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BOARDS: Pulmonary > Pulmonary exam > Flashcards

Pulmonary exam Flashcards

1
Q

How do you calculate pack years?

A

number of packs per day x years smoked

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2
Q

What RR indicates tachypnea?

A

> 20 breaths/min

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3
Q

What is cor pulmonale?

A

dilation of R ventricle d/t chronic lung disease

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4
Q

Typical tidal volumes for adults and children?

A 
adults = 500ml
children = 20ml

TV = volume of gas inhaled (or exhaled) over normal breath

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5
Q

Where will you see cyanosis if it’s present in your patient?

A

lips, around the eyes, nail beds

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6
Q

What is a sign of chronic hypoxemia found in the fingers/nailbeds?

A

digital clubbing

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7
Q

With obstructive pulmonary disease, what happens to the A-P dimension of the chest?

A

increases

- lung recoil is decreased, resulting in barrel chest, increased AP dimension

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8
Q

What is typical thoracic excursion in adults and how do you measure this?

A

2-3in, measured by base of lungs from full inspiration to full experiation

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9
Q

When auscultating your patient, you hear vesicular sounds. What are these?

A

normal breath sounds (heard all through inspiration, beginning of exp)

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10
Q

What do decreased breath sounds sound like? Associated with what kind of lung disease?

A

distant sounds where only some of inspiration is heard

- associated with obstructive lung disease (maybe restrictive though?)

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11
Q

What type of lung sound might you hear with atelectasis, fibrosis, or pulmonary edema?

A

crackles/rales

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12
Q

Your patient has a thoracic burn. What should you make sure to assess in your pulmonary assessment?

A

symmetric thoracic expansion

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13
Q

What are key points to assess with pulmonary inspection/palpation?

A

1) neck - trachea position, accessory muscle use

2) thorax - changes in bony thorax, AP dimension, symmetrical excursion, changes in skin, pain, scars

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14
Q

Where in the lung will you hear more intense inspiration/expiration sounds upon auscultation?

A

more loud/intense at apex

quieter at bases

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15
Q

What are the two adventitious breath sounds?

A

wheezes (heard on expiration)

rales (heard on inspiration)

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16
Q

What is atelectasis?

A

partial/complete collapse of the lunge

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17
Q

What is a pneumothorax?

A

presence of air/gas in the cavity between the lungs and chest wall, causing compression of the lung
- can cause atelectasis

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18
Q

Your patient has aspirated a foreign body. What adventitious breath sound might you hear?

A

wheezes

- vs crackles heard during atelectasis, fibrosis, or pulmonary edema

19
Q

Your patient with COPD might demonstrate what adventitious breath sound?

A

wheezes (which are caused by airway obstruction)

20
Q

What is pulmonary edema? What can cause it?

A

fluid in the lungs

  • fluid collects in the sacs, making it difficult to breathe
  • can be caused by congestive heart failure, or kidney failure (inability to excrete fluid from body, builds up in blood vessels)
21
Q

What is congestive heart failure?

A

heart dysfunction that causes fluid buildup in lungs and surrounding tissue

22
Q

What does normal transmission of vocal sounds sound like?

A

same as breath sounds: loudest near trachea and main-stem bronchi
- less clear but still intelligible at distal areas of lungs

23
Q

If you can hear vocal sounds intensely and clearly in the bases of the lungs, what is this dysfunction called?

A

bronchophony

24
Q

Why might there be abnormal transmission of vocal sounds?

A

fluid filled areas, areas of consolidation, cavitation lesions, pleural effusions

25
Q

What is pleural effusion? Caused by what? How is it commonly treated?

A

excess fluid buildup between the lungs and the chest

  • most commonly caused by congestive heart failure
  • commonly treated with diuretics
26
Q

Why would a chest x-ray be performed for a patient? (2)

A

1) to detect presence of abnormal material (exudate, blood)

2) change in pulmonary parenchyma (fibrosis, collapse)

27
Q

What is exudate?

A

protein-rich fluid with other cellular elements that oozes out of blood vessels d/t inflammation and is deposited in nearby tissues

  • fluid that leaks out around cells of capillaries
28
Q

What type of scan might be performed to assess for the presence of pulmonary emboli?

A

V/Q scan - matches the ventilation pattern of the lung to the perfusion pattern

29
Q

What is ventilation? Perfusion?

A 
ventilation = air getting into alveoli
perfusion = blood getting transported to alveoli in lungs
30
Q

What is alveolar ventilation?

A

ability to remove CO2 from blood and maintain blood pH

31
Q

Your patient exhibits dizziness, syncope, N/T. You check their chart prior to the session and recall that they’re lab values indicate a most recent pH of 7.6. and PaCO2 of 30. What could be occuring?

A 
respiratory alkalosis
(decreased pH = more alkaline)
32
Q

What are the 4 types of abnormal acid-base balance?

A

respiratory alkalosis/acidosis

metabolic alkalosis/acidosis

33
Q

What abnormal acid-base balance issue causes secondary hyperventilatino, nausea, lethargy, and/or coma?

A

metabolic acidosis

  • both respiratory and metabolic acidosis can cause coma, more issues here than alkalosis
34
Q

T/F: PaCO2 remains WNL for respiratory acidosis.

A

false -> remains the same for metabolic acidosis AND alkalosis

  • increases for respiratory acidosis
35
Q

A combination of a high pH and low PaCO2 can cause what?

A

respiratory alkalosis

- remember PaO2 only changes with respiratory acidosis/alkalosis

36
Q

What does an FEV1/FVC value

A

obstructive lung issue decreasing airflow

37
Q

What is FEV1?

A

amount of air that can be expelled in 1 sec

38
Q

What is FVC?

A

forced vital capacity: how much air can be forcefully expelled after a full inhale

39
Q

How many categories of obstructive lung disease are there?

A

4: mild, mod, severe, very severe

40
Q

At what stage of obstructive lung disease do patients start to seek out medical care?

A

2 - may have an exacerbation or may have chronic respiratory problems

41
Q

At what stage of obstructive lung disease is FEV1 <50%?

A

stage 3: <50 but >30

42
Q

Cor pulmonale, increased JVD are signs of what stage of obstructive lung disease?

A

stage 4 - very severe

43
Q

What is cor pulmonale?

A

abnormal enlargement of the R side of the heart d/t failure

BOARDS: Pulmonary (7 decks)

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