pulmonary Flashcards

1
Q

kyphoscloliosis

A

can lead to cor pulmonale and portal HTN

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2
Q

horizontal sloped ribs in…

A

obstructive lung diseases (emphysema, COPD, chronic bronchitis, status asthmaticus)

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3
Q

beading of costochondral joints in…

A

rickets! (rachitic rosary)

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4
Q

Hoover’s sign

A

COPD, flattened diaphragm on inspiration, more acute subcostal angle

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5
Q

pectus excavatum

A

sunken, funnel chest

due to Marfan’s, Rickets, Noonans

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6
Q

accessory muscles of breathing

A

inspiration: SCM, scalenes
expiration: abdominal muscles
- if clavicle moves up >5mm=severe obstructive lung disease
- inspiratory retraction of suprasternal and supraclavicular fossa

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7
Q

Cheyne-stokes breathing

A
  • progressively deeper and faster breathing until temporary stop (apnea)
  • due to damage to respiratory centers in brain or heart failure, high altitude
  • poor prognosis
  • swings in cerebral blood flow (swing between alert/agitated and sleepy/slow)
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8
Q

Biot’s breathing

A

groups of quick shallow inspiration followed by period of apnea

  • brainstem damage
  • opiod use
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9
Q

kussmaul breathing

A

deep labored breathing assoc. w/ severe metabolic acidosis (eg. DKA)

DDX: MAKEUPL (Methanol, Aspirin, Ketones, Ethylene glycol, Uremia, Paraldehyde, Lactic Acidosis)

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10
Q

paradoxical respiration

A
  • all or part of lung is deflated during inhalation and inflated during exhalation
  • due to flail chest (rib fractures)
  • diaphragm paralysis
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11
Q

expiratory bulging of intercostal spaces

A

if focal–>pneumothorax

if diffuse–>obstructive disease

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12
Q

tirage breathing

A

inspiratory retraction of intercostal spaces seen w/ focal obstruction

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13
Q

cyanosis

A

ineffective ventilation

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14
Q

pallor, diaphoresis, agitation

A

ineffective oxygenation

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15
Q

symptoms of SVC syndrome

A

shortness of breath, arm or face swelling

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16
Q

Dahl’s sign

A

COPD patients lean forward and rest on knees to breath, calluses above knees

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17
Q

ipsilateral deviation of trachea

A

atelectasis

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18
Q

contralateral deviation of trachea

A

pneumothorax, large pleural effusion

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19
Q

axial fixation of trachea

A

tumor or mediastinal fibrosis

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20
Q

oliver’s sign

A

systolic “tug” seen w/ aortic aneurysm, synchronous with each heart beat

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21
Q

campbell’s sign

A

tracheal descent with inspiration, due to chronic airflow obstruction, seen w. COPD

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22
Q

costochondritis

A

tietze’s syndrome

inflammation of costal cartilage

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23
Q

sternal pain

A

CML or arthritis

24
Q

What is tactile fremitus? What happens in pneumonia?

A
  • compare sides when patient says “eee” or “99”
  • alveolar pneumonia: inc. fremitus
  • bronchopneumonia: dec. fremitus
25
Q

percussion in patients with emphysema, status asthmaticus, or COPD

A

hyperresonant

  • lower pitch
  • louder intensity
26
Q

percussion in patients with pleural effusion

A
  • flat
  • very high pitch
  • soft intensity
27
Q

late inspiratory crackles seen with…

A
  • pulmonary fibrosis–will have vesicular breathing
  • consolidation (pneumonia, hemorrhage)–will have bronchial breathing
  • asbestosis, sarcoidosis, granulomatous d/o
28
Q

mid-inspiratory crackles seen with…

A

bronchiectasis

29
Q

early inspiratory crackles seen with

A

bronchitis

30
Q

What breath sounds will I have if I have a solid consolidation (pleural effusion)?

A

top: vesicular b/c no fluid
middle: bronchial sound
bottom: no sound b/t alveoli totally collapsed

31
Q

stridor

A

inspiratory wheeze

32
Q

vocal cord dysfunction

A

expiratory wheeze; louder over the neck than the lungs

33
Q

asthma

A

wheeze (expiratory alone or insp+exp)
length of wheeze determines severity of asthma (if both inspiratory and expiratory this is bad)
-asthmatics in impending respiratory failure don’t wheeze b/c too weak to generate airflow

34
Q

cardiac asthma

A

wheezing in the presence of LV failure (due to interstitial edema)

35
Q

rhonchi

A
  • early expiratory, over vesicular breathin
  • air flow through narrow airway, due to inspissated secretions (obstructive lung disease)
  • if localized and persistent, worry about endobronchial neoplasm
36
Q

pleural friction rub

A
  • imposed on underlying vesicular breath sound
    1. bacterial pneumonias
    2. collagen vascular diseases
    3. pulmonary infarcts
37
Q

