Cardio mid term revise

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Questions and Answers

What is the significance of assessing alveolar deadspace in respiratory conditions?

It measures the volume of anatomical deadspace.

It evaluates airway resistance.

It determines the presence of lung cancer.

It indicates the effectiveness of gas exchange. (correct)

Which of the following is NOT a typical assessment technique in a physical examination for respiratory issues?

Auscultation

Observation of breathing pattern

Palpation

Electrocardiogram (correct)

Which factor is considered a contraindication to performing spirometry?

Chronic respiratory issues

Recent haemorrhage (correct)

History of effective sputum production

Normal vital signs

What does a normal FEV1/FVC ratio indicate?

No significant airflow limitation (C) Signup and view all the answers

Why is observing the chest shape relevant during a respiratory examination?

It can signify underlying lung disease. (D) Signup and view all the answers

In the context of respiratory assessment, what does elastic resistance of the lung relate to?

The capacity to expand and contract effectively. (D) Signup and view all the answers

Which process describes the exchange of gases in the alveoli and blood?

Respiration (B) Signup and view all the answers

What is the purpose of assessing coughing effort during a respiratory examination?

To gauge the effectiveness of airway clearance. (D) Signup and view all the answers

Which respiratory condition is suggested by an acute disorder like vomit fever?

Increased airway resistance (A) Signup and view all the answers

What is the role of pulmonary surfactant?

Reduces surface tension (C) Signup and view all the answers

In a pulmonary system, what characterizes non-dependent regions during ventilation?

Higher compliance and better ventilation (D) Signup and view all the answers

What phenomenon helps to minimize V/Q mismatch during expiration?

Dynamic compression (A) Signup and view all the answers

What does hypoxic pulmonary vasoconstriction primarily seek to achieve?

Redirect blood flow to well-ventilated areas (B) Signup and view all the answers

Anatomical deadspace refers to which part of the respiratory system?

The bronchial tree (B) Signup and view all the answers

What does the transpulmonary pressure difference represent?

Alveolar pressure minus pleural pressure (C) Signup and view all the answers

Which statement best describes physiological deadspace?

The volume of gas in the lungs that does not participate in gas exchange (B) Signup and view all the answers

What is primarily affected in patients with COPD during expiration?

Loss of elastic recoil (D) Signup and view all the answers

In comparing asthma and COPD, which feature is specifically indicative of asthma?

Reversible airflow obstruction (D) Signup and view all the answers

What occurs during respiratory failure type 1?

Hypoxemia (C) Signup and view all the answers

Which of the following is a common clinical presentation of COPD?

Increased sputum production (D) Signup and view all the answers

Which factor primarily decreases lung compliance in restrictive diseases?

Reductions in lung structural integrity (C) Signup and view all the answers

Which measurement is indicative of air flow limitation in COPD?

Decreased FEV1 (D) Signup and view all the answers

What pharmacological treatment is commonly used for exacerbations of COPD?

SABA + SAMA/CABA-LAMA (D) Signup and view all the answers

When measuring lung function, which ratio indicates normal function?

FEV1/FVC > 80% (D) Signup and view all the answers

Which of the following components does not directly contribute to airflow limitation in COPD?

Decreased lung volumes (B) Signup and view all the answers

What is the primary issue with uniform ventilation in patients with COPD?

Inadequate CO2 elimination (A) Signup and view all the answers

What is the primary purpose of pursed lip breathing in COPD management?

To create positive pressure and improve gas exchange (A) Signup and view all the answers

Which type of lung cancer accounts for 85% of cases?

Non-small cell lung cancer (B) Signup and view all the answers

Which component is NOT part of the TNM staging system for lung cancer?

Patient age (A) (B) Signup and view all the answers

What is the recommended caloric uptake for someone with greater than 3-4% body surface area burn?

4000 kcal (D) Signup and view all the answers

What is the main focus during the exercise testing for individuals with COPD?

Assessment of dyspnea level (D) Signup and view all the answers

Which of the following is an abnormal sign that may be observed during exercise testing?

Signs of respiratory distress (D) Signup and view all the answers

What is the sequence of steps for managing psychosocial support in COPD patients?

Assessment, Education, Self-management (A) Signup and view all the answers

What is a key component of the role of physiotherapy in early burn management?

Airway clearance and sputum collection (A) Signup and view all the answers

Which technique is used for improving the effectiveness of breathing in individuals managing COPD?

