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NPTE Final Frontier > Pulmonary Exam > Flashcards

Pulmonary Exam Flashcards

1
Q

Lung Volumes:

Volumes Vs Caps (adding 2 things)

ALL FIRST: CHART

A

SEE PICS

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2
Q

Lung Volumes:

Volumes:
Tidal Volume

A

Normal Breathing
500 ml

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3
Q

Lung Volumes:

Volumes:
Tidal Volume

A

Normal Breathing
500 ml

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4
Q

Lung Volumes:

Volumes:
Inspiratory Reserve Volume
IRV

A

“Take deep breathe in, then breathe in AGAIN as much as you can”
- More air IN AFTER normal inhale
- 5-6x TV

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5
Q

Lung Volumes:

Volumes:
Expiratory Reserve Volume
ERV

A

“Breathe OUT, then breathe out AGAIN as much as possible”
- Extra air OUT AFTER normal exhale
- 2-3x TV

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6
Q

Lung Volumes:

Volumes
Residual Volume
RV

A

“Air that hangs out in the lungs”
- Air left AFTER expiration or ERV
- STAYS in lungs
- This is why IRV > ERV

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7
Q

Lung Volumes:

Capacities:
Inspiratory Capacity

Think adding 2 things (volumes) TOGETHER

A

TV + IRV

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8
Q

Lung Volumes:

Capacities:
Vital Capacity

A

“Air in lungs that is VITAL (not including RV)
- ERV + IRV + TV

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9
Q

Lung Volumes:

Capacities:
Total Lung Capacity
TLC

A

ALL Volumes!
RV + ERV + TV + IRV

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10
Q

Lung Volumes:

Capacities:
Functional Residual Capacity

A

ERV + RV

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11
Q

Lung Volumes:

Ex. COPD

A

INC RV, so INC FRV and INC TLC
bc ALL CONNECTED!!!
See chart and it makes sense!!!

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12
Q

Lung Volumes:

Tidal Volume
TV

500mL

A

500 mL
- air inspired during normal, relaxed breathing

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13
Q

Lung Volumes:

Inspiratory Reserve Volume
IRV

A

3,100 mL
- ADD. air that can be forcibly inhaled AFTER inspiration of normal TV== 5-6x TV
- inspired air OVER and ABOVE tidal volume

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14
Q

Lung Volumes:

Expiratory Reserve Volume
ERV

A

1200mL
- Add. air that can be forcibly EXHALED after the expiration of Norm TV
- Expired OVER tidal volume

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15
Q

Lung Volumes:

Residual Volume (RV)

1200 mL

A

1200 mL
- Volume of air still remaining in lungs after the ERV is exhaled
- ALWAYS PRESENT IN LUNGS

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16
Q

Lung Volumes:

TOTAL Lung Capacity
TLC

6000 mL

A

6000 mL
- MAX amt of air that can FILL the lungs
- TV + IRV + ERV + RV (EVERYTHING)

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17
Q

Lung Volumes:

Vital Capacity
VC

A

4800 mL
- TOTAL amt of air that can be expired AFTER fully INhaling
- TV + IRV + ERV–> approx 80% of TLC

NOTE: RV NOT included
Value varies according to age/body size

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18
Q

Lung Volumes:

Inspiratory Capacity
IC

A

3600 mL
- MAX amt of air tht can be INspired
- TV + IRV
- MAX INSPIRATION

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19
Q

Lung Volumes:

Functional Residual Capacity
FRC

A

2400 mL
- Amt of air remaining in lungs AFTER normal expiration
- RV + ERV (kinda like IC, but w/ EXHALE (ERV)
- Air is in lungs AFTER you’ve expired TV

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20
Q

NOTE: What is ALWAYS INCREASED in COPD?

A

INC RV, FRC, TLC

ALL CONNECTED!

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21
Q

Practice!
PT performs spirometry to assess lung functoin. PT tells pt he would like to assess amt of air in lungs AFTER norm exhale. Which volume?

