Pulmonary Physical therapy-II

Question	Answer
What are the four accessory muscles of inspiration?	Scalenes, SCM, Levator Costarum and Serratus
What are the four accessory muscles of expiration?	Abdominals, Quadratus lumborum, Triangularis Sterni and Internal Intercostals
What are the three muscles that become muscles of inspiration with the girdle fixed?	Trapezius, Pectorals and Serratus
The more upright the body position, the lower is the diaphragm therefore the lower is the	Inspiratory reserve
This can be helpful in providing support to abdominal viscera thereby assisting ventilation	Abdominal binder
This covers the inner surface of the thoracic cage, diaphragm and mediastinal border	Parietal pleura
It wraps the outer surface of the lung including the fissure lines	Visceral pleura
It is the point of equilibrium where forces are balanced and occurs at the end tidal expiration?	REEP (resting end expiratory pressure)
It is the volume of gas inhaled (or exhaled) during a normal resting breath	Tidal volume
It is the volume of gas that can be inhaled beyond a normal resting tidal inhalation	Inspiratory reserve volume
It is the volume of gas that can be exhaled beyond the normal resting tidal exhalation	Expiratory reserve volume
It is the volume of gas that remains in the lungs after ERV has been exhaled	Residual volume
It is the amount of air that can be inhaled from REEP	Inspiratory capacity (IRV + TV)
It is the amount of air that is under volitional control; conventionally measured as the forced expiratory tidal capacity (FVC)	Vital capacity (IRV + TV + ERV)
It is the amount of air that resides in the lungs after a normal resting tidal exhalation	Functional residual capacity (ERV + RV)
It is the total amount of air that contained within the thorax during a maximum inspiratory effort	Total lung capacity (IRV + TV + ERV + RV)
The ability of the arterial blood to carry oxygen	Arterial oxygenation
The ability to remove carbon dioxide from the pulmonary circulation and maintain pH	Alveolar ventilation
Normal range of partial pressure of oxygen (PaO2)	80-100mmHg
Normal range of partial pressure of carbon dioxide (PaCO2)	35-45mmHg
Normal range of bicarbonate ions (HCO3)	22-28 mEq/mL
Relationship of pH and PaCO2	Inverse
Relationship of pH and HCO3	Direct
Anatomical or physiological space that is well ventilated but with no gas exchange	Dead space
In gravity dependent, there is more blood than air, therefore V/Q ratio is	Low
In gravity independent, there is more air than blood, therefore V/Q ratio is	High
Normal value (adult and infant): HR	A: 60-100bpm I: 120bpm
Normal value (adult and infant): RR	A: 12-20br/min I: 40br/min
Normal value (adult and infant):BP	A: <120/80mmHg I: 75/50mmHg
Normal value (adult and infant): PaO2	A: 80-100mmHg I: 75-80mmHg
Normal value (adult and infant): Tidal Volume	A: 500ml I: 20ml
A sign of chronic hypoxemia	Digital clubbing
How many inches is the thoracic excursion of the normal individual	2-3inches
Normal breath sound; soft rustling sound heard throughout inspiration and start of expiration	Vesicular sound
A more hollow echoing sound normally found over the right superior anterior thorax. Heard in all of inspiration and most of inspiration	Bronchial breath sound
A very distant sound not normally heard over a healthy thorax. Associated with obstructive lung disease	Decreased breath sound
Two adventitious sounds	Crackles and wheezes
Also termed as rales or crepitations	Crackles
A crackling sound heard usually during inspiration that indicates pathology (atelectasis, fibrosis, pulmonary edema)	Crackles
A musical pitched sound usually heard during expiration caused by airway obstruction	Wheezes
As with normal breath sounds, vocal transmission is loudest in what areas	Trachea and main bronchi
Normally, words should be intelligible though soft and clear at what area	At more distal areas of the lungs
Is a nasal or bleating sound heard during auscultation. E is heard as A.	Egophony
Intense, clear sound during auscultation, even at lung bases	Bronchophony
Occurs when whispered sounds are heard clearly during auscultation	Whispered pectoriloquy
A radiographic examination that identifies the presence of pulmonary emboli	Ventilation perfusion scan
