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Exam 6 Flashcards

1
Q

What are the aspects of the lung exam?

A
  1. Percussion
  2. Vibration transmission (auscultation, whispered pectoriloquy), fremitus
  3. Extra sounds (wheezing, crackles, rhonci, stridor)
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2
Q

What are the two steps of auscultation?

A
  1. Breath sound intensity (normal, increase, decrease)

2. Extra sounds (crackles, wheezing, stridor, rhonci)

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3
Q

What are classic radiographic findings of acute lobar pneumonia?

A
  1. Consolidation
  2. Air bronchograms
  3. Silhouette sign (don’t see left heart border because alveoli and heart are both fluid filled)
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4
Q

What is seen on histology in acute lobar pneumonia?

A

Consolidation

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5
Q

What sound would you hear in acute lobar pneumonia and why?

A

Increased bronchial breath sounds

Alveoli are full of puss, there is less muffling, breath sounds are louder than typically heard over the chest wall

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6
Q

Breath sounds originate in the ___ where turbulence induces vibrations.

A

Large airway

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7
Q

What are bronchial breath sounds?

A

Normal sounds heard over the tracheobronchial tree; louder, harsher, higher pitch, short silence between inspiration and expiration, expiration lasts longer

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8
Q

What are vesicular breath sounds?

A

Normal sounds heard over the lung tissue; soft and low pitched, heard through inspiration, continue without pause through expiration, fade away 1/3 of the way through expiration

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9
Q

What other sounds might be heard in acute lobar pneumonia?

A

Crackles, egophany

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10
Q

Describe the general examination of the patient with lobar pneumonia.

A

Acutely ill, toxic

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11
Q

Describe the resonance to percussion of the patient with lobar pneumonia?

A

+/- dullness over consolidation

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12
Q

Describe the breath sounds in the patient with lobar pneumonia.

A

Bronchial breathing

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13
Q

Describe the adventitious sounds in the patient with lobar pneumonia.

A

Crackles, pleural rub

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14
Q

Describe the classic CXR for COPD.

A
  1. Hyperinflation
  2. Flat diaphragm
  3. Increased retrosternal airspace
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15
Q

Describe the classic PFT findings for COPD.

A
  1. Obstruction with minimal BDR
  2. Hyperinflation/gas trapping
  3. Low DLCO
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16
Q

What physical exam finding is most likely in the patient with COPD?

A

Prolonged expiration

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17
Q

Describe the general examination of the patient with COPD.

A

Tachypneic, +/- hypoxemia, +/- exercise desaturation, pink puffer or blue bloater, NO clubbing

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18
Q

Describe the resonance to percussion in the patient with COPD.

A

Hyperresonant

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19
Q

Describe the breath sounds in the patient with COPD.

A

Decreased to absent/prolonged expiration

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20
Q

Describe the adventitious sounds in the patient with COPD.

A

Wheezing, rhonci

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21
Q

What are the classic CXR findings in a patient with ILD?

A
  1. Small volume

2. Reticulonodular opacities

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22
Q

Describe the general examination of the patient with ILD.

A

Use of accessory muscles of respiration, cyanosis, +/- clubbing, +/- hypoxemia, +/- exercise desaturation

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23
Q

Describe the resonance to percussion in the patient with ILD.

A

+/- decreased

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24
Q

Describe the breath sounds in the patient with ILD.

