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Flashcards in #1 Deck (112):
1

What is the 5th most common presenting complaint?

COUGH

2

What else would a patient with chronic cough have as a complaint?

Musculoskeletal related complaints

3

What is defined as, Acute Cough?

Less than 3 weeks

4

What is the majority of acute cough due to?

VIRAL INFECTION Others: - Inhaled irritants (food, liquid) - Allergies (smoke exposure) - Medications - Bacterial Pneumonias

5

What is defined as, "Chronic Cough?"

Greater than 3 weeks

6

What is the the usual list for due to "chronic cough?"

- Postnasal Drip: 40%

- Asthma: 25-35%

- GERD*** : 20%

- Chronic Bronchitis: 5-10%

- Bronchiectasis: 4& of cases

7

What should you ask when dealing with a "Chronic Cough?"

Ask if it has changed over that period of time, clear throat, exposed to smoke inhalation, positional, or associated complaints (headaches, rib or chest pain, fainting, incontinence, back or leg pain when coughing)

8

What is sputum?

Mucous and shit that comes out of hocking up stuff

9

What is mucoid sputum defined as?

Thin, Frothy, Clear  

 

  • Asthma, Chronic Bronchitis, Emphysema, Viral Pneumonia, Pulmonary Edema

10

What is Purulent Sputum defined as?

Yellow/Green, Thick, Odor - Bronchiectasis, Lung Abscess, Bacterial Pneumonia, TB

11

What is Heompysis Sputum defined as?

Red, Frothy - Lung Cancer, Pulmonary Infarct, TB

12

What would you expect if someone walks in your office and has Dyspnea (shortness of breath)

2/3 of patients have cardiac or pulmonary disorder

13

If a patient has chest pain upon inspiration what would they have?

Possible Musculoskeletal Disorder (Hx of Trauma/overuse)

14

If a patient has tightness of chest what could a patient have?

Cardiac problem or just Anxiety

15

If a patient is out of breath through ONLY activity, what would you expect?

Possible pulmonary or Cardiac Problem

16

If a patient has difficulty breathing WITHOUT exertion (position related) what would you expect?

CLASSIC PULMONARY CONGESTION; CONGESTIVE HEART FAILURE

17

In regards to dyspnea, what would demand immediate medical evaluation?

A sudden onset of difficulty breathing associated with chest pain in suggestive of:

- Pulmonary Embolism**

- Myocardial Infarction

18

What is the order of the Respiratory Physical Exam?

  1. Inspection
  2.  Palpation
  3.   Percussion
  4.    Auscultation

19

When further questioning a patient suffering with SOB dyspnea, what else would be the symptoms associated with Cardiac, Pulmonary, and or Cancer?

Night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis (sweating), cyanosis SEVERITY: Disrupts activities

20

Air Hunger or Kussmaul’s Respirations*****

Extremely deep ventilation such as occurs in patient with acidosis attempting to increase ventilation of alveoli and exhale more carbon dioxide *** test

21

What is cyanosis?

Blue color of mucous membranes, extremities - Lack of oxygen to distal appendages

22

What is a color change and features associated with Pale or Pallor?

White color of mucous membranes Eg. Shock, Blood Loss

23

What is a color change and features associated with Flushing of the skin?

Red color of the mucous membrane Eg. Increased blood flow due to muscle contraction

24

What would FOUL odor of someone's breath indicate?

tonsillitis, sinusitis, gingivitis, lung abscess, dental cavities, or gastroesophageal reflux

25

What would ACETONE (fruity smell) of someone's breath indicate?

Diabetes or acetone, alcohol, phenol, or salicylate ingestion

26

What would MUSTY ODOR (raw liver smell) of someone's breath indicate?

Severe liver disease

27

Should you mention something to a patient with alcohol or weed on their breath?

YES

28

When observing respiration rate, what do we observe?

Rate, Rhythm, Depth, Effort

29

What is the average respiratory rate?

12-20 times per minute

30

What would be signs of distressed breathing?

Increased labored breathing and use of accessory muscles • Intercostal retractions, leaning forward, flaring of nostrils, gasping

31

What would you observe in the symmetry of thoracic musculature?

The muscles of respiration should be used without accessory muscles

- Scalenes

- Platysma

- SCM

- Trapezius

32

What are the secondary muscles of Respiration?

- SCM

- Scalenes

- Trapezius

- Pectorals Major and Minor

A image thumb
33

When looking at abnormalities in chest diameter, what can happen?

Increase in A-P diameter. Ribs are more HORIZONTAL** - Seen in CHRONIC**** (decades)

34

What conditions are chronic abnormalities of the chest?

Emphysema, kyphosis, chronic airflow limitation

A image thumb
35

What is the aka for Pigeon Chest?

Pectus Carinatum

36

Describe Pectus Carinatum?

Sternum is abnormally prominent, severe cases interfere with heart and lung action

A image thumb
37

What is the aka for funnel chest?

Pectus Excavatum

38

What is Pectus Excavatum?

