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Physical Assessment > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

HPI

A

SOB, cough/choking, sputum/characteristics, wheezing, hemoptysis, pleurodynia, chest/bacl pain, fever/night sweats, wt loss

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2
Q

Related Pulm Hx

A

PMH, PSH, Family Hx, Social Hx, Tobacco use/drugs/ETOH, environment, exposure

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3
Q

New Onset Dyspnea

A

PNA, PTHX, Pl Ef, Peanut/FB, P HTN, Peak seekers, PE, Pump porbs, Psychogenic, poisons

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4
Q

Health Promotion

A

smoking cessation- Inc CAm infertility, preterm birth, SID, low birth wt.

5 A’s: Ask, Advise, Assess, Assist, Arrange

2 drugs to quit:

Nicotine replacement

Buprioprion- norepi/dopa reuptake inh/nicotine rec antagonist

Vareniche- nicotine receptor, partagonist

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5
Q

Plueral Effusion

A

Fluid displaces lung tissue away from costophrenic angle

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6
Q

Plueral Effusion

A

Fluid displaces lung tissue away from costophrenic angle

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7
Q

Thorax Anatomy

A

12 prs ribs

12 thoracic spine

suprasternal notch

manubrioangle

costal angle A/P

clavicular reference points

axillary reference points

Tip of scapula T7, if bent over most prominent cspine 7

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8
Q

Where to listen to which lobe

A

RUL- A/P

RML- A

RLL- P

LUL- A

LLL-P

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9
Q

Fissures

A

Minor: between right lobes

Major: between left lobes

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10
Q

Inspect Thorax

A

Rate, Rhythm, Depth, Effort

Listen to breathing

Shape/Symmetry

Neck/Trachea

AP diameter

Skin- clubbing, cyanosis(lips, nails)

Bony deformities

Retractions

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11
Q

Pectus Carinatum

A

Pigeon Chest

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12
Q

Pectus Excavatum

A

Funnel chest

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13
Q

Accessory Muscle Use

A

Muscles: Scalene, Trapezius, Sternomastoid

Retractions- caused by high work of breathing or airway blockage.

Check top of ribcage and ICS

Bulging between ribs may indicate PTX

Inward mvmt of soft tissue reflects -pressure during forced inspiration

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14
Q

Tracheal Position

A

Deviates to side of less pressure

Deviates toward atelectasis, fibrosis, simple PTX

Deviates away from Pl Eff, Tension PTX

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15
Q

Abnormal Breathing Patterns

A

Obstructive breathing

Ataxic breathing (Biots)

Cheyne-stokes breathing

Kussmaul breathing (deep fast or slow- blow off CO2 from acidosis)

Sighing Respirations

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16
Q

Inspection: Chest Symmetry

A

Equal movement bilaterally

One sided movement only?

Consider: hemidiaphragm paralysis, PTX, Old lung resection, fibrosis

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17
Q

Auscultation Technique

A

Sit up

Deep breathe through mouth

stethescope on skin

TV, Radio, Visitors OFF

Systematic comparision L/R and all lobes

18
Q

Normal Breath Sounds

Bronchial

A

Pitch: high

Amplitude: loud

Duration: I<e></e>

<p>
Quality: harsh or hollow</p>

<p>
Normal location: trachea</p>

<p>
found over high lung fields over fast moving air, mainstem bronchi, trachea</p>

</e>

19
Q

Normal Breath Sounds

Bronchovesicular

A

Pitch: medium

Amplitude: moderate

Duration: I=E

Quality: mixed

Normal location: over major bronchi

20
Q

Normal Breath Sounds

Vesicular

A

Pitch: low

Amplitude: sofr

Duration I>E

Quality: soft blowing

Normal location: peripheral lung fields, posterior and lower areas

21
Q

Adventitious Sounds Discontinuous

Fine Crackles/ Rales

A

fine crackles/rales

Mechansm: inspired air collides with deflated terminal airways

Early: COPD, Chronic Bronchitis

Late: PNA, CHF, Fibrosis, RLD

Deflated airways- fluid pressure(serum, mucus or inf materials) or mech restiction/comp; fine crackles are high pitched and heard on exp.

22
Q

Adventitious Sounds Discontinuous

Course Crackles/ Rales

A

Mechanism: inspired air collides with fluid or secretions in bronchi

examples: P Edema, PNA, Bronchiectasis and Moribund patients

23
Q

Adventitious Sounds Discontinuous

Atelectasis crackles/rales

A

Mechanism: when secretions of alveoli are not aerated (deflated)

Examples: bedridden, postop, depressed respirations

location: axillae, bases

clear/reversible on exam

Fine crackles from opening collapsed alveolar sacs- can resolve temporarily with CDB

24
Q

Adventitious Sounds Discontinuous

Pleural Friction Rub

A

Mechanism: inflammed pleura cause friction during respiration

Example: Pleuritis, TB, malignancy, PE, PNA, viral syndromes( Influenza),

during inspiration

25
Q

Adventitious Sounds Continuous

Wheeze (high pitched/rhonchi)

A

Mechanism: air flow through compressed/swollen airways

predominately in expiration

Examples; COPD, Asthma, tumors, CHF

26
Q

Adventitous Sounds Continuous

Wheeze (low pitched/rhonchi)

A

Mechanism: airflow obstruction by secretions or bronchospasm

clears somewhat with cough/suctioning

Bronchitis- major cause in outpts.

