P1.2: RESPIRATORY: INTRO-COPD

Question 1

Normal Breath Sounds

Answer 1

• Tracheal Breath Sounds
• Vesicular Breath Sounds
• Bronchovesicular Breath Sounds

Question 2

Normal Breath Sounds

• Heard over the trachea and are harsh and discontinuous
• E > I

Answer 2

Tracheal Breath Sounds

Question 3

Normal Breath Sounds

• Soft, low-pitched sounds that are heard over the majority of the lung fields; sounds produced
• Produced by air moving through the bronchioles and filling the alveoli
• E < I

Answer 3

Vesicular Breath Sounds

Question 4

Normal Breath Sounds

• Medium-pitched and continuous with muted characteristics of both bronchial and vesicular breath sounds
• Produced by air moving through large airways and are heard over the first and second intercostals spaces along the sterna border and between the scapula

Answer 4

Bronchovesicular Breath Sounds

Question 5

Abnormal (Adventitious) Sounds

Answer 5

A. Crackles (crepitations, rales)
* Fine Crackles
* Coarse Crackles

B. Wheezes

Question 6

Abnormal (Adventitious) Sounds

• Referred to as discontinuous sounds; they are intermittent, non-musical and brief
• May heard either upon inspiration or expiration
• The popping sounds produced are created when air is
  forced through respiratory passages that are narrowed by
  fluid, mucus, or pus
  Often associated with inflammation or infection

Answer 6

Crackles (crepitations, rales)

Question 6

Abnormal (Adventitious) Sounds

• A continuous, coarse, whistling sound produced in the respiratory airways during breathing
• Caused by air moving through narrowed airways
• Do not clear with coughing

Answer 6

Wheezes

Question 7

Radiologic Tests

• Obtained to diagnose disorders of the lung
• Normal lung tissue is radiolucent and that foreign bodies, infiltrates, tumors and fluids appear as white areas or densities
• Performed in the radiology department or at the bedside with a portable unit; they are completed in a few minutes and are painless

Answer 7

Chest Roentgenograms

Question 7

Abnormal (Adventitious) Sounds

• Soft, high-pitched, and very brief
• Sounds like a lock of hair rolled in between fingers

Answer 7

Fine Crackles

Question 7

Radiologic Tests

• Performed to assess the perfusion of the lungs
• A radioactive contrast dye is injected into a vein or an artery and a series of X-rays of the chest are taken to detect blood flow abnormalities (these films provide a picture of the vasculature that can detect pulmonary embolism or infarction

Answer 7

Pulmonary Angiography (Pulmonary Arteriography)

Question 7

Laboratory Tests

Answer 7

1. Complete Blood Count (CBC)
2. Arterial Blood Gases
3. Sputum Analysis

Question 7

Radiologic Tests

Answer 7

1. Chest Roentgenograms
2. Pulmonary Angiography (Pulmonary Arteriography)

Question 7

Abnormal (Adventitious) Sounds

Are somewhat louder, lower in pitch, and last longer than
fine crackles
Sounds like opening a Velcro lock

Answer 7

Coarse Crackles

Question 8

Special Tests

Answer 8

1. Pulmonary Function Test
2. Thoracentesis (Pleural Fluid Analysis)
3. Lung Biopsy
4. Breath Analyzer
5. Fagerstrom Test
6. Oxygen Saturation
7. Skin Test (Mantoux Test

Question 8

Laboratory Tests

Provides information about RBC, hemoglobin, hematocrit and WBC

Answer 8

Complete Blood Count (CBC)

Question 8

Laboratory Tests

• Can be helpful in evaluating patients suspected of having tuberculosis, pneumonia or lung cancer
• It is vital for the care provider to emphasize to the patient the difference between saliva and sputum

Answer 8

Sputum Analysis

Question 9

Laboratory Tests

• Provides information about patient’s oxygenation and ventilation hence deemed valuable in assessing the efficiency of pulmonary gas exchange.
• In this test, the examiner obtains a blood sample (2mL) by direct puncture of a radial, brachial or femoral artery

Answer 9

Arterial Blood Gases

Looking for the gastreous content of the blood

Question 10

Special Tests

• Refers to a non-invasive method of assessing the functional capacity of the lungs
• Measures air flow rates and calculate lung volumes and lung capacities

Answer 10

Pulmonary Function Test

Question 11

The volume of air inspired or expired can be measured during breathing with a recording device called WHAT

Answer 11

Kymograph

Question 12

Terms to describe Lung Capacities

Answer 12

• Tidal Volume (TV)
• Inspiratory Reserve Volume (IRV)
• Expiratory Reserve Volume (ERV)
• Residual Volume (RV)

Question 13

Lung Capacities (determined by combining two or more lung volumes)

Refers to the amount of air remaining in the lungs at the end of normal exhalation (approximately 1,200mL)

Answer 13

Functional Residual Capacity (FRC)

Question 13

Term to describe Lung Capacities

Refers to the amount of air inspired or exhaled during normal, quiet breathing

Answer 13

Tidal Volume (TV)

• Amount is approximately 500mL in a 70kg person
• Volume capacities are 20-25% lower in women
• A decrease in TV without a decrease in respiratory rate (RR) indicates a restrictive disorder such as pulmonary fibrosis
• A decrease in TV with a decrease in RR indicates a neurological
• problem

Question 14

Term to describe Lung Capacities

This refers to the amount of air can be inhaled after a normal or tidal inspiration (normal is approximately 3,300mL)

Answer 14

Inspiratory Reserve Volume (IRV)