• Congenital malformation of the chest wall by a funnel shaped depression with its apex over the lower end of the sternum

 

• Caused by a shortening of the central diaphragm which pulls the sternum backward during inhalation

A image thumb
39

What should you check in regards to the ribs?

Slope (down to the floor almost perpendicular (90 degrees)

40

Unilateral lag of the ribs could indicate:

Phrenic Nerve problem

41

What would cause BULGING of the intercostal spaces?

- Seen on Expiration

- Air outflow Obstruction or compression by a mass

42

What would cause Retraction of the intercostal spaces?

- Seen on INSPIRATION - Air in-flow obstruction, asthma, bronchiolitis, emphysema

43

What does flail chest result in?

Paradoxical Breathing

44

A patient with a blunt chest injury will cause ____ ?

More than 2 ribs to fracture in 2 places

45

Blunt force trauma results in paradoxical breathing, what is this?

Inhalation:

- Injured area collapse in

- Uninjured chest wall moves out

 

Exhalation:

- Injured area moves out

- Uninjured chest wall moves in

46

What are bulbous enlargements of the soft parts of terminal phalanges?

Clubbing of nails

47

What is the angle of the nail bed in clubbing of the nails?

Approaches or exceeds 180 degrees (normal is 160)

48

How does clubbing of the nails occur?

Lack of oxygen getting to the distal tissues

49

The pathophysiological mechanism of clubbing is _____ ?

unknown

50

What is something to determine if someone has clubbing of the nails?

Schamroth's Sign

51

What are "large scars?"

Cicatrix

52

What is something minor that can cause difficulty in chest expansion?

Lack of skin elasticity - Burns, operations, lacerations, and scarring

53

Why do we use the posterior thorax exam?

TO EXPOSE AS MUCH LUNG FIELD AS POSSIBLE****

54

In order to better expose the triangle of auscultation, what might we ask the patient to do?

Crunch forward

55

What do we palpate in the thorax?

Thoracic muscles, tissues, skeleton - Feel for pulsations, tenderness, bulges, depressions, masses

 

VERBALS: Pain, masses, tenderness, sensations, further assess any abnormalities

56

What can cause chest pain and tenderness?

- Herpes Zoster before appearance of eruption

- Pleurisy = Inflammation of the pleura

57

What do we determine masses/swelling with?

- Site

- Temperature

- Tenderness

- Size

- Consistency

- Surface

- Mobility

58

What refers to a Palpable VIBRATION transmitted through the bronchopulmonary tree from the larynx to the surface of the chest wall when the patient speaks?

Tactile Fremitus

59

What is the normal outcome of tactile fremitus?

Normal:  BILATERAL SYMMETRICAL VIBRATION

 

  • 99/Blue Moon
  • Ulnar Surface and/or ball of hand

60

What is the abnormal outcome of tactile fremitus?

Decrease or Absent Fremitus = EXCESS AIR

 

  • There is no mass for the resonant word to travel through
  • Example:  Emphysema, bronchial obstruction (air trap)

61

What is the abnormal outcome of tactile fremitus? (increased)

INCREASED FREMITUS = Increased Mass

 

  • Feels courser or rougher as travels thru more cells
  • Example:  Pneumonia, fluid, tumor

62

Respiratory Excursion's main point:

Evaluate thoracic expansion during respiration

 

- Watch thumbs diverge approximately at T8-T 10

63

What is normal outcome of respiratory excursion?

 

What is abnormal?

Bilateral symmetric movement

 

Abnormal:  Loss of symmetry

- Possible Phrenic Nerve Paralysis

 

64

Where should the trachea be positioned?

Midline above suprasternal notch

65

Something like Lung consolidations (pneumonia etc.) results in ____ ?

NO tracheal deviation

66

What lymph node is most commonly associated with malignancy of the breast?

Axillary Lymph

67

What is the posterior fold of the axillary lymph nodes?

Lats

68

What are the 4 components when checking lymph nodes?**

  1. SIZE:  Large? Small?
  2. Consistency:  Soft? Hard?
  3. Mobility:  Mobile? Fixed?
  4. Condition:  Tender? Non-Tender?

69

What is a normal lymph node supposed to feel like?

Non-palpable

70

If a lymph node is infected, what will it feel like?

Enlarged, Tender, Soft, Mobile****

 

 

TEST

71

If a lymph node has Cancerous properties, what are those?

Enlarged, NON-tender, Hard, Fixed

 

TEST****

72

When percussing the chest thorax how many fingers are on the chest wall?

1

73

How is percussion done with posterior thorax?

SEATED**** 

 

 

TEST

74

How is percussing the Anterior Thorax done?

SUPINE***

 

TEST

75

What do normal lungs sound like when percussed?

Resonance

76

What do lungs with Hyper-Resonance might have?

Hyperinflation/emphysema

 

TOO much air

77

What would dullness/flatness percussing of the lungs possibly indicate?

Pneumonia, atelectasis, asthma

 

EXTRA MASS

78

What is the normal measurment of the diaphgram?

3-5 cm

79

What would possibly indicate "unusual measurments" when doing Diaphragmatic Excursion?

