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PCM Midterm 2020 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is hypopnea

A

Decreased depth (shallow) and rate (slow) of respiration

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2
Q

Bradypnea

A

Regular rhythm but slower than normal rate (RR < 14/min)

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3
Q

Hyperpnea

A

Increased depth (deep) of breathing and rate (fast) of respiration (normal in exercise)

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4
Q

tachypnea

A

Rapid breathing (RR>20-25/min)

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5
Q

dyspnea

A

Feeling short of breath

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6
Q

hypoxia

A

Deficiency in the amt of O 2

reaching the tissues

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7
Q

hypoxemia

A

oxygen deficiency in arterial blood

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8
Q

apnea

A

no breathing

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9
Q

Atelectasis

A

collapse of lung tissue that affects the alveoli from normal O2 absorption

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10
Q

Pleximeter finger

A

hyperextended middle finger of non-dominant hand in percussion

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11
Q

Plexor finger

A

“tapping” finger, dominant hand, for percussion

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12
Q

Where do you insert:

1) Needle thoracentesis
2) Chest tube

A

1) Needle thoracentesis: 2nd IC space, midclavicular for pressure and then 7th for fluid aspiration
2) Chest tube: 4th IC mid or anterior axillary line

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13
Q

Where is the lower margin of the endotracheal tube on a chest xray?

A

T4

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14
Q

What is the 7th IC space a landmark for?

A

Thoracentesis for fluid aspiration

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15
Q

What are some respiratory symptom considerations?

A 
Chest pain
Shortness of breath:
 (SOB or dyspnea) with or without activity 
 Cough (productive? color?)
  Wheezing
  Hemoptysis (coughing up blood)
  Asthma 
 Pneumonia
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16
Q

What is the order of a lower respiratory track exam?

A

inspection
palpation
percussion
auscultaiton

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17
Q

Explain a puls Ox test. What are you measuring? What may interfer with this? What causes a bad wave?

A

measures peripheral arterial oxygen saturation (SpO 2)
interference from: Hypothermia (vasoconstriction and shivering)
bad wave caused by: Improper placement, hypoperfusion, hypothermia, motion artifact

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18
Q

Explain an end tidal CO2 test. What are you measuring? What may interfer with this? What causes a bad wave?

A

Measures ventilation, non-invasive measurement of the partial pressure of CO2 in exhaled breath as the CO2 concentration over time
NORMAL PETCO2, PaCO2 35-40 mmHg

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19
Q

What other things should you look at during physical exam?

A
  1. Sitting position and breathing
    pattern.
  2. Use of accessory Muscles
  3. Color of fingers and lips. Shape of nails.
  4. Breathing thru pursed lips.
  5. Ability to speak
  6. Chest deformities
  7. Spinal deformities
  8. Is the trachea in the mid-line
  9. Chest excursion
  10. Tactile fremitus
  11. Percussion
  12. Lung Sounds
  13. Lymphadenopathy
20
Q

What is a normal breathign like? rate, rhythm, depth, and effort

A

Normal = 14-20 times/min, Regular,

Quiet, No distress or labor

21
Q

What is cyanosis indicative of?

A

 Bluish discoloration of skin and mucus membranes resulting from inadequate oxygenation of the blood.

22
Q

What can a tracheal deviation indicate?

A

BIG ONE: Tension pneumothorax

also seen with:
Pleural effusion
Atelectasis
Mass

23
Q

What causes clubbing of nails?

A 
Congenital heart disease 
Interstitial lung disease 
Bronchiectasis 
Pulmonary fibrosis 
Cystic fibrosis 
Lung abscess 
Malignancy (Lung cancer) 
Inflammatory Bowel Disease
24
Q

What is the difference between chronic bronchitis and emphysema (THINK: pink puffer and blue bloater)

A

CB: productive cough for 3+ months overweight, cyanotic, elevated hemoglobin, peripheral edema, coughing, wheezing
EMPH: older, thin, severe dyspnea, quiet chest, hyperinflation on XRAY

25
Q

What does assymetrical chest expansion mean? retraction? unilateral lagging?

A

Asymmetrical expansion: pleural effusion
Retraction: severe asthma, COPD, or upper airway obstruction (stridor?)
Unilateral lagging: pleural disease (asbestosis, trauma, or phrenic nerve damage)

26
Q

What is accessory muscle use? When is it seen?

