Resp Depression, Breathlessness

Question 1

At Rest respiratory system clears how much O2 and CO2 per minute?

Answer 1

O2 = 250ml
CO2 = 200ml

Question 2

How many horsepower can the aerobic&anaerobic metabolism sustain?

Answer 2

0.1 horse power

Question 3

What PaO2, PaCO2 and pH are the chemoreceptors trying to maintain?

Answer 3

PaO2 = 100mmHg
PaCO2=40mmHg
pH =7.4

Question 4

How many litres/minute can the alveolar capillary membrane exchange?

Answer 4

4L/min

Question 5

Central chemoreceptors respond to what chemical? versus peripheral chemoreceptors?

Answer 5

Central: H+
Peripheral: CO2, O2, H+

Question 6

Name 3 sensors for respiratory control?

Answer 6

Chemoreceptors
lung receptors
stretch/joint receptors

Question 7

What’s the major output nerve of the brainstem for respiration?

Answer 7

phrenic nerve

Question 8

Can the cortex override the brainstem re: respiration?

Answer 8

Yes.

Question 9

Where are the peripheral chemoreceptors?

Answer 9

carotid bodies and aortic arch

Question 10

T/F? small increase in O2 = increase ventilation?

Answer 10

False. Small CO2 = rapid increase ventilation

Question 11

At what point would you start hyperventilating re: PaO2 levels?

Answer 11

<60mmHg

Question 12

During exercise, what happens to PaO2?

Answer 12

Stays same

Question 13

During exercise, what happens to PaCO2?

Answer 13

decreases slightlty due to increased ventilation

Question 14

During exercise, what happens to pH?

Answer 14

drops slightly due to lactic acid

Question 15

Hypoventilation is what in terms of PaO2 and CO2?

Answer 15

decreased PaO2

increased PaCO2

Question 16

Acute hypoventilation causes respiratory what?

Answer 16

acidosis

Question 17

Chronic hypoventilation causes metabolic what?

Answer 17

alkalosis

Question 18

5 causes of hypoventilation?

Answer 18

Central (drive, suppression)
Neuromusular
chest wall
obesity
sleep disorder

Question 19

3 kinds of sleep apnea:

Answer 19

obstructive sleep apnoea
central
obesity hypoventilation syndrome

Question 20

do all snorers have OSA?

Answer 20

Nope

Question 21

Mechnism for snoring?

Answer 21

airway relaxes>throat narrowed>tongue falls backwards>turbulant flow = snoring

Question 22

OSA cycle results in what kind of sleep?

Answer 22

fragmented sleep/deprivation

Question 23

6 reasons to suspect OSA?

Answer 23

snoring
witnessed apnoeas
arousals
disturbed sleep
persistent HTN/unexplained resp failure

Question 24

what is paradoxical movement on polysomnogram mean?

Answer 24

no airflow but still trying to breath

Question 25

Management of OSA?

Answer 25

CPAP surgery mandibular splint lie on side

Question 26

what happens to the brain after chronic hypoventilation due to OSA?

Answer 26

brain accepts higher levels of CO2, you wake less but then it spills over into daytime and normally have lower O2 and higher CO2 in your body

Question 27

Resetting of respiratory centre happens with what other conditions?

Answer 27

severe COPD, pulmnoary fibrosis, neuromuscular disease

Question 28

If patients have chronic hypercapnoea, what do you do about supplemental oxygen?

Answer 28

You don't have large amounts (only until they reach their 'normal') or else they'll die as they are breathing re: O2 levels rather than CO2 levels

Question 29

4 key words for breathlessness?

Answer 29

recognition inappropriate respiratory work total body work

Question 30

When is most of the respiratory work done?

Answer 30

inspiratory

Question 31

Two other things make up respiratory work besides inspiration

Answer 31

stretching work - elastic | airflow work - resistive

Question 32

Dyspnea is sensation of increased what? and what?

Answer 32

load and drive

Question 33

Besides repiratory and cardiac causes, name 4 other causes of dyspnea?

Answer 33

muscle weakness metabolic anaemic psychogenic

Question 34

Does phrenic nerve palsy cause dyspnea?

Answer 34

yes

Question 35

What is usually the cause of SOB, cough, sputum, wheeze/stridor? what tests to do?

Answer 35

affected airways, (upper or lower) bronchiectasis, most likely obstructive test with spirometry

Question 36

68 yr old with SOB, cough, sputum, tobacco, hyperinflation and wheezes, what imaging? what tests?

Answer 36

CT scan spirometry most likely COPD

Question 37

SOB, cough and crepitations, where are problems most likely?

Answer 37

alveolar, could also be bronchiectasis

Question 38

Someone with normal chest examination, haemoptysis, pleuritic pain, look out for?

Answer 38

PE, or pulmonary hypertension/vasculitis

Question 39

What is the Wells Score?

Answer 39

To help dx a PE

Question 40

If Wells score is >4 what to do?

Answer 40

rule in with pulmonary angiogram

Question 41

If Wells Score is <4 then what?

Answer 41

D dimer to rule out

Question 42

How many % of dyspnoea are diagnosed with symptoms, signs and special tests?

Answer 42

80%

Question 43

what is MUD?

Answer 43

medically undiagnosed dyspnoea?

Question 44

Types of MUD include?

Answer 44

psychogenic/anxiety? other disease/new? MI, DM2 increased awareness of maximum effort

Question 45

Breathlessness in young athletes in 12-15% of Australians are usually diagnosed with this?

Answer 45

atopic asthma

Question 46

Breathlessness in young athletes, 30-40% have what? how treat?

Answer 46

exercise induced bronchoconstriction | treat with asthma treatments

Question 47

What can be confused with Breathlessness in young athletes and responds to speech therapy and CBT?

Answer 47

vocal cord dysfunction/laryngeal dysfunction

Question 48

If there are no ECG, BP of SaO2 abnormalities but have have steep heart rate, exceeive Ve max, early anaerobic threshold, what could it be?

Answer 48

De-conditioning

Question 49

How to confirm deconditioning?

Answer 49

3 months of aerobic training then remeasure

Question 50

What is a key marker for if dyspnoea is psychogenic?

Answer 50

If you have it at rest, but goes away during exercise