Pulmonary Flashcards
(129 cards)
1
Q
Kussmaul breathinui
A
Deep and labored breathing
See with metabolic acidosis
2
Q
Cheyenne-stokes breathing
A
Shallow to deep cycle
Normal when asleep
Abnormal awake: indicates brain damage at cerebral level or drugs
3
Q
Biot/ataxic breathing
A
Increases intracranial pressure
Indicates damage to medulla
4
Q
Air trapping
A
Increasing difficulty to get air in and out
Emphysema
5
Q
What do retractions suggest?
Unilateral?
A
Obstruction to inspiration
Unilateral: obstruction lower in tree, after the branch
6
Q
What causes paradoxical breathing?
A
Negative intrathoracic pressure is transmitted to the abdomen by a weak diaphragm (phrenic nerve palsy)
7
Q
What is strider causes by?
A
Laryngeal or tracheal obstruction
8
Q
What may cause decrease lung expansion?
A
Broken rib Obstruction Muscle strain Pneumothorax CF (scarring) COPD
9
Q
What may increase vibrations on fremitus?
A
Consolidation
Tumor inside lung
10
Q
What may cause decrease fremitus?
A
Emphysema (increased air)
Pneumothorax (over air filled space)
Pleural effusion (fluid outside lung)
11
Q
What may cause a tracheal deviation?
A
Thyroid tumor Goiter Pneumothorax: -simple: deviated toward affected side -tension: deviated toward opposite side
12
Q
The more dense the medium during percussion…the _______ the tone
A
Quieter
13
Q
Where is tympanic tone heard
A
Gastric bubble
14
Q
Where is a hyperresonany sound heard
A
Emphysema
15
Q
Where is a dull sound heard
A
Liver
16
Q
Where is a flat sound heard
A
Muscle
17
Q
Where do you start when measuring diaphragmatic excursion
A
T7
18
Q
What may limit diaphragmatic excursion
A
COPD (little to exhale) Emphysema CF Phrenic nerve palsy (Guillion Bare) Abdominal tumor/ascites Pleuritis Pneumothorax Broken rib
19
Q
What does hyperresonance indicate
A
Hyperinflation
20
Q
What does dullness indicate?
A
Diminished air exchange
21
Q
What may cause a dull percussion finding in the lung
A
Consolidation inside lung or insulation outside lung!!
Bronchiogenic carcinoma/tumor Hemothorax Pneumothorax over balled up lung Obesity/increased muscle Pleural effusion
22
Q
Where are the right middle and lingua best heard?
A
Axillary region
23
Q
What are vesicular lung sounds
A
Low pitched, low intensity sounds
24
Q
What are bronchovesicular sounds
A
Moderate in pitch and intensity
25
What are bronchial/trachea sounds
Highest in pitch and intensity
26
Where are bronchial/tracheal sounds hear
Over the trachea
27
Where are bronchiovesicular sounds heard
Major bronchi
28
Where are vesicular sounds heard
Lesser bronchi, bronchioles and lobes
| PERIPHERAL
29
Are bronchiovesicular and bronchial breath sounds normal if heard over peripheral lung tissue?
No
30
Amorphic breath sounds
Similar to sound of blowing over a bottle
Heard with stiff pulmonary cavity
Tension pneumothorax
31
What are cavernous breath sounds
Cave-like
Heard when wall is rigid
32
What are crackles
Velcro’s torn apart
| Usually heard on inspiration and are discontinuous sounds
33
When are crackles heard
Bronchitis (early inspiration)
| Pneumonia (late on inspiration)
34
What are rhonchi
Snoring sounds usually heard on expiration and are more continuous sounding
Causes by passage of air obstructed by thick secretions, pressure or growth
35
When are rhonchi heard
COPD, bronchiectasis, pneumonia
When passage of air is obstructed by pressure, mucus or growth
36
What cause crackles (rales)
Disrupted passage of air through small airways
37
What are wheezes and what causes them
High-pitched whistle, music like
High velocity air flow through narrow or obstructed airway
38
When might you hear wheezes
Asthma, bronchitis
39
What does friction rub sounds like
Low-pitches grating sounds heard on inspiration and expiration due to inflamed surfaces
40
What is mediastinal crunch also known as and when do you hear it
Hamman sign
| Hear when abnormal presence of air in lungs as with mediastinal emphysema
41
When might you hear bro chop honey, pectoriloquy or egophony
Any consisting that causing consolidation of lung tissue (fluid, pus, mass)
42
What is bronchophony
Greater clarity and increased loudness
43
What is pectoriloquy?
