©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
CHA Exam 4 Study Guide.
Anatomy of Upper Airways - answer✔✔NOTE:
-epiglottis
-pharynx
-larynx
Anatomy of Lower Airway - answer✔✔
Oxygen-Hemoglobin Dissociation Curve - answer✔✔-When the need for oxygen is greater in
tissues, hemoglobin will dissociate oxygen even faster than when tissues have less need for
oxygen
-Ex: during an MI, blood flow to the area is reduced, but the hemoglobin that does reach the area
unloads oxygen at a faster rate to prevent cardiac muscle cell death (compensate)
hemoptysis - answer✔✔coughing up blood
paroxysmal nocturnal dyspnea - answer✔✔sudden awakening from sleeping with shortness of
breath
Fremitus - answer✔✔a palpable vibration from the spoken voice felt over the chest wall
Crepitus - answer✔✔a grating sound or sensation produced by friction between bone and
cartilage or the fractured parts of a bone.
Orthopnea - answer✔✔ability to breathe only in an upright position
-hard time breathing when laying down
Classification of Dyspnea - answer✔✔Class 1 (ADL 4): no significant restrictions in normal
activity. Employable. Dyspnea occurs only on more-than-normal or strenuous exertion
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
Class 2 (ADL 3): independent in essential ADLs but restricted in some other activities. Dyspneic
on climbing stairs or on walking on an incline but not on level walking. Employable for only a
sedentary job or under special circumstances
CLass 3 (ADL 2): dyspnea commonly occurs during usual activities, like showering or dressing,
but the patient can manage without assistance from others. Not dyspneic at rest; can walk for
more than a city block at own pace but cannot keep up with others of own age. May stop to catch
breath partway or up a flight of stairs. Is probably not employable in any occupation.
Class 4 (ADL 1): dyspnea produces dependence on help in some essential ADLs such as
dressing and bathing. Not usually dyspneic at rest. Dyspneic on minimal exertion; must pause on
climbing one flight, walking more than 100 yards or dressing. Often restricted to home if lives
alone. Has minimal or no activites outside the home.
Class 5 (ADL 0): entirely restricted to home and often limited to bed or chair. Dyspneic at rest.
Dependent on help for most needs.
Fine crackles, fine rales, high pitched rales - answer✔✔-popping, discontinuous sounds caused
by air moving into previously deflated airways
-sounds like hair being rolled between fingers near the ear
-"velcro" sounds late in inspiration usually associated with restrictive disorders
Associated with: asbestosis, atelectasis, interstitial fibrosis, bronchitis, pneumonia, COPD
Coarse crackles, low-pitched crackles - answer✔✔-Lower-pitched, coarse, rattling sounds
caused by fluid or secretions in large airways;
-likely to change with coughing or suctioning
Associated with: bronchitis, pneumonia, tumors, pulmonary edema
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
Wheeze - answer✔✔-Squeaky, musical, continuous sounds associated with air rushing through
narrowed airways, may be heard without a stethoscope
-arise from small airways
-usually do not clear with coughing
Associated with: inflammation, bronchospasm, edema, secretions, asthma, pulmonary vessel
enlargement
Rhoncus (rhonchi) - answer✔✔-lower pitched, coarse, continuous snoring sounds
-arise from the large airways
Associated with: thick tenacious secretions, sputum production, obstruction by foreign body,
tumors
pleural friction rub - answer✔✔-loud, rough, grating, scratching sounds caused by the inflamed
surfaces of the pleura rubbing together, often associated with pain during deep inspirations
-heard in lateral lung fields
Associated with: pleurisy, TB, pulmonary infarction, pneumonia, lung cancer
Relevant Respiratory Labs - answer✔✔CBC
-RBCs (o2 carrying capabilities)
-Hemoglobin (o2 carrying)
-WBC (increase = infection, associated with symptoms)
ABGs ( decrease air exchange, respiratory acidosis, hypercampnia)
Imagine and Diagnostic Tests - answer✔✔*CXR (PA and LL vs. portable (AP))
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
-CT of chest, usually with contrast
-V/Q scan: for pulmonary emboli
-Pulmonary Function Test (asthma, COPD)
-6 or 12 min walk test (hypoxic with activity)
-skin tests (PPD, TB)
-bronchoscopy
-thoracentesis
FVC (Forced vital capacity) - answer✔✔-records the maximum amount of air that can be
exhaled as quickly as possible after maximum inspiration
Purpose: indicates respiratory muscle strength and ventilatory reserve (asthma)
FEV1 (forced expiratory volume in 1 second) - answer✔✔-records the maximum amount of air
that can be exhaled in the first second of expiration
Purpose: is effort dependent and declines normally with age. It is reduced in certain obstructive
and restrictive disorder (asthma)
FEV1/FVC - answer✔✔-the ratio of expiratory volume in 1 second to FVC
Purpose: indicates obstruction to airflow. This ratio is the hallmark of obstructive pulmonary
disease. It is normaly or increased in restrictive diseases
FEF - answer✔✔-records the forced expiratory flow in 25-75% volume (middle half) of the FVC
CHA Exam 4 Study Guide.
