S1 L2.2: Physical Examination of the Respiratory System Flashcards
What can you tell about a patient in a tripod position?
They are in respiratory distress
There is an exchange of O2 and
CO2 in the pulmonary bed
General color indication with a pt who suffers from hypoxemia
Cyanotic, bluish discoloration, pale
Type of chest that is a sign of air trapping, chronic asthma, or emphysema
Barrel Chest
Type of chest where it creates a compression of the heart & great vessels may cause murmurs.
Pectus Excavatum
Another name for Pectus Carinatum
Pigeon Chest
Curve of the spine where it definitely compromises heart & lungs
Kyphosis
T/F: If symmetrical chest, expect equal expansion on both sides
True
When there is unequal expansion of the chest, you want to observe ___
The collar or movement of the shirt (collapsed lung on the lagging side)
Etiology
Air is now in the pleural cavity compressing normal lungs
Extrapleural Air
This mechanism acts like a vacuum effect on the thorax that suggests an obstruction to inspiration at any point in the respiratory tract
Retractions
Signs of Upper Airway Obstruction
- Inspiratory Stridor
- Alar Flaring
- Retraction at the suprasternal notch
- Cyanosis
Signs of Supraglottic Obstruction
- Stridor tend to be quieter
- Muffling voice
- Dysphagia
- No cough
- Awkwards position of head and neck to preserve the airway
Signs of Infraglottic Obstruction
- Stridor tend to be louder, rasping
- Hoarse Voice
- Swallowing not affected
- Cough is harsh, barking
- Head positioning is not a factor
Peripheral Signs in Physical Examination
- Cyanosis
- Pursing
- Clubbing
- Alar Flaring
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
b. FT
Statement 1: Anteriorly and laterally
T/F: Breath sounds are usually louder in the upper anterior lung fields.
True
Normal Breath Sounds
Inspiratory sounds > expiratory sounds
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
a. Vesicular
Normal Breath Sounds
Inspiratory = expiratory, relatively high intensity of expiratory
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
d. Tracheal
Normal Breath Sounds
Inspiratory = expiratory, intermediate intensity of expiratory
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
b. Bronchovesicular
Normal Breath Sounds
Normally heared over most of both lungs
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
a. Vesicular
Normal Breath Sounds
Normally heard over the manubrium (larger proximal airways)
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
c. Bronchial
Normal Breath Sounds
Often normally heard in the 1st and 2ns iS ant. & between the scapulae
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
b. Bronchovesicular
Normal Breath Sounds
Normally heard over the trachea in the neck
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
d. Tracheal
Normal Breath Sounds
Pitch of Expiratory: Intermediate
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
b. Bronchovesicular
Normal Breath Sounds
Pitch of Expiratory: Relatively high
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
c. Bronchial & d. Tracheal
Normal Breath Sounds
Pitch of Expiratory: Relatively low
a. Vesicular
b. Bronchovesicular
c. Bronchial
d. Tracheal
a. Vesicular
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. TF
Diminished in the overweight or muscular individuals
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. TF
Diminished in the overweight or muscular individuals
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. Fine Crackles
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
b. Medium Crackles
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
e. Wheeze
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
c. Coarse Crackles
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
f. Pleural Friction Rub
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
d. Ronchi
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
c. TT
Early inspiratory and expiratory crackles are classic lung exam findings in what condition?
Chronic bronchitis
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.
Thoracic Expansion
Palpation
You felt a palpable, coarse, grating vibration during thoracic expansion. What is your finding?
Pleural Friction Rub
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?
Crepitus
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?
Tactile Fremitus
Type of Percussion Tones
Intensity: Soft
Pitch: High
Duration: Short
Quality: Very Dull
Flat
Type of Percussion Tones
Intensity: Very Loud
Pitch: Very Low
Duration: Longer
Quality: Booming
Hyperresonant
Type of Percussion Tones
Intensity: Loud
Pitch: Low
Duration: Long
Quality: Hollow
Resonant
Type of Percussion Tones
Intensity: Medium
Pitch: Medium to High
Duration: Medium
Quality: Dull thud
Dull
Type of Percussion Tones
Intensity: Loud
Pitch: High
Duration: Medium
Quality: Drum-like
Tympanic
Common Diagnostic Modalities
Favorite & most commonly done diagnostic x-ray
Chest X-ray
Shows cardiac outline, lungs, blood vessels, bones
Common Diagnostic Modalities
Sound waves
Can be used to detect water in lungs, visualizing the heart
Ultrasound
Common Diagnostic Modalities
Ionizing radiation
3D image of a one-dimensional shot
Computed Tomograohy
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
Pulmonary Ateriography
Common Diagnostic Modalities
Magnetic field & radiowaves
More sensitive and expensive compared to CT scan
Magnetic Resonance Imaging
Common Diagnostic Modalities
To measure the regional distribution of ventilation in the lungs the patient breathes xenon gas.
Ventilation and Perfusion Scans
Common Diagnostic Modalities
Permit observation of normal and variant anatomy and of gross pathological changes in the bronchial wall and lumen.
Bronchography
Common Diagnostic Modalities
Radioactive tracers and used to trace cancer spread
Positron Emission Tomography
Common Diagnostic Modalities
Contrast dye used to visualize the pulmonary tree whether it’s okay or not
Pulmonary Angiogram
Most Common Pulmonary Function Tests
You measure the volume of air and time by asking the patient to maximally breath in and out
Spirometry
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
Forced expiratory volume in one second (FEV1)
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
c. TT
Expiratory restrictive occurs when exhalation volume is limited due to weakness of ____ involved in deep exhalation
Accessory Muscles
Ventilatory Dysfunction Pattern
Identify the Pattern:
1. Decreased lung volume
2. FVC is ALWAYS low
3. FEV1 & FEV1/FVC is usually normal
Restrictive Defect
Ventilatory Dysfunction Pattern
Identify the Pattern:
1. Decreased airflow
2. FVC is usually normal
3. FEV1 & FEV1/FVC is ALWAYS low
Obstructive Defect
Measures peak RR and is usually utilized in the ER
Peak Flow Meter
Measures O2 and CO2 levels, pH of blood, and NaHCO3
Arterial Blood Gas
Measures O2 levels by detecting changes of light absorption in the hemoglobin
Pulse Oximetry
Measures volatile organic compounds in exhaled breath
Chemical Breath Analysis
One of the more common and must know
Measures cardiac and pulmonary performance during exercise and rest
Cardiopulmonary Exercise Test
