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(3) Cardio-Pulmo-Renal Rehabilitation > S1 L2.2: Physical Examination of the Respiratory System > Flashcards

S1 L2.2: Physical Examination of the Respiratory System Flashcards

1
Q

What can you tell about a patient in a tripod position?

A

They are in respiratory distress

There is an exchange of O2 and
CO2 in the pulmonary bed

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2
Q

General color indication with a pt who suffers from hypoxemia

A

Cyanotic, bluish discoloration, pale

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3
Q

Type of chest that is a sign of air trapping, chronic asthma, or emphysema

A

Barrel Chest

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4
Q

Type of chest where it creates a compression of the heart & great vessels may cause murmurs.

A

Pectus Excavatum

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5
Q

Another name for Pectus Carinatum

A

Pigeon Chest

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6
Q

Curve of the spine where it definitely compromises heart & lungs

A

Kyphosis

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7
Q

T/F: If symmetrical chest, expect equal expansion on both sides

A

True

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8
Q

When there is unequal expansion of the chest, you want to observe ___

A

The collar or movement of the shirt (collapsed lung on the lagging side)

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9
Q

Etiology

Air is now in the pleural cavity compressing normal lungs

A

Extrapleural Air

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10
Q

This mechanism acts like a vacuum effect on the thorax that suggests an obstruction to inspiration at any point in the respiratory tract

A

Retractions

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11
Q

Signs of Upper Airway Obstruction

A
  1. Inspiratory Stridor
  2. Alar Flaring
  3. Retraction at the suprasternal notch
  4. Cyanosis
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12
Q

Signs of Supraglottic Obstruction

A
  1. Stridor tend to be quieter
  2. Muffling voice
  3. Dysphagia
  4. No cough
  5. Awkwards position of head and neck to preserve the airway
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13
Q

Signs of Infraglottic Obstruction

A
  1. Stridor tend to be louder, rasping
  2. Hoarse Voice
  3. Swallowing not affected
  4. Cough is harsh, barking
  5. Head positioning is not a factor
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14
Q

Peripheral Signs in Physical Examination

A
  1. Cyanosis
  2. Pursing
  3. Clubbing
  4. Alar Flaring
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15
Q

Auscultation

Statement 1: Listen to the chest anteriorly and medially as the patient breathes with mouth open
Statement 2: Listen to the breath sounds, noting their intensity and identifying any variations from normal vesicular breathing.

a. TF
b. FT
c. TT
d. FF

A

b. FT

Statement 1: Anteriorly and laterally

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16
Q

T/F: Breath sounds are usually louder in the upper anterior lung fields.

A

True

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17
Q

Normal Breath Sounds

Inspiratory sounds > expiratory sounds

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

a. Vesicular

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18
Q

Normal Breath Sounds

Inspiratory = expiratory, relatively high intensity of expiratory

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

d. Tracheal

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19
Q

Normal Breath Sounds

Inspiratory = expiratory, intermediate intensity of expiratory

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

b. Bronchovesicular

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20
Q

Normal Breath Sounds

Normally heared over most of both lungs

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

a. Vesicular

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21
Q

Normal Breath Sounds

Normally heard over the manubrium (larger proximal airways)

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

c. Bronchial

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22
Q

Normal Breath Sounds

Often normally heard in the 1st and 2ns iS ant. & between the scapulae

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

b. Bronchovesicular

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23
Q

Normal Breath Sounds

Normally heard over the trachea in the neck

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

d. Tracheal

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24
Q

Normal Breath Sounds

Pitch of Expiratory: Intermediate

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

b. Bronchovesicular

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25
Q

Normal Breath Sounds

Pitch of Expiratory: Relatively high

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

c. Bronchial & d. Tracheal

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26
Q

Normal Breath Sounds

Pitch of Expiratory: Relatively low

a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal

A

a. Vesicular

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27
Q

Vesicular Breath Sounds

Statement 1: More prominent in thin individuals or children
Statement 2: Diminished in the underweight individuals

a. TF
b. FT
c. TT
d. FF

A

a. TF
Diminished in the overweight or muscular individuals

28
Q

Vesicular Breath Sounds

Statement 1: More prominent in thin individuals or children
Statement 2: Diminished in the underweight individuals

a. TF
b. FT
c. TT
d. FF

A

a. TF
Diminished in the overweight or muscular individuals

29
Q

Adventitious Breath Sounds

High-pitched, discrete, brief, discontinuous crackling at the end of inspiration

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

a. Fine Crackles

30
Q

Adventitious Breath Sounds

Lower, moist sound during the midstage of inspiration & not cleared by a cough

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

b. Medium Crackles

31
Q

Adventitious Breath Sounds

Musical noise like a squeak (asthmatic = kitten sounds)
Most often heard continuously during inspiration or expiration; tubular sound but tube is smaller because of bronchial constriction

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

e. Wheeze

32
Q

Adventitious Breath Sounds

Loud, bubbly noise that is heard during inspiration

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

c. Coarse Crackles

33
Q

Adventitious Breath Sounds

Dry, rubbing, or grating usually caused by inflammation of pleural surfaces (Heard during inspiration or expiration)

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

f. Pleural Friction Rub

34
Q

Adventitious Breath Sounds

Sonorous wheeze, snore-like; “low pitched wheezes” and often heard in pts with COPD, cystic fibrosis, bronchiectasis, pneumonia

a. Fine Crackles
b. Medium Crackles
c. Coarse Crackles
d. Ronchi
e. Wheeze
f. Pleural Friction Rub

A

d. Ronchi

35
Q

Fine Crackles

Statement 1: That is the process by which we create crackles in the lungs that has pneumonia or fluid inside the air sacs
Statement 2: That crackling is produced at the end of inspiration; it’s the entry of air breaking into the fluid that is present in the air sacs

a. TF
b. FT
c. TT
d. FF

A

c. TT

36
Q

Early inspiratory and expiratory crackles are classic lung exam findings in what condition?

