H&P

Question 1

Immunizations that protect against respiratory diseases

ADULT (3)

Answer 1

pneumococcal
influenza
Tdap (pertussis)

Question 2

Immunizations that protect against respiratory diseases

CHILD (8)

Answer 2

DTaP
rotavirus
HIB
PCV
IPV
influenza
MMR
varicella

Question 3

Barrel chest (5)

Answer 3

ribs are more horizontal

spine kyphotic

sternal angle prominent

trachea posteriorly displaced

AP diameter is increased

Question 4

normal AP diameter to transverse diameter is

Answer 4

1:2

Question 5

Kyphosis

Answer 5

the spine is deviated posteriorly

Question 6

Scoliosis

Answer 6

the spine is deviated laterally

Question 7

Pectus carinatum

Answer 7

prominent sternal protrusion

aka “Pigeon chest”

Question 8

Pectus excavatum

Answer 8

indentation of the lower sternum above the xiphoid

aka “funnel chest”

Question 9

pursed lips might indicate

Answer 9

increased expiration

Question 10

flared nares indicate

Answer 10

air hunger

Question 11

clubbing of finger nails indicates

Answer 11

chronic hypoxemia

Question 12

Orthopnea

Answer 12

SOB that begins or increases while supine

– if only at night = paroxysmal nocturnal

Question 13

Platypnea

Answer 13

SOB increases in the upright position

Question 14

Hypopnea

Answer 14

abnormally shallow respirations

Question 15

Cheyne-stokes

Answer 15

varying periods of increasing depth interspersed with apnea

may occur during sleep, especially infants, but typically in seriously ill patients – brain damage at the cerebral level or with drug-caused respiratory compromise

Question 16

Kussmaul respiration

Answer 16

rapid, deep, labored breathing

severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is a form of hyperventilation

Question 17

causes of Rate increases

Answer 17

metabolic acidosis, CNS lesions of the pons, Anxiety, ASA poisoning, hypoxemia, pain, exercise

Question 18

causes of Rate decreases

Answer 18

metabolic alkalosis, CNS lesions of the cerebrum, Myasthenia gravis, narcotic overdoses, extreme obesity, excellent fitness

Question 19

chest wall expansion is obstructed to inspiration

Answer 19

Retractions

can be superior or inferior

Question 20

superior retraction

Answer 20

in upper respiratory

stridor, chest wall caves at sternum and supra sternal notch

Question 21

retraction on one of bronchi

Answer 21

commonly in right

unilateral retraction

no involvement of suprasternal notch

Question 22

Crepitus

Answer 22

PALPATE

“rice krispies”

indicates air in the subcutaneous tissue (from a rupture somewhere in the respiratory system or infection with gas-producing organism)

Question 23

Pleural friction rub

Answer 23

PALPATE

coarse, grating vibration associated with inspiration (inflammation of the pleural surfaces)

Question 24

tactile fremitus

Answer 24

vibration of the chest wall

due to speech

Question 25

tactile fremitus decreased when

Answer 25

Excess air in the lungs, emphysema, pleural thickening or effusion, bronchial obstruction

Question 26

tactile fremitus

Answer 26

Lung consolidation, heavy bronchial secretions, compressed lung, tumor

Question 27

tracheal deviation may be caused by

Answer 27

atelectasis, thyroid enlargement, pleural fibrosis, pleural infusion, tension pneumothorax, tumor