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Duke PA Pulmonology History, Physical, Exam

Most common acute cause of cough in non-smoker Viral infections
Cough due to acute respiratory tract infections resolves within _______ weeks in the vast majority of patients. 3
Persistant cough accompanied by excessive mucus secretions increases the liklihood of _____ COPD
what is suspected when acute cough is accompanied by vital sign abnormalities (tachycardia, tachypnea, fever) Pneumonia
Rales, decreased breath sounds, fremitus, and egophany are findings suggestive of what air space consolidation
Rales, decreased breath sounds, fremitus, and egophany are findings suggestive of what Community aquired pneumonia
Wheezing and rhonchi are suggestive of what in the abscence of asthma acute bronchitis
normal jugular venous pressure and negative hepatojugular reflux decrease the liklihood of what biventricular CHF
Get a chest radiograph if you suspect what pneumonia
The most likely causes of cough with a clear chest x-ray and the abscence of ACEI's postnasal drip, asthma, GERD
The perception of uncomfortable breathing Dyspnea
Rapid onset, severe dyspnea in the abscence of other clinical features should raise the suspicion for pneumothorax, pulmonary embolism, or increased left ventricular end-diastolic pressure
Is accompanied by chest pain and occurs mainly in young, thin adult males Spontaneous pneumothorax
Most patients with pleuritic chest pain in the outpatient clinic have pleurisy due to acute viral respiratory tract infection
Most cases of dyspnea with wheezing are due to Acute bronchitis
pursed lip breathing, use of extra respiratory muscles and barrel shaped chest are indicative of obstructive airway disease
asymmetric excursion pneumothorax
metabolic acidosis Kussmaul respirations
breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, slow, labored and gasping Kussmaul respirations
Focal wheezing raises suspicion of foreign body or other bronchial obstruction
Testing of ______ can help distinguish cardiac from non-cardiac causes of dyspnea in the ED. BNP
Pulse ox values below ____% almost always represents clinically important hypoxemia. 94
Urgent and emergent conditions causing acute dyspnia include pneumonia, COPD, asthma, pneumothorax, pulmonary embolism, cardiac disease, metabolic acidosis, cyanide toxicity, methemoglobinemia, CO poisoning
The expectoration of blood that originates from below the vocal chords hemoptysis
Most cases of hemoptysis in the outpatient setting are due to infection (bronchitis, pneumonia, tuberculosis)
Flexible bronchoscopy is indicated for which patients smokers, over the age of 40, greater than 1 week history of hemoptysis
Characteristic findings in a patient with chronic obstruction of the upper airway Inspiratory stridor, intercostal retractions on inspiration, palpable thrill over larynx, wheezing localized to the neck.
Local parenchymal collapse atelectasis
the trachea bifurcates into the mainstem bronchi at which levels anteriorly and posteriorly Sternal angle, T4 process
the lower border of the lung lies at T __ level posteriorly 10
the lower border of the lung lies at __th rib level in the midclavicular line. 6
the lower border of the lung lies at __th rib level in the midaxillary line. 8
sensation of tingling or "pins and needles" around lips or in the extremities sometimes brought on by shortness of breath paresthesias
Musical respiratory sounds that may be audible to the patient or others wheezes
A reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi. cough
hemoptysis is seen most often in those with cystic fibrosis
Audible stridor is a sign of airway obstruction in the larynx or trachea
decreased fremitus can be caused by obstructed bronchus, COPD, pleural effusion/fibrosis, pneumothorax, infiltrating tumor, very thick chest wall, soft voice.
When it comes to percussion normal lungs are resonant
Dullness replaces resonance when air is displaced by fluid or solid tissue
These breath sounds are soft and low pitched. They are heard througout inspiration and continue without pause through expiration, and fade away 1/3 of the way through expiration vesicular
These lung sounds are about equal in length in regards to inspiration and expiration. There may be a silent interval inbetween bronchovesicular
These breath sounds are loud and higher in pitch, with a short silence between inspiration and expiration. Expiratory lasts longer than inspiratory bronchial
these sounds suggest secretions in large airways rhonci
Relatively low pitched with a snoring quality rhonci
relatively high pitched with a hissing or shrill quality wheezing
increased transmission of voice through chest wall suggests air-filled lung has become airless
Pain that is described as sharp or knife like is usually plueral pain
pectus carinatum pidgeon chest
pectus excavatum funnel chest
dyspnea that occurs in the supine position orthopnea
Paroxysmal nocturnal dyspnea is associated with which condition CHF
wheezing is generally associated with which condition asthma
According to Cecil's the three most common causes of persistant cough are postnasal drip, asthma, GERD
Massive hemoptysis is defined as more than ___ ml of blood in 24 hours 500
this pain is usually reproducible with movement or palpation over the affected area musculoskeletal chest pain
fremitus is increased in areas of underlying lung consolidation
fremitus is decreased in areas of pleural effusion
What may cause hyporesonance to percussion pnemothorax or hyperinflation
a course rattle or fine velcro like sound crackles
Heard in pulmonary edema, and interstitial fibrosis crackles
A crunching sound timed with the cardiac cycle Hamman's sign
Heard in patients with pneumomediastinum Hamman's sign
Elasticity is usually measured as its inverse function ___________ compliance
The change in lung volume produced by a given chang in transpulmonary pressure compliance
This is decreased in diseases such as pulmonary fibrosis, and pulmonary edema because of they restrict lung volume expansion compliance
This is increased in emphysema because of the loss of elastic recoil compliance
How does the body control the narrow range of normal pH elimination or retention of carbon dioxide
The PaCo2 in blood is inversely proportional to the ______ minute ventilation
What is the strongest factor controlling ventilation maintaining normal blood pH
The neuronal control of autonomic respiration resides in the _____ medullary reticular formation
The PaO2 versus ventilation curve is a mirror image of the ______ for hemoglobin oxygen dissociation curve
the volume of air which can be inhaled or exhaled from a person's lungs in one minute minute ventilation
defined as ventilation inadequate to keep PaCO2 from rising above normal hypoventilation
the portion of blood that goes from the right side of the heart to the left without an opportunity for exchange of oxygen and carbon dioxide shunt
When pulmonary capillary blood traverses unventilated lung units physiologic shunt
the maximal amount of air that can be exhaled after maximum inhalation forced vital capacity
"ee" sounds like "ay" egophany
"99" sounds louder and clearer bronchophany
Whispered sounds are clearer whispered pectoriloquy
usually clears with coughing rhonci
does not clear with coughing crackles
cough lasting <3 weeks acute cough
cough lasting >3 weeks persistant cough
most common cause of cough in smokers low-grade chronic bronchitis
according to Pat the most common cause of acute cough in non-smokers URI
Which ribs may be fractured due to cough 5-7
most common cause of hemoptysis in the US airways disease
most common cause of hemoptysis in developing countries tuberculosis
Enlargement and dilatation of the bronchioles bronchiectasis
what dose Amy Winehouse have crack lung
Created by: bwyche