S1_L2_CPR_PhysicalDx - 39-71 Flashcards
1
Q
T or F: Scoliosis is not progressive
A
F
2
Q
Scoliosis is more so ___
A
compressive
3
Q
In scoliosis, one must be fast in detecting early on s/sx, in
other to prevent ___
A
complications
4
Q
What is kyphoscoliosis?
A
kyphosis + scoliosis
5
Q
A symmetrical chest means that there is ___ on both sides
A
equal expansion
6
Q
Unequal expansion and respiratory compromise
A
Chest Asymmetry
7
Q
Causes of chest asymmetry
A
A collapsed lung & limitation of expansion
8
Q
Causes of collapsed lung or limtiation of expansion
A
fibrosis, muscular contracture, jt. mob
problems, etc.
9
Q
If there is UNEQUAL expansion, what do we observe?
A
breast (do not oggle if female)
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
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)
12
Q
Suggest an obstruction to
inspiration at any point in
the respiratory tract
A
Retractions
13
Q
In retractions, ___ become increasingly negative degree and level of retraction depend on the extent and level of obstruction
A
intrapleural pressure; obstruction
14
Q
Mechanism of retractions
A
acts like a vacuum effect on the thorax
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
16
Q
T or F: retraction is not yet a medical emergency
A
F, bring pt immediately to the ER
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
18
Q
Expiratory is severe; audible even without steth
A
Inspiratory Stridor
19
Q
○ “Umiiyak na hindi basa”
○ Like a dog barking
A
Hoarse cough or cry or barking cough
20
Q
○ Sign of air hunger
A
alar flaring
21
Q
○ Could tell level of obstruction
A
Retraction at the suprasternal notch
22
Q
Sign of low levels of oxygen
A
Cyanosis
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
24
Q
Why is stridor quieter in supraglottic obstruction?
A
Because the obstruction is not full
25
(“hot potato in mouth”)
muffling voice
26
Why is there no cough in supraglottic obstruction
Because you’re not irritating the most irritating part
of the airways
27
Why is there awkward position of the head and neck?
Looking for that position to establish a good airway
(air can come in better)
28
Signs of infraglottic obstruction
• stridor tends to be louder, rasping
• hoarse voice
• swallowing not affected
• cough is harsh, barking
• head positioning is not a factor
29
T or F: Head positioning is a factor in infraglottic obstruction
F
30
Why is head positioning not a factor in infraglottic obstruction
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
31
Peripheral Signs
• cyanosis
• pursing
• clubbing: finger nails
• alar flaring
• suggest cardiac or pulmonary
difficulty
32
Peripheral Signs affecting lips, nails
cyanosis
33
Peripheral Signs affecting lips
pursing
34
Peripheral Signs affecting finger nails
clubbing
35
Peripheral Signs leading to air hunger, esp alveolar involvement
alar flaring
36
Peripheral signs suggest what?
cardiac or pulmonary difficulty
37
When a pt becomes cyanotic, cyanosis of the _ and __ may both occur
lips and nails
38
Is cyanosis evident on the onset?
not really
39
What is pursed lip breathing?
something hot between
mentis and lower lip and it seems like you are
blowing that area
40
Clubbing indicates what disease?
chronic hypoxemia
41
In neonates, peripheral signs indicate what?
congenital cardiac or pulmonary defect
42
Degree of normal finger vs clubbed finger
160 deg in normal, 180 + deg in clubbed finger
43
Procedure done with stethoscope
Auscultation
44
Auscultation provides importatnt condition of what
lungs and pleura
45
In terms sof breath sounds, what should we take note of?
○ Intensity
○ Pitch
○ Quality
○ Duration
46
As PTs, it’s okay if you’re listening for normal breath
sounds but once you hear abnormal breath sounds, what to do?
refer
to a doctor
47
T or F: Auscultation starts from bottom to top
top to bottom
48
In auscultation, we should compare ___
both sides (t’s not checking all on one side first, but has to be
contralateral side)
49
Listen to the chest __ and __ as the patient
breathes with mouth open, and somewhat more deeply
than normal
anteriorly, laterally
50
Listen to the breath sounds, noting their ___ and
identifying any __ from normal vesicular
breathing.
intensity, variations
51
Breath sounds are usually louder in the __
upper
anterior lung fields
52
Bronchovesicular breath sounds may be heard over
the __, especially on the __.
large airways, right
53
Normal Breath Sounds
Vesicular
Bronchovesicular
Tubular
54
• heard over most of the lungs
vesicular
55
What is the most commonly auscultated breath sounds?
vesicular
56
Vesicular breath pitch
low (rustling quality)
57
soft and short expiration
vesicular
58
when do sounds become soft in vesicular?
during expiration
59
vesicular breath more prominent in what individuals or age group?
in thin individuals or children
60
vesicular breath is diminished in what individuals or age group?
overweight or muscular individuals
61
IN VESICULAR, what is longer: insipiratory or expiratory time?
