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LC 2 Flashcards

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1
Q

PFT for CB

A

FEV1 < 65% of predicted age height gender
FEV1/FVC < 70% of predicted age height gender
RV increased, VC and compliance decreased

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2
Q

5 steps of clubbing

A

fluctuation and softening of the nail bed, loss of the normal angle (Lovibond angle), increased convexity of the nail fold, thickening of the whole distal finger, shiny aspect and striation of the nail and skin

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3
Q

functional dyspnea scale

A

0: dyspnea only with strenuous exercise

1: troubled by dyspnea when hurrying or walking up slight hill

2: walks slower than people of same age due to dyspnea or has to stop for breath when walking at own pace on level surface

3: stops for breath after walking around 100 yards or after a few minutes on level surface

4: too dyspneic to leave the house or breathless when dressing or undressing

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4
Q

why do different postures relieve dyspnea

A

Reduced recruitment of SCM and scalenes, restores diaphragms natural shape and improves its function, shoulder girdle elevation, improves length tension relationship in respiratory muscles

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5
Q

definition of Chronic Bronchitis

A

Cough history for greater than or equal to 3 months on most days of the month times 2 years as long as other diagnosis have been ruled out

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6
Q

blue bloater

A

stocky build, central and peripheral cyanosis, RH failure, B LE edema, decreased air flow rate with mildly increased lung volumes and relatively normal rate of lung diffusing capacity. Nocturnal hypoxemia and CO2 retention. Air trapping, hyperinflated alveoli, bronchospasm, excess secretion retention. Expiration phase may increase as obstruction worsens

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7
Q

pink puffer

A

short of breath, little sputum, barrel chest, horizontal ribs, uses/hypertrophies accessory muscles, pursed-lip breathing, rounded shoulders (2 degrees short pectoralis major), rapid breath, decreased Vt, high physiological dead space, use large Ve to overcome dead space, barrel-chested because of marked air-trapping, thin generalized muscle wasting, malnutrition, secondary excessive energy cost, malnutrition impairs respiratory muscle strength making it more difficult to sustain high ventilatory demands

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8
Q

physical findings of bronchitis

A

Productive cough, dyspnea, wheezing, barrel chest, prolonged expiration, chronic hypoventilation, polycythemia (increase of red blood cells in the body), and cor pulmonale (right ventricle enlargement)

Perhaps adventitious sounds (wheezing and rhonchi) but is diminished otherwise

Egophony may be heard suggestive of fluid in air spaces

Expansion of chest is decreased

Increased if fluid in lung, decreased fremitis if the airway is obstructed

X rays show changes later in disease progression

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9
Q

why are blue bloaters blue

A

PaO2 (alveoli partial pressure ox oxygen) decreases to 40-50 mmHg (norm is 100), PaCO2 increases to 60-70 mmHg (norm is 40), polycythemia Hct increases 55-60% which increases viscosity (42-45)

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10
Q

changes in radiographs for those with emphysema

A

Lateral: increased AP diameter, kyphosis, increased retrosternal air, horizontal ribs, low diaphragm

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11
Q

definition of bullae

A

large, air-filled spaces within the lungs that result from the destruction of alveolar walls, typically seen in advanced emphysema

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12
Q

Gold 1

A

mild FEV1 greater than or equal to 80% predicted

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13
Q

Gold 2

A

moderate 50% greater than or equal to FEV1 < 80% predicted

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14
Q

Gold 3

A

severe 30% greater than or equal to FEV1 < 50% predicted

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15
Q

Gold 4

A

very severe FEV1 < 30% predicted

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16
Q

mMRC grade 0

A

I only get breathless with strenuous exercise

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17
Q

mMRC Grade 1

A

I get short of breath when hurrying on the level or walking up a slight hill

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18
Q

mMRC Grade 2

A

I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level

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19
Q

mMRC Grade 3

A

I stop for breath after walking about 100 meters or after a few minutes on the level

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20
Q

mMRC Grade 4

A

I am too breathless to leave the house or I am breathless when dressing or undressing

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21
Q

effects of albuterol

A

may increase HR, exercise capacity increases max

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22
Q

Pseudoephedrine effect

A

resting HR stays the same, may increase HR, increases SBP,PVCs on EKG

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23
Q

Theophylline

A

increased resting HR, increased BP, increased endurance

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24
Q

asthma attacks affect what numbers

A

decreased in FEV1 and FEV1/FVC, decreased MEF (max expiratory flow) volume
Decreased VC, increased FRC and RV which improve with treatment

