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Physical Diagnosis II > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Kussmaul breathinui

A

Deep and labored breathing

See with metabolic acidosis

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2
Q

Cheyenne-stokes breathing

A

Shallow to deep cycle
Normal when asleep
Abnormal awake: indicates brain damage at cerebral level or drugs

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3
Q

Biot/ataxic breathing

A

Increases intracranial pressure

Indicates damage to medulla

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4
Q

Air trapping

A

Increasing difficulty to get air in and out

Emphysema

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5
Q

What do retractions suggest?

Unilateral?

A

Obstruction to inspiration

Unilateral: obstruction lower in tree, after the branch

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6
Q

What causes paradoxical breathing?

A

Negative intrathoracic pressure is transmitted to the abdomen by a weak diaphragm (phrenic nerve palsy)

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7
Q

What is strider causes by?

A

Laryngeal or tracheal obstruction

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8
Q

What may cause decrease lung expansion?

A 
Broken rib
Obstruction
Muscle strain
Pneumothorax
CF (scarring)
COPD
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9
Q

What may increase vibrations on fremitus?

A

Consolidation

Tumor inside lung

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10
Q

What may cause decrease fremitus?

A

Emphysema (increased air)
Pneumothorax (over air filled space)
Pleural effusion (fluid outside lung)

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11
Q

What may cause a tracheal deviation?

A 
Thyroid tumor
Goiter
Pneumothorax:
-simple: deviated toward affected side
-tension: deviated toward opposite side
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12
Q

The more dense the medium during percussion…the _______ the tone

A

Quieter

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13
Q

Where is tympanic tone heard

A

Gastric bubble

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14
Q

Where is a hyperresonany sound heard

A

Emphysema

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15
Q

Where is a dull sound heard

A

Liver

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16
Q

Where is a flat sound heard

A

Muscle

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17
Q

Where do you start when measuring diaphragmatic excursion

A

T7

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18
Q

What may limit diaphragmatic excursion

A 
COPD (little to exhale)
Emphysema
CF
Phrenic nerve palsy (Guillion Bare)
Abdominal tumor/ascites
Pleuritis
Pneumothorax
Broken rib
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19
Q

What does hyperresonance indicate

A

Hyperinflation

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20
Q

What does dullness indicate?

A

Diminished air exchange

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21
Q

What may cause a dull percussion finding in the lung

A

Consolidation inside lung or insulation outside lung!!

Bronchiogenic carcinoma/tumor
Hemothorax
Pneumothorax over balled up lung
Obesity/increased muscle
Pleural effusion
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22
Q

Where are the right middle and lingua best heard?

A

Axillary region

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23
Q

What are vesicular lung sounds

A

Low pitched, low intensity sounds

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24
Q

What are bronchovesicular sounds

A

Moderate in pitch and intensity

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25
Q

What are bronchial/trachea sounds

A

Highest in pitch and intensity

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26
Q

Where are bronchial/tracheal sounds hear

A

Over the trachea

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27
Q

Where are bronchiovesicular sounds heard

A

Major bronchi

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28
Q

Where are vesicular sounds heard

A

Lesser bronchi, bronchioles and lobes

PERIPHERAL

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29
Q

Are bronchiovesicular and bronchial breath sounds normal if heard over peripheral lung tissue?

A

No

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30
Q

Amorphic breath sounds

A

Similar to sound of blowing over a bottle

Heard with stiff pulmonary cavity
Tension pneumothorax

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31
Q

What are cavernous breath sounds

A

Cave-like

Heard when wall is rigid

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32
Q

What are crackles

A

Velcro’s torn apart

Usually heard on inspiration and are discontinuous sounds

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33
Q

When are crackles heard

A

Bronchitis (early inspiration)

Pneumonia (late on inspiration)

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34
Q

What are rhonchi

A

Snoring sounds usually heard on expiration and are more continuous sounding

Causes by passage of air obstructed by thick secretions, pressure or growth

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35
Q

When are rhonchi heard

A

COPD, bronchiectasis, pneumonia

When passage of air is obstructed by pressure, mucus or growth

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36
Q

What cause crackles (rales)

A

Disrupted passage of air through small airways

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37
Q

What are wheezes and what causes them

A

High-pitched whistle, music like

High velocity air flow through narrow or obstructed airway

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38
Q

When might you hear wheezes

A

Asthma, bronchitis

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39
Q

What does friction rub sounds like

A

Low-pitches grating sounds heard on inspiration and expiration due to inflamed surfaces

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40
Q

What is mediastinal crunch also known as and when do you hear it

A

Hamman sign

Hear when abnormal presence of air in lungs as with mediastinal emphysema

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41
Q

When might you hear bro chop honey, pectoriloquy or egophony

A

Any consisting that causing consolidation of lung tissue (fluid, pus, mass)

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42
Q

What is bronchophony

A

Greater clarity and increased loudness

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43
Q

What is pectoriloquy?

