Pulmonary Physiology and Assessment Quiz
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Questions and Answers

What does egophony indicate when heard during auscultation?

  • Constricted airways due to asthma
  • Fluid-filled areas or lesions in the lungs (correct)
  • Normal lung sounds
  • Obstruction in the upper airway

    • Which condition is characterized by a shrill, harsh sound during inhalation due to laryngeal obstruction?

  • Wheezing
  • Stridor (correct)
  • Stertor
  • Bronchophony

    • Frequent sighing is considered to be:

  • A symptom of chronic lung disease
  • An abnormal sign requiring further assessment (correct)
  • An indication of hyperventilation
  • A normal physiological response

    • What does bronchophony indicate when there is an intense clear sound heard during auscultation?

    <p>Fluid accumulation in the lungs</p> Signup and view all the answers

    Wheezing is a respiratory sound that can occur during which phases of breathing?

    <p>During both inspiration and expiration</p> Signup and view all the answers

    What is the volume of gas inhaled during a normal resting breath known as?

    <p>Tidal Volume (TV)</p> Signup and view all the answers

    Which blood-gas value indicates severe hypoxemia?

    <p>PaO2 &lt; 40 mmHg</p> Signup and view all the answers

    Which volume represents the amount of air that can be exhaled beyond a normal resting tidal exhalation?

    <p>Expiratory Reserve Volume (ERV)</p> Signup and view all the answers

    What does a pH value of 7.45 indicate?

    <p>Alkalemia</p> Signup and view all the answers

    What is the function of Inspiratory Capacity?

    <p>To represent the amount of air inhaled at the end of tidal expiration</p> Signup and view all the answers

    How is Vital Capacity calculated?

    <p>TV + IRV + ERV</p> Signup and view all the answers

    What does a PaCO2 level greater than 45 mmHg indicate?

    <p>Hypercapnia</p> Signup and view all the answers

    Which of the following volumes makes up 50% of total lung volume?

    <p>Inspiratory Reserve Volume (IRV)</p> Signup and view all the answers

    What is the recommended intensity range for activities in the initial phase of rehabilitation?

    <p>60%-75% of maximal effort</p> Signup and view all the answers

    During which phase is the patient primarily monitored during exercise only, not at rest?

    <p>Phase II</p> Signup and view all the answers

    What is the primary goal for a patient by the end of Phase II rehabilitation?

    <p>To ambulate at least 200 ft.</p> Signup and view all the answers

    What activity is restricted for 6 weeks post-myocardial infarction?

    <p>Lifting activities</p> Signup and view all the answers

    How long is Phase II typically expected to last?

    <p>4-6 weeks</p> Signup and view all the answers

    What is the target MET level the patient should ideally reach before being released to Phase II?

    <p>2.5-3 METs</p> Signup and view all the answers

    Which type of exercise is emphasized during Phase III rehabilitation?

    <p>Exercise focusing on both upper and lower extremities</p> Signup and view all the answers

    What should patients be educated to do during Phase III?

    <p>Monitor their own vitals</p> Signup and view all the answers

    What is Functional Residual Capacity (FRC)?

    <p>The amount of air in the lungs after normal resting tidal exhalation</p> Signup and view all the answers

    What does a FEV1/FVC ratio of less than 70% indicate?

    <p>Obstructive impairment</p> Signup and view all the answers

    Which breathing pattern is characterized by gasping inspiration followed by short expiration?

    <p>Apneustic breathing</p> Signup and view all the answers

    How is Hyperventilation defined?

    <p>Prolonged and deep breathing beyond normal levels</p> Signup and view all the answers

    Which condition is characterized by irregular patterns of both deep and shallow breaths with abrupt pauses?

    <p>Biot’s respiration</p> Signup and view all the answers

    What defines Kussmaul’s breathing?

    <p>Increased respiratory rate and depth, resembling air hunger</p> Signup and view all the answers

    What happens during paradoxical breathing?

    <p>The abdomen may expand during inspiration</p> Signup and view all the answers

    Which of the following describes Crackles in pulmonary auscultation?