Intense bronchophony that even a whisper can be heard through stethoscope
44
What is egophony
Intensity of spoken voice is heard and nasal component that “E” sounds like “A”
45
When does vocal resonance increase
With consolidation
46
When does vocal resonance decrease
Loss of tissue in respiratory tree
47
What might be the cause of loss of vocal resonance
Barrel chest of emphysema
48
What causes decreased breath sounds
Hyperinflated lungs
| Fluid/pus accumulated in pleural space
49
What causes increased breath sounds
Consolidation
| Masses
50
What would a hoarse cough indicate
Croup
51
What would a whoop cough indicate
Pertussis
52
What would a dry/brassy cough indicate
Tumor
53
Is percussion reliable in infants?
Less reliable
54
What is the relationship between head and chest circumference in infants
Chest circumference is usually 2-3cm smaller
55
Is coughing rare or frequent in infants?
Rare
56
What is stridor and indicator of?
Obstruction high in respiratory tree
57
Roundness of chest persisting past _____ year is a possible indication of a _____ problem
2 years
| Pulmonary
58
A child’s chest is usually ______ resonant than an adults
More
59
What breath sounds predominate in a child>
Bronchovesicular
60
How does breathing change in a pregnant woman
Tidal volume increases. They breathe more deeply. RR stays the SAME
61
What lung percussion sound is common in the elderly
Hyperresonance (because of increased A-P diameter)
62
What causes atelectasis?
Compression from outside (tumors) or MC is mucus plug post surgery
63
What findings are pertinent in atelectasis?
Dull percussion
Decreased fremitis
Decreased breath sounds and possible wheezing, crackles or Thales
64
What is chronic bronchitis considered
A COPD
65
What is the number one cause of chronic bronchitis
Smoking
66
What are the pertinent findings in bronchitits
Wheezing, crackles, rhales
Percussion and fremitis normal
67
What usually causes pleurisy/pleuritis?
Pulmonary infection
68
What are the pertinent findings in pleurisy?
Decreased breath sounds and fremitis
| Friction rub heard
69
What may cause pleural effusion
```
CHF
Liver or kidney disease
PE
Autoimmune (Lupus/RA)
Infections
Cancer
Pleurisy
```
70
What are the two main pertinent findings in pleural effusion
Decreased fremitus and dull to percussion
71
What are all the findings in pleural effusion
Decreased fremitis
Dullness to percussion
Decreased chest wall movement
Contralateral tracheal deviation
72
What causes empyema?
Adjacent infections or tissue trauma
73
What is empyema?
Purlulent fluid in pleural space
74
What are the pertinent findings in empyema?
ABSENT fremitis, dull percussion, decreased breath sounds
75
What causes a lung abscess
Aspirating food or poor dental health
76
What are the pertinent findings for lung abcess?
Dull to percussion and decreased breath sounds, potentially friction rub
Patient will look obviously ill
77
What are the pertinent findings in pneumonia
```
Increased fremitis
dull percussion
decreased Breath sounds
Crackles
BRONCHIAL breath sounds
```
78
What pertinent findings might you find in influenza
Crackles and rhonchi
79
What are the pertinent findings in pneumothorax (air between lung and chest wallO
Decreased breath sounds
Decreased fremitus
Hyperresonance
80
What are the findings in hemothorax
Decreased breath sounds
| Dullness to percussion
81
What increase your risk for pulmonary embolism
```
CHF
CA
SURGERY
Prolonged bed rest
Long trips
Smoking
Supplemental estrogen
```
82
What does CF affect
Exocrine glands, lungs, pancreases and sweat glands
Causing sticky and thick secretions that plug tubes, ducts and passageways
83
What does CF lead to
```
Brochiectasis
barrel chest
low body mass
Clubbing of the nails (pulmonary dysfunction)
Pulmonary HTN —> for pulmonale
```
84
What causes a diaphragmatic hernia and what happens
Abnormal opening in diaphragm that allows organs from abdomen to move into the chest cavity
85
What side is diaphragmatic hernias most common on?
LEFT
86
What are the signs and symptoms of a diaphragmatic hernia?
```
Breathing issues after birth
Cyanosis
Decreased breath sounds
BOWEL SOUND HEARD IN CHEST
LESS PROTUBERANT abdomen
```
87
When is epiglottis most common
3-7 years old
88
What are symptoms of epiglottis
```
Fever
Sore throat
Stridor
Painful swallowing
DROOLING
Muffled voice
Neck extended and head forward position
```
89
What causes croup?