  • Pulmonary:  Emphysema - bilateral findings
  • Abdominal:  Ascites, tumor
  • Pain:  Fractured Rib
  • Neuro:  PHRENIC NERVE PARALYSIS**

80

Auscultating the diaphgram is done how?

SEATED**

 

Most common mistake

81

How does the patient breathe when auscultating the diaphragm?

In and out through the MOUTH (using diaphragm of stethascope)

82

What is the breath characterized by?

  • Pitch
  • Intensity
  • Duration

83

Normal breath sounds are classifed by _____ ?

Location

84

What does the majority of the lung field sound like?

VESICULAR

 

  • Pitch:  LOW
  • Duration:  Inspiration > Expiration
  • Intensity:  Soft

85

Where would the bronchovesicular sound be found?

Manubrium Sternum

 

  • Pitch:  Intermediate
  • Duration:  Expiration = Inspiration
  • Intensity:  Intermediate

86

Where would the bronchial sounds be found?

Tracheal Region

 

  • Pitch:  High
  • Duration:  Expiration > Inspiration
  • Intensity:  Loud

87

Describe "Crackles" type breathing

Discrete discontinuous sounds can be find, medium or course 

 

  • Loud on Inspiration
  • Will NOT clear with throat clearing
  • Possible condition:  Pneumonia (fluid in alveoli)

88

Describe wheezes breath sounds

High pitched musical sound (whistle) on inspiration or expiration

 

  • Due to high velocity airflow thru narrow/obstructed airway
  • Possible condition:  Asthma

89

Describe "friction rubs" sounds 

Dry, crackly, grating, low pitched sound during E or I

 

  • Outside respiration.  Tree; due to inflammed rubbing surfaces
  • Possible Condition:  Pleursy

90

Describe the "Rhonchi" sound

Sounds like a "snore", deep tone

 

  • Larger airway obstruction
  • Possible Condition:  COPD, chronic bronchitis

91

What is Vocal Resonance used for?

USED TO CONFIRM CONSOLIDATION OR EXTRA MASS IN THE LUNGS

 

  • Dullness on percussion on the lungs, or changes in tactile fremitus

92

What are confirmation signs of CONSOLIDATION***?

 

TEST

Greater clarity and increased loudness of spoken sounds like "99" are defined as BRONCHOPHONY

93

Greater clarity and increased intelligibly of a whispered word like, "99" is defined as _____ ?

Whispered Pectoriloquy**

94

Increased Intensity of the spoken voice is increase and there is nasal quality (E becomes A) it is defined as _____ ?

Egophony ***

95

What is the procedure regarding costochondritis?

Hypothenar edge of both sides of the sternum and apply gradual increasing pressure

96

Inflammation of the costochondral cartilages of the upper front of the chest that involves SWELLING of the joint in people over 50 years of age, usually women:

TIETZE's Syndrome

 

Key word is SWELLING*

97

Tietze's Syndrome is bilateral or Unilateral?

Unilateral

98

AKA shingles?

Herpes Zoster

99

Can you adjust someone with Intercostal Neuritis?

YES

 

- Pain will be irregular in upper chest, underarm and around shoulder blades.  Taking deep breaths and wearing clothing can be painful

100

What is the procedure of a rib fracture?

One hypothenar is applied to sternum with gradual increasing pressure

101

What are the exam findings of Pneumonia?

Crackles and Rhonchi are common with diminished breath sounds.  

 

Dullness in percussion bc increased mass;  Increased tactile fremitus

 

Increased respiration and pulse rate

102

Describe the main points of bronchitis:

More common than pneumonia

 

  • Cough 1-4 weeks, not usually sick
  • Inflammation of the large airways (Increased mucus secretions)
  • Exam Findings:  Increased temp & Respiratory rate

103

What is a long term lung disease that takes years to develop?

Emphysema

 

  • Alveoli are damaged and destroyed by loss of elasticity, and their walls break down and sacs become larger - hyper - inflating the lung causing air to become trapped

 

 

104

Emphysema, Tactile Fremitus: 

Decreased

105

Emphysema, Respiratory Excursion:

Decreased Bilateral

106

Percussion in Emphysema:

Hyper resonant:  Too much air

 

Diaphragmatic Excursion:  Reduced

107

What is known to be sudden onset with chest pain with inhalation?

Pleurisy

 

- Adventitious breath sound rubbing**

 

VERY PAINFUL

 

test

108

What is a collapsed lung?

Atelectasis

109

What could cause atelectasis?

Outside compression like tumor or airway obstruction.

 

Percussion:  DULL or FLAT

 

 

110

What is usually due to blunt or penetrating chest injury?

Pneumothorax (air rushes in and collapses lung)

 

- May panic and go into shock, happens quickly and is MEDICAL EMERGENCY

111

Pulmonary Embolism main points:

 

TEST

Difficult to diagnose but is LETHAL

 

- Sudden Chest Pain, Dyspnea, tachypnea, tachcardia, hemoptysis

 

- Caused by blood clot that travel to the lungs from LEGS

 

(BIRTH CONTROL OR AIRPLANE RIDE)

112