Respiratory Flashcards
Decreased tactile fremitus
Liquid or air between lungs and chest wall
Pleural effusion
Pneumothorax
Empyema
Pleural thickening
Increased tactile fremitus
Solid between lung and chest wall. Increased conduction.
Consolidation
Mass
Fibrosis
Normal TF
Asthma
ILD??
Asymmetrical chest expansion
Pneumothorax Hemothorax Chylothorax Massive effusion Unilateral diaphragmatic paralysis Pleuritis Atelectasis (lung collapse)
Tracheael deviation
Towards: fibrosis, atelectasis
Away: massive effusion, pneumothorax, mass, hyper infiltration, mediastinal mass
Normal percussion (resonant)
Asthma
ILD
Hyper-resonance
Pneumothorax
COPD
Emphysema
Dull percussion note
Stony: Due to fluid or blood in the pleural cavity. Pleural effusion, hemothorax
Relative: consolidation, lung fibrosis, lung collapse, pleural thickening
Decreased air entry
Obstruction
Pneumonia
Bronchial breath sound
Normally heard over 2 ICS, around manubrium
Gap between inspiration and expiration
Inspiration and expiration equal
Higher pitch, louder
Bronchial breath sounds confirmatory tests
Egophony (‘e’ heard as ‘a’)
Bronchophony (sounds heard clearly)
Whispered pectoriloquy (increased loudness of whisper)
Bronchial breath sound ddx
Consolidation
Fibrosis
Cavitation
Upper border of pleural effusion
Vesicular breath sound
Inspiration longer and louder than expiration
No gap between inspiration and expiration
Adventitious (added breath sounds)
Wheezing Crackles/rales/crepitation Rhonci Stridor Pleural friction rub
Wheezing
Lower airway obstruction
High pitched and continuous
Mostly in expiration
Ddx: asthma, TB, COPD, bronchiecstasis
Crackles/rales
At the level of the alveoli. Due to fluid accumulation
Bilateral: ILD CHF Pneumonia Pulmonary edema PCP
Unilateral:
Pneumonia
Bronchiecstasis
Stridor
Upper airway obstruction
Heard more on inspiration
Croup, foreign bodies, aspiration, vocal cord dysfunction, epiglottitis
Rhonci
Fluid accumulation
Fine crackles
Al the level of the bronchi
Lung parenchyma vs. Interstitium
Lung parenchyma: portion of the lung involved in gas exchange (alveoli, alveolar ducts and respiratory bronchioles)
Interstitium: the tissue and space around the alveoli. Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. The
Pulmonary fibrosis
Y
Pulmonary edema
Fluid accumulation in the tissue and air spaces of the lungs. Either due to failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation (cardiogenic pulmonary edema), or an injury to the lung parenchyma or vasculature of the lung (non-cardiogenic pulmonary edema).
Pulmonary consolidation
A region of normally compressible lung tissue that has filled with liquid instead of air.
The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung.
It is considered a radiologic sign.
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts.
The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood.
Pleural effusion
Excess fluid that accumulates in the pleural cavity.
Hydrothorax Hemothorax Chylothorax Pyothorax (Pleural empyema) Urinothorax
Atelectasis
Collapse or closure of a lung resulting in reduced or absent gas exchange.
Pleural tap (thoracentesis)
Below inferior angle of scapula in the 7th ICS, above 8th rib
Light’s criteria
Pleural fluid protein: serum fluid protein
>0.5 exudate
Pleural fluid LDH: serum fluid LDH
>0.6 exudate
Pleural fluid LDH> 2/3 of upper limit of serum LDH
Exudative
Bacterial infection TB Fungal Viral Parasitic Neoplastic Collagen: vascular disease, SLE, RA Pulmonary embolism Hemothorax Chylothorax Drug induced pleural disease Asbestosis Sarcoidosis Post-coronary artery by-pass surgery
Transudative
CHF Cirrhosis Nephrotic syndrome Myxedema Superior vena cava obstruction
Chest tube
Pleural fluid pH <7.2
Pleural fluid glucose <60mg/dL
Positive gram stain or culture of PF
Presence of gross pus in the pleural space
Clubbing of fingers is due to
Long standing lack of oxygen to the peripheral tissues.