A

Expiratory Reserve Volume (ERV)

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22
Q

Lung Volumes: Comparison

Normal vs Obstructive

A

Cannot get air OUT!
- Note INCd TLC, FRC, RV

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23
Q

Measurements:
Obstructive (CBABE, cannot get air OUT) vs Restrictive (cannot get air IN)

A

see table

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24
Q

Tidal Volume (VT)
Obst vs Restrict

A

O: N or INC
R: N or DEC

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25
Q

IC
Obst vs Restrict

A

O: N or DEC
R: N or DEC

26
Q

ERV
Obst vs Restrict

A

O: N or DEC
R: N or DEC

27
Q

Vital Cap.
O vs R

A

O: N or DEC
R: N

28
Q

Forced Vital Cap
O vs R

A

O: N or DEC
R: DEC

29
Q

RV
O vs R

A

O: N or INC
R: N or DEC

30
Q

FRC
O vs R

A

O: N or INC
R: N or DEC

31
Q

TLC
O vs R

A

O: N or INC
R: DEC

32
Q

FEV1
O vs R

A

O: DEC
R: N

33
Q

Practice!
52yo male w/ COPD and exp wheezing, tightness chest, coughing worse @ night. DOE, uses access mm’s to breath. MOST LIKELY INCd on PFT?

A

COPD
INC RV, TLC, FRC (ERV + VT)

34
Q

COPD GOLD Classification

Stages I (Mild) to Stage IV (Very severe)

A

Stage I (Mild)
- FEV1= >80
- FEV1/FVC= <.7
- Chronic cough + sputum

Stage II (Mod)
- FEV1= 50-80
- FEV1/FVC= <.7
- Chronic cough + Sputum + Dyspnea

Stage III (Severe)
- FEV1= 30-50
- FEV1/FVC= <.7
- Chronic cough + sputum + INC dyspnea

Stage IV (Very severe)
- FEV1= <30
- FEV1/FVC= <.7
- Chronic cough + sputum + DOUBLE INC dyspnea
- Resp or R. HF, Wt loss

<.7 FEV1/FVC= COPD**remember lOw for Obstructive (Looower)

35
Q

Practice!
78yo w/ acute exacerb. COPD. FEV1 40% (30-50, severe) and FEV1/FVC <.7 w/ SOB during amb. GOLD class?

A

SEVERE
Chronic cough + sputum + INC (1arrow) dyspnea

36
Q

Practice!
58yo pt has COPD. During exam PT finds pt has weak wet cough. Which is approp to clear secretions?

A

Huffing–think fogging mirror, huffing feather off hand
- Gentler form of coughing to remove secretions. EASIER to move mucus out of lungs and stabilize airways, prevents collapse

37
Q

NORMAL Breath Sounds
Remember: V-Bv-B-T (Very Big Boobs Tits)

Easiest way to remember? Organize like this!!

A

Intensities:
- Go from SOFTER to VERY loud

Pitch of Expiratory:
- Go from LOW to Rel. High

38
Q

NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits)

Vesicular (gentlest)

A

Duration: INSP longer than EXP
Intensity: SOFT
Pitch of Exp.: LOW
Location: Over MOST of lungs**

39
Q

NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits)

Bronchovesicular

A

Duration: INSP and EXP EQUAL
**Intensity: **Intermed.
**Pitch of Exp: **Intermed.
**Location: ** Bw 1st and 2nd interspace ANT. and bw scapulas

40
Q

NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits)

Bronchial

A

Duration: EXP sounds longer than INSP (just flips from vesicular)
Intensity: LOUD
Pitch of Exp: HIGH
Location: Over manubrium (lower vs Bv)

41
Q

NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits)

Tracheal (its in the name)

A

Duration: Both INSP and EXP EQUAL (same as Bv)
Intensity: VERY Loud
Pitch of Exp: Rel. High
Location (in the name): Over trachea in neck

42
Q

Normal Breath Sounds:
Another way to remember…

A
  • Vesicular: VESSELS on the ocean have to be SOFT to float and its for sailiing/riding beginners
  • Bronchovesicular: When riding a BRONCO in a VESSEL on the ocean, it’s NOT for beginners but also not a hard lvl for sailing/riders, so it’s INTERMED.
  • Bronchial: Riding a BRONCO is LOUD and for those only prepared since it can get crazy (HIGH)
  • Tracheal: A TRAKE (DRAKE) concert gets VERY LOUD no matter who you are, so you know TRAKE (DRAKE) is VERY LOUD
43
Q

PRACTICE!
Which sound is PT auscultating?

MOST of the lungs!

