pulmonary HPI AND PE

Question 1

dyspnea

Answer 1

difficult and labored breathing with SOB

Question 2

important to establish with dyspnea

Answer 2

• present at rest
• walking on level or climbing stairs
• necessary to stop and rest
• what ADL’s bring on dyspnea

Question 3

orthopnea

Answer 3

SOB begins or increases when laying down

Question 4

paroxysmal nocturnal dyspnea

Answer 4

sudden SOB after a period of sleep

Question 5

platypnea

Answer 5

dyspnea increases in the upright posture

Question 6

Kussmaul breathing

Answer 6

deep labored breathing

-a form of hyperventilation

Question 7

kussmaul breathing is associated with

Answer 7

metabolic acidosis

-breathing is rapid and shallow but as acidosis worsens breathing gradually becomes labored and gasping

Question 8

cheyne-stokes respirations

Answer 8

abnormal breathing with progressively deeper and sometimes faster breathing followed by gradual decrease that results in temporary apnea
-this is a repetitive pattern

Question 9

cheyne-stokes is a oscillation of …

Answer 9

ventilation between apnea and hypernea with a crescendo-decresendo pattern and is associated with changing serum partial pressures of oxygen and carbon dioxide

Question 10

rhonchi

Answer 10

course crackles

-coarse rattling caused by secretions (rolling thunderstorm)

Question 11

dx for rhonchi

Answer 11

pneumonia or chronic bronchitis

Question 12

rales

Answer 12

fine crackles

soft high-pitched and very brief sound (velcro opening)

Question 13

rales is associated with

Answer 13

usually indicates an interstitial process such as pulmonary fibrosis or CHF

Question 14

fremitus

Answer 14

vibration transmitted though the body when patient speaks 99

Question 15

two types of fremitus

Answer 15

tactile: vibration intensity felt on the chest wall
vocal: heard with a stethoscope on the chest wall

Question 16

fremitus intensity increases and decreases

Answer 16

increases: consolidation or fibrosis
decreases: fluid or air (effusion, pneumothorax)

Question 17

bronchial space

Answer 17

is upper center chest

Question 18

bronchovesicular space

Answer 18

is the branches of the trachea like a vest for your lung tree - middle chest

Question 19

vesicular space

Answer 19

outer portion of the lung fields

Question 20

adventitious breath sounds

Answer 20

abnormal breath sounds heard during auscultation

• pleural rub
• rales
• rhonchi
• stridor-foreign body
• wheezes

Question 21

anoxia

Answer 21

total absence of oxygen in body tissues

Question 22

pneumothorax

Answer 22

collection of air in the pleural cavity

Question 23

hemothorax

Answer 23

collection of blood in the pleural cavity

Question 24

pleural effusion

Answer 24

abnormal presence of fluid in the pleural cavity

either trauma of spontaneous

Question 25

spontaneous pneumothorax patient description

Answer 25

25 yo white tall skinny male usually smoker walking in with acute onset of SOB

Question 26

underlying pathology for pink puffer

Answer 26

emphysema

Question 27

pathophysiology for pink puffer

Answer 27

destruction of the airway distal to the terminal bronchiole, this includes the gradual destruction of the pulmonary capillary bed and thus decreased inability to oxygenate the blood
-less surface area for gas exchange there is also less vascular bed for gas exchange

Question 28

blue bloater underlying pathology

Answer 28

chronic bronchitis

Question 29

blue bloater pathophysiology

Answer 29

caused by excessive mucus production with airway obstruction resulting from hyperplasia of mucus-producing glands, goblet cell metaplasia and chronic inflammation around bronchi
-unlike emphysema the pulmonary capillary bed is undamaged

Question 30

patient description of blue bloater

Answer 30

age: 40-45
dyspnea: mild
cough: early with copious sputum
overweight & cyanotic
peripheral edema
rhonchi and wheezing
cardiac enlargement

Question 31

patient description for pink puffer

Answer 31

older thin cachectic
severe dyspnea
pursed lip breathing and accessory muscle use
decreased breath sounds
ineffective cough
x-ray: hyperinflation with flattened diaphragm

Question 32

where does the pink come from in pink puffer

Answer 32

increased CO2 retention

Question 33

pectus excavatum

Answer 33

aka sunken or funnel chest

Question 34

pectus carinatum

Answer 34

pigeon chest -prominent bony protrusion of chest

Question 35

barrel chest

Answer 35

determine by looking at the anteriorposterior and transverse chest ratio.

• normal adult is a 1:2
• barrel chested patients is 1:1

Question 36

post-tussive crackles

Answer 36

listen-cough-listen

Question 37

whispered pectoriloguy

Answer 37

bilaterally

increased volume of whisper throughout chest wall

Question 38

egophony

Answer 38

E to A change bilaterally