RESPIRATORY SYSTEM It’s part can be classified according to their structure~ ito ‘© Humidified , warms and filter inspired air. vy Air filled cavities with in hollow bones that surround the nasal passage. Provide resonance during speech. The sinuses are names by their location frontal, ethmoid, sphenoid and maxillary. Located behind the oral and nasal cavities © It is a tube like structure that connects the nasal and oral cavities to the larynx and oesophagus. © Itdivided into the nasopharynx, oropharynx and laryngopharynx. © Passage way for both the respiratory tract and digestive tract. Lymphoid structure ‘Two types :-- palatine tonsils and pharyngeal tonsils (adenoids ) Adenoids are located in the roof of the nasopharynx © Located above the trachea and just below the pharynx at the root of tongue Commonly called voice box Contain two pair of vocal cord — the false and true cord(Located in Lumen of the Larynx) It contain three cartilage :-- Thyroid (Largest) [Thyroid cartilage > Part of it form the adam’s apple] Cricoid cartilage and arytenoids cartilage Glottis :— Opening between the vocal cord in Larynx , the Glottis play an important role in coughing which is the most fundamental defense mechanism of the lungs. 6. Epiglottis ~ © A value flap of cartilage that covers the opening to the larynx during swallowing 1. Trachea :- (Windpipe) © Located in the front of the esophagus, © Branches into the right and left main stem bronchi 16-20 Incomplete, horizontal rings of hyaline cartilage (C Shape). 2. Bronchi and Bronchioles :- ‘* Trachea bifurcates into two main or primary bronchi called right and left bronchi * Right bronchus is slightly wider and shorter than the left bronchus © Right primary bronchi divided into 3 secondary bronchi and left primary bronchi divided into 2 secondary bronchi. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555931RESPIRATORY SYSTEM * Secondary Bronchi (lobar bronchi) divide into tertiary bronchi. In right lung, there are 10 tertiary bronchi and in left lung there are 8 tertiary bronchi. ‘* Tertiary bronchi (segmental bronchi) divide several time with reduction in length and diameter into generation of many bronchioles. When the diameter of bronchiole become Imm itis called terminal bronchiole. Terminal bronchiole continues or divided into respiratory bronchioles, which have a diameter of 0.5mm. 3. Lungs ‘© Located in the pleural cavity in the thorax © The right lung which is larger than the left. It divided into three lobes , the upper middle and lower lobe The left lung, which is narrower than the right lung. It is divided into two lobes, The each lung is encaged with a pleura, outer-parietal pleura, inner — visceral pleura The fluid present in between the parietal and visceral pleura, known as pleural fluid. 4, Respiratory Unit :- Respiratory unit starts from the respiratory bronchioles. Each respiratory bronchiole divide into alveolar ducts. Each alveolar duct enters as enlarged structure called the alveolar Sac. Alveolar sac consist of a cluster of alveoli 5. Alveoli :- Each lung contain about 300 million alveoli, It is defined as the structural and functional unit of lungs. it contain (Epithelial cell, which form its surface (i) Macrophage (Dust cell )> responsible for phogocytosis (iii) Metabolic active secretary cell — Secrete surfactant and phospholipid which reduce the surface tension of lung tissue and reduce the tendency to collapse of lung. 6. Respiratory Membrane :- It is the membranous structure through which the exchange of gases occurs. It is formed by alveolar membrane and capillary membrane. > Respiration © Inspiration + expiration Inspiration :- Air enter into the lungs from atmosphere Expiration :- Air leaves the lungs External Respiration:-- Exchange of Respiratory gases e.g. O» and CO, Between alveoli of lungs and blood is called external respiration © Internal respiration :- exchange of gases between blood and tissue is called internal (i) Temperture Regulation (ii) Regulation of acid base balance :- (iii)Defense Mechanism :- «Nose ~ Hair Mucus * Alveoli ~ Macrophages (iv) Anti-co-agulant Function :~ Mast cell secrete heparin (v) Secretin of Angiotensin Converting Enzyme (ACE) Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555932RESPIRATORY SYSTEM * Pulmonary Artery :- It Supplies Deoxygenated blood pumped from right ventricle to alveoli of lungs (Pulmonary Circulation ) After leaving the right Ventricle , this Artery divided into right and left branches. * Bronchial Artery: - Arises from descending thoracic aorta it supplies oxygenated blood to bronchi, lung, Pleura, Pulmonary Lymphnode. * Venous Drainage :- Respiratory structures is drained by two bronchial vein from each side. » Pulmonary Function Test (P.F. * Pulmonary Function Test or lung function tests are useful in assessing the functional status of the respiratory system both in physiological and pathological condition. . Pulmonary function tests are based on the measurement of volume of air breathed in and out in quiet breathing and forced breathing. * Most of the P.F.T. are carried out by using spirometer. The modified spirometer is known as respirometer. ‘The air in lung is classified into two division. (Giana ote (A) Tidal Volume (TV):- The volume of air breathed in and out of lung in a single quiet respiration is called tidal volume. Normal volume - 500ml (B) Inspiratory Reserve Volume (IRV) :- It is an additional volume of air than can be inspired forcefully after the end of normal inspiration . Normal value - 3300 ml (C) Expiratory Reserve Volume (ERV) :- it is the additional volume of air than can be expired out forcefully after normal expiration Normal value - 1000 ml (D) Residual Volume :- The amount of air remaining in the lungs even after forced expiration is called residual volume Normal value - 1200m1 (2. Lungs Capacity :5) Lung capacity are the combination of two or more lung volume (A) Inspiratory Capacity (IC) It is the maximum volume of air than can be inspired starting from end expiratory position IC - TVHRV - 500+3300 - 3800 ml (B) Functional Residual Capacity (F.R.C. This is the volume of air remaining in lungs after normal expiration FRI ERV+RV - 1000+ 1200 = 2200ml (C) Vital Capacity :- it is the maximum amount of air that can be expelled out forcefully after a maximum inspiration VC= TV+IRV+ERV=500+3300+1000= 4800 ml Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555933RESPIRATORY SYSTEM (D) Total Lung Capacity :- It is the amount of air present in the lungs after a maximum (deep) Inspiration it include all volumes TLC = TVHRV+ERV+RV=500+3300+ 1000+ 1200 - 6000m1 » VENTILATION ;- Ventilation is the rate at which air enters or leave the lungs, Ventilation in respiratory physiology is of two types (A) Pulmonary Ventilation :- (Respiratory Minute Volume ) It is a Cyclic process by which fresh air enters the lungs and equal volume of air is expired in a given unit of time (per minute) During Quiet breathing Pulmonary Ventilation :- Tidal Volume x Respiratory rate PV= 500 x 12 = 6000 mi/minutes (B) Alveolar Ventilation :- Amount of air utilized for gases exchange in every minute. There are certain part where gases exchange does not take place. These part are collectively called dead space. The air present in dead space is called dead space air. Normally it is about150 ml. it does not take part in gases exchange, . Alveolar Ventilation: - (Tidal Volume — Dead Space air Volume)x Respiration rate AV = (500 = 150) x 12 = 4200 mi/ Minute © Dead Space:- Trachea, Bronchi, Bronchioles up to the terminal bronchioles » TRANSPORT OF RESPIRATORY GASES 0. AND CO, (i) Transport of O2:- 1, As Simple Physical Solution :- (3% Only ) © Oxygen Dissolves in water of plasma and is transport in this physical form. 2. Tn Combination with Hemoglobin (Oxvhemoglobin ) (97%) ‘* 97% O2 Combines with hemoglobin only as a physical combination. It is only oxygenation, not oxidation 1 Molecule of Hb Carry 4 molecule of O2 1 gm of Hb Carries 1.34ml of O3 . 