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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
What does a dull resonance indicate?
Denser tissue (liver like) suggesting consolidation, pleural effusion, or a mass
26
How would pneumonia sound on percussion?
Dull resonance, due to denser tissue
27
How would pulmonary edema sound on percussion?
Dull resonance, due to denser tissue
28
How would hemorrhage sound on percussion?
Dull resonance, due to denser tissue
29
How would a pleural effusion sound on percussion?
Dull resonance, due to denser tissue
30
What is the point of palpation during the lung exam?
Evaluate for tenderness
31
What is tactile fremitus?
A special test to feel sound vibrations transmitted to ulnar surface of the hand as the patient says "ninety nine"
32
What does tactile fremitus reflect?
Density of tissue in the chest cavity
33
How does fluid in lung tissue effect tactile fremitus?
Fluid inside the lung tissue increases tactile fremitus
34
How does fluid or air outside lung tissue effect tactile fremitus?
Fluid or air outside the lung decreases tactile fremitus
35
Does pleural effusion increase or decrease tactile fremitus?
Pleural effusion decreases tactile fremitus because the fluid outside the lung impairs transmission of sound
36
Does consolidation increase or decrease tactile fremitus?
Consolidation increases tactile fremitus because fluid inside the lung increases transmission of sound
37
Does pneumothorax increase or decrease tactile fremitus?
Pnemothorax decreases tactile fremitus because air outside the lung impairs transmission of sound
38
What is auscultation?
Listening to the breath sounds
39
What can decrease breath sounds?
Decreased effort, obstructed airway, fluid in alveoli, or fluid/air in pleural space
40
What are normal breath sounds?
Vesicular sounds, inspiratory > expiratory
41
When are trachial, bronchial, and bronchovesicular sounds abnormal?
When they are heard in unexpected areas, such as during consolidation
42
What are crackles?
Discontinuous, brief sounds from popping open of small airways
43
What do late inspiratory cracks suggest?
A lung abnormality like fibrosis
44
Would IPF, Sarcoidosis, and BPD present with early or late inspiratory crackles?
Late inspiratory crackles, because these conditions are lung abnormalities
45
What do early inspiratory crackles suggest?
Fluid in small airways
46
Would pneumonia and pulmonary edema present with early or late inspiratory crackles?
Early inspiratory crackles, because both conditions result in fluid in a lung
47
What are rochni?
Low pitched sounds in both inspiration and expiration that are caused by secretions in the airways
48
What conditions cause ronchi?
Bronchitis and bronchiolitis
49
What distinguishes ronchi?
Variable from breath to breath or after coughing due to the fact they arise from mucous, which can shift
50
What are the 3 special tests?
Bronchophony, Egophony, and Whispered Pectoriloquy
51
What does Bronchophony use?
Say "ninety nine" and increase transmission with consolidation
52
What does Egophony use?
Say "E" and hear "A" through stethoscope due to consolidation
53
What does Whispered Pectoriloquy use?
Whisper "1-2-3" and hear an intensification of the sound on stethoscope due to consolidation
54
What causes wheezing and stridor?
High pitched airflow due to obstruction to airflow
55
How does Wheezing vary with Asthma?
Wheezing in asthma has an end-expiratory component and should be bilateral and diffuse
56
What does localized wheezing suggest?
Local obstruction
57
Where is the airway obstructed in stridor?
Above the thorax, causing a high pitched squeaking sound
58
Does stridor have an inspiratory component?
Yes
59
What radiologic sign suggests stridor?
Steeple sign = narrowing of upper airway
60
What is Croup?
A viral infection with laryngeal edema and secretions
61
How do lower and upper airway obstructions differ?
Upper airway obstructions tend to be inspiratory and bilateral while lower airway obstructions tend to be expiratory and vary side-to-side
62
What type of breath sound is heard in a consolidated lung?
Bronchial sounds outside the Bronchioles = consolidated lung
63
What can cause crackles?
Fibrosis, pneumonia, and pulmonary edema
64
What can cause wheezing?
Asthma, bronchitis, bronchiolitis, airway compression
65
What can cause ronchi?
Bronchitis, asthma, bronchiolitis
66
What can cause stridor?
Airway stenosis, edema, compression

Pulmonology (22 decks)

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