Pulmonary Section

Front 1

What characterizes obstructive pulmonary flow?

Back 1

Decreased expiratory flow from increased airway resistance, causing pulmonary inflation.

Front 2

What are the five obstructive pulmonary diseases?

Back 2

Emphysema
Chronic Bronchitis
Asthma
Bronchiectasis
Cystic fibrosis

Front 3

What characterizes restrictive lung diseases?

Back 3

Decreased inspiratory flow from decreased lung compliance. Lungs are difficult to fill with air.

Front 4

What is the single restrictive lung disease she talked about?

Back 4

Pulmonary fibrosis.

Front 5

What characterizes consolidative lung diseases?

Back 5

Replacement of alveolar air with fluid/collapsed alveoli. Decreases air/fluid ratio of lung tissue.
Transmits higher frequency sounds.

Front 6

Name three common causes for lung consolidation.

Back 6

Alveolar pneumonia with pus and cellular debris.
Left ventricular failure with leaking plasma.
Atelectasis.

Front 7

What characterizes atelectasis?

Back 7

Segment of lung collapses. Water density is increased, air/water ratio decreases.

Front 8

During atelectasis, do the visceral and parietal pleura separate from each other?

Back 8

Nope.

Front 9

What causes atelectasis?

Back 9

BLockage of air from entering alveoli. Air reabsorbs into vasculature and segments of the lung collapse.

Front 10

What characterizes pneumothorax?

Back 10

Air pressure enters pleural space, lung collapses, chest wall springs outwards.

Front 11

Do the visceral and parietal layers of the pleura separate during pneumothorax?

Back 11

Yes.

Front 12

Describe a tension pneumothorax.

Back 12

Air drawn into the pleural space cannot escape--pressure becomes higher.
Rapidly grows fatal as great vessels, heart, and opposite lung are compressed.
Obstructive shock.

Front 13

Will the trachea move to the same side, or the opposite side, as the lung affected by tension pneumothorax?

Back 13

Opposite side.

Front 14

Describe pleural effusion.

Back 14

Accumulation of fluid in pleural space. This fluid moves toward gravity-dependent regions and compresses underlying lungs.

Front 15

In pleural effusion, the fluid that accumulates can either be protein poor, or protein rich. What diseases do these characterize, respectively?

Back 15

Protein poor--congestive heart failure.
Protein rich--cancer.

Front 16

Which side is the trachea pulled to in atelectasis?

Back 16

To the affected side.

Front 17

Which side is the trachea pulled to in pleural effusion?

Back 17

Away from the affected side.

Front 18

Name the three major signs to INQUIRE ABOUT in a pulmonary history.

Back 18

Dyspnea
Cough
Pleuritic chest pain

Front 19

Dyspnea from chronic lung diseases develops gradually. Name three diseases in which this is the case.

Back 19

Emphysema, Obstrucitve bronchitis, pulmonary fibrosis.

Front 20

Dyspnea from acute lung dieases develops quickly, rapidly worsens. Name five conditions in which this is the case.

Back 20

Pneumonia, pulmonary embolism, pneumothorax, aspiration, pulmonary edema.

Front 21

What sort of nerves mediate the cough reflex, and what do they travel within?

Back 21

Afferent and efferent nerves within the vagus.

Front 22

Define acute cough, and name examples.

Back 22

Lasts less than 3 weeks.
Includes viral/bacterial infections, pneumonia, aspiration, pulmonary edema, PE.

Front 23

Define chronic cough, name examples.

Back 23

Lasts more than 3 weeks.
Tobacco-related bronchitis (smokers' cough), allergic postnasal drip, asthma.
Can be caused by meds.

Front 24

What causes clear sputum?

Back 24

Inhaled irritants.

Front 25

What causes purulent sputum?

Back 25

Infectious bronchitis, pneumonia.

Front 26

What causes putrid sputum?

Back 26

Lung abscesses.

Front 27

What causes rusty sputum?

Back 27

Blood in the lung.

Front 28

Define scant hemoptysis.

Back 28

Blood streaking the sputum.

Front 29

Define gross hemoptysis.

Back 29

More blood than streaking hemoptysis, but less than 600 ml.

Front 30

Define massive hemoptysis.

Back 30

Over 600 mls of blood in a 24 hour period.

Front 31

What are the most common causes of hemoptysis?

Back 31

Acute bronchitis, or other disorders involving airways, vasculature, or lung parenchyma. WHich is a supremely vague answer. Can also be caused by eroding aortic aneurisms in the arch.

Front 32

Describe pleuritic pain. What differentiates it from an MI?

Back 32

It is sharp or dull, and increases in intensoty with deep breathing, coughing, movement (unlike MI). It is localized but may radiate.

Front 33

What is the most common cause of chest pain?

Back 33

Costrochondritis.

Front 34

Name three non-thoracic findings that may indicate lung disease.

Back 34

Clubbing, Periosteal inflammation in the distal shaft of the long bones, and hypertrophic osteoarthropathy (HOA).

