Pulmonary Flashcards by Laila Sultana

Hyperresonance occurs in ___

“Excess air”

increased resonance, lower pitch, on percussion
a result of overinflation of the lung

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ARDS usually occurs alongside _____

multiple organ system failure or sepsis

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(T/F) When a lung collapses an inflammatory response ensues. This response becomes stronger after >24 hours of the lung being collapsed

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3 main types of COPD

1) Chronic Bronchitis
2) Emphysema
3) Asthma

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5 most common risk factors for COPD

1) SMOKING 2) Air pollution 3) Hyperresponsive Airways 4) Occupational Factors 5) α1-antitrypsin deficiency

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Abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing (apnea)

Cheyne-Stokes respirations

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Absorption Atelectasis can happen in 2 ways:

1) when high concentrations of O2 are given, oxygen replaces nitrogen in the alveoli,
2) if airway obstruction occurs, the oxygen is absorbed into the bloodstream and alveoli collapse

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Difficiency of Alpha 1- antitrypsin in Primary emphesema causes _____

greater elastase activity (breaks down elastin in the lungs).
alpha 1 trypsin is an inhibitor of elastase.

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an inflammation of the lungs and bronchial tubes that occurs after inhalation of foreign matter. aka. anaerobic pneumonia

Aspiration pneumonitis

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Bradypnea cut-off

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Wheeze

Breath with a whistling or rattling sound in the chest as a result of obstructed air passages

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breathing pattern in restrictive lung diseases:

Rapid, shallow (Respiratory Rate increased, TV decreased)

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Centriacinar Emphysema is characterized by

dilation that affects the respiratory bronchioles (aka the center of the acinus)

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Characteristic breathing patterns in restrictive lung diseases result in ____

increased dead space ventilation

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Feeling the Chest wall vibrations when pt speaks.

Tactile fremitus

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Chronic bronchitis is characterized by

Hypersecretion of very thick mucus and chronic productive cough (lasting at least 3 months/year and for at least 2 years)

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Chronic exposure to cigarette smoke allows free radicals to inactivate ____, which causes what?

inactivates antiproteases (alpha 1 antitrypsin), which increases neutrophil elastases in the lungs

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chronic inflammatory disease of the airways characterized by attacks that are triggered by airflow obstruction that is often reversible

Asthma

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Clicking, rattling, or crackling noises made by one or both lungs

Crackles/ rales

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Common symptoms of COPD

1) Dyspnea
2) Altered lung volumes
3) Hypoxemia/hypercapnea (Loss of hypercapnic drive)
4) Increased mucus secretions
5) Stacking breaths (air trapping)
6) Wheezing

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Cor pulmonale

RHF/weakening secondary to pulmonary HTN

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Deeper/faster breathing than normal causing excessive expulsion of circulating carbon dioxide

Hyperventilation

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Does Asthma have a genetic component?

Yes

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FEV1/FVC ______ predicted indicates obstruction in the airways for asthma.

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For asthma, an FEV1 of _____ predicted indicates obstruction.

For asthma, an FEV1 of ______ predicted indicates severe obstruction.

For asthma, an FEV1 of _______ predicted indicates moderate obstruction.

50-80%

Form of hyperventilation involving deep and labored breathing

Kussmaul respirations

High pitched wheezing sound resulting from turbulent airflow in the upper airway:

Stridor

How long should you count the number of respirations for a regular rhythm?

30 seconds then multiply by 2

How long should you count the number of respirations for an irregular rhythm?

1 minute

In contrast to restrictive lung disease, obstructive lung diseases (COPD) present with ____ FEV1/FVC ratio

Decreased FEV1/FVC ratio (bc FVC \> FEV1)

In restrictive lung diseases, the FEV1/FVC ratio is \_\_\_\_\_

Normal ratio (Because FEV1 and FVC are both reduced)

In sepsis, what is one of the first organs to fail?

lungs

In what lung disease do pts have decreased lung volumes across the board?

Restrictive

In which condition(s) is barrel chest commonly found?

COPD

In which condition(s) is Cheyne-Stokes respirations commonly found?

CHF (LVD)

In which condition(s) is crackles or rales commonly found?

CHF, asthma, pneumonia, bronchitis

In which condition(s) is dullness commonly found?

Pneumonia/ HF

In which condition(s) is egophony commonly found?

Fibrosis, pneumonia, pleural effusion

In which condition(s) is hyperresonance commonly found?

Emphysema (COPD)

In which condition(s) is hyperventilation commonly found?

Stress, anxiety, lung diseases, stroke, metabolic acidosis

In which condition(s) is kussmaul respirations commonly found?

DKA, severe metabolic acidosis

In which condition(s) is pulsus paradoxus commonly found?

