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PCM-1 > Lower Respiratory Exam > Flashcards

Lower Respiratory Exam Flashcards

1
Q

What can tracheal deviation indicate?

A

pneumothorax
pleural effusion
atelactasis
mass

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2
Q

What is a tracheal sound?

A

very loud and high pitched
heard equally over inspiration and expiration
heard best over trachea in neck

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3
Q

What is a bronchovesicular sound?

A

intermediate, equally in inspiration and expiration

heard best in 1st and 2nd interspaces anteriorly and btw scapulae

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4
Q

What does decreased/absent fremitus suggest?

A

COPD

pleural changes = effusions, fibrosis, air (pneumothorax), tumor

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5
Q

What is the pneumonic to remember for Adequacy of chest x ray?

A 
PIER
position - AP/lateral?
Inspiration - should see 10-11 ribs
Exposure
Rotation
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6
Q

What can cause falsely normal or elevated oximetry reading? (4)

A

carboxyhemoglobin (CO poisoning)
high A1c
methemoglobin, sulfhemoglobin
ambient light

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7
Q

What do you palpate for on a lower thoracic exam?

A 
areas of tenderness
abnormalities in overlying skin
rib motion (inhalation vs exhalation dysfunctions)
thoracic expansion
tactile fremitus
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8
Q

Where do you do needle thoracentesis?

A 
2nd intercostal space
midclavicular line (removing air)
superior margin of rib
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9
Q

Where does the neurovascular bundle run?

A

along inferior margins of each rib

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10
Q

How do you use an incentive spirometer?

A

move slider to level that you want to reach
breathe out normally then put mouth on mouthpiece
take a slow deep breath in –> piston will move up as you breath in
when you can’t breath in anymore, hold your breath for 2-5 sec

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11
Q

How do you evaluate thoracic expansion?

A

place thumbs at about 10th ribs and wrap hands around

ask pt to inhale deeply –> watch distance btw thumbs as they move apart and feel for range and symmetry of rib cage

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12
Q

Where do you do chest tube insertion?

A

4th and 5th intercostal space
just anterior to the mid-axillary line (mid clavicular?)
superior margin of rib

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13
Q

What do pursed lips while breathing indicate?

A

an obstructive dx (COPD)

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14
Q

What does a tympanic percussion suggest?

A

thick abdominal percussion

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15
Q

What is dyspnea?

A

feeling short of breath

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16
Q

What is a vesicular sound?

A

soft and low pitched
heard thru inspiration and abt 1/3 of expiration
heard over most of lungs (parenchyma)

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17
Q

What are the pleximeter and plexor fingers?

A 
pleximeter = hyperextended middle finger of non-dominant hand in percussion
plexor = tapping finger
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18
Q

How should the patient be posed during chest percussion?

A

seated with hands crossed in front of chest, holding opposite shoulders w hands

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19
Q

What is traumatic flail chest?

A

multiple rib fractures may result in paradoxical mvnt of the thorax
on inspiration, injured area caves inward and moves out on expiration

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20
Q

What is a pink puffer?

A 
seen in emphysema/COPD
older and thin
severe dyspnea
quiet chest
hyperinflation with flattened diaphragms
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21
Q

What is whispered pectoriloquy?

A

Pt whispers 99 or 123
normal = faint and indistinct or not heard at all
pectoriloquy = whispers are heard louder and clearer during auscultation

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22
Q

What type of percussion note does a healthy lung have?

A

resonant

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23
Q

What does stridor indicate?

A

partial obstruction of larynx or trachea

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24
Q

What can cause a bad pulse oximetry waveform?

A

improper placement
hypoperfusion
hypothermia
motion artifact

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25
Q

What accessory muscles for breathing are located in the neck?

A

scalenes
trapezius
sternomastoid

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26
Q

How many spots do you auscultate the chest?

A

2 spots anterior

4 spots posterior

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27
Q

What do wheezes indicate?

A

narrowed airways (asthma, COPD, bronchitis, heart failure)

28
Q

What do crackles/rales indicate?

A

in dependent portions = after prolonged recumbency

also seen in pneumonia, fibrosis, early heart failure, bronchitis, bronchiectasis

29
Q

What does increased fremitus suggest?

A

pneumonia - increased transmission thru consolidated tissue

30
Q

What are the adventitious breath sounds to know?

A 
crackles/rales
wheezes
rhonchi
stridor
pleural friction rub
31
Q

What are rhonchi?

A

relatively low-pitched, snoring quality

32
Q

What is bronchophony?

A

spoken words become louder and clearer = indicates consolidation
when patient says 99

33
Q

How does pulse oximetry work?

A

oxygenated hemoglobin absorbs infrared light and allows red light to pass
deoxygenated Hgb is the opposite = absorbs red light and allows infrared to pass
% sat = red / red + blue

34
Q

What is a normal diaphragmatic excursion?

