RIPPA Flashcards
(25 cards)
What causes an increased RR?
Airway obstruction.
Asthma, COPD, pneumonia, pulmonary fibrosis, pulmonary embolism, pneumothorax, lung collapse, pleural effusion.
What causes a decreased RR?
Exhaustion, sedation.
Raised intracranial pressure.
Opiate overdose, intoxication.
Metabolic alkalosis.
How can you inspect chest movement?
Symmetrical or asymmetrical.
Paradoxical - breathing causes the chest to move out, which is caused by flail chest (a segment of the ribcage becomes detached due to trauma) or phrenic nerve palsy.
What are accessory muscles of breathing?
Sternocleidomastoids.
Scalene muscles.
Platysma (a broad sheet of muscle fibres extending from the collar bone to the jaw).
What are different breathing sounds?
Noise - airway obstruction.
Stertor - pharynx obstruction.
Stridor (inspiratory) - larynx obstruction.
Wheeze (expiratory) - lower airway obstruction.
What are the different chest shapes?
Barrel - asthma or emphysema.
Pigeon - severe childhood asthma.
Funnel - congenital (not clinically significant).
What are the different chest scars?
From chest drains.
Pneumonectomy.
Tracheostomy.
Why would a trachea deviate towards the pathology?
Pneumothorax.
Pneumonectomy / lobotomy.
Consolidation.
Atelectasis.
Why would a trachea deviate away from the pathology?
Tension pneumothorax.
Pleural effusion.
What causes reduced chest expansion?
Fibrosis.
Consolidation.
Effusion.
Pneumothorax.
What causes hyper-resonant sounds?
Pneumothorax.
Emphysema.
What causes dull sounds?
Pleural effusion.
Consolidation.
Pulmonary fibrosis.
Lung collapse.
Lobectomy.
What causes stony dullness?
A large pleural effusion.
Where is the upper border of liver dullness?
At the level of the 5th interspace anteriorly in the midclavicular line (lower in emphysema).
The lower border of lung resonance is at the 8th rib in the midaxillary line and the 10th rib posteriorly in the scapular line.
What causes diminished breath sounds?
An abnormally thickened chest wall.
Emphysema.
Poor chest movement.
Fluid or air in the pleural cavity.
Pleural thickening.
Total obstruction of a large airway.
Lung/lobe collapse.
What causes increased breath sounds?
An abnormally thin chest wall.
Over-breathing.
What are the distinct characteristics of bronchial breathing?
A harsh resonant quality.
Equality in the length of the sounds heard during inspiration and expiration.
The expiratory sound has the same or higher pitch than the inspiratory sound.
A distinct pause between the sounds heard during inspiration and expiration.
What does bronchial breathing, when heard over the lung fields, indicate?
Consolidation, fibrosis, or cavitations in the lung.
Usually accompanied by increased vocal resonance.
What are wheezes?
Produced by air ‘whistling’ through narrowed bronchi, usually during expiration (asthma).
What are crackles?
Predominantly at the end of inspiration.
May be altered by coughing.
Non-musical sounds.
Basal crackles in bed-ridden patients, which disappear on coughing or a few deep breaths, are usually of no significance.
What are fine crackles?
The explosive reopening of peripheral small airways that have become blocked during expiration (pulmonary oedema).
The noise of ripping paper.
What are coarse crackles?
Air bubbling through secretions in large airways (COPD).
The noise of walking through snow.
What are rubs?
Often detected at the bases (lateral/posterior).
A creaking to-and-fro sound.
Heard in both inspiration and expiration.
Sounds close to the end of the stethoscope.
(Pneumonia, pulmonary embolism with infarction).
What is an aegophony?
A bleating quality in voice sounds.
Usually at the upper limit of a pleural effusion.
