Dyspnea and the Abnormal Pulmonary Exam

Question 1

How do patients perceive dyspnea?

Answer 1

They feel as though they have to work harder to breath normally

Question 2

What does the degree of effort result from?

Answer 2

The perceived need given the feedback from chemoreceptors mechanoreceptors

Question 3

Why do patients Become Dyspneic?

Answer 3

Cardiopulmonary system malfunction

Question 4

What is the purpose of the Cardiopulmonary system?

Answer 4

Deliver O2, remove CO2, and control pH

Question 5

What does the Cardiopulmonary system require?

Answer 5

Adequate functions Hgb

Question 6

What are 3 things can alter Hgb?

Answer 6

Anemia, CO, and CN

Question 7

Where are both CO and CN present?

Answer 7

In smoke that we can inhale

Question 8

What is a 4th thing that can alter Hgb that we aren’t talking about as much?

Answer 8

Methemoglobinemia

Question 9

Besides adequate Hgb, what else does this Cardiopulmonary system require?

Answer 9

Adequate Ventilation and Perfusion of the lungs with a limitation of Dead Space and Shunting

Question 10

What are 7 things that are a part of the upper airway?

Answer 10

Nose, mouth, pharynx, epiglottis, larynx, trachea.

PLEMNT

Question 11

What kind of sound is stridor? What airway is it associated with?

Answer 11

Inspiratory; upper airway

Question 12

What are 2 things that are a part of the lower airway?

Answer 12

Bronchus and bronchioles

Question 13

What kind of sound is wheezing? What airway is it associated with?

Answer 13

Expiratory sound; lower airway

Question 14

What is one of the most common problems that can occur in the alveoli? What is a clue to confirm this?

Answer 14

Consolidation; the sounds that consolidation can produce

Question 15

What are 3 things that can cause consolidation in the alveoli?

Answer 15

Blood, pus, and water

Question 16

What are 7 sounds in the alveoli that can be due to consolidation?

Answer 16

Dullness to percussion and tactile fremitus, tracheal breath sounds, Bronchophony, egophony, whispered pectroiloquy, crackles

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Question 17

What can consolidation result in?

Answer 17

Shunt

Question 18

Emphysema results in what?

Answer 18

Destruction of Functional Lung Tissue with an increase in Dead Space

Question 19

What does Interstitial Lung Disease sound like?

Answer 19

Velcro rales

Question 20

What is our primary finding in Pulmonary Vascular to rule in or out for dyspnea?

Answer 20

Number results in increased dead space

Question 21

What 3 findings in the Cardiovascular System could rule it in or out for dyspnea?

Answer 21

Ischemia presenting as effort dyspnea not clear angina, orthopnea and paroxysmal nocturnal dyspnea (PND)

Question 22

What are 3 things in the pleura that could be causing dyspnea?

Answer 22

Pneumothorax, Plural effusion, Plural fibrosis

Question 23

What are 3 possible indicators that could confirm our pleura findings?

Answer 23

Tympani or Dullness and loss of breath sounds

Question 24

What is a condition in the pericardium that could cause dyspnea?

Answer 24

Pericardial tamponade

Question 25

Could the chest wall or neuromuscular system cause dyspnea?

Answer 25

Yes

Question 26

What are 4 things that could be causing dyspnea when the patient has clear lungs on auscultation?

Answer 26

Idiopathic Pulmonary Hypertension, Pulmonary Embolism, Cardiac Tamponade, Anemia or non-functional hemoglobin CN CO or inability to use Oxygen

PICANI

Question 27

What is the first question we ask ourselves for dyspnea patients?

Answer 27

Acute or chronic?

Question 28

What is the second question we want to ask for dyspnea patients?

Answer 28

Do you have a fever?

Question 29

What is the third question we ask for dyspnea patients? What else do we need to determine in relation to it?

Answer 29

Do you have chest pain?

Is it pleuritic or non-pleuritic?

Question 30

What are 5 things we look for on the PE for this patient?

Answer 30

Stridor or Wheezing, Tympanic or Dullness and lack of breath sounds, Sounds of Consolidation, Velcro crackles, Clear lungs