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MS2 Respiratory > 9/8- Respiratory H&P > Flashcards

9/8- Respiratory H&P Flashcards

1
Q

What is dyspnea? What causes it (broadly)?

A

Def: subjective experience of breathing discomfort; the sensation is holistic

  • Results from interaction (mismatch) of various efferent and afferent signals
  • May be respiratory, cardiovascular, or non-cardiac non-respiratory
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2
Q

What are some specific causes of dyspnea?

A

(Recall: interaction/mismatch of various efferent and afferent signals)

  • Mechanical interference with ventilation
  • Weakness of respiratory pump
  • Increased respiratory drive
  • Wasted ventilation
  • Physiologic
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3
Q

In what situations may dyspnea due to mechanical interference with ventilation arise?

A
  • Airflow obstruction (COPD)
  • Increased resistance of lung
  • Resistance of chest wall
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4
Q

In what situations may dyspnea due to weakness of respiratory pump arise?

A
  • Neuromuscular disorders
  • Hyperinflation
  • Pleural disorders
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5
Q

In what situations may dyspnea due to increased respiratory drive arise?

A
  • Hypoxemia
  • Metabolic acidosis
  • Stimulation of receptors
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6
Q

In what situations may dyspnea due to wasted ventilation arise?

A
  • Capillary destruction (COPD)
  • Large vessel obstruction (PE)
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7
Q

In what situations may dyspnea due to physiologic arise?

A
  • Anxiety
  • Somatization
  • Litigation
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8
Q

What is platypnea?

A

Shortness of breath worse when sitting up (as opposed to lying down)

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9
Q

What is orthopnea?

A

Shortness of breath when laying down

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10
Q

T/F: A pt can have RR = 30 without being dyspneic

A

True

Hyperventilation does NOT = dyspnea

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11
Q

How can dyspnea be quantified?

A

Modified Borg Scale:

0- Nothing at all

0.5- Very, very slight, just noticeable

1- Very slight ……

5- Severe

10- Maximal

Visual Analog Scale (0-10)

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12
Q

Important things to follow up with dyspnea?

A
  • Onset (gradual, acute/sudden)
  • Positional
  • Associated qualitative descriptors
  • Quantify
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13
Q

What is a “chronic” cough? Most common causes?

A

Lasts > 8 weeks

1. Postnasal drip syndrome (upper airway cough syndrome)- typ worse in morning

2. GERD- typ worse after lying down/eating

3. Asthma/other obstructive lung diseases- typ worse at night

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14
Q

Important things to follow up with cough?

A
  • Dry vs. productive
  • Timing/when is it worse (early morning vs. night)
  • Precipitating/relieving factors
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15
Q

Important things to follow up with sputum production?

A
  • Quantity
  • Consistency
  • Color
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16
Q

What is bronchorrhea?

In what condition is it commonly found?

A

Production of copious amounts of sputum

  • Classic for broncho-alveolar carcinoma
  • Bronchiectasis: obstructive disease; destruction of airways
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17
Q

“Tenacious” mucoid (hard to get out of cup) is found in what condition(s)?

A

Asthma

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18
Q

Purulent (watery) sputum is found in what conditions?

A
  • Bronchitis
  • Bronchiectasis
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19
Q

What should you think of with green sputum?

A

Pseudomonas

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20
Q

Important things to follow up with hemoptysis?

A
  • Streaks or clots
  • Quantity
  • Which side it’s coming from
  • Past history of TB, histoplasma
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21
Q

What qualifies as “massive” hemoptysis? What is the problem?

A

Massive = 500 mL in 24 hours (or 250 in 6 hrs)

  • 1 foam cup = 125 mL

Problem is not the blood loss, but rather the volume in the lung

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22
Q

What is wheezing?

A

Musical respiratory sounds that may be audible to patient or others

23
Q

Important things to follow up with wheezing?

A
  • When it occurs (day, night, exercise, foods)
  • Relieving factors
  • Positional
24
Q

How does substernal thyroid goiter present?

A

Wheezing that is worse when supine

25
Q

T/F: lung tissue has extensive pain fibers

A

False; lung tissue has no pain fibers!

(Pleura, however, has many)

26
Q

In what conditions is chest pain typically felt?

A
  • Pneumothorax
  • Pleuritic chest pain (worse with inspiration!)
  • Cardiac chest pain
  • Muscle strain
27
Q

Important respiratory things to cover in the history?

A
  • Family History
  • Occupational History (Important!)
  • Smoking history
  • Exposures
28
Q

What parts of the physical exam inspection should be noted in regard to the respiratory system?

A
  • Color (pallor, cherry-red, cyanosis)
  • Smell of breath
  • Nails (clubbing)
  • Neck
  • Shape of chest (barrel, thoracic kyphoscoliosis, pectus excavatum)
  • Signs of respiratory distress
29
Q

What are some distinctive breath smells tied to medical conditions?

  • Foul
  • Ketone
  • Bitter almond
A
  • Foul smelling sputum: anaerobic infection
  • Ketone/”rotten apple”: diabetic ketoacidosis
  • Bitter almond: cyanide poisoning
30
Q

What are signs up respiratory distress to be aware of upon inspection?

A
  • Tachypnea
  • Intercostal retractions
  • Respiratory alternans (alternating pulse pressure with breathing)
  • Pursed lip breathing
  • Use of accessory muscles
31
Q

How can tracheal position be abnormal?

