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Pulmonary exam Flashcards

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USMLE® Step 1 flashcards
1
Q

What risk factor put a patient into the “very severe” category for COPD?

A
  • FEV<30%

- Or presence of chronic respiratory failure or right heart failure

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2
Q

What are the elastic factors of breathing?

A

lung compliance
chest wall compliance
compliance-ability of tissue to expand (change in volume/change in pressure), 1/elasticity

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3
Q

What are the non-elastic factors of breathing?

A

airway resistance
surface tension- surfactant
tissue elasticity-elastin/collagen, muscle properties/skeletal alignment

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4
Q

Work of breathing

A

the work of the respiratory muscles to overcome the elastic factors and resistance forces needed to expand the lungs and chest wall

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5
Q

Effect of decreased lung compliance on WOB

A

decreases work of breathing

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6
Q

Increasing airway resistance effect on WOB

A

increases work of breathing

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7
Q

Effect of breathing more rapidly and more deeply on WOB

A

-increases the work of breathing

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8
Q

Restrictive lung disease

A

lung diseases that cause REDUCED EXPANSION of lung and/or chest wall
-decreased respiratory compliance

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9
Q

Examples of restrictive lung disease

A

pneumonia, atelectasis, pleural effusion, IPF

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10
Q

pulmonary interstitial disease

A

chronic interstitial lung disease can be caused by known etiologic agents (drugs, toxins) OR
interstiitial pulmonary fibrosis, sarcoidosis, collagen vascular disease

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11
Q

What specific lung volumes are decreased with restrictive lung disease?

A

inspiratory reserve volume

residual volume

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12
Q

IPF (idiopathic pulmonary fibrosis) beginning symptoms

A

-alveolitis: accumulation of inflammatory cells in the interstium and alveolar spaces- immune and inflammatory cells

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13
Q

End-stage IPF characteristics

A

fibrotic lung with useless airspaces; characterized as cystic spaces separated by thick bands of connective tissue with inflammatory cells

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14
Q

Fick’s law- rate of diffusion

A

(area x (P1-P2) x diffusion constant)/thickness of membrane

-passive exchange of gas between lung and blood & blood and tissues/organs

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15
Q

2 classifications of pneumonia

A

Community-acquired pneumonia: contracted outside of hospital

Hospital acquired pneumonia

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16
Q

Areas of pneumonia infection in the lung

A
  • entire lobe
  • segment of lobe
  • alveoli contiguous to bronchi
  • interstitial tissue
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17
Q

Complications of pneumonia

A

-fever/chills/tachycardia /tachypnea
-sputum
-pleurisy (painful chest wall)
-abscess
pleural effusions/empyema

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18
Q

atelectasis

A

lung collapse due to loss of air volume- failure of lungs to inflate

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19
Q

pneumothorax

A

abnormal presence of air in the pleural cavity resulting in the collapse of the lung

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20
Q

2 types of pneumothorax

A

spontaneous: rupture of sub pleural blobs
traumatic: lung puncture/liine instertion, etc.

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21
Q

pleural effusion

A

excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs
- can impair breathing by collapsing underlying lung

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22
Q

pulmonary edema

A
  • fluid accumulation in the lungs
  • impairs gas exchange and may cause respiratory failure
  • DOE, pink frothy sputum
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23
Q

Causes of pulmonary edema

A
  1. failure of heart to remove fluid from lung circulation

2. injury to the lung parenchyma or pulmonary vasculature

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24
Q

COPD

A

-preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Airflow limitation not fully reversible. Usually progressive

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25
Q

3 subsets of disease comprising COPD

A
  • chronic bronchitis
  • asthma
  • emphysema
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26
Q

pneumothorax

A

abnormal presence of air in the pleural cavity resulting in the collapse of the lung (spontaneous or due to injury_

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27
Q

hemothorax

A

abnormal presence of air in the blood

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28
Q

pleural effusion

A

excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs
-impair breathing

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29
Q

pulmonary edema

A

fluid accumulation in the lungs

  • impairs gas exchange
  • may cause reap. failure
  • difficulty breathing, DOE
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30
Q

causes of pulmonary edema

A
  1. failure of the heart to remove fluid from the lung circulation
  2. injury to the lung parenchyma or pulmonary vasculature
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31
Q

causes of COPD

A

chronic bronchitis, emphysema, asthma

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32
Q

Brochiectasis/cystic fibrosis

A

obstructive diseases

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33
Q

COPD

A

Chronic obstructive pulmonary disease

  • preventable and treatable disease with some extra pulmonary effects
  • airflow limitation (not fully reversible)
  • airflow limitation progressive and associated with inflammatory responses of the lung
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34
Q

risk factors for COPD

A
  • aging
  • cigarette smoke
  • occupational dust/chemicals
  • socioeconomic status
  • nutrition
  • infection
  • indoor/outdoor air pollution
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35
Q

what is the success of smoking cessation

A

<30%

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36
Q

Change in FEV1 decline in smokers

A

Increased rate of FEV1 decline

smoking cessation decreases rate of FEV1 decrease

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37
Q

more COPD deaths in men or women?

