Pulmonary Examination

Question 1

Normal respirations, with equal rate and depth, 12-20 bpm

Answer 1

Eupnea

Question 2

Slow respirations <10 bpm

Answer 2

Bradypnea

Question 3

Fast respirations, >24 bpm, usually shallow

Answer 3

Tachypnea

Question 4

Respirations that are regular but abnormal in depth and increase in rate

Answer 4

Kusmaul’s Respirations

Question 5

Irregular respirations of variable depth (usually shallow) followed by periods of apnea

Answer 5

Biots Respiration

Question 6

Gradual increase in depth of respirations followed by gradual decrease and then a period of apnea

Answer 6

Cheyne-Strokes Respiration

Question 7

Absence of breathing

Answer 7

Apnea

Question 8

What should you take note in the Hx of the patient?

Answer 8

1. Demographics
2. Lifestyle
3. Occupation
4. Genetic Predisposition

Question 9

1. A pulmonary disease that is transmitted by and autosomal recessive trait.
2. What trait is this?
3. Dx test to diagnose this condition.
4. What is the implication of no. 3?

Answer 9

1. Cystic Fibrosis
2. Cystic Fibrosis Transmembrane Conductance Regulator on Chromosome 7; long arm
3. Chloride Sweat Test
4. A chloride concentration of greater than or equal to 60 mEq/L in sweat of a child is positive for CF.

Question 10

1. A condition due to constant remodelling of airways in the pulmonary system.
2. Give me the factors of this condition
3. What symptoms does this condition presents?
   4.What deformity does this patient have if she/he have this condition?

Answer 10

1. Chronic Obstructive Pulmonary Disease
2. Host (Alpha 1 Antitrypsin gene dysfunction) and Environmental Factors
3. Hypoxemia and Hypercapnea
4. Barrel Chest Deformity

Question 11

Stage 1- Mild COPD

Answer 11

1. FEV1/FVC <70%
2. FEV1 is greater than or equal to 80% predicted
3. S&Sx: With or without chronic symptoms

Question 12

Stage 2- Moderate COPD

Answer 12

1. FEV1/FVC<70%
2. 50% is less than or equal to FEV1 less than 80% predicted
3. Often with SOB with exertion

Question 13

Stage 3- Severe COPD

Answer 13

1. FEV1/FVC < 70%
2. 30% less than or equal to FEV1 less than or equal to 50% predicted
3. With greater SOB, decreased exercise capacity, exacerbation

Question 14

Stage 4- Very Severe COPD

Answer 14

1. FEV1/FVC < 70%
2. FEV1 is less than 30% predicted FEV1 less than 50% with chronic respiratory failure
3. Impaired QOL, may be life threatening

Question 15

Variables of Prognosis of COPD Using BODE Index

Answer 15

1. FEV1 (% predicted)
2. 6 minute walk test (meters)
3. MMRC Dyspnea Scale
4. BMI

Question 16

Breathlessness only on strenous exercise

Answer 16

MMRC Dyspnea Scale Grade 0

Question 17

Breathless when hurrying on the level or walking up in a slight hill

Answer 17

MMRC Dyspnea Scale Grade 1

Question 18

Walks slower than other people of same age on the level due to SOB or need to stop for breath when walking at own pace

Answer 18

MMRC Dyspnea Scale Grade 2

Question 19

Short of breath after walking few minutes on the level or about 100 yards (90m)

Answer 19

MMRC Dyspnea Scale Grade 3

Question 20

Too breathless to leave the house, or breathless when dressing or undressing

Answer 20

MMRC Dyspnea Scale Grade 4

Question 21

A deformity that the sternume projects forward and downward like the heel of the boot, increasing anteroposterior dimension of the chest.

Answer 21

Pigeon Chest or Pectus Carinatum

Question 22

A congenital deformity that results from the sternum projecting posteriorly by an overgrowth of ribs.

Answer 22

Pectus Excavatum

Question 23

The sternum projects forward and upward so that the anterposterior diameter is increased.

Answer 23

Barrel Chest Deformity

Question 24

Chest Expansion Normal Difference When Using a Measuring Tape

Answer 24

3 to 7.5 cm (1-3 inches)

Question 25

Landmarks in performing Chest Expansion Test in Upper Lobes

Answer 25

Thumbs at the sternal notch, remaining fingers placed above the clavicle

Question 26

Landmarks in performing Chest Expansion Test in Middle Lobes

Answer 26

Thumbs placed on the xiphoid process, remaining fingers placed on the lateral ribs

Question 27

Landmarks in performing Chest Expansion Test in Middle Lobes

Answer 27

Thumbs at lower thoracic spine (T12) back, remaining fingers placed on the lateral ribs

Question 28

What test used for digital clubbing?

