System H&P

Question 1

What is the major respiratory issue that is seen?

Answer 1

Chronic cough

Question 2

What are the major pulmonary ssx?

Answer 2

Dyspnea
Cough
Wheezing
Chest pain
Breathing disorders
Sputum production

Question 3

What is the definition of dypsnea?

Answer 3

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

Question 4

What is the major difference between pathologic and physiologic dyspnea?

Answer 4

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

Question 5

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

Answer 5

Unknown but related to a high level of ventilation perceived centrally

Length tension dissociation of respiratory muscles

Modified by attention

Question 6

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

Answer 6

How much exertion:

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

Question 7

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

Answer 7

Onset (rapid vs gradual)
Activity level (progression)

Question 8

What part of the brain is responsible for perceiving dyspnea?

Answer 8

Limbic system

Question 9

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

Answer 9

Block beta 2 receptors, making asthma worse

Question 10

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

Answer 10

Activity level

Question 11

Are rating scales to rate SOB used often clinically?

Answer 11

No, mostly for studies

Question 12

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

Answer 12

LV failure or PE

Question 13

What are the three main causes of pneumothorax?

Answer 13

Idiopathic
Iatrogenic
Trauma

Question 14

In whom is spontaneous pneumothorax common?

Answer 14

Tall, thin, smoking males

Question 15

What are the physical ssx of hyperventilatio?

Answer 15

Cyanosis

Tingling in the lips

Question 16

SOB over 1-2 hours = ?

Answer 16

LV failure

PE***

Question 17

Dyspnea with hyperventilation = ?

Answer 17

Acidosis
Poisoning
Hyperventilation syndrome

Question 18

True or false: tachypnea = hyperventilating

Answer 18

False, hyperventilation associated with decreased pCO2 on ABG

Question 19

Immediate pain with SOB = ? (3)

Answer 19

Pneumothorax
FB aspiration
PE

Question 20

True or false: recurrent PE is usually abrupt onset

Answer 20

False–usually gradual since they have many, smaller emboli

Question 21

What is pneumoconiosis? Is this gradual or sudden onset?

Answer 21

Inhalation of inorganic particulates

Gradual onset

Question 22

What is wheezing?

Answer 22

High pitched sound with inspiration or expiration

Question 23

What is the cause of wheezing?

Answer 23

Airway obstruction

Question 24

Inspiratory wheezing is suggestive of what? Why?

Answer 24

Upper airway obstruction, outside of the thoracic cavity

Lower airway tends to collapse with each breath

Question 25

Expiratory wheezing is suggestive of what? Why?

Answer 25

Lower airway obstruction, inside the thoracic cavity d/t increased lower airway increase in pressure

Question 26

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

Answer 26

False

Question 27

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

Answer 27

Cyanosis | Mentation

Question 28

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

Answer 28

Tumors

Question 29

Pleuritic chest pain is due to what?

Answer 29

Inflammation of the parietal pleura

Question 30

Can you sense pain with the visceral pleura? Parietal?

Answer 30

Parietal yes, visceral now

Question 31

What are the characteristics of parietal pleura?

Answer 31

Sharp, localized, severe pain that is aggravated by breathing

Question 32

How do you classify a cough?

Answer 32

By its duration

Question 33

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

Answer 33

- Duration - Characteristics (bloody, colored, purulent etc) - Volume - Changes

Question 34

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

Answer 34

posterior tracheal wall and at the carina

Question 35

What type of receptors are irritant receptors?

Answer 35

Mechanoreceptors and chemical receptors

Question 36

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

Answer 36

True

Question 37

What is an acute cough? Subacute? Chronic?

