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103 Cards in this Set
- Front
- Back
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Which 4 causes of dyspnea may present with pleuritic pain?
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-Pneumonia
-Spontaneous pneumothorax -Acute pulmonary embolism -Neoplasm |
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Which 7 causes of cough are categorized as chronic inflammation?
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-Postnasal drip
-Bronchiectasis -Chronic bronchitis -Pulmonary tuberculosis -Lung abscess -Asthma -GERD |
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Dark to bright red sputum is most often associated with?
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-Pulmonary emboli
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In what conditions would you find the diaphragm to be abnormally high?
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-Pleural effusion
-Paralysis of diaphragm -Organomegaly -Atelectasis (lower lobe) |
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Which conditions will cause a bilateral decrease in diaphragmatic excursion?
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-Emphysema
-Thickened chest wall -Elevated diaphragm -Ascites -B/L organomegaly -B/L collapse |
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Which conditions will cause a unilateral decrease in diaphragmatic excursion?
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-Pleural effusion
-Pneumothorax -Bronchial obstruction -Organomegaly -Consolidation |
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Which adventitious lung sound is often coarse and relatively few in #?
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Early inspiratory crackles
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Which 2 adventitious lung sounds are heard in bronchiectasis but are not specific for this dx?
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Midinspiratory and expiratory
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Using landmarks, describe where (anteriorly) the apices of the lungs are
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2-4 cm above proximal 1/3 of clavicle
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Where does the oblique fissure run?
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T3 SP obliquely down & around chest to 6th rib @ midclavical line
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How does the horizontal fissure run?
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Ant: runs close to 4th rib & meets oblique fissure in midaxillary line near 5th rib
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Sighing Resp.
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-Breathing with freq. sighs
-Hyperventilation syndrome -dyspnea & dizziness |
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Obstructive breathing
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Causes include:
Asthma Chronic bronchitis COPD |
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What may cause a decrease in rate/depth of breathing?
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-Alkalosis
-CNS-cerebrum -Severe obesity -Myasthenia Gravis -Narcotic overdose |
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What may cause an increase in rate/depth of breathing?
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-Acidosis
-CNS lesion (pons) -Anxiety, pain -Hypoxemia -Aspirin poisoning |
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Which conditions are assoc. w/ "pulled" tracheal deviation?
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-Infiltrated tumor
-Pneumothorax (open) -Atelectasis (upper lobe) -Fibrosis |
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Which conditions are assoc. w/ "pushed" tracheal deviation?
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-Tension pneumothorax
-Tumor -Nodal enlargement -Pleural effusion -Thyroid enlargement |
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Cheyne-Stokes
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-Periods of breathing alternating w/ periods of apnea
-Classic for CHF!!! -Crescendo/decrescendo pattern |
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Describe Peripheral cyanosis
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-Venous stasis
-Exposure to cold -Found in nail beds, nose, lips -Better w/ warming |
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What is the classic cause of platypnea?
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Intracranial problems causing pressure
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Trepopnea
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Dyspnea relieved by laying on side
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Paroxysmal nocturnal dyspnea
(PND) |
Sudden onset of dyspnea while sleeping relieved by sitting up
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Hemoptysis vs. Hematemesis
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Optysis
-Frothy -Bright red -Mixed w/ pus Emesis -Not frothy -Dark red/coffee color -Mixed w/ food |
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Gravel in the sputum is assoc. w/?
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Broncholithiasis
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Profuse, colorless sputum is typical of?
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Alveolar cell carcinoma
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Yellow-green sputum is typical of?
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Bronchiectasis, chronic bronchitis
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Dry hacking cough is generally assoc. w/?
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-Viral infection & mycoplasma
-Interstitial lung ds -Tumor -Allergy -Anxiety |
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A stridor type cough is assoc. w/?
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Tracheal obstruction
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Morning cough is classic for?
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Smoking
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Cough assoc. w/ eating or drinking is typical of?
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Neuromuscular dx of upper esophageal
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Barking cough is typically assoc. w/?
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Epiglottal ds. (croup)
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Which 2 lung conditions are most commonly assoc. w/ history of smoking?
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-Chronic bronchitis
-COPD |
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Which cause of pneumonia presents w/ sticky, red, jelly-like sputum?
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Klebsiella
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Pink frothy sputum is assoc. W/?
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Pulmonary edema
-Left sided HF |
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Purulent foul smelling sputum is assoc. w/?
