Resp failure, breathing sounds, common conditions

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.

Lung collapse from central airway obstruction
- Blockage of air entering distal airways. Air already present gets absorbed and then alveoli contract down, causing collapse of the alveoli

Question 3

Give a condition which will cause a mediastinal displacement away from the affected side and explain why.

Answer 3

Large effusion

Increased pressure in pleural cavity due to the large effusion pushing entire mediastinum to the opposite 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 a URTI
• Cough may initially be dry, then productive
• Can have SOB and wheeze
• 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 episodes may be triggered by respiratory tract infection

• No preceding URTI
• Dry cough, tenacious, scanty white sputum
• Chest tightness
• Breathlessness and wheeze
• Symptoms show variability
• Past history of similar episodes, with trigger factors
• History of atopy
• 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 oedema
Bronchial wall thickening due to hypertrophy 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 sounds

• Quality suggestive of ‘rustling leaves’
• heard on inspiration and 1st 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.
• Causes: consolidation, localised fibrosis, pleural effusion

Question 9

Give two main effects of chronic respiratory failure

Answer 9

1. CO2 retention
   - CSF acidic corrected by choroid plexus
   - Initial acidosis corrected by the kidney
   - Reduction of respiratory drive
   - Persisting hypoxia
2. Right Heart Failure (Cor pulmonale)
   - Effect of hypoxia on pulmonary arteries causes Pulmonary hypertension
   - Chronic respiratory failure is severely disabling

Question 10

What is the management of respiratory failure? (4)

Answer 10

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