Pulmonary Examination

Question 1

Normal HR infant? Adult?

Answer 1

Infant: 120
Adult: 60-100

Question 2

Normal BP: infant? Adult?

Answer 2

Infant: 75/50
Adult: <120/80

Question 3

Normal RR: infant? Adult?

Answer 3

Infant: 40
Adult: 12-20

Question 4

Normal PaO2: infant? Adult?

Answer 4

Infant: 75-80 mmHg
Adult: 80-100 mmHg

Question 5

Normal PaCO2: infant? Adult?

Answer 5

Infant: 34-54 mmHg
Adult: 35-45 mmHg

Question 6

Normal pH: infant? Adult?

Answer 6

Infant: 7.26-7.41
Adult: 7.35-7.45

Question 7

Normal TV: infant? Adult?

Answer 7

Infant: 20 ml
Adult: 500 ml

Question 8

What is cyanosis?

Answer 8

Acute sign of hypoxemia, bluish tinge to nail beds and areas around eyes/mouth

Question 9

What is digital clubbing?

Answer 9

Sign of chronic hypoxemia

Configuration of distal phalanx of fingers/toes becomes bulbous

Question 10

Ratio of A-P-lateral dimension with breathing?

Answer 10

1:2

Question 11

thoracic excursion in healthy adults measured at base of lungs from full inspiration to end tidal volume expiration is ___ inches

Answer 11

2-3

Question 12

Thoracic excursion in healthy adults, measured at the base of the lungs from full inspiration to full expiration is ___ inches

Answer 12

2-3

Question 13

Soft rustling sound heard throughout all inspiration and beginning of expiration

Answer 13

Vesicular (normal breath sound)

Question 14

More hollow, echoing sound normally found only over R superior anterior thorax. Heard for all of inspiration, most of expiration
What does this sound correspond to?

Answer 14

Bronchial

Corresponds to area over R main stem bronchus

Question 15

Very distant sound not normally heard over healthy thorax; allows only some of the inspiration to be heard.
What is this often associated with?

Answer 15

Distant

OBSTRUCTIVE lung disease

Question 16

What are the adventitious sounds?

Answer 16

Crackles (rales/crepitations)

Wheezes

Question 17

Crackling sound heard usually during inspiration that indicates pathology.
What is it and what pathologies?

Answer 17

Crackles

Atelectasis, fibrosis, pulmonary edema

Question 18

Musically pitched sound, usually heard on expiration called by airway obstruction. May also be heard on inspiration with severe airway constriction, such as croup

Answer 18

Wheezes

Question 19

What conditions would wheezes be heard with?

Answer 19

Asthma, COPD, foreign body aspiration

Question 20

Auscultation and vocal sounds are heard louder/quieter where?

Answer 20

Auscultation: quieter at bases than apex

Vocal sounds: loudest near trachea/main-stem bronchi, quieter near bases

Question 21

Nasal or bleating sound heard during auscultation. “E” sounds like “_”

Answer 21

Egophony

A

Question 22

Intense, clear sound during auscultation, even at lung bases

Answer 22

Bronchophoney

Question 23

Whispered sounds heard clearly during auscultation

Answer 23

Whispered pectoriloquy

Question 24

Detect presence of abnormal material (exudate, blood) or change in pulmonary parenchyma (fibrosis, collapse)

Answer 24

Chest X-ray

Question 25

V/Q Scan: what does it do/what can it detect?

Answer 25

Matches ventilation pattern of lung to perfusion pattern of lung to ID presence of PE

Question 26

Continuous x-ray beams allow observation of diaphragmatic excursion

Answer 26

Fluoroscopy

Question 27

ABG analysis indicates adequacy of: Alveolar ventilation by determining ? (3) Arterial oxygenation by determining ? (2)

Answer 27

Alveolar: pH, HCO3-, PaCO2 Arterial: PaO2 in relation to FiO2

Question 28

Sputum gram stain for immediate category of ____ and its appearance (____).

Answer 28

Bacteria (-/+) | Pairs, chains

Question 29

Sputum culture and sensitivity: identifies specific bacteria as well as what?

Answer 29

Organism’s susceptibility to various antibiotics

Question 30

Reports presence of cancer cells in sputum

Answer 30

Cytology

Question 31

Normal WBC

Answer 31

4000-11000

Question 32

Normal Hct

Answer 32

35-48%

Question 33

Normal Hgb

Answer 33

12-16 g/dL

Question 34

Endoscope used to view, biopsy, wash, suction and/or brush interior aspects of tracheobronchial tree

Answer 34

Bronchoscopy

Question 35

Exercise tolerance tests (ETT) can be used to determine exercise-induced ____ by testing pulmonary function, especially ___ before and after ETT

Answer 35

Bronchospasm | FEV1

Question 36

``` ABG interpretation: Respiratory alkalosis- what happens to: pH PaCO2 HCO3- ```

Answer 36

Increase Decrease WNL

Question 37

ABG interpretation: | Respiratory alkalosis is caused by?

Answer 37

Alveolar hypERventilation

Question 38

ABG interpretation: | respiratory alkalosis- what are s/sx?

Answer 38

Dizziness, syncope, tingling, numbness, early tetany

Question 39

``` ABG interpretation: Respiratory acidosis- what happens to? pH PaCO2 HCO3- ```

Answer 39

Decreases Increases WNL

Question 40

ABG interpretation: | Respiratory acidosis causes?

Answer 40

Alveolar HYPOventilation

Question 41

``` ABG interpretation: Metabolic alkalosis- what happens to: pH PaCO2 HCO3- ```

Answer 41

Increases WNL Increases

Question 42

``` ABG interpretation: Metabolic acidosis- what happens to: pH PaCO2 HCO3- ```

Answer 42

Decreases WNL Decreases

Question 43

ABG interpretation: | Metabolic acidosis causes?

Answer 43

Diabetic, lactic, or uremic acidosis, prolonged diarrhea

Question 44

ABG interpretation: | metabolic alkalosis causes?

Answer 44

Bicarbonate ingestion, vomiting, diuretics, steroids, adrenal disease

Question 45

ABG interpretation: | Metabolic alkalosis s/sx

Answer 45

Vague: weakness, mental dullness, possible early tetany

Question 46

ABG interpretation: | Metabolic acidosis s/sx?

Answer 46

Secondary hyperventilation (Kussmaul breathing), nausea, lethargy, coma

Question 47

Graded Exercise Test Termination Criteria: 1. Maximal ___ 2. Fall in PaO2 greater than __ mmHg or PaO2 less than ___mmHg 3. Rise in PaCO2 of greater than __mmHg or PaCO2 greater than __ mmHg 4. Cardiac __ or __ 5. Symptoms of ___ 6. Increase in DBP of ___ mmHg SBP > ___mmHg, decreases in BP with increasing ____ 7. Leg pain 8. Total fatigue 9. Signs of insufficient ____ 10. Reaching ___ maximum

Answer 47

1. SOB 2. 20, 55 3. 10, 65 4. Ischemia, arrhythmias 5. Fatigue 6. 20, 250, workload 9. Cardiac output 10. Ventilators