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-Bronchiectasis
-Lung abscess |
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Which cause of chronic cough presents early in the morning and late at night?
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Gastroesophageal reflux (GERD)
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Which cause of cough is assoc. w/ anorexia, weight loss, fatigue, fever, and night sweats?
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Pulmonary tuberculosis
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Which 4 causes of cough are categorized as acute inflammation?
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-Laryngitis
-Tracheobronchitis -Mycoplasma & Viral pneumonias -Bacterial pneumonias |
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Which 2 cardiovascular disorders are assoc. w/ cough?
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-Left ventricular failure
-Pulmonary emboli |
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Which cause of cough is often assoc. w/ viral nasopharyngitis?
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Laryngitis
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What cause of sputum is assoc. w/ febrile illness and poor dental hygiene?
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Lung abscess
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Which chest disorder has increased tactile fremitus?
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Consolidation
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Which chest disorder presents w/ all 3 types of transmitted breath sounds?
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Consolidation
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What are the 3 types of transmitted breath sounds?
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-Bronchophony
-egophony -pectoriliguy |
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What chest disorder usually has absent fremitus?
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Atelectasis
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Which chest disorders have decreased tactile fremitus?
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-Pleural effusion (may be absent or increased)
-Pneumothorax (may be absent) -COPD -Asthma |
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Which chest disorders have hyperresonant percussion notes?
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-Pneumothorax (tympanic)
-COPD (diffusely) -Asthma (diffusely) |
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Which chest disorders have dull percussion notes?
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-Consolidation
-Atelectasis -Pleural effusion |
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Which chest disorders have resonant percussion notes?
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-Normal
-Chronic bronchitis -Left-sided HF -Asthma |
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Which cause of cough may be characterized by diffusely pink or rust colored sputum?
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Bacterial pneumonias
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Which cause of cough is seen w/ discharge in the post. pharynx, chronic rhinitis and sinusitis?
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Post nasal drip
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How much should the clavicles move during passive respiration?
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<5mm
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Which conditions are assoc. w/ a "pushed posterior" tracheal deviation?
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-Mediastinal tumors
-Goiter |
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What condition is assoc. w/ a "pushed anterior" tracheal deviation?
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Mediastinitis
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What level would you perform post. chest expansion and what result would you expect?
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-T10
- (3-4) cm |
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What level would you perform ant. chest expansion and what results would you expect?
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Upper Lobe = Ribs 2/3 & 1-2 cm
Lower Lobe = Ribs 5/6 & 2-3 cm |
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Which conditions will cause diaphragmatic excursion to be absent?
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-Inflammation of diaphragm or viscera below
-Phrenic nerve palsy |
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Which adventitious lung sound results from a series of tiny explosions when small airways, deflated during expiration, pop open during inspiration or from air bubbles flowing thru secretions or lightly closed airways during respiration?
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Crackles
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What position is a mediastinal crunch best heard?
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Left lateral position
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What is a mediastinal crunch due to?
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Mediastinal emphysema (pneumomediastinum)
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Describe thoracic kyphoscoliosis
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-Abnormal spinal curvatures and vertebral rotation deform chest
-Distortion of lungs may make interpretation of lung findings difficult |
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Describe traumatic flail chest
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-Multiple flail chest (rib fractures)
-Paradoxical movements of chest -Inspiration injured areas cave inward -Expiration moves outward |
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Describe pigeon chest
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-AKA Pectus Carinatum
-Sternum displaced anterior, Increase A-P diameter -Costal cartilage adjacent to sternum are depressed |
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Describe barrel chest
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Increase A-P diameter, which is normal during infancy, often accompanies aging and COPD
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Describe funnel chest
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-AKA Pectus Excavatum
-Depressed lower sternum -Compression of heart & great vessels may cause murmurs |
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Describe normal adult thorax
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Wider lateral diamter than A-P
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In what chest disorders do you find tracheal deviation?
How does it shift? |
-Atelectasis - towards involved side
-Pleural effusion - towards opposite side -Pneumothorax - towards opposite side |
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What breath sounds are normal?
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-Vesicular
-Bronchovesicular over large bronchi -bronchial over trachea -no adventitious sounds |
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What breath sounds would you find in a pt w/ atelactasis?
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-Usually absent, exception is w/ Rt upper lobe where tracheal sounds transmitted
-Adventitious : none |
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Describe 3 retraction signs
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1. Abnormal contours - variation in normal convexity of each breast
2. Skin dimpling - look for this in pts w/ arm @ rest during compression of breast 3. Nipple retraction & deviation - flattened or pulled inward, broadened/thickened, googley eyed nipple. Points toward center |
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What is Paget's ds of the nipple?
