Pulmonary

Question 1

What are the upper airways?

Answer 1

nose, mouth, pharynx, larynx

Question 2

What are the lower airways?

Answer 2

trachea, terminal bronchioles (conducting airwyas, transport air, nil gas exchange)

respiratoy unit - resp bronchiles, alveolar ducts, alveolar sacs, alveoli (diffusion of gas)

Question 3

What are primary and accessory muscles to inspiration?

Answer 3

Primary - diaphragm, external intercostals

accessory - scalenes, SCM, levator costarum, serratus, traps, pecs

Question 4

What are expiratory muscles of ventilation?

Answer 4

used in exs or disease states

QL, internal intercostals, abs, triangularis sterni

Question 5

What is normal HR?

Answer 5

60-100bpm

Question 6

What is normal BP?

Answer 6

120-80

Question 7

What is normal RR?

Answer 7

12-20

Question 8

What is normal PaO2

Answer 8

80-100mmHg

Question 9

What is normal PaCO2?

Answer 9

35-45 mmHg

Question 10

What is normal pH?

Answer 10

73.5-7.45

Question 11

What are crackles indicative of?

Answer 11

usually on inspiration

atelectasis, fibrosis, PE

Question 12

What are wheezes indicative of?

Answer 12

during expiration

airway obstruction (asthma, COPD, foreign body aspiration)

Question 13

What are normal hemoglobin levels?

Answer 13

12-16 g/dL

Question 14

What is respiratory alkolosis and acidosis?

Answer 14

alkolosis - increased pH, decreased PaCO2, WNL HCO3; alveolar hyperventilation; dizziness, syncope, tingling, numbness

acidosis - decreased pH, increased PaCO2, NWL HCO3; alveolar hypoventilation; anxiety, restlessness, dyspnea, HA, confusion, coma

Question 15

What is metabolic alkolosis and acidosis?

Answer 15

alkalosis - increased pH, increased HCO3, WNL PaCO2; bicarb ingestion, vomiting, duretics, steroids, adrenal disease; vauge symptoms of weakness, mental dullness

acidosis - decreased pH, decreased HCO3, WNL PaCO2; diabetic, lactic, prolonged diarrhea; secondary ventilation, nausea, lethary, coma

Question 16

What is normal WBC count

Answer 16

4,000-11,000

Question 17

What is normal hematocrit levels?

Answer 17

35-48%

Question 18

What is the classification sclae GOLD for obstructive lung disease?

Answer 18

1 mild - 80% predicted, with/without chronic symptoms; unaware of lung function

2 moderate - 50-80%, SOB on exertion

3 severe - 30-50%, decreased exs capacity, exacerbations, heaps of SOB

4 very severe -

Question 19

What are the Graded Exs Test termination criteria?

Answer 19

maximal SOB
cardiac ischemia
symptoms of fatigue
incrase of diastolic pressure of 20, systolic hypertension >250, decrease in blood pressure with increasing workloads
leg pain
total fatigue
signs of insufficient CO
reaching ventilatory max

Question 20

What are the types of pneumonia?

Answer 20

bacterial - intra-alveolar bacterial infection. gram positive (community) and gram negative

viral - interstitial or intra-alveolar inflammatory process caused by viral agents

aspiration pneumonia

Question 21

What are physical findings of COPD?

Answer 21

cough sputum
dyspnea on exertion
decreased breath sounds
increased RR
wt loss/ anorexia
increased AP diameter of chest wall
cyanosis
clubbing
postures to elevate shoulder girdle
CXR showing hyperinflamtion, flattened diaphragm, hyperlucency
hypoxemia, hypercapnea
increased FRC and RV
decreased FEV1, FVC

Question 22

What is asthma?

Answer 22

obstructive disease
reversible in nature
reactivity of trachea and bronch to various stimuli (allergens, exs, cold)
widespread narrowing of ariways due to inflammation
smooth muscle constriction, increased secretions

Question 23

What are physical findings of asthma?

Answer 23

wheezing, crackels, decreased breath dounds
increased secretion
dyspnea
increased accessory muscle use
anxiety
tachycardia
hypoxemia
hypocapnea, then hypercapnea
cyanosis
impaired flow rates
CXR hyperlucency and flattened diaphragm

Question 24

What is cystic fibrosis?

Answer 24

geneticlaly inherited disease characterised by thickening of secretions of all exocrine glands

Question 25

What is bronchiectasis?

Answer 25

chronic congenital or acquired disease characterised by abnormal dilation of bronchi and excessive sputum production

Question 26

What is resp distress syndrome/ RDS?

Answer 26

alveolar collapse in premature infant *PT consideration: increased breathing effort casued by handling premature infant must be carefully weighed against possible benefits of PT

Question 27

What is bronchopulmonary dysplasia?

Answer 27

obstructive pulmonary disease, often a sequela of premature infants with resp distress syndrome Results from high pressures of mechanical vent, high fractions of inspired O2 and/or infection

Question 28

What types of restrictive pulmonary diseases are there?

Answer 28

due to alterations in lung parenchyma and pleura - fibrotic changes due to alterations in chest wall - restricted bony throax; ankylosing spond, scoliosis, arthritis, pectus excavatum, arthrogryposis, skin changes due to burns or scleroderma due to neuromuscular apparatus - decreased muscle strength results in inability to expand ribs; MS, MD, PD, SCI, CVA

Question 29

What postural drainage position do you use for upper lobes (apical segment)?

Answer 29

Pt sitting, leaning back 30degrees | PT clpas of apices

Question 30

What postural drainage position do you use for upper lobes posterior seg?

Answer 30

leans forward over pillo 30 degrees | PT claps over upper back

Question 31

What postural drainage position do you use for upper lobes anterior?

Answer 31

supine pillow under knees, PT claps between clavicle and nipple

Question 32

What postural drainage position do you use for right middle lobe?

Answer 32

foot of table elevated 16in patient head down on left side rotates 1/4 bakcward, knees flexed PT claps over right nipple area

Question 33

What postural drainage position do you use for left upper lobe lingular seg?

Answer 33

foot of table elevated 16 in patients head down on right side and rotates 1/4 turn bakcward PT claps over left nipple area

Question 34

What postural drainage position do you use for lower lobe ant basal seg?

Answer 34

foot of table elevated 20 in lie on side, head down, pillow under knees PT claps over lower ribs

Question 35

What postural drainage position do you use for lower lobes lateral basal seg?

Answer 35

foot of table elevated 20 in lie on abdo, head down, then rotate 1/4 turn upward PT claps over uppermost portion of lower ribs

Question 36

What postural drainage position do you use for for lower lobes posterior basal seg?

Answer 36

foot of table elevated 20 in prone, head down, pillow under hips PT clasp over lower ribs close to spine on each side

Question 37

What postural drainage position do you use for lower lobes superior seg?

Answer 37

table flat prone, two pillows under hips PT claps over middle back at tip of scap on either side of spine