Continuous xray beam that allows observation of diaphragmatic excursion	Flouroscopy
Causes and SSx: Respiratory alkalosis	Alveolar hyperventilation; Dizziness, syncope, tingling, numbness and early tetany
Causes and SSx: Respiratory acidosis	Alveolar hypoventilation; Early: anxiety, restlessness, dyspnea and headache Late: Confusion, somnolence, coma
Causes and SSx: Metabolic alkalosis	Bicarbonate ingestion, vomiting, diuretics, steroids and adrenal disease; Vague symptoms: weakness, mental confusion and possible tetany
Causes and SSx: Metabolic acidosis	Diabetic, lactic, uremic acidosis and prolonged diarrhea; Secondary hyperventilation (Kaussmall breathing), nausea, lethargy and coma
Normal WBC	5000-10000
Normal Hematocrit	35-48%
Normal Hemoglobin	12-16g/dL
10 Criterion for Termination of ETT	Max SOB Fall in PaO2 of >20 or PaO2 of <55mmHg Rise in PaCO2 of >10 or PaCO2 of >65mmHG Cardiac ischemia/arrythmia Sx of fatigue 10mmHg inc DBP, SBP of 250, or dec'g BP c inc'g workload Leg pain Total fatigue Signs of insufficient CO Reach ventil
An intra-alveolar bacterial infection of the lungs	Bacterial pneumonia
Most common type of gram positive pneumonia	Pneumococcal pneumonia
WBC in TB shows	Increased lymphocytes
CBC count in Pneumocystis pneumonia shows	No evidence of infection
GOLD Stage 1 for COPD	Mild FeV1 >=80% With or without complications
GOLD Stage 2 for COPD	Moderate FeV1 <80% SOB with exertion
GOLD Stage 3 for COPD	Severe FeV1 <50% Greater SOB, decreased exercise capacity and exacerbation of disease
GOLD Stage 4 for COPD	Very Severe FeV1 <30% Impaired quality of life, exacerbation of the disease may be life threatening
PFTs in COPD shows	Decreased FeV1, decreased FVC, decreased FeV1/FVC ratio, increased FRC and RV
Increased reactivity of the trachea to various stimuli with narrowing of the airways due to inflammation	Asthma
Cystic Fibrosis: 4	Genetic, there is thickening of secretions of the exocrine glands, may present as obstructive, restrictive or both, onset of symptoms usually in early childhood
3 Clinical signs of CF	Meconeum ileus, frequent respiratory infections, inability to gain weight despite adequate caloric intake
Diagnosis of CF	(+) Trypsinogen, (+) Sweat electrolyte test
It is congenital or acquired, characterized by abnormal dilatation of the bronchi and excessive mucus production	Bronchiectasis
Characterized by alveolar collapse in a premature infant due to lung immaturity and inadequate level of pulmonary surfactant	Respiratory Distress Syndrome /Hyaline Membrane Disease
Air in the pleural space due to a lacerated visceral pleura from a rib fracture or ruptured bullae	Pneumothorax
Blood in the pleural space due to laceration of the pleural space	Hemothorax
Blood and edema within the alveoli and interstitial space	Lung contusion
Cough with pink frothy secretion	Pulmonary edema
CXR of Pulmonary edema	Shows typical butterfly pattern
A thrombus from the peripheral venous circulation becomes embolic and lodges in the pulmonary circulation	Pulmonary emboli
Excessive fluid between the visceral and parietal pleura due to increased pleural permeability to proteins from inflammatory disease	Pleural effusion
Collapsed or airless alveolar unit caused by hypoventilation secondary to pain during the ventilatory cycle	Atelectasis
CXR of Atelectasis shows	Platelet streaks
Indications of pulmonary drainage, percussion and shaking	Increased pulmonary secretions Aspiration Atelectasis
Duration of the pulmonary drainage	20 minutes per postural drainage position
Postural drainage: Upper lobe apical segments	Bed flat Px leans backward at 30 deg angle against the patient PT percusses at area between the clavicle and scapula
Postural drainage: Upper lobe posterior segments	Bed flat Px leans forward at a pillow at 30 deg angle PT percusses at the upper back
Postural drainage: Upper lobe anterior segments	Bed flat Px lies flat with pillows under the knees PT percusses between the clavicle and nipples
Postural drainage: Right Middle lobe	Foot of bed elevated at 16 inches Pt lies on his left side, turns 1/4 backward. Shoulder and hip with pillows and knees flexed. PT percusses at the right nipple area.
