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CPR > S1_L2_CPR_PhysicalDx - 39-71 > Flashcards

S1_L2_CPR_PhysicalDx - 39-71 Flashcards

1
Q

T or F: Scoliosis is not progressive

A

F

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2
Q

Scoliosis is more so ___

A

compressive

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3
Q

In scoliosis, one must be fast in detecting early on s/sx, in
other to prevent ___

A

complications

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4
Q

What is kyphoscoliosis?

A

kyphosis + scoliosis

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5
Q

A symmetrical chest means that there is ___ on both sides

A

equal expansion

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6
Q

Unequal expansion and respiratory compromise

A

Chest Asymmetry

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7
Q

Causes of chest asymmetry

A

A collapsed lung & limitation of expansion

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8
Q

Causes of collapsed lung or limtiation of expansion

A

fibrosis, muscular contracture, jt. mob
problems, etc.

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9
Q

If there is UNEQUAL expansion, what do we observe?

A

breast (do not oggle if female)

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10
Q

What should be observed in the breast for chest asymmetry

A

Observe the collar or movement of the dress or
shirt; collapsed lung on the lagging side

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11
Q

Etiology of Chest Asymmetry (3)

A

■ Extrapleural air: air is now in the pleural cavity
compressing normal lungs
■ Fluid: also limits expansion
■ Mass (or Tumor)

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12
Q

Suggest an obstruction to
inspiration at any point in
the respiratory tract

A

Retractions

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13
Q

In retractions, ___ become increasingly negative degree and level of retraction depend on the extent and level of obstruction

A

intrapleural pressure; obstruction

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14
Q

Mechanism of retractions

A

acts like a vacuum effect on the thorax

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15
Q

Example of retraction situation

A

○ Ex: You bought a cup of sago’t gulaman. As you sip
from a straw, you can’t sip further as it gets blocked
○ Your cheeks become the vacuum

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16
Q

T or F: retraction is not yet a medical emergency

A

F, bring pt immediately to the ER

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17
Q

Signs of Upper Airway Obstruction

A

• inspiratory stridor
(expiratory is severe)
• hoarse cough or cry
or barking cough
• alar flaring
• retraction at the
suprasternal notch
• cyanosis

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18
Q

Expiratory is severe; audible even without steth

A

Inspiratory Stridor

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19
Q

○ “Umiiyak na hindi basa”
○ Like a dog barking

A

Hoarse cough or cry or barking cough

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20
Q

○ Sign of air hunger

A

alar flaring

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21
Q

○ Could tell level of obstruction

A

Retraction at the suprasternal notch

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22
Q

Sign of low levels of oxygen

A

Cyanosis

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23
Q

Signs of Supraglottic Obstruction

A

• stridor tends to be quieter
• muffling voice
• dysphagia
• no cough
• awkward position of head and neck
to preserve the airway

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24
Q

Why is stridor quieter in supraglottic obstruction?

A

Because the obstruction is not full

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25
Q

(“hot potato in mouth”)

A

muffling voice

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26
Q

Why is there no cough in supraglottic obstruction

A

Because you’re not irritating the most irritating part
of the airways

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27
Q

Why is there awkward position of the head and neck?

A

Looking for that position to establish a good airway
(air can come in better)

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28
Q

Signs of infraglottic obstruction

A

• stridor tends to be louder, rasping
• hoarse voice
• swallowing not affected
• cough is harsh, barking
• head positioning is not a factor

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29
Q

T or F: Head positioning is a factor in infraglottic obstruction

A

F

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30
Q

Why is head positioning not a factor in infraglottic obstruction

A

Because no matter the position of the head, pt will
still have difficulty breathing since the obstruction is
infraglottic, which is more difficult to attend to

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31
Q

Peripheral Signs

A

• cyanosis
• pursing
• clubbing: finger nails
• alar flaring
• suggest cardiac or pulmonary
difficulty

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32
Q

Peripheral Signs affecting lips, nails

A

cyanosis

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33
Q

Peripheral Signs affecting lips

A

pursing

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34
Q

Peripheral Signs affecting finger nails

A

clubbing

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35
Q

Peripheral Signs leading to air hunger, esp alveolar involvement

A

alar flaring

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36
Q

Peripheral signs suggest what?