    <p>Bubbling or rattling sounds due to secretions in air passages</p> Signup and view all the answers

    What is the primary muscle used during normal expiration?

    <p>Diaphragm</p> Signup and view all the answers

    How do the upper ribs contribute to chest expansion during inspiration?

    <p>By adopting a pump handle motion</p> Signup and view all the answers

    Which muscles are primarily involved in accessory breathing during abnormal breathing conditions?

    <p>Scalenes and sternocleidomastoid</p> Signup and view all the answers

    What effect does gravity have on pulmonary perfusion when the body is in an upright position?

    <p>Causes more blood to pool at the base of the lung</p> Signup and view all the answers

    What occurs in the diaphragm during typical resting inspiration?

    <p>It contracts and flattens</p> Signup and view all the answers

    In what situation might the use of an abdominal binder be beneficial?

    <p>To support abdominal viscera during ventilation</p> Signup and view all the answers

    What is the primary role of the bony thorax during inspiration?

    <p>To pull the thorax and pleura outward</p> Signup and view all the answers

    What happens to the diaphragm in a more upright body position?

    <p>It lowers, decreasing inspiratory reserve</p> Signup and view all the answers

    What is the impact of gravity on the distribution of blood flow (Q) in the lungs?

    <p>Blood flow is higher in the bases due to gravity.</p> Signup and view all the answers

    Which statement about ventilation-perfusion (V/Q) ratio is accurate?

    <p>The apices of the lungs have a high V/Q ratio due to low blood flow.</p> Signup and view all the answers

    Which condition is primarily caused by obstruction of the bronchus?

    <p>Atelectasis</p> Signup and view all the answers

    What characterizes the prognosis of asthma?

    <p>Good prognosis with decreasing mortality rates due to improved management.</p> Signup and view all the answers

    During inspiration, where is the most air delivered in the lungs?

    <p>To the bases, which are less filled.</p> Signup and view all the answers

    Study Notes

    Anatomy and Physiology of the Cardiovascular System

    • The pericardium is a fibrous protective sac that encloses the heart.
    • The epicardium is the inner layer of the pericardium.
    • The myocardium is the major portion of the heart, composed of heart muscle.
    • The endocardium is the smooth lining of the inner surface and cavities of the heart.
    • The apex is the pointed end of the heart, located at the 5th intercostal space (ICS) left of the midclavicular line.
    • The base is the broad upper border of the heart, below the second rib in the 2nd ICS.

    Cardiac Valves

    • Atrioventricular valves prevent backflow of blood into the atria during ventricular systole.
    • They are anchored by chordae tendinae to papillary muscles, closing when ventricular walls contract.
    • Semilunar valves prevent backflow of blood from the aorta and pulmonary arteries into the ventricles during diastole.

    Cardiac Chambers

    • The right atrium receives deoxygenated blood from systemic circulation from the superior and inferior vena cava.
    • The right ventricle pumps deoxygenated blood to the lungs via the pulmonary artery.
    • The left atrium receives oxygenated blood from the lungs via four pulmonary veins.
    • The left ventricle pumps oxygenated blood to the entire body via the aorta.
    • The walls of the left ventricle are thicker and stronger than the right ventricle.

    Cardiac Vessels

    • The aorta exits the left ventricle.
    • The arch of the aorta gives rise to brachiocephalic, left carotid, and left subclavian arteries.
    • The vena cava drains venous blood into the right atrium.
    • The right and left coronary arteries supply blood to the heart.
    • The left coronary artery branches to anterior interventricular and circumflex arteries.
    • The right coronary artery branches to marginal and posterior interventricular arteries.

    Cardiac Cycle

    • Atrial systole: contraction of the atria forces blood into ventricles.
    • Atrial diastole: relaxation of the atria.
    • Ventricular systole: contraction of the ventricles forcing blood into the pulmonary artery and aorta.
    • Ventricular diastole: Relaxation of the ventricles.

