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Medical SLP > Module 2 > Flashcards

Module 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Respiratory function:
where does oxygen come from and where does it go
…

A

blue blood /red blood (vein/artery)

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2
Q

Our heart sends blood that has circulated body to the lungs via?

blood is oxygenated in the lungs from the ?

oxygenated blood is then sent back to heart via ?

the … connection

A

pulmonary artery

oxygen filtered through alveoli

veins driven throughout the body

cardiac and respiratory connection

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3
Q

Oxygen levels in the blood:
measured with ?
measures the ? that is ?
normal oxygen saturation levels are approx.
pulse oximetry measurements can be ?
-a blood draw from an artery can be done to check ?

A

pulse oximetry (SpO2 -saturation of peripheral oxygen)

hemoglobin (a protein in the blood carries oxygen) saturated with oxygen in blood

93-100% (can vary)

inaccurate
-blood gasses (ABG-arterial blood gas0

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4
Q

What if body’s oxygen levels are low:
blood is not able to ?
body begins to try to ?

the respiratory rate ?

  • normal range is different for
  • check monitor to see
  • be on look out for ?

tachypnea -

begin to see ?

A

send enough oxygen to organs to maintain function

compensate

increases (Normal 12-20 breaths per minute)

  • infants/children
  • patient’s baseline
  • changes with intervention (swallowing)
  • rapid shallow ineffective breathing
  • cyanosis (see deoxygenated hemoglobin)
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5
Q 
Resp. rates in infants/children: 
newborn: 
infant: 
toddler: 
preschoolers 
school age 
adolescent
A 
30-60 breaths pm
30-60 
24-40
22-34
18-30
12-16
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6
Q

Supplemental oxygen:
want to give the least amount of ?
delivered in amount measured in ? or ?

conversion : one litre of flow per minute equals ?

about. .. is O2 content of room air
- if a patient is on 1 litre of oxygen per minute, the air contains ?

-if patient is on 4 litres of oxygen per minute, the air contains about ? oxygen

A

supplemental oxygen as possible
-litres or percent

  • 3-4% of room air
  • 21%

24%-25% oxygen
33% (21+2) -37% (21+16) oxygen

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7
Q 
Type of delivery method supplemental oxygen: 
-.. 
... mask 
-high flow 
non
-
-
intubation with
A 
nasal cannula (NC O2) 
oxygen mask (face or trach) 
nasal cannula 
non-re-breather mask 
-BiPAP 
CPAP
ventilation
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8
Q 
Respiratory Distress/Code Blue:
absent 
-significantly increased ? 
-patient may require a change in the ? potentially? 
patient may require ?
A

respiration

  • respiratory rate
  • respiratory support they are recieving/ increase in level of suppl. oxygen being provided
  • intubation or to be placed on ventilator
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9
Q 
Diseases of lungs: 
Chronic obstructive pulmonary disease
-
-
-
A

emphysema
chronic bronchitis
chronic damage from asthmatic bronchitis

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10
Q 
COPD: 
one of leading causes of 
lung disease that blocks? and leads to impaired ? 
no ? 
eventually, results in ?
A

death wordlwide
airflow /gas exchange of oxygen and carbon dioxide
cure
death

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11
Q

Impact on swallowing/phonation:
any abnormality in respiratory system can negatively ?
period of apnea during ?
voice production is powered by ?

A

impact swallowing or voice function
swallow (.5-3.5 seconds)
exhaled air

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12
Q 
Dysphagia in COPD: 
deficits with coordination of ? 
reduced tolerance for the ? 
generalized ? 
xerostomia: 
-.. breathing 
-... oxygen 
-respiratory ?

timing of respiration/swallow:

  • post-swallow ?
  • risk of ?
A

respiration and swallowing
-apneic event that occurs with swallow
fatigue/reduced endurance

mouth
supplemental
medications/breathing treatment

respiration/swallow

  • inspiration -especially on sequential sips
  • aspiration on inspiration immediately upon completion of swallow
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13
Q

pneumonia:
infection in
caused by?
there are more than?

