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PCM 3 exam 1- MARIYA > Respiratory Exam LAB osce > Flashcards

Respiratory Exam LAB osce Flashcards

1
Q

In inspection of the anterior chest, you look for:

A
  • respiratory distress (wheezing, stridor, labored breathing)
  • work of breathing: accessory m. use, intercostal indrawing, abdominal breathing, flail chest, rate/ depth
  • swelling, erythema, atrophy, deformities, scars, lesions
  • central or peripheral cyanosis
  • clubbing
  • trachea midline
  • thorax: pectus excavatum/carinatum, increased AP diameter (barrel chest)
  • symmetrical chest expansion
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2
Q

Posterior chest inspection:

A
  • deformities: kyphosis, scoliosis
  • work of breathing: accessory muscle use, intercostal indrawing, abdominal breathing
  • swelling, erythema, atrophy, deformities, scars/lesions
  • symmetrical chest expansion
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3
Q

LO#2 is identify anatomical landmarks in assessing chest, so um not sure what landmarks they want but some important ones are:

A

left and right scapular lines, vertebral line, mid axillary line and anterior and posterior axillary lines..take a look?

no idea what else specifically we should know lol

but the upper right lung lobe goes from fourth rib to fifth rib @ mid axillary (horizontal fissure)

the upper left lung lobe ends at the 6th rib midclavicular line

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4
Q

What should you palpate for in a respiratory examination?

A 
anterior/posterior chest wall
tenderness
masses
tactile fremitus
assess for chest expansion
palpate trachea to ensure midline
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5
Q

why would you want to assess for chest expansion?

A

If there is unilaterally reduce posterior chest expansion–> lung collapse or pneumonia

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6
Q

What could decreased fremitus mean?

A

pleural effusion, thickened chest wall, pneumothorax, emphysema (decreased vibration)

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7
Q

What could increased fremitus mean?

A

consolidation of lung tissue, pneumonia, tumor, fibrosis (increased vibration)

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8
Q

What is crepitus and what could it mean when heard?

A

crackling sensation over skin surface

could mean subcutaneous emphysema

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9
Q

How would you percuss the anterior chest wall?

A

Position patients arm across chest

intercostal spaces using ladder technique (ensure bw scapulae and spinous processes)

either dull, resonant, or hyperresonant

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10
Q

How would you percuss the posterior chest wall?

A

breath sounds, air entry quality

presence of adventitia: crackles, wheezes, rhonchi, pleural friction rubs

types of breath sounds/location: vesicular, bronchovesicular, bronchial or tracheal

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11
Q

How do you percuss in a resp exam?

A

palm over chest wall, middle finger strikes 2nd phalanx, movement from waist

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12
Q

What would bone percussion sound like?

A

flatness

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13
Q

What would diaphragm, masses, and fluid percussion sound like?

A

dullness (normal on left 3rd - 5th ICS)

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14
Q

What would lung percussion sound like?

A

resonant

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15
Q

What would hyperinflated lung percussion sound like?

A

hyperresonant

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16
Q

What would abdominal percussion sound like

A

tympany

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17
Q

What is diaphragmatic excursion?

A

determine level of diaphragm w/ inspo and expo on posterior thorax

normal 3-5.5

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18
Q

What would you do in auscultation on a resp exam?

A

assess ant and posterior, ask pt to breathe with mouth open, in and out

posterior chest: arms crossed over chest to move scapulae laterally

use stethoscope and ladder pattern sweeping side to side comparing symmetry at each level

listen for major breath/adventitious sounds

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19
Q

What does it mean if bronchovesicular/bronchial breath sounds are heard in locations where vesicular sounds are expected?

A

means that air filled lung has most likely been replaced by fluid filled or solid lung tissue

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20
Q

What is the duration + location of the normal vesicular(soft) breath sounds?

A

duration: longer than inspiration
location: over most of both lungs

21
Q

What is the duration + location of the normal bronchovesicular (medium intensity) breath sounds?

A

duration: equal in inspo + expo
location: in 1st + 2nd ICS anteriorly, intrascapular area posteriorly

22
Q

What is the duration + location of the normal bronchial (loud) breath sounds?

