Pulmonary Examination Flashcards
Tidal Volume
Normal amount of air inhaled & exhaled
Inspiratory Reserve Volume
Extra amount of air during forced inhalation.
Expiratory Reserve Volume
Extra amount of air during forced exhalation.
Residual Volume
Air left over in lungs that never leaves
Total Lung Capacity
Max amount of air that can fill the lungs.
TLC = IRV + TV + ERV + RV.
*Sum of all 4 volumes.
Inspiratory Capacity
Max amount of air that can be inspired.
IC = IRV + TV.
Vital Capacity
Amount of air that can be expired after a full inhalation.
VC = IRV + TV + ERV.
Functional Residual Capacity
Amount of air remaining in the lungs after a normal expiration.
FRC = ERV + RV
How do volumes/capacities change with obstructive diseases?
-RV increases (so TLC & FRC also increase).
-TV increases or no change.
-Everything else decreases.
How do volumes/capacities change with restrictive diseases?
Everything decreases
COPD is classified based on what values?
-FEV1/FVC (<70% for all stages)
-FEV1 % predicted
Mild COPD
FEV1/FVC < 70%
FEV1 >80%
Moderate COPD
FEV1/FVC < 70%
FEV1 = 50-80%
Severe COPD
FEV1/FVC < 70%
FEV1 = 30-50%
Very Severe COPD
FEV1/FVC < 70%
FEV1 <30%
or
FEV1 <50% plus chronic respiratory failure
List the normal breath sounds
Vesicular
Broncho-vesicular
Bronchial
Tracheal
Vesicular breath sound: location, duration, pitch, & intensity
Location: most of the lungs.
Duration: inspiratory longer than expiratory.
Pitch: low.
Intensity: soft.
Broncho-Vesicular breath sound: location, duration, pitch, & intensity
Location: anterior 1st/2nd IC spaces, posterior btwn scapulae.
Duration: inspiratory longer than expiratory.
Pitch: medium.
Intensity: medium.
Bronchial breath sound: location, duration, pitch, & intensity
Location: manubrium.
Duration: expiratory longer than inspiratory.
Pitch: high.
Intensity: loud.
Tracheal breath sound: location, duration, pitch, & intensity
Location: trachea.
Duration: inspiratory longer than expiratory.
Pitch: high.
Intensity: very loud.
List the abnormal breath sounds
-Rhonchi
-Wheeze
-Crackles (AKA Rales)
-Pleural rub
Rhonchi sounds like…? What conditions can it be heard with?
Low pitch; continuous rattling or snoring.
-COPD
-CF
-Bronchitis
-Bronchiectasis
-Pneumonia
Wheeze sounds like…? What conditions can it be heard with?
High pitch on expiration; whistling.
-COPD
-Asthma
-Aspiration of foreign object
Crackles (Rales) sounds like…? What conditions can it be heard with?
High pitch, discontinuous popping.
-Pulmonary edema
-Secretions
-CHF
Pleural Rub sounds like…? What conditions can it be heard with?
Sandpaper rubbing; lower lateral chest areas.
-Pleural inflammation
Abnormal voice sounds indicate…? What do they sound like (compared to normal)?
Indicates secretions.
Normal should be difficult to hear.
Abnormal is amplified thru stethoscope.
Bronchophony
“99”
Greater clarity & loudness.
Egophony
Spoken “E” sounds like nasally “A”
Whispered Pectoriloquy
Whisper “1,2,3”
Greater loudness.
ABG: normal values
pH = 7.35 to 7.45.
Carbon Dioxide (PaCO2) = 35 to 45.
Bicarbonate (HCO3) = 22 to 26.
ABG: abnormal PaCO2 indicates…
Respiratory
ABG: abnormal HCO3 indicates…
Metabolic
ABG: values with respiratory acidosis
pH <7.35
PaCO2 >45
HCO3 normal (22-26)
ABG: values with metabolic acidosis
pH <7.35
PaCO2 normal (35-45)
HCO3 <22
ABG: values with respiratory alkalosis
pH >7.45
PaCO2 <35
HCO3 normal (22-26)
ABG: values with metabolic alkalosis
pH >7.45
PaCO2 normal (35-45)
HCO3 >26
ABG: compensated vs. uncompensated vs. partially compensated
Compensated: pH normal (7.35-7.45).
