Wk 1

Question 1

functions of the respiratory system

Answer 1

1. gas exchange
2. immunological
3. biological

Question 2

how does the immunological respiratory function protect the lungs from infection?

Answer 2

defense systems in both the airway and alveolus protect the lungs from infectionhy

Question 3

hypoventilation definition

Answer 3

the state in which less air enters the alveoli, resulting in reduced O2 & increased CO2 levels in the blood

Question 4

what can hypoventilation be due to?

Answer 4

breathing that is too shallow/ too slow, from a number of causes e.g. obesity, SC injury, NM diseases

Question 5

is a shunt intrapulmonary or intracardiac?

Answer 5

both

Question 6

what do both intrapulmonary / intracardiac forms of shunting reuslt in?

Answer 6

blood entering the left-sided circulation without an increase in O2 content

Question 7

intra-cardiac shunting defintion

Answer 7

blood passing from right to left side of heart (e.g. via ventricular septal defect) without going through lungs to be oxygenated

Question 8

what is a ‘dead space’

Answer 8

non gas-exchange areas

Question 9

what areas are classified as ‘dead space’

Answer 9

conducting airways (trachea, bronchi, respiratory bronchioles)

Question 10

V/Q mismatch when there is either:

Answer 10

1. blood flow (Q) with reduced ventilation (V) –> low V/Q
2. ventilation (V) with reduced blood flow (Q) –> high V/Q

Question 11

shunt example

Answer 11

obstructed airway –> perfusion without ventilation

Question 12

dead space example

Answer 12

obstructed blood vessel –> ventilation without perfusion (blood cant travel through but air can)

Question 13

driving force for the exchange of gases between alveolar and capillary blood?

Answer 13

difference in partial pressure between the individual gases

Question 14

2 main movements occurring in the respiratory system

Answer 14

1. pump (NM-skeletal structures)
2. lung (gas and secretion movement in the lungs)

Question 15

Pump definition

Answer 15

to move air in and out of the lungwh

Question 16

what does a ‘pump’ require?

Answer 16

neuro, musculo, and skeletal components to be intact e.g. SC, nerves, NMJ, muscles, bone, pleura

Question 17

2 key functions within the lung:

Answer 17

1. gas movement
2. secretion movement

Question 18

where does gas movement go

Answer 18

through the conducting airways to alveoli

Question 19

where is the gas movement occurring?

Answer 19

between the alveolus and capillary

Question 20

secretion movement occurs:

Answer 20

in the airways

Question 21

Link between gas & secretion movement

Answer 21

if gas doesnt get into alveoli, clearance by gas flow will be ineffective

Question 22

what happens if the airways are blocked / narrowed by secretions?

Answer 22

affects gas getting into alveoli (distribution of ventilation)

Question 23

what can gas movement be divided into?

Answer 23

O2 and CO2 movement

Question 24

what are the 2 components of secretion movement?

Answer 24

1. MCC
2. cough (back up clearance mechanism)

Question 25

CO2 movement depends on...

Answer 25

the total volume of gas that moves in and out of the alveoli (Va) and is linked to the efficiency of the 'pump'

Question 26

what is O2 movement largely dependent on?

Answer 26

1. alveolar surface area 2. integrity of the interstitium 3. pulmonary circulation

Question 27

define respiratory load

Answer 27

what the muscles have to work against to: 1. move the chest wall (chest wall compliance) 2. move air through the airways (airway resistance) 3. expand the alveoli (lung compliance)

Question 28

Is reduced O2 movement localised or generalised?

Answer 28

both

Question 29

is reduced MCC mucus issues or cilia issues?

Answer 29

both

Question 30

define symptom

Answer 30

new feeling, or a departure from normal feelings which is noticed by the patient

Question 31

are symptoms subjective or objective ?

Answer 31

subjective

Question 32

common symptoms of respiratory disease

Answer 32

1. dyspnoea (breathlessness) 2. wheeze/ chest tightness 3. cough (+/- sputum, haemoptysis) 4. pain 5. constitutional symptoms

Question 33

what measurement tools are used for dyspnoea

Answer 33

- self reporting scales e.g. VAS, BORG Dyspnoea scale - questionnaires

Question 34

what is the scale that validates cardiac disease?

Answer 34

New York Heart Association (NYHA)

Question 35

which scale describes how dyspnoea affects ADLs

Answer 35

the MRC Breathlessness Scale

Question 36

when does wheeze/ chest tightness occur?

Answer 36

when air moves through airways that are narrowed e.g. by mucus, spasm/ swelling

Question 37

questions to ask the patient to determine the pattern of symptoms and triggers

Answer 37

1. nocturnal? 2. exercise induced? / things in atmosphere 3. post viral infection?

Question 38

what does a cough that is chronic, persistent, or distressing indicate?

