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Flashcards in Pulmonary History & Physical Deck (39):
1

Why is sputum production important?

bc if you have a large amount of sputum you could have bronchiectasis= complete nuclear destruction of the airway (most commonly from haemophilus influenza).

2

What 4 things should you evaluate about sputum?

1. amount
2. color (clear, green, or yellow casts)
3. odor (aspiration, anaerobic infection)
4. frothy (CHF)

3

What are 5 causes of cough?

1. infection (TB, bronchitis, asthma)
2. CHF
3. compression (aneurysm, lymph nodes, substernal thyroid)
4. foreign bodies
5. tumors (malignant, benign) *usually unilateral

4

What could it mean if the cough is worse at night?

chronic sinusitis and bronchiectasis

5

** What could it mean if the cough is worse after eating?
(test question)

aspiration

6

What do we think if pt has acute dyspnea?

- CHF due to acute pulmonary edema with left ventricular failure.
- PE (remember all come from the pelvic veins in the legs). Pts usually hyperventilate with this.

7

What do we think if pt has chronic dyspnea?

- CHF
- COPD

8

What do we think if the pt has recurrent paroxysmal dyspnea (dyspnea that subsides after an hour)?

bronchial asthma

9

What are the 2 general types of chest pain?

1. chest pain that persists when not breathing
2. chest pain that hurts with inspiration (usually pleural pain).

10

What are some causes/types of chest pain?

- pleuropulmonary
- tracheobronchial pain
- cardiovascular pain
- esophageal and mediastinal pain
- neuromuscular pain

11

Do all asthmatics have T3 and T4 lesions?

YES. Treat with OMM

12

What is the problem with hemoptysis (coughing up blood)?

if your left lung is bleeding, as you cough, some of it can go back down into the right lung and clot.

13

What are some causes of hemoptysis?

- TB, neoplasm
Rare:
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu).
- idopathic pulmonary hemosiderosis
- Good Pasture's syndrome= nephritis and lung purpura (immunological).
- amyloidosis of respiratory tract (immunological)
- Wegener's granulomatosis (immunological)

14

What is the most important thing you can ask a pt with pulmonary issue?

past history and personal habits:
- pets (birds=psittacosis, cats= asthma)
- smoking= number of packs/day time number of years smoking.

15

*** Are RHONCHI, WHEEZES?

YES!! (wheeze= nursing word, RHONCHI= doctor word).

16

What is inspiratory stridor (rhonchi)?

loud, harsh, high pitched inspiratory sound that indicates laryngeal obstruction or edema.

17

What could cause unilateral rhonchi?

obstructing lesion, foreign body, or tumor

18

What are some occupations that may cause pulmonary issues?

- coal miner or industrial worker

19

At what landmark does the trachea bifurcate into the left and right primary bronchi?

- anterior= at the sternal angle (angle of Louis)
- posterior= T4 spinous process

20

Where is the apex of the lung located both anteriorly and posteriorly?

- anterior= 2-4 cm above the proximal 1/3 of the clavicle
- posterior= vertebral end of the first rib

21

Where is the inferior border of the lung located both anteriorly and posteriorly?

- anterior= 6th rib at the midclavicular line and 8th rib at the midaxillary line.
- posterior= level of T10 spinous process and may descend to T12 with inspiration.

22

Are the oblique and horizontal fissures on the left or right?

right lung= both
left lung= oblique only

23

What is the order of the pulmonary physical?

1. inspection (cyanosis, clubbing, respiratory movements, lumps in the neck).
2. percussion
3. palpation
4. asucultation

24

What do you feel for with palpation?

1. tactile fremitus (dampening= pleural fluid with fibrosis, increased= consolidated lung).
2. axillae and cervical nodes
3. tracheal deviation

25

What should you look for on inspection?

- deformities of thorax
- slop of the ribs (more horizontal in emphysema).
- abnormal retraction of interspaces, nasal flaring, suprasternal notch retraction during inspiration.
- abnormal bulding of the interspaces during expiration.
- local lag or impariment in respiratory movement.
- rate and rhythm of breathing (tachypnea= faster than 24/min, bradypnea= slower than 12/min).
- orthopnea

26

When does cyanosis occur in terms of deoxyhemoglobin?

when the content of deoxyhemoglobin in blood equals or exceeds 5 g/100 ml. Cyanosis does NOT depend on the % of hemoglobin saturation (aka it's the amount of bad hemoglobin that you have).

27

What are the two types of cyanosis?

1. peripheral= due to peripheral vasoconstriction and is seen with exposure to cold and low cardiac output states (arterial blood is well saturated).
2. central= due to arterial desaturation and reflects abnormal gas transport by the lungs or a right-to-left cardiac shunt.

28

What are some disease states that can cause clubbing of the distal phalanges?

pulmonary, heart, and GI diseases

29

**** What are the 6 abnormal respiratory patterns?
(test question)

1. Cheyne-Stokes= periods of hyperpnea alternating with apnea, with periodicity of 15-30 sec in a crescendo-decresendo pattern.
2. Biot's= periodic irregular breathing w/o the crescendo-decrescnedo pattern.
3. Kussmaul's= deep, rapid, regular respiration (occurring with metabolic acidosis).
4. Gasping= spasmodic inspiratory effort, which is brief and terminates abruptly.
5. Dysynchronous or paradoxical= enlargment of the rib cage in synchrony with flaring out of abdomen (due to respiratory muscle fatigue).
6. Pursed-lip= during expiration to keep alveoli open longer (seen in emphysema).

30

What does a particular percussion sound relate to?

- flatness= over solid tissue (thigh)
- dullness= liver
- resonance= normal lung
- hyperresonance= emphysema or pneumothorax (if unilateral).
- tympani= puffed out cheek

31

What does increased dullness relate to?

pleural effusion, lobar consolidation, and lobar or whole lung atelectasis (lung collapse).

32

What are the 2 types of fremitus?

1. tactile= palpable vibrations
2. vocal= say "99"

33

**** When will fremitus be DECREASED?

Remember PET:
- pneumothorax
- effusion
- tumor in right or left main stem bronchi

34

What do discontinuous (interrupted) "RALES" on inspiration indicate?

the 2 Fs: either fluid or fibrosis
*sounds like crinkling paper and this comes from the ALVEOLI.

35

What are continuous (uninterrupted) "RHONCHI" on expiration?

sound like a "wine or sigh" and could be sibilant (high pitched) or sonorous (low pitched) .

36

What does a pleural sound, sound like on inspiration?

sand paper and could be a friction rub, or a clicking or crunch sound
*This will only last for 10 mins from the time it begins.

37

When will you hear "white noise"?

COPD

38

*** What is stridor?

inspiratory continuous sounds due to inspiratory obstruction of the airways. It will disappear during expiration when the increase in airway pressure relieves the obstruction.

39

**** What is Egophony?

increased resonance of voice sounds heard when auscultating the lungs, asking the patient to say "E". It is often caused by lung consolidation (pneumonia) or pleural effusion, and the E will sound like a goat "eh".