Flashcards in System H&P Deck (90):
What is the major respiratory issue that is seen?
What are the major pulmonary ssx?
What is the definition of dypsnea?
Difficult, labored, uncomfortable breathing that is *qualitative, and subjective*
What is the major difference between pathologic and physiologic dyspnea?
Pathologic is uncomfortable since it occurs when you're not exerting yourself
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
How do you elicit information about how bad the dyspnea is? What is the progression of dyspnea (6)?
How much exertion:
What are the two major characteristics of the history that should be asked with SOB?
Onset (rapid vs gradual)
Activity level (progression)
What part of the brain is responsible for perceiving dyspnea?
What is the problem with beta blockers on the respiratory system?
Block beta 2 receptors, making asthma worse
What is the most useful indicator for the level of severity for SOB?
Are rating scales to rate SOB used often clinically?
No, mostly for studies
What heart dysfunction may present with sudden DOE (besides MI)?
LV failure or PE
What are the three main causes of pneumothorax?
In whom is spontaneous pneumothorax common?
Tall, thin, smoking males
What are the physical ssx of hyperventilatio?
Tingling in the lips
SOB over 1-2 hours = ?
Dyspnea with hyperventilation = ?
True or false: tachypnea = hyperventilating
False, hyperventilation associated with decreased pCO2 on ABG
Immediate pain with SOB = ? (3)
True or false: *recurrent* PE is usually abrupt onset
False--usually gradual since they have many, smaller emboli
What is pneumoconiosis? Is this gradual or sudden onset?
Inhalation of inorganic particulates
What is wheezing?
High pitched sound with inspiration or expiration
What is the cause of wheezing?
Inspiratory wheezing is suggestive of what? Why?
Upper airway obstruction, outside of the thoracic cavity
Lower airway tends to collapse with each breath
Expiratory wheezing is suggestive of what? Why?
Lower airway obstruction, inside the thoracic cavity
d/t increased lower airway increase in pressure
True or false: the severity of wheezing almost always correlates with the severity of airflow obstruction
What evaluating wheezing what should you assess, beside the airway sounds?
Why is a CXR always indicated for a smoker with new onset wheezing?
Pleuritic chest pain is due to what?
Inflammation of the parietal pleura
Can you sense pain with the visceral pleura? Parietal?
Parietal yes, visceral now
What are the characteristics of parietal pleura?
Sharp, localized, severe pain that is aggravated by breathing
How do you classify a cough?
By its duration
What are the characteristics that you should elicit with sputum production? (4)
-Characteristics (bloody, colored, purulent etc)
Where are the irritant receptors located that cause a cough? (2)
posterior tracheal wall and at the carina
What type of receptors are irritant receptors?
Mechanoreceptors and chemical receptors
True or false: irritant receptors that are activated in the ears, stomach, and pericardium can cause a cough
What is an acute cough? Subacute? Chronic?
Acute = less than 3 weeks
Subacute = 3-8 weeks
Chronic = greater than 8 weeks
What is the most common cause of an acute cough?
What are the 3 common causes of a chronic cough?
-Upper airway cough syndromes
What drug will cause a cough? Why?
ACEIs d/t bradykinin buildup
What are the four, lesser causes of a chronic cough?
-Post viral cough
What are the appropriate steps of the PE for a cough? (4)
What are the 4 extra thoracic sites that should be evaluated in a lung exam?
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
How can you diagnose respiratory distress? (4)
-Accessory muscle use
-Pursed lip breathing
True or false: clubbing can be seen in a variety of pathological and nonpathological condition
What is Kussmaul's breathing? When is it seen?
Deep pattern of breathing seen in DKA
What is Biot's breathing?
Deep breathing with periods of apnea
What is the cheyne-stokes breathing?
Crescendo-decrescendo breathing pattern with periods of apnea
Why is the tripod position used for breathing?
Stabilizes the shoulder girdle to help accessory muscles
What are the physical findings of COPD? (percussion and visual findings)
-Tympanic percussion and distant lung sounds
How do you detect fremitus? Why is it used?
Have pt say "99"
Can help with diagnose pneumonia or other consolidated lung if increased
Hyper resonance with chest percussion suggests what?
Increased air in the thorax either from air trapping or pneumothorax
Dullness with chest percussion indicates what?
What is egophony used for?
Detect consolidation (E to A)
What are adventitious sounds?
Crackles or rales
What are the characteristics of wheezing?
High pitched sound
What are the characteristics of rhonchi? What causes this?
Low pitched sounds (like blowing through a straw)
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
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
Rapid or slow onset: acute asthma exacerbation
Rapid or slow onset: LV failure leading to pulmonary edema
Rapid or slow onset: PE
Rapid or slow onset: pneumothorax
Rapid or slow onset: pneumonia
Hours to days
Rapid or slow onset: acute bronchitis
hours to days
Rapid or slow onset: pneumoconiosis
Rapid or slow onset: interstitial lung disease
Rapid or slow onset: neuromuscular disease
What does a localized area of wheezing suggest?
True or false: chronic bronchitis is usually productive
True or false: bronchiectasis is usually productive
What is the advantage of pursed lip breathing?
Prevent deflation of the chest d/t increased back pressure
On history/inspection of a patient with respiratory complaints, you find: productive cough and a fever. What should you suspect?
On history/inspection of a patient with respiratory complaints, you find: dyspnea, chest pain, h/o trauma and increased JVP. What should you suspect?
On history/inspection of a patient with respiratory complaints, you find: dyspnea, mild, non-productive cough, and chest pain. What should you suspect?
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?
What happens with tactile fremitus with pneumonia? Chest wall expansion?
Increased tactile fremitus
Decreased chest wall expansion unilaterally
What happens with tactile fremitus with a pneumothorax? Chest wall expansion? Tracheal deviation?
Decreased chest wall expansion unilaterally
Tracheal deviation towards if not tension pneumo
What happens with tactile fremitus with a pleural effusion? Tracheal deviation?
-Decreased tactile fremitus
-Tracheal deviation away from affected side
What happens with chest wall expansion with COPD?
Decreased expansion bilaterally
What are the percussive findings with pneumonia?
What are the percussive findings with a pneumothorax?
What are the percussive findings with COPD?
What are the percussive findings with pleural effusion?
What are the lungs sounds with pneumonia?
Bronchial breathing with crackles and wheeze
What are the breath sounds with pneumothorax
What are the breath sounds with a pleural effusion
-Crackles at upper edge of effusion
-Decreased vesicular breath sounds
What condition is associated with a pleural friction rub?