A

Intense bronchophony that even a whisper can be heard through stethoscope

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44
Q

What is egophony

A

Intensity of spoken voice is heard and nasal component that “E” sounds like “A”

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45
Q

When does vocal resonance increase

A

With consolidation

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46
Q

When does vocal resonance decrease

A

Loss of tissue in respiratory tree

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47
Q

What might be the cause of loss of vocal resonance

A

Barrel chest of emphysema

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48
Q

What causes decreased breath sounds

A

Hyperinflated lungs

Fluid/pus accumulated in pleural space

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49
Q

What causes increased breath sounds

A

Consolidation

Masses

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50
Q

What would a hoarse cough indicate

A

Croup

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51
Q

What would a whoop cough indicate

A

Pertussis

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52
Q

What would a dry/brassy cough indicate

A

Tumor

53
Q

Is percussion reliable in infants?

A

Less reliable

54
Q

What is the relationship between head and chest circumference in infants

A

Chest circumference is usually 2-3cm smaller

55
Q

Is coughing rare or frequent in infants?

A

Rare

56
Q

What is stridor and indicator of?

A

Obstruction high in respiratory tree

57
Q

Roundness of chest persisting past _____ year is a possible indication of a _____ problem

A

2 years

Pulmonary

58
Q

A child’s chest is usually ______ resonant than an adults

A

More

59
Q

What breath sounds predominate in a child>

A

Bronchovesicular

60
Q

How does breathing change in a pregnant woman

A

Tidal volume increases. They breathe more deeply. RR stays the SAME

61
Q

What lung percussion sound is common in the elderly

A

Hyperresonance (because of increased A-P diameter)

62
Q

What causes atelectasis?

A

Compression from outside (tumors) or MC is mucus plug post surgery

63
Q

What findings are pertinent in atelectasis?

A

Dull percussion
Decreased fremitis
Decreased breath sounds and possible wheezing, crackles or Thales

64
Q

What is chronic bronchitis considered

A

A COPD

65
Q

What is the number one cause of chronic bronchitis

A

Smoking

66
Q

What are the pertinent findings in bronchitits

A

Wheezing, crackles, rhales

Percussion and fremitis normal

67
Q

What usually causes pleurisy/pleuritis?

A

Pulmonary infection

68
Q

What are the pertinent findings in pleurisy?

A

Decreased breath sounds and fremitis

Friction rub heard

69
Q

What may cause pleural effusion

A 
CHF
Liver or kidney disease
PE
Autoimmune (Lupus/RA)
Infections
Cancer
Pleurisy
70
Q

What are the two main pertinent findings in pleural effusion

A

Decreased fremitus and dull to percussion

71
Q

What are all the findings in pleural effusion

A

Decreased fremitis
Dullness to percussion
Decreased chest wall movement
Contralateral tracheal deviation

72
Q

What causes empyema?

A

Adjacent infections or tissue trauma

73
Q

What is empyema?

A

Purlulent fluid in pleural space

74
Q

What are the pertinent findings in empyema?

A

ABSENT fremitis, dull percussion, decreased breath sounds

75
Q

What causes a lung abscess

A

Aspirating food or poor dental health

76
Q

What are the pertinent findings for lung abcess?

A

Dull to percussion and decreased breath sounds, potentially friction rub

Patient will look obviously ill

77
Q

What are the pertinent findings in pneumonia

A 
Increased fremitis
dull percussion
decreased Breath sounds
Crackles
BRONCHIAL breath sounds
78
Q

What pertinent findings might you find in influenza

A

Crackles and rhonchi

79
Q

What are the pertinent findings in pneumothorax (air between lung and chest wallO

A

Decreased breath sounds
Decreased fremitus
Hyperresonance

80
Q

What are the findings in hemothorax

A

Decreased breath sounds

Dullness to percussion

81
Q

What increase your risk for pulmonary embolism

A 
CHF
CA
SURGERY
Prolonged bed rest
Long trips
Smoking
Supplemental estrogen
82
Q

What does CF affect

A

Exocrine glands, lungs, pancreases and sweat glands

Causing sticky and thick secretions that plug tubes, ducts and passageways

83
Q

What does CF lead to

A 
Brochiectasis
barrel chest
low body mass
Clubbing of the nails (pulmonary dysfunction)
Pulmonary HTN —> for pulmonale
84
Q

What causes a diaphragmatic hernia and what happens

A

Abnormal opening in diaphragm that allows organs from abdomen to move into the chest cavity

85
Q

What side is diaphragmatic hernias most common on?

A

LEFT

86
Q

What are the signs and symptoms of a diaphragmatic hernia?

A 
Breathing issues after birth
Cyanosis
Decreased breath sounds
BOWEL SOUND HEARD IN CHEST
LESS PROTUBERANT abdomen
87
Q

When is epiglottis most common

A

3-7 years old

88
Q

What are symptoms of epiglottis

A 
Fever
Sore throat
Stridor
Painful swallowing
DROOLING
Muffled voice
Neck extended and head forward position
89
Q

What causes croup?

