Untitled Quiz

Pulmonary Breath Sounds

• Tracheal: Normal air movement through the trachea. Loud, high-pitched, equal inspiratory/ expiratory phases (1:1).
• Bronchial: Air moving through large airways. High pitched, hollow, louder expiration than inspiration (1:2).
• Bronchovesicular: Air movement in mid-sized airways. Moderate pitch and intensity, equal inspiration/expiration phases (1:1).
• Vesicular: Air moving through small airways. Soft, low pitched, longer inspiration than expiration (3:1).
• Crackles/Rales: Fluid or alveolar popping, represents wetness in the airways. Consistent sound; associated with pneumonia, heart failure, pulmonary fibrosis, or atelectasis.
• Wheezes/Rhonchi: Airflow obstruction, usually heard during exhalation (bronchoconstriction/secretions). Associated with asthma, COPD, bronchitis. Continuous, high-pitched sound. Rhonchi are lower pitched and snoring, often clearing with coughing.
• Stridor: Airflow obstruction at upper airway. Continuous, high-pitched sound; associated with epiglottis, foreign body, laryngeal edema.
• Pleural Rub: Visceral and parietal pleura rubbing together. Creaking or grating sound, heard during both inspiration and exhalation. Associated with pleuritis or pleural effusion.

Mediate Percussion Sounds

• Resonant: Loud/low pitched, heard over air-filled organs (lungs).
• Hyper Resonant: Very low-pitched, heard over tissue with decreased density (diseased lungs, emphysema, inflated lungs).
• Tympanic: High-pitched, heard over hollow organs, (stomach/gas bubbles).
• Dull: Low amplitude, medium to high-pitched, heard over solid organs (lungs with increased tissue density); decreased air.
• Flat: Very dull sound/high pitch; very dense tissues; heard over muscle mass.

Lung Diseases/Pathology

• Bronchitis (Blue Bloater): Airway disease, inflammation of bronchi, obstruction of airways, alveolar wall destruction. Associated with PFT: decreased VC, increased TLC, and RV; CXR: overinflated lungs/horizontal ribs/increased subcostal angle. Barrel chest, slower/shallower breaths, increased vibration over mucosal areas, and dull sounds over the mucosal area.
• Emphysema (Pink Puffer): Abnormal/irreversible enlargement of airways distal to terminal bronchioles. Associated with PFT: decreased VC, increased TLC, and RV; CXR: overinflated lungs/horizontal ribs/increased subcostal angle. Barrel chest, short/faster breath sounds, signs of right heart failure, flat diaphragm, and less fremitus (vibration).
• Asthma: Chronic, reversible obstruction to airflow, bronchospasm. Associated with CXR: hyperinflation. Wheezing, exhalation longer than inhalation. Possible small areas of atelectasis
• Bronchiectasis: Abnormal, permanent dilation of bronchi/bronchioles; chronic inflammation/infection; destruction of elastic and muscular tissue. PFT: with advanced disease may see decreased FEV1 and increased RV. Frequent infections and muscopurulent sputum. Dyspnea, clubbing.
• Cystic Fibrosis: Obstructive disease characterized by thick, excessive secretions and poor ciliary function, leading to obstruction of small airways, affecting bronchial hygiene.
• Bronchopulmonary Dysplasia (BPD): Obstructive/restrictive disease. Associated with underdeveloped lungs, inflammation, scarring of lungs, and most common in children (often related to birth complications).
• Pulmonary Fibrosis: Restrictive lung disease. Associated with scarring, stiffness, and decreased compliance of alveolar walls and stiffness of tissues. Progressive shortness of breath, nonproductive cough, and dyspnea.
• Pneumonia: Restrictive. Inflammation of the lung, often starting in the lower respiratory tract due to infection. Associated with crackles and low-pitched wheezing, bronchial breath sounds over area of consolidation, and abnormal sputum/culture.
• Acute Respiratory Distress Syndrome (ARDS): Restrictive. Sudden respiratory failure due to fluid accumulating in alveoli. Diffuse crackles, wet breath sounds, decreased breath sounds; other symptoms include dyspnea, labored/rapid breathing.
• Lung Cancer: Restrictive. Malignant tumor in the lung. Diminished breath sounds, crackles/wheezing. Other symptoms may include persistent non-productive coughing up blood, chest pain.
• Pleural Effusion: Restrictive. Fluid in the pleural space. Contains decreased breath sounds, pleural rub.
• Atelectasis: Restrictive. Partial or total collapse of alveoli or lung segments/lobes. Reduced breath sounds, diminished or absent breath sounds over affected areas.
• Pneumothorax: Restrictive. Presence of air in the pleural cavity. Absent or diminished breath sounds. Associated symptoms include chest pain, hyperresonance on percussion, decreased tactile fremitus.

