PE & Hx

Question 1

Define dyspnea

Answer 1

Uncomfortable, abnormal awareness of breathing (breathless, tachypnic, increased RR tripod )

Question 2

What are rales when are they heard

Answer 2

Aka crackles - discontinuous sounds made by airways snapping open during inspiration

Question 3

What are the 2 types of crackles generated by

Answer 3

• Course: lower pitched, from larger airways
• Fine: higher pitched, from smaller airways

Question 4

Define a wheeze and when it’s heard

Answer 4

• Shrill whistle or course rattle from fluttering vibrations of narrow airways
• both inspiratory and expiratory

Question 5

Define the two types of wheezes and where the sound comes from

Answer 5

• rhonchi: upper larger airways, low pitch
• wheeze: lower, smaller airways high pitch

Question 6

Define stridor

Answer 6

High pitch inspiratory sound due to turbulent in airflow the upper airway (worry!)

Question 7

Define the classifications of a cough by duration

Answer 7

• acute: less than 3 weeks, think infectious vs noninfectious
• subacute: 3-8 weeks, think post-infectious
• chronic: 8+ weeks, think upper airway cough syndrome, asthma, GERD

Question 8

Define hemoptysis

Answer 8

expectoration of blood originating from the lower respiratory tract
- frothy/foamy pink/bright red sputum

(pseudohemoptysis = from GI or upper respiratory tract)

Question 8

Describe the blood supply to the lungs

Answer 8

largely from pulmonary arteries with small amount from bronchial arteries
- pulm = low pressure system (R heart)
- bronch = high pressure system (L heart)

Question 9

Define the ILPPAS acronym for PE (i love pulmonary PAs)

Answer 9

I = inspection
L = listen
P = palpation
P = percussion
A = auscultation
S = special tests

Question 10

Define tactile fremitus

Answer 10

vibration of the chest wall that results from sound vibrations created by speech/vocal sounds

(air is a poor conductor of lower sounds, solids/dense mediums increase transmission of sounds)

Question 11

Describe the 3 auscultatory special tests

Answer 11

• broncophony - pt says 99 (muffled in healthy, clear in pathology)
• egophony - pt says Eeee (E in healthy, A in pathology)
• whispered pectoriloquy - pt whispers 1-2-3 (unheard in healthy, clearer in pathology)