A

in past men, but women surpassed this rate in 2000

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38
Q

COPD effect of FEV1

A

decreased

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39
Q

COPD effect of FEV1 on FRC and RV

A

increased (hyperinflation)

40
Q

What factors does airflow obstruction result from?

A
  • anatomic airway narrowing (bronchoconstriction/inflammation)
  • loss of elastic recoil of the lung
41
Q

chronic bronchitis

A

persistent cough with sputum production for at least 3 months in at least 2 consecutive years

  • smoking includes predisposition
  • progressive dyspnea on exertion
  • may progress to for pulmonale (right heart failure)
42
Q

Emphysema

A

-permanent, destructive abnormal enlargement of the air spaces distal to the terminal bronchiole with destruction of the alveolar walls without obvious fibrosis

43
Q

Characteristics of emphysema (FEV, gas exchange)

A

Decreased FEV
1/3 of lung function must be lost for clinical manifestations to appear
Impaired gas exchange

44
Q

clinical signs of emphysema

A 
DOE, decreased ex. capacity
hyperinflation/chest deformation
hypertrophy of accessory breathing muscles
wheezing
clubbing of digits
weight loss
45
Q

Emphysema underlying action

A

pleural pressures become greater than alveolar pressures, the tubing will collapse

46
Q

Bronchiectasis and cystic fibrosis

A
  • disorders associated with mucus hyper secretion
  • localized irreversible dilation of bronchial tree
  • cough, fever,
47
Q

Cystic fibrosis

A
  • genetic alteration in chromosome 7

- mucus hypersecretion and plugging combined with repeated infections leading to bronchiectasis and airway obstruction

48
Q

Other organs impaired by CF

A

pancreas
digestive tract
musculoskeletal

49
Q

***3 major factors of CF (bronchiectasis)

A

infection
inflammation
obstruction

50
Q

etiology of bronchiectasis

A
  • bronchial enlargement w obstruction

- results from multiple causes including PNA, tuberculosis, tumor, asthma, CF, kartagener syndrome

51
Q

asthma

A

characterized by chronic airway inflammation and bronchospasm
-history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time

52
Q

Areas of systems review for pulmonary exam

A
  • cardiovascular
  • integumentary
  • pulmonary
  • musculoskeletal
  • neuromuscular
53
Q

5 components of pulmonary exam

A

inspection, palpation, percussion, auscultation, activity

54
Q

tachypnea/bradypnea

A

tachypnea=>20 bpm

bradypnea=<10 bpm

55
Q

kussmaul’s breathing

A

consistent, very deep breathing pattern at a normal or increased rate
-associated w severe metabolic acidosis- form of hyperventilation

56
Q

cheyne stokes breathing

A

creschendo-decrescendo pattern in the depth of respirations with periods of apnea (HF, CVA, TBI)

57
Q

phases of cough

A

irritation
inspiration
compression
expulsion

58
Q

things to check in sputum

A

color, amount, thickness, presence/odor

59
Q

Situations when the trachea deviates towards the affected lung

A

atelectasis

fibrosis

60
Q

Situations when the trachea deviates away from midline

A

pleural effusion
tension pneumothorax
(shifted contralateral)

61
Q

tactile fremitus

A

palpable vibration produced during breathing caused by partial airway obstruction. Can be due to mucus, other secretions in airway, constriction, tumors

62
Q

In which conditions is there increased tactile fremitus

A
  • consolidation
  • large airway
  • pulmonary edema
63
Q

decreased tactile fremitus

A

pneumothorax/pleural effustion

64
Q

conditions with tympanic percussion

A

pneumothorax/airtrapping

65
Q

conditions with dull percussion

A

-consolidation (PNA), atelectasis, pleural effusion

66
Q

normal tracheal breath sounds

A

loud/high pitched
expiration longer than inspiration
short pause between I and E

67
Q

normal bronchovesicular BS

A

heard around sternum/between scapula

I and E are equal duration/loudness- no pause

68
Q

Normal vesicular BS

A
  • heard over majority of lung periphery

- inspiration louder and longer than expiration- very quiet

69
Q

Wheezing

A

small airways= high pitch=sibilant rhonchi

large airways=low pitch=rhonchi

70
Q

Crackles/rales

A

-bubbling/fizz- moist or dry
-primarily heard on inspiration
large airways= low pitch
small airways= high pitch

