physical diagnosis > pulmonary > Flashcards

pulmonary Flashcards

(57 cards)

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1
Q

kyphoscloliosis

A

can lead to cor pulmonale and portal HTN

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2
Q

horizontal sloped ribs in…

A

obstructive lung diseases (emphysema, COPD, chronic bronchitis, status asthmaticus)

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3
Q

beading of costochondral joints in…

A

rickets! (rachitic rosary)

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4
Q

Hoover’s sign

A

COPD, flattened diaphragm on inspiration, more acute subcostal angle

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5
Q

pectus excavatum

A

sunken, funnel chest

due to Marfan’s, Rickets, Noonans

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6
Q

accessory muscles of breathing

A

inspiration: SCM, scalenes
expiration: abdominal muscles
- if clavicle moves up >5mm=severe obstructive lung disease
- inspiratory retraction of suprasternal and supraclavicular fossa

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7
Q

Cheyne-stokes breathing

A
  • progressively deeper and faster breathing until temporary stop (apnea)
  • due to damage to respiratory centers in brain or heart failure, high altitude
  • poor prognosis
  • swings in cerebral blood flow (swing between alert/agitated and sleepy/slow)
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8
Q

Biot’s breathing

A

groups of quick shallow inspiration followed by period of apnea

  • brainstem damage
  • opiod use
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9
Q

kussmaul breathing

A

deep labored breathing assoc. w/ severe metabolic acidosis (eg. DKA)

DDX: MAKEUPL (Methanol, Aspirin, Ketones, Ethylene glycol, Uremia, Paraldehyde, Lactic Acidosis)

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10
Q

paradoxical respiration

A
  • all or part of lung is deflated during inhalation and inflated during exhalation
  • due to flail chest (rib fractures)
  • diaphragm paralysis
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11
Q

expiratory bulging of intercostal spaces

A

if focal–>pneumothorax

if diffuse–>obstructive disease

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12
Q

tirage breathing

A

inspiratory retraction of intercostal spaces seen w/ focal obstruction

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13
Q

cyanosis

A

ineffective ventilation

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14
Q

pallor, diaphoresis, agitation

A

ineffective oxygenation

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15
Q

symptoms of SVC syndrome

A

shortness of breath, arm or face swelling

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16
Q

Dahl’s sign

A

COPD patients lean forward and rest on knees to breath, calluses above knees

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17
Q

ipsilateral deviation of trachea

A

atelectasis

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18
Q

contralateral deviation of trachea

A

pneumothorax, large pleural effusion

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19
Q

axial fixation of trachea

A

tumor or mediastinal fibrosis

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20
Q

oliver’s sign

A

systolic “tug” seen w/ aortic aneurysm, synchronous with each heart beat

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21
Q

campbell’s sign

A

tracheal descent with inspiration, due to chronic airflow obstruction, seen w. COPD

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22
Q

costochondritis

A

tietze’s syndrome

inflammation of costal cartilage

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23
Q

sternal pain

Study These Flashcards
A

CML or arthritis

24
Q

What is tactile fremitus? What happens in pneumonia?