A

duration: longer in expo, silent gap bw inspo and expo
location: central, around sternal area

23
Q

What is the duration + location of the normal tracheal (very loud) breath sounds?

A

duration: equal in inspo and expo, silent gap
location: trachea, upper portion of parasternal aspects to ICS 2

24
Q

What is hyperpnea?

A

deep breathing

25
Q

What is obstructive breathing like?

A

prolonged expiratory phase iv.

26
Q

What is Cheyne-stokes?

A

cyclic crescendo-decrescendo respiratory effort (rate and volume) followed by periods of apnea

27
Q

What is Kussmaul?

A

deep breathing w/ metabolic acidosis; rate may be fast, slow or normal

28
Q

What is ataxic breathing?

A

irregular and unpredictable breathing which may be shallow or deep and may stop for periods of time

29
Q

What are the signs of respiratory distress (theres a lot lol):

A

accessory muscle use

tripod position

pursed lip breathing

intercostal in-drawing

tracheal tug

stridor

displacement of trachea from midline

chest expansion

skin color /cyanosis

clubbing

chest deformities

pectus excavatum/carinatum

barrel chest

flail chest

paradoxical movement

abnormal spinal curvatures

altered work of breathing–> V/Q mismatch

30
Q

Central cyanosis involves the:

A

lips, frenulum, buccal mucosa

31
Q

Peripheral cyanosis involves the:

A

fingers, toes, ears, nose

32
Q

Flail chest:

A

multiple sequential rib fractures form an independently mobile segment of chest wall

33
Q

Paradoxical movement:

A

chest moves inward during inspo and outward on expo

34
Q

What are some visual signs of airway obstruction?

A

Agitation, poor air movement, rib retraction, deformity, foreign material

35
Q

What are some auditory signs of airway obstruction?

A

Speech? “How are you”

hoarseness, noisy breathing, gurgle, stridor

36
Q

What are some palpatory signs of airway obstruction?

A

fracture crepitus

tracheal deviation

hematoma

face

37
Q

What order do you perform the exam in a resp patient?

A

inspect–> palpate–> percuss–> auscultate

38
Q

What is an important finding of consolidation?

A

increased bronchial breath sounds

39
Q

What is an important finding of pleural effusion?

A

decreased percussion note (duller)

40
Q

What is an important finding of lobar collapse?

A

mediastinal shift TOWARDS collapse

41
Q

What is an important finding of pneumothorax?

A

increased percussion note (more resonant)

opp of pleural effusion and most other issues

42
Q

What is an important finding of pneural thickening?

A

decreased chest wall movements

43
Q

How do you assess adventitious sounds?

A

assess location and timing in resp cycle (inspo and expo) and whether they clear with cough

44
Q

Does basilar atelectasis clear with cough?

A

Yes, with cough or deep breath

45
Q

What are discontinuous breath sounds?

A

intermittent, NON musical

CRACKLES!

scratching sound

fine, soft, high pitched, brief

46
Q

What are continuous breath sounds?

A

musical and prolonged

WHEEZING (rales)- relatively high pitched, lower airway obstrxn

may have end inspo or end expo charater

47
Q

What do rhonchi sound like?

A

low pitch with snoring quality

denotes secretions/fluids in airways

48
Q

What does stridor sound like?

A

high pitched on INSPO, typically appear airway (above sternal notch) denoting obstrxn either intrinsically or extrinsically

49
Q

Quick review of the transmitted voice sounds specialty tests (not an LO), but describe bronchophony, egophany, and whispered pectorliquoy:

A

Bronchophony: auscultate posterior chest “nighty-nine”; should be soft and muffled; if LOUD and clear, consider LUNG CONSOLIDATION

Egophany: evaluates intensity of spoken voice; have pt say “eee”; should hear soft, muffled “eee”; if “aaa” heard–> LUNG CONSOLIDATION

Whispered Pectoriloquoy: performed when (+) bronchophony auscultated; have pt whisper “1,2,3” sound should be faint, and muffled; clear with lung consolidation

PCM 3 exam 1- MARIYA (6 decks)

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