IPA Cardiac and Pulm exam Flashcards
Where is breathing controlled
In the brain in the medulla- complex
Function of respiration
provide O2 and remove CO2 from circulatory system
Is experation passive or active?
Expiration is passive
What factor helps during inspiration and alveolar compliance?
Elasticity
What is bradypenea
abnormal slowing of respiration
What is tachypenea
abnormal increased rate of respiration
What is Apnea
temporary cessation of breathing
What is hyperpenea
increased depth of breathing, usually associated with DKA
What are Cheynes-Stokes breathing
Abonormal pattern of breathing, progressively deeper and faster breathing, followed by gradual decrease resulting in apnea.
What is the abonormal pattern of breathing, progressively deeper and faster breathing, followed by gradual decrease resulting in apnea called
Cheynes-stokes breathing
Which breathing has a crescendo-decrescendo pattern with apnea between paterns?
Cheynes-stokes breathing
What is kussmaul breathing
Deep, rapid breathing, DKA or kidney failure, deep and rapid cycles of respirations
What is the breathing pattern that is deep, rapid breathing, DKA or kidney failure, deep and rapid cycles of respirations
Kussmaul breathing
What is the most common symptom of lung disease
cough
What is the earliest manifestation of bronchitis
increase in quanity of sputum production
How much sputum is secreted by bronchi every day
75-100 mL
What is coughing up of blood called
hemoptysis
What is the most common cause of hemoptysis
bronchitis
What are secondary causes of hemoptysis
- Broncheictasis
- Bronchiogenic carcinoma
Hemoptysis vs hematemesis
Coughing up blood vs vomitting blood
What is vommiting blood up called
Hematemesis
What is dyspena
shortness of breath
What are damaged airways called
bronchiectasis
What is the sudden onset of shortness of breath occurring at night during sleep
Paroxysmal-nocturnal dyspena
What is difficulty breathing while lying flat
orthopena
What is difficulty of breathing while sitting up and releved by a recumbent position
Platypenea
What is a condition where patients are more comfortable laying on one side
trepopnea
When does wheezing usually present in the cycle of breathing
during expiration when bronchoconstriction occurs
When does central cyonisis occur
When inadequate gas exchange occurs in the lungs that results in a significant reduction in arterial oxygenation ( mucous membranes, lips)
When does peripheral cyanosis occur
Results from an excessive extraction of oxygen at the periphery ( fingers, toes, nose)
Where does chest pain usually occur
usually chest wall or parietal pleura
What is a common symptom of inflammation of the parietal pleura
pleuritic pain ( Sharp, stabbing pain felt during inspiration. May be localized to one side).
What is snoring associated with
obstructive sleep apnea
What is noisy, harsh breathing produced by turbulent airflow through a partially obstructed airway at the level of the glottis or trachea?
Stridor
What is stridor considered
a medical emergency
What are voice changes caused by
inflammation of the vocal cords or laryngeal nerve issue
What is swelling of the ankles indicative of
right sided heart failure, renal disease, liver disease, obstruction of venous flow
What is COPD
umbrella term for Emphysema ( pink puffers- severe dyspena with little cough or sputum production) and chronic bronchitis (blue bloaters, cyanotic and have productive cough)
What is blue bloaters
chronic bronchitis
What is a pink puffer
emphysema (pathologic diagnosis, where alveoli lose their elastic)
What are the 4 things we look at for respiration
Rate (12-20
Rythym (regular, irregular)
Depth ( Shallow, normal, deep)
Effort ( normal, distressed, grasping)
What do you examine nails for in a thorax and lung exam
clubbing- sign of hypoxia
What are you looking for with thoracic expansion
symmetry and normal thoracic expansion
What test are you doing using the ulnar side of your hand on the posterior thorax, checking for asymmetry moving down the chest while a patient says 99?
Tactile fremitus
- Air or fluid outside the lung can make this not symmetrical
When are tactile fremitus vibrations increased
pnumonia
When are tactile fremitus vibrations decreased
unilateral: pneumothorax, pleural effusion, bronchial obstruction, atelectasis
bilateral: COPD, obesity
Effusion vs consolidation
Effusion- pleural fluid in pleural cavity
consolidation- fluid in alveoli/lung
If you are ascultating and hear loud, harsh, and high pitched sounds that sound like air going through a tube, where are you likely ascultating
You are hearing stridor from the upper respiratory tract
If you are listening to a low pitched noise, caused by fluid in the large and medium sized airways, what are you listening to?
Ronchi
Sound like snoring/gurgling
If you’re hearing scratchy sounds associated with fluid in the alveoli and airways, what are you listening to?
Crackles, rales
What are you hearing if you hear a wisteling, high-pitched noise that is loud on expiration, caused by air forced through a narrow airway?
Wheezing
If you have an absense of sound in the lungs what is it?
Little air movement, clinical emergency, chronic emphysema, severe asthma, effusions, pneumothorax
What is egophony
have patient say letter e while auscultating (if abnormal, will hear like aaaaah. Positive egophany, or e to a change.)
