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Flashcards in System H&P Deck (90):
1

What is the major respiratory issue that is seen?

Chronic cough

2

What are the major pulmonary ssx?

Dyspnea
Cough
Wheezing
Chest pain
Breathing disorders
Sputum production

3

What is the definition of dypsnea?

Difficult, labored, uncomfortable breathing that is *qualitative, and subjective*

4

What is the major difference between pathologic and physiologic dyspnea?

Pathologic is uncomfortable since it occurs when you're not exerting yourself

5

What causes dyspnea? (2). What modifies these?

Unknown but related to a high level of ventilation perceived centrally

Length tension dissociation of respiratory muscles

Modified by attention

6

How do you elicit information about how bad the dyspnea is? What is the progression of dyspnea (6)?

How much exertion:
-DOE
-walking
-Bathing/changing clothes
-Talking
-at rest
-changing positions

7

What are the two major characteristics of the history that should be asked with SOB?

Onset (rapid vs gradual)
Activity level (progression)

8

What part of the brain is responsible for perceiving dyspnea?

Limbic system

9

What is the problem with beta blockers on the respiratory system?

Block beta 2 receptors, making asthma worse

10

What is the most useful indicator for the level of severity for SOB?

Activity level

11

Are rating scales to rate SOB used often clinically?

No, mostly for studies

12

What heart dysfunction may present with sudden DOE (besides MI)?

LV failure or PE

13

What are the three main causes of pneumothorax?

Idiopathic
Iatrogenic
Trauma

14

In whom is spontaneous pneumothorax common?

Tall, thin, smoking males

15

What are the physical ssx of hyperventilatio?

Cyanosis
Tingling in the lips

16

SOB over 1-2 hours = ?

LV failure
PE***

17

Dyspnea with hyperventilation = ?

Acidosis
Poisoning
Hyperventilation syndrome

18

True or false: tachypnea = hyperventilating

False, hyperventilation associated with decreased pCO2 on ABG

19

Immediate pain with SOB = ? (3)

Pneumothorax
FB aspiration
PE

20

True or false: *recurrent* PE is usually abrupt onset

False--usually gradual since they have many, smaller emboli

21

What is pneumoconiosis? Is this gradual or sudden onset?

Inhalation of inorganic particulates

Gradual onset

22

What is wheezing?

High pitched sound with inspiration or expiration

23

What is the cause of wheezing?

Airway obstruction

24

Inspiratory wheezing is suggestive of what? Why?

Upper airway obstruction, outside of the thoracic cavity

Lower airway tends to collapse with each breath

25

Expiratory wheezing is suggestive of what? Why?

Lower airway obstruction, inside the thoracic cavity

d/t increased lower airway increase in pressure

26

True or false: the severity of wheezing almost always correlates with the severity of airflow obstruction

False

27

What evaluating wheezing what should you assess, beside the airway sounds?

Cyanosis
Mentation

28

Why is a CXR always indicated for a smoker with new onset wheezing?

Tumors

29

Pleuritic chest pain is due to what?

Inflammation of the parietal pleura

30

Can you sense pain with the visceral pleura? Parietal?

Parietal yes, visceral now

31

What are the characteristics of parietal pleura?

Sharp, localized, severe pain that is aggravated by breathing

32

How do you classify a cough?

By its duration

33

What are the characteristics that you should elicit with sputum production? (4)

-Duration
-Characteristics (bloody, colored, purulent etc)
-Volume
-Changes

34

Where are the irritant receptors located that cause a cough? (2)

posterior tracheal wall and at the carina

35

What type of receptors are irritant receptors?

Mechanoreceptors and chemical receptors

36

True or false: irritant receptors that are activated in the ears, stomach, and pericardium can cause a cough

True

37

What is an acute cough? Subacute? Chronic?

Acute = less than 3 weeks
Subacute = 3-8 weeks
Chronic = greater than 8 weeks

38

What is the most common cause of an acute cough?

Viral URI
Acute aspiration

39

What are the 3 common causes of a chronic cough?

-Asthma
-Upper airway cough syndromes
-GERD

40

What drug will cause a cough? Why?

ACEIs d/t bradykinin buildup

41

What are the four, lesser causes of a chronic cough?

-Eosinophilic bronchitis
-Post viral cough
-Chronic bronchitis
-Bronchiectasis

42

What are the appropriate steps of the PE for a cough? (4)

-Inspection
-Palpation
-Percussion
-Auscultation

43

What are the 4 extra thoracic sites that should be evaluated in a lung exam?

