4 functions of the upper airway.

Answer 1

1. Conduct air to the lower airway
2. Protective mechanism to prevent material getting into pulmonary tree
3. Portion of anatomical deadspace
4. Role in speech and smell

Question 2

Eupnea

Answer 2

Normal breathing - occasional sigh

Question 3

Tachypnea

Answer 3

Increased rate (not necessarily depth) - more than 20 
Cause: anxiety, hyperventilation, high CO2

Question 4

Hyperpnea

Answer 4

Increased TV (depth) with or without increase in rate

Question 5

Bradypnea

Answer 5

Decreased RR (less than 12) 
Causes: alcohol, drugs, low CO2, neuro, sleep

Question 6

Apnea

Answer 6

Period of no breathing

Causes: sleep, infant

Question 7

Kussmaul’s Ventilation

Answer 7

Increase in RR and TV

Causes: diabetic acidosis (resp system compensation - blowing off CO2)

Question 8

Cheyne Stokes

Answer 8

Ranges from hyperpnea to apnea

Causes: neuro insults

Question 9

Biot’s Ventilation

Answer 9

Small breaths with apnea in between

Causes: neuro insult

Question 10

Name 4 signs of respiratory distress

Answer 10

Increase RR, nasal flaring, intercostal indrawing, paradoxical breathing, leaned forward, wheezing, cyanosis

Question 11

Name 3 possible reasons diaphragmatic excursion may be abnormal

Answer 11

Tumor, pneumothorax, damage to phrenic nerve

Question 12

Name the 2 types of wheezes and their meaning.

Answer 12

High pitched = bronchospasm

Low pitched = secretions in the U/A

Question 13

Name the 2 types of crackles and their meaning.

Answer 13

Coarse = pulmonary edema or secretions in the lower airway 
Fine = atelectasis or pulmonary fibrosis

Question 14

Stridor

Answer 14

Upper airway obstruction

Question 15

Pleural rub

Answer 15

Fluid in pleural space

Question 16

Crunches

Answer 16

Subcutaneous emphysema

Question 17

Name and describe the 3 forms of neural control of breathing.

Answer 17

1. Medullary Neurons - center for generation of rhythm (spinal or propriobulbar) = bulbospinal (insp and exp); propriobulbar (transition between)
2. Neurons of the Pons - not critical for generation of rhythm
3. Upper cervical inspiratory neurons C1-C3

Question 18

Nasal Irritant Reflex

Answer 18

Stimulated by water or chemical gases (results in deep insp and bronchoconstriction = sneezing)

Question 19

Epipharyngeal Irritant Reflex

Answer 19

Receptors sensitive to mechanical deformation; powerful inspiratory efforts
Purpose = bring into esophagus or cough it up

Question 20

Laryngeal Irritant Reflex

Answer 20

Sensitive to mechanical deformation or irritants = cough

Question 21

Tracheal Irritant Reflex

Answer 21

Sensitive to mechanical deformation or irritants = cough

Question 22

Lung Irritant Reflex

Answer 22

Receptors in epithelium of airways from trach to bronchioles; sensitive to mechanical deformation or chemical irritation
Causes: increase ventilation, bronchoconstriction, laryngeal constriction (prevents other substances from getting in)

Question 23

J Receptors Irritant Reflex

Answer 23

Juxta pulmonary capillary receptors in alveolar wall
Stimulated by increased interstitial fluid between capillary endothelium and alveolar endothelium
= abnormal breathing pattern; bronchoconstriction and laryngeal muscle contraction

Question 24

Stretch Reflexes

Answer 24

Info about lung volume to medullary neutrons (receptors in lung get stretched at certain points and stops insp)

Question 25

Tidal Volume

Answer 25

Volume inspired or expired with each normal breath (500mL)

Question 26

Inspiratory Reserve Volume

Answer 26

Max that can be inspired (on top of normal) (2-3L)

Question 27

Expiratory Reserve Volume

Answer 27

Max volume that can be expired after tidal volume (1L)

Question 28

Residual Volume

Answer 28

Volume that remains in the lungs after max expiration (1L)

Question 29

Inspiratory Capacity

Answer 29

Volume of max inspiration (2.4-4L) IRV + TV

Question 30

Functional Residual Capacity

Answer 30

Volume remaining in lung after normal expiration (2L) ERV + RV

Question 31

Vital Capacity

Answer 31

Volume of max inspiration and expiration (3-4.5L) TLC - RV

Question 32

Total Lung Capacity

Answer 32

Volume of air after max inspiration (4-6L) RV + TV + IRV + ERV

Question 33

Dead Space (anatomic vs. physiologic)

Answer 33

Anatomic (150mL) - volume of conducting airways | Physiologic (150mL - greater with lung disease) - volume of lung that doesn't participate in gas exchange

Question 34

What are important considerations for patients using beta blockers?

Answer 34

Blunted HR and BP response (don't use HRmax for exercise prescription - RPE instead); gradual warm up and cool down

Question 35

What are the contraindications to spirometry?

Answer 35

MI in the last month, recent stroke/abdominal/thoracic surgery, uncontrolled HTN, recent pneumo

Question 36

What are the differences between the obstructive and restrictive patterns for lung disease?

Answer 36

``` Obstructive = inc. lung volumes, dec. FVC, ++ dec. FEV1, dec. ratio Restrictive = dec. lung volumes, dec. FVC, dec. FEV1, ratio normal or increased ```

Question 37

What are the precautions with an art line?

Answer 37

Infusion bag kept above insertion site; no hip flexion past 90 if femoral

Question 38

What are the limitations post sternotomy?

Answer 38

No lifting anything more than 10lbs, no pushing, no pulling

Question 39

What are the criteria for spirometry use?

Answer 39

Patient cooperative and motivated; FVC > 15mL/kg or IC > 12mL/kg; RR < 25

Question 40

Name the precautions/contraindications for head down postural drainage positions?

Answer 40

Untreated pneumo, hemoptysis, unstable CV status, inc. ICP, esophageal anastomosis, aneurism, pulmonary edema or CHF, patient upset or agitated, PE, recent laminectomy, large pleural effusion