Pulm Physical Exam Flashcards
Important pulm vital signs
1) HR
2) RR
3) saturation
Inspection of breathing pattern
1) RR and pattern
2) Tachypnea (rapid RR)/Hyperpnea/Rapidshallow breathing
3) Kussmaul/Cheyne-Stokes
Kussmaul Respirations describe
hyperpnea
rapid, deep breathing
DKA (to incr VE to lower acidosisi)
Cheyne-Stokes describe
cyclic breathing
brain doesn’t react as quickly to changes in CO2 = apnic breathing
brain senses high CO2
so start breathing with pursed lips, rapid breathing, then brain recog low CO2
then breathing slows down (time delayed changes in CO2
Overall inspection steps
1) Vital Signs
2) Breathing Pattern
3) Distress (yes/no)
How do you assess distress
1) yes or no = speaking sentences or dyspenea
2) accessory muscle use
3) tripodding = using arms to open up thoracic cage
4) paradoxical abdo movement
5) pursed lip breathing
distinguish tachypnea vs. hyperpnea
hyperpnea = incr minute ventilation
tachypnea = incr RR
what type of breathing common in
DKA
Heart Failure
Kussmaul
Cheyne-Stokes
A
A
A
A
other aspects of inspection
1) cyanosis (central vs. peripheral or acrocyanosis
2) clubbing (lung cancer, pulm firosis, cystic fibrosis
3) body habitus
4) skeletal shape (scoliosis, kyphosis, straight spine, pectus ecavatum or carinatum
what is clubbing diagnostic for?
lung cancer, pulm fibrosis, cystic fibrosis
define paradoxical abd movement (belly breathing)
generating so much negative
force with inspiration
using abdominal muscles as expiring to get lungs to shrink down —> pushing abd out
describe pursed lip breathing
when would you see it
generating auto-PEEP (back pressure)
to keep airway open during ventilation to get air out
asthma, COPD, emphysema
distinguish central vs. peripheral or acrocyanosis and what that indicates
central = hypoxemia
peripheral = poor perfusion of digits
a
a
Define tactile fremitus
Vibration of chest during speech due to transmitted vibrations
through bronchopulmonary tree (pt says “99”)
when you have decr tactile fremitus what could patient have?
1) pneumothroax
2) pleural effusion
3) obstructed bronchus- atelectasis
when increased tactile fremitus with palpation
lung consolidation (water, blood, pus)
pneumonia
if trachea is pushed away what is that indicative of
large pleural effusion
tension pneumothroax
if trachea is pushed toward what is that indicative of
atelectasis
fibrosis
resection
if percussion is dull what is that indicative of?
1) effusion
2) consoldation
3) atelectasis
if percussion is resonant what is that indicative of
incr amount of air in pleural space
1) pneumothorax
2) bullae
3) emphysema
diaphragmatic excursion mechanism
diaphragms are on full expiration (resonant to dull) then on full inspiration
what is diaphragmatic excursion indicative of if abnormal?
1) unilateral diaphragmatic paralysis
2) problems with the diaphragm
describe vesicular breath sounds
when would you hear it?
where would you hear it?
1) soft and low pitch
2) heard through inspiration and continue into expiration (stop 1/3 through expiration)
3) heard throughout chest
describe bronchovesicular breath sounds
when would you hear it?
where would you hear it?
1) moderate pitch and intensity
2) heard during inspiration, brief silent, then again expiration
3) heard over major bronchi
describe bronchial breath sounds
where would you hear it?
1) high pitched
2) heard over trachea
if you hear bronchovesicular and bronchial breath sounds over periphery over lung this indicates?
ABNORMAL
pneumonia
atelectasis
describe adventitious sounds
1) crackles/rales
1) discontinuous and typically during inspiration
2) “velcro sound”
what is crackles assoc with?
1) pulm edema
2) pneumonia
3) interstitial lung disease/fibrosis
describe wheezes
1) continuous high pitched
2) musiical during expiraton occassionally inspiratory
3) caused by high airflow through narrowed airway
diffuse wheezes suggest
airway narrowing
1) asthma
2) bronchiolitis
3) COPD exacerbation
4) localized wheezing suggests focal obstruction
describe rhonchi
caused by?
1) rumbling sounds more continuous
2) caused by passage of air thru airway partially obstructed by mucous or secretions
if you hear bronchial sounds in periphery, then ____
abnormal sounds
describe egophony
1) change in timbre but not pitch or volume
2) patient say E to A
3) occurs over compressed/fluid filled areas of lung (pneumonia)
egophony suggests
compressed/fluid filled areas of lung
pneumonia
describe stridors
1) musical sounds audible without stethoscope
2) inspiratory or expiratory
3) heard over trachea
stridor suggests
upper airway pathology (trachea, larynx, subglottis)
what is inspiratory stridor indicative of
laryngeal pathology
1) laryngospasm
2) laryngeal edema
3) subglottic stenosis
4) vocal cord dysfunction
what is expiratory stridor indicative of?
central airway obstruction
1) tumor obstructing airway
which is more emergent inspiratory or expiratory
expiratory stridor
describe friction rub
1) harsh sound
2) heard during inspiration
friction rub is due to?
pleural inflammation or pleuritis from
1) infection
2) malignancy
3) pulmonary infarct
3) lupus pleuritis
friction rub is due to?
pleural inflammation or pleuritis from
1) infection
2) malignancy
3) pulmonary infarct
3) lupus pleuritis
what does he have? why?
15 year old patient
incr SOB
multiple episode of pneumonia
chronic production of sputum
dyspneic
speakng sentences with RR of 28
sat of 88%
incr resonance on percussion
diffuse expiratory wheezes
scattered crackles on auscultation
clubbing of fingers
CXR = port placement
cystic fibrosis (obstruction)
clubbing
hyperresonance
crackles and wheezes
what does he have?
60 y/o
incr SOB
multiple episodes of bronchitis
chronically produce sputum
smoke PPD x40 yrs
dyspneic speaking senctences
RR = 28
88% sat on RA
tripodding and barrell chested
incr resonance on percussion
diffuse expiratory wheezes and scattered rhonchi
CXR shows long chest cavity vertically
more ribs than usual
diaphragm is flat
emphysema/COPD
smoking history
hyperinflated lungs
wheezing with exacerbations
what does she have?
50 y/o incr SOB
drinks most days and last week fell on sidewalk
since then, more SOB and pain on right chest
dyspneic speaking sentences
RR = 28
sat = 90% on RA
normal breath sounds on left
diminished sounds on right
asymmetry of chest with right chest being larger than left
decr fremitus and hyper-resonance on percussion of right chest
CXR shows pneumothorax
pneumothorax
50 y/o incr SOB
drinks most days and last week fell on sidewalk
since then, more SOB and pain on right chest
RR = 28 90% on RA normal breath sounds on right diminished sounds on left decr fremitus dullness on percussion on left chest 1/2 way up from best
pleural effusion
meniscus of fluid on CXR
50 y/o incr SOB
drinks most days and last week fell on sidewalk
since then, more SOB and pain on right chest
RR = 28 90% on RA normal breath sounds on right diminished sounds on left decr fremitus dullness on percussion on left chest 1/2 way up from best
pleural effusion- likely hemothorax
damage to neurovascular bundle –> bled into pleural space
meniscus of fluid on CXR
