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PCM > Lower resp exam > Flashcards

Lower resp exam Flashcards

1
Q

Regular Breathing Rate

A

14-20 x per minute

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2
Q

Observation of Respiratory Difficulty

A
  • patients color
  • sounds of breathing
  • neck inspection
  • concerns pt expresses
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3
Q

Inspection

A
  • rate
  • rhythm
  • depth
  • effort (lean forward-obstructive, speech-short sentences, pursed luips)
  • clubbing of fingernails
  • shape of chest and quality of movement
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4
Q

Tactile Fremitus

A
  • palpable vibrations transmitted though bronchopulmonary tree to the chest wall when pt speaks
  • assess around medial and inferior border of scapula while pt repeats ‘99’
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5
Q

Decreased Tactile Fremitus

A
  • COPD
  • pleural effusion
  • pneumothorax
  • infiltrating tumor
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6
Q

Increased Tactile Fremitus

A

-pneumonia (increased transmission through consolidated tissue)

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7
Q

2nd Intercostal Space

A

-needle insertion for tension pneumothorax

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8
Q

4th Intercostal Space

A

-chest tube insertion

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9
Q

T4

A

-lower margin of endotracheal tube on X-Ray

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10
Q

7th Intercostal Space

A

-landmark for thoracentesis (fluid removal from between pleura and chest wall)

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11
Q

Percussion

A
  • assesses whether underlying tissues are air filled, fluid filled or solid via sound changes
  • flat, dull, resonant, hyperresonant, tympanic
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12
Q

Resonant

A
  • healthy lungs

- replaced by dullness when fluid or solid tissues replaice air filled spaces

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13
Q

Hyperresonance

A
  • generalized (COPD)

- unilateral (large pneumothorax)

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14
Q

Diaphragmatic Excursion

A
  • boundary between resonant lung tissue and duller structures below the diaphragm
  • not the diaphragm itself

-normally 3-5.5cm

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15
Q

Auscultation

A
  • assesses air flow through the tracheobronchial tree

- if abnormal sounds are heard, adjacent areas should be auscultated to asses the extent of the abnormality

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16
Q

Normal Breath Sounds

A
  • vesicular
  • bronchiovesicular
  • bronchial
  • tracheal
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17
Q

Resonance → Dullness

A
  • when fluid or solid tissue replaces air filled spaces of the lungs
  • ie. lobar pneumonia, pleural accumulations (effusion, hemothorax, empyema, fibrous tissue or tumor)
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18
Q

Hyperresonance

A
  • heartd over hyperinflated lungs
    ie. COPD, asthma

-unilateral suggests large pneumothorax, or air filled bulla

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19
Q

Vesicular Breath Sounds

A
  • soft; low pitched
  • heard throughout inspiration
  • heard through the first 1/3 of expiration then begins to fade
  • heard over most of lung parenchyma
20
Q

Bronchovesicular Breath Sounds

A
  • intermediate in intensity and pitch
  • inspiratory and expiratory sounds approximately equal in length
  • sounds originate at left/right bronchi bifurcations
  • heard best in the 1st and 2nd anterior intercostal spaces
  • heard best between scapulae posteriorly
21
Q

Bronchial Breath Sounds

A
  • loud, harsh and high in pitch
  • expiratory sounds are longer than inspiratory sounds
  • separated by a short silence
  • heard anteriorly at L/R bifurcations at level of sternal angle
  • heard posteriorly at the T4 TP
  • best heard over manubrium
22
Q

Tracheal Breath Sounds

A
  • very loud and harsh
  • inspiratory and expiratory sounds are approximately equal

-heard best over trachea in the neck

23
Q

Bronchovesicular or Bronchial Breath Sounds

A

-if heard distal to their normal locations, indicate normally air filled area has become fluid filled or a solid lung

24
Q

Diaphragm

A

-stethoscope portion used to auscultate lungs

25
Q

Depely Through Open mouth

A

-how patient should breathe for lung auscultation

26
Q

Ladder Pattern

A

-suggested for lung auscultation to allow L and R comparison

27
Q

Middle Lobe Auscultation

A

-anterior chest wall between 4th rib in midclavicular line

28
Q

Adventitious Breath Sounds

A
  • extra breath sounds
  • may be superimposed over usual sounds

-caused by crackles, wheezes, rhonchi and stridor

29
Q

Crackles (Rales)

A
  • discontinuous
  • intermittent, non-musical, brief
  • can be inspiratory, expiratory or between
  • fine or coarse
30
Q

Fine Crackles

A
  • soft, high pitched, very breif

- 5-10ms

31
Q

Course Crackles

A
  • slightly louderm lower in pitch and brief

- 20-30ms

32
Q

Wheezes

A
  • continuous
  • prolonged (not necessarily the entire respiratory cycle)
  • relatively high pitched, musical, hissing or shrill quality
  • suggests narrow airways (asthma, COPD, bronchitis)
33
Q

.

Rhonchi

A
  • continuous
  • prolonged (not necessarily the entire respiratory cycle)
  • low-pitched, snoring quality
  • suggests secretions in large airways
34
Q

Stridor

A
  • wheeze that is entirely or predominantly inspiratory in nature
  • louder in neck vs. chest wall
  • indicates partial obstruction of larynx or trachea
  • requires immediate attention
35
Q

Transmitted Voice Sounds

A
  • assessed if bronchovesicular or bronchial breath sounds are abnormal
  • ie. pneumonia, lobar consolidation, pleural effusion
36
Q

Bronchophony

A

-spoken words become louder and clearer

37
Q

Egophony

A
  • ‘ee’ sounds like ‘A’
  • nasal bleating quality and should be localized

-when combined with fever and cough, bronchial breath sounds: 3x more likely pneumonia

38
Q

Whispered Pectoriloquy

A

-whispers are heard louder and clearer during auscultation

39
Q

Ninety-Nine

A
  • when whispered, normally is muffled and indistinct

- bronchophony (also tactile fremitus)

40
Q

‘99’ or ‘1-2-3’

A
  • whispered voice is normally faint and indistinct or not heard at all
  • whispered pectoriloquy
41
Q

Nail Clubbing

A
  • bulbous swelling of soft tissue at nail base
  • loss of normal angle

-indicates interstitial lung disease, cystic fibrosis, etc.

42
Q

Flat

-intensity, pitch, and duration

A

intensity:soft
Pitch:high
duration:short

43
Q

Dull

-intensity, pitch, and duration

A

intensity:medium
Pitch:medium
duration:medium

44
Q

Resonant

-intensity, pitch and duration

A

intensity: loud
pitch: low
Duration: Long

45
Q

hyperresonant

-intensity, pitch and duration

A

Intensity: very loud
pitch: lower
Duration: longer

46
Q

tympanic

-intensity, pitch and duration

A

intensity: loud
pitch: high
duration: longer

PCM (2 decks)

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