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PCMI Exam 2 > Lower Respiratory Exam > Flashcards

Lower Respiratory Exam Flashcards

(54 cards)

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1
Q

Normal adult breathing

A

Quiet

Regular RR (14-20)

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2
Q

Hypopnea

A

Decreased depth and rate of respiration

Shallow and slow

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3
Q

Bradypnea

A

Regular rhythm but slower RR

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4
Q

Hyperpnea

A

Increased depth of breathing and rate of respiration

Deep, Fast Breathing

Normal in exercise

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5
Q

Tachypnea

A

Rapid breathing (RR > 20-25)

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6
Q

Dyspnea

A

Feeling SOB

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7
Q

Hypoxia

A

Deficiency in amt of O2 reaching tissues

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8
Q

Hypoxemia

A

O2 deficiency in arterial blood

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9
Q

Apnea

A

No breathing

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10
Q

Atelectasis ***

A

Collapse of lung tissue that affects the alveoli from normal O2 absorption

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11
Q

Pleximeter finger

Plexor finger

A

Hyperextended middle finger of non-dominant hand in percussion

Tapping finger on dominant hand use for percussion

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12
Q
  • Basic landmarks
A
  • Midsternal line
  • Midclavicular line
  • Anterior axillary line
  • Midaxillary line
  • Posterior axillary line
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13
Q
  • What things do you need to do for a LRE?
A
  • Vitals (Including Pulse Ox)
  • Inspection
  • Palpation
  • Percussion
  • Ascultation
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14
Q
  • Inspection
A
  • Sitting position and breathing pattern
  • Use of accessory muscles
  • Color of fingers and lips
  • Shape of nails
  • Breathing
  • Ability to speak
  • Chest deformities
  • Spinal deformities
  • Mid-line trachea?
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15
Q

Pulse oximetry

A

Measures amount of oxygen saturated hemoglobin using the difference between infrared light and red light

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16
Q

Causes of a bad waveform in pulse oximetry

A

Improper placement

Hypoperfusion

Hypothermia

Motion artifact

Falsely elevated with: carboxyhemoglobin, high levels of glycohemoglobin,methemoglobin, sulfhemoglobin, ambient light)

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17
Q

End Tidal CO2

A

Concentration of CO2 in exhaled air at the end of respiration

Measures ventilation

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18
Q

Incentive Spirometer

A

Given to post surgery patients

Steps to use:

1) Move slider on the outside of large column to level you want to reach
2) Hold spirometer in front of you and sit or stand up straight
3) Breathe out normally, close lips around mouthpiece
4) Breathe in and take a slow deep breath, breathing as deeply as you can-when you can’t breathe in anymore, hold breath for 2-5 sec

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19
Q

PFT

A

Used to diagnose obstructive v. restrictive lung disorders

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20
Q

Spirometry (also a PFT)

A

Measures lung function by measuring speed/amount of air inhaled and exhaled

Diagnose obstructive v restrictive lung disease

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21
Q

Normal shape of the chest

A

Thorax is wider than it is deep

Lateral diameter larger than AP diameter

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22
Q

Asymmetrical expansion can be d/t

Study These Flashcards
A

Pleural effusion

23
Q

Retraction can be d/t

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A

Severe asthma

COPD

Upper airway obstruction (ie: stridor)

24
Q

Unilateral lagging can be d/t

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A

Pleural disease

(Asbestosis, trauma, phrenic nerve damage)

