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PD Block 2 > Respiratory Exam > Flashcards

Respiratory Exam Flashcards

1
Q

Angle of Louis

A

Manubriosternal junction

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2
Q

Respiration

A

Movement of air back and forth from the alveoli to the outside environment, gas exchange across the alveolar pulmonary capillary membranes, and circulatory system transport of oxygen to, and carbon dioxide from, the peripheral tissues. Purpose is to keep the body adequately supplied with O2, and protected from accumulation of CO2

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3
Q

Ventilation

A

Purpose is to move air in and out of the lungs through inspiration and expiration. Volume of air exchanged in one ventilation cycle is referred to as tidal volume.

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4
Q

Inspection (Resp. Exam)

A

Breathing: rate, depth, pattern, audible sounds (grunting, wheezing, etc), distress
Thorax: shape and symmetry, AP diameter, spinal curvature (lordosis, scoliosis, kyphosis)
Other: clubbing, mediastinal and tracheal position

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5
Q

Palpation (Resp. Exam)

A

Respiratory expansion using hands, tactile fremitus (symmetry), any painful areas?

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6
Q

Percussion (Resp. Exam)

A

Over intercostal spaces, lung fields comparing side to side, diaphragmatic excursion

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7
Q

Auscultation (Resp. Exam)

A

Breath sounds using diaphragm, deep breathing with mouth open, adventitious sounds, timing, location, number and change, vocal fremitus

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8
Q

Assessment of respiratory rate and pattern

A

Mouth/nose breather, pattern, Kussmaul, Cheyne-Stokes, hyperpnic, apnic, bradypnic, etc.

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9
Q

General percussion notes elicited on the chest

A

Flatness: soft intensity, high pitch, short duration (large pleural effusion)
Dullness: medium intensity, medium pitch, medium duration (lobar pneumonia)
Resonance: Loud intensity, low pitch, long duration (simple chronic bronchitis, normal lung)
Hyperresonance: Very loud intensity, lower pitch, longer duration (emphysema, pneumothorax)
Tympany: Loud intensity, high pitch (large pneumothorax)

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10
Q

Tracheal breath sounds

A

Location: Trachea, neck
Sound: Relatively high pitched, harsh, ‘darth vader’ equal inspiration and expiration

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11
Q

Bronchial breath sounds (Tubular)

A

Location: Manubrium if heard at all
Sound: relatively high pitched, quieter, shorter inspiration, longer and louder expiration. If heard elsewhere patient may have consolidation.

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12
Q

Bronchovesicular breath sounds

A

Location: 1st and 2nd interspaces anteriorly, and between the scapulae
Sound: Medium pitched, equal inspiration and expiration

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13
Q

Vesicular breath sounds

A

Location: most of the lungs, normal finding.
Sound: soft, relatively low pitched sounds, long inspiration, short expiration

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14
Q

Adventitious breath sounds

A

Crackles/rales, wheezes, ronchi, stridor, pleural friction rubs

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15
Q

Vocal fremitus

A

Technique: ‘99’ while listening to lungs
Interpretation: generally done in area where abnormality was found upon inspection, palpation or percussion), sounds are normally muffled and indistinct

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16
Q

Egophony

A

‘Voice of the goat’
Say ‘EEEE’
Abnormal finding if it sounds like ‘AAA’ upon auscultation; indicates emphysema

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17
Q

Whispered Pectoriloquy

A

‘Voice of the chest’

Whisper words have increased intensity & pitch and indicates pneumonia, fibrosis

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18
Q

Tactile fremitus

A

Technique: palpable vibration of the chest wall resulting from speech. (ulnar surface of hand)
Interpretation:
Decreased/absent: excess air in the lungs, emphysema, pleural effusion, massive pulmonary edema, or bronchial obstruction
Increased: lung consolidation, heavy/ non obstructive bronchial secretions, compressed lung or tumor

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19
Q

Bronchophony

A

‘Bronchial sounds’

spoken words are louder than normal; indicates consolidation

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20
Q

Diaphragmatic excursion

A

Movement of thoracic diaphragm that occurs with inhalation and exhalation (distance: 3 - 5 cm; higher on the right b/c liver)
Descent may be limited by several types of processes such as pulmonary emphysema, abdominal ascites or tumor, or superficial pain

21
Q

A/P diameter

A

Normally less than the lateral diameter, increases with age

22
Q

Additional organ systems to thoroughly evaluate resp. complaint

A

Face, hands, feet, chest Neuro, abdomen

23
Q

Barrel chest

A

lateral greater than AP, results from compromised respiration such as asthma, emphysema, cystic fibrosis

