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NPTE Final Frontier > Pulmonary Exam > Flashcards

Pulmonary Exam Flashcards

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1
Q

Lung Volumes:

Volumes Vs Caps (adding 2 things)

ALL FIRST: CHART

A

SEE PICS

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2
Q

Lung Volumes:

Volumes:
Tidal Volume

A

Normal Breathing
500 ml

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3
Q

Lung Volumes:

Volumes:
Tidal Volume

A

Normal Breathing
500 ml

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4
Q

Lung Volumes:

Volumes:
Inspiratory Reserve Volume
IRV

A

“Take deep breathe in, then breathe in AGAIN as much as you can”
- More air IN AFTER normal inhale
- 5-6x TV

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5
Q

Lung Volumes:

Volumes:
Expiratory Reserve Volume
ERV

A

“Breathe OUT, then breathe out AGAIN as much as possible”
- Extra air OUT AFTER normal exhale
- 2-3x TV

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6
Q

Lung Volumes:

Volumes
Residual Volume
RV

A

“Air that hangs out in the lungs”
- Air left AFTER expiration or ERV
- STAYS in lungs
- This is why IRV > ERV

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7
Q

Lung Volumes:

Capacities:
Inspiratory Capacity

Think adding 2 things (volumes) TOGETHER

A

TV + IRV

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8
Q

Lung Volumes:

Capacities:
Vital Capacity

A

“Air in lungs that is VITAL (not including RV)
- ERV + IRV + TV

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9
Q

Lung Volumes:

Capacities:
Total Lung Capacity
TLC

A

ALL Volumes!
RV + ERV + TV + IRV

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10
Q

Lung Volumes:

Capacities:
Functional Residual Capacity

A

ERV + RV

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11
Q

Lung Volumes:

Ex. COPD

A

INC RV, so INC FRV and INC TLC
bc ALL CONNECTED!!!
See chart and it makes sense!!!

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12
Q

Lung Volumes:

Tidal Volume
TV

500mL

A

500 mL
- air inspired during normal, relaxed breathing

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13
Q

Lung Volumes:

Inspiratory Reserve Volume
IRV

A

3,100 mL
- ADD. air that can be forcibly inhaled AFTER inspiration of normal TV== 5-6x TV
- inspired air OVER and ABOVE tidal volume

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14
Q

Lung Volumes:

Expiratory Reserve Volume
ERV

A

1200mL
- Add. air that can be forcibly EXHALED after the expiration of Norm TV
- Expired OVER tidal volume

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15
Q

Lung Volumes:

Residual Volume (RV)

1200 mL

A

1200 mL
- Volume of air still remaining in lungs after the ERV is exhaled
- ALWAYS PRESENT IN LUNGS

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16
Q

Lung Volumes:

TOTAL Lung Capacity
TLC

6000 mL

A

6000 mL
- MAX amt of air that can FILL the lungs
- TV + IRV + ERV + RV (EVERYTHING)

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17
Q

Lung Volumes:

Vital Capacity
VC

A

4800 mL
- TOTAL amt of air that can be expired AFTER fully INhaling
- TV + IRV + ERV–> approx 80% of TLC

NOTE: RV NOT included
Value varies according to age/body size

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18
Q

Lung Volumes:

Inspiratory Capacity
IC

A

3600 mL
- MAX amt of air tht can be INspired
- TV + IRV
- MAX INSPIRATION

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19
Q

Lung Volumes:

Functional Residual Capacity
FRC

A

2400 mL
- Amt of air remaining in lungs AFTER normal expiration
- RV + ERV (kinda like IC, but w/ EXHALE (ERV)
- Air is in lungs AFTER you’ve expired TV

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20
Q

NOTE: What is ALWAYS INCREASED in COPD?

A

INC RV, FRC, TLC

ALL CONNECTED!

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21
Q

Practice!
PT performs spirometry to assess lung functoin. PT tells pt he would like to assess amt of air in lungs AFTER norm exhale. Which volume?