25
What are the main muscles of inspiration Accessory muscles of inspiration
Diaphragm, internal intercostals Sternomastoids, scalenes, expiratory intercostals, external obliques, abdominals
26
Cyanosis is a sign of \_
Hypoxia
27
Tracheal deviation can be seen in:
Pneumothorax Pleural effusion Atelectasis Mass
28
Clubbing can be seen in :
Congenital Heart Disease Interstitial Lung Disease Bronchiectasis Pulmonary Fibrosis CF Lung Abscess Malignancy IBD
29
Pectus excavatum
Funnel chest Can compress heart and vessels and cause murmur
30
Pectus carinatum
Pigeon chest Sternum displaced anteriorly (increased AP diameter) Adjacent costal cartilages are depressed
31
Barrel Chest What disease is associated with it?
Increased AP diameter COPD (or normal in aging, normal in infancy)
32
What types of patients are "blue bloaters" ?
* Overweight/cynaotic * Elevated hemoglobin * Peripheral edema * Ronchi and wheezing * **Daily productive cough for last three months or more, in at least two consecutive years**
33
What types of patients are "pink puffers"?
Emphysema Older and thinner Severe dypsnea Quiet Chest TRIPOD POS **Permanent enlargement and destruction of airspaces distal to terminal bronchiole**
34
Paradoxical movement of chest
On inspiratiomn, injured area caves inward (and caves outward on expiration) Can occur with trauma to the ribs
35
* How do you assess whether thoracic expansion is symmetrical? * What part of the exam does this fall under?
* Place thumbs on 10th rib level with fingers parallel to lateral rib cage * Slide hands medially to raise loose fold of skin each side between thumb and spine * Ask patient to inhakle deeply * Watch distance between thumbs * Feel for range and symmetry of the rub cage as it expands and contracts * Palpation
36
* What is tactile fremitus? * Where should you perform test for this? * When will tactile fremitus be increased? * When will it be decreased?
* palpable transmissions thru bronchopulmonary tree to chest wall when patient speaks * See image * Pneumonia * COPD, fibrosis, pneumothorax, thick wall, infiltrating tumor
37
* What is tactile fremitus called when using a steth?
* Egophony
38
* Where should you percuss? * What fashion should you percuss in?
* See image * Non dominant hand is on chest/back * Strike distal interphalangeal joint of middle finger (use other fingers on chest wall to minimize dampening) * Ladder fashion * 2-3 taps per spot
39
* In what types of conditions will you hear hyperresonance upon percussion? * In what types of conditions will you hear a dull sound upon percussion?
* Hyperresonance with excess air * Pneumothorax * Air filled Bulla in lung (COPD/Emphysema) * Asthma * Dull with excess fluid * Effusion * Hemothorax * Empyema * Fibrous tissue or tumor
40
* How do you perform diaphragmatic excursion?
* Patient exhales completely and holds exhalation * Doc feels for diaphragm and marks with pen * Patient breathes normally for a few breaths * Patient inhales completely and holds it * Percuss for level of diaphragm and mark with pen * Distance between two lines =diaphragmatic excursion * **Normal is 3.5-5 cm** * **Asymmetry w/ pleural effusion or high diaphragm secondary to atelectasis or phrenic nerve paralysis**
41
* What are key techniques when ascultating ?
* Patient breathes thru **open mouth** * **Compare sides in ladder like fashion** * **Listen to two spots on front and four on the back** * **Listen for normal and adventitious breath sounds** * **If you suspect abmnormalities, listen for vocal resonance**
42
* What are the normal breath sounds?
* Vesicular * Bronchovesicular * Bronchial * Tracheal
43
* What are the adventitious breath sounds?
* Stridor * Wheezes (Rhonchi) * Crackles (Rales)
44
Stridor
* Generally inspiratory * **Caused by narrowing in upper airway:** * **​Croup** * **Epiglottitis** * **Upper airway foreign body** * **Anaphylaxis**
45
* Wheezing
* Generally expiratory * Continuous musical sound * **Caused by rapid airflow thru narrowed bronchial airway:** * **​RAD** * **Asthma** * **COPD**
46
* Crackles
* Inspiratory * **Caused by small airway closed during expiration opening during inspiration** * **​Pneumonia** * **CHF** * **Atelectasis** * **Pulmonary Fibrosis** * **Bronchiectasis** * **COPD** * **Asthma**
47
* When is vocal resonance abnormal?
* Bronchopony-spoken words get louder * Whispered pectoriloqy-whispered words are louder and clearer during ascultation * Egophony-when patient says "ee" it sounds like "A" (which is nasal and localized)
48
* What are the ABCs of taking a chest x ray?
* A=aqeduate/asessment of quality and Airway * B=Bones and Soft Tisue * C=Cardiac Size/Valves * D=Diaphragms * E=Effusions/Endotracheal tube/EKG Leads/Wires * F=Fields and fissures/foreign bodies * G=Great vessels/gastric bubbles * H=Hilar masses * I=Impression
49
* Trachea * Spinous process * Carina * Right hilum and pulmonary artert * Aortic knob * Left hilum and pulmonary artery * Right atrium * Left ventricle * Costophrenic angle * Right hemidiaphragm * Costocardiac angle * Left hemidiaprhagm
50
Tension pneumothorax
51
COPD
52
* Interstitial lung disease
53
Pleural effusion
54
Trauma pt with breathing tube Fractured ribs Possible hemothorax

PCMI Exam 2 (11 decks)

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