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Clinical Skills Lab > Lung Exam 101 > Flashcards

Lung Exam 101 Flashcards

1
Q

What is the traditional order of the pulmonary exam?

A
  1. inspection 2. palpation 3. percussion 4 auscultation
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2
Q

What are some things to look for upon inspection?

A
  1. General appearance [do they look sick or well?] 2. Is the breathing comfortable or labored? 3. Do you hear any audible breath sounds? 4. How is their coloring? 5. Clubbing of digits? 6. Signs of chronic corticosteroid use [thinning or bruising of skin; redistribution of fat to their trunks and face?
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3
Q

What is Cushing’s syndrome?

A

When someone has abnormally high levels of cortisol. The most common reason why this happens is from overuse of corticosteroid medications. Excess corticosteroids are frequently given for chronic obstructive pulmonary disease.

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4
Q

What is a cardinal sign of pulmonary disease?

A

clubbing of the digits

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5
Q

What are the diagnostic criteria for clubbing?

A
  1. increased interphalangeal depth ratio [end segment of finger is thicker when viewed in profile than the middle segment].
  2. increased hyponychial [Lovibond] angle, the angle from the finger to the nail [normally about 160 degrees when seen in profile]
  3. Postive Schamroth sign - obliteration of space between fingers when the nails are placed face to face - the normal finding is a diamond of light coming through because the preserved angle is less than 180 degrees
  4. when palpating the clubbed digits, the increased connective tissue is spongy, and the nail can be easily rocked back and forth by putting alternating pressure on the proximal and distal edges of the nail as if the nail were a see-saw
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6
Q

Define Kussmaul’s respirations

A

regular, rapid, and deep respirations seen in patients with metabolic acidosis [both hyperpnea and tachypnea]

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7
Q

Define Cheyne-Stokes respirations

A

characterized by periods of increasing hyperpnea that peak, then slow to an apeneic period, followed by resumption of breathing and hyperpnea

This is seen in severe congestive heart failure and stroke, seen especially when the patient is sleeping

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8
Q

What can pursed-lip breathing indicate?

A

obstructive lung disease [such as emphysema]

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9
Q

What does the use of accessory muscles during breathing indicate?

A

This is a sign of respiratory difficulty

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10
Q

What accessory muscles are involved in inhalation?

A

sternocleidomastoid, scalene, and intercostal muscles

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11
Q

What accessory muscles are involved in exhalation?

A

abdominal muscles

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12
Q

Define respiratory paradox.

A

This is when the abdomen retracts [moves inward] during inspiration when it should expand outward during inspiration.

This is seen in patients with weaknes or paralysis of the diaphragm.

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13
Q

What may a trachea deviated to one side indicate?

A

May be devaited towards a collapsed lung or away from a pneumothorax [air in the pleural cavity under high pressure], a large pleural effusion, or pneumonia.

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14
Q

Describe where the different lobes project on the chest.

A
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15
Q

Define tactile fremitus

A

the palpable vibrations felt on the chest when patients speak

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16
Q

What may a decreasd fremitus mean?

A

May be dut to fluid, air, or a mass

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17
Q

What may an increased fremitus mean?

A

Felt in pneumonia [sound waves travel better through consolidated lung than air-filled lung]

18
Q

Describe tactile fremitus for lower pitched sounds and higher pitched sounds

A

lower pitched sounds: more fremitus

higher pitched sounds: fainter fremitus

19
Q

Describe the common sounds heard when percussing areas of the body.

A
  1. Flat: the tone/sensation felt when you precuss the thigh
  2. Dull: found wehn percussing over the liver [or over a pleural effusion, a collection of fluid in the pleural space]
  3. Resonant: found over normal lung
  4. Hyperresonant: found over emphysematous lungs
  5. Tympanitic: found over a pneumothorax [similar to the thone over the gastric air bubble]
20
Q

What are the two basic lung sounds when air moves in and out of the airways?

A
  1. vesicular [normal] breath sounds
  2. bronchial [tubular] breath sounds
21
Q

Define vesicular breath sounds

A
  • heard over normal, health lungs
  • inspiratory phase is louder and longer [about 3:1] than the expiratory phase
  • no gap between the two phases
22
Q

Define bronchial breath sounds

A
  • loud in both inhalation and exhalation
  • sound like Darth Vader breathing [tubular quality]
  • may have a gap between the two phases
  • bronchial breath sounds are heard over areas of lung that are fluid filled [as in pneumonia] or collapsed, as in compressed lung tissue above a pleural effusion
  • bronchial breath sounds may also be heard over parasternal and parascaupular areas in healthy patients
23
Q

Define parasternal area.

A

k.

24
Q

Define parascapular area.

A

k

25
Q

What are adventitious breath sounds? How are they divided?

A

Adventitious breath sounds are ADDED lung sounds that may be heard in some patients superimposed upon the basic lung sounds.

They can be divided into discontinuous and continuous sounds

26
Q

What are the discontinuous sounds?

A

crackles

27
Q

What are the continuous sounds?

A

wheezes, rhonchi, stridor, & the rarely heard late inspiratory squeak or squawk

28
Q

Define crackles

A

Crackles are discontinuous popping sounds that are heard primarily during inspiration.

Larger airways: due to secretions bubbling in the airways

Smaller airways: caused by the popping of the airways during inspiration

29
Q

How are crackles differentiated?

A
  1. by quality: fine vs. coarse
  2. where they fall inspiration [early, mid, & end]
30
Q

What do early inspiratory crackles indicate?

A

obstructive pulmonary disease [emphysema, asthma]

31
Q

What do mid inspiratory crackles indicate?

A

disease of mid-sized airways such as bronchiectasis in cystic fibrosis

32
Q

What do end inspiratory crackles indicate?

A

diseases involving smaller airways, such as congestive heart failure, pneumonia, or pulmonary fibrosis. The crackles of pulmonary fibrosis often sound like the tearing of Velcro.

33
Q

When are pleural rubs primarily heard?

A

during expiration

34
Q

Describe wheezes

A
  • continuous
  • musical
  • primarily heard in expiration
  • high-pitched
  • thought to be caused by vibrations in narrowed airways
  • hear in asthma, reactive airways disease, and occasionally in heart failure [cardiac asthma]
35
Q

Describe rhonchi

A
  • continuous
  • musical
  • primarily heard in expiration
  • low pitched
  • thought to be caused by vibrations in narrowed airways
  • hear in asthma, reactive airways disease, and occasionally in heart failure [cardiac asthma]
36
Q

Describe stridor

A
  • continuous
  • inspiratory wheeze
  • heard loudest over neck
  • sign of upper airway obstruction - could mean impending respiratory arrest, so requires immediate attention
37
Q

Describe inspiratory squawk or squeak

A
  • continuous
  • very rare
  • occurs in late inspiration
  • short & musical
  • heard in some types of interstitial lung diseases
38
Q

Define vocal resonance

A
  • the practice of listening over the chest and having the patient speak and listening for abnormal sound transmission
39
Q

When is vocal resonance increased?

A

over areas of pneumonia

40
Q

Define bronchophony

A
  • the finding of increased volume [loudness] of speech in a focal area [suggests consolidation]
41
Q

Define pectoriloquy

A
  • the finding that words are more clearly heard
42
Q

Define egophony

A
  • the finding that when the patient says E it sounds like A or AH

Clinical Skills Lab (4 decks)

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