Pulmonary Physiology & Pathophysiology
Which physiological change is the body's most immediate compensatory response to a sudden drop in arterial oxygen levels (hypoxemia)?
Increased cardiac output
(The body tries to deliver more oxygen by increasing blood flow when PaO2 drops.)
When performing a respiratory physical assessment, you note dullness upon percussion over the base of the right lung. This finding most strongly suggests the presence of what condition?
Pleural effusion
(Fluid in the pleural space causes dullness to percussion. Emphysema/pneumothorax would be hyperresonant.)
Which method of oxygen delivery typically provides the lowest FiO₂ and is suitable for patients requiring minimal oxygen supplementation?
Nasal cannula
(Provides 24-44% FiO2 depending on flow rate, generally the lowest available.)
Which of the following is the most consistent feature across all obstructive lung diseases? What is a key distinguishing characteristic of chronic bronchitis compared to emphysema?
Reduced expiratory airflow
(All obstructive lung diseases involve increased resistance to airflow, particularly during expiration.)
Which of the following is a key component of long-term physical therapy management for a patient with bronchiectasis to prevent recurrent infections?
Regular, consistent airway clearance techniques
(This is crucial to prevent mucus buildup, reduce infection risk, and preserve lung function in bronchiectasis.)
A patient's ABG results show a pH of 7.48, PaCO₂ of 32 mmHg, and HCO₃⁻ of 25 mEq/L. This pattern is indicative of what condition?
Respiratory alkalosis
(pH is high, PaCO2 is low, HCO3- is normal – indicates uncompensated respiratory alkalosis.)
Auscultation of a patient's lungs reveals fine, crackling sounds that are typically heard during inspiration and do not clear with coughing. These sounds are most consistent with what sound?
Fine crackles (rales)
(Fine crackles are typically associated with fluid in the distal airways/alveoli and do not clear with coughing.)
A patient needs to clear thick secretions from their airways. Which airway clearance technique (ACT) utilizes positive pressure during expiration to help keep airways open and mobilize mucus?
Positive Expiratory Pressure (PEP) therapy
(PEP devices create back-pressure during exhalation to stent airways open and move secretions.)
A patient describes episodic shortness of breath, wheezing, and chest tightness that are often triggered by allergens or exercise, but are largely reversible. This description is most consistent with:
Asthma
(Asthma is characterized by reversible airway obstruction, often triggered by specific stimuli.)
When teaching a patient with COPD energy conservation techniques, which strategy helps reduce the oxygen cost of daily activities?
Breaking down activities into smaller, manageable steps with rest periods.
(This strategy helps to conserve energy and reduce dyspnea by pacing activities and avoiding fatigue.)
In a patient with severe head trauma, you observe respirations that are characterized by prolonged inspiratory gasps followed by short, inefficient expirations. This pattern is known as what?
Apneustic breathing
(Characterized by prolonged inspiration and short expiration.)
Which physical exam finding provides the most direct evidence of a collapsed or consolidated lung segment, allowing sound to transmit more clearly from the bronchi?
Bronchial breath sounds heard in peripheral lung fields
(Normally heard over major airways; hearing them peripherally indicates consolidation, allowing sound to transmit well.)
When coaching a patient on an effective cough, what is the crucial step immediately before the forceful expulsion of air?
Taking a maximal inspiration and closing the glottis
(This builds up intrathoracic pressure before the explosive release of air.)
In the "Blue Bloater" phenotype of COPD, common clinical characteristics often include:
Chronic productive cough and cyanosis
("Blue Bloaters" are typically those with chronic bronchitis, leading to hypoxemia and hypercapnia, often with cyanosis and edema.)
A physical therapist notices a patient with COPD assuming a tripod position during periods of increased dyspnea. This position helps by:
Reducing the work of breathing by stabilizing the accessory respiratory muscles.
(The tripod position optimizes the mechanical advantage of accessory muscles, allowing them to assist more effectively with inspiration.)
Which of the following describes the role of the diaphragm during quiet, resting inspiration?
It contracts and moves downward, increasing thoracic volume.
(This is the primary action of the diaphragm during inspiration.)
A patient with suspected chronic lung disease undergoes pulmonary function testing. A reduced FEV1/FVC ratio below 70% is a key indicator of what type of condition?
Obstructive lung disease
(A reduced FEV1/FVC ratio is the hallmark of obstructive lung diseases, indicating airflow limitation.)
A patient with severe atelectasis in the left lower lobe needs a postural drainage position. Which of the following positions would best facilitate drainage of this lobe?
Lying on the right side in Trendelenburg position
(This position uses gravity to drain the left lower lobe, which is dependent and in a head-down position.)
For a patient with COPD experiencing dyspnea during ambulation, which breathing strategy would be most beneficial to facilitate exhalation and reduce air trapping?
Pursed-lip breathing
(This technique helps to create back-pressure, preventing premature airway collapse and promoting more complete exhalation.)
A patient with exercise-induced asthma wants to participate in a fitness program. The most effective pre-exercise strategy to prevent an acute attack would be: a) Warming up for an extended period (e.g., 30 minutes).
Using a short-acting bronchodilator inhaler before starting exercise.
(This is the most common and effective pre-exercise strategy to prevent exercise-induced bronchospasm.)
If a patient with long-standing hypercapnia (elevated PaCO₂) is given excessive supplemental oxygen, their respiratory drive may decrease. This phenomenon is primarily due to:
Reversal of the hypoxic drive from peripheral chemoreceptors.
(In chronic CO2 retainers, the peripheral chemoreceptors (sensitive to low O2) become the primary drive. Giving too much O2 removes this drive.)
In a patient with suspected tension pneumothorax, one of the physical signs indicating a medical emergency due to increased intrathoracic pressure is:
Tracheal deviation away from the affected side
(A tension pneumothorax causes a mediastinal shift, pushing the trachea to the opposite side.)
The primary advantage of a High-Flow Nasal Cannula (HFNC) over conventional oxygen delivery methods, particularly for patients with acute respiratory distress, is its ability to:
Deliver heated and humidified oxygen at flow rates that meet or exceed inspiratory demand.
(This is a key advantage, reducing respiratory effort and improving patient comfort/tolerance.)
A physical therapist is designing an exercise program for a patient with stable COPD. To minimize dyspnea and optimize participation, which approach to exercise intensity is generally recommended?
Using symptom-limited exercise, guided by dyspnea and fatigue.
(This approach allows patients to exercise safely and effectively within their current tolerance, as opposed to strict HR targets which may not be appropriate.)
During a resistance training session for a patient with COPD, it is generally advised to avoid a Valsalva maneuver primarily because it can:
Cause a transient increase in blood pressure and heart rate.
(The Valsalva maneuver involves forced expiration against a closed glottis, which dramatically increases intrathoracic pressure, leading to a transient rise in BP and HR, which can be dangerous for some patients.)