Midterm 2 - Midterm 1 Content Flashcards
Normal
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Chronic Bronchitis
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Asthma
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Pleural Effusion
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Consolidation
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Atelectasis
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Hemothorax (hemmorrhage pleural effusion)
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
pneumothorax
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Pulmonary Edema (interstitial pulmonary edema)
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Empyema
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Emphysema
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
Chylothorax
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
what is each part of the stethoscope used for?
what are the pulmonary ascultation segments? how should a pt breath during ascultation?
pt should breathe through the mouth slightly deeper than normal breath sounds (makes them easier to hear) - be sure pt isn’t hyperventilated
what are the 4 normal breath sounds and in what regions of the lung are they?
describe tracheal breath sounds
describe bronchial breath sounds
describe bronchovesicular breath sounds
describe vesicular breath sounds
describe the abnormal breaht sounds (and conditions associated with each):
1) decreased air entry or absent breath sounds
2) bronchial breathing
describe adventitious breath sounds
describe crackles (fine and course)
describe wheezes
describe ronchi
describe stridor
describe pleural friction rub
define tactile fremitus and the 3 types
describe vocal fremitus
describe pleural friction fremitus
describe ronchal fremitus
define voice sounds and name the 3 types
describe bronchophony
describe egophony
describe whispered pectoriloquy
describe dyspnea vs leg discomfort
- Difference in information coming in (from peripheral muscles/chemo receptors) and the output
- Discomfort – copd will have more leg fatigue than healthy bc more lactate being produced (decr o2 within the muscle), have more anaerobic mechanisms happening bc changes in muscle fibres (due to steroids, disuse, etc – remember it is a systemic disease!)
Pt asked to exercise – they stop at a certain point – asked why they stopped
Some may say bc of dyspnea, some because I couldn’t exercise anymore
Sometimes pts stop because of leg fatigue – not always just bc of dyspnea
– it depends on the type of exercise they are performing
Why people stop bc of dyspnea more bc of walking than cycling? – bc cycling is more localized exercise and walking is more whole body (vo2 achieved is higher in walking than cycling bc more muscles used)
what are 3 causes of reduced peak VO2 in lung diseases?
- 1) bc usually a smoker too, cardiac involvement
- 2) due to underlying condition – lower perfusion
- 3) this contributes to change in musculature
what is the normal ventilatory limitation to exercise?
- Normally our ventiation increases with increased metabolic rate with exercise
- May be increase in dead space (has to do with VD/VT) – look at later
- Maximum voluntary ventilation = MVV – person asked to breathe in as deep and fast as they can (hyperventilate for 15 seconds) – times 4 to give MVV for 1 minutes – the max ability to move air in and out of lungs
- Move severe FEV1 will have a lower number for ventilatory capacity
- A combination of VE and MVV causes exercise limits.
- Ventilatory demand = the oxygen needs – increased with exercise, with COPD even hgher demand for same level of exercise bc of the decreased efficiency of breathing – they need to work more to have the same level of ventilation – their demands ar greater bc the way they breathe is inefficient
describe the exercise flow volume loop for a healthy young adult, a healthy older adult, and moderate COPD
Graph 2 – decline in fev1 with age, decline in max volume – there may be a portion during high level of exercise where people can be limited by maximum envelope, even though they are very fit
Graph 3 – max envelope is different – this person did not hyprinflate much – they are already close to TLC – they are lying along maximum expiratory flow curve most of the time – there is an expiratory flow limitation
- Point 2: happens bc of reduced compliance at higher lung volumes and muscles a re shortened, worse at generating force
- Look at inspiration – not reaching max envelope at high levels of exercise – but you are In age and COPD
what are pulmonary gas exchange abnormalities?
A-a = alveolar arteriol difference – larger differences
Declines in saturation and hypoxemia – can have this happen during exercise! For these people
describe exercise and COPD graphs
1) Graph on far right – cant reach as high levels as someone healthy (MMV and vo2 peak less)
2) Lower left graph - have a higher breathing freq when they exercise bc cant incr. tidal volumes as much
3) Upper right graph - COPD pts are more hyperinflated
4) lower right graph - a measure of neuroventilatory coupling – maintained in healthy people, but takes more pressure to achieve given ventilation in COPD pts (reduced neurovent coupling) – bc of this they have more dyspnea in exercise for a given minute ventilation bc they must perform more work – COPD get short of breath at lower work efforts *reduced neuro-ventilatory efficiency – why COPD have more dyspnea during exercise - neuro part is activation of muscles in order to generate pressure – ventilation part is ventilation achieved
describe exercise and interstitial lung disease (dyspnea vs leg fatigue)
- Pulmonary fibrosis = interstitial lung disease
- Both diseased, Left stopped due to dysp, left due to leg fatigue
- No flow limit on right, exp flow limit on left
- Right – leg fatigue limited them to be able to reach that flow limitation level like left
describe the exercise and interstitial lung disease graphs
b) vo2 vs ventilation – same graph as before – same limitations as before
c) Breathing frequency – increased – bc primary problem with pts is volumes are small – if cant increase volumes to reach MMT, increase resp rate Bar graph) black = tidal volume, white = end exp lung volume, and = TLC – in general all volunmes smaller with exercise – same graph as upper R on slide 8
a) We see more dyspnea for a given vo2 – bc looking at work necessary for a given vo2 – higher bc of changes in the mechanics of their lungs
d) also limited in neurovent coupling but for different reasons: due to changes in compliance of system
The changes that occur during exercise are similar!! – lung volumes are different – bt overall message – more dyspnea same pattern because of inefficient breathing
Bronchiectasis
(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)
pulmonary fibrosis
