Bates-Pulmonary Flashcards
Name the important anatomy for the anterior thorax
Manubrium, sternum, xiphoid process, costal cartilage, paired ribs, thoracic vertebrae
Where would you insert a needle for a tension pneumothorax
2nd intercostal space
Where would you insert a chest tube
4th intercostal space
Lower margin of endotracheal tube on chest xray would be found where
T4
What is the last rib attached to the sternum
7th rib
What are the landmarks for thoracentesis
T7-8
What are the Anterior thorax anatomical landmarks
Midsternal line (on the sternum), Midclavicular line (drops down from the middle of the clavicle), Anterior axillary line (distal end of the clavicle drops down)
What are the axillary anatomical landmarks
Anterior axillary line( drops down from the distal end of the clavicle or found at the anterior axillary fold), Midaxillary line (Drops from the apex of the axilla), Posterior axillary line (drops from the posterior axillary fold)
What are the Posterior thorax anatomical landmarks
Vertebral line (overlies the spinous process of the vertebrae), Scapular line (drops from the inferior angle of the scapula)
Describe the components of the Right Lung
Three lobes- Upper, Middle, Lower
Describe the Left Lung
Made up of two lobes upper and lower divided by an oblique fissure
Where are the apices of the lungs located
Extend above the clavicles
Where can you find the base of the lungs
The descend to the 6th rib of the mid clavicular line
Where does the trachea bifurcate into its main-stem bronchi
At the level of the sternal angle anteriorly
What type of pleura covers the surface of the lung
Visceral Pleura
What type of pleura lines the inner rib cage and upper surfaces of the diaphragm
Parietal Pleura
What is the potential space between the visceral and parietal pleurae
Parietal/pleural space
Where is breathing controlled
In the brainstem and mediated by muscles of inspiration
What is the primary muscle of breathing
Diaphragm
What happens when the diaphragm contracts downward
Descends the chest and enlarges the thoracic cavity decreasing thoracic pressure allowing air to be drawn through the tracheobronchial tree into the alveoli expanding the lungs.
Describe the expiratory phase
Passive process occurs when the diaphragm relaxes and rises allowing airflow outward and chest and abdomen to return to resting position
What are the accessory muscles of respiration
Sternomastoids (most important) scalenes, and abdominals assist with expiration
Pain in the myocardium is associated with what
Angina pectoris, myocardial Infarction
Pain in the pericardium is associated with what
pericarditis
Pain in the aorta is associated with what
dissecting aortic aneurysm
Pain in the trachea and large bronchi is associated with what
Bronchitis
Pain in the parietal pleura is associated with what
Pericarditis, pneumonia
Pain in the Chest wall, including the musculoskeletal system and skin include what
costochondritis, herpes zoster
Pain in the esophagus is associated with what
Reflux esophagitis, esophageal spasm
Pain in the extrathoracic structures such as the neck, gallbladder, and stomach is associated with what
Cervical arthritis, biliary colic, gastritis
A clenched fist over the sternum suggests what
angina pectoris
a finger pointing to a tender area on the chest wall suggests this
musculoskeletal pain
A hand moving from the neck to epigastrum suggests this
heartburn
What is the most frequent cause of chest pain in children
Anxiety, costochondritis is also common
Anxious patients have have episodes of this during both rest and exercise
hyperventillation, rapid or shallow breathing, frequent sigh
What does wheezing suggest
Partial airway obstructions from secretions, tissue inflammation, or foreign body
This can be a symptom of Left Heart Failure
Coughing
This is the most common cause for acute cough
Viral upper respiratory infections
Describe mucoid sputum
translucent, white or gray
Describe purulent sputum
yellowish greenish
Foul smelling sputum is commonly found due to this
lung abscess
Tenacious sputum is usually a result of this
cystic fibrosis
Large volumes of purulent sputum is found as a result of this
bronchiectasis or lung abscess
What are some diagnostically helpful symptoms
Fever, chest pain, dyspnea, orthopnea, and wheezing
This is rare in infants, children, and adolescents
hemoptysis
This is commonly seen in patients with Cystic fibrosis
Hemoptysis
Describe blood which originates in the stomach
usually darker than blood from the respiratory tract and can be mixed with food
What are the main things to observe while inspecting your patient during the pulmonary exam
Respiratory rate
Cyanosis is a signal for what
hypoxia
Clubbing can result from what
lung abscess, malignancy, congenital heart disease
Audible stridor and a high pitches wheeze is a sign of what
Airway obstruction in the larynx or trachea
Lateral displacement of the trachea occurs when
Pneumothorax, pleural effusion, or atelectasis
What is a sign of sever difficulty breathing
inspiratory contractions of the sternomastoids and scalenes at rest
What would cause the anteroposterior (AP) diameter to increase
COPD, aging
What can cause abnormal retractions during inspiration
severe asthma, COPD, and upper airway obstruction
What does unilateral impairment or lagging of respiratory movements suggest
Disease of the underlying lung pleura
What does intercostal tenderness usually imply
inflamed pleura
What do sinus tracts indicate
infection of the underlying pleura and lung as in tuberculosis and actinomycosis
What are the causes for unilateral decreased delay in chest expansion
Chronic fibrosis of the underlying lung pleura, pleural effusion, labor pneumonia, pleural pain associated with splinting, and unilateral bronchial expansion
What are some causes for decreased Fremitus
Thick chest wall, obstructed bronchus, COPD, Pleural effusion, fibrosis, pneumothorax, infiltrating tumor
What are the causes of asymmetric decreased fremitus
unilateral pleural effusion, pneumothorax, and neoplasm
What are the causes of asymmetric increased fremitus
unilateral pneumonia
When does dullness replace resonance
when fluid or solid tissue replaces air-containing lung or occupies pleural space
What are some examples of dullness replacing resonance
