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Patient Evaluation 1 > The Thorax and Lungs > Flashcards

The Thorax and Lungs Flashcards

0
Q

Pleural effusions that are exudates are seen in what conditions?

A 
pneumonia
tuberculosis
pulmonary embolus
pancreatitis
malignancy
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1
Q

Pleural effusions that are transudates are seen with what disorders/diseases?

A

Heart failure
atelectasis
nephrotic syndrome

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2
Q

A patient with a clenched fist over the sternum suggests what?

A

angina pectoris

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3
Q

A patient with a finger pointing to a tender area on the chest wall suggests what?

A

musculoskeletal pain

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4
Q

A patient with a hand moving from neck to epigastrium suggests what?

A

heart burn

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5
Q

What is the most frequent cause of chest pain in children? What else is common?

A

anxiety

costochrondritis

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6
Q

What two things are used to predict the 5-year survival in COPD patients, and which of the two is better?

A

The degree of dyspnea predicts survival better than forced expiratory volume in one second (FEV1)

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7
Q

Patients that have episodic dyspnea during both rest and exercise and hyperventilation (rapid, shallow breathing) are exhibiting what?

A

anxiety

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8
Q

Under what conditions does wheezing occur?

A

partial airway obstruction from secretions and tissue inflammation in asthma, or from a foreign body

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9
Q

Cough can be a symptom of what heart condition?

A

left-sided heart failure

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10
Q

What is the most common cause of acute cough? What else should you consider?

A

viral upper respiratory infections are most common, but also consider acute bronchitis, pneumonia, left ventricular heart failure, asthma, or a foreign body

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11
Q

What diseases should you consider with a subacute cough?

A

post-infectious cough, bacterial sinusitis, asthma

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12
Q

What conditions should you consider with a chronic cough?

A

postnasal drip, asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis

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13
Q

What does mucoid sputum look like?

A

translucent, white, or gray

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14
Q

What does purulent sputum look like?

A

yellow or green

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15
Q

Foul-smelling sputum is present in what condition?

A

anaerobic lung abscess

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16
Q

Tenacious sputum is found with what condition?

A

cystic fibrosis

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17
Q

Large volumes of purulent sputum is associated with what?

A

lung abscess or bronchiectasis

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18
Q

What are 5 diagnostically helpful symptoms when diagnosing lung disease?

A

fever, chest pain, dyspnea, orthopnea, wheezing

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19
Q

Hemoptysis is common in what disease?

A

cystic fibrosis

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20
Q

How will blood coughed up that originated in the stomach look different than blood that originated from the respiratory tract?

A

it will look much darker and may be mixed with food particles

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21
Q

Cyanosis is a sign of what?

A

hypoxia

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22
Q

Clubbing of the nails occurs in what 6 conditions?

A 
bronchiectasis
congenital heart disease
pulmonary fibrosis
cystic fibrosis
lung abscess 
malignancy
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23
Q

Audible stridor is an ominous sign of what?

A

upper airway obstruction in the larynx or trachea

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24
Q

Describe stridor.

A

a high-pitched wheeze

25
Q

Lateral displacement of the trachea occurs in what three conditions?

A

pneumothorax, pleural effusion, or atelectasis

26
Q

Under what conditions may the AP diameter increase?

A

COPD or with aging

27
Q

There may be an asymmetric expansion of the chest with what condition?

A

pleural effusion

28
Q

Retraction of the interspaces during inspiration occurs in what three conditions?

A

asthma, COPD, or upper airway obstruction

29
Q

Unilateral impairment or lagging in respiratory movement indicates what?

A

pleural disease from asbestosis or silicosis, or in phrenic nerve damage or trauma

30
Q

Although rare, sinus tracts (blind, inflammatory, tubelike structures opening onto the skin) indicate infection of the underlying pleura and lung as seen in what two conditions?

A

tuberculosis

actinomycosis

31
Q

Unilateral decrease or delay in chest expansion occurs in what conditions?

A

chronic fibrosis of the underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain with associated splinting, and unilateral bronchial obstruction

32
Q

Fremitus is decreased or absent under what conditions?