Answer 28

Schamroth Window Test

Question 29

Muscles that helps in respiration during Forced Inspiration

Answer 29

1. SCM 2. Upper Traps 3. Pec. Minor/Major 4. Ant. and Post. Scalene 5. Serratus Anterior 6. External Intercostals

Question 30

Muscles that helps in respiration during Forced Expiration

Answer 30

1. Abdominals 2. Serratus Post. 3. Internal Intercostals

Question 31

Hollow, loud, tubular, high pitched sound

Answer 31

Bronchial and Tracheal

Question 32

Soft pitch sound

Answer 32

Broncho vesicular Vesicular

Question 33

Fine Discontinued Sounds

Answer 33

Crackles/Rales

Question 34

Continuous High or Low pitch sounds

Answer 34

Wheezes

Question 35

Snoring

Answer 35

Stridor

Question 36

Decrease breath sounds

Answer 36

Hyperflation

Question 37

Increase breath sounds

Answer 37

Hypointflation/ Atelectasis

Question 38

Crackles of breath sounds

Answer 38

Presence of secretions

Question 39

Wheezing breath sounds

Answer 39

Constricted Bronchi

Question 40

Balloon Rubbing Breath Sounds

Answer 40

Pleuritis/Pleurisy

Question 41

1. Auscultate posterior chest, ask patient to say “99”. 2. Normal Result? 3. Abnormal Result?

Answer 41

1. Bronchophony 2. Soft and muffled sounds 3. Loud and clear- lung consolidation

Question 42

1. Have patient say “ee” 2. Normal Result 3. Abnormal Result

Answer 42

1, Egophony 2. Soft and muffled sound 3. aa is heard= lung consolidation

Question 43

1. * Performed when (+) bronchophony is ausculatated * Have patient whisper “123”. 2. Normal Result 3. Abnormal Result

Answer 43

1. Whispered Pectoriloquy 2. Should be faint and muffled 3. Loud and clear= lung consolidation

Question 44

1. Associated with Hyperventilation 2. S&Sx of this condition

Answer 44

Dizziness Early Tetany Numbness Tingling Syncope

Question 45

1. Associated with hypoventilation 2. S&Sx of this condition

Answer 45

1. Respiratory Acidosis 2. Early: Headache Anxiety Restlessness Dyspnea Late: Disorientation Somnolence Coma

Question 46

1. MC with vomiting 2. S&Sx

Answer 46

1. Metabolic Alkalosis 2. Weakness Mental Confusion Increase DTR Muscle Twitching

Question 47

1. MC with diarrhea, associated with Kusmaul's Respiration 2. S&Sx

Answer 47

1. Metabolic Acidosis 2. Nausea Lethargic Coma

Question 48

Sputum Color: Red/Scarlet

Answer 48

Blood

Question 49

Sputum Color: Rust

Answer 49

Pneumonia

Question 50

Sputum Color: Yellow

Answer 50

Infection

Question 51

Sputum Color: Green

Answer 51

Pus

Question 52

Sputum Color: Pink

Answer 52

Frothy; Pulmonary Edema

Question 53

Sputum Color: Purple

Answer 53

CA and Neoplasm

Question 54

Sputum Color: Flecked

Answer 54

Carbon Particles

Question 55

Sputum Color: Clear

Answer 55

Normal

Question 56

Exercise Testing Protocols Used for the patient with Pulmonary Disease

Answer 56

1. Cycle Test 2. Treadmill Test 3. 10-meter shuttle test 4. Walk Test (6-12 minutes)

Question 57

Termination Criteria based on ETT Result

Answer 57

1. Maximal SOB 2. Leg Pain 3. Total Fatigue 4. Signs of insufficient cardiac output 5. Reaching a ventilatory maximum 6. Symptoms of fatigue 7. Increase of DBP of 20 mmHg, systolic HTN greater than 250mmHG 8. A fall in PaO2 of greater than 20 mmHg or PaO2 less than 55 mmHg 9. A rise in PaCO2 of greater than 10 mmHg or greater than 65 mmHg 10. Cardiac ischemia or arrhythmias