PE Exam 2 Flashcards
Kussamaul Breathing
Deep, labored sighing respiration
A compensatory response to Metabolic Acidosis
Periodic (Cheyenne-Strokes) breathing
Respiration are interrupted by _______
Cyclic HYPERventilation followed by Compensatory Apnea
Periods of Apnea
Obstructive Breathing
Expiration is prolonged because of narrowed airways
Restrictive Breathing
Reduced lung capacity
Painful respiration
Otherwise normal respiration interrupted by the pain of thoracic movement
Abnormal rate
Reduce CO2 in the blood due to INC rate and depth of respiration
HYPERpnea, HYPERventilation
Dyspnea while laying flat
Orthopnea
Paroxysmal Noctural Dyspnea (PND)
SUDDEN ONSET of Dyspnea while sleeping
Platypnea
Dyspnea worse w/ _______________
Upright posture (Pericarditis)
Signs of Respiratory Compromise
Retractions of the interspaces and
Use of accessory muscles during inspiration
Pursing or Cyanosis of the LIPs
Nasal Flaring
Depression in lower sternum; Compresses the heart and great vessels and may cause murmurs (Pushing away heart, lung, Major vasculature s)
Pectus Excavatum
Pectus Carinatum
Sternum displaced anteriorly
Flail Chest
Multiple rib fractures —> paradoxical movements of the thorax
Fremitus (Increased/louder)
Pneumonia
Fremitus
Decreased or absent
PE, Pneumothorax, COPD, Asthma
Soft and low-pitched sounds heard through inspiration
Vesicular
Louder and high in pitch w/ a short silence between inspiration and expiration
Bronchial
Very loud and high in pitch
Tracheal
Adventitious sounds
Discontinuousm intermittent, nonmusical, brief
Crackles
Pneumonia, Fibrosis, Early CHF, Bronchitis
Continuous, Musical, and Prolonged
Wheezes and Rhonchi (Obstruction)
Relative high-pitched w/ shrill quality
Narrowed airways from Asthma, COPD
Lower-pitched w/ a snoring quality
Rhonchi — Secretions in the larger airways
Marfan;s
Aortic Regurgitation/Dissection
Down’s
ASD/VSD
Turner
Coarctation of aorta
Spondyloarthritides (Ankylosing Spondylitis)
Aortic Regurgitation
Redness on cheeks
Malar Flush
Mitral Stenosis
Yellow lipids around eyes/palm
Xanthomata
HYPERlipidemia
Ring around cornea
Corneal Arcus
Age, HYPERlipidemia
Sings of Infective Endocarditis
Clubbing —
Splinter Hemorrhages — Streak hemorrhages in nailbed
Janeway Lesions — Non-tender macules on hand/fingers
Osler’s Nodes - Tender nodules in fingers
Structure
Needle Tension Pneumothorax —
Chest tube —
Most prominent spinous process —
Inferior tip of scapula —
2 ICS (MCL)
4 ICS (MAL)
C7
7th rib
Lungs
(A)
Apex — _____ above clavicle
Lower border (2)
(P)
Lower border —
Oblique fissures —
2cm above clavicle
6th rib (MCL) & 8th rib (MAL)
(P)
T10 (Lower border)
T3 (Oblique fissures)
Midsystolic, Click, Radiates to Carotid (Carotid Bruits), 2RICS
Aortic Stenosis
Diastolic, 2RICS, Blowing, Carotid pulse (Waterhammer)
Aortic Regurgiation
Midsystolic, 2LICS, Click, Radiate to L Shoulder/Neck
Pulmonic Stenosis
Diastolic, 2LICS, Blowing, Rare
Pulmonic Regurgitation
Diastolic, Erb’s, Blowing, Pulse in neck (Waterhammer)
Aortic Regurgitation
Diastolic, Erb’s, Blowing, Rare
Pulmonic Regurgiation
Midsystolic, Erbs, Cres-Decres w/ Thrill, INC Valsalva/Stand (—Preload)
HCM
Holosystolic, LLSB, Blowing, INC Inspiration
Tricuspid Regurgiation
Mid-diastolic, LLSB, Opening snap
Tricuspid Stenosis
Holosystolic, LLSB, Thrill
VSD
Diastolic (Mid/Late), Apex, Opening Sanp, Decres, Rumbling, Low-pitched
Mitral Stenosis (Bell — Low rumble)
Holosystolic, Apex, Harsh, Radiation to axilla
Mitral Regurgiation
Resonant, Vesicular, Normal Fremitus, Crackles(Late inspiration) wheezes maybe
L HF
Dull to percussion, Bronchial Sounds, Crackles (Late Inspiration), Fremitus (INC)
Lobar Pneumonia
Dull to percussion, Shift toward (Trachea), Absent (Breath sounds), Absent (Fremitus) RU = increases day
Atelectasis partial Lobar Obstruction
Hyperresonant, Decrease/absent (breath sounds), Decreased/absent Fremitus
COPD
Hyperresonant, Decrease/absent (breath sounds), Decreased/absent Fremitus. Tension (Away from Trachea)
Pneumothorax
Resonant (Maybe Hyper)
Wheezing breath sounds
Wheezes (maybe crackles) — Adventitious sounds
Dec/absent (Fremitus)
Asthma
Paradoxical Split (S2)
Syncope + 75 yo
Aortic Stenosis
Paradoxical Split (S2)
Delay on L -> R squeezed so Pulm closes first (not normal) so will the tricuspid
LBBB (MC reason)
NO murmur, Fixed/Wide S2
ASD