24
Q

Flail chest

A

paradoxical chest movement, a section of the chest is disconnected from the bony structure, as may occur with multiple rib fractures, also indicates underlying lung injury (pulmonary contusion)

25
Q

Scoliosis

A

spine deviated laterally, best seen from behind when patient is bent over

26
Q

Kyphosis

A

spine deviated posteriorly

27
Q

Gibbus

A

sharp angular deformity, associated with a collapsed vertebrae from osteoporosis

28
Q

Lordosis

A

inward curvature of the lower spine

29
Q

Pectus carinatum/ excavatum

A

carinatum- prominent sternal protrusion, pigeon chest (most ly cosmentic) excavatum- funnel chest, indentation of the lower sternum above the xiphoid process (results on more issues with internal organs)

30
Q

cough

A

deep inspiration, air and secretions are exhaled, voluntary or reflexive
Note: dry/moist, frequency, regularity, pitch and loudness, quality

31
Q

Sputum production

A

generally associated with a cough, when it involves more than small amount and with any degree of consistency always suggests disease, can be chronic or acute
Note: color, consistency, blood, amount, time of day

32
Q

Hemoptysis

A

coughing up blood

33
Q

Dyspnea

A

difficult, labored breathing with shores of breath. Commonly observed with pulmonary/cardiac compromise
Note: what makes it better/ worse and severity

34
Q

Pulsus paradoxous

A

characterized by an exaggerated decrease (greater than 10mmHg) in the amplitude of pulsation during inspiration and increased amplitude during expiration. Seen with premature cardiac contraction, tracheobronchial obstruction, bronchial asthma, emphysema, pericardial effusion, constrictive pericarditis

35
Q

Shortness of breath

A

Can be subjective, sign of respiratory distress
Note: onset, pattern, position of comfort, relation to activity, harder to inhale or exhale, severity, associated symptoms

36
Q

Tachypnea/bradypnea/eupnea

A

Tachy: rapid breathing (greater than 20)
Brady: slow breathing (less than 12)
Eu: normal (12 - 20)

37
Q

Pleural rub

A

indicates inflammation, increased friction of the pleural lining of the lung

38
Q

Cyanosis

A

results from hypoxia, associated with a pulmonary or cardiovascular condition, can be seen centrally (mottling of lips, thorax) and acrocyanosis (extremities, hands, feet)

39
Q

Chest pain

A

does not generally originate in the heart when there is a constant ashiness that lasts all day, does not radiate, is made worse by palpation, fleeting, needle-like jab that lasts only a few seconds, it is situated in the shoulders or between the shoulder blades in the back.
Note: onset, duration, associated symptoms, efforts to treat, drug use

40
Q

Stridor

A

a wheeze that is entirely or predominantly inspiratory, indicates partial obstruction of the trachea or larynx and warrants immediate attention (commonly seen w/foreign body aspiration, croup)

41
Q

Orthopnea

A

Shortness of breath that begins or increases when the patient lies down, ask for how many pillows they sleep with at night

42
Q

Paroxysmal nocturnal dyspnea

A

Sudden onset of SOB after a period of sleep, sitting upright is helpful

43
Q

Fine crackles

A

Discontinuous; high pitched, discrete, crackling sounds heard during the end of inspiration, cleared by a cough

44
Q

Course crackles

A

Discontinuous; Loud, bubbly noise heard during inspiration, not cleared by a cough

45
Q

Rales

A

Discontinuous; Caused by the disruptive passage of air through the small airways in the respiratory tree, same as crackles

46
Q

Wheezes

A

Continuous; high pitched, musical, suggests narrowed smaller airways such as in asthma, COPD, bronchitis

47
Q

Ronchi:

A

Continuous; low pitched, snoring, honking sounds perhaps caused by the rattling of secretions in the large airways, transient airway plugging (bronchitis, cystic fibrosis, bronchiectasis)

48
Q

Diaphragmatic excursion process

A
  • Have pt take a deep breath and hold it
  • Percuss along the scapular line until you locate the lower border (point marked by a change in note from resonance to dullness)
  • Mark that point with a pen at the scapular line
  • Let pt take a breath and repeat on the other side
  • Ask pt to take several breaths, to exhale as much as possible, and then to hold breath
  • Percuss up from the parked point and make a mark at the change from dullness to resonance
  • Have patient breathe and repeat on other side
  • Measure and record the distance in cm between the marks on each side

PD Block 2 (6 decks)

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