Respiratory anatomy and physiology

Question 1

accessory expiratory breathing muscles

Answer 1

internal intercostals, abdominal muscles, serratus muscles, lats

Question 2

accessory inspiratory muscles

Answer 2

external intercostals, scalene, traps, SCM, pec major, pec minor

Question 3

pleural effusion

Answer 3

fluid builds up in bottom of pleural cavity

Question 4

Obese and COPD patients

Answer 4

diaphragm flattens and requires accessory muscles

Question 5

at sea level in dry atmospheric air,
PO2 =
PN2 =

Answer 5

at sea level in dry atmospheric air,
PO2 = 160 mmHg
PN2 = 600 mmHg
add together = 760 mmHg = 1 atm

Question 6

functions of lungs

Answer 6

1) maintain homeostasis of O2 and CO2 in blood
2) filtering toxic substances
3) temperature regulation

Question 7

pulmonary fibrosis

Answer 7

affects the thickness of membrane

Question 8

O2 transport

Answer 8

• 1-2% = dissolved

- 99% = carries by hemoglobin

Question 9

CO2 transport

Answer 9

• 10% dissolved
• 30% hemoglobin
• 60% HCO3

Question 10

V(e)

Answer 10

minute ventilation
- amount of air breathed in and out in 1 minute
V(e) = V(t) x RR

Question 11

Dead space ventilation

Answer 11

V(d)

• space involved in inspiration that doesn’t participate in gas exchange(nose, trachea, ect.)
  
  • normal = 150mL/breath

Question 12

alveolar ventilation

Answer 12

V(a)
- air that makes it to alveoli for gas exchange
V(a) = (V(t) - V(d)) x RR

Question 13

residual volume

Answer 13

air remaining in lungs after full expiration

- COPD pt’s have a lot of dead space

Question 14

pulmonary embolism

Answer 14

no gas exchange because blood pathway is blocked

Question 15

when sitting down

Answer 15

• inferior lobes of lungs are compressed due to gravity
  
  • decreases ventilation
• superior lobes are more open

Question 16

when laying down

Answer 16

anterior portion of lungs are more open

Question 17

V(a)/Q > 1

Answer 17

ventilation more than perfusion(above rib 3)

- more air than blood

Question 18

V(a)/Q < 1

Answer 18

perfusion more than ventilation(below rib 3)

- more blood than air
- fluid accumulates at bottom
- if L lung damaged, position pt on right side to enhance ventilation for damaged lung

Question 19

distensibility

Answer 19

a change in volume for a given change in pressure

• increased distensibility = increased compliance
• pulmonary fibrosis and emphysema = decreased compliance
  
  • alveoli not as elastic

Question 20

surface tension

Answer 20

the force acting across the surface of the liquid
Surfactant:
- reduces surface tension
- type II cells
- released when alveoli are stretched and expanded

Question 21

regulation of respiration

Answer 21

1) pons(brain stem)
2) ANS
3) cortex level
4) chemoreceptors
- respiratory drive is from hypoxic drive
- if receive too much O2, trigger to breathe wont occur

Question 22

factors that affect accuracy of oximeter

Answer 22

skin color
- dark skin can affect reading
motion artifact
cold finger
- poor circulation = incorrect reading

Question 23

apex of each lung

Answer 23

rises about 2-4cm above clavicle

Question 24

lower border of the lung

Answer 24

• crosses 6th rib at mid-clavicle line
• crosses 8th rib at mid-axillary line
• posteriorly, about the level of T10

Question 25

oblique fissure location

Answer 25

runs from T3 obliquely down and around the chest to the 6th rib at the mid-clavicle line

Question 26

horizontal fissure

Answer 26

anteriorly, runs from the 4th rib and meets the oblique fissure in the mid-axillary line near the 5th rib

Question 27

bronchial sound

Answer 27

location = over trachea
quality = loud, high pitch tubular sound

Question 28

bronchovesicular sound

Answer 28

location = over main stem bronchi
quality = moderate, mixed rustling and tubular

Question 29

vesicular sound

Answer 29

location = over distal airways
quality = soft, low pitch rustling
- inspiratory sounds last longer than expiratory

Question 30

wheezing

Answer 30

caused by narrowed airways(continuous)

• heard during both, but louder during expiration
• pts with bronchospasm, secretions, foreign body, tumor

Question 31

crackles/rales

Answer 31

bubbling or popping sounds(discontinuous)

- from secretion/sputum - sudden opening of previously closed airways - heard during mid to late inspiration - not cleared by cough - CHF pts

Question 32

bronchial sound

Answer 32

abnormal if heard in areas where vesicular sounds should be present
- from fluid or secretions

Question 33

pleural friction rub

Answer 33

dry, rubbing or grating sound

• caused by inflammation of pleural surfaces
• heard during inspiration and expiration
• loudest over lateral anterior surface
• pleuritis, pleurisy

Question 34

decreased or diminished sound

Answer 34

hypoventilation, severe congestion, emphysema

Question 35

absent sound

Answer 35

pneumothorax or lung collapse

Question 36

palpating upper lobe motion

Answer 36

both hands around sternum, push skin medially and deep breath to observe

Question 37

palpation of right middle lobe and left lingular lobe motion

Answer 37

both hands(thumbs on xiphoid process

Question 38

palpation of lower lobe motion

Answer 38

on back, just below inferior angle of scapula

- thumbs on inferior angles of scapulae

Question 39

vocal or tactile fremitus

Answer 39

the vibration produced by the voice and transmitted to the chest wall, where it is detected by the hands as a tactile vibration

• normal = equal intensity
• increased = loss or decrease in ventilation(fluid)
• decreased = increased air within(too much air)

Question 40

egophany

Answer 40

sound of “ee” sounds like “a”

Question 41

bronchophony

Answer 41

vowel sound got transmitted to peripheral lung consolidation areas
“99”

Question 42

whispering pectoriloquy

Answer 42

whispering sound is heard clearly and distinctly over peripheral consolidated lung areas

Question 43

mediate percussion

Answer 43

assess tissue densities within thoracic cage

• resonant = over lung tissue
• hyperresonant = over emphysematous lungs or pneumothorax
• tympanic = over gas bubbles in abdomen
• dull = increased tissue density or lungs with decreased air
• flat = extreme dullness over very dense tissue(thigh muscles)