Pulmonary Examination

Question 1

Tidal volume (TV)

Answer 1

500 mL

Air inspired during normal, relaxed breathing

Question 2

Inspiratory reserve volume (IRV)

Answer 2

3100 mL

Additional air that can be forcibly inhaled after the inspiration of a normal tidal volume

*inspired OVER and ABOVE tidal volume

Question 3

Expiratory reserve volume (ERV)

Answer 3

1200 mL

Additional air that can be forcibly exhaled after the expiration of a normal tidal volume

*Expired OVER tidal volume

Question 4

Residual volume (RV)

Answer 4

1200 mL

Volume of air remaining in the lungs after the expiratory reserve volume is exhaled

Always present in the lungs

Question 5

Total lung capacity (TLC)

Answer 5

6000 mL

Max amount of air that can fill the lungs

TLC = IRV + TV + ERV + RV

Question 6

Vital capacity (VC)

Answer 6

4800 mL

Total amount of air that can be expired after fully inhaling

VC = IRV + TV + ERV = ~80% TLC

Value varies according to age and body size

Question 7

Inspiratory capacity (IC)

Answer 7

3600 mL

Max amount of air that can be inspired

IC = TV + IRV

Question 8

Functional residual capacity (FRC)

Answer 8

2400 mL

Amount of air remaining in lungs after a normal expiration

FRC = ERV + RV

Question 9

Obstructive lung disease and lung volume changes

Answer 9

RV, FRC, TLC increases

All other values decrease

*TV increases or stays normal

Question 10

Restrictive lung disease and lung volume changes

Answer 10

All values decrease

*FEV1 stays the same

Question 11

Chronic obstructive pulmonary diseases (COPD)

Answer 11

CBABE

Cystic fibrosis
Bronchitis (chronic)
Asthma
Bronchiectasis
Emphysemaa

COPD cant get air OUT

Question 12

Restrictive lung diseases

Answer 12

Sarcoidosis
Lung fibrosis
Ankylosing spondylitis
Obesity
Burns
Pneumonia
Pneumothorax
Hemothorax
Pulmonary effusion

Question 13

GOLD classification - mild COPD

Answer 13

FEV1/FVC <70%

> /= 80% FEV1

With or w/o production of cough and sputum production

Question 14

GOLD classification - moderate COPD

Answer 14

FEV1/FVC = <70%

50-80% FEV1

SOB w/ exertion
With or w/o production of cough and sputum production

Question 15

GOLD classification - severe COPD

Answer 15

FEV1/FVC < 70%

30-50% FEV1

Greater SOB w/ exercise
Decreased exercise capacity
Fatigue and repeated disease exacerbation

Question 16

GOLD classification - very severe COPD

Answer 16

FEV1/FVC <70%

<30% FEV1 or <50% FEV1 + chronic respiratory failure

Respiratory failure
Signs of right heart failure/corpulmonale

(corpulmonale/pulmonary heart disease - when the right ventricle of the heart enlarges and fails due to high blood pressure in the lungs)

Question 17

FEV1

Answer 17

Forced expiratory volume in 1 sec

Volume of air exhaled in the 1st second under force after a max inhalation

Question 18

FVC

Answer 18

Forced vital capacity

Total volume of air that can be exhaled during a max forced expiration effort

Question 19

Vesicular breath sounds

Answer 19

Normal

Inspiratory longer than expiratory

Soft and low

Over most of the lungs

Question 20

Broncho-vesicular breath sounds

Answer 20

Normal

Inspiratory and expiratory duration equal

Intermediate intensity and pitch

Question 21

Bronchial breath sounds

Answer 21

Normal

Expiratory longer than inspiratory

Loud and high

Over manubrium

Question 22

Tracheal breath sounds

Answer 22

Normal

Inspiratory and expiratory equal duration

Very loud, very high

Over trachea

Question 23

Rhonchi breath sounds

Answer 23

Abnormal

Continuous, low pitched, rattling
Resemble snoring

Caused by air passing through airway obstructed by inflammatory secretions or bronchial spasms

COPD, bronchiectasis, pneumonia, chronic bronchitis, cystic fibrosis

Question 24

Wheeze breath sound

Answer 24

Abnormal

High pitched, heard in expiration, like whistling

Caused by airway obstruction (asthma, COPD, aspiration of foreign body)

When severe, can be heard in inspiration

Think of a kazoo

Question 25

Crackles breath sounds

Answer 25

Abnormal

Brief, discontinuous, popping, high pitched

Also termed rales, heard in inspiration and expiration

Represents mvmt of secretions or sudden opening of closed airways

Atelectasis, fibrosis, pulmonary edema, pleural effusion

Question 26

Pleural rub breath sounds

Answer 26

Abnormal

Heard in lower lateral chest with inspiration and expiration

Can indicate pleural inflammation

Rubbing of visceral and parietal pleurae

Question 27

Bronchophony voice sounds

Answer 27

Abnormal, due to secretions

Increased vocal resonance with greater clarity and loudness of spoken words. “99”

Question 28

Egophony voice sounds

Answer 28

Abnormal, due to secretions

The spoken long “E” sounds changes to a long, nasal “A” sound

Most commonly seen with pneumonia or pleural effusion

Question 29

Whispered pectoriloquy voice sounds

Answer 29

Abnormal, due to secretions

Increased loudness of whispering. Recognition of whispered words “1,2,3”

Question 30

Normal pH range

Answer 30

7.35 - 7.45

Question 31

Normal PaCO2 range

Answer 31

carbon dioxide

35-45 mmHg

Question 32

Normal HCO3 range

Answer 32

bicarbonate

22-26 mEg/L

Question 33

Respiratory acidosis

Answer 33

increase PaCO2, decrease pH, normal HCO3

ROME

Question 34

Respiratory alkalosis

Answer 34

decrease PaCO2, increase pH, normal HCO3

ROME

Question 35

Metabolic acidosis

Answer 35

decrease HCO3, decrease pH, normal PaCO2

ROME

Question 36

Metabolic alkalosis

Answer 36

increase HCO3, increase pH, normal PaCO2

ROME

Question 37

How to answer alkalosis/acidosis questions

Answer 37

1. Look at pH
   Normal 7.35 - 7.45: Answer is Compensated
2. Look at PaCO2
   Normal 35 - 45: Answer is Metabolic
3. Look at HCO3
   Normal 22 - 26: Answer is Respiratory
4. None of the three are normal:
   Answer is Partially Compensated