Lower Respiratory Exam Flashcards
(76 cards)
1
Q
Physical exam-Basic steps?
A
- Inspection
- Palpation
- Percussion
- Auscultation
2
Q
History
-Chief complaints
A
Cough, hemoptysis, dyspnea, wheezing, edema
3
Q
History
-Dyspnea-conversional?
A
Patient gives short answers when talking
4
Q
PMH
A
Asthma, chronic bronchitis, heart failure
5
Q
PMH
-Chronic bronchitis criteria?
A
Cough more in the morning for at least 3 months out of the year
6
Q
Social history
A
Illicit drug use, alcohol, smoking history
7
Q
Social history
-Smoking history-Pack years=?
A
packs per day x years
8
Q
Occupation
A
- Farmer, wood worker, mining
- Exposure to asbestos, duct-vents cleaning
9
Q
Exposure to asbestos can cause?
A
Mesothelioma
10
Q
The Physical examination
A
- Sitting position and breathing pattern
- Use of accessory muscles
- Color of fingers and lips
- Shape of nails
- Breathing through pursed lips
- Ability to speak
- Chest/spinal deformities
- Is the trachea in the midline?
- Chest excursion
- Tactile fremitus
- Percussion
- Lung sounds
- Lymphadenopathy***(what did he say about this?)
11
Q
Nail clubbing is indicative of?
A
- Hypoxia
- Interstitial lung disease, cystic?, interstitial pulmonary fibrosis, bronchiectasis, lung disease
- Cardiovascular problems
12
Q
When a patient is hypoxic, what is the appearance of their lips?
A
Cyanotic lips and pursed breathing
13
Q
Inspection
A
- Shape
- Color
- Hair distribution
- Landmarks
- Respiration rate and pattern
- Respiratory ribs movement
14
Q
Inspection
-Shape?
A
- pectus carinatum, pectus excavatum
- Barrel chested-COPD
15
Q
Inspection
Respiration rate and pattern
A
Intercostal retraction - respiratory distress
16
Q
Palpation
A
- Palpate thoracic muscles
- Evaluate thoracic cage expansion
- Palpate T-spine/evaluate ribs motion
- Evaluate the tactile fremitus
- Evaluate the trachea
17
Q
Palpation
-Tactile fremitus is increased in?
A
Pneumonia, consolidation of lung tissue
18
Q
Palpation
-Tactile fremitus-Decreased in?
A
COPD, tumor, pleural effusion, pneumothorax
19
Q
Tactile fremitus
-How do you palpate this?
A
- The patient says “99” while the doctor’s hands are placed along the posterior lateral thorax
- With lung consolidation there should be a palpably more pronounced vibration on the side of the consolidation
20
Q
Egophony
A
When patient says the letter E it sounds more like Ayyy
21
Q
Broncophony
A
Spoken words become louder and clearer
22
Q
Whisperred pectoriloquoy
A
Loud whispers
23
Q
Percussion
A
- Listen for abnormal sounds
- Symmetry
24
Q
Percussion-Dull sound?
A
- Over fluid
- Solid tissue
25
Percussion
| -Hyperresonance?
- COPD
| - Pneumothorax
26
Percussion of the chest
- Diaphragmatic excursion?
- Normal?
- Determine the distance between the level of dullness on full expiration and the level of dullness on full inspiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm)
- Normal-3-5.5
27
Auscultation of the chest-sounds
- Bronchial
- where are they located?
- Characteristics?
- Over the trachea
| - Coarse, loud and long expirations
28
Auscultation of the chest-sounds
- Bronchovesicular
- where are they located?
- Characteristics?
- Over the right and left mainstem bronchus
- Medium pitch
- Expiration equals inspiration
29
Auscultation of the chest-sounds
- Vesicular
- where are they located?
- Characteristics?
- Lung fields
| - Soft and low pitched
30
Abnormal sounds
- Crackles: fine and coarse
- Wheezes
- Pleural friction rub
- Rhonchi
31
Vocal resonance
- Normally words are indistinct to auscultation
| - Distinctness increases with lung consolidation (pneumonia, tumor, etc.)
32
Rhonchi
Coarse, low pitched, may clear with cough
33
Wheeze
Whistling, high-pitched bronchus
34
Rub
Scratchy, high pitched
35
Crackles
Fine-crackling, high-pitched
36
Vesicular breath sounds
- When are they more prominent?
- When are they diminished?
- More prominent in a thin person or child
| - Diminished in an overweight or muscular patient
37
Pneumonic for chest x-ray
```
ABCDEFGHI
Adequate: position, inspiration, exposure, rotation (PIER)
Bones and soft tissues
Cardiac size, valves
Diaphragms round, flat, free air
Effusions
Fields and fissures
Great vessels
Hilar masses (caution thymus in children)
Impression
```
37
Identification of special landmarks/anatomy
| -Sternal angle (angle of louis)
Where 2nd rib meets with the manubrium and the body of the sternum
38
Clinically relevant landmarks
| -Needle decompression?
