Midterm 2 - Midterm 1 Content

Question 1

Normal

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 1

Question 2

Chronic Bronchitis

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 2

Question 3

Asthma

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 3

Question 4

Pleural Effusion

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 4

Question 5

Consolidation

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 5

Question 6

Atelectasis

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 6

Question 7

Hemothorax (hemmorrhage pleural effusion)

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 7

Question 8

pneumothorax

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 8

Question 9

Pulmonary Edema (interstitial pulmonary edema)

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 9

Question 10

Empyema

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 10

Question 11

Emphysema

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 11

Question 12

Chylothorax

(1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 12

Question 13

what is each part of the stethoscope used for?

Answer 13

Question 14

what are the pulmonary ascultation segments? how should a pt breath during ascultation?

Answer 14

pt should breathe through the mouth slightly deeper than normal breath sounds (makes them easier to hear) - be sure pt isn’t hyperventilated

Question 15

what are the 4 normal breath sounds and in what regions of the lung are they?

Answer 15

Question 16

describe tracheal breath sounds

Answer 16

Question 17

describe bronchial breath sounds

Answer 17

Question 18

describe bronchovesicular breath sounds

Answer 18

Question 19

describe vesicular breath sounds

Answer 19

Question 20

describe the abnormal breaht sounds (and conditions associated with each):

1) decreased air entry or absent breath sounds
2) bronchial breathing

Answer 20

Question 21

describe adventitious breath sounds

Answer 21

Question 22

describe crackles (fine and course)

Answer 22

Question 23

describe wheezes

Answer 23

Question 24

describe ronchi

Answer 24

Question 25

describe stridor

Answer 25

Question 26

describe pleural friction rub

Answer 26

Question 27

define tactile fremitus and the 3 types

Answer 27

Question 28

describe vocal fremitus

Answer 28

Question 29

describe pleural friction fremitus

Answer 29

Question 30

describe ronchal fremitus

Answer 30

Question 31

define voice sounds and name the 3 types

Answer 31

Question 32

describe bronchophony

Answer 32

Question 33

describe egophony

Answer 33

Question 34

describe whispered pectoriloquy

Answer 34

Question 35

why is cardiopulmonary exercise testing performed?

Answer 35

- level of exercise intolerance - ID the mechanisms limiting exercise - evaluation of disease progression and response to interventions (ie change before and after treatment)

Question 36

describe dyspnea vs leg discomfort

Answer 36

- Difference in information coming in (from peripheral muscles/chemo receptors) and the output - Discomfort – copd will have more leg fatigue than healthy bc more lactate being produced (decr o2 within the muscle), have more anaerobic mechanisms happening bc changes in muscle fibres (due to steroids, disuse, etc – remember it is a systemic disease!) Pt asked to exercise – they stop at a certain point – asked why they stopped Some may say bc of dyspnea, some because I couldn’t exercise anymore Sometimes pts stop because of leg fatigue – not always just bc of dyspnea – it depends on the type of exercise they are performing Why people stop bc of dyspnea more bc of walking than cycling? – bc cycling is more localized exercise and walking is more whole body (vo2 achieved is higher in walking than cycling bc more muscles used)

Question 37

what are 3 causes of reduced peak VO2 in lung diseases?

Answer 37

- 1) bc usually a smoker too, cardiac involvement - 2) due to underlying condition – lower perfusion - 3) this contributes to change in musculature

Question 38

what is the normal ventilatory limitation to exercise?

Answer 38

- Normally our ventiation increases with increased metabolic rate with exercise - May be increase in dead space (has to do with VD/VT) – look at later - Maximum voluntary ventilation = MVV – person asked to breathe in as deep and fast as they can (hyperventilate for 15 seconds) – times 4 to give MVV for 1 minutes – the max ability to move air in and out of lungs - Move severe FEV1 will have a lower number for ventilatory capacity - A combination of VE and MVV causes exercise limits. - Ventilatory demand = the oxygen needs – increased with exercise, with COPD even hgher demand for same level of exercise bc of the decreased efficiency of breathing – they need to work more to have the same level of ventilation – their demands ar greater bc the way they breathe is inefficient

Question 39

describe the exercise flow volume loop for a healthy young adult, a healthy older adult, and moderate COPD

Answer 39

Graph 2 – decline in fev1 with age, decline in max volume – there may be a portion during high level of exercise where people can be limited by maximum envelope, even though they are very fit Graph 3 – max envelope is different – this person did not hyprinflate much – they are already close to TLC – they are lying along maximum expiratory flow curve most of the time – there is an expiratory flow limitation - Point 2: happens bc of reduced compliance at higher lung volumes and muscles a re shortened, worse at generating force - Look at inspiration – not reaching max envelope at high levels of exercise – but you are In age and COPD

Question 40

what are pulmonary gas exchange abnormalities?

Answer 40

A-a = alveolar arteriol difference – larger differences Declines in saturation and hypoxemia – can have this happen during exercise! For these people

Question 41

describe exercise and COPD graphs

Answer 41

1) Graph on far right – cant reach as high levels as someone healthy (MMV and vo2 peak less) 2) Lower left graph - have a higher breathing freq when they exercise bc cant incr. tidal volumes as much 3) Upper right graph - COPD pts are more hyperinflated 4) lower right graph - a measure of neuroventilatory coupling – maintained in healthy people, but takes more pressure to achieve given ventilation in COPD pts (reduced neurovent coupling) – bc of this they have more dyspnea in exercise for a given minute ventilation bc they must perform more work – COPD get short of breath at lower work efforts \*reduced neuro-ventilatory efficiency – why COPD have more dyspnea during exercise - neuro part is activation of muscles in order to generate pressure – ventilation part is ventilation achieved

Question 42

describe exercise and interstitial lung disease (dyspnea vs leg fatigue)

Answer 42

- Pulmonary fibrosis = interstitial lung disease - Both diseased, Left stopped due to dysp, left due to leg fatigue - No flow limit on right, exp flow limit on left - Right – leg fatigue limited them to be able to reach that flow limitation level like left

Question 43

describe the exercise and interstitial lung disease graphs

Answer 43

b) vo2 vs ventilation – same graph as before – same limitations as before c) Breathing frequency – increased – bc primary problem with pts is volumes are small – if cant increase volumes to reach MMT, increase resp rate Bar graph) black = tidal volume, white = end exp lung volume, and = TLC – in general all volunmes smaller with exercise – same graph as upper R on slide 8 a) We see more dyspnea for a given vo2 – bc looking at work necessary for a given vo2 – higher bc of changes in the mechanics of their lungs d) also limited in neurovent coupling but for different reasons: due to changes in compliance of system The changes that occur during exercise are similar!! – lung volumes are different – bt overall message – more dyspnea same pattern because of inefficient breathing

Question 44

Bronchiectasis (1.description of condition, 2. percussion note, 3. tracheal position, 4. breath sounds, 5. adventitious sounds, 6. tactile fremitus and transmitted voice sounds)

Answer 44

Question 45

pulmonary fibrosis

Answer 45