-Neck
-UEs
-LEs
-Abdomen

44

What are the aspects of inspecting the chest that should be done when evaluating the lungs?

-Pattern of sleep
-Evidence of respiratory tripod position
-Accessory muscle use

45

How can you diagnose respiratory distress? (4)

-Tripod position
-Accessory muscle use
-Cyanosis
-Pursed lip breathing

46

True or false: clubbing can be seen in a variety of pathological and nonpathological condition

True

47

What is Kussmaul's breathing? When is it seen?

Deep pattern of breathing seen in DKA

48

What is Biot's breathing?

Deep breathing with periods of apnea

49

What is the cheyne-stokes breathing?

Crescendo-decrescendo breathing pattern with periods of apnea

50

Why is the tripod position used for breathing?

Stabilizes the shoulder girdle to help accessory muscles

51

What are the physical findings of COPD? (percussion and visual findings)

-Tympanic percussion and distant lung sounds
-Barrel chest

52

How do you detect fremitus? Why is it used?

Have pt say "99"
Can help with diagnose pneumonia or other consolidated lung if increased

53

Hyper resonance with chest percussion suggests what?

Increased air in the thorax either from air trapping or pneumothorax

54

Dullness with chest percussion indicates what?

Consolidation
Effusion
Mass

55

What is egophony used for?

Detect consolidation (E to A)

56

What are adventitious sounds?

Crackles or rales

57

What are the characteristics of wheezing?

High pitched sound

58

What are the characteristics of rhonchi? What causes this?

Low pitched sounds (like blowing through a straw)

59

What is a crackle? What causes them?

Discontinuous sounds present with inhalation, but can be heard with exhalation

Caused by explosive opening of the small airways as surface tension is overcome

60

What is a pleural friction rub? What does it sound like? How long does it last?

Pleural inflammation causing a sound similar to wet leather rubbing of a rusty hinge


Typically biphasic and transient

61

Rapid or slow onset: acute asthma exacerbation

Rapid

62

Rapid or slow onset: LV failure leading to pulmonary edema

Rapid

63

Rapid or slow onset: PE

Rapid

64

Rapid or slow onset: pneumothorax

rapid

65

Rapid or slow onset: pneumonia

Hours to days

66

Rapid or slow onset: acute bronchitis

hours to days

67

Rapid or slow onset: pneumoconiosis

Slow

68

Rapid or slow onset: interstitial lung disease

Slow

69

Rapid or slow onset: neuromuscular disease

Slow

70

What does a localized area of wheezing suggest?

Intrabronchial process

71

True or false: chronic bronchitis is usually productive

True

72

True or false: bronchiectasis is usually productive

True

73

What is the advantage of pursed lip breathing?

Prevent deflation of the chest d/t increased back pressure

74

On history/inspection of a patient with respiratory complaints, you find: productive cough and a fever. What should you suspect?

Pneumonia

75

On history/inspection of a patient with respiratory complaints, you find: dyspnea, chest pain, h/o trauma and increased JVP. What should you suspect?

Pneumothorax

76

On history/inspection of a patient with respiratory complaints, you find: dyspnea, mild, non-productive cough, and chest pain. What should you suspect?

Pleural effusion

77

On history/inspection of a patient with respiratory complaints, you find: h/o smoking, repeated chest infx, dyspnea, and a cough. What should you suspect?

COPD

78

What happens with tactile fremitus with pneumonia? Chest wall expansion?

Increased tactile fremitus
Decreased chest wall expansion unilaterally

79

What happens with tactile fremitus with a pneumothorax? Chest wall expansion? Tracheal deviation?

Decreased fremitus
Decreased chest wall expansion unilaterally
Tracheal deviation towards if not tension pneumo

80

What happens with tactile fremitus with a pleural effusion? Tracheal deviation?

-Decreased tactile fremitus
-Tracheal deviation away from affected side

81

What happens with chest wall expansion with COPD?

Decreased expansion bilaterally

82

What are the percussive findings with pneumonia?

Dull

83

What are the percussive findings with a pneumothorax?

Hyperresonant

84

What are the percussive findings with COPD?

Hyperresonant

85

What are the percussive findings with pleural effusion?

Stony dull

86

What are the lungs sounds with pneumonia?

Bronchial breathing with crackles and wheeze

87

What are the breath sounds with pneumothorax

Decreased

88

What are the breath sounds with a pleural effusion

-Crackles at upper edge of effusion
-Decreased vesicular breath sounds

89

What condition is associated with a pleural friction rub?

Pleural effusion

90

What are the breath sounds with COPD?

Wheezes/crackles
Decreased breath sounds