1. What could be the causes of this tingling sensation?

Tingling is a common symptom of anxiety. The patient is probably over breathing which is a form of hyperventilation which means that the person is breathing too shallow or breathing too quickly or too much and from his chest rather than his diaphragm without realizing it. A person can hyperventilate himself without realizing he is doing so.

2. What are the various patterns of respiration and their significance?



Fig. Four types of breathing, their minute ventilation,
respiratory frequency, and body-oxygen test results.

It is easy to prove that over breathing (having larger tidal volume and higher respiratory frequency) leads to a reduced body oxygen level (measured with the body oxygen test - stress-free breath holding time after usual exhalation) due to hypocapnia and other effects (e.g., chest breathing).
There are, of course, many types of irregular respiratory patterns and abnormal breathing patterns. Some people sigh every 3-5 minutes. Others cough a lot, or sniff sporadically. Often, breathing through the mouth is a part of the picture. All these irregularities are signs of low oxygenation and low CP due to chronic hypocapnia (CO2 deficiency in the brain cells). Respiratory irregularities can also occur during sleep and they can cause gradual development of sleep apnea.

3. Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not?

Yes, ethnicity and culture influence risk factors for heart disease.
Cardiovascular disease (CVD) risk factors are higher among ethnic minority women than among white women in the United States. However, because ethnic minority women are disproportionately poor, socioeconomic status (SES) may substantially explain these risk factor differences.
Social and cultural changes that have led to increases in CVD risk factors including tobacco use, obesity, hypertension and diabetes. To put this into perspective, smoking, for example, is projected to kill 50% more people in 2015 than HIV/AIDS, and will be responsible for 10% of all deaths globally.

4. What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain
The pulmonary examination consists of inspection, palpation, percussion, and auscultation. The inspection process initiates and continues throughout the patient encounter. Palpation, confirmed by percussion, assesses for tenderness and degree of chest expansion. Auscultation, a more sensitive process, confirms earlier findings and may help to identify specific pathologic processes not previously recognized.
Palpation: Palpation is also important in the assessment of ventilation. One can sensitively assess the symmetry, synchrony, and volume of each breath. This is done by examining the patient posteriorly, placing the examiner's thumbs together at the midline at the level of the tenth rib with hands grasping the lateral rib cage; both visual and tactile observations are made both during tidal volume breathing and during deep forceful inhalation. With the latter, thumbs typically separate by approximately 2 to 3 cm.
A part of the palpatory portion of the chest examination is to assess the position of the trachea. This is accomplished best with the examiner stationed behind the patient, palpating the anterior inferior neck just above the jugular notch by gently pressing the fingertips between the lateral tracheal wall and the medial portion of the sternocleidomastoid muscle. Comparing one side to the other, an assessment is made of the position of the trachea: midline or deviation away from the centrist position.
Percussion: percussion is best accomplished by the following approach:
1. Press the distal phalanx of the middle finger firmly on the area to be percussed and raise the second and fourth fingers off the chest surface; otherwise, both sound and tactile vibrations will be blunted.
2. Use a quick, sharp wrist motion (like a catcher throwing a baseball to second base) to strike the finger in contact with the chest wall with the tip of the third finger of the other hand. The best percussion site is between the proximal and distal interphalangeal joints. The novice quickly learns to trim the fingernail to prevent personal discomfort of minor abrasions and lacerations.
3. If the sound and the vibrations produced seem suboptimal, make sure that the finger placed directly on the thorax is making very firm direct contact with the chest wall. If not, few vibrations and little sound will be produced.
4. Percuss the posterior, lateral, and anterior chest wall in such a manner that the long axis of the percussed finger is roughly parallel to