COVID-19

• Hypoxemic disease, may scar lungs. Shortness of breath, cough, body/muscle aches, headaches, loss of taste/smell, sore throat/congestion, runny nose, nausea/vomiting, diarrhea, multi-organ failure.

Diagnostic Testing

• Pulmonary Function Tests (PFTs): Measure the volume and flow of air during inspiration and exhalation.
• Chest X-rays (CXR): Allow visualization of the anatomy of the chest.
• Computed tomography (CT) scans: Allow visualization of tissues; used for pulmonary nodules.
• Magnetic Resonance Imaging (MRI): Used for soft tissue and lymph nodes.

Lung Volume/Capacities

• Tidal Volume (TV): Volume of air inhaled and exhaled during normal breathing.
• Inspiratory Reserve Volume (IRV): Maximum volume of air that can be inhaled after normal inspiration.
• Expiratory Reserve Volume (ERV): Maximum volume of air that can be exhaled after normal expiration.
• Residual Volume (RV): Volume of air remaining in the lungs after maximum exhalation.
• Inspiratory Capacity (IC): Maximum volume of air that can be inhaled.
• Functional Residual Capacity (FRC): Volume of air remaining in the lungs at the end of normal expiration.
• Vital Capacity (VC): Maximum volume of air that can be exhaled from a maximum inhalation.
• Total Lung Capacity (TLC): Total volume of air that the lungs can hold.

Surgical Interventiions

• Wedge Resection: Removal of section of lung tissue (triangle shaped).
• Bullectomy: Removal of 1 or more bullae.
• Lobectomy: Excision of lobe.
• Pneumonectomy: Removal of the entire lung.
• Lung Volume Reduction Surgery (LVRS): Reducing the size of lungs to minimize diseased tissue portion.
• Lung Transplant: Replacing a failing lung with a healthy one from a donor.

Pulmonary Angiogram

• Catheter inserted carefully to the pulmonary artery, dye injected to show blood flow.
• X-Ray imaging of blood flow, and detection of blockages.

Bronchoscopy

• Direct visualization of bronchial tree with a scope. Used for diagnosis and therapy.

Radionuclide Ventilation/Perfusion Scan (V/Q scan)

• Ventilation and perfusion should match.
• Poor ventilation may indicate airway obstruction.
• Poor perfusion may indicate blood flow issues (pulmonary embolism).

Oxygen Therapy

• Indications: Hypoxemia, increased work of breathing, increased myocardial work, and decreased exercise/activity tolerance.

Artificial Airways

• Reasons for intubation include airway obstruction.
• Intubation/ventillation may be necessary for patients with apnea (no breathing), ventilatory failure, airway infections, or protective airway issues resulting in aspiration.
• Common types of artificial airways, include endotracheal and tracheostomy tubes

Mechanical Ventilation

• Positive pressure ventilation is used when breathing is laboured or absent.
• Positive pressure is applied to the airway via endotracheal or tracheostomy tube to deliver gas/air into the lungs.
• PPV modes include: controlled modes (ventilator delivers all breaths at a preset frequency) and assist/control modes (ventilator delivers breaths only if patient does not initiate one).

Mechanical and Spontaneous Breaths

• Pressure Support (PS): Constant pressure, but the volume needed to reach the pressure may vary depending on lung compliance and patient effort. Allows patient to control rate and volume of breathing.

Negative Pressure Ventilator

• Also referred to as an Iron Lung, and delivers negative pressure/vacuum to expand patient's chest to allow air to flow into lungs.

Other considerations

• Chest tubes may be inserted to remove secretions or drain fluid surrounding lung tissue.
• Suctioning procedures can be conducted to remove secretions or mucus.
• Coughing exercises and postural drainage to mobilize secretions.