Pursed lip breathing (B) Signup and view all the answers

What does mMRC stand for in the context of assessing dyspnea level?

Modified Medical Research Council (C) Signup and view all the answers

How does excessive oxygen therapy potentially affect nitrogen levels in the lungs?

It can replace all nitrogen in the lungs. (D) Signup and view all the answers

What is a possible consequence of oxygen-induced hypercapnia?

Increased plasma CO2 concentration. (C) Signup and view all the answers

Which clinical sign is associated with pneumonia?

Yellowish/green sputum. (D) Signup and view all the answers

What is one of the roles of pulmonary rehabilitation in patients with interstitial lung disease?

Providing sputum clearance techniques. (B) Signup and view all the answers

In patients with acute lung injury or ARDS, which of the following is commonly observed?

Rapid heart rate. (C) Signup and view all the answers

What is a clinical manifestation of pneumothorax?

Sharp pain in the chest. (C) Signup and view all the answers

Which condition may lead to secondary polycythemia due to increased blood viscosity?

Hypoxemia. (B) Signup and view all the answers

What is the primary focus of breathing exercises in pulmonary rehabilitation?

Improving lung expansion. (C) Signup and view all the answers

What does high flow oxygen therapy do to sputum consistency?

Thickens the secretions. (A) Signup and view all the answers

Which assessment is not typically used in diagnosing pneumonia?

Pulmonary function test. (C) Signup and view all the answers

What is a common education topic included for asthma patients?

Exercise-induced symptoms management. (B) Signup and view all the answers

What could be a complication of low respiratory rates in patients?

CO2 narcosis. (D) Signup and view all the answers

Which factor is NOT typically associated with impaired ciliary clearance?

Normal dietary habits. (A) Signup and view all the answers

What is the effective approach for managing acute symptoms in a patient with asthma?

Immediate use of short-acting bronchodilators. (D) Signup and view all the answers

Study Notes

Cardio Revise

Cardio Revise - title of learning material

Stage of Respiration

Stage 1: Ventilation - mechanical process of air movement in and out of the body
Stage 2: External Respiration - exchange of gases (O2 and CO2) between the alveoli and blood
Stage 3: Gas Transport - movement of gases in the blood
Stage 4: Internal Respiration - exchange of gases between the blood and body cells

Anatomical Aspects

Upper Respiratory Tract - nose, pharynx, larynx, and trachea
Lower Respiratory Tract - bronchi, bronchioles, and alveoli

Functional Aspects

Conducting Zone - from nose to bronchioles, responsible for gas conduction
Respiratory Zone - alveoli ducts to alveoli, site of gas exchange

Pressure Relationships

Atmospheric Pressure (Patm) - pressure of the air surrounding the body
Intrapulmonary Pressure (Ppul or Palv) - pressure within the lungs
Intrapleural Pressure (Pip or Ppl) - pressure in the pleural cavity, always slightly lower than intrapulmonary pressure
Transpulmonary Pressure - difference between intrapulmonary and intrapleural pressures; crucial for lung expansion

Additional Aspects

Pulmonary Surfactant - mixture of phospholipids and proteins, reducing surface tension in alveoli, essential for lung function
Airway Bypass - alternate airway to bypass blocked airways in the lung; vital for removing secretions
Ventilation-Perfusion Mismatch - situation where ventilation and blood flow in different sections of the lungs do not match, resulting in inadequate gas exchange
Non-dependent Ventilation - higher compliance, more blood flow to the base
Dependent Ventilation - higher compliance, less blood flow to the base

Added Sounds During Auscultation

Continuous Sounds (Wheezes) - high-pitched (narrowed airway) or low-pitched (rhonchi-thick secretions)
Discontinuous Sounds (Crackles) - fine (fibrosis/fluid-late inspiratory) or coarse(secretions)
Normal Lung Sounds

Normal Vital Signs and Arterial Blood Gas Values

Blood Pressure (SBP, DBP)
Heart Rate
Respiratory Rate
SpO2 (Oxygen Saturation)

Normal and abnormal Acid-base disturbances

Respiratory Acidosis/Alkalosis - related to the level of CO2
Metabolic Acidosis/Alkalosis - related to the level of bicarbonate (HCO3)

