Pulmonary Flashcards
Kussmaul breathinui
Deep and labored breathing
See with metabolic acidosis
Cheyenne-stokes breathing
Shallow to deep cycle
Normal when asleep
Abnormal awake: indicates brain damage at cerebral level or drugs
Biot/ataxic breathing
Increases intracranial pressure
Indicates damage to medulla
Air trapping
Increasing difficulty to get air in and out
Emphysema
What do retractions suggest?
Unilateral?
Obstruction to inspiration
Unilateral: obstruction lower in tree, after the branch
What causes paradoxical breathing?
Negative intrathoracic pressure is transmitted to the abdomen by a weak diaphragm (phrenic nerve palsy)
What is strider causes by?
Laryngeal or tracheal obstruction
What may cause decrease lung expansion?
Broken rib Obstruction Muscle strain Pneumothorax CF (scarring) COPD
What may increase vibrations on fremitus?
Consolidation
Tumor inside lung
What may cause decrease fremitus?
Emphysema (increased air)
Pneumothorax (over air filled space)
Pleural effusion (fluid outside lung)
What may cause a tracheal deviation?
Thyroid tumor Goiter Pneumothorax: -simple: deviated toward affected side -tension: deviated toward opposite side
The more dense the medium during percussion…the _______ the tone
Quieter
Where is tympanic tone heard
Gastric bubble
Where is a hyperresonany sound heard
Emphysema
Where is a dull sound heard
Liver
Where is a flat sound heard
Muscle
Where do you start when measuring diaphragmatic excursion
T7
What may limit diaphragmatic excursion
COPD (little to exhale) Emphysema CF Phrenic nerve palsy (Guillion Bare) Abdominal tumor/ascites Pleuritis Pneumothorax Broken rib
What does hyperresonance indicate
Hyperinflation
What does dullness indicate?
Diminished air exchange
What may cause a dull percussion finding in the lung
Consolidation inside lung or insulation outside lung!!
Bronchiogenic carcinoma/tumor Hemothorax Pneumothorax over balled up lung Obesity/increased muscle Pleural effusion
Where are the right middle and lingua best heard?
Axillary region
What are vesicular lung sounds
Low pitched, low intensity sounds
What are bronchovesicular sounds
Moderate in pitch and intensity
What are bronchial/trachea sounds
Highest in pitch and intensity
Where are bronchial/tracheal sounds hear
Over the trachea
Where are bronchiovesicular sounds heard
Major bronchi
Where are vesicular sounds heard
Lesser bronchi, bronchioles and lobes
PERIPHERAL
Are bronchiovesicular and bronchial breath sounds normal if heard over peripheral lung tissue?
No
Amorphic breath sounds
Similar to sound of blowing over a bottle
Heard with stiff pulmonary cavity
Tension pneumothorax
What are cavernous breath sounds
Cave-like
Heard when wall is rigid
What are crackles
Velcro’s torn apart
Usually heard on inspiration and are discontinuous sounds
When are crackles heard
Bronchitis (early inspiration)
Pneumonia (late on inspiration)
What are rhonchi
Snoring sounds usually heard on expiration and are more continuous sounding
Causes by passage of air obstructed by thick secretions, pressure or growth
When are rhonchi heard
COPD, bronchiectasis, pneumonia
When passage of air is obstructed by pressure, mucus or growth
What cause crackles (rales)
Disrupted passage of air through small airways
What are wheezes and what causes them
High-pitched whistle, music like
High velocity air flow through narrow or obstructed airway
When might you hear wheezes
Asthma, bronchitis
What does friction rub sounds like
Low-pitches grating sounds heard on inspiration and expiration due to inflamed surfaces
What is mediastinal crunch also known as and when do you hear it
Hamman sign
Hear when abnormal presence of air in lungs as with mediastinal emphysema
When might you hear bro chop honey, pectoriloquy or egophony
Any consisting that causing consolidation of lung tissue (fluid, pus, mass)
What is bronchophony
Greater clarity and increased loudness
What is pectoriloquy?
