19: Pulmonary Breath Sounds

Question 1

three cases that may have tracheal displacement

Answer 1

1. pneumothorax
2. pleural effusion
3. severe atelectasis

Question 2

signs of respiratory distress on inspection

Answer 2

1. accessory muscle use (SCM, scalenes)
2. Retractions (supraclavicular retractions)
3. inability to speak in full sentences
4. tripod positioning
5. abdomen paradoxical movement with breaths

Question 3

causes of nail clubbing

Answer 3

bronchiectasis, congenital heart disease, pulmonary fibrosis, CF, lung abscess, malig

Question 4

causes of unilateral chest expansion

Answer 4

1. fibrosis
2. pleural effusion
3. lobar PNA
4. pleural pain
5. unilateral bronchial obstruction
6. paralysis of hemidiaphragm

Question 5

tactile fremitus

Answer 5

palpable vibrations from patient speaking

Question 6

what does it mean if tactile fremitus is increased vs locally decreased vs globally decreased

Answer 6

1. increased: consolidated tissue like PNA
2. locally decreased: pleural effusion, pneumothorax, neoplasms
3. globally decreased: high pitched voice, thick chest wall, obstructed bronchus, COPD, fibrosis

Question 7

why is lack of wheezing in an asthmatic pt an ominous sign

Answer 7

could be so severe that almost no air is moving thru

Question 8

symp levels of the lungs

Answer 8

T1-7

Question 9

332 rule in intubation

Answer 9

1. 3 fingers between upper/lower teeth with open mouth
2. 3 fingers between mental angle and hyoid bone
3. 2 fingers between floor of mandible to thyroid notch

Question 10

LEMON airway assessment

Answer 10

1. Look externally (trauma, big teeth, beard, large tongue)
2. evaluate 332
3. mallampati score >3
4. obstruction (epiglottitis, peritonsillar abscess, trauma)
5. neck mobility

Question 11

indications for intubation

Answer 11

1. respiratory failure
2. apnea
3. reduced consciousness GCS < 8
4. airway injury
5. high risk for aspiration
6. general anesthesia

Question 12

major contraindication of intubation

Answer 12

laryngeal fracture

Question 13

Most common inflammatory dz of the lung + MC chronic dz in childhood in resource-rich countries

Answer 13

Asthma

Question 14

Confirming asthma dx requires what three elements?

Answer 14

1. Variable expiratory airflow limitation on spirometry
2. Reversible obstruction
3. Exclude other dxs

Question 15

Six types of drugs used in asthma and COPD**

Answer 15

1. SABA
2. LABA
3. SAMA (short acting muscarinic agents)
4. inhaled corticosteroids
5. Systemic corticosteroids
6. Leukotriene R antagonist

Question 16

COPD

Answer 16

Persistent sx and airflow limitations due to alveolar abnormalities caused by significant exposure to noxious particles

Question 17

Most reproducible and objective measurement of airflow limitation in COPD**

Answer 17

Spirometry

Question 18

How to treat acute exacerbations of COPD

Answer 18

1. Asses O2, obtain ABGs, CO2 monitoring
2. Intubation as needed
3. Order CXR, CBC, CMP, cardiac profile, BNP, ECG
4. SAMA and IV glucocorticoids
5. Abx if increased sputum production

Question 19

Four things that cause restrictive lung disease

Answer 19

1. ILD
2. Chest wall issues
3. Pleural effusion
4. Muscle weakness (ALS, muscular dystrophy)

Question 20

Symptoms of ILD in general

Answer 20

Insidious onset, progressive dyspnea, non-productive cough

Question 21

Two most common ILDs

Answer 21

1. IPF

2. Sarcoidosis

Question 22

Most common CT-ILD

Answer 22

Systemic sclerosis