71
Q

diminished breath sounds

A

hyperinflation
air, fluid, blood between lung and chest wall
-airway blockage
-obesity

72
Q

pleural friction rub

A
  • heard through respiratory cycle
  • creaking leather/rubbing balloon
  • pleural membrane inflammation
73
Q

Absolute contraindications for airway clearance therapy

A

head and/or neck injury not yet stabilized

active hemorrhage with hemodynamic instability

74
Q

other contraindications for airway clearance

A 
bleeding abnormalitites
recent pacemaker insertion
burn/skin grafts to the chest
pulmonary hemorrhage
head injury
hypoxia
vomiting/aspiration
75
Q

Amount of time for positioning

A

> /= 5 min

76
Q

Ways to alter breathing through exercise/retraining

A
  • change rate
  • change depth
  • change muscular pattern/breathing pattern
77
Q

potential benefits of breathing exercise/retraining

A
  • reduce work of breathing (decrease RR, increase tidal volume), decrease accessory muscle use
  • improve oxygenation and CO2 removal
  • remove/loosen secretions
  • maintain or improve thoracic mobility
78
Q

types of breathing exercises

A
  • diaphragmatic breathing
  • pursed lip breathing
  • deep breathing/incentive spirometry
  • segmental/lateral costal expansion
79
Q

goals of oxygen therapy

A
  • correct hypoxemia
  • decrease symptoms associated with hypoxemia
  • decrease workload on cardiopulmonary system
80
Q

precautions of oxygen therapy

A
  • oxygen toxicity
  • depression of ventilation
  • retniopathy of prematurity
  • absorption atelactasis
  • bacterial infection w humidifiers
81
Q

The number one rehabilitative procedure

A
  • LE aerobic training: helps patient become more functional and less short of breath
  • DOES NOT improve lung function: may feel better/walk further, but FEV1 will STAY THE SAME
82
Q

What 3 main factors does lung disease impact?

A

ventilation (FEV1…)
cardiac (decreased CO…)
skeletal muscle (deconditioning…)

83
Q

Types of exercise prescription for pulm. rehab

A
  • aerobic
  • inspiratory muscle training
  • strength training
  • LE- treadmill
  • UE-UE ergometer
  • UE/LE isotonic
84
Q

Intensity of exercise prescription

A

3-5 on borg

Initially 60% peak workload, goal of >80% peak workload

85
Q

Time and frequency of ex. training

A

30-40 min continuously
If >5 MET’s , 3-5/wk
3-5 METs 1-2/day
<3 MET- multiple/day

86
Q

Benefits of plum. rehab

A 
improved exercise capacity
improved muscle strength
reduced dyspnea
improve QOL
reduced readmission rates/length of stay in COPD
87
Q

MRC breathlessness scale

A

Grade 1: not trouble by breathlessness except during strenuous activities
Grade 5: too breathless to leave the house, or breathless when undressing

88
Q

difference between MRC and Borg

A

Borg evaluates dypnea before during, after exercise, while the MRC scale is based on degrees of various physical activities that precipitate dypnea

89
Q

In which conditions does chest wall excursion decrease?

A

Pneumothorax, pleural effusion, pneumonia, CF, COPD, IPF

90
Q

In which conditions will tactile fremitus be decreased

A

pneumothorax, pleural effusion, COPD

91
Q

In which conditions will tactile fremitus be increased?

A

penumonia, CF, bronchiectasis

92
Q

Peripherally inserted central catheter

A
  • intravenous access that can be used for a prolonged period of time: antibiotics, chemo, TPN
  • insterted peripherally and advanced to superior vena cava
93
Q

Central venous catheter

A
  • used for motoring in ICU (right trial pressure)
  • administration of meds/fluid
  • venous blood sampling
  • reduces number of venous punctures and allow for simultaneous administration of drugs
94
Q

common problems w IV in PT

A

inflammation/pain due to infection
accidental dislodgment
infiltration
clot formation

95
Q

what do dysrhthmias result from?

A

altered conduction, automaticity or both

96
Q

when is a pacemaker/defibrillator indicated?

A

dysrhythmia results in: hemodynamic instability, life threatening, symptomatic limitations

97
Q

Indications for a defibrilator

A

v-fib or v-tach

Medical Conditions (3 decks)

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