A

Sign of respiratory distress Can see in Asthma, COPD, Airway obstruction, Viral illness (RSV)

27
Q

How do you check of symmetrical thoracic expansion?

A

Place thumbs at level of 10th ribs, fingers loosely grasping and parallel to lateral rib cage, slide them medially just enough to raise a loose fold of skin on each side bw your thumb and spine
Ask the patient to inhale deeply, watch the distance bw your thumbs as they move apart during inspiration and feel for the range and symmetry of the rib cage as it expands and contracts

28
Q

What is tactile fermitus? When is it decreased/absent? When is it increased?

A

Palpable vibrations (use ball of hands or ulnar surface), have patients say 99 or 1-1-1-

Decreased or absent: COPD, pleural changes
increased: pneumonia (consolidation)

29
Q

What does it mean when your percussion of the lungs is dull and not resonant?

A

Fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers
• Lobar pneumonia (alveoli filled with fluid and blood cells)
• Pleural accumulations: emphysema

30
Q

What does it mean when your percussion of the lungs is hyperresonant and not resonant?

A

Chronic bronchitis COPD (especially emphysema) • Asthma

31
Q

What does it mean when your percussion of the lungs is hyperresonant unilaterally and not resonant?

A

• Large Pneumothorax • Large air-filled bulla in lung (COPD/Emphysema)

32
Q

What is the normal diaphragmatic excursion? What is asymmetry indicative of?

A

3-5.5 cm

 Pleural effusion
 High diaphragm secondary to: atelectasis or phrenic nerve paralysis

33
Q

What does STRIDOR indicate?

A

Generally an inspiratory sound but can be expiratory or biphasic. Result form a narrowing in the upper airway
Common Causes  Croup  Epiglottitis  Upper airway foreign body  anaphylaxis

34
Q

What does WHEEZING indicate?

A

Generally an expiratory sound but can be inspiratory or biphasic Continuous musical sounds Caused by rapid airflow through a narrowed bronchial airway
Common Causes  Reactive airway disease (RAD)  Asthma  COPD

35
Q

What do CRACKLES indicate?

A

An inspiratory sound Continuous musical sounds Thought to be caused by small airway closed during expiration, “popping” open during inspiration

Common causes  Pneumonia, CHF, Atelectasis, pulmonary fibrosis, bronchiectasis, COPD, Asthma

36
Q

What is atelectasis? When do you see it? What helps it?

A

the loss of lung volume due to the collapse of lung tissue (alveoli)
Can be seen post-surgery  Post surgical fever consider atelectasis as the cause

IS(incentive spirometer) - helps with atelectasis, treatment and prevention

37
Q

What does the incentive spirometer do?

A

Breath out all the way, breath in slowly and as deep as you can, move the ball inside the spirometer as high as you can. when you can’t breathe in anymore, hold breath for 2-5 seconds

38
Q

What is normal vocal resonance like?

A

 words are muffled and indistinct to auscultation
 whispered words are faint and indistinct, if heard at all
 when patient says “ee”, you hear a muffled long E on auscultation

39
Q

What is bronchopony?

A

spoken words get louder

40
Q

What is whispered pectoriloquy

A

whispered words are louder and clearer during auscultation

41
Q

What is egophony?

A

when patient says “ee” it sounds like “A” (which is nasal and localized)

42
Q

What is a pulmonary function test?

A

AKA sit inside a box and see how well your lungs work:

helpful to diagnose obstructive vs restrictive, NONINVASIVE

43
Q

What are the A-I for Chest Xrays

A 
A - Adequate, Airway
Bones
Cardiac Size
Diaphragms
Effusions, Endotracheal Tube, EKG
Fields, Fissures, Foreign Body
Great vessels
Gastric bubble
Hilar masses
Impression
44
Q

What do you percuss/auscultation on chest? What spots?

A

2 anterior posts, 1 right middle post, 4 posterior posts

45
Q

What do these sound like:

1) vesicular breath sounds
2) bronchovesicular sounds
3) bronchial sounds
4) tracheal

A

1) vesicular breath sounds: soft, low pitched, heard through inspiration, 1/3 of expiration
2) bronchovesicular sounds: intermediate intensity and pitch, inspiration=expieration
3) bronchial sounds: loud and high pitched, expiratory > inspiratory
4) tracheal: loud, high pitched inspiration=expiration

PCM Midterm 2020 (6 decks)

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