History and Physical Exam of the Pulmonary System Flashcards

Question

Bronchial

Answer 1

Louder and higher in pitch, with short silence between inspiratory adn expiratory sounds Expiratory sounds last longer than inspiratory sounds

Answer 2

Vesicular Bronchovesicular Bronchial \*Tracheal

Answer 3

Wheezing Rales/Crackles Rhonchi

Answer 4

Intermittent, non-musical, brief sounds Usually higher pitched and brief Usually occur first in inspiration adn later in both inspiration and expiration Described as fine or coarse

Answer 5

Relatively low pitched nad may be described as snoring Suggestive of secretions in larger airways May be inspiratory or expiratory (or both)

Answer 6

Relatively high pitched with a musical quality Usually begin as an expiratory but with increasing severity can span entire respiratory cycle

Answer 7

Identify alarming symptoms such as associated chest pain. Acute or chronic? ROS: Pay particular attention to upper and lower respiratory tract, CV, and GI Ask about smoking, environmental, and occupational exposures Review current and prior medications and medication and environmental allergies. PMSoHx including previous history of similar complaints, asthma, sinusitis, recent respiratory infections, TB exposure, CAD, and esophageal disease. Family history of pulmonary disease like asthma, COPD and any exposure to second hand smoke.

Answer 8

**SMOKING!** **Aspiration –** stroke, NG tube, trouble protecting airway (i.e. alcoholic), dysphagia. **Debilitation –** alcohol misuse, extremes of age, immunosupression. **Chronic disease –** DM, renal failure, CHF, neuromuscular disorders like Guillian Barre’ or Myasthenia Gravis. **Pulmonary diseases –** Emphysema, Chronic Bronchitis, Asthma, Cystic Fibrosis, Hereditary A1 Antitrypsin deficiency.

Answer 9

Observe the shape of the chest and the movement of the chest wall Asymmetry or obvious deformities Retractions in ICS Inspect skin for cyanosis Nails for cyanosis or clubbing

Answer 10

Barrell Chest Traumatic Flail Chest Funnel Chest (Pectus Excavatum)--depression in lower portion of sternum Pigeon Chest (Pectus Carinatum)--anteriorly displaced sternum Thoracic Kyphoscoliosis

Answer 11

Assess for tenderness, instability, or crepitus in trauma Assess for chest expansion Assess vocal fremitus * Increased fremitus--consolidated fluid magnifies vibration * Decreased fremitus--space b/w lung and chest wall magnified vibration

Answer 12

Pt breathing with mouth open, somewhat more deeply than normal Note intensity of breath sounds and any variations from normal vesicular breathing * Breath sounds are usually louder in the upper, anterior chest * Bronchovesicular breath sounds may be heard over the large airways, especially on the right Identify any adventitious sounds, noting: * Timing in respiratory cycle * Location on chest wall * Do they clear with coughing?

Answer 13

Percuss in the same areas as auscultation The heart produces areas of dull left of the sternum from the 3rd to 5th ICS Percuss diaphragmatic excursion

Answer 14

Cough Dyspnea Hemoptysis Wheezing Chest Pain

Answer 15

A mechanical reflex that involves a deep inspiration, which increases lung volume; followed by muscle contraction against a closed glottis; and then sudden opening of the glottis Protective and helps clear mucus, secretions, and foreign objects from airway

Answer 16

Lasts less than 3 weeks Usually self-limiting Most common causes: * URI * Lower respiratory tract infections * Acute exacerbation of chronic COPD * Allergic rhinitis * Rhinitis due to irritants * Irritants to the respiratory tree

Answer 17

Persistent cough lasting longer than 3 weeks Most common causes: * COPD * Chronic sinus drainage * Asthma * GERD * Meds * Psychiatric

Answer 18

Irritant--dust Allergens--ragweed, pollen Toxic substances--gastric acid Inflammation--asthma Cold air Smoke Rapid change in humidity or temperature Infection--viral vs. bacterial

Answer 19

URI, sinusitis LRI, bronchitis, pneumonia Allergic rxn Asthma Environmental Foreign body

