Respiratory

Question 1

Explain inspiration

Answer 1

Diaphragm contracts downwards, expanding the thoracic cavity and reducing abdominal cavity

Air flows into the lungs as the pressure in the thoracic cavity is now reduced

Question 2

Explain expiration

Answer 2

Diaphragm relaxes upward, thoracic cavity is reduced and abdominal cavity expands.

Pressure is therefore increased in the thoracic cavity and air travels out of the lungs

Question 3

Describe the anatomy of the lungs

Answer 3

Pair of lungs lie either side of the heart within the mediastinum, they are large, spongy organs consisting of 99% air. Each lung is divided into sections called lobes, three in the right and two in the left, separated by fissures. Within the lobes lungs are further divided into 9/10 sections.
The left lung is smaller due to sharing space with the heart
Alveoli within the lungs facilitate gaseous exchange

Question 4

Describe alveoli

Answer 4

Approx 300 million tiny, elastic, expandable sacs called alveoli are attached to the ends of bronchioles within the lung tissue.
Their thin walls allow diffusion of oxygen in and carbon dioxide out of the surrounding capillaries, known as gaseous exchange

Question 5

Describe passage of air in upper respiratory tract

Answer 5

Air enters into the nasal/oral cavity where is is moistened and warmed, it flows into the pharynx, then larynx at c3-c6. Then the trachea which begins at c6 inferior and bifurcates (splits) at t5 (sternal angle) where it becomes bronchi. Made of c shaped hyaline cartilage to maintain an open tunnel by which air can flow in and out despite pressure changes, and circular muscle to control expansion.
The trachea and bronchi/bronchioles are lined with ciliated epithelium and mucous that collect and expel foreign objects

Question 6

Describe position of lungs

Answer 6

Apex- top of lungs superior to clavicle and first rib

Base- concave over the convex diaphragm at 6th costal cartilage

Question 7

Explain visceral and parietal pluera

Answer 7

Parietal pleura; covers inside of thoracic wall, surfaces are;
Costal
Mediastinal
Diaphragmatic 
Cervical

Visceral pleura; covers lungs and interlobar fissures

Between the layers are the pleural cavity full of lubricating serous fluid, which maintains lung position due to slight adhesive quality.

Pleura serves to reduce friction, facilitate expansion, cushion and separate structures.

Question 8

Where are the 2 main pleural recesses and what do they do

Answer 8

Extra space in the pleural cavity between visceral and parietal pleura, allows lungs to expand and fluid to fill

Costomediastinal recess:
Between mediastinum and visceral pleura, during inspiration lung lingula fills space

Costodiaphramatic recess:
Between costal pluera and diaphragmatic pleura, during inspiration lung fills space

Question 9

Locate inferior margin of parietal pleura

Answer 9

Runs from rib 8 mid claviclular line, to rib 10 midaxillary line, to T12 posterior

Question 10

What is pleural effusion and what may cause it

Answer 10

Fluid build up in pleural space caused by imbalance between plural fluid production and lymphatic drainage
May be caused by:
Cancer
Congestive heart failure 
Pneumonia 
Pulmonary embolism

Question 11

Describe passage of air lower respiratory system

Answer 11

At T5 (carina) the trachea bifurcates into primary bronchi entering each lung which functions like the trachea
Right is shorter, more vertical and wider than the left, therefore more at risk of foreign bodies 
The primary bronchi enter the hilum of lung and split into secondary (lobar) bronchi which each supply one lobe, then split into tertiary (segmental) bronchi, followed by bronchioles and then alveoli

Question 12

Describe the right lung

Answer 12

The right lung is larger and has 3 lobes
Superior
Middle
Inferior
And has 2 fissures
Oblique fissure separating inferior lobe from middle and superior
Horizontal fissure separating the superior lobes and middle lobes

Question 13

Describe the left lung

Answer 13

The left lung is smaller and only has 2 lobes, superior and inferior, due to where the heart is positioned
Only 1 fissure, oblique

Question 14

What is unique about the pulmonary vasculature?

Answer 14

The pulmonary blood vessels have less smooth muscle therefore are highly distendable, allowing them to adjust for large variations of venous return, that occur with postural changes or exercise

With increased cardiac output, more pulmonary blood vessels are recruited to accommodate the increase of blood flow

Question 15

What are the three surfaces of the lungs?

Answer 15

Costal
Diaphragmatic
Mediastinal

Question 16

Location of oblique + horizontal fissures ?

