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Z A H&P III > History and Physical Exam > Flashcards

History and Physical Exam Flashcards

1
Q

What is the thorax

A

Ribs
costal cartilage
sternum
thoracic vertebrae

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2
Q

What are the muscles of the chest

A

diaphragm
external intercostals
scalenes

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3
Q

What is the visceral pleura

A

outer layer that lays on lung surface

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4
Q

what is the parietal pleura

A

outer layer that lines inside of thoracic cavity

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5
Q

What is parenchyma

A

lung tissue

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6
Q

How many lobes does the right lung have

A

3 lobes

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7
Q

How many lobes does the left lung have

A

2 lobes

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8
Q

What is the mediastinum

A

area between the lungs

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9
Q

What is in the upper air conduction tract

A

nasopharynx
oropharynx
larynx

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10
Q

What is in the lower air conduction tract

A

trachea
primary bronchi
bronchial tree bifurcation (bronchioles, alveoli)

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11
Q

What is the respiratory tract

A

smallest bronchioles and alveoli

location where gas exchange occurs

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12
Q

What does the diaphragm do

A

provides force for inspiration

minor component in expiration

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13
Q

What is the physiology of the lungs

A

Inhaled air is hydrated
air is heated
oxygen and CO2 diffuse through capillary walls
mucous secreting goblet cells and cilia trap foreign matter

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14
Q

What is inspiration in normal respiration

A

controlled by diapraghm

active process

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15
Q

What is expiration in normal respiration

A

passive

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16
Q

What volume of air/breath changes in thorax with quiet breathing

A

500 ml

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17
Q

What is Minute volume

A

respiratory rate X tidal volume

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18
Q

What is dyspnea

A

subjective description of difficult, labored, or uncomfortable breathing

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19
Q

Is dyspnea a diagnosis

A

No it is a significant symptom of another diagnosis

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20
Q

What is orthopnea

A

Dyspnea in a recumbent position

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21
Q

What is orthopnea the result of

A

pulmonary edema
volume overload
COPD

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22
Q

How document orthopnea

A 
# of pillows used to feel comfortable breathing
progression is important to chart
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23
Q

What is Paroxysmal Nocturnal Dyspnea

A

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”
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24
Q

What is wheezing

A

musical respiratory sounds that may be audible to patient and others

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25
Q

What can cause wheezing

A

secretions
tissue inflammation
foreign body

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26
Q

What is tachypnea

A

rapid breathing

may be associated with dyspnea

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27
Q

What is bradypnea

A

slow breathing

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28
Q

What is platypnea

A

Dyspnea in the upright position

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29
Q

What is hyperpnea

A

hyperventilation

- minute ventilation in excess of metabolic demand

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30
Q

What is capopedal spasm

A

Muscle cramps in hands and feet

associated with hyperventilation and hypocalcemia

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31
Q

How to treat capopedal spasm

A

slow respiratory rate to uncramp hands

32
Q

What is tactile fremitus

A

palpable vibrations transmitted through the bronchopulmonary tree to the chest wall

33
Q

What is bronchophony/egophony

A

phenomena of increased volume and clarity of sounds transmitted through solid or liquid opposed to air

34
Q

What is chest wall expansion

A

normal, symmetrical upward and outward movement of the ribs and chest wall during inspiration

35
Q

What is diaphragmatic excursion

A

movement of diaphragm from its high resting position to lower, flattened position when it is flexed in inspiration

36
Q

What is normal diaphragmatic excursion

A

5 - 6 cm

37
Q

What is hypoxia

A

condition of inadequate oxygenation of blood

38
Q

What is cyanosis

A

bluish discoloration of skin secondary to hypoxia or inadequate peripheral circulation

39
Q

What is hemoglobin

A

component of red blood cell that binds oxygen molecules

40
Q

What is carboxyhemoglobin

A

stable complex of CO and hemoglobin that forms in RBC

hinders ability for O2 to bind to hemoglobin

41
Q

What does pulse oximetry do

A

checks oxygen level but can’t detect carboxyhemoglobin

42
Q

What are normal breathing sounds

A

Vesicular
bronchovesicular
bronchial

43
Q

What is vesicular breathing sounds

A

soft
low
heard through inspiration and partway into expiration

44
Q

What is bronchovesicular breathing sounds

A

Louder

heard on inspiration and expiration and sometimes separated by interval

45
Q

What is bronchial breathing sounds

A

louder
higher pitch
expiratory sounds longer than inspiratory sounds

46
Q

What are adventitious breath sounds

A

Crackles (rales)
Wheezing
Rhonchi

47
Q

Explain crackles

A 
intermittent
non-musical
brief
higher pitched
occur first in inspiration and later in both
fine or coarse sound
48
Q

Explain wheezing

A

high pitched with musical quality

begins in expiratory but as severity increases can be both

49
Q

explain rhonchi

A

low pitched
sound like snoring
suggest secretions in airways
can be one or both

50
Q

What is aspiration

A

breathing in things that don’t belong in lungs

51
Q

What is debilitation

A

alcohol misuse
age
immunosupression

52
Q

What are pulmonary risk factors

A 
Smoking
Aspiration
Debilitation
Chronic disease
pulmonary disease
53
Q

What are some chronic diseases

A

DM
renal failure
CHF

54
Q

What are some pulmonary diseases

A

COPD - emphysema
chronic bronchitis
asthma
Cystic Fibrosis

55
Q

What is the pulmonary exam

A 
Inspection
Palpation
Ascultation
Percussion
Special tests
56
Q

What is crepitus in trauma

A

grating or crunchiness with fracture

57
Q

What does increased fremitus indicate

A

consolidated fluid between lung and chest wall

58
Q

What does decreased fremitus indicate

A

air between lung and chest wall

59
Q

What is flatness

A

soft intensity
high pitch
short duration

60
Q

What is Dullness

A

medium intensity
medium pitch
medium duration

61
Q

What is resonance

A

loud intensity
low pitch
long duration
* normal lung

62
Q

What is hyperresonance

A

very loud intensity
lower pitch
longer duration

63
Q

What is tympany

A

loud intensity

high pitch

64
Q

What are the special tests

A 
Bronchophony
Egophony
Whispered pectoriloquy
Chest wall expansion
diaphragmatic excursion
65
Q

What is the most common complaint presented at clinic

A

cough

66
Q

What is a cough

A

mechanical reflex involving a deep inspiration
Increases lung volume
sudden opening of closed glottis

67
Q

What is an acute cough

A

<3 weeks

68
Q

What is a subacute cough

A

3-8 weeks

69
Q

What is a chronic cough

A

> 8 weeks

70
Q

What percentage of coughs have more than 1 cause

A

25%

71
Q

Common causes of acute cough

A 
URI (viral)
LRTI
exacerbation of COPD
allergic rhinitis
irritants from rhinitis
irritants to bronchial tree
72
Q

common causes of chronic cough

A 
COPD
chronic sinus drainage
asthma
GERD
meds
psychiatric
73
Q

What % of smokers have chronic cough

A

25%

74
Q

What can trigger cough, asthma and/or wheezing

A 
Irritant - dust
Allergens - pollen
Toxic substances - gastric acid
inflammation - asthma
cold air
smoke
change humidity or temp
infection
75
Q

What is hemoptysis

A

expectoration of blood from the respiratory tract below the level of the larynx

76
Q

Causes of hemoptysis

A 
bronchitis
pneumonia
TB
CA
PE
CHF
HTN
trauma

Z A H&P III (6 decks)

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