A

cardiac or pulmonary difficulty

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37
Q

When a pt becomes cyanotic, cyanosis of the _ and __ may both occur

A

lips and nails

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38
Q

Is cyanosis evident on the onset?

A

not really

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39
Q

What is pursed lip breathing?

A

something hot between
mentis and lower lip and it seems like you are
blowing that area

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40
Q

Clubbing indicates what disease?

A

chronic hypoxemia

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41
Q

In neonates, peripheral signs indicate what?

A

congenital cardiac or pulmonary defect

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42
Q

Degree of normal finger vs clubbed finger

A

160 deg in normal, 180 + deg in clubbed finger

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43
Q

Procedure done with stethoscope

A

Auscultation

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44
Q

Auscultation provides importatnt condition of what

A

lungs and pleura

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45
Q

In terms sof breath sounds, what should we take note of?

A

○ Intensity
○ Pitch
○ Quality
○ Duration

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46
Q

As PTs, it’s okay if you’re listening for normal breath
sounds but once you hear abnormal breath sounds, what to do?

A

refer
to a doctor

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47
Q

T or F: Auscultation starts from bottom to top

A

top to bottom

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48
Q

In auscultation, we should compare ___

A

both sides (t’s not checking all on one side first, but has to be
contralateral side)

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49
Q

Listen to the chest __ and __ as the patient
breathes with mouth open, and somewhat more deeply
than normal

A

anteriorly, laterally

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50
Q

Listen to the breath sounds, noting their ___ and
identifying any __ from normal vesicular
breathing.

A

intensity, variations

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51
Q

Breath sounds are usually louder in the __

A

upper
anterior lung fields

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52
Q

Bronchovesicular breath sounds may be heard over
the __, especially on the __.

A

large airways, right

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53
Q

Normal Breath Sounds

A

Vesicular
Bronchovesicular
Tubular

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54
Q

• heard over most of the lungs

A

vesicular

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55
Q

What is the most commonly auscultated breath sounds?

A

vesicular

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56
Q

Vesicular breath pitch

A

low (rustling quality)

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57
Q

soft and short expiration

A

vesicular

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58
Q

when do sounds become soft in vesicular?

A

during expiration

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59
Q

vesicular breath more prominent in what individuals or age group?

A

in thin individuals or children

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60
Q

vesicular breath is diminished in what individuals or age group?

A

overweight or muscular individuals

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61
Q

IN VESICULAR, what is longer: insipiratory or expiratory time?

A

Inspiratory time (I) is longer than Expiratory time (E)

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62
Q

Ratio of inspiratory vs expiratory in vesicular

A

3:1

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63
Q

Vesicular is best heard and prominent where?

A

heard in most areas of the lungs but are
most prominently heard at the lung bases and periphery

64
Q

Where is bronchovesicular heard?

A

Heard over the main bronchus area and over upper right
posterior lung field

65
Q

t or f: Breath sounds that you listened to over the bronchioles
would be different if you listen to the breath sounds over
the air sacs

A

t

66
Q

When you place the stethoscopes over the lung
parenchyma, over the air sacs, what do you hear?

A

vesicular breath

67
Q

When you place the stethoscopes on the bronchioles
or in tubular structures, what sound will you hear?

A

bronchiole or tubular sound

68
Q

There would be parts in the lungs that would be
covered by the bronchioles and air sacs, what sound is heard here?

A

bronchovesicular sound

69
Q

Pitch and ntensity of bronchovesicular breath

A

Medium (mid-range) pitch and intensity

70
Q

time of expiratory vs inspiratory in bronchovesicular + what is the ratio?