Answer 20

Smoking Postnasal discharge Asthma GE Reflux ACE Inhibitors/ARBs

Answer 21

CHF bronchiectasis Lung CA Emphysema Occupational Recurrent aspiration CF, interstitial

Answer 22

Usually worse in the AM, productive

Answer 23

usually productive

Answer 24

associated with PND, nasal mucous drainage, often a hx of seasonal allergies

Answer 25

Worse at night or after exercise Associated with episodic wheezing

Answer 26

beta blocker--makes asthma worse ACEI

Answer 27

H/o heartburn Worse in supine position Improves with antacids

Answer 28

Cough with hemoptysis Cough, fever, and purulent sputum production Cough with excessive sputum production Cough with wheezing and dyspnea Cough with CP Cough with unintentional weight loss Cough, dyspnea, and lower extremity edema

Answer 29

MI PE significant infections CHF

Answer 30

Was the onset acute? * airway obstruction * PE * angioedema * allergic reaction Was the onset gradual? * CHF * AECB * Anemia Any current or previous diseases that may be an exacerbation of? Any recent periods of immobility (surgery)?

Answer 31

**Pulmonary** * CHF, pulmonary edema * Exacerbation of COPD * PE * Aspiration/foreign body * Acute infections * Spontaneous pneumothorax **Cardiac** * Cardiac tamponade * Myocardial ischemia * Pericarditis/endocarditis * Mitral valve prolapse **Miscellanceous** * Anaphylaxis * Metabolic acidosis * Guillain Barre * Myasthenia Gravis **Psych** * Panic attack * Hyperventilation

Answer 32

**Pulmonary** * Asthma * COPD * Interstitial lung disease * Chronic pneumonia * Chronic pulmonary emboli * Pulmonary neoplasia * Pleural effusions **Cardiac** * Cardiomyopathies * CHF * Myocardial ischemia * Primary pulmonary HTN * Pericardial dz **Miscellaneous** * Deconditioning * Anemia * Neuromuscular dz **Psychiatric**

Answer 33

Upper airway obstruction, foreign body, angioedema, hemorrhage Tension pneumothorax Pulmonary embolism Neuromuscular (MG, GB) Anaphylaxis

Answer 34

Chest pain Pink, frothy sputum Swelling, hives, or wheezing Fever and sputum production Weakness/fatigue

Answer 35

Tachypnea, stridor, accessory muscle use. Inability to speak because of breathlessness (3-word dysnpnea) Agitation or lethargy as consequence of hypoxia Paradoxical abdominal wall movement due to diaphragmatic fatigue **What to do: ** Give oxygen Anticipate need for airway control and mechanical ventilation

Answer 36

Amount of hemoptysis Associated sxs Recent illnesses PMH Meds and Drugs Smoking Travel Occupational exposure

Answer 37

Infectious – **bronchitis**, **pneumonia**, **TB** Neoplastic – **lung CA** CV – **PE**, CHF, pulmonary HTN Hematologic - ↓ platelets, anticoagulant Rx Traumatic – foreign body, ruptured bronchus Iatrogenic – lung bx., bronchoscopy Inflammatory – **bronchiectasis**, cystic fibrosis GI- esophageal varicies ENT- following nasal trauma

Answer 38

Massive or severe hemoptysis is considered life threatening Chest imaging indicated Massive hemoptysis carries a mortality rate of 13-58%

Answer 39

Timing and details of onset Any previous attacks? Risk factors and associated disease * Occupational exposure * Immobility * PMH, asthma, CHF, smoking * FHx-atopy * Allergies * Medication Compare severity to baseline Modifying factors Associated sxs

Answer 40

Asthma COPD, especially emphysema PE Anaphylaxis Infection: viral or bacterial Tumors Aspiration Mitral valve disease CHF

Answer 41

PQRSTA Rule out the bad stuff: * MI * PE * TAA * Pneumothorax

Answer 42

Diaphoresis Dyspnea with hemotysis, fever, syncope, or paplpitations Tearing or ripping sensation radiating to the back CP with N/V Radiating to arms, shoulders, or jaw Sudden onset Sense of impending doom

Answer 43

Heart disease Structures of the thorax Lungs: PE, pneumothorax, pneumonia, pleuritis GI causes Musculoskeletal causes