Pulmonary exam

Question 1

How do you calculate pack years?

Answer 1

number of packs per day x years smoked

Question 2

What RR indicates tachypnea?

Answer 2

> 20 breaths/min

Question 3

What is cor pulmonale?

Answer 3

dilation of R ventricle d/t chronic lung disease

Question 4

Typical tidal volumes for adults and children?

Answer 4

adults = 500ml
children = 20ml

TV = volume of gas inhaled (or exhaled) over normal breath

Question 5

Where will you see cyanosis if it’s present in your patient?

Answer 5

lips, around the eyes, nail beds

Question 6

What is a sign of chronic hypoxemia found in the fingers/nailbeds?

Answer 6

digital clubbing

Question 7

With obstructive pulmonary disease, what happens to the A-P dimension of the chest?

Answer 7

increases

- lung recoil is decreased, resulting in barrel chest, increased AP dimension

Question 8

What is typical thoracic excursion in adults and how do you measure this?

Answer 8

2-3in, measured by base of lungs from full inspiration to full experiation

Question 9

When auscultating your patient, you hear vesicular sounds. What are these?

Answer 9

normal breath sounds (heard all through inspiration, beginning of exp)

Question 10

What do decreased breath sounds sound like? Associated with what kind of lung disease?

Answer 10

distant sounds where only some of inspiration is heard

- associated with obstructive lung disease (maybe restrictive though?)

Question 11

What type of lung sound might you hear with atelectasis, fibrosis, or pulmonary edema?

Answer 11

crackles/rales

Question 12

Your patient has a thoracic burn. What should you make sure to assess in your pulmonary assessment?

Answer 12

symmetric thoracic expansion

Question 13

What are key points to assess with pulmonary inspection/palpation?

Answer 13

1) neck - trachea position, accessory muscle use

2) thorax - changes in bony thorax, AP dimension, symmetrical excursion, changes in skin, pain, scars

Question 14

Where in the lung will you hear more intense inspiration/expiration sounds upon auscultation?

Answer 14

more loud/intense at apex

quieter at bases

Question 15

What are the two adventitious breath sounds?

Answer 15

wheezes (heard on expiration)

rales (heard on inspiration)

Question 16

What is atelectasis?

Answer 16

partial/complete collapse of the lunge

Question 17

What is a pneumothorax?

Answer 17

presence of air/gas in the cavity between the lungs and chest wall, causing compression of the lung
- can cause atelectasis

Question 18

Your patient has aspirated a foreign body. What adventitious breath sound might you hear?

Answer 18

wheezes

- vs crackles heard during atelectasis, fibrosis, or pulmonary edema

Question 19

Your patient with COPD might demonstrate what adventitious breath sound?

Answer 19

wheezes (which are caused by airway obstruction)

Question 20

What is pulmonary edema? What can cause it?

Answer 20

fluid in the lungs

• fluid collects in the sacs, making it difficult to breathe
• can be caused by congestive heart failure, or kidney failure (inability to excrete fluid from body, builds up in blood vessels)

Question 21

What is congestive heart failure?

Answer 21

heart dysfunction that causes fluid buildup in lungs and surrounding tissue

Question 22

What does normal transmission of vocal sounds sound like?

Answer 22

same as breath sounds: loudest near trachea and main-stem bronchi
- less clear but still intelligible at distal areas of lungs

Question 23

If you can hear vocal sounds intensely and clearly in the bases of the lungs, what is this dysfunction called?

Answer 23

bronchophony

Question 24

Why might there be abnormal transmission of vocal sounds?

Answer 24

fluid filled areas, areas of consolidation, cavitation lesions, pleural effusions

Question 25

What is pleural effusion? Caused by what? How is it commonly treated?

Answer 25

excess fluid buildup between the lungs and the chest - most commonly caused by congestive heart failure - commonly treated with diuretics

Question 26

Why would a chest x-ray be performed for a patient? (2)

Answer 26

1) to detect presence of abnormal material (exudate, blood) | 2) change in pulmonary parenchyma (fibrosis, collapse)

Question 27

What is exudate?

Answer 27

protein-rich fluid with other cellular elements that oozes out of blood vessels d/t inflammation and is deposited in nearby tissues - fluid that leaks out around cells of capillaries

Question 28

What type of scan might be performed to assess for the presence of pulmonary emboli?

Answer 28

V/Q scan - matches the ventilation pattern of the lung to the perfusion pattern

Question 29

What is ventilation? Perfusion?

Answer 29

``` ventilation = air getting into alveoli perfusion = blood getting transported to alveoli in lungs ```

Question 30

What is alveolar ventilation?

Answer 30

ability to remove CO2 from blood and maintain blood pH

Question 31

Your patient exhibits dizziness, syncope, N/T. You check their chart prior to the session and recall that they're lab values indicate a most recent pH of 7.6. and PaCO2 of 30. What could be occuring?

Answer 31

``` respiratory alkalosis (decreased pH = more alkaline) ```

Question 32

What are the 4 types of abnormal acid-base balance?

Answer 32

respiratory alkalosis/acidosis | metabolic alkalosis/acidosis

Question 33

What abnormal acid-base balance issue causes secondary hyperventilatino, nausea, lethargy, and/or coma?

Answer 33

metabolic acidosis - both respiratory and metabolic acidosis can cause coma, more issues here than alkalosis

Question 34

T/F: PaCO2 remains WNL for respiratory acidosis.

Answer 34

false -> remains the same for metabolic acidosis AND alkalosis - increases for respiratory acidosis

Question 35

A combination of a high pH and low PaCO2 can cause what?

Answer 35

respiratory alkalosis | - remember PaO2 only changes with respiratory acidosis/alkalosis

Question 36

What does an FEV1/FVC value

Answer 36

obstructive lung issue decreasing airflow

Question 37

What is FEV1?

Answer 37

amount of air that can be expelled in 1 sec

Question 38

What is FVC?

Answer 38

forced vital capacity: how much air can be forcefully expelled after a full inhale

Question 39

How many categories of obstructive lung disease are there?

Answer 39

4: mild, mod, severe, very severe

Question 40

At what stage of obstructive lung disease do patients start to seek out medical care?

Answer 40

2 - may have an exacerbation or may have chronic respiratory problems

Question 41

At what stage of obstructive lung disease is FEV1 <50%?

Answer 41

stage 3: <50 but >30

Question 42

Cor pulmonale, increased JVD are signs of what stage of obstructive lung disease?

Answer 42

stage 4 - very severe

Question 43

What is cor pulmonale?

Answer 43

abnormal enlargement of the R side of the heart d/t failure