Question 15

Term to describe Lung Capacities

Refers to the mount of air that can be forcibly exhaled after normal or tidal expiration

Answer 15

Expiratory Reserve Volume (ERV)

Question 15

Terms to describe Lung Capacities ***(determined by combining two or more lung volumes)***

Answer 15

* Vital Capacities (VC) * Inspiratory Capacity (IC) * Functional Residual Capacity (FRC) * Total Lung Capacity (TLC) * Forced Vital Capacity (FVC)

Question 16

# **Lung Capacities** (determined by combining two or more lung volumes) Refers to the amount of air that can be inhaled with maximal effort after normal exhalation (approximately 3,000mL)

Answer 16

Inspiratory Capacity (IC)

Question 16

# **Term to describe Lung Capacities** Refers to the amount of air remaining in the in the lungs after forced, maximal expiration (approximately 1,000mL)

Answer 16

Residual Volume (RV)

Question 17

# **Lung Capacities** (determined by combining two or more lung volumes) * Refers to the maximal amount of air that can be exhaled after maximal inspiration (approximately 5,000mL) * Refers to the total of the TV, IRV and ERV

Answer 17

Vital Capacities (VC)

Question 18

# **Lung Capacities** (determined by combining two or more lung volumes) Refers to the amount of air in the lungs with maximal inspiration (approximately 6,000mL) Total of the four lung volumes: TV + IRV + ERV + RV

Answer 18

Total Lung Capacity (TLC)

Question 19

# **Special Tests** Performed to obtain fluid samples from the pleural space, relieve pressure from accumulated fluid and obtain tissue for biopsy

Answer 19

Thoracentesis (Pleural Fluid Analysis)

Question 19

COPD embraces several diseases which includes:

Answer 19

* Chronic Bronchitis * Emphysema

Question 20

# **Lung Capacities** (determined by combining two or more lung volumes) Refers to the amount of air expelled with maximally forced exhalation

Answer 20

Forced Vital Capacity (FVC)

Question 20

Used to describe a group of conditions that is characterized by permanent changes in the airways leading to the impairment of air flow

Answer 20

CHRONIC OBSTRUCTIVE PULMONARY DISEASE **(COPD)**

Question 20

* Literally means “looking inside” * Refers to a procedure which allows the examiner to visualize internal structures through the use of an instrument known as endoscope

Answer 20

Endoscopy

Question 20

# **Special Tests** * A test to determine the presence of tuberculosis * A small amount of purified protein derivative (0.1mL) is injected intradermally in the forearm and then the area is examined 48-72 hours later to note any swelling and erythema

Answer 20

Skin Test (Mantoux Test)

Question 20

# **Special Tests** * Used to determine whether or not a patient has been smoking * A simple, non-invasive way to measure carbon monoxide poisoning in a patient

Answer 20

Breath Analyzer *(Carbon Monoxide Breath Test)*

Question 20

# **Special Tests** A simple questionnaire used to determine nicotine dependence

Answer 20

Fagerstrom Test

Question 20

# **Special Tests** * Performed to obtain tissue samples for microscopic examination * May be performed through either **open or closed technique**

Answer 20

Lung Biopsy ## Footnote * **Open Technique**- performed in the operating room and require general anesthesia * **Closed Techniques**- involves the use of local anesthesia and may be accomplished through needle biopsy

Question 20

# **Special Tests** * Measures the amount of oxygen dissolved in the arterial blood * Measure through pulse oximetry which makes use of spectrophotometer to determine the amount of light absorbed by the hemoglobin in arterial blood

Answer 20

Oxygen Saturation ## Footnote **Normal saturation levels: 96% - 100%**

Question 21

A **recurrent inflammation of the bronchial walls** with hypertrophy of the mucous goblet cells, characterized by hypersecretion of mucus accompanied by a chronic/recurrent productive cough for a minimum of 3 months a year for two successive years

Answer 21

CHRONIC BRONCHITIS ## Footnote **With excessive mucus and decreased effectiveness of mucocillary blanket, there is mucus stasis, which initiates inflammation and infection**

Question 22

Risk Factors for **CHRONIC BRONCHITIS**

Answer 22

* Cigarette smoking * Immunological factors * Familial predisposition * Respiratory infection

Question 23

Cycle of airway obstruction and destruction with: * Hypertrophy of the goblet cells * a decreae in ciliated epithelial cells * a decrease in mucociliary clearance

Answer 23

CHRONIC BRONCHITIS ## Footnote Patients with this disorder were described as **BLUE BLOATERS** because the increased secretions and airway obstruction causes hypoxemia (hence cyanosis [blue]) and peripheral edema from right sided heart failure (hence bloater).

Question 24

Refers to an abnormal irreversible enlargement of air spaces distal to terminal bronchioles caused by a complex obstruction and destruction of alveolar walls, resulting in decreased elastic recoil properties of lungs.

Answer 24

EMPHYSEMA

Question 24

A condition characterized by loss of lung elasticity, narrowed bronchioles and abnormal dilation of terminal airspaces caused by the destruction of the alveolar walls

Answer 24

EMPHYSEMA

Question 25

Risk Factors of **EMPHYSEMA**:

Answer 25

* Cigarette smoking * Deficiency of **alpha 1 – anti-trypsin (AAT)** * Infectious agent * Environment/Industrial pollution * Hereditary * Aging

Question 26

# **EMPHYSEMA** Administration of medications:

Answer 26

* **Bronchodilators** (ipratropium and albuterol, salmetrol) * **Corticosteroids** if bronchodilators are not sufficient