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Spr2015_Week5 > Pulm Physical Exam > Flashcards

Pulm Physical Exam Flashcards

1
Q

Important pulm vital signs

A

1) HR
2) RR
3) saturation

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2
Q

Inspection of breathing pattern

A

1) RR and pattern
2) Tachypnea (rapid RR)/Hyperpnea/Rapidshallow breathing

3) Kussmaul/Cheyne-Stokes

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3
Q

Kussmaul Respirations describe

A

hyperpnea
rapid, deep breathing
DKA (to incr VE to lower acidosisi)

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4
Q

Cheyne-Stokes describe

A

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

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5
Q

Overall inspection steps

A

1) Vital Signs
2) Breathing Pattern
3) Distress (yes/no)

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6
Q

How do you assess distress

A

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

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7
Q

distinguish tachypnea vs. hyperpnea

A

hyperpnea = incr minute ventilation

tachypnea = incr RR

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8
Q

what type of breathing common in
DKA

Heart Failure

A

Kussmaul

Cheyne-Stokes

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9
Q

A

A

A

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10
Q

A

A

A

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11
Q

other aspects of inspection

A

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

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12
Q

what is clubbing diagnostic for?

A

lung cancer, pulm fibrosis, cystic fibrosis

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13
Q

define paradoxical abd movement (belly breathing)

A

generating so much negative
force with inspiration
using abdominal muscles as expiring to get lungs to shrink down —> pushing abd out

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14
Q

describe pursed lip breathing

when would you see it

A

generating auto-PEEP (back pressure)
to keep airway open during ventilation to get air out

asthma, COPD, emphysema

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15
Q

distinguish central vs. peripheral or acrocyanosis and what that indicates

A

central = hypoxemia

peripheral = poor perfusion of digits

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16
Q

a

A

a

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17
Q

Define tactile fremitus

A

Vibration of chest during speech due to transmitted vibrations
through bronchopulmonary tree (pt says “99”)

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18
Q

when you have decr tactile fremitus what could patient have?

A

1) pneumothroax
2) pleural effusion
3) obstructed bronchus- atelectasis

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19
Q

when increased tactile fremitus with palpation

A

lung consolidation (water, blood, pus)

pneumonia

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20
Q

if trachea is pushed away what is that indicative of

A

large pleural effusion

tension pneumothroax

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21
Q

if trachea is pushed toward what is that indicative of

A

atelectasis
fibrosis
resection

22
Q

if percussion is dull what is that indicative of?

A

1) effusion
2) consoldation
3) atelectasis

23
Q

if percussion is resonant what is that indicative of

A

incr amount of air in pleural space
1) pneumothorax

2) bullae
3) emphysema

24
Q

diaphragmatic excursion mechanism

A

diaphragms are on full expiration (resonant to dull) then on full inspiration

25
Q

what is diaphragmatic excursion indicative of if abnormal?

A

1) unilateral diaphragmatic paralysis

2) problems with the diaphragm

26
Q

describe vesicular breath sounds

when would you hear it?

where would you hear it?

A

1) soft and low pitch
2) heard through inspiration and continue into expiration (stop 1/3 through expiration)
3) heard throughout chest

27
Q

describe bronchovesicular breath sounds

when would you hear it?

where would you hear it?

A

1) moderate pitch and intensity
2) heard during inspiration, brief silent, then again expiration
3) heard over major bronchi

28
Q

describe bronchial breath sounds

where would you hear it?

A

1) high pitched

2) heard over trachea

29
Q

if you hear bronchovesicular and bronchial breath sounds over periphery over lung this indicates?

A

ABNORMAL

pneumonia
atelectasis

30
Q

describe adventitious sounds

1) crackles/rales

A

1) discontinuous and typically during inspiration

2) “velcro sound”

31
Q

what is crackles assoc with?

A

1) pulm edema
2) pneumonia
3) interstitial lung disease/fibrosis

32
Q

describe wheezes

A

1) continuous high pitched
2) musiical during expiraton occassionally inspiratory
3) caused by high airflow through narrowed airway

33
Q

diffuse wheezes suggest

A

airway narrowing

1) asthma
2) bronchiolitis
3) COPD exacerbation
4) localized wheezing suggests focal obstruction

34
Q

describe rhonchi

caused by?

A

1) rumbling sounds more continuous

2) caused by passage of air thru airway partially obstructed by mucous or secretions

35
Q

if you hear bronchial sounds in periphery, then ____

A

abnormal sounds

36
Q

describe egophony

A

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)

37
Q

egophony suggests

A

compressed/fluid filled areas of lung

pneumonia

38
Q

describe stridors

A

1) musical sounds audible without stethoscope
2) inspiratory or expiratory
3) heard over trachea

39
Q

stridor suggests

A

upper airway pathology (trachea, larynx, subglottis)

40
Q

what is inspiratory stridor indicative of

A

laryngeal pathology
1) laryngospasm

2) laryngeal edema
3) subglottic stenosis
4) vocal cord dysfunction

41
Q

what is expiratory stridor indicative of?

A

central airway obstruction

1) tumor obstructing airway

42
Q

which is more emergent inspiratory or expiratory

A

expiratory stridor

43
Q

describe friction rub

A

1) harsh sound

2) heard during inspiration

44
Q

friction rub is due to?

A

pleural inflammation or pleuritis from
1) infection

2) malignancy
3) pulmonary infarct
3) lupus pleuritis

45
Q

friction rub is due to?

A

pleural inflammation or pleuritis from
1) infection

2) malignancy
3) pulmonary infarct
3) lupus pleuritis

46
Q

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

A

cystic fibrosis (obstruction)
clubbing
hyperresonance

crackles and wheezes

47
Q

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

A

emphysema/COPD

smoking history
hyperinflated lungs
wheezing with exacerbations

48
Q

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

A

pneumothorax

49
Q

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
A

pleural effusion

meniscus of fluid on CXR

50
Q

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
A

pleural effusion- likely hemothorax
damage to neurovascular bundle –> bled into pleural space

meniscus of fluid on CXR

Spr2015_Week5 (19 decks)

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