PULMO

Question 1

emphysema, pneumothorax

Answer 1

Hyperresonance (increased air)

Question 2

pleural effusion, consolidation, mass, heart, liver

Answer 2

dullness

Question 3

Gastric air bubble

Answer 3

tympanic

Question 4

Soft or low pitched
I > E in 3:1 ratio, no pause
Most of the lung field

Answer 4

Vesicular

Question 5

Loud and high pitch
E > I, pause
Manubrium – not a normal breath sound in the lung

Answer 5

Bronchial

Question 6

Bronchovesicular

Answer 6

Intermediate pitch
I = E, no pause
1st, 2nd intercostal spaces

Question 7

Increased Intensity
 Crackles 
Increased vocal fremitus 
Increased tactile fremitus 
percussion dullnes
no mediastinal shift
↓expansion,

Answer 7

consolidation (pneumonia)

Question 8

Decreased or Absent breath sounds 
Decreased tactile fermitus 
dull percussion 
mediastinal shift: away (if large) from affected side 
↓expansion

Answer 8

pleural effusion

Question 9

Decreased breath sounds
Decreased tactile fermitus
hyperresonant
mediastinal shift: none

Answer 9

emphysema

Question 10

Decreased or Absent breath sounds 
Decreased tactile fremitus 
hyperresonant
mediastinal shift: away from affected side 
↓expansion,

Answer 10

pneumothorax

Question 11

Decreased or Absent breath sounds
Decreased tactile fremitus
dullness of percussion
mediastinal shift: toward (if large) affected side

Answer 11

atelectasis

Question 12

Slow and shallow

Answer 12

Hypopnea

Question 13

Slow’: Decreased respiratory rate

respiratory rate <12

Answer 13

Bradypnea:

Question 14

Cyclic hyperventilation followed by compensatory apnea

CHF

Answer 14

Cheyne-Stokes

Question 15

Completely irregular breathing pattern with irregular pauses and unpredictable periods of apnea

Damage to the medulla oblongata 20 to trauma or stroke: preterminal

Answer 15

Ataxic breathing

Question 16

eliminate more CO2 than the body produces

Answer 16

Hyperventilation

Question 17

Pulmonary causes for clubbing:

Answer 17

Fibrosis
CF
Bronchiectasis
Malignancy

Question 18

FEV1:FVC :

< 70 % of predicted

Answer 18

Obstructive

Question 19

FEV1:FVC : > 70 % of predicted:

Answer 19

Normal or Restrictive

Question 20

DLCO< 80%:

Answer 20

Emphysema,
ILD,
Anemia,
Pulmonary Vascular Disease

Question 21

DLCO >120%

Answer 21

Asthma, Polycythemia

Question 22

TLC < 80%

Answer 22

Restrictive Disease

Question 23

TLC > 120%

Answer 23

Hyperinflation in Obstructive Lung Disease

Question 24

FEV1:FVC <70% (>12% reversibility), DLCO >120%

Answer 24

Asthma

Question 25

FEV1:FVC <70%, DLCO <80%, TLC >120%

Answer 25

COPD

Question 26

FEV1:FVC >70%, DLCO <80%, TLC <80%

Answer 26

Interstitial lung disease

Question 27

Volumes normal, DLCO <80%

Answer 27

Pulmonary vascular disease

Question 28

``` Risk factors Young 18 – 40 years Male Tall Thin Smoker Usually rupture of subpleural bulla Recurrence: 50% ```

Answer 28

Spontaneous pneumothorax

Question 29

Air drawn into the pleural space during inspiration No route out with expiration Increased pressure on affected hemi-thorax Mediastinum pushed over to the other side Kinking of the great vessels Cardiac arrest Etiologies Blunt penetrating trauma

Answer 29

Tension Pneumothorax

Question 30

If suspect TENSION pneumothorax what investigations do you do ?

Answer 30

don’t do a CXR: TREAT