A

Parainfluenza virus

MC 1.5-3 years

90
Q

What does croup cause

A

Swelling of larynx, trachea and bronchi

SEAL-LIKE cough (obstructed breathing)

91
Q

What is tracheomalacia?

A

Lack of rigidity of the trachea

92
Q

What are signs of tracheomalacia

A

“Noisy” breathing
Wheezing
Stridor/respiratory distress
Improves as infant grows

93
Q

What is bronchiolitis

A

Bronchiolar inflammation that leads to hyperinflanation of the lungs

MC in infants under 6 months

94
Q

What causes bronchiolitis

A

RSV

95
Q

What are the symptoms of bronchiolitis

A 
Similar to cold that progresses to difficulty breathing and RETRACTIONS
Wheezing on expiration
Rapid/short breaths
Decreased breath sounds
Hyperresonance
96
Q

What is COPD

A

Nonspecific group that includes cough, chronic and excessive sputum production and dyspnea

97
Q

What does COPD cause

A

Irreversible expiration airflow obstruction

98
Q

What are the three main conditions that are considered COPD

A

Emphysema
Bronchiectasis
Chronic bronchitis

99
Q

What are the findings in emphysema

A 
Decreased chest wall movement
Decreased breath sounds
Crackles, rhales, wheezing
Decreased fremitis
Hyperresonance
Narrowed heart shadow
Increased retrosternal air space
100
Q

What is bronchiectasis?

A

Chronic dilation of bronchi/bronchioles caused by repeated pulmonary infections and bronchial obstruction

101
Q

What is other condition is frequently seen in patients with CF

A

Bronchiectasis

102
Q

What are findings with bronchiectasis

A

Clubbing of nails
LARGE amounts of sputum
Crackles and rhonchi

103
Q

What is the MC cause of walking pneumonia?

A

Micoplasma

104
Q

What is the most common pneumonia in immunocompromised individuals

A

Fun gals

105
Q

What is the most common pneumonia in children?

A

Viral

106
Q

What might a prolonged expiration and bulging on expiration indicate?

A

Airway outflow obstruction or valve-like action of compression by a tumor, aneurysm, or enlarged heart

107
Q

What causes unilateral retraction?

A

A foreign body in the bronchus (MC right)

108
Q

When does retraction of the lower chest occur?

A

Asthma and bronchiolitis

109
Q

When will respiratory rate increase?

A 
Acidosis
CNS lesions (PONS)
Anxiety
Aspirin poisoning
Hypoxia
Pain
110
Q

When will respiratory rate decrease?

A 
Alkalosis
CNS lesions (CEREBRUM)
MG
Narcotic overdose
Obesity (extreme)
111
Q

Primary apnea

A

Self-limited
MC after blow to head
Also after birth when CO2 builds and breathe spontaneously to correct

112
Q

Secondary apnea

A

Breathing stops and will not begin unless resuscitative measures are taken

113
Q

Reflex apnea

A

Nausea provoking vapors/gases inhaled can be involuntary hault to respiration’s

114
Q

Apneustic breathing

A

Inspiration are prolonged and expiration is constrained

PONS controls

115
Q

Obstruction above the glottis

A

Quiet stridor
Muffled voice
Cough not a factor
Head and neck may be awkwardly positioned (extended with retropharyngeal abcess; to affected side with peritonsillar abcess)

116
Q

Obstruction below the glottis

A 
Loud raspy stridor
Hoarse voice
Swallowing not affected
Cough is harsh and barking
Head position not a factor
117
Q

What may pull the trachea to the affected side

A

Volume loss

Fibrosis/atelectasis

118
Q

What causes the trachea to deviate to opposite side

A

Thyroid enlargement

Pleural effusion

119
Q

Inspiration and expiration ratios on bronchial, bronchovesicular and vesicular breath sounds

A
  1. Inspiration longer than expiration
  2. I=E
  3. I=E or E>I (by a little)
120
Q

What breath sound maybe cleared by a cough?

A

Rhonchi

121
Q

Sibilant crackles

A

High-pitched

122
Q

Sonorous crackles

A

Low-pitched

123
Q

Sibilant rhonchi heard with?

A

Smaller bronchi in asthma

124
Q

Sonorous rhonchi heard with?

A

Larger bronchi with tracheobronchitits

125
Q

When might you find newborn have a smaller chest circumference?

A

Intrauterine growth retardation

126
Q

When might you find an infant has a larger chest circumference?

A

Poorly controlled diabetic mother

127
Q

What may cause increased RR?

A

Liver enlargement

Abdominal ascites

128
Q

What may causes decreases RR

A

Neurological impairment
Electrolyte imbalance
Infection
Cardiovascular fitness

129
Q

What is the appropriate ratio of A-P:lateral diameter

A

0.70-0.75

Physical Diagnosis II (6 decks)

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