Parainfluenza virus
| MC 1.5-3 years
90
What does croup cause
Swelling of larynx, trachea and bronchi
| SEAL-LIKE cough (obstructed breathing)
91
What is tracheomalacia?
Lack of rigidity of the trachea
92
What are signs of tracheomalacia
“Noisy” breathing
Wheezing
Stridor/respiratory distress
Improves as infant grows
93
What is bronchiolitis
Bronchiolar inflammation that leads to hyperinflanation of the lungs
MC in infants under 6 months
94
What causes bronchiolitis
RSV
95
What are the symptoms of bronchiolitis
```
Similar to cold that progresses to difficulty breathing and RETRACTIONS
Wheezing on expiration
Rapid/short breaths
Decreased breath sounds
Hyperresonance
```
96
What is COPD
Nonspecific group that includes cough, chronic and excessive sputum production and dyspnea
97
What does COPD cause
Irreversible expiration airflow obstruction
98
What are the three main conditions that are considered COPD
Emphysema
Bronchiectasis
Chronic bronchitis
99
What are the findings in emphysema
```
Decreased chest wall movement
Decreased breath sounds
Crackles, rhales, wheezing
Decreased fremitis
Hyperresonance
Narrowed heart shadow
Increased retrosternal air space
```
100
What is bronchiectasis?
Chronic dilation of bronchi/bronchioles caused by repeated pulmonary infections and bronchial obstruction
101
What is other condition is frequently seen in patients with CF
Bronchiectasis
102
What are findings with bronchiectasis
Clubbing of nails
LARGE amounts of sputum
Crackles and rhonchi
103
What is the MC cause of walking pneumonia?
Micoplasma
104
What is the most common pneumonia in immunocompromised individuals
Fun gals
105
What is the most common pneumonia in children?
Viral
106
What might a prolonged expiration and bulging on expiration indicate?
Airway outflow obstruction or valve-like action of compression by a tumor, aneurysm, or enlarged heart
107
What causes unilateral retraction?
A foreign body in the bronchus (MC right)
108
When does retraction of the lower chest occur?
Asthma and bronchiolitis
109
When will respiratory rate increase?
```
Acidosis
CNS lesions (PONS)
Anxiety
Aspirin poisoning
Hypoxia
Pain
```
110
When will respiratory rate decrease?
```
Alkalosis
CNS lesions (CEREBRUM)
MG
Narcotic overdose
Obesity (extreme)
```
111
Primary apnea
Self-limited
MC after blow to head
Also after birth when CO2 builds and breathe spontaneously to correct
112
Secondary apnea
Breathing stops and will not begin unless resuscitative measures are taken
113
Reflex apnea
Nausea provoking vapors/gases inhaled can be involuntary hault to respiration’s
114
Apneustic breathing
Inspiration are prolonged and expiration is constrained
| PONS controls
115
Obstruction above the glottis
Quiet stridor
Muffled voice
Cough not a factor
Head and neck may be awkwardly positioned (extended with retropharyngeal abcess; to affected side with peritonsillar abcess)
116
Obstruction below the glottis
```
Loud raspy stridor
Hoarse voice
Swallowing not affected
Cough is harsh and barking
Head position not a factor
```
117
What may pull the trachea to the affected side
Volume loss
| Fibrosis/atelectasis
118
What causes the trachea to deviate to opposite side
Thyroid enlargement
| Pleural effusion
119
Inspiration and expiration ratios on bronchial, bronchovesicular and vesicular breath sounds
1. Inspiration longer than expiration
2. I=E
3. I=E or E>I (by a little)
120
What breath sound maybe cleared by a cough?
Rhonchi
121
Sibilant crackles
High-pitched
122
Sonorous crackles
Low-pitched
123
Sibilant rhonchi heard with?
Smaller bronchi in asthma
124
Sonorous rhonchi heard with?
Larger bronchi with tracheobronchitits
125
When might you find newborn have a smaller chest circumference?
Intrauterine growth retardation
126
When might you find an infant has a larger chest circumference?
Poorly controlled diabetic mother
127
What may cause increased RR?
Liver enlargement
| Abdominal ascites
128
What may causes decreases RR
Neurological impairment
Electrolyte imbalance
Infection
Cardiovascular fitness
129
What is the appropriate ratio of A-P:lateral diameter
0.70-0.75