A

one or both of lungs

  • bacteria, viruses or fungi
  • 30 diff. types of pneumonia
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14
Q

Pneumonia:
aspiration pneumonia: is only ?
-bacteria from material that has ?
often but not always occurs in ?

A

one type of pneumonia

  • entered into lungs is cause
  • right lower lobe of lung
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15
Q 
Mainstem bronchi: 
right bronchus: 
-.. long 
-more in line with 
-enters lung opposite 
the orifice is 
-foreign bodies tend to enter the ? as it is in line with
left bronchus: 
... long 
less in line with 
enters lung opposite 
to orifice is 
foreign bodies less likely to ?
A
  1. 5 cm
    - trachea
    - t5
    - larger
    - right bronchus - inline with trachea
5 cm 
trachea 
T6
smaller 
enter left bronchus
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16
Q 
Aspiration pneumonia: 
clinical signs of aspiration
-low grade 
-changes in 
-change in *** may take up to ? 
not all aspiration is created ? 
-... aspiration 
-
-
-.. contents 
-... feeds
A

fever - may initially present approx. 30 minutes after aspiration event

  • lung sounds (no longer clear)
  • chest x-ray ( 24 hours to manifest depending on pt’s hydration status)

equal

  • prandial vs. postprandial aspiration
  • food
  • liquid
  • gastric contents
  • tube feeds
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17
Q

The heart circulation:
.. chambers
-2
-2

the atrium and ventricle are separated by

A

4 chambers

  • 2 upper (atria)
  • 2 lower (ventricles)

1 way valve

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18
Q

Right atrium
receives … that is returning back to heart from ?

blood is sent to the right atrium via the ?

pumps blood through the

A

used blood / tissues throughout body (blue-deoxygenated)

superior and inferior vena cava

tricuspid valve, to right ventricle

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19
Q

Right ventricle:
blood that is sent to the right ventricle from the right atrium is pumped to lungs via ?
-deoxygenated blood in an artery ??

A

pulmonary artery

yes

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20
Q

left atrium:
blood is returned to heart into the ? from the lungs via the ?
oxygenated blood in a vein?

A

left atrium/ pulmonary veins

yip

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21
Q

Left ventricle:
oxygenated blood is pumped out of the ? to provide all tissue with

the force generated is ?
systolic blood pressure: the amount of force generated on the ?

A

left ventricle / oxygen

120mm of Hg
-walls of arteries when heart beats

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22
Q 
Myocardial Infarction: 
also called 
interruption of ? due to ? 
can cause death of? leading to ? 
.. can result 
need for ? 
...
A

heart attack
blood flow to heart muscle itself/ blockage of blood flow to one or more of coronary arteries
muscle fibers / permanent damage to heart
abnormal heart rhythm
sten placement, angioplasty, coronary artery bypass graft
death

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23
Q 
Heart beat rhythm: 
controlled by ? sent along ? 
...
the pacemaker of the heart aka...
the rate that the electrical impulses are sent out from the SA node=
-when this is normal it is called 
can be seen on an ?
A

electrical messages/ tiny fibers located near top of right atrium and along back wall of heart

sinoatrial node (SA node) 
-coordinates heartbeat

rhythm
sinus rhythm
ECG

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24
Q 
Heart rhythm: 
normal sinus rhythm: 
abnormal heart rhythms 
atrial - most common to 
ventricular ?
ventricular ?
A

60-100 BMP for adults measured by electrocardiogram
atrial fibrillation (Afib) most common to arrhythmia
tachycardia (V-tach)
fibrillation (V-fib)