    Abnormal Rhythms

    • PVC (Premature Ventricular Contraction): A premature contraction of the ventricles. (P wave absent, wide QRS)
    • Ventricular Fibrillation: Ventricles don't contract effectively, leading to a disorganized heartbeat. (P wave absent, irregular QRS)
    • V-tach (Ventricular Tachycardia): Rapid, uncoordinated heartbeat originating in the ventricles. (P wave absent; wide QRS; run of 3 or more PVCs)
    • Atrial Flutter: Rapid, regular atrial contractions. (Saw-tooth pattern , 250-350 bpm with ventricular rate often slower than atrial rate)
    • Atrial Fibrillation: Disorganized, rapid atrial contractions, often with irregular ventricular response. (P waves absent or erratic, rate >150 bpm)
    • A-flutter, A-tach, PACs detailed.

    Pacemakers

    • The SA node is the heart's natural pacemaker, initiating impulses at 60-100 bpm.
    • The AV node delays impulses, allowing the atria to empty into the ventricles before ventricular contraction.
    • The bundle of His, bundle branches and Purkinje fibers initiate ventricular contraction.

    Normal / Abnormal Heart Enzymes

    • CK-MB: Marker for myocardial infarction, elevated initially then decreases over time.
    • Troponin: More sensitive marker for myocardial infarction than CK-MB, remains elevated longer .
    • Troponin I and Troponin T details.
    • SGOT/AST: Elevated in myocardial infarction
    • LDH: Elevated in myocardial infarction.

    Normal Blood Gases

    • PaO2: Partial pressure of oxygen (80mmHg and above).
    • PaCO2: Partial pressure of Carbon dioxide (35 - 45 mmHg).
    • pH (7.35 - 7.45)
    • HCO3: Bicarbonate (22-26 mEq/L).
    • O2Sat: Oxygen saturation (95%-100%)

    Hemostasis

    • Prothrombin time (PT): Time blood takes to clot (11-15 sec).
    • Partial thromboplastin time (PTT): Time for clot formation (25-40 sec).
    • INR: International Normalized Ratio, 0.9-1.1.

    Complete Blood Cell Count

    • Detailed normal ranges for White Blood Cells, RBCs, Erythrocyte Sedimentation Rate, Hematocrit%, Hemoglobin, Platelet count. Various factors for abnormal values are listed .

    Heart Rate Controls

    • The nervous and endocrine systems control heart rate.
    • Endocrine controls heart rate in relaxed situations.
    • Nervous controls are used for adaptation (eg. response to exertion).
    • Sympathetic and Parasympathetic details are discussed, along with baroreceptors and chemoreceptors.

    Cardiac Output & Related Topics

    • Preload: ventricular wall tension at diastole; reflects venous filling pressure.
    • Afterload: the forces that impede blood flow out of the heart.
    • Stroke volume: volume of blood ejected per contraction of the left ventricle (60-80mL).
    • Cardiac output: amount of blood pumped per minute (CO=SVxHR); normal CO for adult males 4.5 – 5.0L/min.
    • Venous return: volume of blood returning to the right atrium

    Common Surgical Interventions

    • Heart transplant: for end-stage heart disease.
    • Balloon angioplasty: to open blocked blood vessels.
    • Coronary bypass surgery: to replace atherosclerotic blood vessels.

    Heart Auscultation

    • S1: closure of AV valves (lub)
    • S2: closure of semilunar valves (dub)
    • S3: extra heart sound during ventricular filling (ventricular gallop)
    • S4: extra heart sound just before ventricular contraction (atrial gallop)
    • Murmurs, bruits, thrills: detailed.

    Cardiovascular Tests & Measures

    • Detailed descriptions of heart auscultation sounds and significance.
    • Normal and abnormal heart rates are listed in age ranges.
    • Definitions and procedures of Stress Testing are explained.
    • Description of normal and abnormal ECG changes during exercise.
    • Description of various cardiac tests including Chemical and pharmacological tests.
    • ECG electrode placement.
    • Methods of determining heart rate values.
    • Description of pulse abnormalities.
    • Various heart blocks (1st, 2nd, 3rd).

