162

How is spirometry performed?

subject exhales as forcefully as possible after taking a full inhalation, in standing

values are compared to normative values\####What are components of the spirometry safety scree?

generally seeing if they wouldn't be ale to tolerate the high pressure, ex. ear infection, eye surgury, aneurysm, chest surgery\####what is TLC

the air that can still be breathed in after normal inspiration\####what is ERV?

expiratory reserve volume. the amount of air that can be exhaled after a normal breath\####what is FRC?

usually 40x greater than the FEV1\####what is DLCO

diffusion capacity (of carbon monoxide)

an amount of CO is inhaled and then exhaled after 10 seconds to measure how much diffused into the blood

determined by volume inspired, pulmonary blood flow, Alveolar capillary surface area, hemoglobi, thickness of AC membrane\####what does the flow volume loop measure on each axis?

Y axis: flow (liters/second)

x axis: volume expired

Expiration is on top, inspiration is on bottom\####what is Peak expiratory flow PEF?

the highest airflow rate during the FVC part of the flow volume loop

normal values are within 80% of age predicted max\####what is FEF or forced expiratory flow

the average flow from the points where 25, 50, 75% of lung volume has been expired. High drop off in patients with obstructive disorders compared to PEF\####what is FEV1

Obstructive: normal or slightly small PEF, then a quick drop off in flow. FEV1/FVC lower than normal\####what are the stages for obstructive pulmonary disease based on FEV1/FVC

mild: \>.8

moderate .5-.8

severe .3-.5

very severe

60-80% - mild

50-60% - moderate

FEV1/FVC

FEV1 decreased

FVC normal or decreased

TLC increased

RV increased

DLCO decreased\####How do the vales for restrictive pulmonary disease compare to normal?

FEV1/FVC: normal or increased

FEV1: decreased

FVC: decreased

TLC: decreased

RV: decreased

DLCO: decreased\####what forces affect the work of breathing?

static lung recoil/chest wall recoil. decreases with restrictive, increases with COPD

Airway resistance like mucus\####what conditions can be caused by chronic lung diseases?

R heart failure

sleep apnea

pulmonary HTN

A fib\####what is digital clubbing and what is it caused by?

the fingers and nails become wide and circular

caused by heart and lung diseases that reduce perfusion to the fingers, most commonly lung cancer\####what are the chronic obstructive pulmonary diseases? what are the septic obstructive pulmonary disease?

Chronic: Bronchitis, emphysema, alpha 1 anitrypsin deficiency, athsma(kinda its own category)

septic: Cystic fibrosi, bronchectasis\####what is the most common risk factor for COPD

tobacco slonking\####what is chronic bronchitis?

genetic deficiency causing emphysema in the lower lungs\####what is the pathophysiology of COPD?

toxic particle inhalation triggers immune response, leads to fibrosis of small airways and collapse of small airways on expiration\####what happens to ventilation during emphysema?

Blue bloater\####what are some muscular changes with COPD

metabolic inefficency leading to fiber shift from type 1 to type 2

increased energy expenditure due to increased work of breathing

reduced fat free mass (in quads)

due to disuse atrophy, inflamatory changes\####what are the diaphragmatic adaptations with COPD

can only generate 60% of pressure

shift in fiber type to type 1 reduces force production

stretching of diaphragm changes length tension\####what are other impairments with COPD?

back and neck pain, reduced functional cpacity, impaired balance, reduced gait speed\####what happens to chemoreceptors in COPD

Diffuse: widespread as part of infectious or chronic diseaase\####What is cystic fibrosis?

a disorder in cell membranes that leads to excessive salty mucus production

affects liver,pancreas, lungs, GI, sweat, sinuses

usually causes death by lung infection\####whats the difference between intrinsic and extrinsic restrictive lung disease?

Intrinsic: reduced airway compliance due to thickening and scarring

extrinsic: reduced compliance due to mechanical issues like obesity, chest wall issues, or diaphragm issues\####Intrinsic chronic Restrictive lung disease causes:

idiopathic pulmonary fibrosis,

drugs: including chronic O2 therapy

occupation: coal mining, asbestos, silicosis

hypersensitivity pneumonitis

autoimmune disorder, RA\####what are major signs and symptoms of intrinsic RLD?

insidious onset, frequent dry nonproductive cough. honeycombing of lung on imaging\####what is idiopathic pulmonary fibrosis?

Burns

neuromuscular complications (brainstem and others)

obesity\####what are paradoxical chest wall movements?

when the chest doesn't move as expected to breath in air. could be result of brainstem, spinal cord injury or polio

ex. post polio, the upper thorax rises and the abdomen sinks in\####what are some respiratory complications with obesity

increased work of breathing due to reduced chest compliance and weak respiratory muscles

imbalance between respiratory muscle demand and capacity. shunting of blood away from other structures to respiratory muscles\####do obese individuals have a higher or lower FRC

lower, however expiratory flow limitation leading to dynamic hyperinflation can seemingly normalize this\####What is obesity hypoventilation syndrome?

this leads to sleep apnea, hypoxemia and cardio abnormalities\####how is pulmonary hypertension diagnosed? what pressure is it diagnosed at?

right heart catherterization.

