Pulm - Physical Exam Of The Respiratory System

Front 1

Normal breathing rate

Back 1

20 + or - 5 per minute

Front 2

Bradypnea

Back 2

Respiratory rate < 8 breaths per minute.

Can be due to hypothyroidism, CNS depression, or narcotics/sedatives.

Front 3

Tachypnea

Back 3

Respiratory rate > 25 breaths per minute.

Moderate to severe cardio-respiratory distress. Its absence makes pulmonary embolism less likely. Argues in favor of pneumonia, both for in- and outpatients. In case of pneumonia can predict death and is an overall bad prognosis in hospitalized patients. Predicts failure to wean from ventilator. In acute abdomen argues for an intrathoracic cause. Does not necessarily predict hypoxemia.

Front 4

Cheyne-Stokes respiration

Back 4

Also known as periodic breathing, is an abnormal pattern of breathing characterized by oscillation of ventilation between apnea and tachypnea with a crescendo-decrescendo pattern in the depth of respirations, to compensate for changing serum partial pressures of oxygen and carbon dioxide.

May be seen in normal people as a result of aging or sleep. Can be seen when moving to high altitudes. Usually reflects either cardiac or CNS disorders. May require administration of Oxygen. Carries a poor prognosis .

Front 5

Kussmaul's respiration

Back 5

Rapid and deep breathing. Often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure.

Possible reasons are methanol, aspirin, ketones, ethylene glycol, uremia, paraldehyde, and lactic acidosis (MAKE UP L).

Front 6

Hypopnea

Back 6

Shallow breathing; suggests impending respiratory failure

Front 7

Pickwickian syndrome

Back 7

A condition in which severely overweight people fail to breathe rapidly enough or deeply enough, resulting in low blood oxygen levels and high blood carbon dioxide (CO2) levels.

Front 8

Apnea

Back 8

Absence of breathing; 20 seconds while awake or 30 seconds while asleep.

Usually seen in patients with either an obstructive or central process.

Front 9

Orthopnea

Back 9

Breathing erect

Commonly seen in congestive heart failure, ascites, pulmonary diseases, pleural effusion, pneumonia, and diaphragmatic paralysis. If found in an asthmatic, usually leads to hospital admission.

Front 10

Paroxysmal nocturnal dyspnea

Back 10

Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. Commonly seen in congestive heart failure and pulmonary diseases with bi-apical bullae.

Front 11

Platypnea

Back 11

Shortness of breath while standing which is relieved by lying down. Due to a right to left shunt. Causes can be ASD with pulmonary HTN, cirrhosis, and bi-basilar processes.

Front 12

Osler-Weber-Rendu disease

Back 12

Hereditary haemorrhagic telangiectasia

Must have 3 of the following 4 for a diagnosis: Epistaxis, telangiectasias, visceral AVMs, and family history.

Front 13

Trepopnea

Back 13

Patient breath better lying in lateral decubitus position than on stomach or back. Usually seen in unilateral lung disease with the good lung down. Found in collapsed lungs or massive effusions.

Front 14

Accessory respiratory muscles

Back 14

Recruitable if diaphragm is insufficient for breathing. Muscles include scaleni, trapezius, and SCM. Use in > 70% of patients hospitalized with COPD. SCM may lift the clavicals and first ribs. COPD patients may also use accessory muscles of expiration (usually a passive process).

Front 15

Dahl's sign

Back 15

Hyperpigmentation seen on the skin of lower thigs and elbows. It occurs in patients with longstanding severe chronic obstructive pulmonary disease.

Due to lung's tripod.

Front 16

Hoover's sign

Back 16

Inward movement of the lower ribcage during inspiration, implying a flat, but functioning diaphragm. Associated with COPD.

Front 17

FETo maneuver

Back 17

To measure the FETo place the bell of the stethoscope on the suprasternal notch, and then ask the patient to exhale forcefully. All breath sounds should stop within 5 seconds. Continued breath sounds points to obstructive lung disease.

FETo > 6 seconds suggests FEV1/FVC < 40%

FETo < 5 seconds suggests FEV1/FVC > 60%

Front 18

Clubbing

Back 18

4/5 patients will have underlying respiratory disorder, usually inflammatory or neoplastic. The rest have cardiac or GI conditions, w/ shunt or chronic inflammation. Seen in hypercapnic conditions (due to embolism of megakaryocytes), not emphysema.

Front 19

Hypertrophic osteoarthropathy

Back 19

Systemic disorder of bones, joints, and soft tissue. Hallmark is painful and tender periosteal new bone proliferation, usually associated with clubbing. Many also occur in non-neoplastic pulmonary disorders, such as cystic fibrosis, bronchiectasis, empyema, and lung absesses.

Front 20

Breath sounds in asthma

Back 20

There is decreased breath sound intensity and increased pitch with airway narrowing (precedes wheezing). Wheezing is the least discriminating factor in predicting hospital admission or relapse. Wheezing is absent in 30% of patients with FEV1 < 1 L.

The length of wheezing, however, is indicative of the severity of the airflow obstruction.

Front 21

Cardiac asthma

Back 21

Asthma in patients with left ventricular failure.

Front 22

Crackles

Back 22

Early - large central airways; low pitched and coarse

Mid - medium airways; bronchiectasis

Late - peripheral airways; fluid or scaring in the interstitium

May be present in healthy individuals at the end of a deep breath.

Front 23

Crackles in heart failure

Back 23

Basilar, high pitched, and late inspiratory. Variable if posturally induced. Indicative of a worse prognosis.

Front 24

Crackles in pulmonary fibrosis

Back 24

Common in idiopathic fibrosis and asbestosis; uncommon in sarcoidosis.