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HMS PDR > Respiratory Exam > Flashcards

Respiratory Exam Flashcards

1
Q

Major pulmonary symptoms

A

Dyspnea

Hemoptysis

Cough

Chest pain

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2
Q

Dyspnea

A

Shortness of breath or windedness out of proportion for the activity.

As opposed to fatigue or tiredness

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3
Q

Dyspnea differential diagnosis

A

Respiratory:

  • Airways (upper/lower)
  • Parenchyma (fluid, fibrosis, inflammation)
  • Circulation (blood clot)
  • Pleura (fluid, malignancy, pneumothorax)
  • Chest wall (kyphoscoliosis)
  • Muscles (generalized, diaphragm)

Cardiac:

  • Heart failure
  • Silent angina

Other:

  • Anemia
  • Acidosis
  • Psychogenic
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4
Q

Ways to ask about dyspnea

A
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5
Q

What to ask about a cough?

A
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6
Q

What causes a cough?

A

Cough receptors line the entire respiratory tract from sinuses to pleura.

May begin as a URI or post-nasal drip, but may also be reflective of life threatening diseases ranging from cancer to pneumonia.

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8
Q

White (mucoid) or clear sputum differential diagnosis

A

Asthma

Chronic bronchitis

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9
Q

Purulent sputum differential diagnosis

A

Pneumonia

Acute bronchitis

bronchiectasis

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10
Q

____ is not the same as no sputum.

A

Swallowing sputum is not the same as no sputum. Just because you don’t cough it up doesn’t mean it isn’t there.

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11
Q

What to ask about hemoptysis?

A
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12
Q

Hemoptysis vs Hematemasis

A

Hemoptysis: Coughing up blood or bloody mucus (respiratory origin)

Hematemasis: Vomitting up blood (gastric origin)

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13
Q

Angina differential diagnosis

A
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14
Q

Hemoptysis differential diagnosis

A

Infection

Infarction

Cancer

Vasculitis

Heart failure

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16
Q
A

Barrel chest

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17
Q

Percussion technique

A
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18
Q

Where to percuss?

A
19
Q

Lung auscultation technique

A
20
Q

What to ask about angina?

A

Character

Location

Precipitants

Elements from history (allergies, smoking, environmental triggers, genetics, etc.)

22
Q

Only ____ or above is normal for O2 saturation.

A

Only 95% or above is normal for O2 saturation.

23
Q

Basic pulmonary exam

A

Breathless from walking? Do you need to sit up to breathe?

Coughing? Wheezing?

Any chest discomfort?

Wearing oxygen? Inhalers by bedside?

Vital signs should inform questions.

28
Q

Egophony

A

Have the patient say “Eee” or “Aah” while listening to different areas of lung to see where voice is transmitted.

Heard where air travels in airways surrounded by consolidated lung tissue (like pneumonia)

Only done if clinical suspicion is high.

29
Q

Respiratory exam for a general practice visit

A

For every patient:

  • Vital signs
  • Inspection
  • Percuss and auscultate posteriorly (>4 locations bilaterally)
  • Auscultate anteriorly

For indicated patients (refer to history):

  • Transmitted voice sounds
  • Fremitus
  • Assessing diaphragmatic movement
  • More thorough anterior exam
30
Q

Typical healthy lung report

A

Lungs clear to auscultation anteriorly and posteriorly and resonant to percussion posteriorly.

31
Q

Typical abnormal lung report

A

Left lung resonant to percussion and clear to auscultation. Over the RLL there is dullness of percussion, crackles, increased fremitus, bronchial breath sounds, and egophony

32
Q

Bronchophony

A

– the normal voice sounds heard over a healthy large bronchus or abnormal voice sounds auscultated more loudly and clearly with high pitch over more distal lung regions. It is a type of pectoriloquy.

33
Q

Inspiratory To Expiratory Ratios

A

the ratio of inspiratory to expiratory time during spontaneous breathing, usually 1:2 in normal circumstances

34
Q

Pectoriloquy

A

voice sounds auscultated with increased resonance through the chest wall, common examples of which are egophony, bronchophony, and whispered pectoriloquy (see below definitions). It usually represents a consolidation process in that region of the lung tissue

35
Q

Whispered Pectoriloquy

A

an increased loudness of whispering noted on auscultation

36
Q

Tactile Fremitus

A

– the palpation of vocal sound transmission - fremitus is increased when the chamber through which the sound is traveling (lung alveoli) is filled with a fluid, but is decreased when there is some other solid in between the vibrating chamber and the examining hand (such as the heart border in the path of the sound, or a pleural effusion in that location).

37
Q

Lung surface anterior

A
38
Q

Lung surface posterior

A
39
Q

Lung surface right lateral

A
40
Q

Lung surface left lateral

A
41
Q

Diaphragmatic Excursion

A

– the movement of the thoracic diaphragm during breathing (usually 3-5 cm)

HMS PDR (30 decks)

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