A

Harsh, coarse

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25
Describe the adventitious sounds in the patient with ILD.
Crackles (dry, cellophane, velcro)
26
Describe the general examination of the patient with PT.
Asymptomatic to dyspneic
27
Describe the resonance to percussion in the patient with PT.
Hyperresonant
28
Describe the breath sounds in the patient with PT.
Absent
29
Describe the adventitious sounds in the patient with PT.
None
30
What is seen on CXR in PT?
Lack of lung markings
31
What is seen on CXR in pleural effusion?
1. Blutning of the angle 2. Meniscus sign 3. White out
32
Describe the general examination of the patient with pleural effusion.
Asymptomatic to dyspneic
33
Describe the resonance to percussion in the patient with pleural effusion.
Dull
34
Describe the breath sounds in the patient with pleural effusion.
Absent or decreased
35
Describe the adventitious sounds in the patient with pleural effusion.
Egophony
36
Describe the general examination of the patient with asthma.
Dyspneic
37
Describe the resonance to percussion in the patient with asthma.
Normal to hyperresonant
38
Describe the breath sounds in the patient with asthma.
Prolonged expiration
39
Describe the adventitious sounds in the patient with pleural asthma.
Wheezing
40
What is the classic cause of wheezing?
Bronchospasm (asthma/COPD)
41
Which lung diseases tend to have crackles?
ILD, pulmonary edema, also lobar pneumonia
42
Which lung diseases tend to have egophony?
Lobar pneumonia | Pleural effusion
43
Which lung diseases are hyperresonant to percussion?
Pneumothorax | COPD and asthma can be
44
Which lung diseases are dull to percusion?
Lobar pneumonia, atelectasis, pleural effusion
45
Which lung diseases tend to have decreased breath sounds and fremitus/pectoriloquy?
PT, atelectasis, pleural effusions
46
What are causes of late inspiratory crackles?
ILD, early heart failure
47
What are causes of early inspiratory crackles?
Chronic bronchitis, asthma
48
What are causes of midinspiratory and expiratory crackles?
Bronchiectasis (not specific)
49
What are causes of wheezes?
Asthma, chronic bronchitis, COPD, heart failure
50
What is stridor?
A wheeze that is entirely/predominantly inspiratory
51
What does stridor indicate?
Partial obstruction of larynx or trachea
52
When will the trachea be shifted toward the involved side of a problem?
Maybe in atelectasis
53
When will the trachea be shift opposite the involved side of a problem?
Pleural effusion, PT
54
How do you differentiate normal bronchial and vesicular breath sounds?
Bronchial: hollow, clear in both phases Vesicular: inspiration and early expiration only
55
Key features of crackles (rales)
Sound like crackles
56
Key features of rhonic
Sounds like snoring
57
Key features of wheezing
Sounds like a dog whining/sighing
58
Key features of stridor
Sounds whimpering, high pitched
59
Key features of pleural rub
Sounds like rubbing, sitting on a leather car seat
60
Key features of abnormal bronchial breathing
Both phases of respiratory cycle, sounds slower/more strained
61
What are the parts of the eFAST exam?
1. RUQ (Morison's pouch) 2. LUQ (splenorenal recess) 3. Sub-xiphoid cardiac window 4. Suprapubic window 5. Thorax (R&L)
62
What is the most sensitive view in eFAST?
RUQ
63
What is seen in the sub-xihpoid cardiac window?
Liver at the top 4 chambers of the heart Pericardium (can be fluid filled)
64
What is seen in the RUQ view?
``` Lung (L) Liver (upper middle) Diaphragm (bottom) Right kidney (R) Morison's pouch - between liver and kidney ```
65
What is seen in the LUQ view?
``` Lung (bottom left) Diaphragm (bottom) Spleen (upper left) Left kidney (R) Splenorenal recess (between spleen and kidney) ```
66
What is seen in the suprapubic window?
Bladder/uterus (female) | Bladder/prostate (male)
67
What is the potential space in females in the suprapubic window?
Pouch of douglas (posterior to uterus)
68
What is the potential space in males in the suprapubic window?
Retrovesicular pouch (between bladder and rectum)
69
What is seen in a normal thorax view?
Pleural line between 2 ribs with ants marching/shimmering appearance
70
What is a negative eFAST in M mode?
Sea-shore line (difference between pleura and lung)
71
What is a positive eFAST in the thorax?
Absence of lung slide (no ants marching) and barcode sign
72
What bloodborne pathogens do we worry about in the hospital?
HIV, HepB, HepC
73
Which factors increase risk after HIV exposure?
1. More blood (visible contamination, direct into vein/artery, deep injury) 2. Hollow bore needle 3. Viral load of patient
74
What are standard precautions for routine patient care?
Wear gloves to touch blood, body fluids except sweat, non-intact skin, mucus membranes Wash hands before and after
75
When should eye protection or a face shield be worn?
OR, ED, suctioning, etc.
76
When do we use soap and water rather than alcohol gel?
C. diff.
77
What is worn in airborne precautions?
Hand hygiene, N-95
78
What is worn in contact precautions?
Hand hygiene, gloves, gown
79
What is worn in droplet precautions?
Hand hygiene, mask, gloves, gown
80
When the problem is coagulation factors, where is bleeding seen?
Joints
81
When the problem is platelets, where is bleeding seen?
Mucosal tissue
82
Spleen palpable to umbilicus is suggestive of ___ pathology.
Hematologic
83
What are the nodes in the axilla/arm?
ALPCA: ``` Anterior pectoral Lateral Posterior Central Apical ``` Also epitrochlear

PCM2 (16 decks)

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