History and Physical Exam Flashcards
What is the thorax
Ribs
costal cartilage
sternum
thoracic vertebrae
What are the muscles of the chest
diaphragm
external intercostals
scalenes
What is the visceral pleura
outer layer that lays on lung surface
what is the parietal pleura
outer layer that lines inside of thoracic cavity
What is parenchyma
lung tissue
How many lobes does the right lung have
3 lobes
How many lobes does the left lung have
2 lobes
What is the mediastinum
area between the lungs
What is in the upper air conduction tract
nasopharynx
oropharynx
larynx
What is in the lower air conduction tract
trachea
primary bronchi
bronchial tree bifurcation (bronchioles, alveoli)
What is the respiratory tract
smallest bronchioles and alveoli
location where gas exchange occurs
What does the diaphragm do
provides force for inspiration
minor component in expiration
What is the physiology of the lungs
Inhaled air is hydrated
air is heated
oxygen and CO2 diffuse through capillary walls
mucous secreting goblet cells and cilia trap foreign matter
What is inspiration in normal respiration
controlled by diapraghm
active process
What is expiration in normal respiration
passive
What volume of air/breath changes in thorax with quiet breathing
500 ml
What is Minute volume
respiratory rate X tidal volume
What is dyspnea
subjective description of difficult, labored, or uncomfortable breathing
Is dyspnea a diagnosis
No it is a significant symptom of another diagnosis
What is orthopnea
Dyspnea in a recumbent position
What is orthopnea the result of
pulmonary edema
volume overload
COPD
How document orthopnea
# of pillows used to feel comfortable breathing progression is important to chart
What is Paroxysmal Nocturnal Dyspnea
Orthopnea that awakens the patent from sleep
- the need to sit up abruptly to breathe
- extremely frightening
- usually due to left-sided heart failure “cardiac asthma”
What is wheezing
musical respiratory sounds that may be audible to patient and others
What can cause wheezing
secretions
tissue inflammation
foreign body
What is tachypnea
rapid breathing
may be associated with dyspnea
What is bradypnea
slow breathing
What is platypnea
Dyspnea in the upright position
What is hyperpnea
hyperventilation
- minute ventilation in excess of metabolic demand
What is capopedal spasm
Muscle cramps in hands and feet
associated with hyperventilation and hypocalcemia
How to treat capopedal spasm
slow respiratory rate to uncramp hands
What is tactile fremitus
palpable vibrations transmitted through the bronchopulmonary tree to the chest wall
What is bronchophony/egophony
phenomena of increased volume and clarity of sounds transmitted through solid or liquid opposed to air
What is chest wall expansion
normal, symmetrical upward and outward movement of the ribs and chest wall during inspiration
What is diaphragmatic excursion
movement of diaphragm from its high resting position to lower, flattened position when it is flexed in inspiration
What is normal diaphragmatic excursion
5 - 6 cm
What is hypoxia
condition of inadequate oxygenation of blood
What is cyanosis
bluish discoloration of skin secondary to hypoxia or inadequate peripheral circulation
What is hemoglobin
component of red blood cell that binds oxygen molecules
What is carboxyhemoglobin
stable complex of CO and hemoglobin that forms in RBC
hinders ability for O2 to bind to hemoglobin
What does pulse oximetry do
checks oxygen level but can’t detect carboxyhemoglobin
What are normal breathing sounds
Vesicular
bronchovesicular
bronchial
What is vesicular breathing sounds
soft
low
heard through inspiration and partway into expiration
What is bronchovesicular breathing sounds
Louder
heard on inspiration and expiration and sometimes separated by interval
What is bronchial breathing sounds
louder
higher pitch
expiratory sounds longer than inspiratory sounds
What are adventitious breath sounds
Crackles (rales)
Wheezing
Rhonchi
Explain crackles
intermittent non-musical brief higher pitched occur first in inspiration and later in both fine or coarse sound
Explain wheezing
high pitched with musical quality
begins in expiratory but as severity increases can be both
explain rhonchi
low pitched
sound like snoring
suggest secretions in airways
can be one or both
What is aspiration
breathing in things that don’t belong in lungs
What is debilitation
alcohol misuse
age
immunosupression
What are pulmonary risk factors
Smoking Aspiration Debilitation Chronic disease pulmonary disease
What are some chronic diseases
DM
renal failure
CHF
What are some pulmonary diseases
COPD - emphysema
chronic bronchitis
asthma
Cystic Fibrosis
What is the pulmonary exam
Inspection Palpation Ascultation Percussion Special tests
What is crepitus in trauma
grating or crunchiness with fracture
What does increased fremitus indicate
consolidated fluid between lung and chest wall
What does decreased fremitus indicate
air between lung and chest wall
What is flatness
soft intensity
high pitch
short duration
What is Dullness
medium intensity
medium pitch
medium duration
What is resonance
loud intensity
low pitch
long duration
* normal lung
What is hyperresonance
very loud intensity
lower pitch
longer duration
What is tympany
loud intensity
high pitch
What are the special tests
Bronchophony Egophony Whispered pectoriloquy Chest wall expansion diaphragmatic excursion
What is the most common complaint presented at clinic
cough
What is a cough
mechanical reflex involving a deep inspiration
Increases lung volume
sudden opening of closed glottis
What is an acute cough
<3 weeks
What is a subacute cough
3-8 weeks
What is a chronic cough
> 8 weeks
What percentage of coughs have more than 1 cause
25%
Common causes of acute cough
URI (viral) LRTI exacerbation of COPD allergic rhinitis irritants from rhinitis irritants to bronchial tree
common causes of chronic cough
COPD chronic sinus drainage asthma GERD meds psychiatric
What % of smokers have chronic cough
25%
What can trigger cough, asthma and/or wheezing
Irritant - dust Allergens - pollen Toxic substances - gastric acid inflammation - asthma cold air smoke change humidity or temp infection
What is hemoptysis
expectoration of blood from the respiratory tract below the level of the larynx
Causes of hemoptysis
bronchitis pneumonia TB CA PE CHF HTN trauma
