Respiratory Physical Exam Flashcards
Key aspects of resp physical (10 letters)
ROOCCSPAVT
ROOCCS letters meaning
Resp rate Observe (resp pattern, distress, chest wall shape and mvmt) Oximetry Clubbing Cyanosis Surface anatomy (of lobes)
PAVT letters meaning
Percussion
Auscultation
Vocal fremitus (egophony and whispered pectoriloquy)
Tactile fremitus
Trick to ID oblique fissure
ID vertebra prominens (C7) and T1, count down to T3: posterior origin of oblique fissure
other name for sternal angle
Angle of Louis
Trick to ID horizontal fissure
Angle of Louis, go laterally to 2nd rib, count down to 4th rib
normal resp rate
8-16 breaths per min
tachypnea and bradypnea values
over 20 and under 8 breaths per min
Resp rate of 40+ for hours shows what
sign of resp failure and is not sustainable
normal inspiratory time vs expiratory time ratio
I:E is 1:2
prolonged expiratory phase shows what
underlying obstructive impairment
Cheyne-Stokes breathing explan
rhythmic auscillation of depth of resp (changes between shallow and deep)
ataxic breathing def
completely chaotic resp pattern (short, long, shallow, deep)
Kussmaul breathing def
sustained deep breathing for hours
Kussmaul breathing, a condition where it’s seen
metabolic acidosis
What is the abdominal paradox
when breathing, chest wall goes up and abdoment goes down (inwards)
normal opposite of abdominal breathing + explan
synchronous thoraco-abdominal movement: breathe in, chest goes up and abdomen goes up too
why abdominal paradox happens
diaphragm problem (becomes a simple piece of tissue, not working), accessory muscles of resp recruited (neck), suck air into airways bc are able to lift chest up. create suction and neg pressure sucks abdominal contents
Abdominal paradox: what portion of diaphragm is not working
Two sides are not working (in order to see abdominal paradox)
signs of resp distress that can be seen in the resp pattern on or near chest (3)
tachypnea
use of accessory muscles of resp
intercostal indrawing
signs of resp distress that can be seen on face (3)
nasal flaring (nostrils open and close)
pursed lip breathing
unable to complete sentence verbally
signs of resp distress that can be seen in periphery (3)
cyanosis
goal of pursed lip breathing
send back positive pressure in lung as to block the end of expiration to keep alveoli open
ataxic breathing shows what
sign of CNS problem
Cyanosis how to see it
Finger nails are blue and hand too
Central cyanosis sign
mouth mucosa is blue
clubbing def
angle between nail and finger is lost
Clubbing: thing we can ask patient to do to see it + name
Shamroth’s sign. Put hands together on exterior surface and see if gap between fingers
Nails characteristics in clubbing
Are spongier and softer than normal (if were to push on them)
clubbing can be sign of what, is seen in what conditions
lung cancer, bronchiectasis, indulent (tough) pulm infections (lung abcess, TB, fungal infection of lung)
Conditions in which clubbing is NOT seen
COPD, emphysema, chronic bronchitis, asthma
T-F: if remove cancer, clubbing stays
F: clubbing goes away when cancer removed
Exam Q T-F: COPD causes clubbing
False
familial clubbing shows what
nothing, it would then be benign
clubbing only characteristic of resp conditions: T-F?
False. few extra-thoracic conditions where it appears
T-F: Clubbing caused by hypoxia
False. Has nothing to do with hypoxia
Percussion principle and name of surface receiving blow
Apply palm of hand and hit third finger. No stethoscope.
Pleximeter
Percussion: air-filled structures produced ___ sound
tympanitic or resonant sound
chest percussion: diff in sound between bone and surface between bone
no difference
auscultation meaning
listening (with steth)
auscultation in resp done with that part of steth + exception
with diaphragm
exception: bell of apex of the lung
breath sounds: bronchial sound def
inspiratory and expiratory sounds are equal
normal location of a bronchial breath sound
over the trachea and central airways (on top of sternum)
vesicular breathing sound def
expir and inspi sounds are lower but can barely hear exp sound
normal location of vesicular breathing
periphery. away from central airways (lateral chest wall for ex)
broncho-vesicular breathing def
mix of bronchial and vesicular. Hear insp well and expiratory barely
broncho-vesicular breathing normal location
parasternal (side of sternum)
added or adventitial sounds indicate what
pathology. you normally don’t hear them
3 adventitial (added) sounds
1) discontinuous crepitations or crackles (rales)
2) continuous wheezes or ronchi
3) discontinuous rubs that are monotonous from breath to breath, dry
2 adventitial sounds that are very similar
crepitations-crackles-rales and rubs are similar
percussion: how to detect pleural effusion or consolidation (as in pneumonia)
percussion: dull sound instead of tympanitic sound
auscultation: how to detect pleural effusion or consolidation (as in pneumonia)
pleural effusion: can’t hear breathing
pneumonia: hear bronchial breathing instead of usual vesicular breathing
Egophony test what you do
put stethoscope over region of chest and ask patient to say eeeeeeeeeeee.
If effusion, eee still sounds like eee
If pneumonia, eeee becomes aaaa.
whispered pectoriloquy: what you do and purpose
listen with stethoscope and ask patient to whisper 1,2,3 continuously.
If pneumonia, can hear sound well
If effusion, sound not transmitted
tactile fremitus: what you do and purpose
put hand on region as if chopping something, ask patient to say 99 loudly (33 in french).
If pneumonia, feel vibration over consolidation
If effusion, won’t feel the vibration