15 gm% of Hb carries only 19ml % of O;, This is known as oxygen carrying capacity of blood. Gi) Transport of COs :- a) As Dissolve Form (7%) b) As Bicarbonate (63%) ©) As Carb Amino Compounds (30%) CO) + Hb = CarbHemoglobin CO2 + Protein = Carb Amino Protein >» EXCHANGE OF RESPIRATORY GASES IN LUNGS ‘* Exchange of gases between blood and alveoli take place through respiratory membrane. ‘© Exchange Occurs through diffusion from high partial pressure to low partial pressure of gases Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555934RESPIRATORY SYSTEM (i) Exchange of _O» Environment Alveoli Pulmonary Artery PO2= 159 mmHg ——————> PO» = 104 mmHg —————+ PO = 40 mmHg Arterial Blood. ©» Tissue PO = 95 mmHg O2Content =19 ml % (ii) Exchange of CO, Arterial Blood -——————+ Tissue ——______+ Venous Blood, PCO; = 40 mmHg PCO>= 46 mmHg CO Content =48 ml% CO; Content =52 ml% Pulmonary Artery © + Alveoli. —————» _ Pulmonary Vein PCO) = 46 mmHg PCO, = 40 mmHg CO; Content =52 mI% CO; Content =48 ml% Environment PCO; = 0.3 mmHg >» MECHANICS OF RESPIRATION Respiration occur in two phases namely inspiration and expiration During inspiration thoracic cage enlarges and lungs expand so that air enters the lungs easily During expiration the thoracic cage and lungs decrease in size and attain the pre inspiratory position so that air leaves the lungs easily © During normal quiet breathing inspiration is the active process and expiration is the passive process > MI OF RESPIRATO THE PAST CANNOT BE CHANGED. Respiratory muscles are of two types- (1) Inspiratory muscles (a) Primary inspiratory muscles (Chief inspiratory muscle) © Diaphragm, which is supplied by phrenic nerve ‘© External intercostals muscles supplied by intercostal nerves (b) Accessory Inspiratory Muscles They helps primary respiratory muscles during forced inspiration Example:- Stemnocleidomastoid muscle ,scalene, anterior serrati, elevator of scapulae and pectorals. (2) Expiratory Muscles :- (A) Primary Expiratory Muscles :~ Eg. Internal intercostal muscle (B) Accessory Expiratory Muscle :- Eg. Abdominal muscles * Note :- Eleventh and twelveth pair of ribs are the floating ribs, These ribs are not involved in changing the size of thoracic cage or respiration. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb, 7426955591, 74269855935RESPIRATORY SYSTEM n of Respiratio There are two regulatory mechanism of respiration 1) Nervous or Neural Mechanism : It Includes — A. Respiratory Centers. B. Afferent Nerves C. Efferent Nerves A. Respiratory Centers :- © Respiratory center are group of neurons , which control the rate, Rhythm and force of respiration © Depending upon the situation the respiratory centers are classified into two groups. (a) Medullary Centers :- Situated at medulla oblongata. It consist of- (i) Inspiratory Center This center generate inspiratory ramp signal by of their autorythmic property It is responsible for basic (normal) Rhythm of respiration (ii) Expiratory Center :- Normally , Expiratory center are inactive during quiet breathing and become active during forced breathing, (b) Pontine Centers Situated in pons. It consist of (i) Apneustic Center :- © Teincreases depth of inspiration (i) Pheumotaxic Center :- © It Increase respiratory rate by reducing the duration of inspiration B. Afferent Nerves :~ (Afferent pathway ) Respiratory center receive afferent impulse via afferent nerves from- © Perpheral chemoreceptors and baro receptors © Stretch receptors of lungs C. Efferent Pathway :- Respiratory center send the efferent impulse via efferent nerves to- Diaphragm and external intercostals muscle. © Other Accessory Muscles. 2) Chemical Regulation of Respiration :- This Mechanism is operated through the chemoreceptor Types of chemoreceptor (Central chemoreceptor :- (Present in Brain) * Indirectly Increase CO, (hypercapnea) is responsible for the stimulation of central chemoreceptor (ii) Peripheral chemoreceptor :~ © They are present in carotid and aortic region ‘* Increase Hydrogen ion (H") Concentration( PH) and Hypoxia is responsible for the stimulation of peripheral chemoreceptor ‘Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426958591, 7426955593 6RESPIRATORY SYSTEM Mechanism of Regulation ;- Whenever Ventilation is decreased It cause hypoxia’, hypercapnea and 1" ion concentration. Stimulation of enorecepo (Central and Peripheral) Stimulation of respiratory center ‘Then ventilation’is increased (Inspiration and expiration is increased) Zs INSPIRED, AIR AND EXPIRED AIR AIR INSPIRED AIR EXPIRED AIR ‘Oxygen 21 16 ‘Carbon Dioxide 0.04 4 Nitrogen 78 78. Water Vapor ete 0.50 6.20 Total 100 100 > SURFACTANT i Agents that is responsible for lowering the surface tension of fluid ‘© Surfactant that lines the epithelium of Alveoli in Jungs is known as pulmonary surfactant. © They are responsible to decrease the collapsing tendency of lungs. Chemistry of Surfactant :- ‘Surfactant is a lipoprotein complex formed by lipid especially phospholipids, Protein and Ions. (Phospholipids :- eg. Dipalmitoyl Phosphatidy! choline (DPPC) Gi) Other Lipids >» Disturbances of Respiration Eupnea :- Normal Respiratory patter Tachypnea :- Increase in the rate of Respiration Bradypnea :- Decrease in the rate of Respiration Apnea :- Temporary arrest of breathing, Hypernea :- Increase in pulmonary ventilation due to increase in rate or force of Respiration Hyperventilation :- - Triglycerides and phosphatidylglycerol Abnormal Increase in rate and force of respiration Removal of excess carbon dioxide Reduction in par pressure of COs Suppression of Respiratory center Apnea Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555937RESPIRATORY SYSTEM ‘© Hypoventilation :- Decrease in rate and force of respiration. © Hypoxia:-reduced availability of oxygen to the tissue. ‘© Hypercapnea:-increased CO> content of blood. ‘© Hypocapnea:-decreased CO» content in blood. © Cyanosis:-diffused bluish coloration of skin and mucus membrane. © Dyspnea:-difficulty in breathing (AIR hunger), “IF YOU CANNOT DO GREAT THINGS, ‘Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426958501, 74269585938DISORDER OF RESPIRATORY SYSTEM 1, ACUTE TRACHEO — BR¢ iT Itis an acute inflammation of the mucous membranes of trachea and the bronchial tree. > Etiology: ‘* Infection of upper respiratory tract by bacteria or virus ‘© Inhalation of chemical irritant, gases or aspiration of vomitus > Risk Factor © Cigarette smoking, Air pollution, Occupational dust or gases > Clinical Features:- © Dry Irritating cough with purulent sputum ‘© Shortness of breathing ‘© Fever, chills, headache and fatigue > Diagnostic Measures:- History and Physical Examination ‘Sputum culture Chest X- Ray Arterial Blood gases study (ABGs) > Management:- ‘© Antibiotics therapy: - Such as ciprofloxacin, ofloxacin, amoxycillin depending upon the result of sputum culture. Anti histaminic or anti allergic: - ceterizine, Diphenhydramine Expectorants and mucolytic agents: - eg. Guaifenesin, acetylcysteine, Dextromethopran Administer Broncho-dilator: - eg. Salbutamol, theophylline Antipyretics: - such as paracetamol Antitussive(cough supperessant):- eg. Codeine Sulphate 2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Itis also regarded as chronic obstructive lung disease or chronic airflow limitation. COPD. may include disease that causes airflow obstruction such as-chronic bronchitis, emphysema, © Other disease such as bronchiectsis and Asthma that were previously classified as the types of COPD. But now classified as chronic pulmonary disease. Risk Factor for COPD: ‘© Cigarette smoking (most important causative factor) © Prolonged and intense exposure to occupational dust and chemicals, air pollution. ‘© Genetic abnormalities, including a deficiency of alpha,-anti trypsin, an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzymes. 3. CHRONIC BRONCHIT! It is the chronic inflammation of bronchi (Lower Respiratory Tract) Characterized by excessive mucus secretion, cough and Dyspnea, associates with infection of bronchi, that lasts three month in each of two continuous year. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 74269555939DISORDER OF RESPIRATORY SYSTEM » Clinical Features:- Chronic productive cough lasting at least three month ‘* Inspiration and expiration become noisy, wheezing sound may present. © Fever, chills, headache malaise, cyanosis, shortness of breathing * Spirometry shows airway obstruction. » Diagnostic Measures:- © History and Physical examination, sputum culture © Pulmonary function test, ABGs Analysis © Chest X-ray and pulse oxymetry > Management:- © Avoid cigarette smoking, occupational dust exposure or air pollution. Bronchodilator, Carticosteroids, Expectorant and mucolytic agents Antibiotics, anti histaminic drug > Therapy if needed Patient should be encouraged to take plenty of fluid. 