Respiratory

Question 1

Hemoptysis

Answer 1

Blood-streaked sputum

Question 2

Orthopnea

Answer 2

Shortness of breath when supine

Question 3

Paroxysmal nocturnal dyspnea

Answer 3

Shortness of breath at night relieved by sitting upright

Question 4

Stridor

Answer 4

Audible high-pitched inspiratory whistling (ominous sign of upper airway obstruction)

Question 5

Inspection

Answer 5

Shape of chest

How the chest moves (symmetry, retractions, accessory muscle use)

Question 6

Palpation

Answer 6

Areas of tenderness or bruising
Respiratory expansion
Crepitus
Fremitus

Question 7

Fremitus

Answer 7

Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks (“99”)

Question 8

Percussion

Answer 8

7 locations bilaterally
Sounds: flat (thigh), dull (liver), resonant (healthy lung), hyperresonant (usually absent), tympanic (puffed cheek)

Diaphragmatic excursion

Question 9

Identify lung sounds by
1.
2.
3.

Answer 9

1. Intensity
2. Pitch
3. Relative duration

Question 10

Vesicular

Answer 10

Soft or low pitched

Question 11

Bronchovesicular

Answer 11

Equal in length with inspiration and expiration, sometimes separated by a silent interval

Question 12

Bronchial

Answer 12

Louder, harsher, higher in pitch

Short silence between inspiratory and exploratory sounds

Question 13

Tracheal sounds

Answer 13

Loud harsh sounds heard over trachea in neck

Question 14

Egophony

Answer 14

Ask patient to say “ee”
Will hear muffled long E

Egophony present if “ee” sounds like “A”, sounds nasal, or there is an E-to-A change

Question 15

Broncophony

Answer 15

Ask patient to say “99”
Normal sounds: muffled and in distinct
Louder sounds are bronchophony

Question 16

Egophony is indicative of

Answer 16

Consolidation

Question 17

Bronchophony is indicative of

Answer 17

Consolidation

Question 18

Whispered pectoriloquy

Answer 18

Ask patient to whisper “99” or “1-2-3”
Normal: faint indistinct whispered voice heard, if at all
Abnormal: louder, clear whispered sounds = whispered pectoriloquy

Question 19

Tachypnea

Answer 19

Rapid shallow breathing

Question 20

Hyperpnea

Answer 20

Rapid deep breathing (e.g. from exercise)

Question 21

Kussmaul breathing

Answer 21

Compensatory overbreathing due to systemic acidosis

Question 22

Cheyne-stokes Breathing

Answer 22

Periods of deep breathing that alternate with apnea (combination of hyperpnea and apnea)

Normal in children and older adults during sleep

Question 23

Ataxic Breathing

Answer 23

Apnea alternates with regular deep breaths which stop suddenly for short intervals

Question 24

Flail Chest

Answer 24

Inspiration: Diaphragm descent decreases intrathoracic pressure —> injured area caves inward
Expiration: area moves outward

Question 25

Consolidation

Answer 25

Alveoli fill with fluid and cellular debris

Question 26

Cough Classifications 1. 2. 3.

Answer 26

1. Acute (< 3 weeks) 2. Subacute (3-8 weeks) 3. Chronic (> 8 weeks)

Question 27

Diagnostic for Asthma

Answer 27

FEV1/FVC

Question 28

Diagnostic for COPD

Answer 28

Spirometry NOT CXR; CXR confirms diagnosis

Question 29

3 Primary Causative Organisms for Pneumonia 1. 2. 3.

Answer 29

1. Streptococcus pneumoniae 2. Haemophilus influenzae 3. Staphylococcus aureus

Question 30

Community-Acquired Pneumonia Decision Rule: ________

Answer 30

CURB-65 ``` Confusion of new onset BUN > 20mg/dL RR > 30 SBP < 90mmHg or DBP <= 60mmHg Age 65 or older ```

Question 31

Diagnostic for PNa

Answer 31

CXR

Question 32

PNA Red Flag

Answer 32

Pleural effusion also present -> refer for possible thoracentesis to rule our empyema