Pulm Physical Exam Flashcards by A B

Important pulm vital signs

1) HR
2) RR
3) saturation

How well did you know this?

Not at all

Perfectly

Inspection of breathing pattern

1) RR and pattern
2) Tachypnea (rapid RR)/Hyperpnea/Rapidshallow breathing

3) Kussmaul/Cheyne-Stokes

How well did you know this?

Not at all

Perfectly

Kussmaul Respirations describe

hyperpnea
rapid, deep breathing
DKA (to incr VE to lower acidosisi)

How well did you know this?

Not at all

Perfectly

Cheyne-Stokes describe

cyclic breathing
brain doesn’t react as quickly to changes in CO2 = apnic breathing

brain senses high CO2
so start breathing with pursed lips, rapid breathing, then brain recog low CO2

then breathing slows down (time delayed changes in CO2

How well did you know this?

Not at all

Perfectly

Overall inspection steps

1) Vital Signs
2) Breathing Pattern
3) Distress (yes/no)

How well did you know this?

Not at all

Perfectly

How do you assess distress

1) yes or no = speaking sentences or dyspenea
2) accessory muscle use
3) tripodding = using arms to open up thoracic cage
4) paradoxical abdo movement
5) pursed lip breathing

How well did you know this?

Not at all

Perfectly

distinguish tachypnea vs. hyperpnea

hyperpnea = incr minute ventilation

tachypnea = incr RR

How well did you know this?

Not at all

Perfectly

what type of breathing common in
DKA

Heart Failure

Kussmaul

Cheyne-Stokes

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

other aspects of inspection

1) cyanosis (central vs. peripheral or acrocyanosis
2) clubbing (lung cancer, pulm firosis, cystic fibrosis
3) body habitus
4) skeletal shape (scoliosis, kyphosis, straight spine, pectus ecavatum or carinatum

How well did you know this?

Not at all

Perfectly

what is clubbing diagnostic for?

lung cancer, pulm fibrosis, cystic fibrosis

How well did you know this?

Not at all

Perfectly

define paradoxical abd movement (belly breathing)

generating so much negative
force with inspiration
using abdominal muscles as expiring to get lungs to shrink down —> pushing abd out

How well did you know this?

Not at all

Perfectly

describe pursed lip breathing

when would you see it

generating auto-PEEP (back pressure)
to keep airway open during ventilation to get air out

asthma, COPD, emphysema

How well did you know this?

Not at all

Perfectly

distinguish central vs. peripheral or acrocyanosis and what that indicates

central = hypoxemia

peripheral = poor perfusion of digits

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

Define tactile fremitus

Vibration of chest during speech due to transmitted vibrations
through bronchopulmonary tree (pt says “99”)

How well did you know this?

Not at all

Perfectly

when you have decr tactile fremitus what could patient have?

1) pneumothroax
2) pleural effusion
3) obstructed bronchus- atelectasis

How well did you know this?

Not at all

Perfectly

when increased tactile fremitus with palpation

lung consolidation (water, blood, pus)

pneumonia

How well did you know this?

Not at all

Perfectly

if trachea is pushed away what is that indicative of

large pleural effusion

tension pneumothroax

How well did you know this?

Not at all

Perfectly

if trachea is pushed toward what is that indicative of

atelectasis
fibrosis
resection

if percussion is dull what is that indicative of?

1) effusion
2) consoldation
3) atelectasis

if percussion is resonant what is that indicative of

incr amount of air in pleural space
1) pneumothorax

2) bullae
3) emphysema

diaphragmatic excursion mechanism

diaphragms are on full expiration (resonant to dull) then on full inspiration

what is diaphragmatic excursion indicative of if abnormal?

1) unilateral diaphragmatic paralysis | 2) problems with the diaphragm

describe vesicular breath sounds when would you hear it? where would you hear it?