    Heart Diagnostic Imaging

    • Angiogram
    • Carotid ultrasound
    • Fluoroscopy
    • PET scans
    • Cardiac catheterization
    • Myocardial perfusion imaging
    • Echocardiogram
    • Central line (Swan-Ganz catheter)
    • CXR

    Signs and symptoms of Cardiac Distress

    • Angina
    • Dyspnea
    • Diaphoresis
    • Orthopnea
    • Blood pressure
    • Dizziness
    • Nausea/emesis (vomiting)
    • Ataxia
    • Cyanosis
    • Pallor
    • Ventricular tachycardia

    MET Values

    • Description of various MET values (and their related activities).

    Peripheral Pulses

    • Detailed description, procedure & significance

    ABI (Ankle-Brachial Index)

    • Description of ratio and significance

    Circulation Tests

    • Doppler Ultrasound: Function, procedure and significance, details on frequency.
    • Percussion test: Procedure and importance.
    • Trendelenburg test: Procedure and importance.
    • Venous Filling Time: Procedure and significance.

    Pulmonary Anatomy & Physiology

    • Mediastinum: Location and contents.
    • Pleural cavity.
    • Apex and base of the lungs.
    • Bronchioles: Role in airflow control.
    • Alveoli: Role in gas exchange.
    • Lobes, fissures and segments of the lungs.
    • Muscles of ventilation.
    • Upper and Lower respiratory tracts detailed.
    • Physiology of gas exchange.
    • Respiratory rates in various age groups.
    • Normal sounds heard during auscultation of the lungs.

    Pulmonary Diseases and Conditions

    • Detailed information about various pulmonary conditions like Asthma, Atelectasis, Bronchiectasis, Bronchitis, COPD, Cystic fibrosis, Emphysema, Lofgren's syndrome, Pancoast syndrome, Pleural effusion, Pneumonia, Pneumothorax, Pulmonary edema, Pulmonary embolism, Pulmonary fibrosis, Pulmonary hypertension, and Tuberculosis.

    Pulmonary Tests & Measures

    • Detailed discussion on various pulmonary tests (FEV1, FEV, IRV, TV, ERV, RV, VC, TLC, FEV1/FVC).
    • Interpretation of normal and abnormal blood gas values (pH, PaCO2, PaO2, HCO3).

    Pulmonary Auscultation Abnormal Sounds

    • Description of various abnormal breathing patterns and sounds during auscultation.
    • Examples of each and their potential causes.

    Signs and Symptoms of Pulmonary Distress

    • Detailed information about various signs and symptoms of pulmonary distress, including noisy breathing, breathlessness, difficulty breathing at rest, or during activity

    Pulmonary Drainage

    • Description of indications and procedures for various lung drainage techniques, including postural drainage, percussion, and shaking/vibration

    Assisted Airway Clearance Techniques

    • Detailed descriptions and procedures of various airway clearance techniques such as Huffing, Coughing, and Suctioning

    Non-Pharmacological Medical Management

    • Detailed info on interventions for COPD, Asthma: Examples of specific exercises, guidelines for implementation and how to monitor patients.

    Lymphatic Anatomy and Function

    • Composition and components of lymph
    • Location and functions of major lymph nodes.
    • Pathways of lymphatic fluid.

    Lymphatic Diseases and Conditions

    • Detailed information about conditions such as Lymphoedema, Lymphoma, Lymphocytosis. Detailed information about various signs.

    Impact of Other Interventions

    • Exercise physiology of the pulmonary system
    • General conditioning
    • Inspirational muscle trainer (IMT)
    • Paced breathing

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    Description

    Test your knowledge on pulmonary physiology, auscultation findings, and respiratory sounds with this comprehensive quiz. Dive into questions about breath volumes, blood-gas values, and laryngeal conditions to enhance your understanding of respiratory health. Ideal for students and professionals in medical fields.

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