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PCM Exam 2 > Lower Respiratory Exam > Flashcards

Lower Respiratory Exam Flashcards

1
Q

Physical exam-Basic steps?

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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2
Q

History

-Chief complaints

A

Cough, hemoptysis, dyspnea, wheezing, edema

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3
Q

History

-Dyspnea-conversional?

A

Patient gives short answers when talking

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4
Q

PMH

A

Asthma, chronic bronchitis, heart failure

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5
Q

PMH

-Chronic bronchitis criteria?

A

Cough more in the morning for at least 3 months out of the year

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6
Q

Social history

A

Illicit drug use, alcohol, smoking history

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7
Q

Social history

-Smoking history-Pack years=?

A

packs per day x years

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8
Q

Occupation

A
  • Farmer, wood worker, mining

- Exposure to asbestos, duct-vents cleaning

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9
Q

Exposure to asbestos can cause?

A

Mesothelioma

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10
Q

The Physical examination

A
  • Sitting position and breathing pattern
  • Use of accessory muscles
  • Color of fingers and lips
  • Shape of nails
  • Breathing through pursed lips
  • Ability to speak
  • Chest/spinal deformities
  • Is the trachea in the midline?
  • Chest excursion
  • Tactile fremitus
  • Percussion
  • Lung sounds
  • Lymphadenopathy***(what did he say about this?)
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11
Q

Nail clubbing is indicative of?

A
  • Hypoxia
  • Interstitial lung disease, cystic?, interstitial pulmonary fibrosis, bronchiectasis, lung disease
  • Cardiovascular problems
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12
Q

When a patient is hypoxic, what is the appearance of their lips?

A

Cyanotic lips and pursed breathing

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13
Q

Inspection

A
  • Shape
  • Color
  • Hair distribution
  • Landmarks
  • Respiration rate and pattern
  • Respiratory ribs movement
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14
Q

Inspection

-Shape?

A
  • pectus carinatum, pectus excavatum

- Barrel chested-COPD

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15
Q

Inspection

Respiration rate and pattern

A

Intercostal retraction - respiratory distress

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16
Q

Palpation

A
  • Palpate thoracic muscles
  • Evaluate thoracic cage expansion
  • Palpate T-spine/evaluate ribs motion
  • Evaluate the tactile fremitus
  • Evaluate the trachea
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17
Q

Palpation

-Tactile fremitus is increased in?

A

Pneumonia, consolidation of lung tissue

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18
Q

Palpation

-Tactile fremitus-Decreased in?

A

COPD, tumor, pleural effusion, pneumothorax

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19
Q

Tactile fremitus

-How do you palpate this?

A
  • The patient says “99” while the doctor’s hands are placed along the posterior lateral thorax
  • With lung consolidation there should be a palpably more pronounced vibration on the side of the consolidation
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20
Q

Egophony

A

When patient says the letter E it sounds more like Ayyy

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21
Q

Broncophony

A

Spoken words become louder and clearer

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22
Q

Whisperred pectoriloquoy

A

Loud whispers

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23
Q

Percussion

A
  • Listen for abnormal sounds

- Symmetry

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24
Q

Percussion-Dull sound?

A
  • Over fluid

- Solid tissue

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25
Q

Percussion

-Hyperresonance?

A
  • COPD

- Pneumothorax

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26
Q

Percussion of the chest

  • Diaphragmatic excursion?
    • Normal?
A
  • Determine the distance between the level of dullness on full expiration and the level of dullness on full inspiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm)
    - Normal-3-5.5
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27
Q

Auscultation of the chest-sounds

  • Bronchial
    • where are they located?
    • Characteristics?
A
  • Over the trachea

- Coarse, loud and long expirations

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28
Q

Auscultation of the chest-sounds

  • Bronchovesicular
    • where are they located?
    • Characteristics?
A
  • Over the right and left mainstem bronchus
  • Medium pitch
  • Expiration equals inspiration
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29
Q

Auscultation of the chest-sounds

  • Vesicular
    • where are they located?
    • Characteristics?
A
  • Lung fields

- Soft and low pitched

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30
Q

Abnormal sounds

A
  • Crackles: fine and coarse
  • Wheezes
  • Pleural friction rub
  • Rhonchi
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31
Q

Vocal resonance

A
  • Normally words are indistinct to auscultation

- Distinctness increases with lung consolidation (pneumonia, tumor, etc.)

32
Q

Rhonchi

A

Coarse, low pitched, may clear with cough

33
Q

Wheeze

A

Whistling, high-pitched bronchus

34
Q

Rub

A

Scratchy, high pitched

35
Q

Crackles

A

Fine-crackling, high-pitched

36
Q

Vesicular breath sounds

  • When are they more prominent?
  • When are they diminished?
A
  • More prominent in a thin person or child

- Diminished in an overweight or muscular patient

37
Q

Pneumonic for chest x-ray

A 
ABCDEFGHI
Adequate: position, inspiration, exposure, rotation (PIER)
Bones and soft tissues
Cardiac size, valves
Diaphragms round, flat, free air
Effusions
Fields and fissures
Great vessels
Hilar masses (caution thymus in children)
Impression
37
Q

Identification of special landmarks/anatomy

-Sternal angle (angle of louis)

A

Where 2nd rib meets with the manubrium and the body of the sternum

38
Q

Clinically relevant landmarks

-Needle decompression?

