Chapter 2 Physical Exam Flashcards
Angle of Louis correlates to what rib?
Second rib
Usually no more than 90 degrees, with ribs inserted at 45-degree angles
Costal angle
Vertebrae prominences are what two bony processes?
C7 and T1
In pregnant women, what causes the ligaments of the rib cage to relax, and the chest expansion to increase
Estrogen increase
Pregnant:
An increase in the lateral diameter of ___ cm.
An increase in circumference of ______ cm.
2 cm
5-7 cm
Pregnant:
Major work of breathing is done by:
The diaphragm
Type of breathing
Pregnant women have:
Deeper breathing and slightly increased rate of respirations
Results from loss of muscle strength in thorax and diaphragm, coupled with a decreased lung resiliency.
Barrel chest
Alveoli in older adults
Less elastic and more fibrous
Aging mucous membranes become:
Drier
(Number of years smoking) x (Number of packs smoked per day)
Pack years
Hobbies that could cause respiratory problems
Owning pigeons
Parrots or other animals
Woodworking
Welding
Sequence of steps in examination of the chest and lungs
Inspection, Palpation, Percussion, Auscultation
What lighting is used to highlight chest movement?
Tangential lighting
Inferior border of lungs cross at what rib?
6th rib
Best place to listen to the R middle Lobe
5th intercostal space, Anterior Axillary
Indicative of prolonged respiratory/cardiac distress
Clubbing of the fingernails
Odor:
Sweet Smell
Diabetic ketoacidosis
Odor:
Ammonia
Uremia
Odor:
Musty fish
Hepatic failure
Odor:
Foul/putrid
Respiratory infection
Odor:
Foul/feculent
Intestinal obstruction/diverticulum
Odor:
Halitosis
Gingivitis, Vincent’s angina
Odor:
Cinnamon
Tuberculosis
Ratio of respirations to heartbeats is approximately:
1:4
So the patient does not mislead you, count the respiratory rate while:
Holding the radial artery
Breathing:
Chest goes up, belly goes down and vice versa
Paradoxical breathing
Absence of spontaneous respirations
Apnea
Feeling or sensation that one cannot breath well enough. Distict sensations include effort/work, chest tightness, and air hunger.
Dyspnea
Grave condition in which breathing stops and will not spontaneously start again unless resuscitative measures are immediately instituted.
Secondary Apnea
Shortness of breath that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps.
Orthopnea
Sudden onset of shortness of breath after a period of sleep; sitting upright is helpful.
Paroxysmal nocturnal dyspnea
Dyspnea increase in the upright posture
Platypnea
Persistent respiratory rate faster than 20 and approaching 25 breaths per minute
Tachypnea
Rate slower than 12 breaths per minute.
May indicate neurologic or electrolyte disturbance, infection or a sensible response to protect against the pain of pleurisy.
Bradypnea
A regular periodic pattern of breathing, with intervals of apnea followed by crescendo/decrescendo
Cheyne Stokes Respirations
Somewhat irregular respirations varying in depth and interrupted by intervals of apnea but lacking the repetitive pattern of periodic respirations of Cheyne Stokes
Biot Respirations
Respirations greater than 20 and deep
Hyperpnea
Rapid, deep and labored respiratory pattern associated with metabolic acidosis
Kussmaul breathing
Regular comfortable breathing at a rate of 12-20 breaths per minute
Eupnea
Percuss at intervals of
4-5cm
Diaphragm is usually higher on what side?
Right (because of the liver)
Length of diaphragmatic excursion is usually:
3-6cm
Breath sounds can be characterized same as percussion notes:
Intensity, pitch, quality, and duration
Greater clarity and increased loudness of spoken sounds during auscultation, can be seen with what test?
Bronchophony
Test for whispered sounds, normally will not be heard or completely unintelligible
Whispered pectoriloquy
Consolidation is present and the patient speaks the letter “e”, what is actually auscultated is “a”
Egophony
Decreased tactile or vocal fremitus is associated with:
Emphysema
Lateral curvature/deviation of the spine
Scoliosis
Excessive curvature of the lumbar spine
Lordosis
Hyper-resonance indicates:
Hyperinflation of the lungs
Dullness indicates:
Lung consolidation
Costal angle can reach up to ____ degrees in pregnancy
103
A persistent cough may be the only manifestation. Peak expiratory flow rates should be obtained before and after nebulizer treatments to verify improved lung function.
Asthma
Inflammatory process involving the pleural and parietal pleura
The resultant rub can be heard and felt during exam
Pleurisy
Diminished breath sounds and dullness to percussion occur over the area of consolidation.
Involvement of the right lower lobe can stimulate the tenth and eleventh thoracic nerves to cause right lower quadrant pain and simulate abdominal pain
Pneumonia
Presence of air or gas in the pleural space
Positive coin click can help diagnose, place a coin over the suspicious area in the chest, and while listening to the opposite side, have someone strike the coin with the edge of another.
A positive finding is when you hear a clear click.
Pneumothorax
A collection of purulent exudates in the pleural space
Empyema
Both characterized by dullness heard on percussion
Pleural effusion and lobar pneumonia
A condition where pH levels of the entire body has decreased (increased hydrogen ion concentration) which will trigger increased respiratory rate.
Metabolic acidosis
An autosomal recessive disorder of the exocrine glands involving the lungs, pancreas and sweat glands.
Characterized by abnormally thick mucus and subsequent pulmonary infections.
Cystic Fibrosis