Sonorous, may be coarse as well as low cracles present

27
Q

Adventitious Sounds

Mediastinal Crunch

A

Precordial crackles synchronous with heart beat

Mechanism: mediastinal emphysema (pneumomediastinum)

Examples: postop CV surgery, mech vent, PTX

procedure or pathology that introduces air to MS space

28
Q

Tactile Fremitus

A

refers to palpable vibration when patient speask

used to check symmetry

“99” or “ 1 1 1”

Increased or absent with lobar consolidation, pl eff and obstruction

reflects increased transference of voice through partially filled fluid lung. If + check bronchophony, egophony, and whispered petriloquy

29
Q

Percussion

A

determines if underlying structure is air, fluid or solid

vibrates tissue and chest wall

symmetrical or generalized

best used to ID pl eff, empyema, PTX

normal: resonant
dull: consolidation (acculmulation pus, cellular debris with PNA)
flat: fluid filled (Pl Eff, some PTX, HTX)

30
Q

Percussion Sounds

A

Flat

Dull

Resonant

Hyperresonant

Typmanic

Uses: Diaphragm excursion, Pl Eff, PTX

31
Q

Alteration of Breath/Voice Sounds

A

Bronchial BS: loud/high pitched- lobar PNA

Egophony: EE to AY changes- with consolidation (PNA)

Bronchophony: louder/clear with consolidation (PNA)

Whispered Pectoriloquy: 1-2-3 whispered- sounds clear/loud with consolidation (PNA)

32
Q

Lobar PNA

A

Percussion: dull

TF: increased

Bronchophony, Egophony, WP- present

Abn bronchial sounds

consolidation of infection (mucus, bacterial material, cellular debris)

33
Q

Pleural Effusion

A

Percussion: dull to flat

TF: decr or absent

B, E, WP: may be present near top

BS- decreased

Fluid from inc Pl pressure from CHF transudative or inf/CA- exudative

Fill pl space between visceral(lung tissue) and parietal(chest wall), compressing lung parenchyma, lose BS at base often unilat.

34
Q

Pneumothroax (PTX)

A

Percussion: hyperresonant

TF: dec or absent

B, E, WP: decr or absent

BS: absent

Lung collapse(spont/iatrogenic); pleural space is partly air filled->compresses lung tissue- fluid filled space dull(effusion), air filled space hyperresonant

35
Q

COPD

A

Percussion: hyperresonant

TF: decrea

B, E, WP- decreased

BS: decreased with prolonged expiration

Alveolar walls broken down, small air spaces become large with less surface area for gas exchange but more air trapping and decr exp flow= obstr disease

36
Q

Atelectasis

A

Percussion: dull

TF: decr

B, E, WP: decr/absent

BS: decr/vesicular

Collapsed alveoli at bases- not air/fluid filled, but dull to percussion, no voice transfer

37
Q

Clubbing of digits

Osteoarthopathy

A

Early: nail base spongy, angle close to 180 degrees

Late: nail base elevated or swollen, nail angle greater than 180 degrees

38
Q

Pneumonia

A

Air space disease and consolidation. Space filled with bacteria or other microorganisms/pus

Other causes of air space filling not distinguishable radiographically would be fluid: inflammatory, cancer cells, protein (alveolar proteinosis), and blood (pulm hemmorghage).

PNA not associated with volume loss

CXR: air space opacity, lobar consolidation or interstitial opacities.

Masses are well defined

PNA may have associated parapneumonic effusion

39
Q

PNA- CXR findings

A

Lobar: pneummococcal, entire lobe consolidation/ air bronchograms common

Lobular: Staphlococcus, multifocal, patchy, sometimes wo bronchograms

Intersititial: Viral/mycoplasma, latter starts perihilar and can become confluent and/or patchy as disease progresses, no air bronchograms

Aspiration PNA: follow gravity flow, imp consciousness, post anestesia, common with alcoholics, debilitated, demented, anerobic: bacterorides, fusobacrerium

Diffuse pulm inf: community acquired(mycoplasma), nosocomial(pseudomonas, debilitated, mech vents, high mortaltiy rate, patchy opacity, caviation, ill-defined nodular), immunocompromised host(bacterial, fungal, PCP)

40
Q

Atelectasis vs PNA

A

Atelectasis: volume loss, assoc ipsilateral shift, linear wedge shaped, apex at hilum.

PNA: Normal/inc volume, no shift, or if present contralateral, consolidation, air space process, not centered at hilum

Air bronchograms can occur in both

41
Q

Cough

A

acute < 3 weeks

subacute 3-8 weeks

chronic > 8 weeks

Physical Assessment (7 decks)

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