Respiratory Care – Assessment & Diagnostics

Thoracic Physical Examination

  • Vocal fremitus

    • ↑ with lung tissue consolidation: pneumonia, atelectasis (if airway patent)
    • ↓ with air/fluid separating lung from chest wall: pleural effusion, pneumothorax, COPD

  • Percussion notes

    • Dull/soft (↑ tissue density): pleural thickening, atelectasis, consolidation
    • Hyper-resonant (↑ air): pneumothorax, emphysema

  • Breath sounds

    • Bronchial over lung fields → suggests alveolar consolidation or atelectasis

  • Wheeze characteristics

    • Caused by bronchospasm
    • High-pitched, expiratory, hallmark of bronchial asthma

  • Whispered pectoriloquy (whisper transmission)

    • Markedly clear over consolidation & atelectasis

  • Abnormal breathing pattern

    • Kussmaul’s respiration ↔ diabetic ketoacidosis (deep, rapid)

Basic Hematology & Immunology Values

  • Hematocrit (Hct)

    • Healthy women: 38\% \text{–} 42\% (≈ option 38\%)

  • Hemoglobin (Hb)

    • Men: 14 \text{–} 16\,g\%

  • Red blood cell count (men)

    • ≈ 5{,}000{,}000/mm^3

  • White blood cell (WBC) count

    • Normal total: 5{,}000 \text{–} 10{,}000/mm^3
    • Neutrophils: 60\% \text{–} 70\% of WBC (primary bacterial defense)
    • Eosinophils & basophils → activated by allergic / asthmatic reactions (eosinophils most noted)

  • Platelets

    • Invasive procedures acceptable when ≥ 50{,}000/mm^3

Blood Chemistry

  • Hyperglycemia associations: diabetes mellitus, myocardial infarction, thiazide/loop diuretics, acute infection
  • Hyponatremia clinical signs: seizures, confusion, muscle twitching, abdominal cramps

Chest Radiography Basics

  • Standard series: Posteroanterior (PA) + Lateral views
  • Anteroposterior (AP) vs PA
    • AP: magnified heart, more distortion, hazier image, more extraneous shadows
  • Lateral view
    • To visualize right lung & heart → left side of chest against cassette
  • Decubitus view nomenclature
    • Right lateral decubitus = patient lying on right side (right side down)
  • Mediastinal shift
    • Toward left: left upper-lobe atelectasis or fibrosis (volume loss)
    • Away from left: right-sided over-expansion/tumor/gas