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25
Q 
Abnormal heart rhythms: 
atrial fibrillation (A-fib) 
-... heartbeat involving the ? 
the most common 
causes are ? 
can cause the formation of ? increases risk of ? 
ventricular fibrillation (V-fib) 
... heartbeat - involving the 
the most ? 
causes include ? 
the heart cannot? leads to ?
A

irregular - atria
abnormal heart rhythm
-varied and sometimes unknown
-formation of blood clots/ stroke risk

irregular/ quivering - ventricles
serious heart rhythm abnormality
MI, sepsis, cardiomyopathy, inadequate blood flow to myocardium
pump blood - leads to cardiac arrest

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26
Q

Heart valves:
can fail to function by not?
-
-

causes of valve dysfunction include: 
- ... abnormalities 
....
-... disease 
... cholesterol 
-.... abuse 
.... fever

abnormal valve function can result in

bacteria can grow on?
-this can result in ?
dental cleanings:

A

opening and closing appropriately

  • regurgitation (leaking)
  • stenosis (narrowing)
congenital abnormalities 
age 
heart disease 
high cholesterol 
IV drug abuse 
rheumatic fever

heart failure and heart enlargement

diseased heart valves

  • bacterial endocarditis - life threatening infection
  • antibiotic prophylaxis
27
Q 
Coronary arteries: 
nourish the ? 
attach to and ? 
... disease 
narrowing of the ? due to ?
A

heart muscle (myocardium) itself
-wrap around the surface of the heart
coronary artery disease (CAD)
coronary arteries / plaque build up results in lack of oxygen to the heart muscle itself

28
Q 
Dysphagia following CABG: 
etiology of dysphagia ? 
-neurological 
-impaired function of 
-laryngeal changes following

dysphagia symptoms are similar in patients who undergo?

A

likely varies

changes (small brainstem infarct - not detected on MRI)
recurrent laryngeal nerve
intubation (ETT tube)

thoracotomy for lung resection and lung transplant, as well

29
Q

Congestive heart failure (CHF):
scarring and weakening of the ? results in decreased ability of the heart to ?
the blood then backs up and creates ?
some of the blood’s fluid component ? and results in?

A

myocardium (heart muscle) contract with enough force to push out needed volume of blood

pressure in lungs and other organs where blood is coming from

leaks through walls of small blood vessels/ swelling or edema of tissue

30
Q

CHF:
the liver and kidneys that filter blood cnanot
organs receive less
-the back pressure of blood in the heart itself causes the chambers of th eheart to ?
ventricular muscle ? causing heart to ?
the enlarged heart requires more ? and thus this results in ?
heart rate ?
what can also result

A 
work efficiently 
oxygenated blood 
- dilate
-thickens in attempt to compensate/ enlarge 
oxygen/ more damage 
increases to try to compensate 
abnormal heart rhythm
31
Q 
CHF patients can experience ? 
-patients often experience difficulty ? 
lungs fill with ? 
wet lungs and poor circulation allows for ? 
death by CHF results from ?
A

shortness of breath (SOB)

  • breathing in supine position because they need to be upright to help fluid drain from lungs
  • fluid (pulmonary edema)
  • growth of bacteria - can result in pneumonia
  • drowning in fluid
32
Q

COVID:
conditions due to COVID
-
-

-

A

pneumonia
MI (due to blood clotting issues)

intubation/ventilator support

COPD
CHF

33
Q

What is Respiratory Muscle Strength Training:
the process of building strength within ?
inspiratory muscle strength training:
-
-

-
-

A

muscles and muscle groups that control respiration

-diaphragm
external intercostal muscles (raise ribs for inspiration)

abdominals
internal intercostal muscles (assist in rib depression for expiration)
supralaryngeal (suprahyoid)

34
Q

Addressing the common dys

A

dystussia
dysphonia
dysphagia
dyspnea

35
Q

What’s the goal of RMST:
increase the ?

improve the function of ? through?

