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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
What accessory muscles for breathing are located in the neck?
scalenes trapezius sternomastoid
26
How many spots do you auscultate the chest?
2 spots anterior | 4 spots posterior
27
What do wheezes indicate?
narrowed airways (asthma, COPD, bronchitis, heart failure)
28
What do crackles/rales indicate?
in dependent portions = after prolonged recumbency | also seen in pneumonia, fibrosis, early heart failure, bronchitis, bronchiectasis
29
What does increased fremitus suggest?
pneumonia - increased transmission thru consolidated tissue
30
What are the adventitious breath sounds to know?
``` crackles/rales wheezes rhonchi stridor pleural friction rub ```
31
What are rhonchi?
relatively low-pitched, snoring quality
32
What is bronchophony?
spoken words become louder and clearer = indicates consolidation when patient says 99
33
How does pulse oximetry work?
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
What is a normal diaphragmatic excursion? | What does asymmetry mean?
``` normal = 3-5.5 cm asymmetry = pleural effusion or high diaphragm from atelactasis or phrenic nerve paralysis ```
35
What is pectus excavatum?
funnel chest
36
What are the 4 major vital signs? | what is the 5th you should always get for respiratory cases?
RR, HR, BP, temp | 5th = oxygen saturation
37
What is end tidal CO2?
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
What is the difference btw hypoxia and hypoxemia?
``` hypoxia = deficiency in the amt of O2 reaching the tissues hypoxemia = low O2 in arterial blood ```
39
What is a normal cardiac size on chest x ray?
<50% of chest diameter of PA films and <60% of AP films
40
What are the ABCs for chest x ray interpretation? (A thru I)
``` 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
What has occurred if dullness replaces resonance upon percussion?
fluid or solid tissue replaces air-containing lung pleural accumulations empyema (pus) fibrous tissue or tumor
42
What is hypopnea?
decreased depth and rate of respiration
43
What is atelactasis?
collapse of lung tissue that affects alveoli from normal O2 absorption
44
What is pectus carinatum?
pigeon chest
45
How do you perform diaphragmatic excursion?
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
What is cyanosis a sign of?
hypoxia | see in nails and lips (perioral)
47
What is hyperpnea?
increased depth of breathing and rate of respiration (normal in exercise)
48
Where is the lower margin of an endotracheal tube on xray?
T4
49
How do you perform tactile fremitus?
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
What is bradypnea?
regular rhythm but slow rate <14/min
51
What does accessory muscle use in breathing indicate?
sign of respiratory distress | can see in asthma, COPD, airway obstruction, viral illness (RSV)
52
What is a bronchial sound?
loud and high pitched expiratory sounds heard longer than inspiratory heard best over manubrium
53
What physical findings will you see with atelectasis?
decreased breath sounds diaphragmatic excursion tracheal deviation
54
What is a normal breathing rate?
14-20/min
55
What is a thoracentesis and where do you perform it?
insertion of a needle to remove fluid from pleural space | insert at 7th intercostal space
56
What can cause decreased breath sounds?
decreased air flow (COPD, muscular weakness) | poor transmission of sound (COPD, pleural effusion, pneumothorax)
57
What is tachypnea?
rapid breathing | >20-25/min
58
What is egophony?
when pt says ee --> hear A, sounds nasal and bleating, should be localized triples likelihood of pneumonia if pt has fever and cough
59
What is considered chronic bronchitis?
daily productive cough for 3 months or more, in at least 2 consecutive years
60
What are the causes of fingernail clubbing? (8)
``` congenital heart disease interstitial lung disease bronchiectasis pulmonary fibrosis cystic fibrosis lung abscess/mass malignancy inflammatory bowel disease ```
61
What do rhonchi suggest?
secretions in large airways
62
What do you suspect if bronchovesicular or bronchial sounds are hear more distal than expected?
suspect fluid or solid lung tissue (abnormal)
63
What is a blue bloater?
``` chronic bronchitis from smoking overweight and cyanotic elevated hemoglobin peripheral edema rhonchi and wheezing ```
64
What are normal breath sounds?
bronchial Bronchovesicular vesicular tracheal
65
What has occurred if there is hyperressonance upon chest percussion?
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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