A

Expiration equals inspiration (1:1)

71
Q

Bronchovesicular is an Intermediate/ mixture of:

A

○ Higher-pitched bronchial sounds
○ Low-pitched vesicular sounds

72
Q

Bronchovesicular can be hear throughout the __, but can be commonly heard in the __

A

lung fields; upper third of the chest

73
Q

Heard only over trachea

A

Bronchial;Tracheal (tubular)

74
Q

Pitch of bronchial or tracheal breath

A

high pitch

75
Q

Hollow or tubular sounds

A

Bronchial;Tracheal (tubular)

76
Q

Metaphor for bronchial sounds

A

like blowing trough a pipe

77
Q

Expiration characteristics in bronchial breath

A

Loud and long expirations, sometimes a bit longer than
inspirations

78
Q

Which is louder: bronchial or vesicular?

A

bronchial;Tracheal (tubular)

79
Q

expiration vs inspiration time in bronchial

A

same or very similar
durations

80
Q

bronchial breath is considered normal breath sounds if auscultated over the
trachea

A

bronchial;Tracheal (tubular)

81
Q

What is indicated if bronchial is heard in the periphery of the lungs?

A

inding which is abnormal and suspicious for pneumonia,
pleural effusions or atelectasis

82
Q

T or F: A Distinct pause between inspiration and expiration is heard in tracheal breath

A

T

83
Q

Duration of Vesicular

A

Inspiratory
sounds >
expiratory
sounds

84
Q

Duration of bronchovesicular

A

Inspiratory =
expiratory

85
Q

Duration of bronchial

A

Expiratory >
inspiratory

86
Q

Duration of tracheal

A

Inspiratory =
expiratory

87
Q

Intensity of Expiratory Vesicular

A

Soft

88
Q

Intensity of Expiratory Bronchovesicular

A

Intermediate

89
Q

Intensity of Expiratory Bronchial

A

Loud

90
Q

Intensity of Expiratory Tracheal

A

Relatively high

91
Q

Pitch of Expiratory of vesicular

A

Relatively low

92
Q

Pitch of Expiratory of bronchovesicular

A

Intermediate

93
Q

Pitch of Expiratory of bronchial

A

Relatively high

94
Q

Pitch of Expiratory of tracheal

A

Relatively high

95
Q

Locations where heard normally in vesicular

A

Over most of both lungs

96
Q

Locations where heard normally in bronchovesicular

A

Often in the 1st and 2nd IS ant.& between the scapulae

97
Q

Locations where heard normally in bronchial

A

Over the manubrium, (larger proximal airways)

98
Q

Locations where heard normally in tracheal

A

Over the trachea in the neck

99
Q

Adventitious breath sounds

A

Fine crackles
Medium crackles
coarse crackles
rhonchi
wheeze
pleural friction rub

100
Q

high-pitched, dicrete, discontinuous
crackling at the end of inspiration

A

Fine Crackle

101
Q

T or F: Fine crackle can be cleared by cough

A

F, not cleared by cough

102
Q

Fine crackles are also called as?

A

rales

103
Q

Metaphor for fine crackles

A

Imagine you are drinking sago’t gulaman and you blow
some air into the drink → creating bubbles

104
Q

When is fine crackles produced?

A

end of inspiration

105
Q

Fine crackles is usual in pts with lungs that has __ or __

A

pneumonia or fluid inside the air
sacs, heart failure

106
Q

When you cough out in fine crackles, what is observed

A

phlegm and
that’s the one causing the crackles

107
Q

But the crackles that we get to hear as a sign of
an abnormal problem (heart failure, pneumonia)
is caused by

A

fluid that is present in the air sacs

108
Q

They have a characteristic __ that are
high-pitched

A

popping sound

109
Q

Fine crackles can be heard when?

A

both phases of respiration (inspiration &
expiration)

110
Q

Early inspiratory and expiratory crackles are classic lung
exam findings in __

A

chronic bronchitis

111
Q

Late inspiratory crackles can
suggest __

A

pneumonia, congestive
heart failure, or atelectasis

112
Q

Where is fine crackles best auscultated

A

lung bases

113
Q

fine crackles vs coarse crackles, which is shorter?

A

fine

114
Q

When you hear fine crackles, what to do?