4, EMPHYSEMA:- ‘© It described an abnormal distention of ait spaces beyond the terminal bronchioles. with destruction of the wall of alveoli ‘© The disease progress slowly for many years Itis the ir-reversible condition associated with dyspnea and reduction in air flow. Cigarette smoking is the major cause. > Clinical Feature: © Cough with sputum production © Exertional dyspnea ~ it progress slowly as emphysema progress, dyspnea occur at rest in later condition. '* Weight loss, use of accessory muscle during respiration > Diagnostic Measure: © History and physical examination — it show “barrel shaped chest” © ABGs Examination ‘* Blood examination shows polycythemia © Spirometry or pulmonary function test © Chest X-ray, CT scan, MRI > Management:- ‘Stop smoking to prevent the progression of disease Pharmacological therapy:- Bronchodilators: - to relieve dysphoea eg. Albuterol, salbutamol, aminophylline, theophylline Antibiotics: - to control/prevent infection Mucolytic and anti tussive agents Cortico steroid therapy: - to reduce inflammation Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559310DISORDER OF RESPIRATORY SYSTEM ‘© Ibis also regarded as “Reactive airways disease” or “Chronic Pulmonary Disease” * Iisa chronic inflammatory disease of airway characterized by periodic reversible broncho spasm * It is a chronic inflammatory disease of airways that cause airway hyperresponsiveness, mucosal oedema and mucus production and characterized by cough, chest tightness, wheezing sound and dyspnoea. Heredity, infection Extrinsic factors: - allergy is the strongest predisposing factor for asthma. Common allergens are- dust, pollen grain, grass, tree, animal dander, air pollution, cold , heat, weather changes , strong odors, perfumes or smoke, © The Disease may be precipitated by smoking, tobacco, exercise, stress, gastro esophageal reflux disorder, and viral or bacterial respiratory tract infection. ‘* Intrinsic factors: - there is no particular etiology in some cases, Asthma develops in same person allergies of unknown etiology, it may be precipitate by infection of upper and lower respiratory tract. > Pathophysiology: Asthma may be divided into two categories. Extrinsic (Allergic) Asthma Exposure to allergens (Cold, Smoke, Dust, Pollen) IgE Antibody Production by B- Lymphocyte Attach to mast cell and stimulate it for release of chemical mediator | +— Mast cell release 4 1 ' Histamine Bradykinin Leukotrine t They Cause airway Hyper responsiveness ¥ Mucus Inflammation Bronchospasm Secretion and plugging ’ They Cause Narrowing of Airway Asthma attack or asthmatic symptoms ‘Wheezing sound, Cough, Dyspnea, Chest Tightness, Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559311DISORDER OF RESPIRATORY SYSTEM Intrinsic (Non- Allergic) Asthma a- Adrenergic Receptor (In Bronchi) fr Adrenergic receptor (in Stimulation bronchi) Stimulation f Release of chemical mediator Inhibit release of chemical mediator Bronchospasm Bronchodilation > Clinical Manifestation:-During asthma attack, the client are continuous © Cough with or without mucus production Dyspnea, wheezing sound, chest tightness Cynosis, hypoxemia, tachypnea, tachycardia, restlessness Marked respiratory efforts such as nasal flaring, pursed lip breathing, use of accessory muscles. > Diagnostic Findings:- * History collection-A complete family history, © personal history, Environmental history * occupational history ‘© history of allergic substances such as dust, chemical, pollen ete Physical Examination- Wheezing sound may be present Blood Examination-Serum level of IgE and eosinophills count may be increased in allergic asthma, ABGs Analysis- Pulse Oximetry-Hypoxemia during acute attack Spirometry Examination (pulmonary function test)-The forced Expiratory volume and forced vital capacity are markedly decrease. > Medical management- Management of asthma is based on the severity of the disease, general treatment for an asthmatic patient includes- * Avoid all sources of inhalant factors or allergic factors-e.g. home dust, tobacoo, smoke, pollen and strong odour. Pharmacologic Therapy:- (@ Long-Acting control medicatior Long acting beta-2 adrenergic agonists Eg. Albuterol, salmeterol Xanthine Derivatives: - e.g. Aminophylline, theophylline Corticosteroids: - e.g. beclomethasone, budesonide, triamcinolone acetonide, prednisone Antihistaminic: - e.g. cetrizine, levocetrizine Teukotriene Inhibitors:- e.g. zafitlukast , montelukast Mast Cell stabilizers: - e. g. cromolyn sodium Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742698559312DISORDER OF RESPIRATORY SYSTEM Quick Relief Medications:- © Short acting beta-y adrenergic agents: - e.g. Levalbuterol salbutamol Anti Cholinergics: - e.g. ipratropium bromide. ‘Two general classes of asthma medication are, long acting medications to achieve and maintain control of persistent asthma and quick relief medications for immediate treatment of asthma symptoms and exacerbations. these medications have systemic side effects when used long term. The route of choice for administration of these medications is the MDI (metered dose inhaler) ‘© Peak flow monitoring: - peak flow meters measure the highest airflow during a forced expiration. Daily peak flow monitoring is recommended for all patient with moderate or SEVERE ASTHMA because it helps to measure the severity of asthma. The patient is instructed about proper techniques of the use of peak flow meter. * Tuberculosis is an highly infectious disease that primarily affect the lung parenchyma especially the upper lobes where the oxygen content is greatest (Pulmonary tuberculosis) ‘© It also may be transmitted to other part of body including meninges, kidneys , bones joints, uterus intestine and lymphnodes (Extra pulmonary Tuberculosis) ‘© The primary infection agent , mycobacterium tuberculosis which is- * Anacid fast aerobic rod shaped bacilli ‘* It grows slowly and is sensitive to heat and ultraviolet light. © Culture Media :- Lowenstein Jensen (L-J) Media © Staining :-Ziehl — Neelsen Stain (Z-N) > ‘Transmission: - Droplet infection by cough, laughs, sneezes, talking or singing. v Risk Factor:- * Alcoholism , Mal Nutrition , Advanced age © Intravenous drug users, Homeless + Individual from a lower socio economic group ‘© Individual living in crowed area such as prisons and mental health facilities. ‘+ Close contact with someone who has active TB. ‘© Immuno Compromised Status (e.g-HIV Infection, cancer and prolonged high dose corticosteroid therapy). ‘© Immigration from countries with a high prevalence of TB. > Patho-Physiology:- ‘* The Initial infection usually occurs 2 to 10 weeks after exposure. ‘* When susceptible person inhales mycobacterium bacilli and become infected. At initial stage an exudative type response causes a non-specific pneumonitis and later it cause development of granuloma / chronic Inflammation / tubercle in the lung tissue. ‘© Granulomas are then transformed to a fibrous tissue mass, the Central portion of which is called ghon tubercle Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559313DISORDER OF RESPIRATORY SYSTEM © The material (Bacteria and macrophages) becomes necrotic forming a chessy mass, then it liquefy (Liquefication Necrosis) and releasing it into the branchi, Then ulcerated tubercle heals and forms scar tissue. iinical Manifestation: ‘* The sign and symptoms of pulmonary TB are insidious most patient have- © Low grade fever © Cough, Hemaptysis Chest pain, weight loss, Anorexia, Fatigue © Night Sweats > Assessment and Diagnostic findings:- ‘© History and Physical Examination © Chest X-ray:- it reveals lesions in the upper lobe of lung, © Sputum cultures © Blood examination :- ESR are increased ‘© Tuberculin skin test (Mantoux test) :- A small amount (0.1ml) of purified protein derivative (PPP)containing 5 tuberculin units is administered intradermally in for arm, approximately 4 inches below the elbow with a half inch 26 or 27 gauze needle. > Interpretation of results * An area of induration measuring 10mm or more in diameter, 48 to 72 hours after injection indicates the individual have been exposed to TB. © For individual, with HIV infection or who are immuno compromised , a reaction of Smm or greater is considered positive. * A zeaction of less than Smm is considered negative. > Medical Management: © Pulmonary TB is treated with chemotherapeutic agents (anti tuberculosis agents/ anti Koch treatment) for 6 to 12 month. Several types of drugs resistance must be considered when planning effective therapy. ‘© Primary drug resistance ~ a resistance to one of the first line antituberculosis agents in a person who has not had previous treatment. © Secondary or acquired drug resistance — resistance to one or more anti tubercular agents in patient undergoing therapy. ‘* Multidrug resistance ~ resistance to two agents isoniazid and rifampin © Recommended treatment guidelines for newly diagnosed cases of pulmonary TH consist of multiple-medication regimen (First line treatment) of isoniazid, rifampin, pyrazinamide and either streptomycin or ethambutol. ‘* A person is considered non-infectious after 2 to 3 weeks of continuous medication therapy. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559314DISORDER OF RESPIRATORY SYSTEM ‘© This initial intensive treatment regimen is usually administered daily for 8 weeks (2month). After 8 weeks pyrazinamide and ethambutol can be discontinued and isoniazid and rifampin are administered for additional 4 month. + Isoniazide also may be used as a prophylactie (Preventie) measure for those at risk for significant disease include- ‘* House holds family members of patients with active disease. © HIV infected patient with a PPD test reaction of 5 mm. © Drug users with PPD test result of 10mm. 1 line Anti Tubercular medicati ‘Agents Side Effect Contra-indication , Precaution and intervention Tisoniazid (INH) | Peripheral Neurities | use with caution in client with active liver disease Bactericidal Hepatotoxicity Avoid Alcohol Monitor liver function test. Monitor for tingling, numbness. Administer 1 hour before or 2 hour after a meal because food may delay absorption. Pyridoxine is given as prophylaxis for neuritis. 