Pulmonary Exam and Assessment

Question 1

Classic cardiac symptoms:

Answer 1

chest pain, tightness, pressure, shortness of breath, palpitations, indigestion, burning

Question 2

Classic pulmonary symptoms:

Answer 2

shortness of breath, dyspnea, wheezing, cough, increased work of breathing, sputum

Question 3

Risk factors for heart disease

Answer 3

HTN, smoking, elevated cholesterol, family history, stress, sedentary lifestyle, older age, obesity, diabetes

Question 4

Semi-Fowler’s position:

Answer 4

HOB raised to 45 degrees

Question 5

Professorial position:

Answer 5

sitting, trunk flexed forward with arms on knees

stabilizes thorax and arms to increase effectiveness of accessory muscles during breathing

Question 6

Abnormal rib angle:

Answer 6

greater than 90 degrees and attaching to the vertebrae with angles greater than 45 degrees in the hyperinflated chest. Also note that the position of the diaphragm is flattened

Question 7

Respiratory rate greater than 25 may indicate:

Answer 7

Pulmonary dysfunction
Metabolic acidosis
Systemic stress

Question 8

Respiratory rate less than 10 indicates:

Answer 8

CNS abnormality or metabolic alkalosis

Question 9

Normal inspiratory to expiratory ration (I/E):

Answer 9

1:2

Question 10

Obstructive disease inspiratory to expiratory ration (I/E):

Answer 10

1:3 or 1:4

Question 11

Tachypnea inspiratory to expiratory ration:

Answer 11

1:1

Question 12

What causes I/E ration to decrease?

Answer 12

respiratory distress

Question 13

RR birth to 1 year:

Answer 13

30-60

Question 14

RR 1-3 years

Answer 14

24-40

Question 15

RR 3-6 years

Answer 15

22-34

Question 16

RR 6-12 years

Answer 16

18-30

Question 17

RR 12-18 years

Answer 17

12-16

Question 18

RR 18+ years

Answer 18

12-20

Question 19

S/s of hypoxemia

Answer 19

Confusion
Changes in skin color –blue to red
Cough
Tachycardia
Tachypnea
SOB
Diaphoresis
Wheezing

Question 20

S/s of hypercapnia

Answer 20

Flushed/red skin coloring
Tachycardia
HTN or hypotension
Diaphoresis
Decreased mental status, confusion, drowsiness, coma
Headache
Muscular twitching, myoclonic jerking
Papilledema if chronic

Question 21

Normal diaphragmatic excurison:

Answer 21

3-5 cm

Question 22

Normal breath sounds:

Answer 22

vesicular – soft, low=pitched sounds heard primarily during inspiration
soft rustling sound
heard throughout all of inspiration and the beginning of expiration

Question 23

Bronchovesicuar

Answer 23

normal” – heard over junction of the mainstem bronchi with the segmental bronchi

Question 24

Bronchial breath sounds (tubular sounds)

Answer 24

loud high-pitched sounds
A more hollow, echoing sound normally found only over the right superior anterior thorax
Corresponds to an area over the right main stem bronchus
All of the inspiration and most of expiration heard with bronchial breath sounds

Question 25

Graded Exercise Test Termination Criteria

Answer 25

Maximal shortness of breath A fall in PaO2 of greater than 20 mm Hg or a PaO2 less than 55 mm Hg A rise in PaCO2 of greater than 10 mm Hg or PaCo2 greater than 65 mm Hg Cardiac ischemia or arrhythmia Symptoms of fatigue Increase in diastolic BP readings of 20 mmHg, systolic HTN greater than 250 mmHg, decrease in BP with increasing workloads Leg Pain Total Fatigue Signs of insufficient cardiac output Reaching a ventilator maximum

Question 26

Decreased breath sounds heard with:

Answer 26

hyperinflation in chronic obstructive disease | hypoinflation in acute lung disease (pneumothorax, pleural effusion)

Question 27

Absent breath sounds heard with:

Answer 27

pleural effusion pneumothorax sever hyperinflation obesity

Question 28

Bronchial breath sounds heard with:

Answer 28

consolidation | atelectasis with adjacent patent airway

Question 29

Crackles heard with:

Answer 29

secretions if biphasic | deflation if monophasic

Question 30

Wheezes heard with:

Answer 30

diffuse airway obstruction, if polyphonic | localized stenosis, if monophasic

Question 31

Sympathomimetic

Answer 31

stimulate adrenergic receptors = bronchodilation

Question 32

Adrenergic agonists

Answer 32

stimulate adrenergic receptors = bronchodilation

Question 33

Sympatholytic

Answer 33

inhibits adrenergic receptors = bronchoconstriction

Question 34

Adrenergic antagonists

Answer 34

inhibits adrenergic receptors = bronchoconstricion

Question 35

Parasympathomimetics

Answer 35

stimulate cholinergic receptors = bronchoconstricition

Question 36

Muscarinic agonists

Answer 36

stimulate cholinergic receptors = bronchoconstriction

Question 37

Parasymatholytics

Answer 37

inhibit cholinergic receptors = bronchodilation

Question 38

Muscarinic antagonists

Answer 38

inhibit cholinergic receptors = bronchodiallation