Answer 38

bronchial irritation by excess secretions, chronic infection/ inflammation or airflow restriction

Question 39

questions to determine cough characteristics

Answer 39

1. frequency & pattern (aggs ? AM/PM) 2. is it moist or dry 3. is it productive / non-productive of sputum, blood

Question 40

sign definition

Answer 40

something that can be demonstrated physically - objective - noticed by other people/ the therapist

Question 41

what is pectus excavatum?

Answer 41

funnel chest

Question 42

what is pectus carinatum?

Answer 42

pidgeon chest

Question 43

how many dimensions do you observe the chest wall movement?

Answer 43

3

Question 44

what are the dimensions of chest wall movement?

Answer 44

- AP - Basolaterally - inferior/ superior

Question 45

breathing pattern - observe muscle action

Answer 45

- diaphragmatic movement pattern - are there accessory muscles being used in quiet breathing?

Question 46

what do you observe with muscle recruitment with abnormalities of breathing pattern?

Answer 46

Muscle recruitment - excessive / early recruitment of accessory muscles - can be an appropriate strategy to deal with increased CVS demands of strenuous activity, or may be a sign of respiratory distress

Question 47

what is paradoxical breathing patterns?

Answer 47

- abdominal, lower ribs or intercostal in-drawing - sign of respiratory distress / chest wall abnormality

Question 48

observable abnormalities of breathing pattern

Answer 48

1. pursed lip breathing 2. nasal flaring 3. barrel chest 4. accessory muscle use 5. fatigue 6. SOB 7. lateral basal expansion 8. paradoxical breathing

Question 49

how does pursed lip breathing assist breathing?

Answer 49

- creates back pressure - splints airways - helps with gas exchange

Question 50

what is the NORMAL ADULT RR?

Answer 50

12-16 breaths/min with insp:exp ratio approx 1:1.5/ 1:2

Question 51

tachypnoea

Answer 51

too fast RR (>20 breaths/min)

Question 52

bradypnoea

Answer 52

too slow RR (<10 breaths/ min)

Question 53

apnoea / hypopnoea

Answer 53

period of absent respiration

Question 54

where are normal breath sounds loudest?

Answer 54

over the trachea

Question 55

where do normal breath sounds become softer and softer?

Answer 55

more peripherally

Question 56

what can wheeze be?

Answer 56

polyphonic or monophonic

Question 57

what must you define with wheeze?

Answer 57

in which phase of the respiratory cycle they occur (i.e. inspiratory / expiratory)

Question 58

what are crackles characterised as?

Answer 58

coarse / fine

Question 59

UPPER AIRWAY SOUNDS characteristics of stridor

Answer 59

harsh, loud, louder in inspiration

Question 60

what does stridor indicate?

Answer 60

acute upper airway narrowing (extra-thoracic)

Question 61

what is the cause of pleural/ pericardial rub sounds?

Answer 61

inflamed pleural/ pericardial tissues may transmit a sound through the airways

Question 62

haemoptysis define

Answer 62

presence of blood in the sputum from a bleeding source in the airway

Question 63

what can haemoptysis range from?

Answer 63

very mild (streaking) to life threatening

Question 64

when should you documented and reported?

Answer 64

always (haemoptysis of any volume)

Question 65

what can bilateral ankle oedema indicate?

Answer 65

- cor pulmonale, right sided heart failure - congestive heart failure

Question 66

what is digital clubbing associated with?

Answer 66

some conditions where there is chronic hypoxia, such as lung cancer, CF

Question 67

what are some validated QoL tools to use with patients with respiratory disease?

Answer 67

- St George's Respiratory Questionnaire - Chronic Respiratory Questionnaire - Short Form 36 - COPD Assessment Test - Cystic Fibrosis Quality of Life

Question 68

what can the results of the QoL tools be used to do?

Answer 68

- assess disease progression - set treatment goals - outcome measure

Question 69

red flags to Rx

Answer 69

- chest pain - calf pain - are they in respiratory distress? - do they have stridor? - paradoxical breathing? - have they had any haemoptysis ? - has there been any acute deterioration / change in their condition

Question 70

what is a 'relevant finding'?

Answer 70

some that you need to consider, which: - may influence hypothesis generation and / or treatment choice/ implementation - is often found in the patient's history - may or may not have a cause

Question 71

examples of a relevant finding

Answer 71

- main diagnosis of the patient - multimorbidities - older age - smoking history - medications - past intervention strategies (and their effect)

Question 72

example of how signs and symptoms = relevant findings

Answer 72

new shortness of breath (symptom) --> reduced Oxygen saturations ( signs) + fatigue and increased SOB walking to bathroom (symptoms) --> opaque changes on CXR in Right middle lobe (signs) = MEDICAL DIAGNOSIS OF PNEUMONIA (RF)