Lecture 21: Pulmonary Eval and Assessment Flashcards

Question

types/descriptions of coughs

Answer 1

productive/wet - clear discolored secretions can differentiate between pathology and infection - frothy/foamy secretions indicate pulmonary edema/HF non-productive/dry hemoptysis "barking" or "whooping"

Answer 2

does cough become more productive with abdominal splinting

Answer 3

does coughing change their exam or symptoms

Answer 4

bacterial PNA obstructive disease

Answer 5

viral PNA IPF smoking

Answer 6

bronchiectasis chronic bronchitis fungal PNA

Answer 7

TB cancer early fibrosis

Answer 8

alveolar hemorrhage, PE, UGIB

Answer 9

alveolar hemorrhage PE UGIB

Answer 10

HF pulmonary edema

Answer 11

foreign body aspiration choking

Answer 12

mm of ventilation chest wall mobility thoracic cavity mechanics tactile fremitus - vibration caused by retained secretions or abnormal air movement - can be made worse with speaking or coughing - wide variety of presentations

Answer 13

lung density and diaphragmatic excursion

Answer 14

normal = lung tissue and resonance is normal dull = "thud" or dense resonance felt over area of fluid consolidation or non-aerated tissue tympanic = loud, hollow resonance felt over area of hyperinflation

Answer 15

middle finger of non-dominant hand placed flat on chest wall in IC space middle finger of dominant hand strikes the finger on the chest wall in rapid succession

Answer 16

diaphragm is best for hearing normal sounds bell is best for hearing abnormal performed over entire lung space in systemic manner, anteriorly then posterior at least 1 breath should be auscultated in each bronchopulmonary segment normal sounds are created by the turbulence in air flow

Answer 17

heard over tracheobronchial tree louder/high pitched than vesicular louder during exhalation but still heard at the end of inhalation

Answer 18

heard over mainstem and segmental bronchi OR between shoulder blades softer versions of bronchial auscultation heard equally during inhalation and exhalation

Answer 19

heard through all lung fields soft, lower pitched louder during inglantoion but still heard at beginning of exhalation

Answer 20

aka adventitious lung sounds

Answer 21

increased tissue density increases sound transmission (water carries sound better than air) consolidative pathology creates stronger/louder sounds (i.e. PNA, tumors) areas of hyperinflation greater weaker/softer sounds (i.e. emphysema) areas without air movement create no sound at all (i.e. pneumothorax, obstructive atelectasis)

Answer 22

whispered words (usually counting) are heard loudly in presence of fluid consolidation normally would not be heard during auscultation

Answer 23

normal volume words/numbers are heard louder than normal in the presence of fluid consolidation normally would be heard at a normal volume

Answer 24

high pitched "nasal" sound transmitted through areas of fluid consolidation "EEE" sounds like "AAA" normally "EEE" sounds like "EEE"

Answer 25

continuous musical sound more common to heard during exhalation from airway obstruction wheezing with inhalation indicates a more severe obstruction must differentiate between expiratory wheeze and inspiratory wheeze to differentiate pathology

Answer 26

continuous lower pitch than wheezing heard during inhalation and exhalation caused by copious airway secretions

Answer 27

continuous high pitched sound higher intensity than wheezing severe upper airway obstruction can be caused by edema, anaphylactic allergic reaction, tumor burden, bleeding, choking, recent extubation, etc

Answer 28

discontinuous sound sounds like brief bursts of popping bubbles, velcro ripping apart, wood burning most common during inhalation as a result from sudden opening of closed airway other causes: - bronchitis - atelectasis - pulmonary edema - fibrosis

Answer 29

either continuous or discontinuous sounds like pieces of leather or sandpaper rubbing together indications inflammation of pleura heard best at lower lateral chest wall usually accompanied by pain