Inspiratory time (I) is longer than Expiratory time (E)
62
Ratio of inspiratory vs expiratory in vesicular
3:1
63
Vesicular is best heard and prominent where?
heard in most areas of the lungs but are
most prominently heard at the lung bases and periphery
64
Where is bronchovesicular heard?
Heard over the main bronchus area and over upper right
posterior lung field
65
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
t
66
When you place the stethoscopes over the lung
parenchyma, over the air sacs, what do you hear?
vesicular breath
67
When you place the stethoscopes on the bronchioles
or in tubular structures, what sound will you hear?
bronchiole or tubular sound
68
There would be parts in the lungs that would be
covered by the bronchioles and air sacs, what sound is heard here?
bronchovesicular sound
69
Pitch and ntensity of bronchovesicular breath
Medium (mid-range) pitch and intensity
70
time of expiratory vs inspiratory in bronchovesicular + what is the ratio?
Expiration equals inspiration (1:1)
71
Bronchovesicular is an Intermediate/ mixture of:
○ Higher-pitched bronchial sounds
○ Low-pitched vesicular sounds
72
Bronchovesicular can be hear throughout the __, but can be commonly heard in the __
lung fields; upper third of the chest
73
Heard only over trachea
Bronchial;Tracheal (tubular)
74
Pitch of bronchial or tracheal breath
high pitch
75
Hollow or tubular sounds
Bronchial;Tracheal (tubular)
76
Metaphor for bronchial sounds
like blowing trough a pipe
77
Expiration characteristics in bronchial breath
Loud and long expirations, sometimes a bit longer than
inspirations
78
Which is louder: bronchial or vesicular?
bronchial;Tracheal (tubular)
79
expiration vs inspiration time in bronchial
same or very similar
durations
80
bronchial breath is considered normal breath sounds if auscultated over the
trachea
bronchial;Tracheal (tubular)
81
What is indicated if bronchial is heard in the periphery of the lungs?
inding which is abnormal and suspicious for pneumonia,
pleural effusions or atelectasis
82
T or F: A Distinct pause between inspiration and expiration is heard in tracheal breath
T
83
Duration of Vesicular
Inspiratory
sounds >
expiratory
sounds
84
Duration of bronchovesicular
Inspiratory =
expiratory
85
Duration of bronchial
Expiratory >
inspiratory
86
Duration of tracheal
Inspiratory =
expiratory
87
Intensity of Expiratory Vesicular
Soft
88
Intensity of Expiratory Bronchovesicular
Intermediate
89
Intensity of Expiratory Bronchial
Loud
90
Intensity of Expiratory Tracheal
Relatively high
91
Pitch of Expiratory of vesicular
Relatively low
92
Pitch of Expiratory of bronchovesicular
Intermediate
93
Pitch of Expiratory of bronchial
Relatively high
94
Pitch of Expiratory of tracheal
Relatively high
95
Locations where heard normally in vesicular
Over most of both lungs
96
Locations where heard normally in bronchovesicular
Often in the 1st and 2nd IS ant.& between the scapulae
97
Locations where heard normally in bronchial
Over the manubrium, (larger proximal airways)
98
Locations where heard normally in tracheal
Over the trachea in the neck
99
Adventitious breath sounds
Fine crackles
Medium crackles
coarse crackles
rhonchi
wheeze
pleural friction rub
100
high-pitched, dicrete, discontinuous
crackling at the end of inspiration
Fine Crackle
101
T or F: Fine crackle can be cleared by cough
F, not cleared by cough
102
Fine crackles are also called as?
rales
103
Metaphor for fine crackles
Imagine you are drinking sago’t gulaman and you blow
some air into the drink → creating bubbles
104
When is fine crackles produced?
