DSA- Lower Respiratory Tract Exam Flashcards
Hypopnea
Decreased depth and rate of respiration
Bradypnea
regular rhythm but slower than normal rate ( RR<14/min)
Hyperpnea
increased depth and rate of respiration (exercise)
Tachypnea
rapid breathing ( RR> 20-25/ min)
Dyspnea
feeling short of breath
Hypoxia
deficiency in amount of O2 reaching tissues
Hypoxemia
oxygen deficiency in arterial blood
Apnea
no breathing
Atelectasis
collapse of lung tissue that affects the alveoli from normal O2 absorption
Pleximeter Finger
hyperextended middle finger of non-dominated hand in percussion
plexor finger
“tapping” finger, dominant hand , for percussion
Landmarks of chest (11)
- Supraclavicular: above clavicles
- infraclavicular: below clavicles
- interscapular: between scapulae
- infrascapular: below scapulae
- bases of lungs: lowermost portions
- upper, middle, lower lung fields
- vetebral line
- scapular line
- right anterior axillary line
- right midclavicular line
- midsternal line
Sternal Angle
Angle of Louis
- 2nd ribs join sternum
Needle Thoracentesis
- decompression
- 2nd intercostal space, midclavicular line
Chest tube Insertion
- location
- 4th and 5th intercostal space (anterior to midaxillary line)
- 5th intercostal space- inferior to nipple
Neurovascular bundle
- runs along inferior margins of each rib
- chest tubes need to be placed OVER superior margin of rib to avoid bundle
Pulse Oximetry
- reasons for bad waveform
- measures peripheral arterial oxygen saturation ( SpO2)
- “fifth vital sign”
uses red and infrared light to measure fraction of oxygenated hemoglobin (absorbs infrared> red) and deoxygenated blood ( absorbs red > infrared)
bad waveform causes
- improper placement, hypoperfusion, hypothermia, motion artifact
End Tidal CO2
- concentration of CO2 in exhaled air at end of respiration
- measures ventilation
Normal PETCO2= 35-40 mmHg
Normal PaCO2= 35-45 mmhG
Incentive Spirometer (IS)
- device used to help you keep your lungs healthy after surgery or when you have a lung illness, such as pneumonia
- teaches you how to take slow deep breaths
Atelectasis
- loss of lung volume due to collapse of lung tissue (alveoli)
- can be seen post-surgery
Treatment: use IS
Pulmonary Function Test (PFT)
- noninvasive
- show how well lungs are working
- diagnose certain lung disorders (obstructive vs Restrictive)
Spirometry
- aka PFT
- measure lung function
- amount and speed of air inhaled and exhaled
- diagnose condition (obstructive vs restrictive)
Accessory Muscle in Respiration( 6)
- Sternomastoids
- Scalenes
- Inspiratory intercostals
- expiratory intercoastals
- diaphragm
- external obliques
- expiratory abdominals
Cyanosis
signs of hypoxia
- nail bed
- perioral
Tracheal Deviation seen in ( 4)
- pneumothorax (tension and nontension)
- Pleural effusion
- Atelectasis
- Mass
Clubbing
- causes
- congenital heart disease
- interstitial lung disease
- bronchiectasis
- pulmonary fibrosis
- cystic fibrosis
- lung abscess
- malignancy (lung cancer)
- inflammatory bowel disease
Pectus Excavatum
- funnel chest
- depression in lower portion in sternum
Pectus Carinatum
- pigeon chest
- sternum displaced anterior (increased AP diameter)
- adjacent costal cartilage are depressed
Barrel Chest
- increased AP diameter resembling barrel
- COPD
Chronic Bronchitis
- symptoms
- daily productive cough for more than 3 months
- blue bloater
symptoms
- overweight and cyanotic
- elevated hemoglobin
- peripheral edema
- Rhonchi and wheezing
Emphysema
- symptoms
- pink puffer
- pathologic diagnosis
- permanent enlargement and destruction of airspaces distal to terminal bronchiole
Symptoms
- older and thin
- severe dyspnea
- quiet chest
- x ray hyperinflation with flattened diaphragm
Traumatic Flail Chest
- multiple rib fracture may result in paradoxical movements of thorax
- inspiration -> injured area caves inward
- expiration-> injured area moves outward
Tactile Fremitus
- differentials if increased/decreased
- Palpable vibration as patients says “99”
Decreased or absent
- COPD
- Pleural changes ( effusion, fibrosis, air, infiltrating tumor)
increased
- pneumonia ( consolidation)
Percussion sounds
- differentials
Resonant= healthy lung
Dullness
- fluid/ solid tissue in air-containing lungs
- effusion
- hemothorax
- emphysema
- fibrous tissue or tumor
- pretty white in majority of x-ray
Hyperresonance
- hyperinflated lungs
- COPD or asthma
- very black lungs on X-ray
Tympanic- abdominal percussion
Abnormal sounds in respiratory ( 5)
1) rhonchi: coarse low-pitched, may be clear with cough
2) wheeze: whistling, high pitched bronchus
3) bronchial: coarse, loud, heard with consolidation
4) Rub: scratchy, high pitched
5) crackle: fine crackling, high pitched
Adventitious vs normal (4) breath sounds
Normal
- vesicular
- Bronchovesicular
- bronchial
- tracheal
Adventitious
- stridor
- wheezes (rhonchi- low pitched wheezes)
- crackles
Stridor
- generally an inspiratory sound
- but can be expiratory or biphasic
- result from a narrowing in upper airway
Causes
- croup
- epiglottis
- upper airway foreign body
- anaphylaxis
Wheezing
- generally an expiratory sound but can be inspiratory or biphasic
- continuous musical sounds
- caused by rapid airflow through a narrowed bronchial airway
- RAD
- Asthma
- COPD
Crackles
- inspiratory sound
- continuous musical sounds
- caused by small airway closed during expiration
- “popping” open during inspiration
Causes
- pneumonia
- CHF
- Atelectasis
- pulmonary fibrosis
- brochiectasis
- COPD
- Asthma
Vocal Resonance (normal vs abnormal(3) )
Normal
- words are muffled/indistinct
Abnormal
- distinctness increases with lung consolidation (tumor, pneumonia effusions)
- bronchophony- spoken words get louder
- whispered pectoriloquy- whispered words are louder and cleared during auscultation
- egophony- when patients says “ee” it sounds like “A” ( nasal and localized)
Mnemonic for Chest X-Ray Interpretation (A-I) ( 2 a’s, 2f’s, 2g’s)
- Adequate/ Assessment of quality (Pier)
- Airway
- Bones and soft tissues
- Cardiac Size/valves
- Diaphragms
- Effusions/ Endotracheal tube/ EKG/ wires
- Fields and Fissures
- Foreign body
- Great Vessels
- Gastric Bubble
- Hilar masses
- Impression
adequate/ assesment of quality (Pier)
Position- AP/Lateral
Inspiration- should see 10-11 ribs
Exposure
Rotation
Airway
trachea midline, carina
bones and soft tissues
- osteopenia/osteoporosis
- fractures/ metastatic lesion
- subcutaneous emphysema
Cardiac size
normal= <50% of chest diameter on PA or < 60% on AP films
- heart shape, calcifications and prosthetic valves
Diaphragm
round/flat/free air
Fields and Fissures
infiltrates (interstitial or alveolar), masses, consolidation, air bronchogram, pneumothorax, vascular markings
Foreign body
piercing, bullet fragments, lines
Great Vessels
aortic size and shape
Hilar Masses
lymphadenopathy, widening (aortic dissection), mass
