Phys Di II
Exam I Questions
1. What are the symptoms of respiratory disease?
Cyanosis, wheezing, hemoptysis, sputum production, stridor, voice changes, cough,
dyspnea and chest pain Also anasarca and swelling of ankles.
2.
3.
4.
5.
When should a respiratory exam be performed?
As part of a complete physical exam, abnormal rate, rhythm or depth of respiration. Patient complains of SOB.
List some risk factors for the development of respiratory diseases.
Smoking
Family history of COPD
Incidence of recurrent respiratory infections
> incidence in men, difference between sexes diminishes with age
Employment - exposure to asbestos, etc.
Hobbies
Sedimentary lifestyle
Group A beta-hemolytic strep
List 6 causes of coughing with a differential between these conditions.
Dry, hacking - viral infection, tumor, allergies, stress
Chronic productive- bronchiectasis, TB, chronic bronchitis or bacterial pneumonia
Wheezing - bronchospasm, asthma, allergy, cysticfibrosis
Barking - croup - Gram (+) bacteria
Stridor - tracheal obstruction
Morning cough - smoking, chronic bronchitis
Nocturnal cough - CHF, post-nasal drip, gastro-esophageal reflux
List 6 causes of sputum production and differentiate the disorders.
Mucoid - tumor, asthma, TB, emphysema
Mucopurulent - tumor, pneumonia, asthma, TB, emphysema
Purulent & rusty - bacterial pneumonia
Purulent & yellow-green - chronic bronchitis, bronchiectasis, TB, pneumonia
Pink &frothy -pulmonary edema
6. How is hemoptysis different than hemetemesis?
Hemoptysis is blood that is coughed up and originates from lungs. It often has a
frothy appearance. Hemetemesis is blood coughed up and originates from
the stomach.
7. Provide a differential for chest pain. What respiratory conditions are associated with chest pain?
Chest pain is a cardinal symptom of cardiac disease. Also consider pulmonary
disease, thoracic NMS disease or pleuritis. See table 2-3.
8. How does paroxysmal nocturnal dyspnea differ from orthopnea?
Paroxysmal nocturnal dyspnea is a sudden onset of SOB that occurs at night.
Usually presents as a feeling of heaviness on the chest - pt will often run to the window to catch their breath. Orthopnea is
discomfort on breathing while prone.
Usually relieved by propping pt up with several pillows.
9. In suspected respiratory system disease, where would you look for cyanosis?
What kind of cyanosis is this, and what other features might be associated?
You would look for bluish ring around lips and in nailbeds, the major findings in central cyanosis.
Associated symptoms include dyspnea, cough & bleeding.
Peripheral cyanosis will be noted in fingertips, toes and extremities.
10.
What are the features of clubbing?
In clubbing, the distal phalanx of each finger is rounded & bulbous. The angle between the plate and the proximal nailfold
increases to 180o or more. The nail old, on palpation, feel spongy or floating. This is indicative of intrathoracic tumor,
heart malformation, chronic pulmonary disease in children or chronic liver failure.
11. How would you distinguish between a normal chest and a barrel-shaped chest?
A barrel chest is a common result in old age or COPD. The anteroposterior diameter of the chest in increased.
12. How would you distinguish. between a normal chest and a pigeon-shaped chest?
Often seen in children with chronic-type asthma. The sternum is displaced anteriorly, increasing the anteroposterior
diameter. The costal cartilages adjacent to the protruding sternum are depressed.
13. How would you distinguish between a normal chest and a funnel shaped chest?
Often congenital abnormal chest the thorax is wider than it is deep. A funnel chest is characterized by a depression in the
lower portion of the sternum, leading to compression of the heart and great vessels, sometimes causing heart murmurs,
14.
What is the normal respiratory rate?
Should be 12-20 breaths per minute (14-20 per Bates) in adults. Infants respiration
is up to 44 beats/ min, and newborns up to 80 beats/minute.
15. What is the breathing pattern in a normal adult male?
Abdominal muscle breathing
16. What is the breathing pattern in a normal adult female?
Diaphragmatic - leads to less capacity
17. What is the breathing pattern in a normal child?
Abdominal muscle breathing
18. How would you recognize paradoxical breathing?
"flailed Chest" sucks in during inspiration and pushes out during expiration
In which condition does it occur? May see after an accident.
With multiple fractures of the ribs, Trauma
19. How would you recognize Cheney-Stokes breathing? In which condition does it occur?
It is recognized by a crescendo (elevation, depression, apnea). Seen in children and elderly in their sleep.
Classic sign for heart failure, uremia and respiratory or drug-induced depression.
20. How do you recognize Kussmal's breathing? In which condition does it occur?
Usually very noisy, though not a true wheeze. Rapid Deep Breathing.
