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PCM II Midterm > Respiratory Lab > Flashcards

Respiratory Lab Flashcards

1
Q

Needle Thoracentesis (decompression)

A

2nd intercostal space just superior to 3rd rib margin at the midclavicular line for emergent decompression of tension pneumothorax, followed by chest tube placement

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2
Q

Where does the neurovascular bundle run?

A

inferior to each rib, so needles should be placed superior to the rib margins

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3
Q

Chest tube insertion

A

4th intercostal space at mid or anterior axillary line just superior to the margin of the 5th rib

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4
Q

Where is the lower margin of the endotracheal tube after insertion seen on a chest x-ray?

A

T4

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5
Q

Healthy adult Respiration Rate

A

14-20x a minute

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6
Q

Pursed lips indicate

A

COPD

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7
Q

Asymmetrical movement indicates

A

pleural effusion

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8
Q

Intercostal retractions indicate

A

severe asthma, COPD, upper airway obstruction

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9
Q

Tripoding

A

obstructive lung disorders

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10
Q

Barrel chest

A

COPD

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11
Q

contraction of accessory muscles

A

scm, scalenes, supraclavicular retraction

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12
Q

lateral displacement of trachea

A

tension pneumothorax

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13
Q

Clubbing

A
  • bulbous swelling of soft tissue at nail base
  • loss of normal angle between nail and proximal nail fold leading to spongy or floating feeling
  • mechanism involves vasodilation with increased blood flow to distal portion of digits and changes in hypoxia, changes in innervation, or a platelet derived growth factor
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14
Q

Conditions in which clubbing is seen

A
  • congenital heart disease
  • interstitial lung disease
  • bronchiesctasis
  • pulm fibrosis
  • lung abscess
  • IBD
  • malignancies
  • cystic fibrosis
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15
Q

Focus of palpation

A
  • areas of tenderness
  • abnormalities overlying skin
  • respiratory expansion
  • tactile fremitus
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16
Q

Tactile fremitus

A
  • palpable vibrations transmitted through bronchopulm tree to the chest wall as the patient speaks
  • perform on anterior and posterior chest
  • use ball or ulnar surface of hands
  • often more prominent in interscapular area than in the lower lung fields
  • more prominent on the right side than the left
  • disappears below the diaphragm
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17
Q

Decreased/absent fremitus

A

COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, infiltrating tumor

18
Q

Increased fremitus

A

pneumonia (increased transmission through consolidated tissue)

19
Q

Percussion technique

A
  • hyperextend middle finger and firmly contact skin
  • strike extended finger aiming for DIP with quick wrist motion
  • start superiorly percussing both dies of chest, working toward base in a ladder like pattern
  • done on posterior and anterior chest
  • percussion penetrates 5-7cm into chest, so may miss deep seated lesions
  • percuss 4 posts on the back and on the right middle post for the lower right lobe
  • patient seated with arms crossed in front of chest
20
Q

Flat sound

A
  • soft, high pitch, short duration

- ex) thigh

21
Q

Dull sound

A
  • medium intensity, medium pitch, medium duration

- ex) liver

22
Q

Resonant sound

A
  • loud intensity, low pitch, long duration

- ex) healthy lung

23
Q

Hyperresonant sound

A
  • very loud, lower pitch, longer duration

- ex) usually none

24
Q

Tympanic sound

A
  • loud intensity, lower pitch, longer duration

- ex) gastric air bubble or puffed out cheek

25
Q

When does dullness replace resonance?

A

when fluid or solid tissue replaces air containing lung or occupies space beneath percussing fingers

  • lobar pneumonia
  • pleural accumulations
26
Q

Generalized hyperresonance

A
  • hyper inflated lungs
  • COPD/emphysema
  • asthma
27
Q

Unilateral hyperresonance

A
  • large pneumothorax

- large air filled bulla in lung

28
Q

Diaphragmatic Excursion

A
  • determine distance between level of dullness on full expiration and level of dullness on full inspiration by progressive percussion down from resonance to dullness
  • normal excursion = 3-5.5 cm
  • dullness at a higher level than expected suggests a pleural effusion or a high diaphragm (atelectasis or phrenic nerve paralysis)
29
Q

Vesicular Breath Sound

A
  • soft and low pitched
  • heard through inspiration and about 1/3 of expiration
  • heard over most of lungs
30
Q

Bronchovesicular sound

A
  • intermediate in intensity and pitch
  • heard equally in inspiration and expiration
  • heard best in 1st and 2nd interspaces anteriorly and between the scapulae posteriorly
31
Q

Bronchial

A
  • loud and high pitched
  • expiratory sounds heard longer than inspiratory
  • heard over manubrium
32
Q

Tracheal sound

A
  • very loud and high pitched
  • heard equally in inspiration and expiration
  • heard best over trachea in neck
33
Q

Crackles

A
  • discontinuous, intermittenet, nonmusical
  • fine: soft, high pitched, brief
  • coarse: louder, lower pitch, brief
  • timing in respiratory cycle
  • seen in pneumonia, fibrosis, early heart failure, bronchitis, bronchiectasis
34
Q

Wheezes

A
  • continuous, musical quality, prolonged
  • relatively high pitched
  • suggest narrowed airways (asthma, COPD, bronchitis, heart failure)
35
Q

Rhonchi

A
  • relatively low pitched, snoring quality

- suggest secretions in large airways

36
Q

Stridor

A
  • high pitched wheeze that is entirely or predominantly inspiratory
  • often louder in neck than over chest wall
  • indicated partial obstruction of larynx or trachea (medical emergency)
37
Q

Pleural friction rub

A
  • inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction
  • sounds like cracking, usually during expiration
  • usually confined to small area of the chest wall
38
Q

Bronchophony

A

spoken words become louder and clearer

indicates consolidation

39
Q

Egophony

A

“ee” sounds like “A”

pneumonia

40
Q

Whispered Pectoriloquy

A

whispers head louder and clearer during auscultation

PCM II Midterm (11 decks)

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