Respiratory System

Question 1

Types of breathing

Answer 1

Diaphragmatic: typical for men, diaphragm mainly involved

Costal/thoracic type: typical for women , intercostal muscles are more involved

Costal diaphragmatic:

Question 2

What diseases cause difficulties in intercostal-diaphragmatic breathing
What breathing do they do then

Answer 2

Diaphragm diseases, emphysema, pleuritis, ascites, flatulence, pregnancy, tumours in abdominal cavity

Breathing mainly thoracic/costal

Question 3

What happens when a patient has difficulty in thoracic breathing
When does the is occur

Answer 3

They are forced to breathe diaphragmatically

In inspiratiry muscle paralysis, broken ribs, emphysema, pneumofibrosis

Question 4

What is normal respiratory rate

Answer 4

Number of inspirations and exhalations in one min
12-20 breaths per min

Impaired breathing may include changes in frequency, depth,rhythm and minute ventilation

Question 5

What are some quantitative changes in breathing

Answer 5

Bradypnea- slow breathing RR<10 breaths /min

Tachypnea- rapid breathing RR>20breaths/min

Apnea-temporary cessation of breathing. Interruption of airflow in upper respiratory tract by more than 90% of normal

Hyperpnea- deep rapid breathing.respiratory volume increases

Hypopnea-reduced depth of breathing due to decreased sensitivity of respiratory center , weakness in respiratory muscles,loss of alveolar volume

Hyperventilation: increased ventilation of lung due to accelerated and deep breathing. Decreases co2

Hypoventilation: increase in partial pressure of co2

Question 6

When does bradypnea occur

Answer 6

Hypothyroidism
Increases intracranial pressure
Brain tumours
Menignitints
Intoxication w opioids
Uremia/diabetic coma

Question 7

When does tachypnea occur

Answer 7

Physical overload
Fever
Pneumonia
Resp and heart failure
Pulmonary embolism

Question 8

When does apnea occur

Answer 8

Sleep related breathing disorders
Alcohol
Brain damage
Poisoning w opiates
Asphyxia

Question 9

When does hyperpnea occur

Answer 9

Hypoxemia
Shock
Ketoacidosis
Renal failure
Sepsis

Question 10

When does hyponea occur

Answer 10

Obstructive sleep apnea- oro nasal airflow is decreases by 50%

Myasthenia gravis
Neuromuscular dystrophic desases
Multiple sclerosis
Respiratory distress syndrome
Alveolar edema

Question 11

When does hyperventilation occur

Answer 11

Panic attacks

Question 12

When does hypoventilstion occur

Answer 12

Obesity
Respiratory disorders during sleep

Question 13

What are some qualitative changes in breathing

Answer 13

Cheyne-stokes : alternating cycles of hyperpnea and hypopnea then apnea. During apnea pupils narrow, pulse slows, cyanosis, loss of consciousness

Kussmaul breathing : pathological deep breathing, noisy. Form of hyperventilation

Biots breathing : similar to cheyne stokes. Sudden start

Question 14

What is the difference between cheyne stokes and biots breathing

Answer 14

In biots, the apnea stage is longer lasting hot to 1 min
In cheyne stokes, apnea phase is 15-30 sec

Question 15

When can you have cheyne stokes breathing
When can you have biots breathing
When can you have kussmaul bretahing

Answer 15

1. Severe heart failure, ischemic stroke, cerebral hemorrhage, brain tumours, drug abuse, hyperglycemia
2. Brain tumours, brain hemorrhages, encephalitis, meningitis
3. Ketoacidosis, diabetes

Question 16

What is dyspnea
What can cause it

Answer 16

Shortness of breath

Obstruction in resp tracts
Ventilation perfusion mismatch
Impaired gas exchange through alveolar capillary membrane
Disturbed ventilation

Question 17

Types of dyspnea

Answer 17

Inspiratory: obstruction/ narrowing of upper respiratory tract ( larynx,trachea) due to tumours , infections
Prolonged inhalation 2:2
On chest, there will be depression in jugular and supraclavicular fossae (inspiratory tirage)

Expiratory: obstruction/ narrowing of lower airways like bronchial asthma,COPD, tumours in bronchi
Prolonged exhalation 1:3
Sitting position=arms support body

Restrictive: both phase of breathing disturbed ratio 1:1
Occurs in acute pulmonary diseases and chronic parchymal lung diseases, pleuritis, pneumothorax,chest wall diseasss
So decreased elasticity and fibrosis of lung

Question 18

What is cyanosis

Answer 18

Bluish discolouration of skin and visible mucus membranes

Due to non oxidised hemoglobin increases in capillary blood > 3.1 mmol/l

Question 19

What is central cyanosis
What is peripheral cyanosis

Answer 19

Central= decrease in oxygen saturation of arterial blood
Seen as bluish grey discolouration of skin, lips tongue,
Ear lobes, sublingual muscoa
In COPD, tuberculosis, severe pneumonia, pulmonary edema

Peripheral= increased oxygen consumption by tissues therefore decreases
O2 in blood (hypoxemia) and in tissues ( hypoxia)
Bluish violet skin, skin cold, expressed on fingers, tip of nose,
ear clams ,lips NOT expressed well tongue and sublingual
In shock, congestive heart failure, vessel clots

Question 20

Do lungs have pain receptors

Answer 20

No

Question 21

What is chest pain
Types

Answer 21

Occurs due to pathological changes in pleura, heart, oesophagus, mediastinum, sometimes abdominal organs

Parietal pain: originates from chest wall and parietal pleura then propagates along intercostal nerves. Pain is superficial and localised . Pain intensifies during coughing ir deep breathing
Diseases associated with pleura

Acromial pain is a type of parietal pain which caused by pleura, peritoneum, ant diaphragm. Translated by phrenic nerve so pain felt in scapula, shoulder, treaoszius muskxe

Visceral pain: diseases of heart, pericardium, large blood vessels, oesophagus, mediastinum
Deep pain usually behind sternum and radiates to shoulders neck etc