A

2nd intercostal space just superior to the 3rd rib margin (neurovascular bundle runs inferior to each rib) at the mid-clavicular line for emergent decompression tension pneumothorax, followed by chest tube placement

39
Q

Chest tube insertion?

A

4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib

40
Q

Where is T4 located?

A

Lower margin of endotracheal tube on a chest x-ray

41
Q

Landmark for thoracentesis?

A

7th intercostal space

42
Q

Evaluation of respiration

-Patient’s posture and position?

A

Patient with obstructive lung disorders will tend to sit leaning forward with shoulders elevated

43
Q

Evaluation of respiration

-Inspection of the neck?

A
  • Contraction of accessory muscles (sternocleidomastoid, scalenes, or supraclavicular contraction)
  • Tracheal position
44
Q

Lateral displacement of the trachea can occur in?

A

tension pneumothorax

45
Q

Thoracic expansion

A
  • Place thumbs at about the level of the 10th ribs with fingers loosely grasping and parallel to the lateral rib cage
  • Ask patient to inhale deeply
  • Watch the distance between thumbs as they move apart during inspiration and feel for the range and symmetry of the rib cage as it expands and contracts
46
Q

Tactile fremitus

-Where is it normally more prominent?

A
  • Often more prominent in the interscapular area than in lower lung fields
  • More prominent on the right than the left
47
Q

Percussion

-Pattern for percussion?

A

Start superiorly percussing both sides of the chest working toward the base proceeding in a “ladder-like” pattern

48
Q

5 percussion notes?

A

Flat, dull, resonant, hyperresonant, tympanitic

49
Q

Flat

-Intensity, pitch, duration?

A

soft, high, short1

50
Q

Dull

-Intensity, pitch, duration?

A

Medium, medium, medium

51
Q

Resonant

-Intensity, pitch, duration?

A

Loud, low, long

52
Q

Hyperresonant

-Intensity, pitch, duration?

A

Very loud, lower, longer

53
Q

Tympanitic

-Intensity, pitch, duration?

A

Loud, high, longer

54
Q

Percussion notes

-Clinical examples-Dullness replaces resonance when?

A

-Replaces resonance when fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers

55
Q

Percussion notes

-Clinical examples-Dullness?

A
  • Lobar pneumonia

- Pleural accumulations (effusion, hemothorax, empymema, fibrous tissue or tumor)

56
Q

Percussion notes

-Bilateral (generalized) hyperresonance may be heard over?

A

Hyperinflated lungs

-Obstructive lung diseases (COPD, asthma)

57
Q

Percussion notes

-Unilateral hyperresonance suggests?

A
  • Large pneumothorax

- Large air-filled bulla in lung

58
Q

Normal breath sounds

-Vesicular?

A
  • Soft and low pitched
  • Heard through inspiration and about 1/3 of expiration
  • Heard over most of lung tissue
59
Q

Normal breath sounds

-Bronchovesicular?

A
  • Intermediate in intensity and pitch
  • Heard equally in inspiration and expiration
  • Heard best in 1st and 2nd interspaces anteriorly and between scapulae
60
Q

Normal breath sounds

-Bronchial

A
  • Loud and high pitched
  • Expiratory sounds heard longer than inspiratory
  • Heard best over manubrium (larger proximal airways)
61
Q

Normal breath sounds

-Tracheal?

A
  • Very loud and high pitched
  • Heard equally in inspiration and expiration
  • Heard best over trachea in neck
62
Q

If bronchovesicular or bronchial breath sounds are heard more distal to expected locations?

A

Suspect air-filled lung has been replaced by fluid-filled or solid lung tissue

63
Q

Adventitious breath sounds

A

Superimposed on the usual breath sounds

64
Q

Crackles (rales)

-Characteristics?

A

-Discontinuous, intermittent, non-musical, and brief

65
Q

Crackles

-Defined by the following?

A
  • Fine or coarse

- Timing in respiratory cycle

66
Q

Crackles

-Fine crackles characteristics?

A

Soft, high-pitched, very brief

67
Q

Crackles

-Coarse crackles characteristics?

A

Louder, lower in pitch, brief

68
Q

Crackles

-Timing in respiratory cycle?

A

Inspiratory, expiratory, mid-inspiratory/expiratory

69
Q

Wheezes and rhonchi

-Characteristics?

A

-Continuous, musical quality, and prolonged (not necessarily the whole respiratory cycle)

70
Q

Wheezes

-Characteristics?

A

Relatively high pitched, musical, hissing or shrill quality

71
Q

Rhonchi

-Characteristics?

A

Relatively low-pitched, snoring quality

72
Q

Wheezes

-Suggest?

A

Narrowed airways (asthma, COPD, bronchitis)

73
Q

Rhonchi

-Suggest?

A

secretions in large airways

74
Q

Stridor

A
  • Wheeze that is entirely or predominantly inspiratory in nature
  • Often louder in neck vs chest wall
  • Indicates partial obstruction of larynx or trachea (immediate attention needed)
75
Q

Pleural friction rub

A
  • Inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction
  • Sounds like creaking, usually during expiration but can occur in both phases of respiration
  • Usually confined to a relatively small area of the chest wall

PCM Exam 2 (3 decks)

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