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25
Bronchodilators
no effect on HR, no effect on BP, may increase exercise capacity for patients with COPD
26
Sympathomimetics
no effect on HR, no effect on BP, may have no effect or increase exercise capacity
27
Anticholinergics
increase or no effect on HR, no effect on BP, no effect on exercise capacity
28
Beta blockers
no effect on HR, no effect on BP, no effect on exercise capacity
29
exercise helpful for asthma
Exercise that is beneficial in pts with asthma: breathing exercises(nasal breathing in/mouth out, diaphragmatic breathing, breath-holding, hypoventilation), inspiratory muscle training, physical training
30
Bronchiectasis
permanent, abnormal dilation and distortion of 1 or more bronchi or bronchioles caused by destruction of elastic and muscular components of bronchial walls
31
physical examination on those with emphysema
PERCUSSION: hyper-resonance in both lungs, low pitch, long duration AUSCULTATION: ↓ed/diminished breath sounds o wheezes and crackles in bases TACTILE FREMITUS: Decreased WHISPERED PECTORILOQY: ↓ed over hyperinflated areas
32
PLB
Specific breathing technique for controlling oxygenation and ventilation; maintains open alveoli, ↑ oxygenation, ↓ symptomology and ↑ function (PLB maintains PEEP)
33
MIP number
120 cm H2O
34
SMIP
493 PTU
35
asthmatic attack includes
bronchial smooth muscle constriction, Increased Mucus, production by bronchial glands, Bronchial mucosal inflammation, Decreased ciliary activity Clinically patient has cough, dyspnea, wheezing, inability to exhale o Air entrapment and alveolar hyperinflation during the episode w/ symptoms disappearing between attacks
36
physical findings of bronchiectasis
Auscultation: moist crackles (72%), rhonchi/wheezes (22%), pleural rubs Chronic cough, fetid breath, hemoptysis, dyspnea, clubbing/cyanosis. Inspiratory squeaks, recurrent pulmonary infections, fever, fatigue PFT: obstructed airway Chest CT: bronchial dilation (cardinal sign), lack of bronchial tapering and visible airways within 1 cm of pleural surface
37
cystic fibrosis clinical findings
PFT’s initially reflect small airway obstruction -> frank obstruction V:Q abnormalities persist and worsen Pulmonary HTN develops o àcor pulmonale and RV failure follow Auscultation: persistent crackles, rhonchi Percussion: hyperressonance Increased fremitus due to excessive fluid
38
percussion sessions for CF
10-15 or up to 45-60 minute 1-2 sessions/day
39
pulmonary fibrosis major and minor criteria
Major: exclude other causes (drug toxicities, environmental exposures, CR diseases, abnormal PFT with evidence of restriction (decreased VC, increased FEV1/VC), impaired gas exchange (increased A-a PO2 gradient with rest or exercise), transbronchial lung biopsy or bronchoalveolar lavage does not support alternative diagnosis Minor: >50 years old, insidious onset of otherwise unexplained dyspnea on exertion, duration of illness > 3 months, bilateral basilar/inspiratory crackles
40
lung function in scoliosis
VC and TLC ↓ Greater curves -> predicted, ↓VC, ↓TLC, ↓FRC, ↓RV, ↓Compliance Muscle length Δs -> MLT Δ s -> ↓PFT Increased bf, decreased oxygenation
41
FEV1 and VC in obesity and aging
decrease in both
42
effects of obesity on lung function
ERV ↓ FRC↓= (↓ERV + RV? ↓) TLC↓ VC↓ FEV1↓ FEV1/VC normal or low ↑ in airway resistance ↑ d V/Q mismatch from atelectasis of dependent lung units which are well perfused -> ↓ PaO2 Greater VE to maintain PaCO2
43
obesity exercise guidelines
Greater than 5 days a week at 40-59% VO2 or HRR -> 60% HRR Greater than 30 minutes a session -> 60 minutes a session Resistance 2-3 times a week at 60-70% of 1RM (2-4 sets at 8-12 reps) Flexibility training 3+ days a week Nutrition (-500 to -1000 kcals/day, reduce dietary fat to less than 30% of total energy intake)
44
ARDS
acute respiratory distress syndrome
45
Resonance
normal (loud, low, long)
46
Hyperresonance
hyperinflated lungs (boom, low, long)
47
Flatness
atelectic lung or muscle (dull, high, short)
48
Dullness
pleural effusion, neoplasm, heart liver (thud, medium, medium)
49
Tympany
stomach (drum, high, medium)
50
atelectasis
A condition where the tiny air sacs in the lungs collapse, leading to a partial or full collapse of one or more lung sections. Can be found on X-rays or using percussion
51
Egophony
pt says E (normal= E should be muffled or non distinct, abnormal = clear “A” sound suggesting fluid in air spaces)
52
Bronchophony
pt says 99 (you should hear muffled sounds , clear 99 suggests consolidation of fluid or solid filling lung enhancing sound transmission)
53
Pectoriloqy
pt says 1, 2, 3 (you should hear muffled sounds, clearly audible in lungs suggests consolidation)
54
effusion
shows dullness in percussion, obliterates traube’s space, decreased breath sounds, contralateral tracheal deviation, decreased fremitus, pectoriloquy decreased
55
edema
shows increased fremitus, dull percussion, maybe pectoriloquy if consolidated, course crackles in severe but breath sounds maybe normal, rhonchi, sounds wet due to high pressure being pushed into alveoli
56
CB physical exam findings
no tracheal deviation, decreased fremitus due to pleural effusion, flatness over lungs, dull, high pitch, short duration, egophony is positive, scattered crackles, wheezes, rhonchi
57
emphysema physical exam findings
no tracheal deviation, decreased fremitus, percussion is hyper-resonant, crackles, wheezes
58
asthma physical exam findings
no tracheal deviation, fremitus maybe, percussion is hyper resonant, pectoriloquy maybe, wheezes
59
pulmonary edema/CHF physical exam findings
tracheal deviation maybe, maybe increased fremitus, dull percussion, pectoriloquy maybe, fine or course crackles
60
Crackles
ateletectasis, CHF/pulmonary edema, pneumonia, fibrosis, bronchitits
61
Rhonchi
rattling, bubbling, sound; due to air moving through secretions in large airways
62
Pleural rub
pleurisy, TB, pneumonia
63
Increased breath sounds
pneumonia, aspiration, cancer, pulmonary edema, hemorrhage
64
Emphysema
serious infection characterized by a collection of pus within a naturally existing body cavity, most commonly in the pleural space
65
Hemothorax
accumulation of blood in the pleural space, the area between the lungs and the chest wall, often caused by trauma
66
Pneumothorax
air leaks into space between lung & chest wall, causing lung to collapse
67
Pneumonia
lung infection where the air sacs are filled with fluid or pus
68
cardiothoracic ratio
0.42-0.50

Cardiopulmonary (4 decks)

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