Pulmonary stuff

Question 1

Muscles of Inspiration

Answer 1

Diaphragm and external intercostals (principles m of inspiration)

Accessory m of inspiration:
SCM, scalenes, pec major, pec minor, serratus anterior

Question 2

Muscles of Expiration

Answer 2

Passive exhale - passive recoil from lungs and rib cage.

Forceful exhale - rectus abdominus, external oblique, internal oblique, and TA

Question 3

Lobes of lungs

Answer 3

R: 3 lobes (upper, middle, lower)

L: 2 lobes (upper and lower)

Main bronchi branch – lobar bronchi – segmental bronchi – bronchioles – terminal bronchioles

Question 4

Lung innervation

Answer 4

lungs, trachea, and bronchi innervated by both sympathetic and parasympathetic

Question 5

Ankle-Brachial Index (ABI)

Answer 5

• Compares systolic BP at the ankle and arm to check for peripheral artery disease
• Systolic BP in both brachial arteries and both tibialis posterior arteries
• divide the ankle BP by the brachial BP
  (A/B) = ABI

Question 6

Interpretation of the ABI

Answer 6

> 1.40 = indicates rigid arteries and the need for an US test to check for peripheral artery disease

1.0-1.40 = normal; no blockage

.8 - .99 = mild blockage; beginnings of peripheral artery disease

.4-.79 = Moderate blockage; associated with intermittent claudication during exericse

<.4 = severe blockage (suggests sever peripheral artery disease); may have claudication at rest.

Question 7

Which of the signs or symptoms would most likely lead a health care provider to perform an ankle-brachial index measurement on a patient?

Answer 7

claudication

The ankle-brachial index is an objective measurement that can be used to determine the presence of peripheral arterial disease. Claudication is a symptom commonly reported by patients with peripheral arterial disease due to diminished perfusion to the lower extremities.

Question 8

Which diagnostic test would be most beneficial to compare the relative perfusion pressure in the upper extremities compared to the lower extremities?

Answer 8

ankle-brachial index

The ankle-brachial index (ABI) can be used to provide a ratio of systolic blood pressure of the lower extremity compared to the upper extremity.

Question 9

Which arteries are used for ABI?

Answer 9

UE – brachial artery is the only artery used for assessing upper extremity blood pressure.

LE – the posterior tibial artery is most commonly used, though the dorsalis pedis artery is an acceptable alternative

Question 10

Which ankle-brachial index measurement is most consistent with non-compressible vessels?

Answer 10

1.40

An ankle-brachial index (ABI) above 1.4 would be indicative of non-compressible or rigid arteries. An ultrasound may be recommended to further assess for peripheral artery disease.

Question 11

Physiological control of breathing (how is it controlled?)

Answer 11

through central respiratory center in the brainstem (medulla) and peripheral receptors in the lungs, airways, chest wall, and blood vessels

• Central chemoreceptors (in medulla)
• Peripheral chemoreceptors (in cartoid bodies)
• Mechanoreceptors (inhibit m activity when the force of the contraction reaches injurious levels)

Question 12

Central chemoreceptors

Answer 12

• In medulla
• Respond to ↑ in the partial pressure of CO2 and hydrogen ion concentration = ↑ ventilation

Question 13

Peripheral chemoreceptors

Answer 13

• In carotid bodies
• Respond to hypoxemia by ↑ ventilation

Question 14

Tracheal and bronchial sounds

Answer 14

Tracheal
* Loud, tubular sounds normally heard over the trachea
* Inspiratory phase is shorter than the expiratory phase and there is a slight pause between them.

Vesicular breath sounds
* High pitched, breezy sounds heard over the distal airways in healthy lung tissue.
* Inspiratory phase is longer than expiratory phase and there is no pause between them.

Question 15

Crackle (formerly rales)

Answer 15

• An abnormal, discontinuous, high-pitched popping sound heard more often during inspiration. May be associated with restrictive or obstructive respiratory disorders.
• Typically represents the movement of fluid or secretions during inspiration (wet crackles) or occurs from the sudden opening of closed airways (dry crackles).
• Crackles that occur during the latter half of inspiration typically represent atelectasis fibrosis, pulmonary edema or pleural effusion.
• Crackles due to the movement of secretions are usually low-pitched and can be heard during inspiration and/or expiration.
  *Pulmonary edema may produce fine crackles as air bubbles through fluid in the dist small airways.

Question 16

Pleural Friction Rub

Answer 16

• Dry, crackling sound heard during both inspiration and expiration.
• Occurs when inflamed visceral and parietal pleurae rub together.

Question 17

Rhonchi

Answer 17

• Continuous low-pitched sounds described as having a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration.
• Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller or larger airways.