Seen in metabolic acidosis, Uremic Acidosis, infection, exercise, anxiety and hypoxia.
20. How would you recognize sterturous breathing? In which condition does it occur?
It is bubbly breathing.
22. How do you recognize Stridor? In which condition does it occur?
Stridor is a harsh sound usually occurring on inspiration. Usually signifies a tracheal obstruction, and demands immediate
attention. If both inspiratory & expiratory it is an extremely dangerous sign.
23.
How do you recognize wheezing? In which condition does it occur?
Wheezing is due to rapid airflow through narrowed bronchi. Wheezing suggests asthma, chronic bronchitis, COPD, or
congestive heart failure. Persistent localized wheeze may indicate a foreign body or tumor.
24. How do you locate any tender areas over the chest?
By palpation & percussion, using the across and down method
25. How do you find chest expansion over the upper lung, lower lung and apices of the lung?
Upper lobe should have symmetrical motion above the nipples, 1-2 cm, between rib 2&3.
Lower lobe below nipples moves -2-3cm, between rib 5&6.
Normal lateral movement is 3-4cm at T10.
26. What conditions cause the trachea to pull to the same side? To push to the opposite side?
Trachea is pulled to the same side in atelectasis or fibrosis, pushed to the opposite side by thyroid enlargement, tumor,
pleural effusion or pneumothorax.
27. What conditions affect tactile fremitus?
Fremitus is increased by consolidation of the lung such as lobar pneumonia or atelectasis.
Fremitus is decreased or absent in COPD, pleural effusion, obstructed bronchi, fibrosis or pneumothorax.
28. What are the five types of percussion notes?
Over what normal viscera is the percussion note tympanic?
Over what normal viscera is the percussion note dull?
Over what normal viscera is the percussion note hyperresonant?
Flatness
Dullness
Resonance
Hyperresonances
Tympany
large pleural effussions
lobular pneumonia
Bronchitis or deep seated tumor
asthma, emphysema,small pneumothorax,
pulls trachea to same side
Large pneumothorax
pushes trachea away
thigh
heart & liver
lung
no normal tissue
puffed out cheek, stomach,
intestines
29. How would you find diaphragmatic excursion? What is normal excursion?
It is located by percussion - locate the transition between the normal lung resonance
and the dullness of the subdiaphragmatic viscera while pt exhales and holds his
breath. Then have pt inhale, and percuss for downward motion of diaphragm. The
difference in these two measurements is the excursion, normally 4-6 cm between full
inspiration and full expiration.
30. In a normal adult, where would you hear vesicular breath sounds?
Normally over most of both lungs. Inspiratory sounds are longer than expiratory
- 3:1 Insp/Exsp ratio is normal
31. In a normal adult, where would you hear bronchial breath sounds?
Over the inferior trachea & manubrium, if at all. Expiratory sounds last longer than inspiratory @ a ratio of
1:3.
32. In a normal adult where would you hear bronchovesicular breath sounds?
Often appreciated in the 1st and 2nd interspaces anteriorly and between the scapulae posteriorly.
33. How would you distinguish between vesicular and bronchial breath sounds?
Vesicular are longer in inspiration with a low pitched gentle rustling sound, bronchial are longer in expiration with
a harsh intensity.
34. What are adventitious (added) lung sounds, and when do you hear them?
These are sounds that are superimposed on normal sounds.
Crackles(rales): heard when the fluid pressure around the alveoli is greater than normal so it takes more
inspiration to open them and when they do open it is with a little pop (Example: congestive heart failure; allergies;
interstitial lung Di; pneumonia; obstructive lung dx),
wheezes & ronchi: rapid oscillation of airway wall, has a continuous musical sound (Examples: asthma;
emphysema; chronic bronchitis; late stage heart failure),
stridor: ?
pleural friction rub: is heard on insp & exsp, sounds abrasive (Example: Pleural effusion; pneumothorax;
empyema; hemoema.) When present, note if they are early or late inspiration.
NOTE: Mediastinal Crunch = crackles or grating sound in the pericardium differentiated from parietal sounds by
having the pt. hold their breath / if sound is still there it is not the lung.
35. Explain broncophony, egophony and whispered pectoriloquy.
All are transmitted voice sounds.
Broncophony - increased clarity & loudness of bronchial sounds over the area (from consolidation)
Egophony - "e " sounds like "a" (consolidation)
Whispered pectoriloquy - whispered sounds are louder & clearer
36. What are the physical signs in :
Chronic bronchitis - chronic cough that lasts for at least two months of two
consecutive years
Consolidation - "the triad of ausculatory sounds of consolidation" : 1)Bronchial Breath Sounds; 2)Bronchophony;
3)Whispered Pectoriloquy