DSA Lower Respiratory Exam Flashcards
Hypopnea
decreased depth and rate of resp
Hypoxia
deficiency in the amt of O2 reaching tissues
Hypoxemia
O2 deficiency in arterial blood
Atelectasis
Collapse of lung tissue that affects alveoli from normal O2 absorption
Plexor finger
“tapping” finger, dominant hand for percussion
Anatomy -Sternal angle -Needle thoracentesis -Chest tube insertion -Neurovascular bundle -
-Sternal angle: 2nd rib joins sternum -Needle thoracentesis: 2nd ICS, midclavicular -Chest tube insertion: 4th ICS at mid or anterior axillary line or just sup to margin of 5th rib -Neurovascular bundle: runs in the inferior margins
Pulse Ox
-gives peripheral arterial O2 saturation level -Oxygenated Hb absorbs infrared and lets red light pass when deoxygenated blood absorbs red light -pulse ox measures ratio of red to infrared light -hypothermia might interfere because of vasoconstrictoin
End Tidal CO2 (EtCO2)
-Capnography: non-invasive measurement of partial pressure of CO2 in exhaled breath as [CO2]/time -[CO2] in exhaled air at end of resp
Clubbing of Fingernails
- loss of normal angle between nail and nail fold (>180) -think THINK Chronic
- Causes: CHD, Intersitital lung disease, bronchiectasis, pulmonary fibrosis, CF, lung absess, malicnancy
Tracheal Deviation
- can indicate pneumothorax, pleural effusion, atelectasis, mass

Pectus Excavatum “funnel chest”
- depression in lower pt of sternum
- can compress heart and vessels and cause murmurs
Pectum Carinatum (Pigeon chest)
- sternum displaced anteriorly (increase AP diameter)
- adj costal cartilages depressed
Barrel Chest
- increased AP diameter
- seen in COPD
Chronic Bronchitis versus Emphysema
Chronic Bronchitis
- daily productive cough for 3 mths in 2 consecutive years
- overweight and cyanotic
- elevated Hb
- peripheral edema
- rhonci and wheezing
Emphysema
- older and thin
- severe dyspnea
- quiet chest
- hyperinflation and flattened diaphragm
- perm enlargement and destruction of airspaces
Chest Movement
- Asymmetrical expansion
- Retraction
- Unilateral lagging
- Asymmetrical expansion: pleural effusion
- Retraction: severe asthma, COPD, UR obstruction
- Unilateral lagging: pleural disease
Traumatic Flail Chest
- mult. rib fractures result in paradoxical movements of thorax
- on inspiration, injured areas cave inward and move outward in expiration
Tactile Fremitus
Absent or Decreased
- COPD
- Pleural changes (fibrosis, effusions, air)
Increased
-pneumonia
OSE
- viscerosomatic lungs
- OMM treatment options
- viscerosomatic lungs: T2-7
- OMM treatment options
doming diaphragm
rib raising
tapotement
thoracic pump
Pathology of Percussion
- dullness
- generalized hyperresonance
- unilateral hyperresonance suggests
- tympanic
dullness: fluid replaces air
lobar pneuominia, pleural effusion, hemothorax
generalized hyperresonance: hyperinflate lungs
COPD, asthma
-unilateral hyperresonance suggests
large pneumothorax, COPD, emphysema
-tympanic
abdominal percussion
Diaphragmatic Excursion
- pt exhales and holds it
- percuss level of diaphragm and mark
- pt inhales and holds it
- percuss and mark
- distance between 2
Normal: 3-5.5 cm
Asymmetry with one side higher than other: pleural effusion, high diaphragm secondary to atelectasis or phrenic nerve paralysis
Stridor Common causes
- narrowing of airway
- croup
- epiglottitis
- UA foreign body
- anaphylaxis
- inspiratory sound
Wheezing Causes
- expiratory sound
- rapid airflow through narrowed bronchial airway
Causes:
Reactive airway disease
Asthma
COPD
Crackling Causes
- inspiratory sound
- small airway closed during expiration, popping open during inspiration
- Causes:
pneumonia, CHF, atelectasis, pulmonary fibrosis, bronchiectasis, COPD, asthma
Athelectasis
-loss of lung vol due to collapse of lung tissue
- post surgical fever-> consider!!
- inspired spirometry helps with atelectasis, treatment, prevention
-alveolar collapse not complete collapse