A

Vesicular

44
Q

Abnormal Resp Sounds:
RWCP

A

Rhonchi- think snoring LOW
Wheeze- think WHistle
Crackles- think Snap, Crackle, Pop HIGH
Pleural rub- think sandpaper

45
Q

Abnormal Resp Sounds:

Rhonchi
Think Ryan snores LOW

Snoring LOW

A
  • continuous, LOW PITCHED rattling sounds often resemble Snoring.
  • COPD, Bronchiectasis, PNA, Chronic bronchitis, CF

This is the only LOW one

46
Q

Abnormal Resp Sounds:

Wheeze
Think Wheeze, Whistle HIGH

A
  • high pitched heard in EXP (wheeze has lots of E’s so EXP.).
  • Airway obstruct–> asthma, COPD, aspiration (if severe, heard during INSP also)
47
Q

Abnormal Resp Sounds:

Crackles (bubble wrap pop)
Think snap, Crackle, POP HIGH

Blowing thru straw in water makes bubbles

A
  • brief, DIScontinuous, Popping sounds HIGH-pitched
  • prev Rales– heard during BOTH Insp/Exp
48
Q

Abnormal Resp Sounds:

Pleural rub
Think sandpaper…literally

A
  • Auscultate lower lat. chest–INSP and EXP
  • Pleural inflammation!
49
Q

PRactice!
76yo w/ s/s CHF. During auscultation, PT frinds S3 (CHF). Which high-pitched sound MOST likely assocd w/ CHF?

A

Crackles–snap, crackle, pop HIGH
- CHF= S3 + crackles (pop HIGH)

50
Q

More on S3 vs S4

A

S3
- Ventricular gallop
- CHF, Crackles, Dyspnea
CHF–tachypnea, pulm edema, PND, orthopnea
S4
- Atrial gallop
- MI/HTN

51
Q

Voice Sounds:
3 types and what they use

A
  1. Bronchophony: “99”
  2. Egophony: Long “E” sounds
  3. Whispered pectoriloquy: Whispering
52
Q

Voice Sounds

Bronchophony

A
  • Incd Vocal Resonance w/ greater clarity and loudness of spoken words
  • Ex. 99

Aka if you hear “99” loud/clear==> Secretions

should be muffled= normal

53
Q

Voice Sounds

Egophony

A

Form of Bronchophony in which the spoken long “E” sounds changes to long, nasally-sounding “A”
aka if you hear “A” loud/clear== Secretions

Muffled= normal

54
Q

Voice Sounds

Whispered pectoriloquy

A
  • Incd loudness of whispering
  • recognition of whispered words (you’ll hear loudly) “1, 2, 3”

aka if you hear 1, 2, 3 LOUD==Secretions

Muffled= normal

55
Q

PRactice!
PT assesses voice sounds. Stethoscope over thorax and asks to say “E” (Egophony!)

A

Egophony is “E” one!!

You will hear it as “A”

56
Q

Abnormal Blood Gases
What SHOULD values be?

A

pH= 7.35-7.45
CO2= 35-45
HCO3-= 22-26

See table

57
Q

Resp vs Met Acidosis vs Alkalosis

A

Resp== CO2 changes (lungs)
Met== HCO3- changes (kidneys)
- Resp acidosis–> pH DEC, CO2 INC, HCO3- Norm
- Resp alkalosis–> pH INC, CO2 DEC, HCO3- Norm
- Metabolic acidosis–> pH DEC, CO2 Norm, HCO3- DEC
- Metabolic alkalosis–> pH INC, CO2 Norm, HCO3- INC

58
Q

Resp vs Met Acidosis vs Alkalosis
ROME
Resp Opposite
Metabolic Equal

A

ROME
Resp Opp
- pH high, CO2 down= alkalosis
- pH low, CO2 high= acidosis

Metabolic Equal
- pH high, HCO3 high= alkalosis
- pH low, HCO3 low= acidosis

59
Q

PRactice!
What is going on here?

A

Metabolic ALKalosis
pH High, HCO3- High= Met alkalosis

60
Q

Resp vs Met Acid/Alkalosis
STEPS!

A
  1. Look @ pH: IF Norm= 7.35-7.45, answer is compensated
  2. Look @ PaCO2: IF Norm= 35-45, answer is metabolic
  3. Look @ HCO3-: IF Norm= 22-26, answer is respiratory
  4. NONE of three are normal: answer is Partially compensated
61
Q

Practice!
Chronic smoker w/ COPD undergoes ABG. (COPD usually HIGH CO2 bc cannot get air OUT!) MOST LIKELY to see on ABG?

A

INCd PaCO2, DECd PaO2, DECd pH

NPTE Final Frontier (19 decks)

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