OSCE 4: Respiratory Exam Flashcards

1
Q

What is the correct order of a respiratory exam?

A

Inspection
Palpation
Percussion
Auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is tripoding?

A

Patients with obstructive lung diseases will tend to sit leaning forward with shoulders elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In what illnesses can clubbing be seen in?

A
Congenital heart disease
Interstitial lung disease
Bronchiectasis
Pulmonary fibrosis
Lung abscess
Inflammatory Bowel Disease (IBD)
Malignancies (lung cancer)
Cystic fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is tactile fremitus?

A

Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is tactile fremitus more prominent?

A

Interscapular area

  • more prominent on the right than the left
  • disappears below the diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In what disease states is there decreased or absent tactile fremitus?

A
COPD
Pleural effusions
Fibrosis
Pneumothorax
Thick chest wall
Infiltrating tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In what disease states is there increased tactile fremitus?

A

Pneumonia

-due to consolidated tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of percussion is expected in a healthy lung?

A

Resonant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If fluid or solid tissue replace air-containing lungs, what type of percussion would be expected?

A

Dull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can cause dullness in lungs?

A

Lobar pneumonia
Pleural accumulations (effusion, hemothorax, pus, fibrous tissue)
COPD/emphysema
Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a normal diaphragmatic excursion?

A

3-5.5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe vesicular breath sounds.

A

Soft and low pitched

-heard through inspiration and about 1/3 of expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where are vesicular breath sounds heards?

A

Most of lungs (parenchyma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe bronchovesicular breath sounds.

A

Intermediate in intensity and pitch

-heard equally in inspiration and expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where are bronchovesicular breath sounds heards?

A

Heard best in 1st and 2nd interspaces anteriorly and between the scapulae posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe bronchial breath sounds.

A

Loud and high pitched

-expiratory sounds heard longer than inspiratory

17
Q

Where are bronchial breath sounds heards?

A

Heard best over manubrium (larger proximal airways)

18
Q

Describe tracheal breath sounds.

A

Very loud and high pitched

-Heard equally in inspiration and expiration

19
Q

What are crackles/rales?

A

Discontinuous, intermittent, nonmusical, brief

  • fine: soft, high-pitched, brief
  • coarse: louder, lower in pitch
20
Q

Where are crackles heard?

A
Pneumonia
Fibrosis
Early heart failure
Bronchitis
Bronchiectasis
21
Q

What are wheezes?

A
  • Continuous; musical quality and prolonged

- Relatively high pitched, musical, hissing or shrill quality

22
Q

Where are wheezes heard?

A
Narrow Airways: 
Asthma
COPD
Bronchitis
Heart failure
23
Q

What are rhonchi?

A

Relatively low-pitched, snoring quality

24
Q

What is stridor?

A

High pitched wheeze predominantly inspiratory in nature

-louder in neck than over chest wall

25
Q

What does stridor indicate?

A

Partial obstruction of larynx or trachea

-medical emergency: immediate attention needed

26
Q

What is pleural friction rib?

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

27
Q

What does bronchophony indicate?

A

Consolidation

-ex: pneumonia

28
Q

What is whispered pectoriloquy?

A

Whispers are hard louder and cleared during auscultation

-lobar pneumonia