\>25 mm at rest, 30 during exercise\####what are signs and symptoms of pulmonary hypertension?

progressive dyspnea, exertional syncope, normal spriotomy with reduced DLCO\####Is small cell or non-small cell lung cancer more common?

most common in smokers are squamous cell and adenocarcinma\####how can you prevent atelectasis from developing into pneumonia?

take at least 10 full breaths an hour, change position, early mobilization, encourage coughing\####what are the 3 types of acquired pneumonia?

health care associated

ventilator associated\####which type of pneumonia has lobar consolidations?

bacterial\####what are the 4 stages of bacterial pneumonia?

Red hepatization - 2-3 days post exudate with fibrin and RBCs fill alveolar space. has the consistency of the liver

Grey hepatization - no new RBCs in consolidation gives it a grey color

Resolution - debris from inflammatory response has been cleared, little exudate remaining\####what is Bronchiolitis obliterans?

characterized by diffuse destruction of small bronchioles caused by underlying disease like infection or lung transplant\####what is cryptogenic organizing pneumonia?

accompanied by unproductive cough and dyspnea\####what is pleural effusion?

fluid in the pleural space

causes decreased chest sounds, pleural rub, meniscus sign on CXR\####what is the difference between transudative and exudative pleural effusion?

Transudative: caused my mechanical factors, lack of drainage and increased pulmonary capillary pressure

exudative: caused by an infection\####what is likely the cause of rib fractures in children?

abuse\####what is a flail chest?

results in opposite chest movemts during breathing and can be life threatening\####What is a pneumothorax?

air in the plural space causing lack of pressure gradient and lung collapse

can cause tracheal shift or JVD\####what are the causes of pneumothroax?

primary

secondary: COPD related

Iatrogenic: due to diagnostic procedure

traumatic: either puncturing or non puncturing\####What is a tension pneumothorax?

pneumothorax with a one way valve causing airflow in but not out. results in mediastinal shift\####what are the levels of wells score for PE

2-6 moderate

\>4 and positive D dimer indicates likely PE\####what is pulmonary Edema?

Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs. Caused by plasma moving from blood into alveoli

produces pink frothy sputum\####What is ARDS

acute onset of noncardiac pulmonary edema and hypoxia requiring ventilation

involves a series of cellular events leading to protein rich edema, stiffness and decreased compliance of the lungs\####what is the difference between type 1 and type 2 respiratory failure?

Type 1: hypoxia wi/o hypercapnia. Low SpO2

Type 2: hypoxia w/ hypercapnia. Low spO2, high SpCO2 35-45. Low pH\####how do you treat respiratory failure?

through non invasive airway ventilation CPAP or BiPAP, or mechanical ventilation\####what is respiratory failure a balance of?

chest wall mobility

respiration

ventilation

lung segment exam

visual exam

cough exam

QoL report

exercise test

balance

mobility

strength\####what should you look for in a visual chest inspection?

disposition

skin

body position/posuture

breathing pattern (paradoxical wall mvmt)\####what are flared nostrils, pursed lips, hunched over posture a sign of during a visual exam?

COPD emphysema\####what is an appropriate respiratory rate?

SaO2 is a direct arterial measurement of O2 using ABG\####what is hemoptysis a sign of?

pulmonary embolism\####What is frothy pink sputum indicative of?

4 being breathless when dressing or undressing

possibly better than GOLD classification for COPD QoL changes\####what is SGRQ (st georges respiratory questionare)

50 question specific disease respiratory test graded on a scale 0-100 with 100 being more limitation\####how do you want the pt do breath during ausculation?

overinflation

reduced airflow to lung

thick chest wall\####what are increased breath sounds a sign of?

consolidaiton of compression of that segment\####what are crackles, wheezes, stridor and a pleural rub a sign of?

wheezes: asthma, mucus, inflammation, obstructing bodies

Stridor: foreign body in upper airway

pleural rub: inflamation of pleural linings\####what are abnormal voice sounds a sign of?

atelectasis or consolidation

clearer wispers or voice sounds, ayy sound with egophany\####what is a cause of increased tactile fremitus

consolidation of the lung

pleural effusion deminishes fremitus\####what are different percussive sounds a sign of?

dull sounds: atelectassis, consolidation

hyperesonant sounds: emphysema\####what is the lowest rib you can palpate by the sternum?

7th rib\####what does a compression test of the ribs test for?

used for patients with limited chest wall expansion\####what positions help relieve dyspnea

supporting the arms, spine or accessory muscles\####what is postural drainage?