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DU PA PULM HPE
Duke PA Pulmonology History, Physical, Exam
| Question | Answer |
|---|---|
| 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
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