Respiratory Physical Exam

Front 1

general steps of PE and exception

Back 1

Inspection Palpation Percussion Auscultation Special Maneuvers Special Tests/Signs exception - abdomin - auscultate before percuss

Front 2

inspection

Back 2

pt sitting in gown - start anterior move posterior Observe: breathing rate (normal 12 - 20 br/min) and pattern Observe: deformities- asymmetry or abnormal movements of thorax

Front 3

type of abnormal breathing Causes include diabetic coma- drugs- and „´ intracranial pressure

Back 3

bradypnea

Front 4

type of abnormal breathing Causes include restrictive lung disease- pleuritic pain- and an elevated diaphragm

Back 4

tachypnea - rapid shallow breathing

Front 5

type of abnormal breathing Causes include exertion- anxiety- metabolic acidosis (Kussmaul)

Back 5

hyperpnea or hyperventalation

Front 6

Periods of deep breathing alternating with periods of apnea (absence of breathing)

Back 6

Cheyne-Stokes Breathing

Front 7

What type of breathing? Causes include heart failure- uremia- respiratory depression from drugs- or extensive brain damage

Back 7

Cheyne-Stokes Breathing

Front 8

Prolonged expiratory phase due to narrowed airways

Back 8

Obstructive Breathing

Front 9

What type of breathing? Causes include asthma or COPD (Chronic Bronchitis or Emphysema)

Back 9

Obstructive Breathing

Front 10

depression in lower portion of sternum. compression of the heard and great vessels may cause murmurs

Back 10

funnel chest ( pectus excavatum)

Front 11

inc anterior postior diameter - normal in infancy and seen with normal aging and chronic obstructive pulmonary diseases

Back 11

barrel chest

Front 12

sternum is displaced anteriorly - inreasing the AP diameter. The costal cartilages adjacent to the protruding sternum are depressed

Back 12

pigeon chest (pectus cavinatum)

Front 13

multiple rib fractures may result in pardoxical movements of thorax. as descent of diagphram decreases intrathroacic pressure - on inspiration the injured area caves inward - on expiration it moves outward

Back 13

traumatic fall chest

Front 14

abnormal spinal curvature and vertebral rotation deform the chest. distortion of underlying lung may make interperation of lung findings very difficult

Back 14

throacic kyphoscollosis

Front 15

palpatation

Back 15

pt sitting with gown so posterior chest exposed 1. palpate trachea - note position and any tenderness 2. palpate chest - note tenderness/mass also place thumbs on post chest wall to assess equal chest expansion 3. palpate for tectile fremitus using ulnar surface of had on post chest wall asking pt to say "99"

Front 16

what is the abnormal finding of palpation of chest wall? Causes include chronic fibrosis of the lung or pleura -pleural effusion -lobar pneumonia -pain and splinting due to pleurisy -unilateral bronchial obstruction

Back 16

Unilateral decreased chest expansion

Front 17

what is the abnormal finding of palpation of chest wall? Causes include -obstructed bronchus -COPD -pleural effusion -pleural thickening -pneumothorax -infiltrating tumor -or a very thick chest wall

Back 17

Decreased or absent fremitus

Front 18

percussion of lung and thorax

Back 18

ladder pattern of sites on the posterior chest for percussion and auscultation to diaphragm

Front 19

normal finding for percussion of chest

Back 19

resonant sound

Front 20

sound heard when percussion of chest when fluid or solid tissue replaces air-containing lung

Back 20

dull or flat

Front 21

what disease states should come to mind when dull or flat sound heard when percussion of chest

Back 21

-lobar pneumonia -pleural effusion (serous fluid in the pleural space) -hemothorax (blood in the pleural space) -empyema (pus in the pleural space) -fibrous tissue or tumor

Front 22

sound heard when percussion of chest when hyperinflated lungs

Back 22

hyperresonant or typmpanic sound

Front 23

diseases associated with hyperresonant or tympanic sounds heard when percussiong the chest

Back 23

-emphysema or asthma -or if unilateral - pneumothorax

Front 24

Noted on percussion with atelectasis or diaphragmatic paralysis

Back 24

Elevated level of diaphragmatic dullness

Front 25

Noted on percussion with hyperinflated lungs (emphysema or asthma)

Back 25

Depressed or lowered diaphragms

Front 26

Can be caused by paralysis of the diaphragm or by emphysema

Back 26

Decreased diaphragmatic excursion

Front 27

auscultation of lung and thorax

Back 27

-use ladder patter of sites on post chest -ask pt to breath in and out deeply through mouth

Front 28

Which normal Findings on Auscultation of the Chest? Soft low-pitched sounds heard throughout inspiration and the first third of expiration over most of the lung fields

Back 28

Vesicular

Front 29

Which normal Findings on Auscultation of the Chest? Louder higher-pitched sounds of air rushing through a tube during inspiration and expiration with a short gap. Normally heard over the manubrium

Back 29

Bronchial

Front 30

Which normal Findings on Auscultation of the Chest? A mixture of the other two normal sounds heard in the areas of the smaller bronchi

Back 30

Bronchovesicular

Front 31

Which normal Findings on Auscultation of the Chest? Very loud sounds over the this part of airway

Back 31

Tracheal

Front 32

Which abnormal Findings on Auscultation of the Chest? Caused by -pneumonia -fibrosis -early CHF -bronchitis -or bronchiectasis

Back 32

Crackles (Rales)

Front 33

Which abnormal Findings on Auscultation of the Chest? Caused by narrowed airways due to -asthma -COPD -or bronchitis

Back 33

Wheezes

Front 34

Which abnormal Findings on Auscultation of the Chest? Suggest secretions in large airways in conditions such as pneumonia

Back 34

Rhonchi

Front 35

Patient whispers “ninety-nine”—Hearing louder clearer words („´ transmission) indicates airless area of lung as in lobar pneumonia

Back 35

Whispered Pectoriloquy

Front 36

Patient say “ee”—sounds like “ay”

Back 36

Egopony

Front 37

Patient says “ninetynine”— If sounds are loud and clear rather than expected muffled and indistinct

Back 37

Bronchophony

Front 38

Examination of the Anterior Chest

Back 38

inspection - palpatation - percussion - auscultation