Answer 37

``` Acute = less than 3 weeks Subacute = 3-8 weeks Chronic = greater than 8 weeks ```

Question 38

What is the most common cause of an acute cough?

Answer 38

Viral URI | Acute aspiration

Question 39

What are the 3 common causes of a chronic cough?

Answer 39

- Asthma - Upper airway cough syndromes - GERD

Question 40

What drug will cause a cough? Why?

Answer 40

ACEIs d/t bradykinin buildup

Question 41

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

Answer 41

- Eosinophilic bronchitis - Post viral cough - Chronic bronchitis - Bronchiectasis

Question 42

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

Answer 42

- Inspection - Palpation - Percussion - Auscultation

Question 43

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

Answer 43

- Neck - UEs - LEs - Abdomen

Question 44

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

Answer 44

- Pattern of sleep - Evidence of respiratory tripod position - Accessory muscle use

Question 45

How can you diagnose respiratory distress? (4)

Answer 45

- Tripod position - Accessory muscle use - Cyanosis - Pursed lip breathing

Question 46

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

Answer 46

True

Question 47

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

Answer 47

Deep pattern of breathing seen in DKA

Question 48

What is Biot's breathing?

Answer 48

Deep breathing with periods of apnea

Question 49

What is the cheyne-stokes breathing?

Answer 49

Crescendo-decrescendo breathing pattern with periods of apnea

Question 50

Why is the tripod position used for breathing?

Answer 50

Stabilizes the shoulder girdle to help accessory muscles

Question 51

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

Answer 51

- Tympanic percussion and distant lung sounds | - Barrel chest

Question 52

How do you detect fremitus? Why is it used?

Answer 52

Have pt say "99" | Can help with diagnose pneumonia or other consolidated lung if increased

Question 53

Hyper resonance with chest percussion suggests what?

Answer 53

Increased air in the thorax either from air trapping or pneumothorax

Question 54

Dullness with chest percussion indicates what?

Answer 54

Consolidation Effusion Mass

Question 55

What is egophony used for?

Answer 55

Detect consolidation (E to A)

Question 56

What are adventitious sounds?

Answer 56

Crackles or rales

Question 57

What are the characteristics of wheezing?

Answer 57

High pitched sound

Question 58

What are the characteristics of rhonchi? What causes this?

Answer 58

Low pitched sounds (like blowing through a straw)

Question 59

What is a crackle? What causes them?

Answer 59

Discontinuous sounds present with inhalation, but can be heard with exhalation Caused by explosive opening of the small airways as surface tension is overcome

Question 60

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

Answer 60

Pleural inflammation causing a sound similar to wet leather rubbing of a rusty hinge Typically biphasic and transient

Question 61

Rapid or slow onset: acute asthma exacerbation

Answer 61

Rapid

Question 62

Rapid or slow onset: LV failure leading to pulmonary edema

Answer 62

Rapid

Question 63

Rapid or slow onset: PE

Answer 63

Rapid

Question 64

Rapid or slow onset: pneumothorax

Answer 64

rapid

Question 65

Rapid or slow onset: pneumonia

Answer 65

Hours to days

Question 66

Rapid or slow onset: acute bronchitis

Answer 66

hours to days

Question 67

Rapid or slow onset: pneumoconiosis

Answer 67

Slow

Question 68

Rapid or slow onset: interstitial lung disease

Answer 68

Slow

Question 69

Rapid or slow onset: neuromuscular disease

Answer 69

Slow

Question 70

What does a localized area of wheezing suggest?

Answer 70

Intrabronchial process

Question 71

True or false: chronic bronchitis is usually productive

Answer 71

True

Question 72

True or false: bronchiectasis is usually productive

Answer 72

True

Question 73

What is the advantage of pursed lip breathing?

Answer 73

Prevent deflation of the chest d/t increased back pressure

Question 74

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

Answer 74

Pneumonia

Question 75

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

Answer 75

Pneumothorax

Question 76

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

Answer 76

Pleural effusion

Question 77

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?

Answer 77

COPD

Question 78

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

Answer 78

Increased tactile fremitus | Decreased chest wall expansion unilaterally

Question 79

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

Answer 79

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

Question 80

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

Answer 80

- Decreased tactile fremitus | - Tracheal deviation away from affected side

Question 81

What happens with chest wall expansion with COPD?

Answer 81

Decreased expansion bilaterally

Question 82

What are the percussive findings with pneumonia?

Answer 82

Dull

Question 83

What are the percussive findings with a pneumothorax?

Answer 83

Hyperresonant

Question 84

What are the percussive findings with COPD?

Answer 84

Hyperresonant

Question 85

What are the percussive findings with pleural effusion?

Answer 85

Stony dull

Question 86

What are the lungs sounds with pneumonia?

Answer 86

Bronchial breathing with crackles and wheeze

Question 87

What are the breath sounds with pneumothorax

Answer 87

Decreased

Question 88

What are the breath sounds with a pleural effusion

Answer 88

- Crackles at upper edge of effusion | - Decreased vesicular breath sounds

Question 89

What condition is associated with a pleural friction rub?

Answer 89

Pleural effusion

Question 90

What are the breath sounds with COPD?

Answer 90

Wheezes/crackles | Decreased breath sounds