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ICM Exam 1 > Week 2 - Pulmonary Exam > Flashcards

Week 2 - Pulmonary Exam Flashcards

1
Q

What is the respiratory ROS question?

A

Any shortness of breath or cough?

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2
Q

What 2 things is the Respiratory System responsible for?

A
  1. Ventilation

2. Respiration

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3
Q

Define Ventilation

A

Getting air into and out of the lungs

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4
Q

Respiration

A

Exchanging of air between the alveoli and the blood and between the blood and the tissues

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5
Q

During what process does cough occur? Name 3 ways it can happen.

A

Ventilation; Tumors, infection, asthma

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6
Q

During what process does alteration of blood gases (O2, CO2, pH) occur?

A

Respiration

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7
Q

What 4 things do we observe in respiration?

A
  1. Rate
  2. Rhythm
  3. Depth
  4. Effort of breathing
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8
Q

How do we assess respiration rate?

A

Count the number of breaths in 1 minute

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9
Q

What 2 ways can we measure respiration rate?

A
  1. Visual inspection

2. Subtly listening over pt’s trachea with stethoscope head/neck or chest exam

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10
Q

What is the normal breaths per minutes for an adult?

A

14-20 breaths per minute in a quiet, regular pattern

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11
Q

Is an occasional sigh normal in respiration?

A

Yes

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12
Q

How high can breaths per minute go in infants?

A

44 breaths per minute

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13
Q

Go observe the picture on your phone about the different breathing patterns

A

GO LOOK

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14
Q

Slow breathing may be secondary to what 3 things?

A
  1. Diabetic coma
  2. Increased intracranial pressure
  3. Drug-induced respiratory depression
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15
Q

What is slow breathing called?

A

Bradypnea

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16
Q

Rapid shallow breathing may be caused by what 3 things?

A
  1. Restrictive lung disease
  2. Elevated diaphragm
  3. Pleuritic chest pain
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17
Q

What is rapid shallow breathing called?

A

Tachpnea

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18
Q

What is Cheyne-Strokes Breathing?

A

Periods of deep breathing alternate with periods of apnea (no breathing)

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19
Q

Where is Cheyne-Strokes Breathing often seen?

A

In children and aging people during sleep

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20
Q

What 4 things could cause Cheyne-Strokes Breathing?

A
  1. Drug-induced respiratory depression
  2. HF
  3. Uremia
  4. Brain damage
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21
Q

2 terms specifically seen in Cheyne-Strokes

A
  1. Hyperpnea

2. Apnea

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22
Q

What happens in Obstructive Breathing?

A

Expiration prolonged because narrowed airways increase the resistance to air flow

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23
Q

What 3 things can cause Obstructive Breathing?

A
  1. Chronic Bronchitis
  2. Asthma
  3. COPD
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24
Q

What is Sighing Respiration?

A

Breathing punctuated by frequent sigghs

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25
Q

What should Sighing Respiration alert us to?

A

Possibility of hyperventilation syndrome

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26
Q

What is hyperventilation syndrome a common cause of?

A

Dyspnea and dizziness

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27
Q

What could cause Rapid Deep Breathing

A
  1. Metabolic acidosis
  2. Exercise
  3. Anxiety
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28
Q

What 3 things should we consider in a comatose patient in Rapid Deep Breathing? What would these affect?

A
  1. Hypoxia
  2. Infarction
  3. Hypoglycemia

Medulla or Pons

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29
Q

What is Kussmaul Breathing?

A

Deep breathing due to metabolic acidosis

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30
Q

Could Kussmaul Breathing be fast, normal in rate, or slow?

A

Yes

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31
Q

What is Ataxic Breathing?

A

Unpredictable irregularity in breathing

32
Q

What is another name for Ataxic Breathing?

A

Blot’s Breathing

33
Q

Breaths could be what in Ataxic Breathing? (Blot’s)

A

Shallow, deep, or stop for short periods

34
Q

What 2 things could cause Ataxic (Blot’s) Breathing? At what level?

A
  1. Respiratory depression
  2. Brain damage

Medullary level

35
Q

Order for Pulmonary Exam

A
  1. Inspect
  2. Palpate
  3. Percuss
  4. Auscultate
  5. Compare one side to another (see asymmetries)
  6. Adjust the gown
36
Q

How do we adjust the gown for men?

A

So that we can see the chest fully

37
Q

How do we adjust the gown for women?

A

Cover the anterior chest when examining the back; when examining the chest, drape the gown over each half of the chest as you exam the other half

38
Q

What do we inspect the patient for in the pulmonary exam?

A

Respiratory difficulty

39
Q

Why do we assess color?

A

For cyanosis

40
Q

What do we assess from midline position behind the patient?

A
  1. Movement of chest
  2. Abnormalities such as masses
  3. Shape of chest
41
Q

What does unilateral impairment or lagging in the chest indicate? From what?

A

Pleural disease from asbestosis or silicosis

42
Q

What could also be a problem in unilateral impairment or lagging in the chest?

A

Phrenic nerve damage or trauma

43
Q

What 3 things could abnormal retraction be caused by?

A
  1. Upper airway obstruction
  2. COPD
  3. Severe asthma
44
Q

What 4 things do we palpate the chest for?

