DSA- Lower Respiratory Tract Exam Flashcards
1
Q
Hypopnea
A
Decreased depth and rate of respiration
2
Q
Bradypnea
A
regular rhythm but slower than normal rate ( RR<14/min)
3
Q
Hyperpnea
A
increased depth and rate of respiration (exercise)
4
Q
Tachypnea
A
rapid breathing ( RR> 20-25/ min)
5
Q
Dyspnea
A
feeling short of breath
6
Q
Hypoxia
A
deficiency in amount of O2 reaching tissues
7
Q
Hypoxemia
A
oxygen deficiency in arterial blood
8
Q
Apnea
A
no breathing
9
Q
Atelectasis
A
collapse of lung tissue that affects the alveoli from normal O2 absorption
10
Q
Pleximeter Finger
A
hyperextended middle finger of non-dominated hand in percussion
11
Q
plexor finger
A
“tapping” finger, dominant hand , for percussion
12
Q
Landmarks of chest (11)
A
- 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
13
Q
Sternal Angle
A
Angle of Louis
- 2nd ribs join sternum
14
Q
Needle Thoracentesis
A
- decompression
- 2nd intercostal space, midclavicular line
15
Q
Chest tube Insertion
- location
A
- 4th and 5th intercostal space (anterior to midaxillary line)
- 5th intercostal space- inferior to nipple
16
Q
Neurovascular bundle
A
- runs along inferior margins of each rib
- chest tubes need to be placed OVER superior margin of rib to avoid bundle
17
Q
Pulse Oximetry
- reasons for bad waveform
A
- 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
18
Q
End Tidal CO2
A
- concentration of CO2 in exhaled air at end of respiration
- measures ventilation
Normal PETCO2= 35-40 mmHg
Normal PaCO2= 35-45 mmhG
19
Q
Incentive Spirometer (IS)
A
- 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
20
Q
Atelectasis
A
- loss of lung volume due to collapse of lung tissue (alveoli)
- can be seen post-surgery
Treatment: use IS
21
Q
Pulmonary Function Test (PFT)
A
- noninvasive
- show how well lungs are working
- diagnose certain lung disorders (obstructive vs Restrictive)
22
Q
Spirometry
A
- aka PFT
- measure lung function
- amount and speed of air inhaled and exhaled
- diagnose condition (obstructive vs restrictive)
23
Q
Accessory Muscle in Respiration( 6)
A
- Sternomastoids
- Scalenes
- Inspiratory intercostals
- expiratory intercoastals
- diaphragm
- external obliques
- expiratory abdominals
24
Q
Cyanosis
A
signs of hypoxia
- nail bed
- perioral
25
Tracheal Deviation seen in ( 4)
- pneumothorax (tension and nontension)
- Pleural effusion
- Atelectasis
- Mass
26
Clubbing
| - causes
- congenital heart disease
- interstitial lung disease
- bronchiectasis
- pulmonary fibrosis
- cystic fibrosis
- lung abscess
- malignancy (lung cancer)
- inflammatory bowel disease
27
Pectus Excavatum
- funnel chest
| - depression in lower portion in sternum
28
Pectus Carinatum
- pigeon chest
- sternum displaced anterior (increased AP diameter)
- adjacent costal cartilage are depressed
29
Barrel Chest
- increased AP diameter resembling barrel
| - COPD
30
Chronic Bronchitis
| - symptoms
- daily productive cough for more than 3 months
- blue bloater
symptoms
- overweight and cyanotic
- elevated hemoglobin
- peripheral edema
- Rhonchi and wheezing
31
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
32
Traumatic Flail Chest
- multiple rib fracture may result in paradoxical movements of thorax
- inspiration -> injured area caves inward
- expiration-> injured area moves outward
33
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)
34
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
35
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
36
Adventitious vs normal (4) breath sounds
Normal
- vesicular
- Bronchovesicular
- bronchial
- tracheal
Adventitious
- stridor
- wheezes (rhonchi- low pitched wheezes)
- crackles
37
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
38
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
39
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
40
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)
41
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
42
adequate/ assesment of quality (Pier)
Position- AP/Lateral
Inspiration- should see 10-11 ribs
Exposure
Rotation
43
Airway
trachea midline, carina
44
bones and soft tissues
- osteopenia/osteoporosis
- fractures/ metastatic lesion
- subcutaneous emphysema
45
Cardiac size
normal= <50% of chest diameter on PA or < 60% on AP films
| - heart shape, calcifications and prosthetic valves
46
Diaphragm
round/flat/free air
47
Fields and Fissures
infiltrates (interstitial or alveolar), masses, consolidation, air bronchogram, pneumothorax, vascular markings
48
Foreign body
piercing, bullet fragments, lines
49
Great Vessels
aortic size and shape
50
Hilar Masses
lymphadenopathy, widening (aortic dissection), mass