Respiratory Failure

Type 1 - hypoxemia (low oxygen) with normal or low carbon dioxide
Type 2 - hypercapnia (high CO2) with low oxygen

Oxygen Therapy

Limitation - by hemoglobin (anemia)
Secondary Polycythemia - increased blood viscosity leading to stroke
Hypoxic Vasoconstriction

Absorption Atelectasis

Cause - too much oxygen intake removes nitrogen, collapsing alveoli

Oxygen-Induced Hypercapnia

COPD patients at risk of worsening V/Q mismatch.
Management - maintaining SpO2 around 88-92%, with 24-28% O2

Breathing Devices

Incentive Spirometry - improves lung expansion
PEP/OPEP - prevents collapse, facilitates secretion clearance

Inspirational Muscle Training (IMT)

Resistance training to strengthen inhalation muscles
Advantages - improve inspiratory muscle strength and endurance for better breathing.

Pneumonia

Cause - inflammation or infection in airways (bronchitis) or lungs (alveoli)
Diagnosis - X-ray reveals consolidation or patchy airspace opacities, white blood cell count is elevated, and C-reactive protein is elevated

Asthma vs COPD

Bronchodilator response used to diagnose asthma from COPD
Reversible airway disease .

Interstitial Lung Disease (ILD)

Presentation- progressive shortness of breath and/ or cough, often worse with exertion.
Cause - inflammation of lung tissue resulting in scarring

Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)

Cause - rapid onset respiratory failure due to lung parenchyma or lung blood vessel injury (inflammation)
Classification - based on the level of oxygenation (PaO2/FiO2 ratio) and pulmonary artery wedge pressure

Treatment of ALI/ARDS

Stabilization of abnormal gas exchange, hemodynamics and hypoxia.
Mechanical ventilation may be required including lung-protective ventilation strategy.
Prone positioning and ECMO
Corticosteroids

Pneumothorax

Definition - presence of air/gas in the pleural space
Cause - trauma or spontaneous (secondary or primary), due to underlying conditions (COPD, asthma, TB)
Types - simple (without mediastinal shift), tension (with mediastinal shift), or open
Clinical presentation- sudden chest pain, shortness of breath, rapid breathing, decreased blood pressure, and/or altered mental status
Treatment - urgent treatment for tension pneumothorax, insertion of a chest tube to drain air

Pleural Effusion

Definition - a fluid accumulation in the pleural space
Causes - various underlying lung/heart/kidney diseases, infections, tumours
Presentation - dyspnea, chest pain, dry cough (often associated with other underlying conditions)

Pulmonary Rehab Program

Structure - 6-12 supervised weekly sessions (at least 12 sessions)
Focus - cardiovascular and respiratory fitness, activity progression, and education
Components - assessment (6MWT/Spirometry/CAT), exercises, education, self-management

Assessment of Dyspnea and COPD

MMRC grading used to assess the severity of dyspnea in COPD
BODE Index measures the severity of COPD based on several factors (BMI, dyspnea, exercise capacity, and presence of exacerbations).

Breathing Exercises

Diaphragmatic Breathing - to improve efficacy of oxygen (increases lung capacity) and tidal volume.
Pursed Lip Breathing - to create a positive pressure in the airway to facilitate breathing exhalation, relieves SOB.

Abnormal Signs in Exercise

Heart rate - insufficient increase or delay to decrease after exercise.
Blood Pressure (SBP and DBP) - elevated values that do not return to baseline after exercising

Burn Injuries

Types of burns- epidermal, dermal, and subdermal
Clinical presentation- variable depending on the degree and area of involvement
Initial management - involves immediate airway support, thermal protection, and pain control
Role of physiotherapy- assessment, management of airway clearance and sputum, and nebulization

Stages of Lung Cancer

Non-small cell lung cancer (NSCLC) - more common, tends to be adenocarcinoma or squamous cell carcinoma.
Small cell lung caner (SCLC) - less common, grows rapidly and spreads quickly
Staging is done using tumor size, lymph node involvement, and presence of metastasis.

Cancer Treatment & Rehabilitation

Prehabilitation before treatment
Rehabilitation involves aerobic and strengthening exercises, education and support, and setting for supervised exercises.

Post-Operative Care

High Fowler’s position - sitting upright and elevating the head to improve chest expansion postoperatively
Breathing exercises - to prevent or resolve atelectasis, improve gaseous exchange, and facilitate secretion clearance.

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