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Pulmonology > CM Pulmonary Exam > Flashcards

CM Pulmonary Exam Flashcards

1
Q

What are the components of a lung exam?

A

Inspection, Palpation/Percussion, Auscultation, Special Tests

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2
Q

Why might a child cry on inspection?

A

Stranger anxiety, pain, or respiratory distress

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3
Q

What is important about the patient’s position of comfort?

A

How they sit may indicate if they are trying to open their airways, a sign of respiratory distress

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4
Q

What is important about how a patient talks?

A

A patient that struggles to talk may be in respiratory distress

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5
Q

Why do patients take the tripod position?

A

Lean forward with their hands rested on their arms and legs to try and use accessory muscles to facilitate respiration, a sign of respiratory distress

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6
Q

Why do patients exhale through pursed lips?

A

Pursed lip exhalation creates a positive back pressure that stents airways open and keeps them from collapsing

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7
Q

What is a normal respiratory rate in an adult?

A

10 - 14 breaths per minute

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8
Q

What is a normal neonate respiratory rate?

A

30 - 60, but may be irregular and periodic

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9
Q

What is a normal respiratory rate in young children?

A

20 - 40 breaths per minute

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10
Q

What is a normal respiratory rate in older children?

A

15 - 25 breaths per minute

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11
Q

What should be considered in terms of chest expansion?

A

Depth, asymmetry, and hyperinflation

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12
Q

How do the mechanics of breathing differ in children?

A

Chest wall is more cartilaginous and therefore more complaint, while intercostals are less developed, so children rely on diaphragm/abdominal breathing to some extent

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13
Q

What is nasal flaring?

A

A sign of respiratory distress, where the nares are dilated to improve airflow

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14
Q

What is head bobbing?

A

A sign of respiratory distress in infants

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15
Q

Why does grunting occur?

A

Attempt to raise expiratory pressure to keep airways open

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16
Q

Why do retractions occur?

A

Indicate that accessory muscles are being used during respiratory distress, such as tracheal tugging and intercostal contraction

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17
Q

What is percussion?

A

Tapping on the chest wall to gain information about the tissue underneath

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18
Q

Do you percuss on ribs or between ribs?

A

Percussion occurs between ribs

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19
Q

What part of which finger should be used during percussion?

A

Use the distal joint of the middle finger of one hand, and tap on that joint with the middle finger of the other hand

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20
Q

Should you percuss over scapulae?

A

No

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21
Q

What is a normal lung percussion note?

A

Resonant

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22
Q

What does hyperresonance indicate?

A

Extra air that produces a louder, lower sound on percussion indicates emphysema or pneumothorax

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23
Q

How would emphysema sound on percussion?

A

Hyperresonant, due to extra air

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24
Q

How would pneumothorax sound on percussion?

A

Hyperresonant, due to extra air

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25
Q

What does a dull resonance indicate?

A

Denser tissue (liver like) suggesting consolidation, pleural effusion, or a mass

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26
Q

How would pneumonia sound on percussion?

A

Dull resonance, due to denser tissue

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27
Q

How would pulmonary edema sound on percussion?

A

Dull resonance, due to denser tissue

28
Q

How would hemorrhage sound on percussion?

A

Dull resonance, due to denser tissue

29
Q

How would a pleural effusion sound on percussion?

A

Dull resonance, due to denser tissue

30
Q

What is the point of palpation during the lung exam?

A

Evaluate for tenderness

31
Q

What is tactile fremitus?

A

A special test to feel sound vibrations transmitted to ulnar surface of the hand as the patient says “ninety nine”

32
Q

What does tactile fremitus reflect?

A

Density of tissue in the chest cavity

33
Q

How does fluid in lung tissue effect tactile fremitus?

A

Fluid inside the lung tissue increases tactile fremitus

34
Q

How does fluid or air outside lung tissue effect tactile fremitus?

A

Fluid or air outside the lung decreases tactile fremitus

35
Q

Does pleural effusion increase or decrease tactile fremitus?

A

Pleural effusion decreases tactile fremitus because the fluid outside the lung impairs transmission of sound

36
Q

Does consolidation increase or decrease tactile fremitus?

A

Consolidation increases tactile fremitus because fluid inside the lung increases transmission of sound

37
Q

Does pneumothorax increase or decrease tactile fremitus?

A

Pnemothorax decreases tactile fremitus because air outside the lung impairs transmission of sound

38
Q

What is auscultation?

A

Listening to the breath sounds

39
Q

What can decrease breath sounds?

A

Decreased effort, obstructed airway, fluid in alveoli, or fluid/air in pleural space

40
Q

What are normal breath sounds?

A

Vesicular sounds, inspiratory > expiratory

41
Q

When are trachial, bronchial, and bronchovesicular sounds abnormal?

A

When they are heard in unexpected areas, such as during consolidation

42
Q

What are crackles?

A

Discontinuous, brief sounds from popping open of small airways

43
Q

What do late inspiratory cracks suggest?

A

A lung abnormality like fibrosis

44
Q

Would IPF, Sarcoidosis, and BPD present with early or late inspiratory crackles?

A

Late inspiratory crackles, because these conditions are lung abnormalities

45
Q

What do early inspiratory crackles suggest?

A

Fluid in small airways

46
Q

Would pneumonia and pulmonary edema present with early or late inspiratory crackles?

A

Early inspiratory crackles, because both conditions result in fluid in a lung

47
Q

What are rochni?

A

Low pitched sounds in both inspiration and expiration that are caused by secretions in the airways

48
Q

What conditions cause ronchi?

A

Bronchitis and bronchiolitis

49
Q

What distinguishes ronchi?

A

Variable from breath to breath or after coughing due to the fact they arise from mucous, which can shift

50
Q

What are the 3 special tests?

A

Bronchophony, Egophony, and Whispered Pectoriloquy

51
Q

What does Bronchophony use?

A

Say “ninety nine” and increase transmission with consolidation

52
Q

What does Egophony use?

A

Say “E” and hear “A” through stethoscope due to consolidation

53
Q

What does Whispered Pectoriloquy use?

A

Whisper “1-2-3” and hear an intensification of the sound on stethoscope due to consolidation

54
Q

What causes wheezing and stridor?

A

High pitched airflow due to obstruction to airflow

55
Q

How does Wheezing vary with Asthma?

A

Wheezing in asthma has an end-expiratory component and should be bilateral and diffuse

56
Q

What does localized wheezing suggest?

A

Local obstruction

57
Q

Where is the airway obstructed in stridor?

A

Above the thorax, causing a high pitched squeaking sound

58
Q

Does stridor have an inspiratory component?

A

Yes

59
Q

What radiologic sign suggests stridor?

A

Steeple sign = narrowing of upper airway

60
Q

What is Croup?

A

A viral infection with laryngeal edema and secretions

61
Q

How do lower and upper airway obstructions differ?

A

Upper airway obstructions tend to be inspiratory and bilateral while lower airway obstructions tend to be expiratory and vary side-to-side

62
Q

What type of breath sound is heard in a consolidated lung?

A

Bronchial sounds outside the Bronchioles = consolidated lung

63
Q

What can cause crackles?

A

Fibrosis, pneumonia, and pulmonary edema

64
Q

What can cause wheezing?

A

Asthma, bronchitis, bronchiolitis, airway compression

65
Q

What can cause ronchi?

A

Bronchitis, asthma, bronchiolitis

66
Q

What can cause stridor?

A

Airway stenosis, edema, compression

Pulmonology (22 decks)

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