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-Uncommon form of breast cancer
-Starts as scaly eczema-like lesion that may weep, crust or erode |
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Peau d'orange sign
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-Edema of skin produced by lymphatic blockade
-Thickened skin w/ enlarged pores -1st seen in lower portion of breast |
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Common Breast Masses
Cysts |
Age: 30-50
#: Single or multiple Shape: round Consistency: Soft to firm, elastic Delin: Well delineated Mobility: mobile Tender: often Retraction sign: absent |
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Common Breast Masses
Cancer |
Age: 30-90
#: usually single Shape: Irregular or stellate Consist.: Firm or hard Delin.: Not clearly delineated Mobility: fixed to skin or underlying tissue Tender: usually nontender Retraction sign: may be present |
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What are 2 causes of late inspiratory crackles?
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-Interstitial lung ds (consolidation)
-Early CHF |
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What breath sounds would you auscultate in a pt w/ consolidation?
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-Bronchial over involved areas
-Adventitious: late inspiration crackles over involved area |
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What breath sounds are heard w/ chronic bronchitis?
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-Vesicular
-Adventitious: none or scattered coarse crackles in early inspiration. Wheezes or Rhonchi |
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What breath sounds would expect to hear w/ early Left-sided HF?
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-Vesicular
-Adventitious: late inspiratory crackles in dependent portions of lung |
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What are the visible signs of breast cancer?
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-Retraction signs
-Edema of skin -Paget's ds of nipple |
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What is the landmark for a thoracentesis?
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-T7-8 Interspace
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Using landmarks, describe where the lower border of the lungs are (anteriorly & posteriorly)
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-Ant.: crosses 6th rib @ midclvicular line & 8th rib @ midaxillary line
-Post.: about T10 SP |
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Where is the lower margin of endotracheal tube is seen on x-ray
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T4
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Common Breast Masses
Fibroadenoma |
Age: 15-25
#: usually single, may be multiple Shape: Round, dislike or lobular Consis.: May be soft, usually firm Delin.: Well delineated Mobility: Very mobile Tender: Usually non-tender |
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Ataxic (Biot's) Breathing
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-Unpredictable irregularity
-Respiratory depression & brain damage typically @ medullary level |
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Kussmaul breathing
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Deep breathing due to metabolic acidosis. It may be fast, normal, or slow
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What breath sounds are found w/ pleural effusion?
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-Decreased to absent
-Adventitious: none, possible pleural rub |
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This is a series of precordial crackles synchronous w/ the heart beat, not w/ the respiration?
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-Mediastinal crunch
(Hamman's sign) |
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What breath sounds are heard in a pt w/ COPD?
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-Decreased to absent
-Adventitious: non or crackles. Wheezes or Rhonchi |
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What landmarks are used to determine where to insert the needle for....
1) Tension pneumothorax 2) Chest tube |
1) 2nd intercostal space
2) 4th intercostal space |
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What breath sounds are heard in a pt w/ asthma?
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-Often obscured by wheezes
-Adventitious sounds: Wheezes, possibly crackles |
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What breath sounds may be heard w/ pneumothorax?
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-Decreased to absent
-Adventitious: non, possible pleural rub |
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What does persistent localized wheezing suggest?
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Partial obstruction of a bronchus
(tumor or foreign body) |
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Silent chest is assoc. w/ what ds?
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Severe obstructive pulmonary ds
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Is a rub usually confined to a relatively small or large area?
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Small area
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A wheeze that is entirely or predominately inspiratory is called?
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Stridor
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Where is stridor the loudest?
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The neck
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What does stridor indicate?
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Partial obstruction of larynx or trachea
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List 4 causes of Wheezes
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-Asthma
-Chronic bronchitis -COPD -CHF |
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______ suggest secretion in the larger airways
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Rhonchi
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What type of crackle begins in 1st half of inspiration, but must continue into late INspiration?
They are usually fin, fairly profuse, and persist breath to breath. |
Late inspiratory crackle
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Which type of adventitious lung sound appears and ends soon after the start of inspiration?
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Early inspiratory crackles
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What are 2 causes of early inspiratory crackles?
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-Chronic Bronchitis
-Asthma |
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Which adventitious lung sound occurs when air flows rapidly through bronchi that are narrowed nearly to the point of closure?
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Wheezes
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