Examination Of The Pulmonary Patient

Question 1

Examination of the Pulmonary Patient

Schamroth Sign

Answer 1

Question 2

Examination of the Pulmonary Patient

Normal respiratory rate of infants, children, and adults:

Answer 2

• Infants = 40 - 60
• Children = 18 - 24
• Normal adult RR =12-20

Question 3

Examination of the Pulmonary Patient

if you REALLY want lung disease…

Answer 3

Smoking is the greatest risk factor for developing pulmonary disease

Question 4

Examination of the Pulmonary Patient

What is orthopnea?

Answer 4

Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.

Question 5

Examination of the Pulmonary Patient

Chest wall shapes:

Answer 5

Question 6

Examination of the Pulmonary Patient

Eupnea:

Answer 6

In the human respiratory system, eupnea or eupnoea is normal, good, unlabored breathing, sometimes known as quiet breathing or resting respiratory rate. In eupnea, expiration employs only the elastic recoil of the lungs.

Question 7

Examination of the Pulmonary Patient

Kussmaul’s respirations:

Answer 7

• Deep, slow or rapid, gasping
• Common in diabetic ketoacidosis

Question 8

Examination of the Pulmonary Patient

Cheyne-Stokes respirations:

Answer 8

• End of life
• Progressively deeper, faster breathing alternating gradually with shallow, slower breathing.
• May indicate brain stem injury

Question 9

Examination of the Pulmonary Patient

Biot’s respirations:

Answer 9

• Irregular pattern of rate and depth with sudden, periodic episodes of apnea
• May indicate increased intracranial pressure

Question 10

Examination of the Pulmonary Patient

Central neurogenic hyperventilation​:

Answer 10

• Abnormal breathing patterns
• Deep, rapid respirations
• Often indicating increased intracranial pressure

Question 11

Examination of the Pulmonary Patient

Agonal respirations:​

Answer 11

• Abnormal breathing pattern
• Shallow, slow, or infrequent breathing
• Usually indicating brain anoxia

Question 12

Examination of the Pulmonary Patient

Apneustic respiration (apneusis):

Answer 12

• Abnormal breathing pattern
• Deep, gasping inspiration with pause at full inspiration followed by brief insufficient release
• Usually indicates brain injury (often of pons)

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Question 13

Examination of the Pulmonary Patient

Hemoptysis

Answer 13

Coughing blood

Question 14

Examination of the Pulmonary Patient

Dyspnea:

Answer 14

Dyspnea is unpleasant or uncomfortable breathing. It is experienced and described differently by patients depending on the cause.

Question 15

Examination of the Pulmonary Patient

Ventilatory Response Index (VRI):

Answer 15

→Ask pt to count to 15 in an 8 second time period and count how many breaths it takes

• 0 to 4 rating, score = number of breaths taken.

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Question 16

Examination of the Pulmonary Patient

subcutaneous emphysema:

Answer 16

air trapped under the skin

Question 17

Examination of the Pulmonary Patient

fremitus

Answer 17

Vibration produces by voice or secretions

Question 18

Examination of the Pulmonary Patient

Normal TRACHEAL sreath sound:

Answer 18

• Tubular
• (1:1)
• over the trachea

Question 19

Examination of the Pulmonary Patient

Normal BRONCHIAL breath sound:

Answer 19

• 1:2
• Near sternal angle

Question 20

Examination of the Pulmonary Patient

Normal BRONCHVESICULAR breath sound:

Answer 20

• 1:1
• Where mainstem bronchi branch to segmental bronchi

Question 21

Examination of the Pulmonary Patient

Normal VESICULAR breath sound:

Answer 21

• 3:1

Question 22

Examination of the Pulmonary Patient

Wet” or “coarse” crackles (aka RALES) are due to

Answer 22

fluid or secretions

Question 23

Examination of the Pulmonary Patient

“Dry” or “fine” crackles usually due to

Answer 23

sudden opening of closed airways

Question 24

Examination of the Pulmonary Patient

Discontinuous, bubbling or popping sound that can be associated with obstructive and restrictive dz:

Answer 24

CRACKLES

Question 25

Examination of the Pulmonary Patient

High pitched wheezes:

Answer 25

• Expiratory: indicative of airway obstruction (secretions or bronchospasm).
• Inspiratory: uncommon, more severe obstruction

Question 26

Examination of the Pulmonary Patient

Continuous, “musical”, or whistling sound usually heard during exhalation due to
bronchoconstriction or retrained secretions:

Answer 26

WHEEZES

Question 27

Examination of the Pulmonary Patient

Expiratory, high pitched wheezes may be indicative of

Answer 27

airway obstruction (secretions or bronchospasm)

Question 28

Examination of the Pulmonary Patient

Inspiratory, high pitched wheezes may be indicative of

Answer 28

(Uncommon) a more severe obstruction than when wheezes are expiratory

Question 29

Examination of the Pulmonary Patient

Low pitched wheezes (ronchi):

Answer 29

• Rhonchi are continuous low pitched, rattling lung sounds that often resemble snoring.
• Obstruction or secretions in larger airways are frequent causes of rhonchi.
• They can be heard in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis

Question 30

Examination of the Pulmonary Patient

Stridor:​

Answer 30

• Medical emergency
• Continuous very high pitched wheeze heard with inspiration and/or exhalation
• Usually indicates upper airway obstruction

Question 31

Examination of the Pulmonary Patient

Pleural Rub:

Answer 31

• Dry, crackling sound heard during inspiration and exhalation
• Visceral and parietal pleura rubbing together
• Best heard in the lower lungs

Question 32

Examination of the Pulmonary Patient

Egophony:

Answer 32

Increase voice transmission, vocal ‘E’sounds like ‘A’

Question 33

Examination of the Pulmonary Patient

Bronchophony:

Answer 33

• increased voice transmission when whispered
  
  • Repeat “99”

Question 34

Examination of the Pulmonary Patient

Whispered pectoriloquy:

Answer 34

• extreme bronchophony (increased voice transmition)
  
  • Say “one, two, three”

Question 35

Examination of the Pulmonary Patient

Mediate Percussion can be used to

Answer 35

• Evaluate tissue densities and indirectly measure diaphragmatic excursion
• Resonant: loud, low-pitched:
  – Hear over air-filled organs (lungs)
• Hyperresonant: very low pitched:
  – Heard over tissue with decreased density (diseased lungs/ emphysema)
• Tympanic: high pitched:
  – Hear over hollow organs (stomach, gas bubbles in abd)
• Dull: low amplitude medium to high pitch—increased tissue density or lungs w/decreased air
  – Heard over solid organs
• Flat: very dull sound, high pitch—very dense tissues: – Heard over muscle mass

Question 36

Examination of the Pulmonary Patient

Tachypnea:

Answer 36

rapid, shallow breathing (RR >24)

Question 37

Examination of the Pulmonary Patient

Bradypnea:

Answer 37

slow breathing (RR < 10)

Question 38

Examination of the Pulmonary Patient

heard over the trachea, ratio?

Answer 38

tracheal sound

1:1 with gap

Question 39

Examination of the Pulmonary Patient

Sound heard over the sternum or manubrium

Answer 39

Bronchial

1:2 with gap

Question 40

Examination of the Pulmonary Patient

Sound heard anteriorly at the 1st and 2nd ICS and posteriorly between the scapulae

Answer 40

bronchovesicular

1:1 continuos

Question 41

Examination of the Pulmonary Patient

Heard throughout lung periphery

Answer 41

vesicular

3:1 continuous