- Accompanies pneumonia
What do you perform if bronchophony is present
a whispered pectoriloquy
whisper 99
abnormal if you can hear
What causes barrel chest
COPD, aging
What causes flail chest
3 or more adjacent rib fractures
When your injured ribs cave in with inspiration and outward with expiration what is this called
flail rib
What is kyphoscoliosis
scoliosis and forward curving spine
What are decreased or absent breath sounds, fine crackles called
Atelectasis- complete or partial collapse of lung or lobe
What is the PMI and where is it
right at left niple line, mid-clavicular, 5th intercostal space. Apex of tip of heart
What is S1 produced by
closure of tricuspid and mitral valves
What is S2 produced by
closure of aoritc andpulmonic semilunar valves
What are the 2 components of S2
A2 (aortic valve closure which happens 1st)
P2 (Pulmonic valve closure which happens 2nd)
What part of the heart do extra heart sounds usually arise from
usually Left ventricle, rarely R
What is S3 usually associated with
heart failure- too much volume, fill L ventricle too quickly.
Most common cause of left ventricular hypertophy? How does this sound on auscultation?
long standing hypertension ( atrial kick, gallop because of stiff heart)
Which part of the stethescope do you use to listen for S3 and S4
Bell
Most murmors are ?/6 ?
2-3/6
What part of the stethescope for high pitched sounds vs low pitched sounds
High pitched- diaphragm
Low pitched- Bell
What is Homan’s sign
Extend pt’s knee, check for calf tenderness after sudden dorsiflexion of foot- pain could be associated w DVT
What is the Allen Test
determine patency of radial and ulnar arteries- check for arterial insufficiency
What are vibratory sensations you feel when palpating the heart
Thrills
Associated with murmors
what are impules that rythymically lift your fingers when you palpate the heart
Heaves
Which side of the stethescope do you use to listen for murmors
Bell
When do you hear ventricular septal defect
during all of systole
What sound do you hear if you have pericardial disease
rubs usually
Thick and stiff arteries are called what
Arteriosclerosis
Plaque buildup in the arteries, causing narrowing, (a type of arteriosclerosis) is called what
Atherosclerosis
What is a common vasospastic disorder
Raynaud disease (Turn white–>cyanotic(blue) –>rubor (red)
What disease is categorized by the 5 P’s and what are the 5 P’s
Arterial occlusion
5P’s
-Pain
-Pallor
-Paresthesia
-Paralysis
-Pulselessness
What is the high-pressure delivery system of the body
the left side of the heart and arteries
What is the area of exchange in the body
capillaries
What is the low-pressure return system in the body
the Right side of the heart and veins
What are the 2 layers of the pericardial sac
- Visceral pericardium- the cells of the heart
- The parietal pericardium- outer layer/sac
Blood flow through the heart
IVC/SVC–> Right atrium–>Tricuspid valve–>Right ventricle –>Pulmonic semilunar valve–>Pulmonic artery–> Lungs–>Pulmonic veins–> Left atrium–>Bicuspid valve–>Left ventricle–> Aortic semilunar valve–> Aorta
What is S1 produced by
Closing of mitral valve(Bicuspid valve, between L atrium and ventrical), and tricuspid valve; occurs at the same time as a pulse does
Where is S2 heard
As the pulmonic and aortic valves shut
What is the QRS complex demonstrating
ventricular contraction
If you hear a sound between S1 and S2, what is this?
Systolic murmor
When is S3 heard
At the end of filling with the opening of the tricuspid and mitral valves
Right after S2 (when these close)
Very beginning of diastole
When is S4 heard
end of diastole, also called an atrial kick or gallop.
Ejection click vs opening snap
Ejection click occurs during systole (opening of aortic valve between S1 and S2)
Opening snap is opening of the AV valves because of stenosis, occurs during diastole
What are the systolic murmors
- Aortic or pulmonary stenosis
- Mitral or tricuspid regurgitation
Between S1-S2
What are the diastolic murmors
-Aortic or pulmonary regurgitation
- Mitral or tricuspid stenosis
Between S2–>S1
What are palpable cords
thrombosed veins
What are thrills associated with
murmors
pectus excavatum vs pectus carinatum
excavatum- funnel chest (think “cave”)
Carinatum- pigeon chest
Effusion vs consolidation in terms of where fluid is
Effusion–>Fluid in pleural cavity
Consolidation–> Fluid in lung
Signs of Effusion vs consolidation with auscultation, percussion, fremitus, and egophony
Effusion: Decreased auscultation, no breath signs. Dull percussion. Decreased Fremitus. Absent egophony
Consolidation: Bronchial breath sounds. Dull percussion. Increased Fremitus. Present egophony
Key differences: Same for percussion (dull), opposite for everything else.
When do effusion and consolidation give the same sign
percussion- both are dull
Do you hear ronchi on inspiration or expiration
Inspiration- air moving through lungs on inspiration- sounds like snoring/gurgling
What are crackles (rales) due to
Scratchy sounds associated with fluid in alveoli and airways. Rales occur at the end of the lung in the alveoli.
Where are rales vs ronchi
Rales in tales (end of lung) and ronchi in the bronchi
Wheezing vs stridor, insperation vs expiration?
Wheezing is in expiration, stridor is inspratory
How is chronic bronchitis classified
three consecutive months of bronchitis, 2 years in a row
What do a pnumothorax, hemothorax, pleural effusion, atelectisis, and emphysema have in common
They can have absent breath sounds
- Pleural effusion, Hemothorax, and Atelectasis can all have decreased or absent breath sounds
-Atelectasis is accompanied by fine crackles