end of inspiration
105
Fine crackles is usual in pts with lungs that has __ or __
pneumonia or fluid inside the air
sacs, heart failure
106
When you cough out in fine crackles, what is observed
phlegm and
that’s the one causing the crackles
107
But the crackles that we get to hear as a sign of
an abnormal problem (heart failure, pneumonia)
is caused by
fluid that is present in the air sacs
108
They have a characteristic __ that are
high-pitched
popping sound
109
Fine crackles can be heard when?
both phases of respiration (inspiration &
expiration)
110
Early inspiratory and expiratory crackles are classic lung
exam findings in __
chronic bronchitis
111
Late inspiratory crackles can
suggest __
pneumonia, congestive
heart failure, or atelectasis
112
Where is fine crackles best auscultated
lung bases
113
fine crackles vs coarse crackles, which is shorter?
fine
114
When you hear fine crackles, what to do?
If you hear this sound, inform first
the doctor before starting PT on
the pt
115
lower, moist sound during the midstage of inspiration
medium crackles
116
T or F: medium crackles cannot be cleared by cough
T
117
Loud, bubbly noise
coarse crackles (just like fine crackles but coarser)
118
when is coarse crackles heard?
during inspiration
119
T or F: coarse crackles cannot be cleared by cough
T
120
Longer duration: fine or coarse?
coarse crackles
121
Sibilant wheeze
wheeze
122
A smaller lumen of tube causes what?
higher pitch
123
When is wheeze most often heard?
continuously during inspiration or
expiration
124
cause of tubular sound where tube is smaller
bronchial constriction
125
when is wheeze louder?
expiration
126
In wheeze, because of the airway obstruction, __ can be prolonged
expiratory phase
127
Are musical respiratory sounds that may be audible to
the patient and to others.
wheeze
128
Do not start PT session if pt has wheezes or asthmatic
attack, instead what to do?
send to ER or ask if they had meds for asthma
129
Sonorous wheeze, snore-like; “low pitched wheezes”
rhonchi (just like wheeze but lower in pitch)
130
Rhonchi are Loud, low, coarse sounds most often heard continuously during _ or _
insipration; expiration
131
Where is rhonchi heard loudest?
center of the chest
instead of the periphery
132
rhonchi is heard in pts with ___
COPD, cystic fibrosis,
bronchiectasis, pneumonia
133
T or F: rhonchi cannot be cleared by cough
F, can clear
134
There is ___ in trachea or large bronchi
mucus accumulation in
trachea or large bronchi
135
Cause of rhonchi
phlegm
136
Dry, rubbing, or grating usually caused by inflammation of
pleural surfaces
pleural friction rub
137
metaphor for pleural friction rub
rubbing hair
138
when is pleural friction rub heard?
inspiration or expiration
139
pleural friction rub: loudest where?
lower lateral anterior surface
140
pleural friction rub implies
arenchymal inflammation
141
causes of pleural friction rub
pulmonary embolism, pneumonia, or
inflamed surfaces of lungs sliding against one anothe
142
pleural friction rub best heard where?
axilla and base of the lungs
143
Ill or Well? Describe Rhonchi
Ill: course low-pitched; may clear iwith cough
144
Ill or Well? Describe Bronchial
Well: coarse, loud
145
Ill or Well? Describe Bronchovesicular
Well: combined bronchial and vesicular, normal in some areas
146
Ill or Well? Describe Vesicular
Well: high-pitched, breezy
147
Ill or Well? Describe Wheeze
Ill: whistiling, high-pitched bronchus
148
Ill or Well? Describe Bronchial
Ill: course loud; heard with consolidation
149
Ill or Well? Describe Rub
Ill: scratchy, high-pitched
150
Ill or Well? Describe Crackles
Ill: fine crackling, high-pitched
151
As you palpate the chest, focus on areas of _
tenderness or
bruising, respiratory expansion, and fremitus
152
How to palpate thoracic expansion
Place a thumb on the midline and ask the pt to take a
deep breath
153
Thoracic expansion checks for?
symmetry; lung expansion
154
In thoracic expansion, hands are placed at ___
lower
border of rib cage usually
10th rib
155
In thoracic expansion, what do we ask the pt?
Ask the patient to inhale
and observe the separation
of the two thumbs
156
The movement seen in thoracic expansion is called as?
lung excursion
157
If one hand lags behind in thoracic expansion, it indicates what problems with
that lung
atelectasis, tumor, fluid, or
anything that would obstruct lung expansion