A

Chronic bronchitis

37
Q

Palpation

You palpate by placing a thumb on the midline and ask the pt to take a deep breath. You use this to check for lung expansion.

A

Thoracic Expansion

38
Q

Palpation

You felt a palpable, coarse, grating vibration during thoracic expansion. What is your finding?

A

Pleural Friction Rub

39
Q

Palpation

You hear a crackly or crinkly sensation or a gentle or bubbly feeling (when pressing the chest) which indicates air in the subcutaneous tissue from a rupture. What is your finding?

A

Crepitus

40
Q

Palpation

You palpated a vibration on the patient’s chest walls around the 2ns ICS at the level of the bifurcation of bronchi that results from speech or other verbalizations. What is the finding?

A

Tactile Fremitus

41
Q

Type of Percussion Tones

Intensity: Soft
Pitch: High
Duration: Short
Quality: Very Dull

A

Flat

42
Q

Type of Percussion Tones

Intensity: Very Loud
Pitch: Very Low
Duration: Longer
Quality: Booming

A

Hyperresonant

43
Q

Type of Percussion Tones

Intensity: Loud
Pitch: Low
Duration: Long
Quality: Hollow

A

Resonant

44
Q

Type of Percussion Tones

Intensity: Medium
Pitch: Medium to High
Duration: Medium
Quality: Dull thud

A

Dull

45
Q

Type of Percussion Tones

Intensity: Loud
Pitch: High
Duration: Medium
Quality: Drum-like

A

Tympanic

46
Q

Common Diagnostic Modalities

Favorite & most commonly done diagnostic x-ray

A

Chest X-ray

Shows cardiac outline, lungs, blood vessels, bones

47
Q

Common Diagnostic Modalities

Sound waves
Can be used to detect water in lungs, visualizing the heart

A

Ultrasound

48
Q

Common Diagnostic Modalities

Ionizing radiation
3D image of a one-dimensional shot

A

Computed Tomograohy

49
Q

Common Diagnostic Modalities

Considered to be the gold standard for diagnosis of PE, it is invasive and has been thought to have increased morbidity and mortality

A

Pulmonary Ateriography

50
Q

Common Diagnostic Modalities

Magnetic field & radiowaves
More sensitive and expensive compared to CT scan

A

Magnetic Resonance Imaging

51
Q

Common Diagnostic Modalities

To measure the regional distribution of ventilation in the lungs the patient breathes xenon gas.

A

Ventilation and Perfusion Scans

52
Q

Common Diagnostic Modalities

Permit observation of normal and variant anatomy and of gross pathological changes in the bronchial wall and lumen.

A

Bronchography

53
Q

Common Diagnostic Modalities

Radioactive tracers and used to trace cancer spread

A

Positron Emission Tomography

54
Q

Common Diagnostic Modalities

Contrast dye used to visualize the pulmonary tree whether it’s okay or not

A

Pulmonary Angiogram

55
Q

Most Common Pulmonary Function Tests

You measure the volume of air and time by asking the patient to maximally breath in and out

A

Spirometry

56
Q

Pt is asked to forcefully expire the fastest he could, then the volume of air exhaled in the first second will a parameter of whether he has the disease/improving or not

A

Forced expiratory volume in one second (FEV1)

57
Q

Statement 1: Inspiratory Restrictive conditions limit lung expansion when inhaling
Statement 2: This happens when lungs become stiff as a result of scaring, fibrosis within lung tissue, or the respiratory muscles are too weak (diaphragm) to inflate the lungs

a. TF
b. FT
c. TT
d. FF

A

c. TT

58
Q

Expiratory restrictive occurs when exhalation volume is limited due to weakness of ____ involved in deep exhalation

A

Accessory Muscles

59
Q

Ventilatory Dysfunction Pattern

Identify the Pattern:
1. Decreased lung volume
2. FVC is ALWAYS low
3. FEV1 & FEV1/FVC is usually normal

A

Restrictive Defect

60
Q

Ventilatory Dysfunction Pattern

Identify the Pattern:
1. Decreased airflow
2. FVC is usually normal
3. FEV1 & FEV1/FVC is ALWAYS low

A

Obstructive Defect

61
Q

Measures peak RR and is usually utilized in the ER

A

Peak Flow Meter

62
Q

Measures O2 and CO2 levels, pH of blood, and NaHCO3

A

Arterial Blood Gas

63
Q

Measures O2 levels by detecting changes of light absorption in the hemoglobin

A

Pulse Oximetry

64
Q

Measures volatile organic compounds in exhaled breath

A

Chemical Breath Analysis

65
Q

One of the more common and must know
Measures cardiac and pulmonary performance during exercise and rest

A

Cardiopulmonary Exercise Test

(3) Cardio-Pulmo-Renal Rehabilitation (34 decks)

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