1) soft and low pitch 2) heard through inspiration and continue into expiration (stop 1/3 through expiration) 3) heard throughout chest

describe bronchovesicular breath sounds when would you hear it? where would you hear it?

1) moderate pitch and intensity 2) heard during inspiration, brief silent, then again expiration 3) heard over major bronchi

describe bronchial breath sounds where would you hear it?

1) high pitched | 2) heard over trachea

if you hear bronchovesicular and bronchial breath sounds over periphery over lung this indicates?

ABNORMAL pneumonia atelectasis

describe adventitious sounds | 1) crackles/rales

1) discontinuous and typically during inspiration | 2) "velcro sound"

what is crackles assoc with?

1) pulm edema 2) pneumonia 3) interstitial lung disease/fibrosis

describe wheezes

1) continuous high pitched 2) musiical during expiraton occassionally inspiratory 3) caused by high airflow through narrowed airway

diffuse wheezes suggest

airway narrowing 1) asthma 2) bronchiolitis 3) COPD exacerbation 4) localized wheezing suggests focal obstruction

describe rhonchi caused by?

1) rumbling sounds more continuous | 2) caused by passage of air thru airway partially obstructed by mucous or secretions

if you hear bronchial sounds in periphery, then ____

abnormal sounds

describe egophony

1) change in timbre but not pitch or volume 2) patient say E to A 3) occurs over compressed/fluid filled areas of lung (pneumonia)

egophony suggests

compressed/fluid filled areas of lung pneumonia

describe stridors

1) musical sounds audible without stethoscope 2) inspiratory or expiratory 3) heard over trachea

stridor suggests

upper airway pathology (trachea, larynx, subglottis)

what is inspiratory stridor indicative of

laryngeal pathology 1) laryngospasm 2) laryngeal edema 3) subglottic stenosis 4) vocal cord dysfunction

what is expiratory stridor indicative of?

central airway obstruction | 1) tumor obstructing airway

which is more emergent inspiratory or expiratory

expiratory stridor

describe friction rub

1) harsh sound | 2) heard during inspiration

friction rub is due to?

pleural inflammation or pleuritis from 1) infection 2) malignancy 3) pulmonary infarct 3) lupus pleuritis

friction rub is due to?

pleural inflammation or pleuritis from 1) infection 2) malignancy 3) pulmonary infarct 3) lupus pleuritis

what does he have? why? 15 year old patient incr SOB multiple episode of pneumonia chronic production of sputum dyspneic speakng sentences with RR of 28 sat of 88% incr resonance on percussion diffuse expiratory wheezes scattered crackles on auscultation clubbing of fingers CXR = port placement

cystic fibrosis (obstruction) clubbing hyperresonance crackles and wheezes

what does he have? 60 y/o incr SOB multiple episodes of bronchitis chronically produce sputum smoke PPD x40 yrs dyspneic speaking senctences RR = 28 88% sat on RA tripodding and barrell chested incr resonance on percussion diffuse expiratory wheezes and scattered rhonchi CXR shows long chest cavity vertically more ribs than usual diaphragm is flat

emphysema/COPD smoking history hyperinflated lungs wheezing with exacerbations

what does she have? 50 y/o incr SOB drinks most days and last week fell on sidewalk since then, more SOB and pain on right chest dyspneic speaking sentences RR = 28 sat = 90% on RA normal breath sounds on left diminished sounds on right asymmetry of chest with right chest being larger than left decr fremitus and hyper-resonance on percussion of right chest CXR shows pneumothorax

pneumothorax

50 y/o incr SOB drinks most days and last week fell on sidewalk since then, more SOB and pain on right chest ``` RR = 28 90% on RA normal breath sounds on right diminished sounds on left decr fremitus dullness on percussion on left chest 1/2 way up from best ```

pleural effusion meniscus of fluid on CXR

pleural effusion- likely hemothorax damage to neurovascular bundle --> bled into pleural space meniscus of fluid on CXR