What does asymmetry mean?

A 
normal = 3-5.5 cm
asymmetry = pleural effusion or high diaphragm from atelactasis or phrenic nerve paralysis
35
Q

What is pectus excavatum?

A

funnel chest

36
Q

What are the 4 major vital signs?

what is the 5th you should always get for respiratory cases?

A

RR, HR, BP, temp

5th = oxygen saturation

37
Q

What is end tidal CO2?

A

concentration of CO2 in exhaled air at the end of respiration
expressed as partial pressure in mm Hg (PETCO2)
normal PETCO2 = 35-40 mmHg
normal PaCO2 = 35-45 mmHg

38
Q

What is the difference btw hypoxia and hypoxemia?

A 
hypoxia = deficiency in the amt of O2 reaching the tissues
hypoxemia = low O2 in arterial blood
39
Q

What is a normal cardiac size on chest x ray?

A

<50% of chest diameter of PA films and <60% of AP films

40
Q

What are the ABCs for chest x ray interpretation? (A thru I)

A 
Adequate/assessment
Airway
Bones and soft tissue
Cardiac size, valves
Diaphragm
Effusions/endotracheal tube
Fields and fissures
Foreign body
Great vessels
Gastric bubble
Hilar masses
Impression
41
Q

What has occurred if dullness replaces resonance upon percussion?

A

fluid or solid tissue replaces air-containing lung
pleural accumulations
empyema (pus)
fibrous tissue or tumor

42
Q

What is hypopnea?

A

decreased depth and rate of respiration

43
Q

What is atelactasis?

A

collapse of lung tissue that affects alveoli from normal O2 absorption

44
Q

What is pectus carinatum?

A

pigeon chest

45
Q

How do you perform diaphragmatic excursion?

A
  1. Pt exhales and holds it
  2. Percuss for spot where resonant lung tissue and dullness of structures below meet = diaphragm
  3. mark w/ a pen
  4. Pt breathes a few normal breaths
  5. Pt inhales completely and holds it
  6. Percuss for level of diaphragm
    distance btw 2 = diaphragmatic excursion
46
Q

What is cyanosis a sign of?

A

hypoxia

see in nails and lips (perioral)

47
Q

What is hyperpnea?

A

increased depth of breathing and rate of respiration (normal in exercise)

48
Q

Where is the lower margin of an endotracheal tube on xray?

A

T4

49
Q

How do you perform tactile fremitus?

A

perform on anterior and posterior chest
use ball or ulnar surface of hands
pt says ninety-nine or one-one-one
often more prominent in interscapular area than in lower lung fields, more prominent on right than left

50
Q

What is bradypnea?

A

regular rhythm but slow rate <14/min

51
Q

What does accessory muscle use in breathing indicate?

A

sign of respiratory distress

can see in asthma, COPD, airway obstruction, viral illness (RSV)

52
Q

What is a bronchial sound?

A

loud and high pitched
expiratory sounds heard longer than inspiratory
heard best over manubrium

53
Q

What physical findings will you see with atelectasis?

A

decreased breath sounds
diaphragmatic excursion
tracheal deviation

54
Q

What is a normal breathing rate?

A

14-20/min

55
Q

What is a thoracentesis and where do you perform it?

A

insertion of a needle to remove fluid from pleural space

insert at 7th intercostal space

56
Q

What can cause decreased breath sounds?

A

decreased air flow (COPD, muscular weakness)

poor transmission of sound (COPD, pleural effusion, pneumothorax)

57
Q

What is tachypnea?

A

rapid breathing

>20-25/min

58
Q

What is egophony?

A

when pt says ee –> hear A, sounds nasal and bleating, should be localized
triples likelihood of pneumonia if pt has fever and cough

59
Q

What is considered chronic bronchitis?

A

daily productive cough for 3 months or more, in at least 2 consecutive years

60
Q

What are the causes of fingernail clubbing? (8)

A 
congenital heart disease
interstitial lung disease
bronchiectasis
pulmonary fibrosis
cystic fibrosis
lung abscess/mass
malignancy
inflammatory bowel disease
61
Q

What do rhonchi suggest?

A

secretions in large airways

62
Q

What do you suspect if bronchovesicular or bronchial sounds are hear more distal than expected?

A

suspect fluid or solid lung tissue (abnormal)

63
Q

What is a blue bloater?

A 
chronic bronchitis from smoking
overweight and cyanotic
elevated hemoglobin
peripheral edema
rhonchi and wheezing
64
Q

What are normal breath sounds?

A

bronchial
Bronchovesicular
vesicular
tracheal

65
Q

What has occurred if there is hyperressonance upon chest percussion?

A

bilateral: heard over hyperinflated lungs (COPD, asthma)
unilateral: large pneumothorax, large air-filled bulla in lung (COPD)

PCM-1 (11 decks)

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