Leads to increase in the vascularity of the distal fingers and consequently an increased spin giantess of the nail beds (compensation)
Clubbing ddx
Respiratory: Bronchial ca Lung ca Pulmonary TB CF Chronic suppurations lung diseases (empyema, lung abscess, bronshiecstasis)
Cardiac: cyanotic CHD, IE
GI: IBD (Crohn’s, UC) Malabsorption (Celiac) GI lymphoma Liver cirrhosis
Not a cause of clubbing
Chronic bronchitis
Chest expansion
Around the level of 4th ICS, the nipple
5-8 cm
Diaphragmatic excursion
3-5 cm
Tracheael deviation
Towards: fibrosis, atelectasis
Away: massive effusion, pneumothorax, mass, hyper infiltration, mediastinal mass
Normal percussion (resonant)
Asthma
ILD
Hyper-resonance
Pneumothorax
COPD
Emphysema
Dull percussion note
Stony: Pleural effusion, hemothorax
Relative: Consolidation, fibrosis, lung collapse
Decreased air entry
Obstruction Pneumonia Pleura also effusion Pneumothorax Hemothorax Emphysema
Bronchial breath sound
Normally heard over 2 ICS, around manubrium
Gap between inspiration and expiration
Inspiration and expiration equal
Higher pitch, louder
Bronchial breath sounds confirmatory tests
Egophony (‘e’ heard as ‘a’)
Bronchophony (sounds heard clearly)
Whispered pectoriloquy (increased loudness of whisper)
Bronchial breath sound ddx
Consolidation
Cavitation
Vesicular breath sound
Inspiration longer and louder than expiration
No gap between inspiration and expiration
Adventitious (added breath sounds)
Wheezing Crackles/rales/crepitation Rhonci Stridor Pleural friction rub
Wheezing
Lower airway obstruction
High pitched and continuous
Mostly in expiration
Ddx: asthma, TB, COPD, bronchiecstasis
Crackles/rales ddx
At the level of the alveoli, due to fluid accumulation
Bilateral: Pneumonia, pulmonary edema, CHF, ILD, PCP
Unilateral: Pneumonia, bronchiecstasis
Stridor
Upper airway obstruction
Heard more on inspiration
Croup, foreign bodies, aspiration, vocal cord dysfunction, epiglottitis
Rhonci
Fluid accumulation
Fine crackles
Al the level of the bronchi
Lung parenchyma vs. Interstitium
Lung parenchyma: portion of the lung involved in gas exchange (alveoli, alveolar ducts and respiratory bronchioles)
Interstitium: the tissue and space around the alveoli. Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. The
Pulmonary edema
Fluid accumulation in the tissue and air spaces of the lungs. Either due to failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation (cardiogenic pulmonary edema), or an injury to the lung parenchyma or vasculature of the lung (non-cardiogenic pulmonary edema).
Pulmonary consolidation
A region of normally compressible lung tissue that has filled with liquid instead of air.
The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung.
It is considered a radiologic sign.
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts.
The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood.
Pleural effusion
Excess fluid that accumulates in the pleural cavity.
Hydrothorax Hemothorax Chylothorax Pyothorax (Pleural empyema) Urinothorax
Extrapulmonary TB
Lymph nodes (painless)
Pleura
Genitourinary tract
Asymmetrical chest expansion
Pneumothorax Hemothorax Chylothorax Massive effusion Unilateral diaphragmatic paralysis Pleuritis Atelectasis (lung collapse)
Respiratory cause of chest pain
Pleuritic pain:
TB pleurisy
Para-pneumonic effusion
Pulmonary embolism
Respiratory causes of SOB
Asthma COPD Pneumonia Pulmonary embolism Pneumothorax Diffuse ILD
Cheyne-Stokes breathing
Occurrence of periodic apnea in HF
Kussmaul breathing
DKA
No air entry
Effusion
Pneumothorax
Vesicular breath sound in
Asthma
ILD
Pleural friction rub
Pleuritis
Pleural fibrosis
Mass (pleural??)
Hemorrhagic pleural fluid
TB
Malignancy
Trauma
Pulmonary embolism
Turbid pleural fluid
Anaerobic
Pyogenic pleural fluid
TB
Bacterial
Amoeba (chocolate color)
Opaque/milky color pleural fluid
Thoracic duct trauma
Lymphatic obstruction
Ddx of peripheral cyanosis
Cold weather
Low CO (shock)
Arterial occlusion
Venous occlusion.
Central cyanosis ddx
Respiratory failure
Cyanotic HD
Abnormal Hb pigment
PDA with reversal of shunt
Pleural fluid normal amount
10-20ml
Decreased diaphragmatic excursion occurs in
COPS
Paralysis of diaphragm
Chest X-ray consolidation
Pneumonia
Cancer
Fungal infections
Aspergillosis
Pleural effusion chest X-ray
Homogeneous
Blunting of costophrenic angle
Meniscus
Diaphragm of the stethoscope
High-pitched sounds
S1, S2, pan systolic murmurs
Bell of the stethoscope
S3, S4, diastolic murmurs at the apex
S3 gallop
Left/right ventricular heart failure Mitral regurgitation Constrictive pericarditis Anemia Pregnancy Fever Thyrotoxicosis
S4 gallop
Hypertension
Aortic stenosis
Hypertrophic cardiomathy
Opening snap
Mitral stenosis
Tricuspid stenosis
Gallaveredin phenomenon
Dissociation between the noisy, harsh and musical components of aortic stenosis murmur. Noisy heard at the neck and musical at the apex.
