Respiratory

Question 1

List the functions/structures & patterns of breathing

Answer 1

gas exchange
mobility & stability
assists with digestion and fluid movement
nose/abdomen breathing, primary use of diaphragm with little chest movement in & out of nose

lateral costal breath pattern - 2nd stage of diaphragm activity is lateral expansion of lower thorax used when you need more air - bucket handle movement

Question 2

How many average breaths per minute

Answer 2

12-16: Inspiration to expiration ratio: 1.5:2

optimal breathing uses minimal mechanical effort

Question 3

Dysfunctional breathing patterns

Answer 3

apical/upper chest breathing pattern - mouth to chest breath
recruitment of secondary breathing muscles - uses more energy
upper rib breathing - pump handle

Question 4

4 kinds of dysfunctional breathing patterns

Answer 4

1 - Cog-wheel type - sensation of air hunger, inhalation greater than exhalation, a little more air is inhaled with each subsequent breath until max is reached, dynamic hyperinflation
2 - paradoxical breathing - opposite to optimal - breathing in as abdo goes in
3 - mouth breathing
4 - habitual sighing, coughing or yawning

Question 5

anatomy of bio mechanical breathing -

bony structures involved….

Answer 5

upper rib pump handle - ant. sup. movement on inhalation
posterior inferior movement on inhalation
lower ribs - bucket handle
floating ribs - pincer
sternum - ant. sup.
spine - ext. flexion

Question 6

muscles of respiration

Answer 6

diaphragm
parasternal internal intercostals
lateral external intercostals
transverse abdominus
psoas
quad lum

Accessory -
scalenes
scm, upper traps, pec major, minor, subclavius, serratus ant. longisimus thoracic

Question 7

muscles of expiration

Answer 7

Primary - elastic recoil of diaphragm
internal intercostals
transverse thoracic

Secondary - 
abdominal
iliocostalis
longissimus
serratus posterior
QL

Question 8

Clinical features of breathing pattern disorders

Answer 8

dyspnoea
frequent yawning and sighing
air hunger

Other symptoms can include
dizziness
chest pain
altered vision
panic attack
nausea and reflux
general fatigue
difficulty concentrating

Question 9

BPD Pain

Answer 9

common & you must distinguish from cardiac pathologies
sharp pain on inspiration is associated with aerophagia (pressure on the diaphragm)
dull diffuse pain associated with intercostal muscle fatigue
heavy retrosternal pain radiating to neck & arms, long lasting and does not change with rest or activity

Question 10

Causes of BPD

Answer 10

biomechanical - think posture, types of breathing, occupation
physiological - lung disease, diet
psychological

Question 11

Musculoskeletal pathophys

Answer 11

loss of thoracic cage compliance
constant overuse & tension of accessory resp. muscles
dysfunctional postures
lumbar spine respiratory muscles may involve dysfunction - including QL & diaphragm attach. to lumbar spine

Question 12

Physiological pathophysiolgy

Answer 12

breathing exceeds metabolic needs
leads to reduced CO2 in blood - hypocapnia……leads to
respiratory alkolosis which stimulates a sympathetic response……………..which is……
increased neural excitability
increased muscle contractility
decreased blood supply to brain
decrease of oxygen to other bodies tissues

Question 13

Psychological factors of pathophys

Answer 13

anxiety levels up
increase neurological arousal which changes rate & depth of breath and leads to resp. alkolosis creating sympathetic dominance

Question 14

Assessing

Answer 14

MARM test - rib cage movement, pinkie horizontal, thumb vertical

HI LO breathing - assessing paradoxical breathing pattern - one hand on sternum, one on abdo