4 reasons why rubs are not crackles

A
  1. rubs are both insp and exp (crackles just insp)
  2. rubs dont’ clear with coughing (crackles do!)
  3. rubs are localized over chest (crackles are bilateral)
  4. rubs are palpable (crackles are not)
38
Q

tachypnea

A

RR>25

  • bad prognosis in hospitalized pts
  • more valuable if absent–>if absent not PE (90% patients with PE have tachy)
39
Q

bradypnea

A

RR<8

  • tiring/hypothyroidism
  • stroke/CNS depression
  • narcotics/sedatives
40
Q

grunting respiration

A
  1. Rale de la mort: preterminal grunting/gurgling by patients too ill to clear respiratory secretions
  2. kids: forced expiration against a closed glottis
41
Q

pursed lip breathing

A

emphysema

  • improves tidal volume
  • slows RR
  • dec. dyspnea
  • overall dec. work of breathing
42
Q

orthopnea

A
  • dyspnea that is relieved by sitting upright and aggravated by lying flat
    1. CHF
    2. massive ascites
    3. COPD/asthma (improves vital capacity and lung compliance)
    4. bullous bi-apical lung disease (keeps perfusion in lower lobes)
    5. pleural effusion, pneumonia, diaphragmatic paralysis (fluid in lungs)
43
Q

pickwickian syndrome

A

obesity hypoventilation

44
Q

paroxysmal nocturnal dyspnea

A

dyspnea relieved by lying down and aggravated in erect position

  • assoc. w/ orthodeoxia: Hb desaturation from upright posture
  • R–>L shunt (intracardiac=ASD or intrapulmonary=bi-basilar disease, PE, pneumonia, effusion)
  • cirrhotics (AV shunting at lung bases)
45
Q

trepopnea

A
  • preference for lateral decubitus position
  • down with the good lung–>unilateral lung collapse
  • down with the bad lung–>lung filled with fluid or if you’re a kid with unilateral lung disease
46
Q

abdominal paradox breathing

A

rocking motion of chest and abdomen due to paralysis or weakening of diaphragm
-predicts respiratory failure

47
Q

respiratory alternans

A

alternate use if diaphragm or intercostal mm

  • rock in one direction then switch to antoher
  • predicts respiratory failure
48
Q

still abdomen

A

diffuse: generalized peritonitis
localize to LLQ: focal diverticulitis
localized to RLQ: appendicitis

49
Q

clubbing

A
  • focal enlargement of CT in ends of fingers and toes
  • never painful
  • diagnostic features: loss of lovibond’s angle, floating nails (inc. sponginess of nailbed), abnormal phalangeal depth ratio

Causes:

  • underlying respiratory d/o (chronic bronchitis but NOT emphysema)
  • GI (cirrhosis, IBD, cancer)
  • Cardiac (endocarditis, congential heart disease)
  • pregnancy
50
Q

hypertrophic osteoarthropathy

A
  • painful and tender periosteal new bone proliferation, often assoc w/ clubbing
  • intrathoracic neoplasm (lymphoma, mesothelioma, metastatic cancer)
  • non-neoplastic pulmonary d/o (CF, bronchiectasis, empyema, abscess)
51
Q

pink puffer

A

thin, uses accessory mm, no clubbing

emphysema

52
Q

blue bloater

A

stocky, pulmonary HTN, coughs up stuff, clubbing
chronic bronchitis
-inc. breath sounds at mouth but dec over chest
-chest can be noisy (early crackles, rhonchi, wheezes) but most clears with coughing

53
Q

bibasilar fine late crackles with no clinical signs of pulmonary disease are considered a sign of…

A

heart failure

posturally induced crackles: PIS have prognostic significance

54
Q

patient presents with cough, fever, sputum and dyspnea

A

Pneumonia

  • paplation: inc. tactile fremitus
  • percussion: dull
  • ausculatation: bronchial breath sounds, late insp. crackles adn egophony
  • diminished breath sounds indicate concomitant pleural effusion
  • poor prognosis: hypothermia, and hypotension
  • good prognosis: improved BP and fever, dec. HR, dec RR
55
Q

wheeze

A

length of wheeze correlates wtih severity (not intensity)
-can be expiratory or insp+exp (not just insp=stridor)
-

56
Q

pulmonary embolism

A
  • tachycardia
  • tachypnea
  • peripheral crackles
  • pleural friction rub
  • distended neck veins (if massive PE!)
57
Q

transmitted voice sounds

A
  1. bronchophony (voice sounds heard over chest in areas remote from bronchi or layrnx)
  2. pectorlioquy (clear words heard over chest)
  3. egophony (bleating and goatlike sounds heard over areas of consolidation)
  4. E-to-A changes
    * indicate that lung parenchyma has become airless and consolidated (bronchi must be open)