A

force generating capacity of inspiratory or expiratory muscles

respiratory muscles/ specific though not task specific exercise

36
Q

-
-

A

voice (reduced glottic closure)
swallowing function
cough strength

37
Q 
cough: 
a mechanism that protects the pulmonary system by ? 
a cough is comprised of three steps: 
1.
2.
3.

EMST- targets

A

generating expiratory flows to create a scrubbing action to remove material from airway

inspiration
closure of VFs (generates subglottic pressure)
forced expiration

cough strength

38
Q 
Inspiratory Muscle strength training: 
vocal cord ? 
impaired ? 
-....
cystic 
-ventilator 
....
A 
dysfunction 
true vocal fold movement (bilateral) resulting in airway issues (reduced subglottic space) 
-COPD
-cystic fibrosis 
-weaning 
Myasthenia gravis
39
Q

Why focus on respiratory muscles ?
age related ? along with reductions in ?

respiratory muscle strength decreases in elderly with ?

lack of physical exercise accelerates ?

reported that EMS is reduced more than ?
-due to reductions in ?

A

loss of muscle strength, sacropenia / elastic recoil and chest wall compliance decreases intrathoracic airway pressure as well as expiratory flow rates and velocity

muscle fiber atrophy by approx. 20% by age 70

reduction in respiratory muscle force generation

inspiratory muscle strength
-muscle fiber cross sectional area of expiratory muscles

40
Q

How does training work?
muscle overload:
.. of either maxium expiratory pressure or maximum inspiratory pressure

overall typically less intrathoracic intracranial pressure than produced during?

A

muscle overload
high freq. high resistance
70-75%

bowel movement

41
Q

Measurement
force of expiration or inspiration measured in ?
displacement of ? notated

A

centimeters of water
water
cm H20

42
Q

Pressure generation -safety
when there is concern regarding safety consider other ?

speech
cough
bowel movement

A

pressures generated

5-10 cm H20
100-200
200-300

43
Q 
Rehabilitative/restorative treatments:
increase or maintain 
improve or maintain 
increase or decrease 
improve or maintain 
improve 
...,...,...
-adaptations
-adaptation
A 
muscle strength 
range of motion 
muscle tone 
maintain coordination of structures 
endurance

plasticity, plasticity, plasticity

  • central adaptations
  • peripheral adaptations
44
Q

Skeletal muscle tissue: plasticity

performance ?
.. changes
…changes

A

performance (behavioural) changes
muscle changes
CNS changes

45
Q

What changes?

neural changes:
peripheral -
central -
cortical -

-

A

level of motor unit
level of spinal cord or brainstem (sensory nerves)
cortical map area (synapses, etc)

muscular hypertrophy
fiber type changes

46
Q

Neural changes:
neural changes occur … than muscular changes

endurance training results in increased ?

increased ?

cortical mapping adaptations in ?

A

earlier

increased blood flow and angiogenesis with motor cortex

muscle activation

sensory nerves, cortical thickness, and angiogenesis

47
Q

Myogenic changes:
increase in ?
oxidative capacity refers to the muscles?

skeletal muscles are made of both ?
-slow:
-fast:
all muscles have a ?

RMST stimulates ?

A

oxidative capacity in trained muscles
-maximal capacity to use oxygen in micrometers of O2 per gram per hour

slow twitch or fast twitch muscle fibres
-slow to contract but very resistant to fatigue (posture)
-fast to contract with great force, but prone to fatigue (cough)
combination, depending on function

fast twitch resulting muscular enlargement or hypertrophy

48
Q

Studies that show the effects of EMST on ?

A 
stroke 
MS
ALS 
PD
sedentary elderly 
Head and neck cancer
49
Q

EMST and swallow:
activation of ?
this may result in changes in the activation of ?

associated with ?