A

Expiratory Reserve Volume (ERV)

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22
Q

Lung Volumes: Comparison

Normal vs Obstructive

A

Cannot get air OUT!
- Note INCd TLC, FRC, RV

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23
Q

Measurements:
Obstructive (CBABE, cannot get air OUT) vs Restrictive (cannot get air IN)

A

see table

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24
Q

Tidal Volume (VT)
Obst vs Restrict

A

O: N or INC
R: N or DEC

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25
IC Obst vs Restrict
O: N or DEC R: N or DEC
26
ERV Obst vs Restrict
O: N or DEC R: N or DEC
27
Vital Cap. O vs R
O: N or DEC R: N
28
Forced Vital Cap O vs R
O: N or DEC R: DEC
29
RV O vs R
O: N or INC R: N or DEC
30
FRC O vs R
O: N or INC R: N or DEC
31
TLC O vs R
O: N or INC R: DEC
32
FEV1 O vs R
O: DEC R: N
33
Practice! 52yo male w/ COPD and exp wheezing, tightness chest, coughing worse @ night. DOE, uses access mm's to breath. MOST LIKELY INCd on PFT?
COPD INC RV, TLC, FRC (ERV + VT)
34
# COPD GOLD Classification Stages I (Mild) to Stage IV (Very severe)
Stage I (Mild) - FEV1= >80 - FEV1/FVC= <.7 - Chronic cough + **sputum** Stage II (Mod) - FEV1= 50-80 - FEV1/FVC= <.7 - Chronic cough + Sputum + Dyspnea Stage III (Severe) - FEV1= 30-50 - FEV1/FVC= <.7 - Chronic cough + sputum + INC dyspnea Stage IV (Very severe) - FEV1= <30 - FEV1/FVC= <.7 - Chronic cough + sputum + DOUBLE INC dyspnea - Resp or **R. HF, Wt loss** | <.7 FEV1/FVC= COPD**remember lOw for Obstructive (Looower)
35
Practice! 78yo w/ acute exacerb. COPD. FEV1 40% (30-50, severe) and FEV1/FVC <.7 w/ SOB during amb. GOLD class?
SEVERE Chronic cough + sputum + INC (1arrow) dyspnea
36
Practice! 58yo pt has COPD. During exam PT finds pt has **weak wet cough.** Which is approp to clear secretions?
Huffing--think fogging mirror, huffing feather off hand - Gentler form of coughing to remove secretions. EASIER to move mucus out of lungs and stabilize airways, prevents collapse
37
NORMAL Breath Sounds Remember: V-Bv-B-T (Very Big Boobs Tits) | Easiest way to remember? Organize like this!!
**Intensities:** - Go from SOFTER to VERY loud **Pitch of Expiratory:** - Go from LOW to Rel. High
38
# NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits) Vesicular (gentlest)
**Duration:** INSP longer than EXP **Intensity:** SOFT **Pitch of Exp.:** LOW **Location:** Over **MOST** of lungs**
39
# NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits) **B**roncho**v**esicular
**Duration:** INSP and EXP EQUAL **Intensity: **Intermed. **Pitch of Exp: **Intermed. **Location: ** Bw **1st and 2nd interspace ANT. and bw scapulas**
40
# NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits) Bronchial
**Duration:** EXP sounds longer than INSP (just flips from vesicular) **Intensity:** LOUD **Pitch of Exp:** HIGH **Location:** Over manubrium (lower vs Bv)
41
# NORMAL Breath Sounds: V-Bv-B-T (Very Big Boobs Tits) Tracheal (its in the name)
**Duration:** Both INSP and EXP EQUAL (same as Bv) **Intensity:** VERY Loud **Pitch of Exp:** Rel. High **Location (in the name):** Over **trachea in neck**
42
Normal Breath Sounds: Another way to remember...
- **Vesicular:** VESSELS on the ocean have to be SOFT to float and its for sailiing/riding beginners - **Bronchovesicular:** When riding a BRONCO in a VESSEL on the ocean, it's NOT for beginners but also not a hard lvl for sailing/riders, so it's INTERMED. - **Bronchial:** Riding a BRONCO is LOUD and for those only prepared since it can get crazy (HIGH) - **Tracheal:** A TRAKE (DRAKE) concert gets VERY LOUD no matter who you are, so you know TRAKE (DRAKE) is VERY LOUD