Anatomy of Upper Airways - answer✔✔NOTE:
-epiglottis
-pharynx
-larynx
Anatomy of Lower Airway - answer✔✔
Oxygen-Hemoglobin Dissociation Curve - answer✔✔-When the need for oxygen is greater in
tissues, hemoglobin will dissociate oxygen even faster than when tissues have less need for
oxygen
-Ex: during an MI, blood flow to the area is reduced, but the hemoglobin that does reach the area
unloads oxygen at a faster rate to prevent cardiac muscle cell death (compensate)
hemoptysis - answer✔✔coughing up blood
paroxysmal nocturnal dyspnea - answer✔✔sudden awakening from sleeping with shortness of
breath
Fremitus - answer✔✔a palpable vibration from the spoken voice felt over the chest wall
Crepitus - answer✔✔a grating sound or sensation produced by friction between bone and
cartilage or the fractured parts of a bone.
Orthopnea - answer✔✔ability to breathe only in an upright position
-hard time breathing when laying down
Classification of Dyspnea - answer✔✔Class 1 (ADL 4): no significant restrictions in normal
activity. Employable. Dyspnea occurs only on more-than-normal or strenuous exertion
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
Class 2 (ADL 3): independent in essential ADLs but restricted in some other activities. Dyspneic
on climbing stairs or on walking on an incline but not on level walking. Employable for only a
sedentary job or under special circumstances
CLass 3 (ADL 2): dyspnea commonly occurs during usual activities, like showering or dressing,
but the patient can manage without assistance from others. Not dyspneic at rest; can walk for
more than a city block at own pace but cannot keep up with others of own age. May stop to catch
breath partway or up a flight of stairs. Is probably not employable in any occupation.
Class 4 (ADL 1): dyspnea produces dependence on help in some essential ADLs such as
dressing and bathing. Not usually dyspneic at rest. Dyspneic on minimal exertion; must pause on
climbing one flight, walking more than 100 yards or dressing. Often restricted to home if lives
alone. Has minimal or no activites outside the home.
Class 5 (ADL 0): entirely restricted to home and often limited to bed or chair. Dyspneic at rest.
Dependent on help for most needs.
Fine crackles, fine rales, high pitched rales - answer✔✔-popping, discontinuous sounds caused
by air moving into previously deflated airways
-sounds like hair being rolled between fingers near the ear
-"velcro" sounds late in inspiration usually associated with restrictive disorders
Associated with: asbestosis, atelectasis, interstitial fibrosis, bronchitis, pneumonia, COPD
Coarse crackles, low-pitched crackles - answer✔✔-Lower-pitched, coarse, rattling sounds
caused by fluid or secretions in large airways;
-likely to change with coughing or suctioning
Associated with: bronchitis, pneumonia, tumors, pulmonary edema
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
Wheeze - answer✔✔-Squeaky, musical, continuous sounds associated with air rushing through
narrowed airways, may be heard without a stethoscope
-arise from small airways
-usually do not clear with coughing
Associated with: inflammation, bronchospasm, edema, secretions, asthma, pulmonary vessel
enlargement
Rhoncus (rhonchi) - answer✔✔-lower pitched, coarse, continuous snoring sounds
-arise from the large airways
Associated with: thick tenacious secretions, sputum production, obstruction by foreign body,
tumors
pleural friction rub - answer✔✔-loud, rough, grating, scratching sounds caused by the inflamed
surfaces of the pleura rubbing together, often associated with pain during deep inspirations
-heard in lateral lung fields
Associated with: pleurisy, TB, pulmonary infarction, pneumonia, lung cancer
Relevant Respiratory Labs - answer✔✔CBC
-RBCs (o2 carrying capabilities)
-Hemoglobin (o2 carrying)
-WBC (increase = infection, associated with symptoms)
ABGs ( decrease air exchange, respiratory acidosis, hypercampnia)
Imagine and Diagnostic Tests - answer✔✔*CXR (PA and LL vs. portable (AP))
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/26/2024 11:32 AM
-CT of chest, usually with contrast
-V/Q scan: for pulmonary emboli
-Pulmonary Function Test (asthma, COPD)
-6 or 12 min walk test (hypoxic with activity)
-skin tests (PPD, TB)
-bronchoscopy
-thoracentesis
FVC (Forced vital capacity) - answer✔✔-records the maximum amount of air that can be
exhaled as quickly as possible after maximum inspiration
Purpose: indicates respiratory muscle strength and ventilatory reserve (asthma)
FEV1 (forced expiratory volume in 1 second) - answer✔✔-records the maximum amount of air
that can be exhaled in the first second of expiration
Purpose: is effort dependent and declines normally with age. It is reduced in certain obstructive
and restrictive disorder (asthma)
FEV1/FVC - answer✔✔-the ratio of expiratory volume in 1 second to FVC
Purpose: indicates obstruction to airflow. This ratio is the hallmark of obstructive pulmonary
disease. It is normaly or increased in restrictive diseases
FEF - answer✔✔-records the forced expiratory flow in 25-75% volume (middle half) of the FVC
