PE of Thorax / Cough Flashcards
Breathing pattern seen in increased ICP; meningitis; stroke
Biot’s
Increased depth and rate of respiration; seen in metabolic acidosis, hyperventilating patients
Kussmaul’s
Apneic followed by gradually increasing depth and ventilation rate
Cheyne-Stokes
Prolonged expiration is seen in
COPD
asthma
severe bilateral pulmonary fibrosis
High pressure / low pH in breathing centers will stimulate this pattern of breathin
Biot’s
Most resistant to fatigue; last to fail in respiration
diaphragm
Breathing caused by heart failure, uremia, drug-induced depression, brain damage
Cheyne-Stokes
Unpredictable, chaotic pattern
Biot’s
Coughing reflex that happens when cleaning ear
Arnold’s nerve stimulaion
Breathing pattern response to accumulation and loss of CO2
Cheyne-Stokes
Pigeon chest; sternum is convex
pectus carinatum
Concave sternum
pectus excavatum
Jugular engorgement is seen in
RVF CHF facial edema engorged UE SVC syndrome (compressed SVC)
Chest shape that explains why right nipple is closer to middle than left
pectus excavatum
Chest deformity: nipples looking in opposite directions
pectus carinatum
Massive atelectasis to the RIGHT results in what tracheal deviation
RIGHT (same side)
atelectasis, PF = ipsilateral
Left pneumothorax results in what tracheal devation
RIGHT (opposite side)
pneumothorax, tumor, pleural effusion = contralateral
Decreased volume of air that is inspired in an affected lung -- seen in pneumothorax pleural effusion, pleural fibrosis, significant atelectasis
inspiratory lag
Pressure between pleural surfaces becomes so high, the lung and mediastinal structures are pushed inward
tension pneumothorax
lung does not slide off smoothly
pleural fibrosis
flail chest =
multiple rib fractures
Tracheal deviation in pleural fibrosis
ipsilateral side
costochondritis is similar to
Tietze syndrome
pinpoint tenderness of ribs =
rib fracture
intercostal pain seen in
pleuritis
empyema
supradiaphragmatic extension of a liver abscess
increased fremitus seen in
pneumonia atelectasis pulmonary edema lung tumors thin chest walls
decreased fremitus seen in
(when air increases, sound is dampened…or solid mass obstructing sound)
COPD, pleural tumors, pleural fibrosis, pleural effusion, massive atelectasis
crackling sensation over skin surface on chest palpitation
crepitus
crepitus is seen in
pneumothorax
tracheostomy
barotrauma
(air escaping to subcu areas)
rule out gas gangrene
Consolidation sound on percussion
dull
COPD, pneumothorax sound on percussino
hyperresonant
High pitched percussion on abdomen or lower left chest (gastric bubble)
tympany
Auscultation I>E
vesicular
Auscultation I<E
bronchial
Auscultation I=E
bronchovesicular, tracheal
Location of bronchovesicular sounds
ICS 1&2, between scapula
Decreased breath sounds:
emphysema
pleural effusion
pneumothorax
obesity
like wheezes but inspiratory
stridor
emergency - large airway obstruction
usually due to secretions change in character (sonorous wheezes)
rhonchi
stridor is seen in
epiglottitis, fbao, laryngeal edema, anaphylactic shock
large airway obstruction
due to forceful (inspiratory) opening of previously closed alveoli
crackles
rhonchi associated with
(thick secretion)
bronchiectasis
bronchitis
dry rales =
pleural friction rubs
pleural friction rub is seen generally when there is
loss of pleural fluids (due to pleuritis)
friction rub between parietal and visceral
When eee sound becomes aaay
egophony (more nasal)
whispered pectoriloquy is seen in
alveolar consolidation
partial atelectasis
Sounds become amplified and more intelligible – absence of normal alveoli cannot muffle voice sounds
Egophony is seen when there is
consolidation above pleural effusion
Most common cause of Upper Airway Cough Synd
postnasal drip
Chronic stimulation of submnucosal lymphoid tissue results in a cobblestone appearance of posterior oropharyngeal mucosa:
UACS
Asthma without wheezing but cough is termed
cough variant asthma
common in children, DDx: COPD
Normal CXR Normal PFT (-) airflow obstruction (-) airway hyper-responsiveness (+) eosinophil
non-asthmatic eosinophilic bronchitis (NAEB)
Non-smoker with normal CXR. Heartburn ater meals.
GERD
Bronchiectasis is rarely affected when it is located where
upper lungs
lower lungs = infection, mucus pooling
Wheezing, dyspnea, cough.
Treated with bronchodilators and steroids. No recurrence.
postinfective bronchial hyper-responsiveness
Cough and normal CXR. What kind of lung cancer?
small lesions such as adenoma
Lack of stretch receptor stimulation induces cough =
restrictive lung diseases
Drug associated with cough
ACE inhibitors
Beta blockers
Nocturnal cough is absent in
psychogenic cough
GERD, asthma, and COPD have nocturnal cough
Paroxysmal coughing can cause
syncope
intrathoracic pressure increases –> pressure on vena cava and aorta –> coronary circulation compromised
What other complication of cough aside from paroxysms can cause syncope?
post-tussive inhalation