Uncompensated: pH abnormal.
Partially Compensated: all 3 values abnormal.
General pathophysiology of obstructive diseases
Air trapping d/t obstruction.
Expiration is impaired.
General pathophysiology of restrictive diseases
Lung shrinks & does not expand.
Inspiration is impaired.
Muscle activity during inspiration & expiration
Inspiration = active diaphragm.
Expiration = passive recoil of inspiratory mm.
Fremitus
-Vibrations during speaking that can be palpated thru the chest.
-Consolidation = increased fremitus.
Percussion
-Sounds produced from tapping on chest wall.
-Fluid = decreased percussion (dull).
-Air = increased percussion (hyper-resonant or tympanic resonance).
-“Resonant” = normal loudness.
Asthma: physiology, fremitus, & percussion
Obstructive.
Narrowed/swollen airways. Extra mucous production.
Fremitus: normal or decreased.
Percussion: resonant or hyper-resonant.
Chronic Bronchitis: physiology, fremitus, & percussion
Obstructive.
Inflamed bronchial tubes. Mucous buildup.
Fremitus: decreased.
Percussion: resonant.
Emphysema: physiology, fremitus, & percussion
Obstructive.
Enlargement of air spaces, destruction of alveoli without fibrosis. Reduced gas exchange.
Fremitus: decreased
Percussion: hyper-resonant or tympanic resonance.
Pneumonia: physiology, fremitus, & percussion
Restrictive.
Alveoli fill with pus/fluid. Fever often occurs. “Water IN the lungs.”
Fremitus: increased.
Percussion: dull.
Pleural Effusion: physiology, fremitus, & percussion
Restrictive.
Fluid buildup btwn layers of pleura. “Water ON the lungs.”
Fremitus: decreased.
Percussion: dull.
Pneumothorax: physiology, fremitus, & percussion
Restrictive.
Collapsed lung. Air leaks into space outside lungs, pushes inward on the lung & causes collapse.
Fremitus: decreased.
Percussion: hyper-resonant or tympanic resonance.
Atelectasis: physiology, fremitus, & percussion
Restrictive.
Collapsed lung. Alveoli deflate or fill w/ fluid. Often as a post-surgical complication.
Fremitus: absent.
Percussion: dull.
Difference between DVT, Embolism, and PE?
DVT: clot is stagnant (not moving).
Embolism: clot is moving thru body.
PE: clot moves into pulmonary vessels.
Sxs of DVT & PE
-Sudden onset dyspnea.
-Diaphoresis.
-Hemoptysis (blood in sputum).
-Fever.
-LE swelling.
What to do if suspected DVT?
Semi-fowlers (this isn’t normal dyspnea, so not supine or usual dyspnea-relieving positions).
Immediate MD referral.
What to do if suspected PE?
Do NOT move them!
CALL 911
Well’s Criteria: how to score & interpret scores?
+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.
Well’s Criteria: items
- Previous DVT.
- Active cancer.
- Paralysis/immobilization of LE.
- Bedridden >3 days and/or recent major surgery.
- Localized tenderness (posterior calf, popliteal space, or femoral vein).
- Entire LE swelling.
- Unilateral calf swelling.
- Unilateral pitting edema.
- Collateral superficial veins.
- Alternative diagnosis is as or more likely as DVT (-2pts).
AAA: key sxs & appropriate response
Pulsating in abdomen.
Abdominal bulge.
CALL 911
Heat stroke: key sxs & appropriate response
Body temp >104
CALL 911
Acute Compartment Syndrome: key sxs & appropriate response
6 P’s:
1. Pain
2. Palpable tenderness
3. Paresthesia
4. Pallor
5. Paresis
6. Pulselessness
CALL 911