Respiratory Physical Exam

Question 1

Key aspects of resp physical (10 letters)

Answer 1

ROOCCSPAVT

Question 2

ROOCCS letters meaning

Answer 2

Resp rate
Observe (resp pattern, distress, chest wall shape and mvmt)
Oximetry
Clubbing
Cyanosis
Surface anatomy (of lobes)

Question 3

PAVT letters meaning

Answer 3

Percussion
Auscultation
Vocal fremitus (egophony and whispered pectoriloquy)
Tactile fremitus

Question 4

Trick to ID oblique fissure

Answer 4

ID vertebra prominens (C7) and T1, count down to T3: posterior origin of oblique fissure

Question 5

other name for sternal angle

Answer 5

Angle of Louis

Question 6

Trick to ID horizontal fissure

Answer 6

Angle of Louis, go laterally to 2nd rib, count down to 4th rib

Question 7

normal resp rate

Answer 7

8-16 breaths per min

Question 8

tachypnea and bradypnea values

Answer 8

over 20 and under 8 breaths per min

Question 9

Resp rate of 40+ for hours shows what

Answer 9

sign of resp failure and is not sustainable

Question 10

normal inspiratory time vs expiratory time ratio

Answer 10

I:E is 1:2

Question 11

prolonged expiratory phase shows what

Answer 11

underlying obstructive impairment

Question 12

Cheyne-Stokes breathing explan

Answer 12

rhythmic auscillation of depth of resp (changes between shallow and deep)

Question 13

ataxic breathing def

Answer 13

completely chaotic resp pattern (short, long, shallow, deep)

Question 14

Kussmaul breathing def

Answer 14

sustained deep breathing for hours

Question 15

Kussmaul breathing, a condition where it’s seen

Answer 15

metabolic acidosis

Question 16

What is the abdominal paradox

Answer 16

when breathing, chest wall goes up and abdoment goes down (inwards)

Question 17

normal opposite of abdominal breathing + explan

Answer 17

synchronous thoraco-abdominal movement: breathe in, chest goes up and abdomen goes up too

Question 18

why abdominal paradox happens

Answer 18

diaphragm problem (becomes a simple piece of tissue, not working), accessory muscles of resp recruited (neck), suck air into airways bc are able to lift chest up. create suction and neg pressure sucks abdominal contents

Question 19

Abdominal paradox: what portion of diaphragm is not working

Answer 19

Two sides are not working (in order to see abdominal paradox)

Question 20

signs of resp distress that can be seen in the resp pattern on or near chest (3)

Answer 20

tachypnea
use of accessory muscles of resp
intercostal indrawing

Question 21

signs of resp distress that can be seen on face (3)

Answer 21

nasal flaring (nostrils open and close)
pursed lip breathing
unable to complete sentence verbally

Question 22

signs of resp distress that can be seen in periphery (3)

Answer 22

cyanosis

Question 23

goal of pursed lip breathing

Answer 23

send back positive pressure in lung as to block the end of expiration to keep alveoli open

Question 24

ataxic breathing shows what

Answer 24

sign of CNS problem

Question 25

Cyanosis how to see it

Answer 25

Finger nails are blue and hand too

Question 26

Central cyanosis sign

Answer 26

mouth mucosa is blue

Question 27

clubbing def

Answer 27

angle between nail and finger is lost

Question 28

Clubbing: thing we can ask patient to do to see it + name

Answer 28

Shamroth's sign. Put hands together on exterior surface and see if gap between fingers

Question 29

Nails characteristics in clubbing

Answer 29

Are spongier and softer than normal (if were to push on them)

Question 30

clubbing can be sign of what, is seen in what conditions

Answer 30

lung cancer, bronchiectasis, indulent (tough) pulm infections (lung abcess, TB, fungal infection of lung)

Question 31

Conditions in which clubbing is NOT seen

Answer 31

COPD, emphysema, chronic bronchitis, asthma

Question 32

T-F: if remove cancer, clubbing stays

Answer 32

F: clubbing goes away when cancer removed

Question 33

**Exam Q** T-F: COPD causes clubbing

Answer 33

False

Question 34

familial clubbing shows what

Answer 34

nothing, it would then be benign

Question 35

clubbing only characteristic of resp conditions: T-F?

Answer 35

False. few extra-thoracic conditions where it appears

Question 36

T-F: Clubbing caused by hypoxia

Answer 36

False. Has nothing to do with hypoxia

Question 37

Percussion principle and name of surface receiving blow

Answer 37

Apply palm of hand and hit third finger. No stethoscope. | Pleximeter

Question 38

Percussion: air-filled structures produced ___ sound

Answer 38

tympanitic or resonant sound

Question 39

chest percussion: diff in sound between bone and surface between bone

Answer 39

no difference

Question 40

auscultation meaning

Answer 40

listening (with steth)

Question 41

auscultation in resp done with that part of steth + exception

Answer 41

with diaphragm | exception: bell of apex of the lung

Question 42

breath sounds: bronchial sound def

Answer 42

inspiratory and expiratory sounds are equal

Question 43

normal location of a bronchial breath sound

Answer 43

over the trachea and central airways (on top of sternum)

Question 44

vesicular breathing sound def

Answer 44

expir and inspi sounds are lower but can barely hear exp sound

Question 45

normal location of vesicular breathing

Answer 45

periphery. away from central airways (lateral chest wall for ex)

Question 46

broncho-vesicular breathing def

Answer 46

mix of bronchial and vesicular. Hear insp well and expiratory barely

Question 47

broncho-vesicular breathing normal location

Answer 47

parasternal (side of sternum)

Question 48

added or adventitial sounds indicate what

Answer 48

pathology. you normally don't hear them

Question 49

3 adventitial (added) sounds

Answer 49

1) discontinuous crepitations or crackles (rales) 2) continuous wheezes or ronchi 3) discontinuous rubs that are monotonous from breath to breath, dry

Question 50

2 adventitial sounds that are very similar

Answer 50

crepitations-crackles-rales and rubs are similar

Question 51

percussion: how to detect pleural effusion or consolidation (as in pneumonia)

Answer 51

percussion: dull sound instead of tympanitic sound

Question 52

auscultation: how to detect pleural effusion or consolidation (as in pneumonia)

Answer 52

pleural effusion: can't hear breathing | pneumonia: hear bronchial breathing instead of usual vesicular breathing

Question 53

Egophony test what you do

Answer 53

put stethoscope over region of chest and ask patient to say eeeeeeeeeeee. If effusion, eee still sounds like eee If pneumonia, eeee becomes aaaa.

Question 54

whispered pectoriloquy: what you do and purpose

Answer 54

listen with stethoscope and ask patient to whisper 1,2,3 continuously. If pneumonia, can hear sound well If effusion, sound not transmitted

Question 55

tactile fremitus: what you do and purpose

Answer 55

put hand on region as if chopping something, ask patient to say 99 loudly (33 in french). If pneumonia, feel vibration over consolidation If effusion, won't feel the vibration