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Physical Diagnosis > thorax and lungs ABN > Flashcards

thorax and lungs ABN Flashcards

1
Q

identify

A

barrel chest

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2
Q

kyphosis

A
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3
Q

identify

A

pectus excavatum

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4
Q

identify

A

pectus carinatum

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5
Q

apnea: characteristic and cause

A
  • characteristic: absence of breathing
  • cause: cardiac arrest
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6
Q

Biot’s breathing pattern: characteristic and cause

A
  • characteristic: irregular breathing with long periods of apnea
  • cause: increased intracranial pressure; drug induced respiratory depression; brain damage (usually at medullary level)
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7
Q

cheyne-stokes breathing pattern characteristic and cause

A
  • characteristic: irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea
  • cause: drug induced respiratory depression; congestive heart failure; brain damage (usually at cerebral level)
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8
Q

Kussmaul’s breathing pattern characteristics and cause

A
  • characteristics: fast and deep
  • cause: metabolic acidosis
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9
Q

normal respiratory rate

A

14-20 breaths per minute

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10
Q

sighing breathing

A

periodic deeper breaths

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11
Q

two kinds of crepitus you are palpating for

A
  1. rib movement from fracture: (bone crepitus)
  2. subcutaneous emphysema (subQ crepitus)
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12
Q

how do you perform tactile fremitus

A
  1. feeling for vibrations through bronchopulmonary tree
  2. use ulnar surface of hand to appreciate vibrations
  3. ask patient to say 99
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13
Q

what conditions would give a decreased tactile fremitus

A
  • obstructed bronchus
  • COPD
  • effusion
  • fibrosis
  • pneumothorax
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14
Q

what conditions would give a increased tactile fremitus

A

consolidated pneumonia

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15
Q

rhonchi sound

A
  • coarse low-pitched (snoring quality), continuous
  • may clear with cough
  • often caused by secretions in larger airways or obstructions.
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16
Q

crackles

A

fine crackling, high-pitched; discontinuous sounds

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17
Q

wheezes

A
  • high-pitched
  • continuous
18
Q

what is a mediastinal crunch (Hamman sign)

A
  • loud crackles, clicks, and gurgling sounds
  • due to mediastinal emphysema
  • synchronous with heart beat
  • caused by the heart beating against air-filled tissues
19
Q

stridor

A
  • high-pitched
  • largely inspiratory
  • usually louder in the neck
  • indicates laryngeal/upper airway obstruction
20
Q

in a normal air-filled lung, breath sounds are predominantly

A

vesicular

21
Q

what normally happens to voice sounds the farther away from the larynx you listen

A

sounds become softer and less distinct

22
Q

what does a positive bronchophony test indicate

A
  • “99” heard louder and clearer even at a distance from larynx
  • indicates presence of fluid or solid tissue in alveoli
    • PNA; atelectasis; tumors
23
Q

what does a positive egophony test indicate

A
  • when “E” sounds like “A” and has a nasal quality
  • indicates any consolidation of lung tissue such as pneumonia, atelectasis, or tumor
24
Q

what is a positive whispered pectoriloquy indicate

A
  • positive: a whisper can be heard more loudly through consolidated lung tissue
  • most noticeable when comparing a normal area of lung to an abnormal area
25
Q

when happens to the voice sounds when a patient has emphysema

A
  • vocal resonance decreases
  • due to increased lung expansion and reduced air flow
26
Q

what does breath sounds sound like when listening over a pneumonia? What signs indicate a PNA?

A
  • sound bronchial or bronchovesicular over involved area
  • spoken words are louder, clearer
    • egophony
    • whispered pectoriloquy
  • tactile fremitus increased
27
Q

what is atelectasis

A

loss of air from lung or collapse of lung tissue with reduced lung volume

28
Q
  • may hear crackles, rhonchi, or wheezes
    • may clear with cough
  • normal tactile fremitus and resonance to percussion
  • exam may be normal
A

acute bronchitis

29
Q

what exam finding would indicate pleurisy/pleuritis

A

may hear pleural friction rub

30
Q

clinical presentation

  • dyspnea, crackles, tachypnea
  • reduced breath sounds
  • dullness to percussion
  • egophony
A

PNA

31
Q

clinical presentation

  • dullness to percussion
  • reduced breath sounds at base
  • decreased fremitus
A

pleural effusion

32
Q

what is empyema

A

pus in pleural space

33
Q

clinical presentation

  • breath sounds decreased unilaterally
  • percussion increased
  • fremitus decreased
A

tension pneumothorax

34
Q

clinical presentation

  • inspiration is short, expiratory phase is prolonged
  • wheezing, may be heard during inspiration and expiration
  • patient may appear to be working hard to breathe
  • chest xray is typically normal
A

asthma

35
Q

clinical presentation on exam

  • hyper-resonant to percussion
  • possible purse-lip breathing
  • using accessory muscles

xray findings:

  • vertical shaped heart
  • flattened diaphragm
  • increased substernal space
A

emphysema/COPD

36
Q

A pleural effusion would have what findings on tactile fremitus, percussion, breath sounds, whispered pectoriloquy, voice sounds, and +/- crackles

A
  • tactile fremitus: decreased or absent
  • percussion: dull
  • breath sounds: decreased
  • whispered pectoriloquy: decreased
  • voice sounds: decreased
  • crackles: absent
37
Q

a pneumonia will have what findings on tactile fremitus, percussion, breath sounds, whispered pectoriloquy, voice sounds, and +/- crackles

A
  • tactile fremitus: increased
  • percussion: dull or flat
  • breath sounds: bronchial
  • whispered pectoriloquy: present
  • voice sounds: bronchophony and egophony
  • crackles: present
38
Q

what is a normal finding on diaphragmatic excursion

A

difference between full expansion and full inspiration is 5-6 cm

39
Q

how do you perform clinical pulmonary function tests

A

ask patient to walk down hall, climb one flight of stairs and observe rate and effort

40
Q

forced expiratory time

A

ask patient to “blow out candles”

  • > 6 seconds suggests obstructive pulmonary disease
41
Q

why would you auscultate during forced expiration

A

may allow faint wheezes to be heard better

Physical Diagnosis (16 decks)

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