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System H&P Flashcards

1
Q

What is the major respiratory issue that is seen?

A

Chronic cough

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2
Q

What are the major pulmonary ssx?

A 
Dyspnea
Cough
Wheezing
Chest pain
Breathing disorders
Sputum production
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3
Q

What is the definition of dypsnea?

A

Difficult, labored, uncomfortable breathing that is qualitative, and subjective

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4
Q

What is the major difference between pathologic and physiologic dyspnea?

A

Pathologic is uncomfortable since it occurs when you’re not exerting yourself

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5
Q

What causes dyspnea? (2). What modifies these?

A

Unknown but related to a high level of ventilation perceived centrally

Length tension dissociation of respiratory muscles

Modified by attention

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6
Q

How do you elicit information about how bad the dyspnea is? What is the progression of dyspnea (6)?

A

How much exertion:

  • DOE
  • walking
  • Bathing/changing clothes
  • Talking
  • at rest
  • changing positions
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7
Q

What are the two major characteristics of the history that should be asked with SOB?

A 
Onset (rapid vs gradual)
Activity level (progression)
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8
Q

What part of the brain is responsible for perceiving dyspnea?

A

Limbic system

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9
Q

What is the problem with beta blockers on the respiratory system?

A

Block beta 2 receptors, making asthma worse

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10
Q

What is the most useful indicator for the level of severity for SOB?

A

Activity level

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11
Q

Are rating scales to rate SOB used often clinically?

A

No, mostly for studies

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12
Q

What heart dysfunction may present with sudden DOE (besides MI)?

A

LV failure or PE

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13
Q

What are the three main causes of pneumothorax?

A

Idiopathic
Iatrogenic
Trauma

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14
Q

In whom is spontaneous pneumothorax common?

A

Tall, thin, smoking males

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15
Q

What are the physical ssx of hyperventilatio?

A

Cyanosis

Tingling in the lips

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16
Q

SOB over 1-2 hours = ?

A

LV failure

PE***

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17
Q

Dyspnea with hyperventilation = ?

A

Acidosis
Poisoning
Hyperventilation syndrome

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18
Q

True or false: tachypnea = hyperventilating

A

False, hyperventilation associated with decreased pCO2 on ABG

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19
Q

Immediate pain with SOB = ? (3)

A

Pneumothorax
FB aspiration
PE

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20
Q

True or false: recurrent PE is usually abrupt onset

A

False–usually gradual since they have many, smaller emboli

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21
Q

What is pneumoconiosis? Is this gradual or sudden onset?

A

Inhalation of inorganic particulates

Gradual onset

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22
Q

What is wheezing?

A

High pitched sound with inspiration or expiration

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23
Q

What is the cause of wheezing?

A

Airway obstruction

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24
Q

Inspiratory wheezing is suggestive of what? Why?

A

Upper airway obstruction, outside of the thoracic cavity

Lower airway tends to collapse with each breath

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25
Q

Expiratory wheezing is suggestive of what? Why?

A

Lower airway obstruction, inside the thoracic cavity

d/t increased lower airway increase in pressure

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26
Q

True or false: the severity of wheezing almost always correlates with the severity of airflow obstruction

A

False

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27
Q

What evaluating wheezing what should you assess, beside the airway sounds?

A

Cyanosis

Mentation

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28
Q

Why is a CXR always indicated for a smoker with new onset wheezing?

A

Tumors

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29
Q

Pleuritic chest pain is due to what?

A

Inflammation of the parietal pleura

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30
Q

Can you sense pain with the visceral pleura? Parietal?

A

Parietal yes, visceral now

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31
Q

What are the characteristics of parietal pleura?

A

Sharp, localized, severe pain that is aggravated by breathing

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32
Q

How do you classify a cough?

A

By its duration

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33
Q

What are the characteristics that you should elicit with sputum production? (4)

A
  • Duration
  • Characteristics (bloody, colored, purulent etc)
  • Volume
  • Changes
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34
Q

Where are the irritant receptors located that cause a cough? (2)

A

posterior tracheal wall and at the carina

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35
Q

What type of receptors are irritant receptors?

A

Mechanoreceptors and chemical receptors

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36
Q

True or false: irritant receptors that are activated in the ears, stomach, and pericardium can cause a cough

A

True

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37
Q

What is an acute cough? Subacute? Chronic?

A 
Acute = less than 3 weeks
Subacute = 3-8 weeks
Chronic = greater than 8 weeks
38
Q

What is the most common cause of an acute cough?

A

Viral URI

Acute aspiration

39
Q

What are the 3 common causes of a chronic cough?

A
  • Asthma
  • Upper airway cough syndromes
  • GERD
40
Q

What drug will cause a cough? Why?

A

ACEIs d/t bradykinin buildup

41
Q

What are the four, lesser causes of a chronic cough?

A
  • Eosinophilic bronchitis
  • Post viral cough
  • Chronic bronchitis
  • Bronchiectasis
42
Q

What are the appropriate steps of the PE for a cough? (4)

A
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
43
Q

What are the 4 extra thoracic sites that should be evaluated in a lung exam?