2. Rifampicin Hepatotoxic. ‘Use with caution in client with chronic liver disease. (Bactericidal) | Red Orange color of | Avoid alchohol, moniter L.F.T. Urine, feces. and | Drug should o take with 1 hour before meal sweet 3. Pyrazinamide | Hyperuricemia Moniter LFT, Painful and swollen joint , uric acid level (Bactericidal) _ | Hepatotoxie Instruct the client to take medication with food to reduce Arthalgias Gl distress. 4Ethambutol | Optic-Neuritis (May | Contra indicated in client with optic neuritis and in (Bacteriostatic) | Causes Blindness) — | children less than 13 year of age. Use with caution in clients with renal dysfunction, cataracts and diabetic retinopathy. Administer once every 24 hours with food to decrease GI upset Moniter for visual change if changes occur, discontinue medication and notify the physician, 5. Streptomucin. |8" cranial Nerve | Monitor hearing acuity (Bactericidal) —_| damage Monitor renal function Monitor intake and output II. Second Line Medication:- ‘These includes- “A MISTAKE IS NOT A MISTAKE IF © Capreomycin © Kenamycin © Ethionamide ‘© Aminosaliclate Sodium (Sodium para Aminosalicylic Acid) Cycloserine Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559315DISORDER OF RESPIRATORY SYSTEM Itis the collection of fluid in the pleural space more than normally (5-15 ml) > Etiology:- © Respiratory tract infection, tuberculosis. * Pneumonia © Chest trauma © Congestive heart failure * Pulmonary embolism. * Bronchogenic Carcinoma. > Clinical Manifestation: © The clinical feature depends upon the underlying disease same common feature are~ © Chest pain during inspiration © Dyspnea on Exertion © Drynon Productive Cough © Shortness of Breathing © Tachy Cardia, Increase Body Temperature. > Assessment and Diagnostic Finding:- ‘* History and Physical Examination; >A dull, flat sound during percussion — © Chest X-ray © Chest CT Scan * Blood Examination > Management: ‘© Specific treatment is directed at the underlying cause (eg. Heart failure, pneumonia, cancer) » Other treatment include: ‘* Antibiotics (if infection is the cause) * Analgesics (to reduce pleuritic pain) > Thoracentesis - © It refer’s to the puncture by needle through the chest wall into the pleural space, for the purpose of removing pleural fluid , blood, air and Pus. > Site of Thoracentesi © Just below the inferior angle of scapula at the 7” intercostals space. * Position: - Sitting up-right position with arm and shoulder are raised. 8. PLEURISY (PLEURITIS):- It refers to inflammation of both layers of the pleura. In this, both membrane rub together during respiration & cause pain. > Etiology:- ‘© Pneumonia, upper respiratory tract infection, TB. © Chest trauma, pulmonary embolism, cancer Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559316DISORDER OF RESPIRATORY SYSTEM > Clinical Features:- ‘© Severe sharp knife like pain , it increase during deep breathing coughing © Fever, Chills, Dyspnoea, >» Management:- ‘© Depend upon the underlying cause. © Analgesics © Antibiotics ‘* Hot or Cold application as prescribed. Tris an Accumulation of thick, purulent fluid(pus) within the pleural space, > Etiology: ‘* Bacterial pneumonia or lung abscess © Penetrating chest trauma © After thoracentesis > Clinical features:- © Fever , Chills, Night sweat © Pleural pain, Cough, Dyspnea. © Anorexia, Weight loss > Assessment and Diagnostic Finding: © Chest X-ray, Chest CT Sean '* Thoracentesis to aspirate fluid for culture and sensit > Management:- © Antibiotics © Analgesics © Amtipyreties * Hemothorax: - Accumulatiopn of blood with in pleural space. ‘+ Pneumothorax: - Accumulation of air with in pleural space. Itis a choric irreversible dilation and distortion of bronchi and bronchioles. > Risk Factor: ‘© Respiratory infection which cause airway obstruction © Immunodeficiency Disorder. © Recurrent Pneumonia and tuberculosis. © Diffuse airway injury. © Idiopathic Causes. © Smoking © Bronchiectasis is usually localized, affecting a segment or lobe of lung. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559317DISORDER OF RESPIRATORY SYSTEM > Clinical Manifestations:- © Chronic Cough with purulent sputum. © Hemaptysis may be present * Abnormal breath sound and dyspnea > Diagnostic finding:- ‘© History and Physical Examination, © Chest X-Ray © CT-Scan > Management:- ‘© Smoking cessation © Antibiotic therapy to treat infections, © Bronchodilators. > Surgical intervention:- ‘© Segmental resection © Lobectomy ‘* Atelectasis refers to collapse of alveoli or lungs. It develops when there is any interface with the natural forces that promote lung expansion. It commonly occurs in the post operative setting or in people who are immobilized and have a shallow breathing pattern, » Etiology and Risk Factors:- Reducation in lung distention forces (Alveolar ventilation) such as ~ ‘© Decrease pleural space ~ e.g. pneumo thorax, pleural effusion, hemothorax. © Impaired Diaphragmatic movement such as in ascites , obesity. * Central Nervous system dysfunction ~ e.g. coma, over sedation Localized airway obstruction:~ Mucus plugging Chronic airway obstructive disorder - e.g. Bronchiectes Decrease pulmonary surfactant Prolonged immobile position > Clinical 5 fanifestation:- * Cough, sputum production, low grade fever ‘+ Dyspnea , tachypnea , tachycardia , cyanosis > Diagnostic Findings: © Physical examination-Diminished breath sound © Chest X-ray pulse oxemetry, ABGs analysis > Prevention: © Frequently change the position of patient. ‘© The patient is instructed to deep breathing exercise. ‘© Early detection and management of airway obstructive disorder Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559318DISORDER OF RESPIRATORY SYSTEM > Management:- ‘The management of atelectasis is mainly depending upon cause. It includes * To improve ventilation and remove secretion by s ‘© Oxygen therapy if needed ‘* If bronchial obstruction is the cause, it may be removed by suction or by the help of bronchoscopy. © If pleural effusion, pneumothorax, hemothorax is cause then thoracentesis is performed. ‘© Bronchodilator may be prescribed to improve dyspnea or airway obstruction. iction 12, PNEUMONIA: Pneumonia (pneumonitis) is an inflammation of lungs parenchyma that is mainly caused by a microbial agent. Classification of pneumonia:~ 1. Community acquaired pneumonia(CAP):~ It occurs either in the community setting or within first 48 hours of hospitalization. the most frequent causative agents are [Link], [Link], psuedomanas. 2 a pera . " as ‘It is defined as the onset of pneumonia symptoms more than 48 hours after administration of hospital. The most frequent organism responsible are Escherichia coli, Klebsiella, and staphylococcus aureus. Immuno compromised host pneumonia : The responsible organism are pneumocystic carinii, hemophillus influenza. 4. Aspiration pneumonia:. Tt refers to the pulmonary consequences resulting from the entry of endogenous or exogenous substance into the lower AIRWAYS. » Risk Factors: cigarette smoking, prolonged immobility and shallow breathing pattern. Alcohol intoxication, sedative, anesthesia (due to depressed level of consiousness) Endotracheal, nasogastric intubation Immuno compromised patient. © Clinical manifestation=> Fever with chills, pleuritic chest pain, coughing Tachypnea, shortness of breathing, use of accessory musde. (© Assessment and diagnostic findings=> History and physical examination. Sputum examination, X-ray. Blood examination- TLC increases. Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559319DISORDER OF RESPIRATORY SYSTEM > 1 2. 4. 4. 5 Management:- Antibiotic therapy Antipyretic and analgesic Cough suppressant, mucotytics and expectorant. . 02 therapy, if needed Corticosteroid therapy may be used, “THE MOST BEAUTIFUL THING IN THIS WORD IS TO SEE YOUR PARENTS SMILING & KNOWING THAT Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 20IMPORTANT NOTES Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 21IMPORTANT NOTES Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 22IMPORTANT NOTES Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 23MCQs Qi Q2 Q3 Q4 Qs Q6 Q7 Qs Qo Quo Qu qr Bleeding from the nose is Known a5 (a) Epi (b) Haemoptysis (©) Hematemesis (4) Haematuria [DSSSB Staff Nurse 2013] Blood into sputum of patient called : (a) Haemoptysis, (b) Epistaxis (©) Hemetemesis (a) Metena What condition is responsible for inspiration ? (a) Contraction of intercostals muscles (b) Dilatation of intercostals muscles (©) Contraction of diaphragm (@) Both (a) and (©) Shalawar (Raj) H.