Approach to Lower Respiratory Complaint

Question 1

pursed lip breathing

Answer 1

try to keep some air left in lungs to expand alveoli

Question 2

Cheyne Stokes Breathing

Answer 2

increased breathing depth and f and then decrease and then period of apnea , followed by waking up abruptly and same process again
(tissues start demanding O2, breath a lot and CO2 builds up = confusion , respiratory acidosis

Question 3

Kussmaul breathing

Answer 3

deep rapid breathing, from metabolic acidosis, seen in DKA patients, sepsis, Methanol poisoning, uremia

Question 4

Clubbing of fingers show

Answer 4

fibrosis, lung absess, chronic hypoxia, congenital heart d, bronchoisis, IBS

Question 5

excavatum vs carinatum (pectus)

Answer 5

in and out of sternum

Question 6

tripod sitting position

Answer 6

hangs on knees leaning forward, to maximize airway exchange

Question 7

crepitus can be heard in

Answer 7

subcutanous emphysema (a bunch of air in the tissues outside the pleural cavity)

Question 8

Diaphragmatic excursion

Answer 8

palpate and see movement of ribs during breathing

Question 9

67yo m, sweating and chills for 4days, mild respiratory distress, 4 word conversational dyspnea, Tectile fremitus increased over right anterior chest near midline at T4 and posterior chest, Crackles and Rhonchi over RML and RLL + dullness to percussion

Answer 9

4 word dyspnea: 4 words then breathing needed for a bit,

DX: Pneumonia RLL +RML

Question 10

patient 1 has

Answer 10

80% pneumotorax, tympanic precussion

Question 11

patient 2 has

Answer 11

pleural effusion fluid in lung , drain with thoroscentisis drain like chest tube
sounds dull and solid

Question 12

type of fluid in Pulmonary edema, PE, CHF, lung malignancies

Answer 12

Transudate (from serum form BVs)

Question 13

type of fluid in inflammation or plural absess

Answer 13

Exudate

Question 14

empyema

Answer 14

lung abscess in parenchyma
need to drain with chest tube
can go into pleural space = pleural effusion

Question 15

rhonchi

Answer 15

low pitched wheezing

Question 16

crackels sound like

Answer 16

aluminum foil and sprinking salt over the top of it, aveoli popping open
= small airways closed during expiration and popping open during inspiration

Question 17

normal breath sounds

Answer 17

bronchial : over trachea
Bronchovesicular : aver main bronchi
Tracheal -> over trachea
Vesicular -> over lesser bronchi

Question 18

CTAB

Answer 18

Clear To Auscultation bilaterally

Question 19

low breath sounds unilaterally usually means

Answer 19

Pneumothorax

fluid : hemothorax, pleural effusion, empyema

Question 20

low breath sounds heard bilaterally usually means

Answer 20

COPD, asthma

Question 21

stridor

Answer 21

wheezes in inspiration, can include some expiration sounds also, narrowing of upper airway (trachea in children is most narrow) = medical emergency

1. Croup
2. Epiglottistis
3. foreign body
4. Anaphylaxis

Question 22

crackles can be heard in

Answer 22

pneumonia, CHF, atelectasis (collapse of lung from lack of expansion), pulmonary fibrosis, asthma bronchiectasis, COPD

Question 23

wheezing usually heard in

Answer 23

COPD or asthma

Question 24

croup sounds like

Answer 24

barky sound, need epinephrine and steroids

Question 25

pertussis

Answer 25

whooping sound from whooping cough

Question 26

checking Hb saturation

Answer 26

to see if O2 is getting to body = 5th vital sign

* can be missread in CO poisoning, since Hb is 100 saturated

Question 27

how to keep intracranial P down during brain injury

Answer 27

hyperventilate pt

Question 28

normal PETCO2 and PaCO2

Answer 28

both 40mmHg

Question 29

atelectasis

Answer 29

complete lung alveolar tissue collapse with air in the thoracic cavity, SOB, fast breathing RR, or absence of breathing, low O2 saturation, assessory muscles to breath, tripod postion
makes rest of lung expand to compensate

Question 30

18 yo SOB, CXR done and you see all mediastinal structures shifted to the right side
what will you hear
what is happening
TX:

Answer 30

Hyperresonance when percussing left side
left lung completely collapsed = tension pneumophorax
pushing all organs to the right side which can cause it to collapse as well
TX : a lot of air is built up , needle decompression, midclavicular line, 2nd ICS pop needle in and air gets out, right lung reexpansion, chest tube needed to reexpand left lung

Question 31

how to see cyanosis in darker skin

Answer 31

you can look in the oral mucosa and can see

Question 32

prevent atelectosis after surgery

Answer 32

peak flow meter, spirometer, to force them to reexpand lung tissue