General Diagnosis 3 Flashcards
deformities of thorax
barrel chest- COPD, cystic fibrosis pectus excavatum (funnel chest) pectus carinatum (pigeon chest)
tachypnea
rapid, shallow breathing
bradypnea
slow breathing
biot’s breathing
characterized by groups of quick, shallow inspriations followed by irregular periods of apnea
cheyne stokes respiration
breathing pattern characterized by alternating periods of apnea and hyperpnea
respiratory acidosis
kussmauls’s
breathing is first rapid and shallow but as metabolic acidosis worsens
breathing gradually becomes deep, slow, labored and gasping
pitted nails
unguinal indentations (psoriasis)
spinter hemorrhage
subacute bacterial endocarditis
beau’s lines
transverse ridging associated with acute severe disease
paronychia
inflammation of mail fold near cuticle
clubbing
nail base has an angle >180
hypoxia(early), COPD (late)
koionychia
spoon nail
iron deficiency anemia
respiratory exursion
place hands over posteiror ribs and ahve patient stake keep greaths
tactile fremitus
palpable vibration, say 99
increase with fluid (pneumonia)
decreased with air ( emphysema, penumothorax)
decreased with atelectasis and pleuisy because sound barrier is created
resonant
normal over lungs
hyperresonant
increased air in chest (emphysema, pneumothorax)
dull
increased density (pneumonia, atelectasis)
diaphragmatic excursion
go from resonant to dull
have patient breathe in and hold
measure distance between bottom lung fields
breath sounds
tracheal- inspiration=expiration, over trachea
bronchial- expiration longer than inspiration, over manubrium
bronchovesicular- inspiration =expiration, between 1st and 2nd ribs anteriorly, between scapulae posteriorly
vesicular- inspiration longer than expiration, remaining lung field
rales
small clicking, bubbling, or rattling sounds in lung
moist, dry, fine, coarse (bronchitis)
rhonchi
resembles snoring
when air is blocked or becomes rough through large ariways (bronchiectasis)
wheezes
high pitched sounds
asthma in young people
emphysema in old people
stridor
wheeze like sound heard upon inspiration
usually blockage of airflow
croup
bronchophony
if clear, distinct sounds are heard as the patietns says 99, consolidation is present
egophony
if you hear aaa as patient says eee, consolidation is present
whispered pectoriloquy
if words 1,2,3 are heard clearly and distinctly, consolidation is present
conditions that have resonant sounds
asthma
bronchiectasis
bronchitis
conditions that have dull sounds
atelectasis
pleurisy
pneumonia
conditions that have hyperresonant sounds
emphysema
pneumothorax
fremitus decreased in what conditions?
asthma atelectasis emphysema pleurisy pneumothorax
fremitus normal in what conditions?
bronchiectasis
bronchitis
fremitus increase in what condition?
pneumonia
breath sound is wheezing in what conditions
asthma
emphysema
breath sound is absent/decreased in what conditions?
atelectasis
decrased
lobar pneumonia
consolidation of lung
rusty brown sputum for around 10 days and a fever
percussion is dull, rales, increased tactile fremitius
silhouette sign, air bronchogram
friedlander’s pneumonia
currant red jeely sputum and caused by klebsiella pneumonia
seen with old age of immune compromised hosts, alcoholics
pneumocystic carinii
caused by yeast/fungus
MC seen in AIDS, pregnancy
cytomegalovirus
caused by CMV, MC AIDS
tuberculossi
mycobacterium tuberculosis
presents with low-grade fever, night sweats, productive cough (yellow/green sputum)
small white lesions (ghon lesions)
positive tine test/mantoux test, purified protein derivative
most definitive test for diagnosis is a sputum culture
pleurisy
inflammation of pleura, producing exudative pleural effusion stabbing chest pain worse with breathing dry, non productive cough decreased respiratory excursion decreased tactile fremitus dull percussion friction rub is present positive shepelmann's test
pneumothorax
ruptured lung cauing air to become trapped in a pleural space
decreased chest expansion
decreased tactile fremitus
hyperresonant on percussion
decreased breath sounds
tracheal deviation away from bad lung
can occur in young, preiously healthy individuals
atelectasis
collapse of lung that is usually result of bronchial bostruction due to a mucous plug presents ith decreased tactile fremitus dull on percussion decreased chest expansion decreased/absent breath sounds
bronchiectasis
irreversible focal bronchial dilation that presents with a chronic, productive cough
COPD
long term cough with mucus
SOB, wheezing
cigarrette smoking main cause
asthma
bronchospasm
Type I hypersensitivity reaction triggered by airborned allergens
tachycardia, tachypnea, decreased tactile fremitus, wheezing
eosinophils and IgE rise
labs: curshmann’s spirals, charcot laden cyrstals (in sputum
emphysema
destruction of elastic pulmonary CT results in permanent dilation of alveoli air sacs deficiency of alpha I antitrypsin decreased tactile fremitus hyperresonant on percussion decreased breath sounds wheezing
bronchogenic carcinoma
primary malignant lung tumor that starts in area of bronchus
long term history of smoking
patient presents with non productive cough, more than 30 days, afebrile, dyspnea, weight loss
costochondritis
inflammation of cartilage connection between ribs and sternum
physical activity causes it, worse with eercise
pain increased wile taking deep breath
palpable tenderness at 3rd, 4th, 5th costosternal articulation
can be chronic
herpes zoster
shingles
painful rash along a dermatome
involves DRG, can involved CN (V MC)
sarcoidosis
disease inwhich abnormal collections fo inflamatory cells (granulomas) form as nodules
most often appear in the lungs or lymph nodes
MC seen in african descent in US
hodgkin’s
pain after alcohol
cancer of lymphatic system, can spread to spleen
caucasian males
fever, night sweats, weight loss, intense puritis, enlarged spleen
biopsy
cystic fibrosis
COPD chronic, progressive, frequently fatal genetic disease of body's mucus glands produce/secrete sweat, mucus lots of salt in sweat pancreatic insufficiency meconium ileus
jugular venous pulsations
measures pressure of right side of heart
can be made more proncounced when CHF is present by applying pressure to liver (hepatojugular reflex
pulsus magnus
bounding
increased CO
exercise, anxiety, fever, hyperthyroidism
pulsus parvus
weak/thready, decreased stroke volume, hypovolemia, aortic stenosis CHF
pulsus alternans
alternates in amplitude, left ventricular filure
pulsus bisferiens
2 strong systolic peaks separated by mid systolic dip (best felt at carotid artery)
aortic regurgitation, aortic stenosis
pulsus paradoxus
decreased amplitude on inspiration, increased with expiration COPD bronchial asthma emphysema pericardial effusion
water hammer pulse
jerky pulse that is rrapidly increasing and then collapsing because of aortic insufficiency
thrills
vibration produced by turbulent blood flow within the heart (murmurs)