A

submental swallow muscles with EMST device

sensory system which triggers swallowing

significant decrease in the penetration or aspiration during sequential swallow tasks

50
Q

wet swallow: EMST

dry swallow: EMST

A

25%

75%

51
Q

CVA:
aspiration pneumonia most common cause of death

acute: 
subacute:
PNA #1 cause of ?
Associated with ? 
both cough and swallow impairments?
EMST hypothesised to improve ?
A

post CVA

40-80%
11-25%

readmission up to 5 years
worse overall outcomes
common post CVA
strength and coordination of expiratory and submittal musculature

52
Q

EMST impact on swallowing function:
evaluated with?
feasibility study to determine swallowing-related patterns of palatal and pharyngeal muscle activity can be detected during EMST

swallowing related muscle activity during EMST:
increased ?
-… activity
-… activity

submental EMG patterns:
activity was ? however, may have corresponded with ? further ?

A

high resolution manometry and electromyography

EMG activity with increased expiratory load

  • palatal activity
  • pharyngeal activity

detected/ mouth posturing and prep for task (meg influenced by jaw movement, tongue protrusion, posturing)/ study needed

53
Q

EMST
… device

calibrated ?
load is set at ?
targets ?

A

pressure-threshold device

one way, spring-loaded valve
75% of MEP
muscles of expiration

54
Q

EMST - low threshold device
threshold PEP ?
threshold range

A

positive pressure device

5-20 cm

55
Q 
training program EMST 
5 sets of 
in ? 
how many days a week 
increase device threshold level by ? as tolerated
A

5 breaths (25)
-in one sitting, once per day
5/7 days a week
1/4 turn after each week of training

56
Q

Application for patients following total laryngectomy:
..management
loss of ?
can we improve the ?

A

secretion management
filtration, humidification of inhaled air
the pump ?

57
Q

Inspiratory muscle strength training:
the PCA is the principle ?
there is a temporal relationship between the ?

activation of the diaphragm has a ? stimulation of the diaphragm activates

A

abductor of the vocal cords

inspiratory phase of the respiratory cycle and PCA activation

synergistic effect - stimulation of the diaphragm activates the antagonist muscles

58
Q

COVID-19
IMST use after ?
inspiratory muscle training for recovered COVID-19 patients after

conclusion:
a 2-week IMT improves ?

IMT program should be encouraged in? specifically with

A

ventilator weaning

weaning from mechanical ventilation

pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit

COVID-19 management protocol, specifically with ICU patients

59
Q

Determining the device setting:
formal measurement of
EMST
-maximum

IMST
maximum

A

Maximum expiratory pressure (MEP)

inspiratory pressure (MIP)

60
Q

What if I don’t have a manometer to determine MEP and or /MIP

... for setting the device 
-not too
-not too 
-start at a ? have patient 
increase by 
back off by
A 
low tech 
easy 
difficult 
low setting/blow into device 
1 turn until unable to activate valve 
1 turn
61
Q

-
-

both

A

aspire
the breather
powerlung

expiratory and inspiratory training

62
Q

contraindications for RMST:
COPD:
mild to moderate cases: keep device setting at ?
close ?

HTN?
…
possibly ?
ALWAYS discuss ?

A

50% of maximum pressure
monitoring

uncontrolled
hernia
post-operative patients (lung resection)
RMST with physician prior to intiiating use

63
Q

RMST is NOT a one size fits all

adjustments may include: 
.... for patient 
-more 
adjust
more 
training on

more ? of caregiver
clinician judgment re:
combination with ?

A 
more/less intensive training for patient 
days with therapist 
mouthpiece 
weeks 
use of device itself

involvement and training of caregiver
EMST versus IMST versus both
compensatory or other restorative behavioural swallow therapeutic technique

64
Q

How long to complete training: The rule of ?

detraining:
skeletal muscle will?

however respiratory muscle gains remain ?

A

neuroplasticity
use it or lose it

return to pre-training levels within 1 month of exercise cessation

significantly higher than pre-training levels up to 8 weeks after training cessation

Medical SLP (11 decks)

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