Pulm Physical Exam Flashcards Preview

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Flashcards in Pulm Physical Exam Deck (50):
1

Important pulm vital signs

1) HR
2) RR
3) saturation

2

Inspection of breathing pattern

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

3) Kussmaul/Cheyne-Stokes

3

Kussmaul Respirations describe

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

4

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

5

Overall inspection steps

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

6

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

7

distinguish tachypnea vs. hyperpnea

hyperpnea = incr minute ventilation

tachypnea = incr RR

8

what type of breathing common in
DKA

Heart Failure

Kussmaul

Cheyne-Stokes

9

A

A

10

A

A

11

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

12

what is clubbing diagnostic for?

lung cancer, pulm fibrosis, cystic fibrosis

13

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

14

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

15

distinguish central vs. peripheral or acrocyanosis and what that indicates

central = hypoxemia

peripheral = poor perfusion of digits

16

a

a

17

Define tactile fremitus

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

18

when you have decr tactile fremitus what could patient have?

1) pneumothroax

2) pleural effusion

3) obstructed bronchus- atelectasis

19

when increased tactile fremitus with palpation

lung consolidation (water, blood, pus)

pneumonia

20

if trachea is pushed away what is that indicative of

large pleural effusion

tension pneumothroax

21

if trachea is pushed toward what is that indicative of

atelectasis
fibrosis
resection

22

if percussion is dull what is that indicative of?

1) effusion

2) consoldation

3) atelectasis

23

if percussion is resonant what is that indicative of

incr amount of air in pleural space
1) pneumothorax

2) bullae

3) emphysema

24

diaphragmatic excursion mechanism

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

25

what is diaphragmatic excursion indicative of if abnormal?

1) unilateral diaphragmatic paralysis

2) problems with the diaphragm

26

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

27

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

28

describe bronchial breath sounds

where would you hear it?

1) high pitched

2) heard over trachea

29

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

ABNORMAL

pneumonia
atelectasis

30

describe adventitious sounds
1) crackles/rales

1) discontinuous and typically during inspiration

2) "velcro sound"

31

what is crackles assoc with?

1) pulm edema

2) pneumonia

3) interstitial lung disease/fibrosis

32

describe wheezes

1) continuous high pitched

2) musiical during expiraton occassionally inspiratory

3) caused by high airflow through narrowed airway

33

diffuse wheezes suggest

airway narrowing

1) asthma

2) bronchiolitis

3) COPD exacerbation

4) localized wheezing suggests focal obstruction

34

describe rhonchi

caused by?

1) rumbling sounds more continuous

2) caused by passage of air thru airway partially obstructed by mucous or secretions

35

if you hear bronchial sounds in periphery, then ____

abnormal sounds

36

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)

37

egophony suggests

compressed/fluid filled areas of lung

pneumonia

38

describe stridors

1) musical sounds audible without stethoscope

2) inspiratory or expiratory

3) heard over trachea

39

stridor suggests

upper airway pathology (trachea, larynx, subglottis)

40

what is inspiratory stridor indicative of

laryngeal pathology
1) laryngospasm

2) laryngeal edema

3) subglottic stenosis

4) vocal cord dysfunction

41

what is expiratory stridor indicative of?

central airway obstruction
1) tumor obstructing airway

42

which is more emergent inspiratory or expiratory

expiratory stridor

43

describe friction rub

1) harsh sound

2) heard during inspiration

44

friction rub is due to?

pleural inflammation or pleuritis from
1) infection

2) malignancy

3) pulmonary infarct

3) lupus pleuritis

45

friction rub is due to?

pleural inflammation or pleuritis from
1) infection

2) malignancy

3) pulmonary infarct

3) lupus pleuritis

46

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

47

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

48

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

49

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

50

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- likely hemothorax
damage to neurovascular bundle --> bled into pleural space

meniscus of fluid on CXR