& m, College Staff Nurse 2010, RIMS & R SAIFAT UP. 2013 ‘The organ which is located in the pleural cavity of the thorax is (@) Liver (©) Lungs (b) Heart (@ Kidneys [IGNOU Post [Link]. Nursing 2012] Bleeding from nose is termed as-[ (a) Hyperemesis, (b) Haemoptysis (©) Hematemesis (a) Epistaxis DSSSB PHN 2015] ‘The nurse would expect which pulmonary function test result in a patient with pulmonary aspiration ? (a) Increased lung volume (b) Increased compliance (©) Decreased compliance (@) Increased functional residual capacity [RAK MSC. Nursing 2013] Removal of an entire lung is called as (a) Lobectomy (b) Pheumonectomy (©) Segmental resection (@) Wedge resection [DSSSB Staff Nurse 2013] Right lung has how many lobes ? (2 (b) 3 @4 @5 [Ruhs Post Basie Nursing Entrance 2013] Rings found of trachea are in number (@) 8-10 (b) 5-7 (©) 16-20 (4) 10-13 [BSF Staff Nurse 2014 (SI) ‘Adam’s apple is related to : BSF Staff Nurse 2014 (SD) (a) Pharynx (byLarynx, (©) Trachea (@ Esophagus The trachea or wind pipe is made up of cartilage rings; shape of the rings is (a)C shaped (b) S shaped (©) Cone shaped (a) Straight RUHS [Link]. NSG Entrance 2015 In human body, right lung has (a) One lobe (b) Two lobes (©) Three lobes (@) Four lobes Qus Qua Qs Q16 Quy Qus Quy Q.20 Qu Q22 Q.23 ‘Abnormal dilation of bronchi is referred as = (a) Emphysema (b) Bronchiectasis (©) Pneumonia (d) Bronchitis IGNOU Post [Link]. Nursing 2014 Which gases also work as a respiratory stimulant (a) O» (b) Cor (N20 @co ESIC Staff Nurse Dehli 2009 During intetnal respiration gases exchange occur between: (@) Between lungs and environment (b) Between blood vessels and tissues (©) Between heart and lungs (G) All above ESI Staff Nurse Jaipur 2009 Effect on shape of heart during expiration: (a) Decrease (b) Increases (©) Unchanged (d) None of above ESI Staff Nurse Jaipur 2009 Right lung has how many lobes @I 2 ©3 wa RRB Staff Nurse 2015 Yellow How many lobes are present in Right lung ? (@)7 (2 ©3 @9 SCTIMST Thiruvananthapuram, Staff Nurse 2010 ‘The exchange of gases inside the lungs actually occurs inside tiny sacs called (a) Bronchi (b) Cilia (©) Capillaries (d) Alveoli RRB Staff Nurse 2015 Yellow The ‘membrane surrounds the lungs (a) Pericardial (b) Mediastinal (©) Pleural (@) Peritoneal RRB Staff Nurse 2015 Green & RRB Staff ‘Nurse 2015 Red (Set I) Atmospheric pressure is. important in the process of. —_ (a) Blood flow (©) Reproduction (4) Breathing RRB Staff Nurse 2015 Green & RRB Staff ‘Nurse 2015 Red (Set I) The destruction of alveolar walls is called: (a) Empyema (b) Bronchitis (©) Emphysema (@) Lung abscess RRB Staff Nurse 2015 Green The collapse of the alveoli is prevented by: (@) Cilia (b) Mucus (©) Surfactant (d) Pleural fluid DSSSB PHN 2015 Gurjar Ki Thadi, Opp. Metro Pillar No, 67, New Sanganer Road, Jaipur Mb. 742695591, 742695559324MCQs Qa Q25 Q.26 Q27 Q.28 Q29 Q.30 Q31 Q.32 Q33 During, swallowing food centering the larynx. by the (a) Esophagus (b) Pharynx (©) Eustachian Tube (4) Epiglottis RUHS Post [Link]. NSG Entrance 2015 ‘The surfactant is. responsible for (a) Bronchiectasis, (b) Prevention of pulmonary embolism (©) Prevention f collapse of alveoli (@) Prevention of emphysema IGNOU Post [Link]. Nursing 2015 ‘The lung function tests are determined by: (a) Tonometer (b) Spirometer (©) Sphygmomanometer (@) Barometer is. stopped from RUHS Nurse Grade Il 2013 Volume remaining in the lungs & airways following a maximum expiratory effort is, known as : (a) Vital capacity (b) Residual volume (©) Tidal capacity (@) Total lung capacity GMCH Mewat Haryana 2014 While at rest, how much air is pulled in during inhaling process? (a) 1000 cc (©) 500ce (b) 1500ce (@800ce BSF Staff Nurse 2014 (ST) ‘Normal tidal volume is (a) 100ml (©) 400m (b) 600ml (a) 500ml RPSC Raj. Nursing tutor 2012 Amount of air inspired a normal a normal adult healthy person during rest a single breathing (a) 200ml (b) 300ml (©) 400m! (a) 500m RPSC Raj. Staff Nurse 2007 ‘The average tidal volume is : (a) 500m! (b) 250ml (©) 150ml (2) 600m DSSSB PHN 2015 ‘The rationale for asking a patient to breathe in and hold breath for 3 seconds during incentive (a) Help re- expansion of alveoli (b) Reduce pain at incision site (©) Mobilize secretions (@) Produce hypercarbia GMCH Chandigarh Staff Nurse 2015 In majority of the cases the causative organism for sore throat is : (a) Gonococei (b) Staphylococci (©) Meningococei (@) Streptococci BHU Staff Nurse 2015 Qs Q.35 Q36 Q37 Q38 Q40 Qa ‘The common cause for bacterial sore throat is = (a) Streptococcus pyogenes (b) Mycoplasma pneumonia (©) Corynbacterium (d) Mycobacterium DSSSB PHN 2015 Which of the following nursing measures would be most appropriate in the care of the patient who has acute epistaxis ? (a) Tilt the patient’s head back (b) Place the patient's head between his legs (©) Pinch the nose and have the patient lean forward (d) Place warm compresses on the patient's nasal bridge Rubs Post Basic Nursing Entrance 2013 & JIPMER Staff Nurse 2013, Which of the following drug is not available as metered dose inhaler (MDI)? (@) Salbutamol (b) Aminophylline (©) Albuterol (a) Terbutaline LNJP Staff Nurse Delhi 2013 A pulmonary infection is located. inside the (@) Brain (b) Heart (©) Lungs (A) Nails ‘Nursing Orderly ESI 2012 The exercise that would be most beneficial for a client with COPD is (a) Controlled coughing (b) Whistling while exhaling (©) Deep breathing (d) Use of spirometer IGNOU Post [Link]. Nursing 2013 Treatment for a patient with severe flail chest and respiratory compromise may include (a) Chest tube placement at the mid-clavicular Tine (b) Chest tube placement at the anterior, third intercostals space (©) Positive pressure ventilation (d) Sedation and restrictive chest expansion band RAK MSc. Nursing 2013 A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing priority for this client ‘would be to (a) Assess the client's airway (b) Provide pain relief (©) Encourage deep breathing and coughing (4) Splint the chest wall with a pillow Ruhs Post Basic Nursing Entrance 2013 Which symptom would a patient most likely complain of after an asthma attack? (a) Dry cough (b) Sore chest (©) Restlessness (d) Profuse perspiration RUHS MSc. Nursing Entrance 2013 Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955891, 742695559325MCQs Qaz Q.43 Qa Q.45 Q.46 Qa7 Qs Qao Q.50 What measurement can best be used to monitor the respiratory status of a patient with pulmonary oedema ? (a) Arterial blood gas analysis (b) Pulse oximetry (c) Skin colour assessment (@) Lung sounds RAK [Link]. Nursing Entrance 2013 & RUHS [Link]. Nursing Entrance 2014 Which of the following monoclonal antibody is approved for the treatment of asthma ? (@) Bevacizumab (b) Omalizumab (©) Cetuximab (@) Trastuzumab RUHS Nurse Grade 112013 Pleural effusion is also known as (a) Pheumothorax _(b) Hemothrax (©) Hydrothorax (@) Spontaneous pneumothorax IGNOU Post [Link]. Nursing 2011 Expanded from of SARS is, (a) Severe acquired respiratory syndrome (b) Severe acute respiratory syndrome (©) Severe acute reproductive syndrome (@) Severe acquired reproductive syndrome BSF Staff Nurse 2014 (SI) Organ affected into SARS (a) Lungs (b) Heart (©) Liver (@ Brain ESIC Staff Nurse Bhiwari 2010 What is an important symptom of pneumothorax? (a) Increase in breath sound on effected side (b) Absence of breath sound on affected side (€) Absence of breath sound on both (@) Absence of breath sound on unaffected side BSF Staff Nurse 2014(S1) The most common accurate way to determine the need for oxygen in a patient with COPD is by (a) Observing the skin colour (b) Noting changes in the vital signs () Asking how the patient feels (@Blood gas analysis, RPSC Raj. Nursing tutor 2009 A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests ? (@) Atterial blood gas (ABG) analysis () Chest X-ray (€) Blood cultures (@ Sputum culture and sensitivity ESIC Staff Nurse Kolkata & Bangalora 2012 Which of the following indicators would show if the condition of the — client with adult respiratory distress syndrome (ARDS) is improving ? (a) Arterial blood gas (ABG) values (b) Bronchoscopy results QSL Q.52 Q54 Qss Q56 Qs7 Q58 (© Increased blood pressure (@) Sputum culture and sensitivity results ESIC Staff Nurse Kolkata & Bangalore 2012 Which of the following term is used to describe a Thrombus lodged in the lunge ? (a) Hemothorax (b) Pneumothorax. (©) Pulmonary Embolism () Pulmonary hypertension ESIC Staff Nurse Kolkata & Bangalore 2012 During assessment the nurse notes symptoms positively correlated with ARDS that include : (a) Contraction of the , accessory muscled of respiration (b) Dysthythmias and hypotension (©) Tachypnea and tachycardia (@) All of the above ‘When a patient is receiving aminophylline, the nurse should observe for (@) Visual disturbance (b) Decreased output (©) Decreased pulse rate (d) Hypotension ESIC Staff Nurse Kolkata & Bangalore 2012 Which of the following. symptoms is common is Asthma ? (a) Barking Cough —_(b) Bradycardia (©) Dry productive cough (6) Wheezing BSF Staff Nurse 2014 (SI) Asthma is best characterized as (@) An inflammatory (b) A steady progressive disease (©) An obstructive disease with loss of alveolar walls (@) A chronic obstructive disorder characterized ‘mucus production RML Debli Staff Nurse 2011 COPD stands for (a) Chronic obstructive pulmonary disease (b) Continuous obstructive pulmonary disease (©) Chronic operative pulmonary disease (4) Chronic oesophageal pulmonary disease ‘Ihalawar (Raj.) H.