A
  1. Identify tender areas
  2. Assess of observed abnormalities
  3. Further assessment of chest expansion
  4. Asses for Tactile Fremitus (TF)
45
Q

What is Tactile Fremitus?

A

Vibration felt on the chest when someone says “99

46
Q

What 3 things might be occurring in DECREASED Tactile Fremitus? Due to what?

A
  1. Neoplasm
  2. Unilateral pleural effusion
  3. Pneumothorax

Decreased transmission of low frequency sounds

47
Q

What is seen in INCREASED Tactile Fremitus? Due to what?

A
  1. Unilateral pneumonia

Increased transmission through consolidated tissue

48
Q

What does Percussion do?

A

Sets chest wall and underlying tissues in motion producing a sound

49
Q

What does percussion help establish about underlying tissues?

A

If they are:

  1. Solid
  2. Air-filled
  3. Fluid filled
50
Q

How far does Percussion penetrate? Does it help detect deep-seated lesions?

A

5-7cm; no

51
Q

In reference to pitch, how does increased air sound?

A

Increased air = lower pitch

52
Q

Which is lower in Percussion, R or L?

A

R (bigger air filled lung) is lower than L

53
Q

Can we Percuss the diaphragm itself?

A

No; but can infer probably location from level of dullness

54
Q

What are we identifying in diaphragmatic percussion?

A

Resonant lung tissue and duller structures below diaphragm

55
Q

What does an abnormally high level suggest in diaphragmatic percussion?

A

Pleural effusion

56
Q

Where do we see a high diaphragm?

A
  1. Atelectasis

2. Phrenic nerve paralysis

57
Q

What is the normal diaphragmatic excursion?

A

3-5.5cm

58
Q

If abnormalities are suspected during Auscultation, what do we do?

A

Listen to sound of pt’s spoken or whispered voice as transmitted through chest wall

59
Q

Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Vesicular Breathing

A
  1. Duration - inspiratory sounds longer than expiratory
  2. Intensity - soft
  3. Pitch - relatively low
  4. Location - over most of both lungs
60
Q

Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Broncho-Vesicular Breathing

A
  1. Duration - I/E equal
  2. Intesntiy - intermediate
  3. Pitch - intermediate
  4. Location - often in 1st or 2nd interspaces anteriorly between the scapulae
61
Q

Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Bronchial Breathing?

A
  1. Duration - E > I
  2. Intensity - Loud
  3. Pitch - Relatively high
  4. Location - over manubrium (larger proximal airways)
62
Q

Give the duration of sounds, intensity/pitch of expiratory sounds, and locations where head normally of Tracheal Breathing?

A
  1. Duration - E=I
  2. Intensity - very loud
  3. Pitch - relatively high
  4. Location - over trachea
63
Q

Give the breath sounds, transmitted voice sounds, and tactile fremitus for a Normal, Air-filled lung

A
  1. Breath Sounds - predominantly vesicular
  2. Voice Sounds - muffled and indistinct, “ee” heard as “ee”, whispers faint or not heard
  3. TF - normal
64
Q

Give the breath sounds, transmitted voice sounds, and tactile fremitus for a airless lung

A
  1. Breath Sounds - bronchial or bronchovesicular
  2. Voice Sounds - spoken louder, “ee” heard as “ay”, whispers louder, clearer
  3. TF - increased
65
Q

2 causes of Crackles

A
  1. Series of tiny explosions when small airways, deflated during expiration, pop open during inspiration
  2. Air bubbles flowing through secreations or lightly closed airways during respiration
66
Q

What 3 things do crackle explosions explain?

A
  1. Late inspiratory crackles
  2. Interstitial lung disease
  3. Early HF
67
Q

What is related to coarse crackles?

A

Air bubbles

68
Q

What 7 adventitious sounds are possible?

A
  1. Late inspiratory crackels
  2. Early inspiratory crackles
  3. Midinspiratory and expiratoy crackles
  4. Wheezes and Rhonchi
  5. Wheeze (Stridor)
  6. Pleural Rub
  7. Mediastinal crunch
69
Q

What 2 things do we look for in Inspection of the Neck?

A
  1. Contraction of accessory muscles

2. If trachea is midline

70
Q

What 3 deformities of the chest are possible?

A
  1. Pectus Excavatum (Funnel chest)
  2. Barrel Chest
  3. Pectus Carinatum (Pigeon Chest)
71
Q

Another name for Pectus Excavatum

A

Funnel Chest

72
Q

Another name for Pectus Carinatum

A

Pigeon Chest

73
Q

Another name for Pectus Carinatum

A

Pigeon Chest

74
Q 
Normal Pulmonary Findings for:
Percussion
Trachea
Breath Sounds
Adventitious Sounds
TF and Transmitted Vocie
A
  1. Resonant
  2. Midline
  3. Vesicular
  4. None
  5. Normal
75
Q 
Conslidation Pulmonary Findings for:
Percussion
Trachea
Breath Sounds
Adventitious Sounds
TF and Transmitted Vocie
A
  1. Dull over airless areas
  2. Midline
  3. Bronchial over involed area
  4. Late inspiratory crackles over involved area
  5. Increased TF w/ higher voice sounds

ICM Exam 1 (7 decks)

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