Approach to Pulm Flashcards
The carina bifurcates at what spinous level?
T4-T5
Describe Cheyne-Stokes Respirations and what conditions you might see them in.
Crescendo/decrescendo respirations with pauses of apnea. Could be caused by a stroke/brain injury. Common condition
Describe Wheezes and what conditions you might hear them in?
Inspiratory and expiratory High pitched and musical in quality (narrowed airway) Might see in Asthma, brochospasm
What condition might cause rusty colored sputum?
Pneumococcal pneumonia
A line drawn between the inferior lungs crosses what spinous process?
T10
A flat/dull percussion sound generally indicates what pathology?
Pleural Effusion or Lobular Pneumonia
What are pulmonary angiograms useful in detecting in the lungs?
Definitive diagnosis for pulmonary embolism.
What constitutes a good sputum sample?
Contamination = 10-25 squamous epithelial cells (inadequate) Alveolar macrophages 1 dominant pathogen
Where is the sternal angle (angle of Louis) located?
Approx 5 cm inferior to jugular notch T4 Level Posteriorly Second costal cartilage/space anteriorly
What conditions might you hear fine crackles in?
Fine (rubbing of hair) - diffuse interstitial disease, fibrosis, atelectasis, pneumonia, CHF
What are ultrasounds useful in detecting in the lungs?
Small amounts of pleural fluid, walled off compartments (loculations) within pleural effusions, distinguishing between pleural thickening
A hyperresonant percussion sound generally indicates what lung conditions?
Emphysema or Pneumothorax
Describe Crackles in the lungs.
On inspiration. High pitch and discontinuous
What space do you put a chest tube in?
4th Intercostal
A sudden onset of hemoptysis can be indicative of what condition?
Pulmonary Embolus
What area of the back does the scapula span?
2-7th rib
What is a VQ scan?
A scan that evaluates both airflow and blood flow in the lungs. Done by breathing in radioactive xenon.
Which lung lobes are more prominent anteriorly?
The upper lobes
What intercostal space is the nipple located at in men?
4th
What level is the xyphoid at?
T10
What pathogens might cause foul smelling sputum?
anaerobes
Describe Rhonchi and what conditions you might hear them in.
Snoring or gurgling quality. Pneumonia, Consolidation
What landmark lies at T3?
Jugular notch
What are CTs good for when viewing the lungs?
Viewing lung tumors, mediastinal masses, soft tissue disorders
What condition might cause purulent pus (yellow, green) sputum?
Acute/Chronic bronchitis (yellow to brown associated with G- bacteria)
A line drawn between the inferior angle of the scapula crosses what vertebral bodies?
T7-T8
What is the Pulmonary Embolus triad?
hemoptysis, dyspnea, chest pain
What condition might cause bloody sputum?
Tuberculosis
Describe Kussmaul’s respirations and what condition you might see them in.
Fast breathing, full tidal volume, metabolic acidosis (DKA)
Describe a mediastinal crunch and what conditions you might hear them in.
Precordial crackles synchronous with heart beat. Pneumomediastinum, called Hamman’s sign
A slightly blood tinged sputum (hemoptysis) might be indicative of what conditions?
Sinusitis, bronchitis, pneumonia. non-emergent
Describe Ataxic (Biot’s) Respirations and what conditions you might see them in.
Fast breathing, full tidal volume, with apnea between episodes. Could be caused by a medullary lesion.
Persistent hemoptysis can be indicative of what conditions?
Tuberculosis Cancer
What procedures can be done through a bronchoscope?
Direct visualization of airways Collection of various samples Brushings, transbronchial needle aspiration, endobronchial biopsy, transbronchial biopsy
A healthy/resonant percussion sound generally indicates what lung conditions?
Normal lungs or Bronchitis
What conditions might you hear course crackles in?
Course (blowing bubbles in water) - severe COPD Louder, lower in pitch, not quite as brief
What might heavy hemoptysis be indicative of?
Vascular origin
When is a VQ scan useful?
Decreased perfusion and normal ventilation = PE Blood clots is suspected in areas that have good airflow but poor blood flow.
Describe Apneustic respirations and what conditions you might see them in.
steady respirations with normal inspirations, but shallow expirations. Could be caused by midbrain/pons lesions, CHF, renal failure, or sleeping (child/elder)
Which lung lobes are more prominent posteriorly?
The lower lobes
What sounds might be abnormal with consolidation?
Bronchophony - 99 Egophony - ee Whispered pectoriloquy - 99 whispered
What is the x-ray pneumonic?
A - Airway, Adenopathy B - Bones, Breast C - Cardiac Shadow D - Diaphragm E - Everything else (soft tissue) F - Fields (lung, vascular)
What condition might cause pink-tinged, foamy or frothy white sputum?
Pulmonary edema
Describe Stridor and what conditions you might hear them in.
Inspiratory wheeze from upper airway obstruction (croup) Epiglotitis, extubation reaction. Might need to emergency crike them!
Describe a pleural (friction) rub and what conditions you might hear them in.
Sound generated from inflammed pleural surfaces rubbing together. Pleuritic chest pain
