Pulm Exam

Question 1

the primary function of the pulm system is the vent and respirate… where does the pulm system receive its automatic neural input

Answer 1

1. medulla controls rhythmicity

2. pons control depth and rate

Question 2

what are the five primary obstructive pulmonary disorders we should know

Answer 2

asthma, chronic bronchitis, emphysema, CF, and bronchiectasis

Question 3

what are the two major restrictive pulm disorders we should know

Answer 3

atelectasis and pneumonia

Question 4

what are the four special considerations for pulm disorders we should know

Answer 4

SCI, lung cancer, ARDS, and respiratory failure

Question 5

CVP measurement is a direct reflection of _______

Answer 5

R sided heart function

Question 6

before proceeding with tests and measures/activities assessment in the acute care setting with pulm patients, what are four objective things to consider

Answer 6

1. stable vitals at rest
2. no dyspnea at rest
3. lab values
4. any post op complications

Question 7

what is the MMRC dyspnea scale

Answer 7

modified medical research council dyspnea scale

0 - only breathless during strenuous exercise
1 - short of breath hurrying on level ground or walking up a small hill
2 - slower than normal on level ground due to breathlessness or have to stop to catch breath
3 - must stop after 100m or a few minutes of walking on level ground
4. to breathless to leave the house or breathless when dressing

Question 8

what is 0, 2, 5, and 10 on the modified borg scale for dyspnea

Answer 8

0 - nothing
2 - mild SOB
5 - strong/hard of breathing
10 - SOB severe enough to stop activity

Question 9

what is the normal sequence of breathing

Answer 9

1. diaphragm contracts and descends as the abdomen rises
2. lateral costal expansion as ribs move up and out
3. upper chest rises

Question 10

what is diaphragmatic excursion

Answer 10

thumbs over costal margin tips near the xiphoid - instruct the patient to deep breathe and analyze chest expansion

Question 11

where do you test chest wall excursion

Answer 11

1. upper lobes - palms on anterior first 4 ribs
2. right mid and lingular segments - palms on anterolateral chest at the xiphoid line
3. lower lobes - palms on posterior cage below scap

Question 12

what is fremitus

Answer 12

vibratory tremors

1. ask pt to repeat “99” while palpating varioius segments
2. normal = uniform vibration
3. abnormal = increased vibration indicates secretions in the area

Question 13

what is normal inspiration:expiration, how does it change in obstructive disease?

Answer 13

1: 2
1: 3-4 (expiration is prolonged)

Question 14

normal RR?

Answer 14

12-20

Question 15

RR > 25 indicates

Answer 15

primary pulm dysfunction, metabolic acidosis, or systemic stress

Question 16

RR < 10 indicates

Answer 16

CNS abnormality or metabolic alkalosis

Question 17

define

lack of airflow to lungs for > 15 s

Answer 17

apnea

Question 18

define

increased rate and depth resulting in decreased PCO2

Answer 18

hyperventilation

Question 19

define

RR > 20

Answer 19

tachypnea

Question 20

define

RR < 12

Answer 20

bradypnea

Question 21

define

increased depth of breathing

Answer 21

hyperpnea

Question 22

define

decreased rate and depth of respiration resulting in increased PCO2

Answer 22

hypoventilation

Question 23

define

breathing that results from hemiplegia and surgery

Answer 23

asymmetrical breathing

Question 24

define

increasing depth of respiration followed by a period of apnea

Answer 24

cheyne-stokes respirations

Question 25

define inward abd/chest movement with inspiration and outward movement with expiration

Answer 25

paradoxical respiration

Question 26

define dyspnea that occurs supine but relieved with upright standing or sitting

Answer 26

orthopnea

Question 27

maximal inspiratory pressure (MIP) is a good indication of _________ what is a score that denotes such an indication?

Answer 27

inspiratory muscle strength MIP < 50% predicted in the presence of clinical signs

Question 28

when is maximal expiratory pressure (MEP) decreased?

Answer 28

decreased in neuromuscular disorders and other cases of generalized muscle weakness

Question 29

what are the two adventitious auscultation sounds

Answer 29

wheezing (usually on exhalation) and crackles (usually upon inspiration)

Question 30

what is egophony

Answer 30

"e" get "a" is positive for fluid in airspaces

Question 31

what is bronchophony

Answer 31

"99" heard clearly over the entire chest + for consolidation if phrases clearly audible in distal lung fields + for hyperinflation if less audible in distal lung fields

Question 32

what is whispering pectroliquy

Answer 32

whispered "one, two, three" heard clearly with the same rules as bronchophony

Question 33

in many situations, pts will achieve ventilatory maximum before cardio max; therefore, max exercise heart rate is _________ than predicted max HR due to pulmonary constraints

Answer 33

lower

Question 34

what is the 6mwt threshold value for patients with COPD. I.e. patients below this value have a higher mortality

Answer 34

350m (1150ft)

Question 35

what is the MCID for the 6mwt

Answer 35

86m