A

If you hear this sound, inform first
the doctor before starting PT on
the pt

115
Q

lower, moist sound during the midstage of inspiration

A

medium crackles

116
Q

T or F: medium crackles cannot be cleared by cough

A

T

117
Q

Loud, bubbly noise

A

coarse crackles (just like fine crackles but coarser)

118
Q

when is coarse crackles heard?

A

during inspiration

119
Q

T or F: coarse crackles cannot be cleared by cough

A

T

120
Q

Longer duration: fine or coarse?

A

coarse crackles

121
Q

Sibilant wheeze

A

wheeze

122
Q

A smaller lumen of tube causes what?

A

higher pitch

123
Q

When is wheeze most often heard?

A

continuously during inspiration or
expiration

124
Q

cause of tubular sound where tube is smaller

A

bronchial constriction

125
Q

when is wheeze louder?

A

expiration

126
Q

In wheeze, because of the airway obstruction, __ can be prolonged

A

expiratory phase

127
Q

Are musical respiratory sounds that may be audible to
the patient and to others.

A

wheeze

128
Q

Do not start PT session if pt has wheezes or asthmatic
attack, instead what to do?

A

send to ER or ask if they had meds for asthma

129
Q

Sonorous wheeze, snore-like; “low pitched wheezes”

A

rhonchi (just like wheeze but lower in pitch)

130
Q

Rhonchi are Loud, low, coarse sounds most often heard continuously during _ or _

A

insipration; expiration

131
Q

Where is rhonchi heard loudest?

A

center of the chest
instead of the periphery

132
Q

rhonchi is heard in pts with ___

A

COPD, cystic fibrosis,
bronchiectasis, pneumonia

133
Q

T or F: rhonchi cannot be cleared by cough

A

F, can clear

134
Q

There is ___ in trachea or large bronchi

A

mucus accumulation in
trachea or large bronchi

135
Q

Cause of rhonchi

A

phlegm

136
Q

Dry, rubbing, or grating usually caused by inflammation of
pleural surfaces

A

pleural friction rub

137
Q

metaphor for pleural friction rub

A

rubbing hair

138
Q

when is pleural friction rub heard?

A

inspiration or expiration

139
Q

pleural friction rub: loudest where?

A

lower lateral anterior surface

140
Q

pleural friction rub implies

A

arenchymal inflammation

141
Q

causes of pleural friction rub

A

pulmonary embolism, pneumonia, or
inflamed surfaces of lungs sliding against one anothe

142
Q

pleural friction rub best heard where?

A

axilla and base of the lungs

143
Q

Ill or Well? Describe Rhonchi

A

Ill: course low-pitched; may clear iwith cough

144
Q

Ill or Well? Describe Bronchial

A

Well: coarse, loud

145
Q

Ill or Well? Describe Bronchovesicular

A

Well: combined bronchial and vesicular, normal in some areas

146
Q

Ill or Well? Describe Vesicular

A

Well: high-pitched, breezy

147
Q

Ill or Well? Describe Wheeze

A

Ill: whistiling, high-pitched bronchus

148
Q

Ill or Well? Describe Bronchial

A

Ill: course loud; heard with consolidation

149
Q

Ill or Well? Describe Rub

A

Ill: scratchy, high-pitched

150
Q

Ill or Well? Describe Crackles

A

Ill: fine crackling, high-pitched

151
Q

As you palpate the chest, focus on areas of _

A

tenderness or
bruising, respiratory expansion, and fremitus

152
Q

How to palpate thoracic expansion

A

Place a thumb on the midline and ask the pt to take a
deep breath

153
Q

Thoracic expansion checks for?

A

symmetry; lung expansion

154
Q

In thoracic expansion, hands are placed at ___

A

lower
border of rib cage usually
10th rib

155
Q

In thoracic expansion, what do we ask the pt?

A

Ask the patient to inhale
and observe the separation
of the two thumbs

156
Q

The movement seen in thoracic expansion is called as?

A

lung excursion

157
Q

If one hand lags behind in thoracic expansion, it indicates what problems with
that lung

A

atelectasis, tumor, fluid, or
anything that would obstruct lung expansion

CPR (3 decks)

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