Question 18

Wheeze

Answer 18

• Continuous “musical” or whistling sound composed of a variety of pitches.
• Heard during both inspiration and/or expiration, but variable from minute to minute and area to area.
• Arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm or foreign body.

Question 19

Voice Sounds

Answer 19

• In the normal lung, transmission of spoken sounds is usually muffled; whispered words are faint and the syllables are not distinct, except over the main bronchi.
• Increases in loudness and distinctness indicate consolidation, atelectasis or fibrosis, all of which improve transmission of vibrations through lung tissue.
• Whispered and spoken voice sounds are somewhat more valuable than breath sounds in detecting pulmonary consolidation, infarction, and atelectasis.
• Bronchophony. Increased vocal resonance with greater clarity and loudness of spoken words (e.g., “99*).
• Egophony. A form of bronchophony in which the spoken long “E” sound changes to a long, nasal-sounding “A.”
• Whispered pectoriloquy Recognition of whispered words *1, 2, 3.

Question 20

Stridor

Answer 20

• Continuous high-pitched wheeze heard with inspiration or expiration.
• Indicates upper airway obstruction.

Question 21

Tidal volume (TV):

Answer 21

volume of gas inhaled (or exhaled)
during a normal resting breath.

~10% of TLC ~500 mL

Question 22

Inspiratory reserve volume (IRV):

Answer 22

volume of gas that can be inhaled beyond a normal resting tidal inhalation.

55-60% TLC

Question 23

Expiratory reserve volume (ERV):

Answer 23

volume of gas that can be exhaled beyond a normal resting tidal exhalation.

Question 24

Residual volume (RV):

Answer 24

volume of gas that remains in the lungs after ERV has been exhaled.

~25% of TLC or 1,000mL

Question 25

Inspiratory capacity (IRV + TV):

Answer 25

the amount of air that can be inhaled from the resting end-expiratory position (REEP).

Question 26

Vital capacity ([RV + TV + ERV):

Answer 26

the amount of air that is under volitional control; conventionally measured as forced expiratory vital capacity (FVC).

Question 27

Functional residual capacity (ERV + RV):

Answer 27

the amount of air that resides in the lungs after a normal resting tidal exhalation.

~40% of TLC

Question 28

Total lung capacity (IRV + TV + ERV + RV):

Answer 28

the total amount of air that is contained within the thorax during a maximum inspiratory effort.

4000-6000mL

Question 29

Forced expiratory volume in 1 second (FEV1):

Answer 29

the amount of air exhaled during the first second of FVC. In the healthy person, at least 70% of the FVC is exhaled within the first second (FEV1/FVC × 100%>70%).

Question 30

Forced expiratory flow rate (FEF 25%-75%)

Answer 30

is the slope of a line drawn between the points 25% and 75% of exhaled volume on a forced vital capacity exhalation curve. This flow rate is more specific to the smaller airways and shows a more dramatic change with disease than FEV1.

Question 31

Active cycle breathing

Answer 31

• Diaphragmatic breathing for 5-10 sec (aka breathing control)
• Thoracic expansion
• Diaphragmatic breathing for 5-10 sec
• Thoracic expansion
• Diaphragmatic breathing for 5-10 sec
• Forced expiration technique (huffing 1-2 time)
• Diaphragmatic breathing

Question 32

Pursed lip breathing

Answer 32

To help decrease the respiratory rate (to improve gas exchange)

Also to help prevent airway (alveolar) collapse due to positive pressure

Dyspnea at rest or with exertion and/or wheezing

wording from PTFE test
(Create back-pressure in the airways to ease airflow)

Question 33

Huffing

Answer 33

to mobilize secretions

Exhaling through an open mouth (steam mirror)

Question 34

Inspiratory hold technique

Answer 34

prolonged holding of breath with Valsalva. Inflates poor ventilated area of lungs and improved cough

For hypoventilation, atelectasis, and improved effective cough

Question 35

Stacked breathing

Answer 35

Take a breath and hold it, breathe in more and hold it, breathe in more and hold it and then let it out when there is no more.

Helps open distal airways

Question 36

Segmental breathing (aka lateral costal breathing)

Answer 36

tactile cues to help at the ribs and diaphragm.

Helps with asymmetrical expansion, consolidated lunges or secretions, or poor posturing.

A question on the PTFE said cuing for more exhaling.

Question 37

Paced breathing

Answer 37

Low endurance, dyspnea on exertion, fatigue, anxiety, tachypnea

Question 38

Biots (ataxic) breathing

Answer 38

Ataxic breathing is characterized by unpredictable irregularity. Breaths may be shallow or deep and stop for short periods

From brain damage typically at the brainstem/medulla level

Question 39

Cheyne Stoke breathing

Answer 39

gradual increase in depth of respirations followed by gradual decrease and then a period of apnea

Hypo perfusion of the brain

Seen at end of life.