Give me a Sign
The FEV1/FVC ratio is reduced in this type of lung disease.
What is obstructive lung disease?
What does SOAP stand for?
What are Subjective, Objective, Assessment, and Plan?
You can use future tense when charting a medical record because the physician will see it later anyway. (True or False)
False, you should NEVER use future tense, always write in present tense as the medical record is written.
What is the most common cause of hemoptysis? (In the US)
Bronchitis (acute)
List all traditional vital signs, give a NORMAL example of each:
BP: 120/80, Pulse (HR): 60-100 mmHg, SpO2: 92-100%, RR: 12-20 breaths/min
Name two examples of diagnostic testing used in RC
ABGs, PFTs, sputum collection, and CXR.
This term describes the inability of the heart and lungs to adequately oxygenate tissues and remove CO2.
What is respiratory failure?
These abbreviations stand for… HEENT, NG, ABG, and DC.
Head, eyes, ears, nose, throat… nasogastric tube, arterial blood gas, and discharge.
Why would you need to use biomedical verification? (ie. CO2/Cotinine levels?)
How could you assess if a patient is underreporting their tobacco use?
Note, you can also check for clinical indicators: yellow fingers, chronic cough, odor
What is tactile fremitus? What is indicative of decreased fremitus?
Fremitus refers to vibrations transmitted through the chest wall when a person speaks or breathes. These vibrations can be felt (or sometimes heard) by a healthcare provider during a physical examination.
Decreased fremitus: more air/fluid ( e.g., emphysema, pleural effusion, pneumothorax); increases the ratio of air to lung tissue, such as pneumothorax and emphysema.
List 3 examples of factors that are determinants of individual health
Genetic makeup, gender, income level, social status, education, social support, natural physical environment, healthcare services, and personal behavior.
Provide the ranges for ARDS (3).
Mild - PaO2/FiO2 = 200 -300 mmHg
Moderate: PaO2/FiO2 = 100-200 mmHg
Severe: PaO2/FiO2 = 100 or <100
Describe the difference between objective and subjective information. Provide an example of each.
Subjective: Information reported by the patient about their personal experience, feelings, or symptoms -- “It is hard to breathe when I sit up”
Objective: Information that is measurable, observable, and gathered by the healthcare provider using examination, tests, or equipment. -- BP: 124/86 mmHg
Define the ranges for the following: Social space, personal space, and intimate space.
Social: 4-8ft
Personal: 18in- 4ft
Intimate: 0-18in
What is GCS? And the 3 sections?
Glasgow Coma Scale:
Eye-opening (1-4)
Verbal Response (1-5)
Motor response (1-6)
Note: Final scores
13 to 15: Mild traumatic brain injury (mTBI). Also known as a concussion.
9 to 12: Moderate TBI.
3 to 8: Severe TBI.
Explain the goal of “Triple Aim”. Additionally, list the three main drivers for healthcare.
The goal is to simultaneously improve patient experience of care, improve the health of populations, and reduce the per capita cost of healthcare.
The main drivers are quality, cost, and access to healthcare.
Explain the difference between IPPB and IS.
Intermittent positive pressure breathing (IPPB) is reserved for patients who have clinically important atelectasis in which other therapy has been unsuccessful.
Incentive spirometry (IS) is when a patient takes deep breaths with spirometry to prevent atelectasis after operations.
A 76-year-old patient with end-stage heart failure is admitted to the hospital. While reviewing the chart, you see a clearly documented Do Not Resuscitate (DNR) order. During your shift, the patient becomes unresponsive and pulseless.
Review the following situation: In response to the patient coding, you begin full CPR and call the code team immediately, as all patients must be resuscitated unless a family member is present to confirm the DNR.
Would you change anything about how you react in the situation?
Yes, A DNR order means the patient has legally and ethically chosen not to receive resuscitative efforts (such as CPR or intubation) in the event of cardiac or respiratory arrest. It must be respected by the healthcare team and reflect the patient’s right to make decisions about their own end-of-life care. Initiating CPR in this case would go against the patient's documented wishes.
Match the sputum color/texture to the description:
Normal:
Indicative of PE:
High bacterial concentration:
Low bacterial concentration:
Normal: clear/colorless
Indicative of pulmonary edema: pink, bubbly, frothy
High bacterial concentration: Green, yellow, rusty color, thick (purulent)
Low bacterial concentration: cream, white, clear, thin (mucoid)
What is clubbing? What is central/peripheral cyanosis? What are each indicative of?
Clubbing: Bulbous enlargement of fingers/toes, spongy nail bases, increased angle at nail bed.
Associated with chronic hypoxemia (e.g., COPD, bronchiectasis, interstitial lung disease, congenital heart disease), lung cancer, and cystic fibrosis
Cyanosis:
Central cyanosis refers to cyanosis of the oral mucosa or trunk, which is associated with generalized hypoxemia; bluish lips and tongue. Always indicates serious underlying respiratory/cardiac pathology.
Peripheral cyanosis is observed in the hands, fingertips, and nail beds of the hands and feet; it may be caused by vascular occlusive diseases.
Explain EBP. Give an example of the best and worst kinds of evidence.
Evidence-based practice: integrates research findings with clinical expertise and patient values to provide a structured approach to clinical decision making.
best evidence: multicenter randomized controlled trial (many hospitals)
worst evidence: single-center, animal trials
DAILY DOUBLE
What is acute, non-compensated respiratory acidosis with hypoxemia, best treated with low-flow oxygen via nasal cannula at 1–2 L/min to raise PaO₂ above 60 mmHg and SaO₂ above 90% while avoiding worsening CO₂ retention?
Define EMR. Describe the advantages and disadvantages of using EMR. (2 of each)
EMR: Electronic Medical Record
Advantages: to produce legible records, access multiple patients at a time, reduce the number of lost records, expedite data transfer between facilities, expedite billing and speed retrieval of data, and decrease medical records.
Disadvantages: initial high implantation cost, large training investment, power failures, hardware crashes/breakdowns, software glitches, unauthorized access causing breach in patient privacy, sabotage of system via disgruntled employees or hackers, maintenance, upgrading hardware and software.
What are the 5 A’s of smoking cessation, as well as the 5 R’s of motivation?
5 A’s
Ask
Advice
Assess
Assist
Arrange
5 R’s
Relevance
Risks
Rewards
Roadblocks
Repetition
Describe what the patient is experiencing (via ALL findings), calculate their IBW, and Max HR.
You are called to assess a 67-year-old male who was admitted to the ICU with severe shortness of breath.
On initial evaluation:
Blood pressure: 78/46 mmHg
Heart rate: 118 bpm
Respiratory rate: 30 breaths/min
SpO₂: 86%
Height: 5 feet 10 inches
Weight: 193 lbs
On auscultation, you note:
Decreased breath sounds with diffuse crackles bilaterally and a prolonged expiratory phase.
BP shows hypotension. (shock),
tachypnea, tachycardia.
IBW: 166lbs
Max HR: 153 bpm
Breath sounds show evidence of obstructive lung disease