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N507 Exam 1 > (8) Lungs > Flashcards

(8) Lungs Flashcards

1
Q

Vesicular breath sounds

A

soft and low pitched
usually heard over most of both lungs
inspiratory > expiratory

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2
Q

Bronchial breath sounds

A

louder and higher in pitch
usually heard over the manubrium
inspiratory < expiratory

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3
Q

Bronchovesicular breath sounds

A

intermediate intensity and pitch
usually heard over the 1st and 2nd interpsaces
expiratory = inspiratory

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4
Q

Normal breath sounds

A

Vesicular
Bronchial
Bronchovesicular

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5
Q

Test chest expansion

A

place thumbs @ level of 10th rib w/ fingers loosely grasping and parallel to the lateral rib cage
watch the distance between the thumbs as they move apart during inspiration

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6
Q

Percussion techniques

A
  • perform side to side to assess asymmetry
  • strike using tip of tapping finger
  • use lightest percussion that produces clear note
  • helps establish whether underlying tissues (5-7cm deep) are air-filled, fluid-filled, or solid
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7
Q

percussion notes

A 
flatness
dullness
resonance
hyperresonance
tympany
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8
Q

which breath sound is auscultated over the majority of both lungs?

A

Vesicular

(Bronchial - over manubrium)

(Bronchvesicular - over 1st & 2nd interspaces)

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9
Q

aspiration pneumonia is more common where in lung?

A

right middle and lower lobe b/c right main bronchus is more vertical

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10
Q

pleural effusion - transudate - abnormal dx?

A

heart failure
cirrhosis
nephrotic syndrome

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11
Q

pleural effusion - exudate - abnormal dx?

A 
pneumonia
malignancy
PE
TB
pancreatitis
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12
Q

irritation of parietal pleura: pleuritic pain w/ deep inspiration - abnormal dx?

A 
viral pleurisy
pneumonia
pulmonary embolism
pericarditis
collagen vascular disease
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13
Q

Respiratory: common or concerning symptoms

A 
chest pain
shortness of breath (dyspnea)
wheezing
cough
hemoptysis
daytime sleepiness, snoring, disordered sleep
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14
Q

myocardium chest pain - abnormal dx?

A

angina pectoris
MI
myocarditis

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15
Q

pericardium chest pain - abnormal dx?

A

pericarditis

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16
Q

aorta chest pain - abnormal dx?

A

aortic dissection

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17
Q

trachea/large bronchi chest pain - abnormal dx?

A

bronchitis

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18
Q

parietal pleura chest pain - abnormal dx?

A 
pericarditis
pneumonia
pneumothorax
pleural effusion
pulmonary embolus
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19
Q

chest wall (MS/neuro) chest pain - abnormal dx?

A

costochondritis

herpes zoster

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20
Q

esophagus chest pain - abnormal dx?

A

GERD
esophageal spasm
esophageal tear

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21
Q

extra thoracic structures (neck, gallbladder, stomach) chest pain - abnormal dx?

A

cervical arthritis
biliary colic
gastritis

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22
Q

acute cough (<3 wks)m- abnormal dx?

A 
viral URI
actue bronchites
pneumonia
left sided heart failure
asthma
smoking
foreign body
ACE-I
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23
Q

sub-acute cough (3-8wks) - abnormal dx?

A 
post infectious cough
pertussis
acid reflux
bacterial sinusitis
asthma
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24
Q

chronic cough (>8 wks) - abnormal dx?

A 
postnasal drip
asthma
GERD
chronic bronchitis
bronchiectasis
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25
Q

mucoid sputum - abnormal dx?

A

(translucent, white/gray)
viral
CF (thick, tenacious sputum)

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26
Q

purulent sputum - abnormal dx?

A

(yellow/green)
bacterial pneumonia
bronchiectasis
lung abscess

27
Q

foul smelling sputum - abnormal dx?

A

anaerobic lung abscess

28
Q

hemoptysis - abnormal dx?

A 
bronchitis
malignancy
CF
bronchiectasis
mitral stenosis
Goodpasture syndrome
Wegener granulomatosis
29
Q

models to assess readiness to quit smoking

A 
5As
Ask
Advise
Assess willingness
Assist
Arrange follow up
Stages of Change Model
Precontemplation (don't want to quit)
Contemplation (concerned but not ready)
Preparation (ready)
Action (just quit)
Maintenance (>6 mnths)
30
Q

positioning for thorax exam

A

posterior - sitting

anterior - supine

31
Q

tachypnea - abnormal dx?

A

pneumonia

cardiac disease

32
Q

pallor and sweating - abnormal dx?

A

heart failure

33
Q

nail clubbing - abnormal dx?