& M. College Staff Nurse 2010 Why patient of pneumonia advise for complete bed test (a) To reduce O; demand (b) To reduce metabolism (©) To improve O: consumption (@) To increase CO, ESIC Staff Nurse Bhiwari 2010 Treatment of choice in tension pneumothorax: (a) Water seal drainage _(b) Needle drainage (©) Suctioning (4) Postural drainage ESI Staff Nurse Jaipur 2009 Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 26MCQs O59 Q.60 Qor Q.62 Q.63 Q64 Q.65 Tn order to facilitate breathing, while repositioning a patient with emphysema, which among the following position facilitates maximum it exchange ? (a) Supine (b) Orthopneic (©) Low- fowler (@) Semi-fowler ATIMA Patna Staff Nurse 2015 Which of the following pathophysiological changes are seen in patient with pleurisy (a) Inflammation of pleura stimulate nerve ‘endings causing pain (b) Decrease of absence of inflammation (©) Increase of absence of inflammation (@) Increase pulmonary arterial pressure RUHS MSc. NSG Entrance 2015 What will nurse do if she receives a patient with status asthamaticus manifest with tachypnea, labored respiration with effort on exhalation, tachycardia, elevated blood pressure and is irritable : (a) Administer treatment as preseribed (b) Monitor iv therapy and give signs (c) Start oxygen check vital signs (@) Provide comfortable position and check vital signs RUHS [Link]. NSG Entrance 2015 Dietician will prescribe one of the following diet for the patient with emphysema (a) Low protein low calorie (b) High protein high calorie (©) High calorie normal diet (@) High calorie soft diet RUHS [Link]. NSG Entrance 2015 Before endotracheal intubation some facts about trachea a nurse has to understand and all the following are true regarding trachea EXCEPT: (a It's about 13 em long (b) It bifurcates. into two major bronchi (c) It starts at the level of 7” cervical vertebra (@) It ends at the level of sterna angle of Louis JIPMER Staff Nurse 2013 How a nurse will teach Breathing exercise for a Patient with chronic bronchitis ? (a) Use chest breathing (b) Use diaphragmatic breathing (©) Use open mouth breathing (@) Use deep inhalation breathing JIPMER Staff Nurse 2013 Diagnosis of COPD can be firmly made by (a) Spirometry (b) X = ray chest (©) Auscultation (@) Blood tese IGNOU Post [Link]. Nursing 2015 Q.66 Q67 Q.68 Q.69 Q70 an Qn Q73 Q76 Q77 Exchange of gases between the blood and lungs is called as (a) Oxygenation (b) External respiration (©) Internal respiration (d) Excretion Exchange of gases between the blood and the cells is known as (a) Oxygenation (b) External respiration (©) Internal respiration (4) Excretion In. following which is not an organ of respiratory system (@) Larynx (b) Pharynx (©) Oesophagus (@) Bronchi ‘The bones which form the roof of nasal cavity are except (a) Sphenoid bone (b) Frontal (©) Ethmoid (d) Maxiilla In following which bone is found in the floor of nasal cavity (@) Maxilla (b) Sphenoid (©) Palatine (@) Both aand ¢ ‘What do you mean by sinuses (a) Space between two bones (b) Cavities in the bones (©) Space between two tissue layers (d) Space between two lungs What is the function of conchae in the nasal cavity (a) They secrete mucus (b) They increase the surface area (©) They decrease the surface area (4) They have no function In following which is a function of nose in human being (a) Filtering the inspired air (b) Humadification of inspired air (6) Sense of smell (all Length of pharynx in an adult is about (@)6-8em (b) 12-14 om (©) 20-25 em (@) [Link] Opening of the auditory tube found in- (a) Nasopharynx (b) Oropharynx (c) Laryngophaynx (@) Oesophagus Which structure is known as voice box (a) Pharynx (b) Larynx (©) Oesophagus (4) Intercostal muscles ‘Adam's apple is more prominent in (a) Adult male (b) Adult female (©) Male child (d) Female child Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695589327MCQs Q78 Q79 Q.80 Qst sz Q.83 Q.s4 Q.85 Q.86 Q.87 Q.88 Q.89 Q.90 Qo Q92 “The most prominant cartilage foundin larynx is known as (a) Thyroid (b) Cricoid (©) Arytenoid (a) Epiglottis ‘The hyaline cartilages of larynx are except (a) Thyroid (b) Cricoid (©) Arytenoid (@) Epiglottis By which cartilage of larynx, Adam's apple is formed (a) Thyroid (b) Cricoid (©) Arytenoid (@) Epiglottis ‘Number of arytenoid cartilages in the larynx are (2 (b)3 4 @s In following which cartilage acts as a lid (@) Cricoid (b) Thyroid (©) Arytenoid (a) Epiglottis What will happen during relaxation of muscles controlling vocal cords in larynx except (a) Vocal cords open (b) Pitch of sound is low (©) Vocal cords are abducted (a) Vocal,cords are stretched out ‘The space between the vocal cords isknown as (a) Epiglottis (b) Glottis (©) Adam’s apple (@) Vermis| The organ which plays an important role in production of sound is known as (a) Mouth (b) Larynx (©) Pharynx (4) Teeth If the vocal cords begin to grow longer then pitch of voice will be (@) Low (©) It may be low or high (@) No woice will be produced Volume of the voice produced by a man depends upon (a) Length of the cords (b) Tightness of the cords (©) Force with which the cords vibrate (@) Shape of the mouth In following which organ prevents the food from passing into the lower respiratory tract (b) High (a) Pharynx (b) Oesophagus (©) Epiglottis (a) Larynx In following which organ is known as a windpipe (a) Larynx (b) Trachea (©) Lung (d) Bronchi Length of trachea is about (a) 10-12. em (b) 25-30 em (©) 40-45 em (@2-4em In following which structure is found posterior to trachea (a) Larynx (b) Bronchi (©) Oesophagus (@) Isthmus of the thyroid gland Which organ is superiorly associated with the trachea Q.93 Q04 Q.95 2.96 Q97 Q98 Q.99 Q.100 Quo1 Q.102 Q.103 (@) Larynx (©) Bronchi (©) Oesophagus (4) Isthmus of the thyroid gland Number of incomplete rings found in trachea are (2-4 (b)10-12 (©) 16-20 (d) 30-35 What is the shape of cartilage rings found in trachea (@) V - shaped (b) C-shaped (©) 0- shaped (d)J- Shaped In following which structure is not found in mediastinum (@) Heart (b) Trachea (©) Lungs (d) Oesophagus Total number of lobes found in right lung, are (a) Two lobes (b) Three lobes (©) Four lobes (A) Five lobes Left lung is divided into (a) Two lobes (b) Three lobes (©) Four lobes (a) Five lobes During breathing which structure prevents friction between two layers of lungs (a) Subarachnoid space (b) Pericardial sac (©) Pleural cavity (@) Subdural space In following which layer covers each lobe of the Jung and passes into the fissures that separate lobes (a) Parietal pleura (b) Visceral pleura (©) Endocardium (@) Myocardium At which level the trachea is divided into bronchi (a) At the level of Sth thoracic vertebra (b) At the level of 3rd thoracic vertebra (©) At the level of 4th thoracic vertebra (d) At the level of Sth cervical vertebra Which sentence is incorrectregarding bronchus (a) Itis wider then left bronchus (b) Itis 2.5 om long (©) It is longer than left bronchus (4) Itis more vertical than left bronchus After entering the lung left bronchus is divided imo (a) Two branches __(b) Three branches (©) Four branches _(d) Five branches From upper side to lower, subdivision of bronchi is correct (@) Bronchus —* bronchioles —> terminal broanchioles > respiratory bronchioles (b) Bronchi > bronchioles —> respiratory bronchioles + terminal bronchioles (©) Bronchi > respiratory —> bronchioles bronchioles —> respiratory branch (d) None of above right which Gurjar Ki Thadi, Opp. Metro Pillar No, 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955893 28.MCQs Q.104 Q.10s Q.106 Q.107 Q.108 Q.109 Quo Qu Qu Q.u3 Quit quis Surfactant is related with (a) Respiration (b) Digestion (©) Excertion of urine (@) Secretion of pituitary harmone What is the action of surfactant in human body (a) It prevents the alveoli from drying out (b) Reduces surface tension (©) During expiration it prevents alveolar wall from collapsing (@) All of the above ‘The main muscles used in respiration, are (a) Intercostal muscles (b) Diaphragm (©) Biceps and triceps muscles (@) Both A and B Number of intercostal muscles in human being are (a) 12 pairs (b) 7 pairs (©) LI pairs (@) 10 pairs Intercostal muscles are found (a) In between ribs (b) In between thoracic vertebra (©) In between thoracic and cervical vertebra (@) In front of ribs. ‘The organ which separates the thoracic and abdominal cavities is known as (a) Lung (b) Heart (©) Diaphragm (@ Stomach What does happen during relaxation of musloes of diaphragm except (a) Length of thoracic cavity decreases (b) Pressure in thoracic cavity increases (©) Airis expelled from the lurigs (@) Length of thoracic cavity increases Which condition is responsible for inspiration (a) Contraction of intercostal muscles (b) Dilatation of intercostal muscles (©) Contraction of diaphragm (@) Both a and ¢ During resting inspiration is about (@) | second (b) 2 second (©)3 second (a) 4 second Relaxation of intercostal muscles cause (a) Inspiration (b) Expiration (©) Both inspiration and expiration (@) Imtercostal muscles have no effect on respiration In following which sentence is true (a) Process of inspiration is passive (b) Process of expiration is active (c) Process of inspiration is active (@) Both the processes of respiration