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NPTE > Pulmonary Examination > Flashcards

Pulmonary Examination Flashcards

1
Q

Tidal Volume

A

Normal amount of air inhaled & exhaled

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2
Q

Inspiratory Reserve Volume

A

Extra amount of air during forced inhalation.

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3
Q

Expiratory Reserve Volume

A

Extra amount of air during forced exhalation.

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4
Q

Residual Volume

A

Air left over in lungs that never leaves

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5
Q

Total Lung Capacity

A

Max amount of air that can fill the lungs.
TLC = IRV + TV + ERV + RV.
*Sum of all 4 volumes.

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6
Q

Inspiratory Capacity

A

Max amount of air that can be inspired.
IC = IRV + TV.

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7
Q

Vital Capacity

A

Amount of air that can be expired after a full inhalation.
VC = IRV + TV + ERV.

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8
Q

Functional Residual Capacity

A

Amount of air remaining in the lungs after a normal expiration.
FRC = ERV + RV

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9
Q

How do volumes/capacities change with obstructive diseases?

A

-RV increases (so TLC & FRC also increase).
-TV increases or no change.
-Everything else decreases.

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10
Q

How do volumes/capacities change with restrictive diseases?

A

Everything decreases

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11
Q

COPD is classified based on what values?

A

-FEV1/FVC (<70% for all stages)
-FEV1 % predicted

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12
Q

Mild COPD

A

FEV1/FVC < 70%
FEV1 >80%

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13
Q

Moderate COPD

A

FEV1/FVC < 70%
FEV1 = 50-80%

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14
Q

Severe COPD

A

FEV1/FVC < 70%
FEV1 = 30-50%

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15
Q

Very Severe COPD

A

FEV1/FVC < 70%
FEV1 <30%
or
FEV1 <50% plus chronic respiratory failure

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16
Q

List the normal breath sounds

A

Vesicular
Broncho-vesicular
Bronchial
Tracheal

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17
Q

Vesicular breath sound: location, duration, pitch, & intensity

A

Location: most of the lungs.
Duration: inspiratory longer than expiratory.
Pitch: low.
Intensity: soft.

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18
Q

Broncho-Vesicular breath sound: location, duration, pitch, & intensity

A

Location: anterior 1st/2nd IC spaces, posterior btwn scapulae.
Duration: inspiratory longer than expiratory.
Pitch: medium.
Intensity: medium.

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19
Q

Bronchial breath sound: location, duration, pitch, & intensity

A

Location: manubrium.
Duration: expiratory longer than inspiratory.
Pitch: high.
Intensity: loud.

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20
Q

Tracheal breath sound: location, duration, pitch, & intensity

A

Location: trachea.
Duration: inspiratory longer than expiratory.
Pitch: high.
Intensity: very loud.

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21
Q

List the abnormal breath sounds

A

-Rhonchi
-Wheeze
-Crackles (AKA Rales)
-Pleural rub

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22
Q

Rhonchi sounds like…? What conditions can it be heard with?

A

Low pitch; continuous rattling or snoring.
-COPD
-CF
-Bronchitis
-Bronchiectasis
-Pneumonia

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23
Q

Wheeze sounds like…? What conditions can it be heard with?

A

High pitch on expiration; whistling.
-COPD
-Asthma
-Aspiration of foreign object

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24
Q

Crackles (Rales) sounds like…? What conditions can it be heard with?

A

High pitch, discontinuous popping.
-Pulmonary edema
-Secretions
-CHF

25
Q

Pleural Rub sounds like…? What conditions can it be heard with?

A

Sandpaper rubbing; lower lateral chest areas.
-Pleural inflammation

26
Q

Abnormal voice sounds indicate…? What do they sound like (compared to normal)?

A

Indicates secretions.
Normal should be difficult to hear.
Abnormal is amplified thru stethoscope.

27
Q

Bronchophony

A

“99”
Greater clarity & loudness.

28
Q

Egophony

A

Spoken “E” sounds like nasally “A”

29
Q

Whispered Pectoriloquy

A

Whisper “1,2,3”
Greater loudness.

30
Q

ABG: normal values

A

pH = 7.35 to 7.45.
Carbon Dioxide (PaCO2) = 35 to 45.
Bicarbonate (HCO3) = 22 to 26.