Postural drainage: Left Lingular lobe	Foot of bed elevated at 16 inches Px lies on his right, turn 1/4 backward. Shoulder and hip with pillow, knees flexed. PT percusses at the left nipple area.
Postural drainage: Lower lobe anterior segments	Foot of bed elevated at 20 inches. Px lies on one side. PT percusses at the lower rib area.
Postural drainage: Lower lobe superior segments	Bed flat. Px lies on abdomen with 2 pillows under the hips. PT percusses the middle back at the tip of the scapula.
Postural drainage: Lower lobe posterior segments	Foot of bed elevated at 20 inches. Px lies on abdomen with a pillow under the hips. PT percusses at the lower ribs near the spine
Postural drainage: Lower lobe lateral segments	Foot of bed elevated at 20 inches. Px lies on abdomen, turns 1/4 upwards with pillows on flexed knee for support. PT percusses the uppermost portion of the lower ribs. PT
Bouncing maneuver applied after percussion	Shaking
Duration for shaking	5-10 deep inhallations Less than 5 is ineffective More than 10 can cause hyperventilation
Effective in clearing secretions on major central airways	Cough
Used in COPD patients. Prevents high intrathoracic pressure which causes premature airway closing	Huff
Used for patients who cannot cough on command	Tracheal stimulation
Used when all other forms of airway clearance fails	Endotracheal suctioning
Endotracheal suctioning is set at	120 mmHg of suction
Usual suctioning time	10-15 seconds
Complications associated with suctioning (7)	Hypoxemia Bradycardia or tachycardia Hypotension or hypertension Increased intracranial pressure Atelectasis Tracheal damage Infections
Segmental breathing is inappropriate in intractable hypoventilation until medical situation is resolved	True
Pursed lip breathing is used to (6)	Reduce respiratory rate Increase tidal volume Reduce dyspnea Improve gas mixing at rest for COPD pxs Decrease the mechanical disadvantage of impaired ventilatory pump Facilitate relaxation
Patients with severe and very severe pulmonary disorders will likely reach a pulmonary endpoint before a cardiovascular endpoint	True
How and where is paced breathing or activity pacing used?	Used to spread out the metabolic demands of an activity, used with patients who become dyspneic during performance of an activity
Beta 2 agonists drugs	Are sympatomimetic drugs that causes bronchodilation, increase HR and BP
3 examples of short acting beta 2 agonists	Ventolin (albuterol) Alupent (metaproterenol) Maxair (pirbuterol)
Example of long acting beta 2 agonists for maintenance	Serevent (salmeterol xinafoate)
Anticholinergics	inhibits PNS therefore causes bronchodilation, increase HR and BP
Side effects of anticholinergics	Lack of sweating, dry mouth and delusions
Example of anticholinergics	Atrovent (ipratropium)
Methylxantines	Produces smooth muscle relaxation
Examples of methylxantines	Aminophylline Theophylline
If tube of mechanical ventilator is moved, a nurse or respiratory therapist should check the placement of the tube	Correct
If tube of the mechanical ventilator is dislodged, a physician or anesthesiologist needs to replace the tube	Correct
Used to evacuate air or fluid trapped in the intrapleural space	Chest tubes
If the chest tube is dislodged during treatment, cover the defect and seek assistance	Correct
For IVs, the UE should not be raised above the level of the IV medication for any length of time or backflow of blood will occur	Correct
Artery usually used for arterial line	Radial artery
If arterial line is dislodged, immediate firm pressure needs to be applied to or above the arterial insertion site to stop bleeding	Correct
Supplemental oxygen is indicated for (SaO2 and PaO2)	SaO2 of <88% or PaO2 <55mmHg