Intense bronchophony that even a whisper can be heard through stethoscope
What is egophony
Intensity of spoken voice is heard and nasal component that “E” sounds like “A”
When does vocal resonance increase
With consolidation
When does vocal resonance decrease
Loss of tissue in respiratory tree
What might be the cause of loss of vocal resonance
Barrel chest of emphysema
What causes decreased breath sounds
Hyperinflated lungs
Fluid/pus accumulated in pleural space
What causes increased breath sounds
Consolidation
Masses
What would a hoarse cough indicate
Croup
What would a whoop cough indicate
Pertussis
What would a dry/brassy cough indicate
Tumor
Is percussion reliable in infants?
Less reliable
What is the relationship between head and chest circumference in infants
Chest circumference is usually 2-3cm smaller
Is coughing rare or frequent in infants?
Rare
What is stridor and indicator of?
Obstruction high in respiratory tree
Roundness of chest persisting past _____ year is a possible indication of a _____ problem
2 years
Pulmonary
A child’s chest is usually ______ resonant than an adults
More
What breath sounds predominate in a child>
Bronchovesicular
How does breathing change in a pregnant woman
Tidal volume increases. They breathe more deeply. RR stays the SAME
What lung percussion sound is common in the elderly
Hyperresonance (because of increased A-P diameter)
What causes atelectasis?
Compression from outside (tumors) or MC is mucus plug post surgery
What findings are pertinent in atelectasis?
Dull percussion
Decreased fremitis
Decreased breath sounds and possible wheezing, crackles or Thales
What is chronic bronchitis considered
A COPD
What is the number one cause of chronic bronchitis
Smoking
What are the pertinent findings in bronchitits
Wheezing, crackles, rhales
Percussion and fremitis normal
What usually causes pleurisy/pleuritis?
Pulmonary infection
What are the pertinent findings in pleurisy?
Decreased breath sounds and fremitis
Friction rub heard
What may cause pleural effusion
CHF Liver or kidney disease PE Autoimmune (Lupus/RA) Infections Cancer Pleurisy
What are the two main pertinent findings in pleural effusion
Decreased fremitus and dull to percussion
What are all the findings in pleural effusion
Decreased fremitis
Dullness to percussion
Decreased chest wall movement
Contralateral tracheal deviation
What causes empyema?
Adjacent infections or tissue trauma
What is empyema?
Purlulent fluid in pleural space
What are the pertinent findings in empyema?
ABSENT fremitis, dull percussion, decreased breath sounds
What causes a lung abscess
Aspirating food or poor dental health
What are the pertinent findings for lung abcess?
Dull to percussion and decreased breath sounds, potentially friction rub
Patient will look obviously ill
What are the pertinent findings in pneumonia
Increased fremitis dull percussion decreased Breath sounds Crackles BRONCHIAL breath sounds
What pertinent findings might you find in influenza
Crackles and rhonchi
What are the pertinent findings in pneumothorax (air between lung and chest wallO
Decreased breath sounds
Decreased fremitus
Hyperresonance
What are the findings in hemothorax
Decreased breath sounds
Dullness to percussion
What increase your risk for pulmonary embolism
CHF CA SURGERY Prolonged bed rest Long trips Smoking Supplemental estrogen
What does CF affect
Exocrine glands, lungs, pancreases and sweat glands
Causing sticky and thick secretions that plug tubes, ducts and passageways
What does CF lead to
Brochiectasis barrel chest low body mass Clubbing of the nails (pulmonary dysfunction) Pulmonary HTN —> for pulmonale
What causes a diaphragmatic hernia and what happens
Abnormal opening in diaphragm that allows organs from abdomen to move into the chest cavity
What side is diaphragmatic hernias most common on?
LEFT
What are the signs and symptoms of a diaphragmatic hernia?
Breathing issues after birth Cyanosis Decreased breath sounds BOWEL SOUND HEARD IN CHEST LESS PROTUBERANT abdomen
When is epiglottis most common
3-7 years old
What are symptoms of epiglottis
Fever Sore throat Stridor Painful swallowing DROOLING Muffled voice Neck extended and head forward position
What causes croup?