31
Q

ABG: abnormal PaCO2 indicates…

A

Respiratory

32
Q

ABG: abnormal HCO3 indicates…

A

Metabolic

33
Q

ABG: values with respiratory acidosis

A

pH <7.35
PaCO2 >45
HCO3 normal (22-26)

34
Q

ABG: values with metabolic acidosis

A

pH <7.35
PaCO2 normal (35-45)
HCO3 <22

35
Q

ABG: values with respiratory alkalosis

A

pH >7.45
PaCO2 <35
HCO3 normal (22-26)

36
Q

ABG: values with metabolic alkalosis

A

pH >7.45
PaCO2 normal (35-45)
HCO3 >26

37
Q

ABG: compensated vs. uncompensated vs. partially compensated

A

Compensated: pH normal (7.35-7.45).
Uncompensated: pH abnormal.
Partially Compensated: all 3 values abnormal.

38
Q

General pathophysiology of obstructive diseases

A

Air trapping d/t obstruction.
Expiration is impaired.

39
Q

General pathophysiology of restrictive diseases

A

Lung shrinks & does not expand.
Inspiration is impaired.

40
Q

Muscle activity during inspiration & expiration

A

Inspiration = active diaphragm.
Expiration = passive recoil of inspiratory mm.

41
Q

Fremitus

A

-Vibrations during speaking that can be palpated thru the chest.
-Consolidation = increased fremitus.

42
Q

Percussion

A

-Sounds produced from tapping on chest wall.
-Fluid = decreased percussion (dull).
-Air = increased percussion (hyper-resonant or tympanic resonance).
-“Resonant” = normal loudness.

43
Q

Asthma: physiology, fremitus, & percussion

A

Obstructive.
Narrowed/swollen airways. Extra mucous production.
Fremitus: normal or decreased.
Percussion: resonant or hyper-resonant.

44
Q

Chronic Bronchitis: physiology, fremitus, & percussion

A

Obstructive.
Inflamed bronchial tubes. Mucous buildup.
Fremitus: decreased.
Percussion: resonant.

45
Q

Emphysema: physiology, fremitus, & percussion

A

Obstructive.
Enlargement of air spaces, destruction of alveoli without fibrosis. Reduced gas exchange.
Fremitus: decreased
Percussion: hyper-resonant or tympanic resonance.

46
Q

Pneumonia: physiology, fremitus, & percussion

A

Restrictive.
Alveoli fill with pus/fluid. Fever often occurs. “Water IN the lungs.”
Fremitus: increased.
Percussion: dull.

47
Q

Pleural Effusion: physiology, fremitus, & percussion

A

Restrictive.
Fluid buildup btwn layers of pleura. “Water ON the lungs.”
Fremitus: decreased.
Percussion: dull.

48
Q

Pneumothorax: physiology, fremitus, & percussion

A

Restrictive.
Collapsed lung. Air leaks into space outside lungs, pushes inward on the lung & causes collapse.
Fremitus: decreased.
Percussion: hyper-resonant or tympanic resonance.

49
Q

Atelectasis: physiology, fremitus, & percussion

A

Restrictive.
Collapsed lung. Alveoli deflate or fill w/ fluid. Often as a post-surgical complication.
Fremitus: absent.
Percussion: dull.

50
Q

Difference between DVT, Embolism, and PE?

A

DVT: clot is stagnant (not moving).
Embolism: clot is moving thru body.
PE: clot moves into pulmonary vessels.

51
Q

Sxs of DVT & PE

A

-Sudden onset dyspnea.
-Diaphoresis.
-Hemoptysis (blood in sputum).
-Fever.
-LE swelling.

52
Q

What to do if suspected DVT?

A

Semi-fowlers (this isn’t normal dyspnea, so not supine or usual dyspnea-relieving positions).
Immediate MD referral.

53
Q

What to do if suspected PE?

A

Do NOT move them!
CALL 911

54
Q

Well’s Criteria: how to score & interpret scores?

A

+1 point for each yes (items 1-9).
-2 points if alternative dx equally as likely as DVT (item 10).
DVT Likely if >/= 2 points.
DVT Unlikely if <2 points.

55
Q

Well’s Criteria: items

A
  1. Previous DVT.
  2. Active cancer.
  3. Paralysis/immobilization of LE.
  4. Bedridden >3 days and/or recent major surgery.
  5. Localized tenderness (posterior calf, popliteal space, or femoral vein).
  6. Entire LE swelling.
  7. Unilateral calf swelling.
  8. Unilateral pitting edema.
  9. Collateral superficial veins.
  10. Alternative diagnosis is as or more likely as DVT (-2pts).
56
Q

AAA: key sxs & appropriate response

A

Pulsating in abdomen.
Abdominal bulge.
CALL 911

57
Q

Heat stroke: key sxs & appropriate response

A

Body temp >104
CALL 911

58
Q

Acute Compartment Syndrome: key sxs & appropriate response

A

6 P’s:
1. Pain
2. Palpable tenderness
3. Paresthesia
4. Pallor
5. Paresis
6. Pulselessness
CALL 911

NPTE (22 decks)

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