A

when the voice is higher pitched or soft, when the transmission of vibrations is impeded by a thick chest wall, with an obstructed bronchus, COPD, or pleural changes from effusion, fibrosis, air (pneumothorax) or infiltrating tumor

33
Q

Asymmetric decreased fremitus occurs in what conditions?

A

unilateral pleural effusion, pneumothorax, neoplasm due to decrease transmission of low frequency sounds

34
Q

asymmetric increased fremitus occurs in what conditions?

A

unilateral pneumonia from increased transmission through consolidated tissue

35
Q

Name a pathologic example where you would hear a flat sound during percussion where otherwise not expected?

A

large pleural effusion

36
Q

Name a pathologic example where you may hear a dull sound in percussion where otherwise not expected?

A

lobar pneumonia

37
Q

Name a pathologic example where you may hear a resonant sound during percussion where otherwise not expected?

A

simple chronic bronchitis

38
Q

Name a pathologic example where you may hear a hyperresonant sound where otherwise not expected during percussion?

A

COPD, pneumothorax

39
Q

Name a pathologic example where you may hear a tympanitic sound during percussion where otherwise not expected

A

large pneumothorax

40
Q

When does dullness replace resonance in percussion of the thoracic region? What are some pathologic examples of this?

A

when fluid or solid tissue replaces air containing lung or occupies the pleural space beneath your percussing fingers

examples include lobar pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue, or tumor

41
Q

Dullness with percussion makes what two conditions 5 and 8 times more likely, respectively?

A

pneumonic and pleural effusion

42
Q

Generalized hyperresonance may be heard over the hyperinflated lugs of what two conditions?

A

COPD, asthma

43
Q

Unilateral hyperresonance suggests what?

A

a large pneumothorax or possibly a large air-filled bulla in the lung

44
Q

An abnormally high diaphragm suggests what?

A

atelectasis or phrenic nerve paralysis

45
Q

If bronchovesicular or bronchial breath sounds are heard in locations distant from where normally heard, suspect that air-filled lung has been replaced by what?

A

fluid-filled or solid lung tissue

46
Q

When may breath sounds be decreased?

A

when air flow is decreased (as in obstructive lung disease or muscular weakness) or when the transmission of sound is poor (as in pleural effusion, pneumothorax, or COPD

47
Q

Fine late inspiratory crackles that persist from breath to breath suggests what?

A

abnormal lung tissue

48
Q

Clearing of crackles, wheezes, or rhonchi after coughing or position change suggests what? What conditions is this seen in?

A

inspissated secretions, seen in bronchitis or atelectasis

49
Q

Crackles may be from what?

A

abnormalities in the lungs (pneumonia, fibrosis, early heart failure) or in the airways (bronchitis, bronchiectasis)

50
Q

Wheezes suggest narrowed airways as seen in what three conditions?

A

asthma, COPD, or bronchitis

51
Q

Rhonchi suggest secretions where?

A

in large airways

52
Q

Findings of predictive COPD include combinations of signs and symptoms, especially what?

A

wheezing by self report or examination, history of smoking, age, decreased breath sounds

53
Q

Increased transmission of voice sounds suggests what?

A

and air-filled lung has become airless

54
Q

Define bronchophony

A

louder voice sounds

55
Q

Define egophony

A

change in “ee” sounds to “a” when speaking

56
Q

If egophony is present, what condition is likely?

A

lobar consolidation from pneumonia

57
Q

If patient has a fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of what condition?

A

pneumonia

58
Q

Define whispered pectoriloquy

A

louder, clearer whispered sounds

59
Q

Persons with COPD may prefer to sit in what position?

A

sitting leaning forward, with lips pursed during exhalation and arms supported on their knees or a table

60
Q

The dullness of pneumonia typically occurs where? What must you do so that you don’t miss this abnormal percussion note?

A

behind the right breast, displace the breast

61
Q

A lung affected by what disorder will displace the upper boarder of the liver downward and lowers the level of the diaphragmatic dullness posteriorly?

A

COPD

Patient Evaluation 1 (2 decks)

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