Respiratory

Question 1

• The bronchioles continue to subdivide into..

Answer 1

– Terminal Bronchioles
– Respiratory Bronchioles
– Alveolar Ducts
– Alveoli

Question 2

Alveoli

Answer 2

• Tiny, thin walled air sac at the end of bronchiole branches where gas exchange occurs.
• Millions of alveoli in each lung

Question 3

The lungs

Answer 3

• Two lungs lying each side of the midline in the thoracic cavity
• The area between is the mediastinum occupied by the heart, great vessels, trachea, and right and left bronchi

Question 4

The Pleura

Answer 4

• Closed sac of serous membrane that covers each lung and separates them from other organs
• Consists of two layers
– Visceral Pleura (adhered to lung)
– Parietal Pleura (adhered to chest wall and diaphragm)
– Two layers separated by thin film of serous fluid secreted by the membrane to prevent friction when breathing

Question 5

Function - Respiratory system

Answer 5

Purpose – gas exchange
• Deoxygenated blood to oxygenated blood
Moving air – through the ducting system
Function
- Warms
- Humidifies
- Filters

Question 6

Lung volumes

Answer 6

Male = 6L
Female = 4.2L
Tidal volume = 400mL … single breath volume
Dead space = 150mL … no perfusion
Respiration rate = 12-20/min adults

Question 7

Cough - Common causes

Answer 7

• Asthma – wheeze, often nocturnal, worse in mornings
• COPD – (‘smokers’) usually produces sputum in mornings
• Chronic heart failure
• Interstitial lung disease
• Drugs

Question 8

Cough - Ask about

Answer 8

• Time of cough – when is it worse?
• Duration – acute <3 weeks, sub-acute 3-8 weeks, chronic > 8 weeks
• Relief with inhaler
• Worse on lying down
• Wakening
• Sputum
• Haemoptysis

Question 9

Sputum and haemoptysis - Types

Answer 9

• serous: clear waters (acture pulmonary oedema), frothy pink (alveolar cell cancer)
• mucold: clear, grey (chronic bronchitis/chronic obstructive pulmonary disease), white, viscid (asthma)
• purulent: yellow (acute bronchopulmonary infection, asthma eosinophils), green (longer standing infection - pneumonia, bronchiectasis, cystic fribrosis, lung abscess)
• rusty: rusty red, phneumococcal pneumonia

Question 10

Sputum and haemoptysis - ask about

Answer 10

• Colour
• Amount
• Taste or smell
• Solid material
• Haemoptysis
– Amount, fresh, in sputum?
– Coughed up vs.
• vomited/regurgitated
• from nasopharynx

Question 11

Breathlessness, shortness of breath,

dyspnoea

Answer 11

• Dyspnoea – the sensation that unable to breath properly (subjective)
• Shortness of breath, breathlessness – includes objective measures of difficulty in breathing
• Orthopnoea – SoB on lying, usually associated with LVF
• Paroxysmal nocturnal dyspnoea – wakes patient from sleep – usually LVF (in asthma – wheeziness often causes waking in early morning)
• Exercise induced bronchoconstriction
• Assessment of severity – MRC breathlessness scale

Question 12

Dysphonia define

Answer 12

hoarseness caused by damage to larynx or the nerve to larynx

Question 13

wheeze define

Answer 13

– high pitch whistling noise – air passing through narrowed airways

Question 14

stridor define

Answer 14

– high pitched, harsh noise caused by obstruction of

large airway – always needs investigation (unless viral croup!)

Question 15

Physical Assessment

Answer 15

IPPE
Introduction
Permission
Position
Exposure

IPPA
Inspection
Palpation
Percussion
Auscultation

Question 16

Red flag signs for cough - Non acute

consider investigation and referral

Answer 16

• Haemoptysis
• Breathlessness
• Fever
• Chest pain
• Weight loss

Question 17

Red flag signs for cough - Signs of serious acute illness

urgent admission

Answer 17

• Respiratory rate of more than 30 breaths per minute.
• Tachycardia greater than 130 beats per minute.
• Systolic blood pressure less than 90 mmHg, or diastolic blood pressure less than 60 mmHg (unless this is normal for them).
• Oxygen saturation less than 92%, or central cyanosis (if the person has no history of chronic hypoxia).
• Peak expiratory flow rate less than 33% of predicted.
• Altered level of consciousness.
• Use of accessory muscles of respiration (particularly if the person is becoming exhausted).

Question 18

Red flag signs – suspected lung cancer, aged 40 yrs plus: Do urgent CXR (<2 weeks), if unexplained:

Answer 18

• Persistent or recurrent chest infection.
• Finger clubbing.
• Supraclavicular lymphadenopathy or persistent cervical
lymphadenopathy.
• Chest signs consistent with lung cancer.
• Thrombocytosis

URGENT REFERRAL (<2wks)
• CXR abnormal
• Aged 40 and over with unexplained haemoptysis

Question 19

Red flag signs – suspected lung cancer, aged 40 yrs plus: Consider urgent CXR (<2weeks), if 2 or more in non-smoker, or if 1 in ever smoker:

Answer 19

• Cough
• Fatigue
• Shortness of breath
• Chest pain
• Weight loss
• Appetite loss