Respiratory System: History and Physical Exam

Flashcards covering the history, physical exam, anatomy, and special considerations for the respiratory system, based on Dr. Palmer's lecture.

What are the main components of the respiratory system, starting from nose/mouth?

The nose and mouth, then the airway, and finally the lungs.

What are the key bifurcating airways mentioned in the respiratory anatomy?

Trachea, left main bronchus, and right main bronchus.

Which anatomical landmarks are found on the anterior chest for the respiratory system?

Midsternal line, midclavicular line, anterior axillary line, apex of lung, horizontal fissure, and oblique fissure.

Which anatomical landmarks are found on the posterior chest for the respiratory system?

Scapular line, vertebral line, spinous process of T3, and inspiratory descent.

Which anatomical lines are relevant on the lateral chest?

Anterior axillary line, midaxillary line, posterior axillary line, and the left oblique fissure.

What aspects should be quantified and qualified during a respiratory history?

Baseline, setting, progression, and urgency.

What three related symptoms should be distinguished when discussing the 'quality' of breathing difficulty?

Dyspnea, orthopnea, and nocturnal dyspnea.

What characteristics of mucus should be inquired about when a patient has a cough?

Amount/volume, color, blood, odor, and consistency.

What other causes of cough should be considered during the history?

Reflux, allergies, tobacco use, or medications such as ACE Inhibitors.

What areas are included in the respiratory system physical exam besides the thorax?

The nose, mouth, neck, and hands.

What accessory muscles contract during inspiration?

The SCM (sternocleidomastoid) and scalene muscles.

What muscles contract during expiration?

The intercostal and oblique muscles.

What specific components are included in Palpation of the chest?

Palpation of the chest, chest expansion, and Tactile Fremitus.

What specific aspects are observed during inspection of the neck and chest?

The neck, accessory muscles, chest shape, how the chest moves, and chest expansion.

What abnormalities should be noted during inspection of the chest?

Asymmetry, deformities, and retractions.

What is 'Pigeon Chest' (Pectus Carinatum)?

The sternum is displaced anteriorly, increasing the anteroposterior diameter, with depressed costal cartilages adjacent to the protruding sternum.

What is 'Funnel Chest' (Pectus Excavatum)?

A depression occurs in the lower portion of the sternum, which may cause murmurs due to compression of the heart and great vessels.

What is 'Barrel Chest'?

There is an increased anteroposterior diameter; this shape is normal during infancy and often accompanies aging and chronic obstructive pulmonary disease.

What is 'Thoracic Kyphoscoliosis'?

Abnormal spinal curvatures and vertebral rotation deform the chest, which may distort the underlying lungs and make interpretation of lung findings very difficult.

What is 'Traumatic Flail Chest' and how does it present during breathing?

Multiple rib fractures result in paradoxical movements of the thorax; as the diaphragm descends and decreases intrathoracic pressure on inspiration, the injured area caves inward; on expiration, it moves outward.

What should be noted when palpating the skin overlying the thorax?

Tenderness, crepitus, and masses.

How is chest expansion tested posteriorly?

Place thumbs along each costal margin (at the level of the 10th ribs posteriorly), raise a fold of loose skin between the thumbs, and ask the patient to inhale deeply, observing the distance between the thumbs as they move apart.

What is Tactile Fremitus used to detect?

Asymmetric air, fluid, or mass.

What are the four main types of normal breath sounds?

Vesicular, Bronchovesicular, Bronchial/Tubular, and Tracheal.

Describe Vesicular breath sounds.

Inspiratory sounds lasting longer than expiratory ones, soft intensity, relatively low pitch, and normally heard over most of both lungs.

Describe Bronchovesicular breath sounds.

Inspiratory and expiratory sounds approximately equal in duration, intermediate intensity, intermediate pitch, and often heard in the 1st and 2nd interspaces anteriorly and between the scapulae.

Describe Bronchial breath sounds.

Expiratory sounds lasting longer than inspiratory ones, loud intensity, relatively high pitch, and heard over the manubrium (if heard at all).

Describe Tracheal breath sounds.

Inspiratory and expiratory sounds approximately equal in duration, very loud intensity, relatively high pitch, and heard over the trachea in the neck.

What are the two main categories of adventitious lung sounds?

Discontinuous and Continuous.

What are the three categories of transmitted voice sounds?

Bronchophony, Pectoriloquy, and Egophony.

Describe Fine Crackles.

Soft, high-pitched, very brief (5-10 msec) sounds, often described as like dots in time.

Describe Coarse Crackles.

Somewhat louder, lower in pitch, brief (20-30 msec) sounds, also described as like dots in time.

Describe Wheezes.

Continuous, relatively high-pitched (>400 Hz) sounds with a hissing or shrill quality, like dashes in time.

Describe Rhonchi.

Continuous, relatively low-pitched (<200 Hz) sounds with a snoring quality, which may disappear with coughing.

Describe Pleural Rub.

A low frequency 'grating' sound heard during inspiration and expiration.

Describe Stridor.

An inspiratory, continuous, relatively high-pitched sound.

When should transmitted voice sounds be assessed during lung auscultation?

If abnormally located bronchovesicular or bronchial breath sounds are heard.

How is Egophony assessed, and what is a positive finding?

Ask the patient to say 'E' in a normal voice; normally a muffled long 'EE' sound is heard. An 'AY' sound indicates egophony.

How is Bronchophony assessed, and what is a positive finding?

Ask the patient to say '99' in a normal voice; normally a muffled/indistinct 'ninety-nine' is heard. Louder voice sounds indicate bronchophony.

How is Whispered Pectoriloquy assessed, and what is a positive finding?

Ask the patient to whisper '99' or '1-2-3'; normally heard faintly if at all. Clearer whispered sounds indicate whispered pectoriloquy.

What findings should be inspected on the hands during a respiratory exam?

Cyanosis and clubbing.