Parainfluenza virus
MC 1.5-3 years
What does croup cause
Swelling of larynx, trachea and bronchi
SEAL-LIKE cough (obstructed breathing)
What is tracheomalacia?
Lack of rigidity of the trachea
What are signs of tracheomalacia
“Noisy” breathing
Wheezing
Stridor/respiratory distress
Improves as infant grows
What is bronchiolitis
Bronchiolar inflammation that leads to hyperinflanation of the lungs
MC in infants under 6 months
What causes bronchiolitis
RSV
What are the symptoms of bronchiolitis
Similar to cold that progresses to difficulty breathing and RETRACTIONS Wheezing on expiration Rapid/short breaths Decreased breath sounds Hyperresonance
What is COPD
Nonspecific group that includes cough, chronic and excessive sputum production and dyspnea
What does COPD cause
Irreversible expiration airflow obstruction
What are the three main conditions that are considered COPD
Emphysema
Bronchiectasis
Chronic bronchitis
What are the findings in emphysema
Decreased chest wall movement Decreased breath sounds Crackles, rhales, wheezing Decreased fremitis Hyperresonance Narrowed heart shadow Increased retrosternal air space
What is bronchiectasis?
Chronic dilation of bronchi/bronchioles caused by repeated pulmonary infections and bronchial obstruction
What is other condition is frequently seen in patients with CF
Bronchiectasis
What are findings with bronchiectasis
Clubbing of nails
LARGE amounts of sputum
Crackles and rhonchi
What is the MC cause of walking pneumonia?
Micoplasma
What is the most common pneumonia in immunocompromised individuals
Fun gals
What is the most common pneumonia in children?
Viral
What might a prolonged expiration and bulging on expiration indicate?
Airway outflow obstruction or valve-like action of compression by a tumor, aneurysm, or enlarged heart
What causes unilateral retraction?
A foreign body in the bronchus (MC right)
When does retraction of the lower chest occur?
Asthma and bronchiolitis
When will respiratory rate increase?
Acidosis CNS lesions (PONS) Anxiety Aspirin poisoning Hypoxia Pain
When will respiratory rate decrease?
Alkalosis CNS lesions (CEREBRUM) MG Narcotic overdose Obesity (extreme)
Primary apnea
Self-limited
MC after blow to head
Also after birth when CO2 builds and breathe spontaneously to correct
Secondary apnea
Breathing stops and will not begin unless resuscitative measures are taken
Reflex apnea
Nausea provoking vapors/gases inhaled can be involuntary hault to respiration’s
Apneustic breathing
Inspiration are prolonged and expiration is constrained
PONS controls
Obstruction above the glottis
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)
Obstruction below the glottis
Loud raspy stridor Hoarse voice Swallowing not affected Cough is harsh and barking Head position not a factor
What may pull the trachea to the affected side
Volume loss
Fibrosis/atelectasis
What causes the trachea to deviate to opposite side
Thyroid enlargement
Pleural effusion
Inspiration and expiration ratios on bronchial, bronchovesicular and vesicular breath sounds
- Inspiration longer than expiration
- I=E
- I=E or E>I (by a little)
What breath sound maybe cleared by a cough?
Rhonchi
Sibilant crackles
High-pitched
Sonorous crackles
Low-pitched
Sibilant rhonchi heard with?
Smaller bronchi in asthma
Sonorous rhonchi heard with?
Larger bronchi with tracheobronchitits
When might you find newborn have a smaller chest circumference?
Intrauterine growth retardation
When might you find an infant has a larger chest circumference?
Poorly controlled diabetic mother
What may cause increased RR?
Liver enlargement
Abdominal ascites
What may causes decreases RR
Neurological impairment
Electrolyte imbalance
Infection
Cardiovascular fitness
What is the appropriate ratio of A-P:lateral diameter
0.70-0.75