A
  • Neck
  • UEs
  • LEs
  • Abdomen
44
Q

What are the aspects of inspecting the chest that should be done when evaluating the lungs?

A
  • Pattern of sleep
  • Evidence of respiratory tripod position
  • Accessory muscle use
45
Q

How can you diagnose respiratory distress? (4)

A
  • Tripod position
  • Accessory muscle use
  • Cyanosis
  • Pursed lip breathing
46
Q

True or false: clubbing can be seen in a variety of pathological and nonpathological condition

47
Q

What is Kussmaul’s breathing? When is it seen?

A

Deep pattern of breathing seen in DKA

48
Q

What is Biot’s breathing?

A

Deep breathing with periods of apnea

49
Q

What is the cheyne-stokes breathing?

A

Crescendo-decrescendo breathing pattern with periods of apnea

50
Q

Why is the tripod position used for breathing?

A

Stabilizes the shoulder girdle to help accessory muscles

51
Q

What are the physical findings of COPD? (percussion and visual findings)

A
  • Tympanic percussion and distant lung sounds

- Barrel chest

52
Q

How do you detect fremitus? Why is it used?

A

Have pt say “99”

Can help with diagnose pneumonia or other consolidated lung if increased

53
Q

Hyper resonance with chest percussion suggests what?

A

Increased air in the thorax either from air trapping or pneumothorax

54
Q

Dullness with chest percussion indicates what?

A

Consolidation
Effusion
Mass

55
Q

What is egophony used for?

A

Detect consolidation (E to A)

56
Q

What are adventitious sounds?

A

Crackles or rales

57
Q

What are the characteristics of wheezing?

A

High pitched sound

58
Q

What are the characteristics of rhonchi? What causes this?

A

Low pitched sounds (like blowing through a straw)

59
Q

What is a crackle? What causes them?

A

Discontinuous sounds present with inhalation, but can be heard with exhalation

Caused by explosive opening of the small airways as surface tension is overcome

60
Q

What is a pleural friction rub? What does it sound like? How long does it last?

A

Pleural inflammation causing a sound similar to wet leather rubbing of a rusty hinge

Typically biphasic and transient

61
Q

Rapid or slow onset: acute asthma exacerbation

62
Q

Rapid or slow onset: LV failure leading to pulmonary edema

63
Q

Rapid or slow onset: PE

64
Q

Rapid or slow onset: pneumothorax

65
Q

Rapid or slow onset: pneumonia

A

Hours to days

66
Q

Rapid or slow onset: acute bronchitis

A

hours to days

67
Q

Rapid or slow onset: pneumoconiosis

68
Q

Rapid or slow onset: interstitial lung disease

69
Q

Rapid or slow onset: neuromuscular disease

70
Q

What does a localized area of wheezing suggest?

A

Intrabronchial process

71
Q

True or false: chronic bronchitis is usually productive

72
Q

True or false: bronchiectasis is usually productive

73
Q

What is the advantage of pursed lip breathing?

A

Prevent deflation of the chest d/t increased back pressure

74
Q

On history/inspection of a patient with respiratory complaints, you find: productive cough and a fever. What should you suspect?

75
Q

On history/inspection of a patient with respiratory complaints, you find: dyspnea, chest pain, h/o trauma and increased JVP. What should you suspect?

A

Pneumothorax

76
Q

On history/inspection of a patient with respiratory complaints, you find: dyspnea, mild, non-productive cough, and chest pain. What should you suspect?

A

Pleural effusion

77
Q

On history/inspection of a patient with respiratory complaints, you find: h/o smoking, repeated chest infx, dyspnea, and a cough. What should you suspect?

78
Q

What happens with tactile fremitus with pneumonia? Chest wall expansion?

A

Increased tactile fremitus

Decreased chest wall expansion unilaterally

79
Q

What happens with tactile fremitus with a pneumothorax? Chest wall expansion? Tracheal deviation?

A

Decreased fremitus
Decreased chest wall expansion unilaterally
Tracheal deviation towards if not tension pneumo

80
Q

What happens with tactile fremitus with a pleural effusion? Tracheal deviation?

A
  • Decreased tactile fremitus

- Tracheal deviation away from affected side

81
Q

What happens with chest wall expansion with COPD?

A

Decreased expansion bilaterally

82
Q

What are the percussive findings with pneumonia?

83
Q

What are the percussive findings with a pneumothorax?

A

Hyperresonant

84
Q

What are the percussive findings with COPD?

A

Hyperresonant

85
Q

What are the percussive findings with pleural effusion?

A

Stony dull

86
Q

What are the lungs sounds with pneumonia?

A

Bronchial breathing with crackles and wheeze

87
Q

What are the breath sounds with pneumothorax

88
Q

What are the breath sounds with a pleural effusion

A
  • Crackles at upper edge of effusion

- Decreased vesicular breath sounds

89
Q

What condition is associated with a pleural friction rub?

A

Pleural effusion

90
Q

What are the breath sounds with COPD?

A

Wheezes/crackles

Decreased breath sounds

Respiratory (34 decks)

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