pulmonary eval

Question 1

What are the 3 different categories of pulmonary function tests?

Answer 1

-tests of lung vol+ capacity
-tests of gas flow rates
-tests of diffusion

Question 2

tests of lung volumes and capacity include tidal volume, vital capacity, residual volume, and ____? (2)

Answer 2

inspiratory and expiratory reserve

Question 3

Tests of gas flow use what values to inform us of lung function

hint: a lot of them start with “forced”

Answer 3

FVC
FEV1
FEV1/FVC
FEF (forced midexpiratory)
MVV (max vol ventiliation)-fyi this is total air exhaled in ~12s of hyperventilation

Question 4

what are the FEV1/FVC cutoffs for restrictive and obstructive lung disease

Answer 4

restrictive >.8
obstructive <.7

Question 5

You walk into a pt’s treatment room and observe their posture/position, integ and extremities, brething effort/technique and external devices. What characteristic might you observe in the fingers of a hypoxemic pt?

Answer 5

cyanosis, clubbing

Question 6

Your pt begins to show signs of pulmonary distress and you see them start becoming pale and sweating. What other s/s should you look out for

Answer 6

nasal flaring and enlarged pupils

Question 7

what adaptive changes of the neck might suggect chronic pulmonary condition?

Answer 7

hypertrophy (and JVD-RHF)
fwd head posture
prominent clavicle

Question 8

the resting chest is observed for symmetry, rib angles and musculatures for signs of chronic dx. What are we looking for in each

Answer 8

symmetry: normal A/P diamter is 1/2 transverse

rib: <90* and attach to vertebrae @ 45*

muscle: hypertrohpy/ SCM shortening

Question 9

If eupnea and hyperpnea both have a normal rate and regular rhythm, what’s the difference between them .

Answer 9

depth-eupnea is completely normal while hyperpnea has increased depth

Question 10

If hyperventilation and tachypnea both involve an increased breathing rate, what makes hyperventilation a risk factor for respiratory alkylosis?

Answer 10

increased depth> decreased arterial CO2

Question 11

T/F: Bradypnea describes a decreased rate but regular rhythm that can be shallow OR normal in depth.

Answer 11

true

Question 12

How does tissue density impact sounds heard during lung auscultation in someone w/ emphysema?

Answer 12

it would sound quieter due to decreased density.

more density= more sound and vice versa

Question 13

what are the more common adventitious lung sounds and what do they signify?

Answer 13

-wheeze (esp w/ exhale)
-high-pitch wheex: narrowed airway
-rhonchi (snore-type of wheeze): large obstruction/fluid
-crackles: fluid/ air trapping
pleural rub: pleurisy

Question 14

a cough is measured in terms of what 3 characteristics?

Answer 14

strength, depth and duration

Question 15

what kind of qualities should you include when documenting your pt’s sputum?

Answer 15

amount, consistency, color, smell and any changes

“mucoid” is normal consistency

Question 16

what kind of qualities should you include when documenting your pt’s breathing? (4)

Answer 16

rate, used of diaphragm, effort + accessory muscle use

Question 17

Paradoxical breathing (chest moving opposite direction for inhale/exhale) can be seen in the case of neurological conditions or broken ribs. What other causes are there? ( 3)

Answer 17

obstruction
trauma to the chest wall
diaphragmatic dysfn

Question 18

why do we care about tracheal positioning (distance between trachea and clavicles) ?

Answer 18

asymmetry can be a red flag for:
ateclectasis/alveolar closing: trachea towards
pneumothorax/air filling: trachea away

Question 19

your pt has distant (maybe even absent) breath sounds and you’re concerned about a pneumothorax. What other signs might you observe? (4)

hint: IF you could hear adventitious sounds, which might you expect?

Answer 19

tachypnea
asymmetric lung expansion
decreased fremitus
sounds: ipsalteral crackles, wheezes

fremitus: vibrations felt when they speak

Question 20

in addition to the tracheal position, what else might we palpate for in the physical examination?

Answer 20

diaphragm use
symmetry of costal expansion
crepitus

Question 21

The rice crispy feeling, aka crepitus/ subcutaneous emphysema is developed when air leaks out and follows fascial planes. In what locational pattern does it usually develop?

Answer 21

edema in chest> scapula> neck>face

Question 22

mediate (finger) percussion would likely sound____ as opposed to resonant/typanic in a fluid filled lung. On the other hand, air trapping might lead to a ___ sound

Answer 22

deadened/dull; drum like, **HYPERresonant (ex emphysema)

regular resonance is normal due to air in thorax

Question 23

During a test of egophany, you hear a nasal “A”.Is it normal?

Answer 23

Nope. you should hear “eeeee”

Question 24

T/F: When conducting bronchophony, or whispered pectriloquy, you hear clear reponses form the patient. This is an abnormal response.

Answer 24

true. it should sound muffled and unintelligible

Question 25

when observing chest wall expansion, it should be completed w/ direct contact in 3 directions. describe them

Answer 25

apical, anterolateral, posterolateral

Question 26

mediate percussion can be be used for outlining structures, lung resonance, and what else? (1)

Answer 26

assessing diaphragmatic excursion

Question 27

T/F: Normal inhalation is usually the same or slightly slower than exhalation. It is also can be a slight bit louder.

Answer 27

False. it's the same or slightly quicker.

Question 28

broncho-vesicular sounds are usually heard best just lateral to the ___ and in the ____ region--particularly to the left. If bronchial sounds are present we'd be concerned about...?

Answer 28

trachea, interscapular tracheal shift

Question 29

what are the primary muscles of inspiration? accessory muscles (6)?

Answer 29

diaphragm and portions of intercostals; scalenes, SCM, levator costorum, serratus, traps, and pecs

Question 30

what are the primary muscles of expiration? accessory muscles (4)

Answer 30

none really> a relaxation supported by abdominal tone. QL, portions of intercostals, ab muscles, triangularis sterni

Question 31

define resting end expiratory pressure

Answer 31

this is the midpoint between elastic reoil (inward pull) of exhalation and active force (outward oull) of inspiration.

Question 32

Maximal inspiritory pressure and maximal expiratory pressure are measures of _____. The can be used as a guide for intubation and can indicate the presence of ____

Answer 32

muscle strength; NM dx.

Question 33

normal partial pressure of O2 (PaO2) of blood at room air is ___. Hypoxemia occurs when it reaches___. Hyperoxemia is ____

Answer 33

95-100mmHg; < 90mmHg; >100mmHg

Question 33

what does FiO2 represent? How does it relate to supplemental O2? what is normal?

Answer 33

the O2 content of the environment; normal is ~ 21% and supplemental O2 is meant to increase this.

Question 34

normal range for body pH

Answer 34

7.35- 7.45

Question 35

normal range for body CO2

Answer 35

35-45 mmHg

Question 36

normal range for HCO3

Answer 36

22-28 mEq/L

Question 37

describe pectus excavatum

Answer 37

sunken chest

Question 38

describe pectus carinatum

Answer 38

barrel chest

Question 39

normal breath sounds or,____, sounds, are heard throughout all of ___ and begining of ___

Answer 39

vesicular; inspiration/expiration

Question 40

the best place to hear bronchial sounds is the ___

Answer 40

right superior anterior thorax.