Asthma

In which condition(s) is rhonchi commonly found?

COPD, bronchitis

In which condition(s) is stridor commonly found?

any blockage of the larynx

In which condition(s) is tactile fremitus commonly found?

Pneumonia

In which condition(s) is wheeze commonly found?

Asthma attack, bronchitis, COPD

In which condition(s) is whispered pectoriloquy commonly found?

Cancer, pneumonia

In which part of the pulmonary exam would you identify barrel chest?

inspection

In which part of the pulmonary exam would you identify Cheyne-Stokes respirations?

Inspection

In which part of the pulmonary exam would you identify crackles or rales?

Auscultation

In which part of the pulmonary exam would you identify dullness?

Percussion

In which part of the pulmonary exam would you identify egophony?

Auscultation

In which part of the pulmonary exam would you identify hyperresonance?

Percussion

In which part of the pulmonary exam would you identify hyperventilation?

Inspection

In which part of the pulmonary exam would you identify Kussmaul respirations?

Inspection

In which part of the pulmonary exam would you identify retractions?

Inspection

In which part of the pulmonary exam would you identify rhonchi?

Auscultation

In which part of the pulmonary exam would you identify stridor?

Auscultation

In which part of the pulmonary exam would you identify Tactile fremitus?

Palpation

In which part of the pulmonary exam would you identify wheeze?

Auscultation

In which part of the pulmonary exam would you identify whispered pectoriloquy?

Auscultation

In \_\_\_\_, an underlying inflammatory process causes the capillaries to become more permeable, resulting in the extravasation of fluid into the lungs

increased permeability pulmonary edema

In \_\_\_\_\_\_, pulmonary vasoconstriction causes the heart to generate enough pressure to push fluid from the capillaries into the alveoli

Hydrostatic pulmonary edema

Increased loudness of whispering noted during auscultation on the lung fields on a patient's back due to lung consolidation

whispered pectoriloquy

Increased resonance of voice sounds due to enhanced transmission of high-frequency noise across fluid with lower frequencies filtered out "e to a transition"

egophony

long term complications of Chronic asthma:

smooth muscle hypertrophy, fibrosis, and airway obstruction

Most common treatments for smooth muscle constriction triggered by an asthma attack (2)

1) Anticholinergics 2) Beta Agonists

Muscle between the ribs pulls inward

Retractions

Normal rpm

...

Once restrictive lung disease becomes advanced, Pts may present with increased (1) and decreased (2) with concomitant (3) and (4)

1) PaCO2 2) PaO2 3) Pulmonary HTN 4) Cor Pulmonale

Panacinar Emphysema is characterized by ...

dilation that affects the alveolus or alveolar duct (aka the periphery of the acinus)

Patients with COPD typically first have difficulty with\_\_\_\_ (inspiration/expiration), which then progresses to difficulty ____ (inspiring/expiring)

1) Expiration 2) Inspiring

Patients with restrictive lung diseases experience reduced ____ in their lungs and chest wall

Reduced Compliance

Patients with ____ disease have to be monitored closely when put on O2 because they often have lost their hypercapnic drive to breathe (due to being chronically hypercapnic) and are relying on their hypoxic drive. Eliminating their hypoxia may then lead to suffocation

COPD

Peak flow rate measures what?

the air exhaled in first 10 msec of expiration (only used in asthma)

Predicted PFTs are based on what?

population values for age, gender, and height

Rattling, snore-like sound in the throat or bronchial tubes due to partial obstruction

Rhonchi

Rounded, bulging chest that resembles the shape of a barrel

Barrel chest

Short and high-pitched with little resonance

Dullness

Tacypnea cut-off

\>20 rpm

The cut point for FEV1 for COPD

The cut point for FEV1/FVC for COPD

These two diseases are often observed in conjunction with COPD

1) Absorption Atelectasis 2) Varicose Bronchiectasis

Tx for inflammation caused by an asthma attack

Steroids

Varicose Bronchiectasis

varicose swelling of the smooth muscle of the airways; constriction of airways and dilation of SM; **irreversible**

What are the different techniques used in a physical assessment?

Inspection Palpation Percussion Auscultation

What do you look for during inspection?

Respiratory Rate Respiratory Rhythm Visual abnormalities Skin color/condition Speech/ visual distress

What do you look for during palpation?

Tactile fremitus (say 99 and place hands on back) Thoracic expansion

What do you look for during percussion?

Pleural effusion (dullness or hyperresonance)

What does FEV1 measure?

the volume of air exhaled in 1st second of breath

Which disease? Hypoxemia and pulmonary edema, but normal pulmonary capillary wedge pressure

ARDS