Front 35

Most clubbing results from which two types of diseases?

Back 35

Neoplastic/inflammatory lung disease. Ugh, such a vague question.

Front 36

Tachyapnea in hospitalized patients is a bad prognostic factor and may indicate:

Back 36

The presence of underlying cardiopulmonary disease--may portend imminent cardiopulmonary arrest.

Front 37

Tachyapnea may be the first physical indication of:

Back 37

Pneumonia, heart failure.

Front 38

Bradypnea should prompt an evaluation for:

Back 38

Hypothyroidism.

Front 39

Chest ratio of anterioposterior diameter to lateral diameter is usually:

Back 39

0.70 to 0.75, increasing to 0.90 in the elderly.

Front 40

Name three curvatures of the spine that may inhibit breathing.

Back 40

Kyphoscoliosis, pectus excavatum, pectus carinatum.

Front 41

Describe flail chest.

Back 41

One/both sides of chest move paradoxically inward during inspiration. Develops following multiple rib fractures.

Front 42

Describe respiratory/abdominal paradox.

Back 42

Retraction of the abdominal wall during inspiration--indicates bilateral diaphragmatic weakness/paralysis.
Very sensitive for predicting respiratory failure.
Precedes hypoxemia and CO2 retention.

Front 43

What are the four steps to a pulmonary physical?

Back 43

Inspection, palpitation, percussion, ausculatation.

Front 44

Does tenderness upon palpation indicate coronary artery disease as a diagnosis?

Back 44

No.

Front 45

In diseases such as chronic obstructive lung disease, restrictive lung diseases, pneumothorax, and atelectasis, will thoracic expansion increase or decrease?

Back 45

Decrease.

Front 46

What expansive chest measurement is considered abnormal? What does it indicate disease-wise?

Back 46

Anything less than 1 inch is abnormal. It is consistant with emphysema and/or restrictive lung disease.

Front 47

Describe a vocal tactile fremitus (VTF)

Back 47

Sound transmitted from teh larynx, causes a thrill on the suface of the chest that can be detected on palpation.

Front 48

Asymmetric VTF is abnormal--describe the one exception and where it is located.

Back 48

VTF over the right upper lobe is often great in intensity, because the trachea is closer to the apex of the right lung than the left.

Front 49

What generally causes decreased VTF; a greater air/water ratio, or a lesser air/water ratio?

Back 49

Greater air/water ratio.

Front 50

Pleural effusion, Pneumothorax, obesity do what to VTF intensity?

Back 50

Decrease it.

Front 51

Airway obstruction does what to VTF?

Back 51

Decreases it.

Front 52

Airway obstruction by mucous does what to VTF?

Back 52

Decreases intensity.

Front 53

Emphysema decrease VTF by doing what to the air/water ratio?

Back 53

Increases air/water ratio, which decreases VTF.

Front 54

When the air/water ratio goes down, VTF intensity...

Back 54

Increases

Front 55

Name several causes of lung consolidation.

Back 55

Alveolar edema, alveolar pneumonia, alveolar hemorrhage, alveolar fibrosis.

Front 56

Lung consolidation (barring atelectasis) causes VTF intensity to...

Back 56

Increase.

Front 57

Trachea will move towards the affected side in these diseases:

Back 57

Atelectasis, tumors, and I THINK consolidation diseases.

Front 58

Trachea will move away from the affected side in these diseases:

Back 58

Pneumothorax, pleural effusion

Front 59

Percussion with the highest air/water ratio--heard over stomach and pneumothorax.

Back 59

Tympany

Front 60

Hyperresonance has a high air/water ratio. Where is it heard normally, and in what diseases abnormally?

Back 60

Normally at the end of a full, held breath.
Present bilaterally with emphysema and uniliaterally with a single lobe pneumothorax.

Front 61

What low pitched note is heard over normal lungs during quiet breathing?

Back 61

Resonance.

Front 62

This note is produced over a solid organ. Low air/fluid ratio.
What diseases produce it?

Back 62

Dullness. Present over consolidated areas, medium pleural effusions, widespread pulmonary fibrosis, and unilaterally in pneumonia.

Front 63

Flatness has the lowest air/fluid ratio and is normally heard over thigh muscle. Where and how is it detected in diseased patients?

Back 63

Unilaterally, it is present over large pleural effusions, which compress underlying lung parenchyma and causing atelectasis.

Front 64

Define diaphragmatic excursion.

Back 64

It is the distance of diaphragm movement between rounds of normal inspiration and expiration.

Front 65

Which hemi-diaphragm normally percusses 1-2 cm higher?

Back 65

The right side.

Front 66

Where is Ewart's sign ascertained, and what does it indicate?

Back 66

It is dullness at the tip of the left scapula, and it points to a massive pericardial effusion.

Front 67

Where is Kronig's isthmus, and what does it sound like if percussed?

Back 67

It is where tank top straps run, and it should sound hyperressonant.
Dullness points to consolidation or pleural effusion in apex=TB.