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A
  • compare sides when patient says “eee” or “99”
  • alveolar pneumonia: inc. fremitus
  • bronchopneumonia: dec. fremitus
25
percussion in patients with emphysema, status asthmaticus, or COPD
hyperresonant - lower pitch - louder intensity
26
percussion in patients with pleural effusion
- flat - very high pitch - soft intensity
27
late inspiratory crackles seen with...
- pulmonary fibrosis--will have vesicular breathing - consolidation (pneumonia, hemorrhage)--will have bronchial breathing - asbestosis, sarcoidosis, granulomatous d/o
28
mid-inspiratory crackles seen with...
bronchiectasis
29
early inspiratory crackles seen with
bronchitis
30
What breath sounds will I have if I have a solid consolidation (pleural effusion)?
top: vesicular b/c no fluid middle: bronchial sound bottom: no sound b/t alveoli totally collapsed
31
stridor
inspiratory wheeze
32
vocal cord dysfunction
expiratory wheeze; louder over the neck than the lungs
33
asthma
wheeze (expiratory alone or insp+exp) length of wheeze determines severity of asthma (if both inspiratory and expiratory this is bad) -asthmatics in impending respiratory failure don't wheeze b/c too weak to generate airflow
34
cardiac asthma
wheezing in the presence of LV failure (due to interstitial edema)
35
rhonchi
- early expiratory, over vesicular breathin - air flow through narrow airway, due to inspissated secretions (obstructive lung disease) - if localized and persistent, worry about endobronchial neoplasm
36
pleural friction rub
- imposed on underlying vesicular breath sound 1. bacterial pneumonias 2. collagen vascular diseases 3. pulmonary infarcts
37
4 reasons why rubs are not crackles
1. rubs are both insp and exp (crackles just insp) 2. rubs dont' clear with coughing (crackles do!) 3. rubs are localized over chest (crackles are bilateral) 4. rubs are palpable (crackles are not)
38
tachypnea
RR>25 - bad prognosis in hospitalized pts - more valuable if absent-->if absent not PE (90% patients with PE have tachy)
39
bradypnea
RR<8 - tiring/hypothyroidism - stroke/CNS depression - narcotics/sedatives
40
grunting respiration
1. Rale de la mort: preterminal grunting/gurgling by patients too ill to clear respiratory secretions 2. kids: forced expiration against a closed glottis
41
pursed lip breathing
emphysema - improves tidal volume - slows RR - dec. dyspnea - overall dec. work of breathing
42
orthopnea
- dyspnea that is relieved by sitting upright and aggravated by lying flat 1. CHF 2. massive ascites 3. COPD/asthma (improves vital capacity and lung compliance) 4. bullous bi-apical lung disease (keeps perfusion in lower lobes) 5. pleural effusion, pneumonia, diaphragmatic paralysis (fluid in lungs)
43
pickwickian syndrome
obesity hypoventilation
44
paroxysmal nocturnal dyspnea
dyspnea relieved by lying down and aggravated in erect position - assoc. w/ orthodeoxia: Hb desaturation from upright posture - R-->L shunt (intracardiac=ASD or intrapulmonary=bi-basilar disease, PE, pneumonia, effusion) - cirrhotics (AV shunting at lung bases)
45
trepopnea
- preference for lateral decubitus position - down with the good lung-->unilateral lung collapse - down with the bad lung-->lung filled with fluid or if you're a kid with unilateral lung disease
46
abdominal paradox breathing
rocking motion of chest and abdomen due to paralysis or weakening of diaphragm -predicts respiratory failure
47
respiratory alternans
alternate use if diaphragm or intercostal mm - rock in one direction then switch to antoher - predicts respiratory failure
48
still abdomen
diffuse: generalized peritonitis localize to LLQ: focal diverticulitis localized to RLQ: appendicitis
49
clubbing
- focal enlargement of CT in ends of fingers and toes - never painful - diagnostic features: loss of lovibond's angle, floating nails (inc. sponginess of nailbed), abnormal phalangeal depth ratio Causes: - underlying respiratory d/o (chronic bronchitis but NOT emphysema) - GI (cirrhosis, IBD, cancer) - Cardiac (endocarditis, congential heart disease) - pregnancy
50
hypertrophic osteoarthropathy
- painful and tender periosteal new bone proliferation, often assoc w/ clubbing - intrathoracic neoplasm (lymphoma, mesothelioma, metastatic cancer) - non-neoplastic pulmonary d/o (CF, bronchiectasis, empyema, abscess)
51
pink puffer
thin, uses accessory mm, no clubbing | emphysema
52
blue bloater
stocky, pulmonary HTN, coughs up stuff, clubbing chronic bronchitis -inc. breath sounds at mouth but dec over chest -chest can be noisy (early crackles, rhonchi, wheezes) but most clears with coughing
53
bibasilar fine late crackles with no clinical signs of pulmonary disease are considered a sign of...
heart failure | posturally induced crackles: PIS have prognostic significance
54
patient presents with cough, fever, sputum and dyspnea
Pneumonia - paplation: inc. tactile fremitus - percussion: dull - ausculatation: bronchial breath sounds, late insp. crackles adn egophony - diminished breath sounds indicate concomitant pleural effusion - poor prognosis: hypothermia, and hypotension - good prognosis: improved BP and fever, dec. HR, dec RR
55
wheeze
length of wheeze correlates wtih severity (not intensity) -can be expiratory or insp+exp (not just insp=stridor) -
56
pulmonary embolism
- tachycardia - tachypnea - peripheral crackles - pleural friction rub - distended neck veins (if massive PE!)
57
transmitted voice sounds
1. bronchophony (voice sounds heard over chest in areas remote from bronchi or layrnx) 2. pectorlioquy (clear words heard over chest) 3. egophony (bleating and goatlike sounds heard over areas of consolidation) 4. E-to-A changes * indicate that lung parenchyma has become airless and consolidated (bronchi must be open)
physical diagnosis
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