labor pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue, tumor
When can Generalized resonance be heard
over the hyperinflated lungs of COPD (not a reliable sign)
What does unilateral hyperresonance suggest
Large pneumothorax or a large air-filled bulla in the lung
When percussing the diaphragm an abnormally high level indicates what
pleural effusion, or a high diaphragm which can occur due to atelectasis or diaphragmatic paralysis
When can breath sounds be decreased
when air flow is decreased as in obstructive lung disease, or muscular weakness
What can cause poor sound transmission when auscultation the lungs
pleural effusion, pneumothorax, COPD
Describe Vesicular breath sounds
inspiratory sounds last longer than expiratory
Describe bronchovesicular lung sounds
Inspiratory and expiratory sounds are equal
Describe Bronchial breath sounds
Expiratory sounds last longer than inspiratory
Describe tracheal breath sounds
inspiratory and expiratory sounds are equal
What would cause bronchovesicular or bronchial breath sounds to be heard in abnormal locations
Occurs when air filled lung is replaced with fluid filled or solid tissue
What a silent gap between inspiration and expiration breath sounds suggest
bronchial breath sounds
What is a sign of abnormal lung tissue
Fine late inspiratory crackles that persist from breath to breath
When does dullness replace resonance when percussing the chest
When fluid or solid tissue replaces air containing lung or pleural space
Hyperresonance of this disease may totally replace cardiac dullness
COPD
Where does the dullness of right middle lobe pneumonia typically occur
behind the right breast this is why you must displace the breast when you percuss
A lung affected by COPD often has this result on the liver
displaces the upper border of the liver downward as a result lowering the level of diaphragmatic dullness posteriorly
Patients older than 60 years with a forced expiratory time of 6-8 sec are twice as likely to have what disease
COPD
An increase in the local pain (distant from your hands) suggests this
rib fracture rather than just soft tissue injury
Describe a normal thorax
wider than deep, lateral diameter is larger than its anteroposterior
Describe a Funnel chest (pectus excavatum)
Depression in the lower portion of the sternum
Describe Barrel Chest
Increased anteroposterior diameter
Pigeon Chest (Pectus carinatum)
Sternum is displaced anteriorly, increasing the anteroposterior diameter
Describe traumatic flail chest
multiple rib fractures result in paradoxical movements of the thorax
Describe thoracic kyphoscoliosis
abnormal spinal curvatures and vertebral rotations deform the chest can make lung findings very difficult
Describe the breath sounds in normal air filled lungs
Predominantly vesicular
Describe transmitted voice sounds in normal air filled lungs
muffled indistinct, spoken ee heard as ee whispered words are faint, indistinct if heard at all
Describe tactile fremitus in normal lungs
normal
describe tactile fremitus in airless lungs as in lobar pneumonia
increased
Describe transmitted voice sounds in airless lungs as in lobar pneumonia
spoken words are louder, clearer. spoken ee heard as ayy.
Describe breath sounds in a airless lung as in lobar pneumonia
bronchial or bronchialvesicular over the involved area
Describe late inspiratory crackles
begin in the first half of inspiration and are continue into late inspiration
What are the causes of late inspiratory crackles
interstitial lung disease (fibrosis), early CHF
Describe early inspiratory crackles
appear and end soon after the start of inspiration
What are the causes of early inspiratory crackles
chronic bronchitis and asthma
When are mid inspiratory and expiratory crackles heard
bronchiectasis but not specific for diagnosis. Can be associated with wheezing and rhonchi
When do wheezes occur
when air flows rapidly through bronchi that are narrowed nearly to the point of closure. Often are audible through the mouth and chest.
What are the causes of wheezing
Asthma, COPD, chronic Bronchitis, CHF
What do rhonchi suggest
secretions in the larger airways and can be cleared with coughing in diseases such as chronic bronchitis
In sever obstructive pulmonary disease what does silent chest mean
Pt is unable to force enough air through the narrowed bronchi to produce wheezing this warrants immediate attention
What does persistent localized wheezing suggest
partial obstruction of the bronchus by a tumor or foreign body
What is a wheeze that is predominantly inspiratory called
stridor. Often louder in the neck than the chest wall. This indicates a partial obstruction of the larynx or trachea and is a medical emergency
Creaking sounds that occur when pleural surfaces are inflammed and roughened
pleural rub
This is a series of precordial crackles synchronous with the heart beat not with respiration. Best heard in the left lateral position and is due to mediastinal emphysema
Mediastinal crunch
What are some evidence of distress
tripoding, pursed lip breathing, central cyanosis, accessory muscle use, retractions
Percussion helps to determine what
air filled lungs vs fluid filled or solid mass
When percussing during the pulmonary exam Resonance means what
healthy aerated lungs loud intensity
When percussing during the pulmonary exam hyperresonance means what
air trapping, very loud intensity
When percussing during the pulmonary exam hyporesonance sounds like what
dull/flat lower intensity
When would you perform diaphragmatic excursion
respiratory expansion is asymmetrical, abnormal percussion notes, adventitious breath sounds
Describe a normal diaphragmatic excursion
Resonance above the level of the diaphragm
This adventitious sound is intermittent, brief, nonmusical and is more fine than course
Crackle (rales)
This adventitious sound is continuous, musical, and high pitched
Wheezes
This adventitious breath sound is continuous, snoring quality, and low pitched
Rhonchi
This test is performed if crackles are appreciated
Post tussive check
This test involves the patient saying EE during auscultation and if abnormal will sound like AYY
egophony
This test involves the pt whispering 123 during auscultation if abnormal the sounds will be loud and clear as a result of consolidation
whispered pectoriloquy