is active Contraction of intercostal muscles cause except (a) Increasing the capacity of thoracic cavity (b) Reduction in the pressure in thoracic cavity stage, time period of Qu16 Qui7 Quis Quy Q.120 Qu2t Qua Q122 Q.123 Qu24 (© Reduction in the pressure in. abdominal cavity (4) Inspiration The amount of ait passing into and out of the lungs during each cycle of respiration is known (@) Tidal Volume (b) Inspiratory Reserve Volume (©) Inspiratory Capacity (@) Residual Volume The extra volume of air that can be during maximal inspiration is known as (@) Tidal Volume (b) Inspiratory Reserve Volume (©) Inspiratory Capacity () Residual Volume ‘The amount of air remaining in the air passages and alveoli at the end of quiet expiration is termed as (a) Expiratory Reserve Volume (b) Residual Volume (c) Functional Residual Capacity (d) Vital Capacity The largest volume of air which can be expired from the lungs during maximal expiration is termed as (a) Expiratory Reserve Volume (b) Residual Volume (©) Functional Residual Capacity (4) Vital Capacity The air remaining in the lungs after forceful expiration is known as (a) Expiratory Reserve Volume (b) Residual Volume (©) Functional Residual Capacity (d) Vital Capacity ‘What is the formula for measuring vital capacity (a) VC = Tidal Volume + Inspiratory Reserve volume + Expiratory Reserve Volume (b) VC = Tidal Volume + Inspiratory Capacity + Residual Volume (©) VC = Tidal Volume + Inspiratory Reserve Volume + Residual Volume (@) VC = Tidal Volume + Inspiratory Capacity + Expiratory Capacity In normal adult Tidal Volume is about inspired (a) 1000 mi (b) 50 ml (©) 2500 mi (d) 500 ml Amount of 02 in inspired air is about (@) 21% (b) 78% (©) 45% (6) 60% Which gas is found in maximum amount in inspired ait (a) Oxygen (b) CO, (©) Nitrogen (d) Chlorine Amount of Nitrogen in inspired air is about (a) 21% (b) 78% (©) 0.04% (2% Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559329MCQs Q.125) Q.126 Q127 Q.128 Q.129 Q.130 Qust Q.132 Q.133 Qus4 Qu35 Priniay cause of cancer of larynx is (a) Bacteria (b) Malnut (©) Cigarette smoking (@) Improper hygiene ‘The partial pressure of deoxygenated and oxygenated respectively are (a) 40 mm Hg and 100 mm Hg (b) 60 mm Hg and 120 mm Hg (©) 20 mm Hg and 60 mm Hg (@) 100 mm Hg and 140 mm Hg In deoxygenated blood, partial pressure of 02 and CO, respectively are (a) 40 mm Hg and 80 mm Hg (b) 60. mm Hg and 90 mm Hg, (©) 40 mm Hg and 44 mm Hg (@) 24 mm Hg and 20 mm Hg In following, partial pressure of which gas oxygen in blood remains constant in both oxygenated and deoxygenated blood (@o, (CO, (©)N2 (a) None of above Exchange of gas between alveoli of lungs and blood is taken place by (a) Diffusion (b) Osmosis: (© Filteration (@) All During external respiration (a) O; diffuses from blood to alveoli (b) 0) diffuses from alveoli to blood (©)O; diffuses from blood to tissues (a) Os diffuses from tissues to blood What happens during internal respiration - (a) CO, diffuses from body tissues to blood (b) CO, diffuses from blood to alveoli (©) Os diffuses from blood to body tissues (@) both aand c In the blood most of O; is carried in combination with (a) Water (b) RBC () Hb (@) tron In following mainly which condition will stimulate chemoreceptors (a) Decrease partial pressure of CO: (b) Increase partial pressure of CO: (©) Increase partial pressure of O» (a)Decrease partial pressure of O> Priority nursing diagnosis in a patient with pneumonia will be- (a) Altered mucous membranes (b) Impaired gas exchange (©) Altered nutrition less requirement (@) Activity intolerance Ambubag is used when- (a) Patient develop respiratory arrest (b) Patient develop renal failure (c) Patient develop hepatic failure (@) Patinet develop severe hypertension than body Q136 Q.137 Q.138 Q139 Q.140 Quai Quaz Q143 Q.144 4s ‘Most appropriate treatment for a patient with empyema is- (a) Fowler's position (b) Postural drainage (©) Diuretic drug (d) Passive breathing exercise Under normal physiological conditions, the respiratory centre is stimulated by- (a) Oxygen (b) Lactic acid (©) Carbon dioxide (d) Calcium ions Meaning of Cheyne strokes respiration is- (a) Periods of tachypnea alternating with periods of apnea (b) Periods of hyperpnea alternating with periods of apnea (©) An increase in both rate and depth of respiration (@) Deep, regular and sighing respirations Most common clinical feature of Pleurisy (a) Sharp stabbing pain when breathing (b) Productive cough (©) Cyanotic nailbeds (@) Tachycardia The most reliable way to respiratory status of a patient is (a) Observe the chest rising and falling (b) Listen and feel the air movement (©) Observe the colour of sclera (G) None of the above ‘A patient who is experiencing dyspnoea should be placed in- (a) Orthopneic position (b) Supine position (©) Left lateral position (6) Lithotomy position The sensor of pulse oximeter can be applied to the all following body parts except one- (a) Earlobe (b) Finger (©) Lip (d) Thumb and toe Most common complication of chronic asthma is: (@) Atelactasis (b) Emphysema (©) Pneumothorax (4) Pulmonary fibrosis To facilitate maximum air exchange, a patient should be placed in the- (a) Supine position (b) Orthopneic position (©) High-Fowler's position (G) Semi-Fowler’s position Which of the following is a complication associated with tracheostomy tube- (a) Damage to the laryngeal nerve (b) Pulmonary oedema (c) Rheumatic Heart disease (d) Tuberculosis assess the Gurjar Ki Thadi, Opp. Metro Pillar No, 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 30.MCQs Q.146 Qua7 Q.148 Quay Q.150 Quast Qusz Q.153 Q.154 Quss Q.156 Qu57 Which is the preferred position for a patient tundergoine thoracentesis- (a) Supine (b) prone (©) Sitting (4) Left - lateral Which is the best time to take sputum specimen- (a) After awakening in morning (b) Before bed time (©) After having lunch (@) In between lunch and dinner Which of the following is the commonest symptom of foreign body in the respiratory passage of a child- (a) Vomiting (b) Cough (©) Wheezing (a) Cyanosis Which of the following feature is consistent with longterm COPD- (a) Hypoxemia (b) Hypercapnia (©) Leukopenia (@) Alll of the above Dyspnoea means (a) Absence of breathing (b) Increase respiratory rate (€) Decrease respiratory rate (@ Difficulty in breathing In following which is lower airway disorder- (a) Rhinitis (b) Pharyngitis (©) Asthma, (@ Laryngitis Smoking cause all except- (a) Chronic bronchitis (b) Bronchectasis| (©) Emphysema (@) Bronchogenie carcinoma Which of the following is true about asthma- (a) Extrinsic and intrinsic triggering factors are responsible (b) Sputum contains eosinophil and charcot layden crystals (©) Treatment includes bronchodilators and corticosteroids (@) All are true Fowler's position facilitates- (a) Expansion of lung (b) Digestion of food (©) Ingestion of food @all Commonest cause. of, Pulmonary Embotism is — (a) Inferior vena cava thrombosis (b) Thrombosis in deep veins of the leg (©) Thrombosis of carotid artery (@) Thrombosis of prostatic veins Pulmonary embolism is best diagnosed. by — (a) X-ray chest (b) Ultrasonography (©)CT sean (@) Ventilation-Perfusion scan Asthma is a- Q.158 Q.159 Q.160 Q.161 Q162 Q.163 Q.164 Q.16s Q.166 Q.167 (@) Neurological disorder (b) Cardiovascular disorder (©) Intestinal disorder (4) Respiratory disorder ‘Treatment plan of Asthma includes- (a) Maintain patent airway (b) Maintain nutrition (©) Maintain proper breathing pattern (@) All of the above Which of the following drug is not used in asthma- (a) Bronchodilators (b) Steroids (©) Antichotinergies (d) Antacids is not included in (@) Asthma (b) Bronchitis (c) Emphysema (d) Pneumonia Destruction of alveolar walls is known as- (a) Empyma_ (b) Bronchitis (©) Emphysema (d) Lung abscess Aims of medical management of a patient with COPD is to- (a) Improve ventilation (b) Remove bronchial secretion (©) Improve general health (All ‘The nursing interventions for improving ventilation includes all the following except- (a) Administration of Oxygen (b) Insertion of NG tube (©) Provide fowler position (4) Administer bronchodilators ‘The best nursing intervention for clearance of airway is- (a) Administer of oxygen (b) Tracheobrochial suctioning (©) Maintain nutrition (d) Sitting position Permanent abnormal dilation and distration of bronchi and bronchioles is known as- (@) Atelactesis (b) Bronchiectesis (©) Trachiobronchitis, (4) Pneumonia Collapse of lung tissue is termed as- (a) Atelactesis (b) Bronchiectesis (©) Trachiobronchitis, () Pheumonia An embolus is a- (a) Movable blood clot (b) Fixed blood clot (©) Air bubble (d) Movable air bubble Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559331MCQs Q.168 Q.169 Q.70 Qua Qu Qu73 Quam Qu7s Q.176 Qu77 Qu7s Qu79 Which of the following is not a risk factors for Pneumonia- (a) Respiratory infections (b) Malnuttition (©) Urinary tract infection (@) Prolonged immobility Causative organism for Pneumonia is- (@) Streptococcus (b) Staphylococci (©) Hemophilds influenzae @all Which of