43
PRACTICE! Which sound is PT auscultating? | MOST of the lungs!
Vesicular
44
Abnormal Resp Sounds: RWCP
Rhonchi- think snoring LOW Wheeze- think WHistle Crackles- think Snap, Crackle, Pop HIGH Pleural rub- think sandpaper
45
# Abnormal Resp Sounds: **R**honchi Think **R**yan snores LOW | Snoring LOW
- **continuous, LOW PITCHED** rattling sounds often resemble **Snoring.** - COPD, Bronchiectasis, PNA, Chronic bronchitis, CF | This is the only LOW one
46
# Abnormal Resp Sounds: Wheeze Think **Wh**eeze, **Wh**istle HIGH
- **high pitched** heard in EXP (wheeze has lots of E's so EXP.). - Airway obstruct--> asthma, COPD, aspiration (if severe, heard during INSP also)
47
# Abnormal Resp Sounds: Crackles (bubble wrap pop) Think **snap, Crackle, POP HIGH** | Blowing thru straw in water makes bubbles
- brief, DIScontinuous, **Popping** sounds HIGH-pitched - prev Rales-- heard during **BOTH Insp/Exp**
48
# Abnormal Resp Sounds: Pleural rub Think **sandpaper...literally**
- Auscultate **lower lat. chest**--INSP and EXP - **Pleural inflammation!**
49
PRactice! 76yo w/ s/s CHF. During auscultation, PT frinds S3 (CHF). Which high-pitched sound MOST likely assocd w/ CHF?
Crackles--snap, crackle, **pop HIGH** - CHF= S3 + crackles (pop HIGH)
50
More on S3 vs S4
S3 - Ventricular gallop - **CHF**, Crackles, Dyspnea CHF--tachypnea, pulm edema, PND, orthopnea S4 - Atrial gallop **- MI/HTN**
51
Voice Sounds: 3 types and what they use
1. **Bronchophony:** "99" 2. **E**gophony: Long **"E"** sounds 3. **Whispered** pectoriloquy: Whispering
52
# Voice Sounds Bronchophony
- Incd Vocal Resonance w/ greater clarity and loudness of spoken words - **Ex. 99** Aka if you hear "99" loud/clear==> Secretions | should be muffled= normal
53
# Voice Sounds **E**gophony
Form of Bronchophony in which the spoken **long "E" sounds** changes to **long, nasally-sounding "A"** aka if you hear "A" loud/clear== Secretions | Muffled= normal
54
# Voice Sounds Whispered pectoriloquy
- Incd loudness of **whispering** - recognition of whispered words (you'll hear loudly) "1, 2, 3" aka if you hear 1, 2, 3 LOUD==Secretions | Muffled= normal
55
PRactice! PT assesses voice sounds. Stethoscope over thorax and asks to say "E" (Egophony!)
**E**gophony is **"E" one**!! | You will hear it as "A"
56
Abnormal Blood Gases **What SHOULD values be?**
pH= 7.35-7.45 CO2= 35-45 HCO3-= 22-26 | See table
57
Resp vs Met Acidosis vs Alkalosis
Resp== CO2 changes (lungs) Met== HCO3- changes (kidneys) - **Resp acidosis--> pH DEC, CO2 INC, HCO3- Norm** - **Resp alkalosis--> pH INC, CO2 DEC, HCO3- Norm** - **Metabolic acidosis--> pH DEC, CO2 Norm, HCO3- DEC** - **Metabolic alkalosis--> pH INC, CO2 Norm, HCO3- INC**
58
Resp vs Met Acidosis vs Alkalosis **ROME** **R**esp **O**pposite **M**etabolic **E**qual
ROME **R**esp **O**pp - pH high, CO2 down= alkalosis - pH low, CO2 high= acidosis **M**etabolic **E**qual - pH high, HCO3 high= alkalosis - pH low, HCO3 low= acidosis
59
PRactice! What is going on here?
Metabolic ALKalosis pH High, HCO3- High= Met alkalosis
60
Resp vs Met Acid/Alkalosis STEPS!
1. Look @ pH: IF Norm= 7.35-7.45, answer is **compensated** 2. Look @ PaCO2: IF Norm= 35-45, answer is **metabolic** 3. Look @ HCO3-: IF Norm= 22-26, answer is **respiratory** 4. **NONE of three are normal:** answer is **Partially** compensated
61
Practice! Chronic smoker w/ COPD undergoes ABG. (COPD usually HIGH CO2 bc cannot get air OUT!) MOST LIKELY to see on ABG?
INCd PaCO2, DECd PaO2, DECd pH

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