Pulmonary

Question 1

Most advantageous position for the diaphragm

Answer 1

supine

Question 2

PaO2 levels (normal, hypo, hyper)

Answer 2

normal - 95-100 mmHg

hypoxemia <90 mmHg

hyperoxemia > 100 mmHg

Question 3

PaCO2 levels (normal, hypo, hyper)

Answer 3

normal - 35-40 mmHg

hypocapnea - <35 mmHg

hypercapnea - >45 mmHg

Question 4

PaCO2 and body pH relationship

Answer 4

increase in PaCO2 decreases body pH

decrease in PaCO2 increases body pH

Question 5

normal HCO3 (bicarbonate)

Answer 5

22-28 mEq/L

Question 6

bicarbonate and body pH relationship

Answer 6

increase in bicarbonate increases the body pH

decrease in bicarbonate decreases the body pH

Question 7

common sequelae to chronic lung disease

Answer 7

right ventricular hypertrophy and dilation (cor pulmonale)

Question 8

sign of chronic hypoxemia

Answer 8

digital clubbing

Question 9

where are bronchial sounds heard

Answer 9

R superior anterior thorax

Question 10

crackles (sound) are a sign of what

Answer 10

pathology - atelectasis, fibrosis, pulmonary edema

Question 11

wheezes (sound) is a sign of what

Answer 11

airway obstruction (asthma, chronic obstructive pulmonary disease COPD, foreign body aspiration)

Question 12

Stop exercise testing: A fall in PaO2 of ________ or a PaO2 _______

Answer 12

A fall in PaO2 of greater than 20mmHg or a PaO2 less than 55 mmHg

Question 13

Stop exercise testing: A rise in PaCO2 of ________ or a PaCO2 ________

Answer 13

A rise in PaCO2 of greater than 10 mmHg or a PaCO2 greater than 65 mmHg

Question 14

sarcoidosis
- how is it diagnosed
- how is it managed

Answer 14

restrictive lung disease - multisystem inflammatory disease consisting of granulomas in multiple organs (most often lungs, skin, lymph nodes, eyes, and liver)

often diagnosed as an incidental finding on chest films

managed w/ long term corticosteroids

Question 15

Who is most affected by sarcoidosis?

Answer 15

persons of color more often than other races

Question 16

atelectasis

Answer 16

alveolar collapse of lung

Question 17

cardiogenic vs non-cardiogenic pulmonary edema

Answer 17

cardiogenic - results from increased pressure in pulmonary capillaries associated w/ left ventricular failure, aortic valvular disease, or mitral valvular disease

non-cardiogenic - results from increased permeability of the alveolar capillary membranes due to inhalation of toxic fumes, hypervolemia, or narcotic overdose

Question 18

what can cause pulmonary hypertension?

Answer 18

• idiopathic pulmonary HTN
• L heart disease
• chronic lung disease/hypoxemia
• pulmonary artery obstruction

Question 19

active cycle of breathing

Answer 19

1) normal diaphragmatic breathing
2) 3-4 deep breaths
3) hold breath 1-3 sec
4) relaxed exhale and cough/huff as needed
5) repeat

Question 20

autogenic breathing

Answer 20

1) blow out all air
2) small breaths in and out x20
3) medium breaths x20
4) large breaths x20
5) cough

Question 21

When to use active cycle of breathing vs autogenic breathing?

Answer 21

active cycle - assist in removal of peripheral secretions that coughing may not clear

autogenic - clear secretions w/o tracheobronchial irritation from coughing

Question 22

segmental breathing - what is it used for?

Answer 22

apply pressure at end of exhalation

• improve ventilation to hypoventilated lung segments

Question 23

pertinent physical findings of postoperative pulmonary complications

Answer 23

• increased temp
• increase in WBC count
• change in breath sounds
• abnormal chest x-ray
• decreased expansion of thorax
• shortness of breath
• change in cough and sputum production

Question 24

aerobic conditioning for pulmonary patients

Answer 24

Frequency - 20-30 min for 3-5 x per week, (durations less than 20 min, 5-7 x per week)
Intensity - near max HR using RPE or Borg scale
Time - 20-30 of continuous before increase (interval if 20-30 of continuous is too much)
Type - aerobic circuit

Question 25

normal FEV1

obstructive lung disease FEV1

restrictive lung disease FEV1

Answer 25

normal - 70-80%

obstructive - < 60% (harder to exhale_

restrictive - > 90% (harder to inhale)

Question 26

Cheyne-Strokes respiratory pattern

Answer 26

Irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth of respirations

Question 27

Biot respirations

Answer 27

Irregular respiration pattern characterized by highly variable respiratory depth and intermittent periods of apnea

Question 28

Regular respiration pattern characterized by a rate of more than 24 breaths/minute

Answer 28

Tachypnea - respiratory insufficiency and fever as body attempts to rid itself of excess heat

Question 29

Regular respiration pattern characterized by a rate of less than 10 breaths/minute

Answer 29

Bradypnea - impairment of the respiratory control center and may occur with an increased intracranial pressure, drug intake, or metabolic disorder.

Question 30

What is common after abdominal surgery? How to combat this?

Answer 30

atelectasis - present in up to 95% of patient who undergo abdominal surgery
- Deep breathing (diaphragmatic breathing) is used to resolve atelectasis and increase oxygenation

Question 31

continuous monophonic high-pitched crowing sound heard during inspiration

What causes this?

Answer 31

stridor - caused by upper airway obstruction

Question 32

continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both

What causes this?

Answer 32

high-pitched wheezes - caused by narrow airways or stenosis

Question 33

inspiratory and expiratory grating, creaking sound like sandpaper or leather being rubbed together

What causes this?

Answer 33

pleural rub - caused by pleural inflammation

Question 34

discontinuous, nonmusical, crackling sounds similar in sound to several hairs being rubbed together

What causes this? When is it most heard?

Answer 34

crackles (rales) - caused by sudden opening of closed airways or movement of secretions
- most often heard on inspiration

Question 35

Normal excursion of the diaphragm is

Answer 35

1.2 to 2 inches

Question 36

Diaphragmatic excursion is decreased in patients who have

Answer 36

COPD - flattened diaphragm (below 1.2 in)