the following investigation is performed for the diagnosis of Pneumonia- (a) Blood culture (b) Chest x-ray (©) Sputum culture @all Lang abscess means- (a) Presence of tumor in lung (b) Accumulation of fluid in lung (©) Collection of pus in lung (@) Collection of the blood in lung Causative organism of Tuberculosis is- (a) Streptococci (b) Staphylococci (©) Mycobacterium tuberculosis, (@) Mycobacterium laprae Mycobacterium Tuberculosis is a- (a) Virus (b)- Acid fast bail (©) Acid fast fungi (@) Protozoa DOTs therapy is used for the treatment of- (a) Diarrhoea (b) Leprosy (©) Tuberculosis (@) Polio Differential symptom of TB include- (a) Fever (b) Hemoptysis (©) Chills (@) Vomiting Mantoux test is used for the diagnosis of (a) Tuberculosis, (b) Polio (c) Diphtheria (a) Leprosy In DOTs diagnosis of tuberculosis is made on the basis of- (a) X-ray finding (b) Sputum examination (©) Both (a) & (b) (@) Urine examination Removal of entire lung is known as- (a) Lobectomy (b) Pheumonectomy (©) Gastrectomy @) Orchiectomy Pleural effusion is- (a) Enlargement of pleura (b) Constriction of pleural cavity (©) Accumulation of fluid in pleural cavity (@) None of these Q.180 Qisi Q.182 Q.183 Q.184 Q.185 Q.186 Q87 Q.188 Which of the following respiratory disease is characterized by periods of reversible ronchospasm- (a) Lung abscess (b) Rhinitis (©) Pharyngitis (a) Asthma Most prominent cause of Lung-cancer is (a) Cigarette smoking (b) Alcoholism (©) Exposure in sunlight (d) High fiber diet Clinical features of Lung-Caner includes- (@) Persistent cough (b) Hemoptysis, (c) Chest pain (all Which of the following is a indication of Pneumonectomy- (a) Laryngitis (b) Emphysema (©) Lung cancer (@) Empyma ‘The best method for assessing respiration in a non-responsive person is: (@) Put hand in front of nose (b) Look listen and feel (©) Put the hand on the chest (4) Hear heartbeat (AIMS Bhopal, 2016) Exchange of gases takes place in which part of the body? (a) Liver (b) Kidney (©) Lung (d) Heart (AIMS Bhopal, 2016) The goal of pursed lip breathing exercise is to: (a) Prevent aspiration pneumonia (b) Strengthen the diaphragm (©) Loosen the bronchial secretions (4) Reduce the amount of trapped air (GMCH Chandigarh, 2016) A patient admitted in the emergency is having tachypnoea with respiratory rate of 28 breaths per minute, The likely diagnosis is (a) Narcotic overdose (b) Raised intracranial pressure (©) Pneumonia (6) Brain (GMCH Chandigarh, 2016) You identify that a poly-trauma patient has gone into Acute respiratory Distress Syndrome when: (a) He develops pallor and cyanosis, (b) You hear crackling sounds over the chest on auscultation (©) His respiratory rate goes up from 18/minute to 30/minute (d) His blood pressure talls from 140/80 mmHg to 90/60 mmHg (GMCH Chandigarh, 2016) Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559332MCQs Q189 Q.190 Quist Q.192 Q.193 Qu94 Qu95 Q.196 Q.u97 Empyema means (a) Collection of fluid in peritoneal cavity (b) Collection of fluid in pleural cavity (©) Collection of pus in pleural cavity (@) New growth in the lungs (ESIC Staff Nurse, 2016) A space called the ___ is found between the two pleural cavities: (a) Serosa (b) Parietal (©) Soleus (@) Mediastinum (ESIC Staff Nurse, 2016) Normal tidal volume is (a) 500 mi (©) 1000 ml (b) 750 mi (@) 1500 ml (ESIC Staff Nurse, 2016) Which among the following devices assists a critical patient in breathing? (a) Gamo machine (b) Ventilator machine (©) Defibrillator machine (a) Oxygen humidifier (AIMS Raipur Staff Nurse, 2017) Which of the following drug in DOTS therapy ‘can cause deafness? (a) Ethambutol (b) Isoniazed (©) Rifampicin (@) Streptomycin (AIMS Raipur Staff Nurse, 2017) A client who smokes tow packs of cigarettes per day is most at risk postoperatively for? (a) Infection (b) Pneumonia (@) Cardiac dysrhythmias (AIMS Raipur Staff Nurse, 2017) The artery that supply blood to the diaphragm is called: (a) Inferior mesenteric artery (b) Suprarenal arteries (©) Inferior phrenic arteries (@) Coelie arteri (AIMS Raipur Staff Nurse, 2017) The largest volume of ait, which can be expelled from the lungs during maximal expiration is called: (a) Tidal volume (b) Residual volume (©) Inspiratory reserve volume (@) Expiratory reserve volume (AHIMS Raipur Staff Nurse, 2017) A low ~ pitched, continuous gurgling sounds caused by secretions in the large airways is called: (a) Wheezes (©) Coughing (b) Rhonchi (@) Stertor Q.198 Q.199 Q.200 Q.201 Q.202 Q.203 Q.204 Q.205 (AIMS Raipur Staff Nurse, 2017) Which of the following artificial ventilation mode is best suitable for a patient with respiratory arrest? (a) Continuous positive airway pressure (b) Controlled mandatory ventilation (©) Assistant controlled mandatory ventilation (d) Noninvasive positive pressure ventilation (AIMS Raipur Staff Nurse, 2017) ‘The tumor of the hyaline cartilage is called: (a) Osteochondroma, (b) Osteosarcoma (©) Enchondroma, (d) Chondrosarcoma (AUMS Raipur Staff Nurse, 2017) The cartilage that completely encircles the larynx with the narrow part anteriorly and the broad part posterioly is called: (a) Thyroid cartilage (b) Cricoid cartilage (©) Arytenoid cartilage (d) Bpiglottis, (AIMS Raipur Staff Nurse, 2017) Which lobe is most commonly affected in children with pulmonary atelectasis? (@) Right upper lobe (b) Right lower lobe (©) Left upper lobe (4) Left lower lobe (AIMS Raipur Staff Nurse, 2017) Which of the following nursing diagnosis is a priority for a patient diagnosed with pneumonia? (a) Fluid volume deficit (b) Impaired gas exchange (©) Ineffective coping (4) Risk for infection (AIMS Raipur Staff Nurse, 2017) Which of these body systems is involved in the removal of carbon dioxide? (a) Respiratory system (b) Digestive system (©) Urinary system (d) Resproductive system (AIMS Raipur Staff Nurse, 2017) Which among the following tissues is found in the vocal cord of humans? (a) Liquid connective (b) Hard connective tissue (©) Fibrous connective tissue (d) Soft connective tissue (Recruitment Tutor Nursing, 2016) In which among the following cases we can find Progressive Massive Fibrosis (PMF)? (a) Complicated silicosis (b) Lobar pneumonia (©) Sarcoidosis (d) Extrinsic allergic alveolitis (Recruitment Tutor Nursing, 2016) e Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur Mb. 7426955591, 742695559333MCQs Q.206 Q.207 Q.208 “The most commonest cause of Asthma is (a) Allergy (b) Microbial infection (©) Pulmonary hypertension (@) Pneumothorax (RUHS [Link] Nursing Exaim, 2017) Which diagnostic test will be ordered to confirm pneumonia? (a) Arterial blood gas (ABG) (b) Chest X-ray (©) Blood cultures (@) Sputum culture and sensitivity (RUHS [Link] Nursing Exam, 2017) A client has received a preliminary diagnosis of tuberculosis. What is the definitive diagnostic test to be done (a) Chest X-ray (b) Mantoux test (©) Sputum culture (@) Tuberculin test (RUHS [Link] Nursing Exam, 2017) ANSW Q.209 Which of the following is tue about acute Q210 Qu respiratory distress syndrome (ARDS) (a) Alveoli are over expanded (b) Alveoli increase perfusion (©) Alveolar spaces are filled with fluid (@) Alveoli improve gaseous exchange (RUHS [Link] Nursing Exam, 2017) Increased depth of breathing with normal respiratory rate is called: (@) Hyperpnoea (b) Kussmaul’s breathing (©) Orthopnoca (@ Bradypnoea (AIIMS Bhopal Staff Nurse Gr.2, 2018) weer KS fee TAG eMaTTTEN Gell eT 8? (a) we % pH ofe () ods satergs A are (© station ah wh (@ stetar A aren (AIMS Bhubaneswar Staff Nurse, 2018) ER KEY 1tat2 tats fo[« [cls ]fole[c]7][s[s]s][so]c]w[s ufala|c|as[e | ss [elas [ofa] far[cl[as[c [a [olalec 21 | o | 22 [cc | 23 | c | 2a [oo] as | c | 26 | [27 [8 [os [ c | 29 | 0 | 30 | 0 ata lata [ss] [34 [alas [c [as [e [a7 [cc] ae] [atc [ala afte [ata las | [aa [cl as [es [as [ala [es [as] |] [sola si] c|s2[o]s3[c] sa lo] ss [alse] als7z[a[se[s | so[s |oola a lclelolelc|elslslalelele|cles|c]|es|o| mo nielrfelalolmlelslalmlelalalalal alo eola ailalez[ol[sslolealslaslslelale|clelclalslola salcloa2falss|cl[olelasl[closle|o|alsa|c| oo] 5 | 100] a aoa | _¢ | a02[ a [103 [a [104 [a [105] 0 [06] > [107] ¢ [aos | a [a09] c [aso] o ano [a2] 6 [a3[ 5 [asa [ec [is | c [ase | a [ar | 8 [ais | c [aro] a [20 [ 8 a21| a [222] @ [aaa] c [2a [ 8 | a25| cc [are | [a7] c Jaze] cc [a9] a [a0 5 131] 0 [132] ¢ [133] 5 [134 [8 [1350 [a36 |e [437 | c [38] 8 [139] a [sao 5 sai | a [aa2 | c [193 | [aaa |e [145 | [ae | c [a7 [a [ras | 8 | sa9] 0 [aso | 0 asi | c [152] 8 [153] o | asa [a [155 |8 [156] [1s7| 0 [ase] o | 159] | 160] o sei] c [162] 0 [rea 5 | a6a [6 | 165 | 8 [acc | a |a67 | a [rea] c | 169] 0 [170[ 0 aa| c¢ [azz | c [ava | [ara [c [a5] 8 [ave] a [a77| cc [aze| 6 fare | c [rao] 0 asi] a [182] ¢ [183] c | 194] 6 | 185 | ¢ [ase | 0 [497 | c [as] c | 129] ¢ [190 0 asi] a [as2[ 8 [as3[ 0 [19a [ 6 | 195| c [asc | o [197] e [ase] 8 [a9] c | 200| 6 2o1| a | 202 | & | 203 | a | 204 | ¢ [205] A | 206] a | 207| b | 208| c | 209] c | 210 | a 2ula Gurjar Ki Thadi, Opp. Metro Pillar No, 67, New Sanganer Road, Jaipur Mb. 7426955591, 7426955593 34