Pulmonary Physical Exam Flashcards
Normal value for respiratory rate?
12-20 breaths per minute
What is the difference between tachypnea and hyperventilation?
Tachypnea - refers to rapid breathing, especially rapid and shallow breathing, but CO2 levels aren’t going to be greatly lowered.
Hyperventilation - a frequency and/or depth to the ventilation without increasing respiratory rate such that the levels of CO2 in the body drop to abnormally low levels
What is the correct order of examining the lungs?
Inspection
Palpation
Percussion
Auscultation
What lobe of the lungs cannot be examined on the posterior side of the chest?
What part of the chest is best to examine the upper lobes of the lungs?
The right middle lobe.
The anterior chest.
What can cause tracheal deviation to the right?
Large pneumothorax of left lung or any increase in volume at the left lung.
Right lobar lung collapse (lung cancer) –> Right lung volume shrinks which pulls trachea to the right.
What is a likely finding in the fingers of patients with chronic pulmonary disease? How can you tell if this feature is present?
Clubbing of fingers (inflated tip of finger with nail bending over)
Line the patients for fingers up back to back if the tips separate forming a “v” then it’s clubbing.
Chronic use of cigarettes can lead to what sign on the fingers.
the fingers will be tinted darkened where they hold the cigarette.
What are the two things you are looking for when palpating a patient for the respiratory exam?
If you can reproduce any pain noted by the patient.
If the lungs are expanding with symmetry (hands on back with thumbs facing each other)
Describe the following percussion sounds:
Increased Resonance
Dullness
Increased Resonance - Sound is more hollow than expected (ie. pneumothorax)
Dullness - Sound is less hollow (more dull) than expected.(ie. fluid)
Percussion can be used to assess the movement of…?
At What point, based on percussion is it located?
This movement should be assessed on one or both sides of the back?
The Diaphragm.
It is located at the point where resonant (lung) sound changes to dull (abdomen) sound
Both sides
What are bronchial and vesicular breath sounds?
Bronchial - Normal sounds heard heard over the trachea
Vesicular - Normal sounds heard heard over the lung fields (parenchyma)
Describe the following abnormal breath sounds:
Whispered pectorlioquy
Egophony
You hear people whispering with stethoscope over lung fields (in pneumonia).
E sounds like A when patient whispers E (in pneumonia)
When looking at a pneumothorax on an MRI, what can help you determine which lung is collapsed?
There won’t be any “interstitial markings” (lil white lines) on the side that’s collapsed.
What does it mean if you hear bronchial breathe sounds over the lung fields?
The lung is infected/has fluid. Indicative of pneumonia.
In a patient presenting with “barrel chest,” what disease should be suspected? Why?
Emphysema. Alveoli “trap” air inside, which expands lungs and subsequently chest wall.