Answer 16

Oblique
t4 posterior, runs obliquely to rib 6 costal cartilage

Raise arm overhead and follow medial border of scapula

Horizontal

Horizontal runs across rib 4 at the sternum, and meets the Oblique fissure at the mid claviclar line

Question 17

Reasons for doing respiratory system examination/cardiovascular system examination?

Answer 17

History of disease-patient/family
Chest pain or tightness
SOB (dyspnoea)
Wheeze
Cough
Haemoptysis (blood in sputum)

Question 18

When examining posterior aspect what main lobe is accessible?

Answer 18

Inferior, which runs from T4 downwards, scapula blocks superior lobe above T4, however it can be somewhat accessed by protracting and upwardly rotating scapula to expose more surface area

Question 19

When examine anterior aspect which lobe is mainly accessible?

Answer 19

Superior, the oblique fissure runs diagonally inferior in a PA direction, therefore there is more superior lobe accessible anteriorly and more inferior lobe accessible posteriorly

Question 20

Order and patient position for examination

Answer 20

Observe
Palpate
Percuss
Auscultate

Superficial to deep
Explain to patient, gain consent

Posterior exam- seated, arms on opposite shoulders
Anterior exam- seated/supine, arms by sides
Side exam- seated, arm raised behind head

Question 21

What do we observe?

Answer 21

Breathing: rate, rhythm, depth, sound

Inspect: lips, fingertips, skin, deviation of trachea to one side in throat, shape and symmetry of chest

Movement/muscle tone: thorax, ribs, shoulders, neck

Question 22

What three types of sound do we listen for?

Answer 22

Bronchial
Bronchio-vesticular
Vesticular

Question 23

Why is the sternal angle - T4/T5 disk an important reference point?

Answer 23

Separates superior-inferior mediastinum
Bifurcation of trachea at carina indicating beginning of lower respiratory tract and primary bronchi
Arch of aorta

Question 24

Explain what type of resonance sound you would expect to hear when percussing/auscultating around rib 6 (base of lung)

Answer 24

During inhilation lung should fill this area therefore will be hyper resonat
During exhalation diaphragm/liver should fill this area therefore will be hypo resonant as organs are more dense and not full of air

Question 25

Describe normal vesicular sound

Answer 25

Low pitch, inspiration > expiration

All lung fields “ladder”

Question 26

Explain bronchi-vesicular sound

Answer 26

Medium pitch, muffled, inspiration = expiration

Intercostal space rib 2-3 a/p

Question 27

Explain bronchial sound

Answer 27

High pitch
Inspiration < expiration
Manubrium/trachea

Question 28

What might it indicate for bronchial sound heard over vesicular area?

Answer 28

Consolidation- change in normal tissue, filled with fluid or solid

Question 29

What does cackling indicate?

Answer 29

Course- bubbling soda present with course
Fine- rubbing hair together, clears with cough/change of position

May Indicate infection, fibrosis, fluid

Question 30

What does wheezing indicate?

Answer 30

Narrowing of airway

Question 31

Explain rhonchi?

Answer 31

Course, low pitch, like snoring

May indicate secretions in large airways
May clear with coughing

Question 32

Where does respiratory chest pain usually occur?

Answer 32

In the pleura as they are richly innervated, pain felt superficially
Ribs/Costocartilage pain felt upon breathing as ribs expand and retract

Question 33

What does forced/ longer duration exhale indicate?

Answer 33

Inability to exhale via elastic recoil, possible obstruction

Question 34

What does pleural friction sound like?

Answer 34

Harsh, grating sound and pain on chest wall

Question 35

Explain hyper vs hypo resonance and what you would expect to hear on percussion of vesicular (lung) fields?

Answer 35

Lungs are 99% air hence percussion produces resonant sound

Hyporesonance sounds flat and dull, indicating lack of air and abnormal lung density

Hyperresonance sounds louder and lower pitched, indicating hyperinflation of air

Question 36

Explain bronchial tree division

Answer 36

The trachea bifurcates at the sternal angle/T4, where it becomes the primary bronchi supplying each lung. Within the lungs, the bronchi split to become secondary bronchi, supplying each lobe. Within the lobe, the bronchi split again to become tertiary bronchi, supplying each section of each lobe

Question 37

Describe pulmonary vs systemic blood supply to lungs

Answer 37

Pulmonary:
Pulmonary arteries supply deoxygenated blood to the lungs where it is oxygenated and returned to the heart via pulmonary veins

Systemic:
Bronchial arteries supply oxygenated blood to the lung tissue, they are smaller in diameter therefore 6x the pressure of pulmonary arteries. They do not facilitate gaseous exchange, they supply the lungs