How does it respond to certain medical conditions (pneumothorax, effusion, collapse, mass)?

A

Deviates:

  • Away from pneumothorax and effusion
  • Towards collapse

May also be deviated by a mass (e.g. enlarged lymph nodes)

32
Q

How can vocal fremitus clue you in to a certain disorder?

A
  • Increased over areas of consolidation
  • Decreased/absent over areas of effusion or collapse
33
Q

What may cause symmetrical reduction in chest expansion?

A
  • Overinflated lungs (e.g. emphysema)
  • Stiff lungs (e.g. pulmonary fibrosis)
  • Ankylosing spondylitis
34
Q

What may cause asymmetrical reduction in chest wall expansion?

A

Reduced expansion:

  • Pulmonary consolidation
  • Collapse

Absent expansion:

  • Empyema
  • Pleural effusion
35
Q

Results of chest percussion (picture)?

A
36
Q

Flatness: what is the relative intensity? pitch? duration? example location? pathologic example?

A
  • Intensity: soft
  • Pitch: high
  • Duration: short
  • Ex: thigh
  • Pathologic: Large pleural effusion
37
Q

Dullness: what is the relative intensity? pitch? duration? example location? pathologic example?

A
  • Intensity: medium
  • Pitch: medium
  • Duration: medium
  • Ex: liver
  • Pathologic: Lobar pneumonia
38
Q

Resonance: what is the relative intensity? pitch? duration? example location? pathologic example?

A
  • Intensity: loud
  • Pitch: low
  • Duration: long
  • Ex: normal lung
  • Pathologic: –
39
Q

Hyper-resonance: what is the relative intensity? pitch? duration? example location? pathologic example?

A
  • Intensity: very loud
  • Pitch: lower
  • Duration: longer
  • Ex: normal none (normally)
  • Pathologic: Emphysema, pneumothorax
40
Q

Tympany: what is the relative intensity? pitch? duration? example location? pathologic example?

A
  • Intensity: loud
  • Pitch: high* (musical timbre)
  • Duration: *
  • Ex: gastric air bubble or puffed out cheeks
  • Pathologic: large pneumothorax
41
Q

What percussion sounds are heard with the following conditions?

  • Large pleural effusion
  • Lobar pneumonia
  • Emphysema
  • Pneumothorax
  • Large pneumothorax
A
  • Large pleural effusion: flatness
  • Lobar pneumonia: dullness
  • Emphysema: hyper-resonance
  • Pneumothorax: hyper-resonance
  • Large pneumothorax: tympany
42
Q

Vesicular breath sounds:

  • Duration
  • Intensity of Expiration
  • Pitch of Expiration
  • Normal location
  • Sounds like
A

Vesicular breath sounds:

  • Duration: insp > exp
  • Intensity of Expiration: soft
  • Pitch of Expiration: low
  • Normal location: majority of both lungs
  • Sounds like: wind blowing through trees
43
Q

Broncho-vesicular breath sounds:

  • Duration
  • Intensity of Expiration
  • Pitch of Expiration
  • Normal location
  • Sounds like
A

Broncho-vesicular breath sounds:

  • Duration: insp = exp
  • Intensity of Expiration: intermediate
  • Pitch of Expiration: intermediate
  • Normal location: ant 1-2 interspaces, between the scapula
  • Sounds like: —
44
Q

Bronchial breath sounds:

  • Duration
  • Intensity of Expiration
  • Pitch of Expiration
  • Normal location
  • Sounds like
A

Bronchial breath sounds:

  • Duration: exp > insp
  • Intensity of Expiration: loud
  • Pitch of Expiration: high
  • Normal location: possibly over manubrium
  • Sounds like: air blowing through cardboard tube
45
Q

Characteristics of crackles?

When are fine/coarse crackles heard?

A

Aka rales

- Discontinuous

- Non-musical/brief

Fine crackles: soft, high pitched, very brief (fibrosis)

Coarse crackles: louder, lower in pitch, brief (pneumonia, CHF)

46
Q

Characteristics of wheezes and ronchi? When is each heard?

A
  • Continuous
  • Musical prolonged

Wheezes: higher pitch with hissing, shrill quality (narrowed airways like asthma, COPD, bronchitis)

Rhonchi: lower pitch with snoring quality (secretions in large airways)

47
Q

Characteristics of stridor?

A

Predominantly inspiratory; suggests partial obstruction of larynx or trachea

48
Q

Characteristics of pleural rub?

A

Sound like crackles but more continuous in both phases and in small area

49
Q

Characteristics of mediastinal crunch?

A

Precordial crackles synchronous with heart beat; best heard in left lateral

50
Q

What does bronchophony indicate?

A

Consolidation

51
Q

What is egophany?

A
  • Patient says “ee”
  • Normal: muffled “ee” sound
  • Abnl: “ee” heard as “ay” with nasal quality
  • Atelectasis from effusion; consolidation
52
Q

What is whispered pectoriloquoy?

A
  • Patient whispers “ninety-nine”
  • Normal: heard faintly/indistinctly
  • Abnl: louder, clearer whisper (Early pneumonia, atelectasis)
53
Q

Summary of findings:

  • Normal lung
  • Pleural effusion
  • Atelectasis
  • Consolidation
  • Pneumothorax
A

MS2 Respiratory (26 decks)

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