2nd intercostal space just superior to the 3rd rib margin (neurovascular bundle runs inferior to each rib) at the mid-clavicular line for emergent decompression tension pneumothorax, followed by chest tube placement
39
Chest tube insertion?
4th intercostal space at mid or anterior axillary line in the 4th intercostal space just superior to the margin of the 5th rib
40
Where is T4 located?
Lower margin of endotracheal tube on a chest x-ray
41
Landmark for thoracentesis?
7th intercostal space
42
Evaluation of respiration
| -Patient's posture and position?
Patient with obstructive lung disorders will tend to sit leaning forward with shoulders elevated
43
Evaluation of respiration
| -Inspection of the neck?
- Contraction of accessory muscles (sternocleidomastoid, scalenes, or supraclavicular contraction)
- Tracheal position
44
Lateral displacement of the trachea can occur in?
tension pneumothorax
45
Thoracic expansion
- Place thumbs at about the level of the 10th ribs with fingers loosely grasping and parallel to the lateral rib cage
- Ask patient to inhale deeply
- Watch the distance between thumbs as they move apart during inspiration and feel for the range and symmetry of the rib cage as it expands and contracts
46
Tactile fremitus
| -Where is it normally more prominent?
- Often more prominent in the interscapular area than in lower lung fields
- More prominent on the right than the left
47
Percussion
| -Pattern for percussion?
Start superiorly percussing both sides of the chest working toward the base proceeding in a "ladder-like" pattern
48
5 percussion notes?
Flat, dull, resonant, hyperresonant, tympanitic
49
Flat
| -Intensity, pitch, duration?
soft, high, short1
50
Dull
| -Intensity, pitch, duration?
Medium, medium, medium
51
Resonant
| -Intensity, pitch, duration?
Loud, low, long
52
Hyperresonant
| -Intensity, pitch, duration?
Very loud, lower, longer
53
Tympanitic
| -Intensity, pitch, duration?
Loud, high, longer
54
Percussion notes
| -Clinical examples-Dullness replaces resonance when?
-Replaces resonance when fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers
55
Percussion notes
| -Clinical examples-Dullness?
- Lobar pneumonia
| - Pleural accumulations (effusion, hemothorax, empymema, fibrous tissue or tumor)
56
Percussion notes
| -Bilateral (generalized) hyperresonance may be heard over?
Hyperinflated lungs
| -Obstructive lung diseases (COPD, asthma)
57
Percussion notes
| -Unilateral hyperresonance suggests?
- Large pneumothorax
| - Large air-filled bulla in lung
58
Normal breath sounds
| -Vesicular?
- Soft and low pitched
- Heard through inspiration and about 1/3 of expiration
- Heard over most of lung tissue
59
Normal breath sounds
| -Bronchovesicular?
- Intermediate in intensity and pitch
- Heard equally in inspiration and expiration
- Heard best in 1st and 2nd interspaces anteriorly and between scapulae
60
Normal breath sounds
| -Bronchial
- Loud and high pitched
- Expiratory sounds heard longer than inspiratory
- Heard best over manubrium (larger proximal airways)
61
Normal breath sounds
| -Tracheal?
- Very loud and high pitched
- Heard equally in inspiration and expiration
- Heard best over trachea in neck
62
If bronchovesicular or bronchial breath sounds are heard more distal to expected locations?
Suspect air-filled lung has been replaced by fluid-filled or solid lung tissue
63
Adventitious breath sounds
Superimposed on the usual breath sounds
64
Crackles (rales)
| -Characteristics?
-Discontinuous, intermittent, non-musical, and brief
65
Crackles
| -Defined by the following?
- Fine or coarse
| - Timing in respiratory cycle
66
Crackles
| -Fine crackles characteristics?
Soft, high-pitched, very brief
67
Crackles
| -Coarse crackles characteristics?
Louder, lower in pitch, brief
68
Crackles
| -Timing in respiratory cycle?
Inspiratory, expiratory, mid-inspiratory/expiratory
69
Wheezes and rhonchi
| -Characteristics?
-Continuous, musical quality, and prolonged (not necessarily the whole respiratory cycle)
70
Wheezes
| -Characteristics?
Relatively high pitched, musical, hissing or shrill quality
71
Rhonchi
| -Characteristics?
Relatively low-pitched, snoring quality
72
Wheezes
| -Suggest?
Narrowed airways (asthma, COPD, bronchitis)
73
Rhonchi
| -Suggest?
secretions in large airways
74
Stridor
- Wheeze that is entirely or predominantly inspiratory in nature
- Often louder in neck vs chest wall
- Indicates partial obstruction of larynx or trachea (immediate attention needed)
75
Pleural friction rub
- Inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction
- Sounds like creaking, usually during expiration but can occur in both phases of respiration
- Usually confined to a relatively small area of the chest wall