A 
bronchiectasis
congenital heart disease
pulmonary fibrosis
cystic fibrosis
lung abscess
malignancy
34
Q

lateral displacement of trachea - abnormal dx?

A

pneumothorax
pleural effusion
actelectasis

35
Q

AP to lateral chest ratio > 0.9 - abnormal dx?

A

COPD

normal 0.7-0.9

36
Q

asymmetric expansion - abnormal dx?

A

large pleural effusions

37
Q

abnormal posterior chest retraction - abnormal dx?

A

severa asthma
COPD
upper airway obstruction

38
Q

impaired respiratory movement on one side (unilateral lag) - abnormal dx?

A

pleural disease from asbestosis or silicosis

phrenic nerve damage or trauma

39
Q

intercostal tenderness - abnormal dx?

A

inflamed pleurae

costal cartilage tenderness in costochondritis

40
Q

crepitus and chest wall edema - abnormal dx?

A

mediastinitis

41
Q

unilateral decrease or delay in chest expansion - abnormal dx?

A 
chronic fibrosis of underlying lung to pleura
pleural effusion
lobar pneumonia
pleural pain associated w/ splinting
unilateral bronchial obstruction
paralysis of the hemidiaphragm
42
Q

decreased fremitus - abnormal dx?

A 
(occurs when voice is higher pitched or soft or when transmission of vibrations from larynx to surface of chest is impeded by a thick chest wall)
obstructed bronchus
COPD
pleural effusion
fibrosis
air (pneumothorax)
infiltrating tumor
43
Q

what is fremitus

A

palpable vibrations that are transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking and is normal symmetric

typically more prominent in inter scapular area than lower lung fields

use ball or ulcer surface of hand to assess, have pt say 99 or 1,1,1

44
Q

lung percussion: dullness replaces resonance - abnormal dx?

A

occurs when fluid or solid tissue replaces air-containing lung or occupies l=pleural space

lobar pneumonia
pleurale fusion
hemothorax
empyema
fibrous tissue
tumor
45
Q

lung percussion: hyper resonance - abnormal dx?

A

asthma

unilateral - large pneumothorax or air filled bulla

46
Q

lung percussion: change from resonant to dull represents?

A

level of diaphragm

47
Q

high diaphragmatic level - abnormal dx?

A

pleural effusion
atelectasis
phrenic nerve paralysis

(normal diaphragmatic excursion is 3-5.5cm)

48
Q

percussion notes w/ examples

A 
flat - thigh
dull - liver
resonant - healthy lung
hyper-resonant - usually none
tympanitic - gastric air bubble of puffed out cheek
49
Q

decreased breath sounds - abnormal dx?

A

COPD
pleural effusion
pneumothorax
respiratory muscle weakness

50
Q

tracheal breath sounds

A

inspiratory = expiratory
loud and relatively high
over the trachea in the neck

51
Q

Crackles

A 
(rales)
discontinuous
intermittent, nonmusical, brief
like dots in time
fine: soft, high pitched, very brief
coarse: somewhat louder, lower in pitch, brief
52
Q

Wheezes & Rhonchi

A

continuous
sinusoidal, musical, prolonged
like dashes in time

wheezes: high pitched w/ hissing/shrill quality
rhonchi: low pitched, snoring quality (may describe sounds from secretions in large airways that may change with coughing)

53
Q

crackles - abnormal dx?

A 
abnormalities of lung parenchyma
pneumonia
interstitial lung disease
pulmonary fibrosis
atelectasis
heart failure (posterior inferior lung)

abnormalities of airways
bronchitis
bronchiectasis

54
Q

wheezes - abnormal dx?

A

asthma
COPD
bronchitis

55
Q

fine late inspiratory crackles - abnormal dx?

A

abnormal lung tissue

56
Q

clearing of crackles, wheezes, rhonchi after coughing or position change - abnormal dx?

A

inspissated secretions: bronchitis or atelectasis

57
Q

silent chest, air flow minimal - abnormal dx?

A

severe asthma

58
Q

pleural rub - abnormal dx?

A

pneumonia
pleurisy
pulmonary embolism

59
Q

increased transmission of voice sounds - abnormal dx?

A

embedded airways are blocked by inflammation or secretion

60
Q

Egophony

A

pt says “ee” normaly hear muffled long E sound

-if sounds like A egophony is present

61
Q

Bronchophony

A

askant to say 99 - normally sounds transmitted through chest wall are muffled and indistinct (louder voice sounds are called bronchophony)

abnormal: pneumonia

62
Q

anterior chest retraction - abnormal dx?

A

severe asthma
COPD
upper airway obstruction

lag occurs in underlying disease of lung or pleura

63
Q

tender pectoral muscle - abnormal dx?

A

localized musculoskeletal origin (doesn’t prove but suggests)

N507 Exam 1 (10 decks)

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