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Physical Diagnosis > Bates-Pulmonary > Flashcards

Bates-Pulmonary Flashcards

1
Q

Name the important anatomy for the anterior thorax

A

Manubrium, sternum, xiphoid process, costal cartilage, paired ribs, thoracic vertebrae

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2
Q

Where would you insert a needle for a tension pneumothorax

A

2nd intercostal space

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3
Q

Where would you insert a chest tube

A

4th intercostal space

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4
Q

Lower margin of endotracheal tube on chest xray would be found where

A

T4

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5
Q

What is the last rib attached to the sternum

A

7th rib

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6
Q

What are the landmarks for thoracentesis

A

T7-8

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7
Q

What are the Anterior thorax anatomical landmarks

A

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)

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8
Q

What are the axillary anatomical landmarks

A

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)

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9
Q

What are the Posterior thorax anatomical landmarks

A

Vertebral line (overlies the spinous process of the vertebrae), Scapular line (drops from the inferior angle of the scapula)

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10
Q

Describe the components of the Right Lung

A

Three lobes- Upper, Middle, Lower

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11
Q

Describe the Left Lung

A

Made up of two lobes upper and lower divided by an oblique fissure

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12
Q

Where are the apices of the lungs located

A

Extend above the clavicles

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13
Q

Where can you find the base of the lungs

A

The descend to the 6th rib of the mid clavicular line

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14
Q

Where does the trachea bifurcate into its main-stem bronchi

A

At the level of the sternal angle anteriorly

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15
Q

What type of pleura covers the surface of the lung

A

Visceral Pleura

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16
Q

What type of pleura lines the inner rib cage and upper surfaces of the diaphragm

A

Parietal Pleura

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17
Q

What is the potential space between the visceral and parietal pleurae

A

Parietal/pleural space

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18
Q

Where is breathing controlled

A

In the brainstem and mediated by muscles of inspiration

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19
Q

What is the primary muscle of breathing

A

Diaphragm

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20
Q

What happens when the diaphragm contracts downward

A

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.

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21
Q

Describe the expiratory phase

A

Passive process occurs when the diaphragm relaxes and rises allowing airflow outward and chest and abdomen to return to resting position

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22
Q

What are the accessory muscles of respiration

A

Sternomastoids (most important) scalenes, and abdominals assist with expiration

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23
Q

Pain in the myocardium is associated with what

A

Angina pectoris, myocardial Infarction

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24
Q

Pain in the pericardium is associated with what

A

pericarditis

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25
Q

Pain in the aorta is associated with what

A

dissecting aortic aneurysm

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26
Q

Pain in the trachea and large bronchi is associated with what

A

Bronchitis

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27
Q

Pain in the parietal pleura is associated with what

A

Pericarditis, pneumonia

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28
Q

Pain in the Chest wall, including the musculoskeletal system and skin include what

A

costochondritis, herpes zoster

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29
Q

Pain in the esophagus is associated with what

A

Reflux esophagitis, esophageal spasm

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30
Q

Pain in the extrathoracic structures such as the neck, gallbladder, and stomach is associated with what

A

Cervical arthritis, biliary colic, gastritis

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31
Q

A clenched fist over the sternum suggests what

A

angina pectoris

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32
Q

a finger pointing to a tender area on the chest wall suggests this

A

musculoskeletal pain

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33
Q

A hand moving from the neck to epigastrum suggests this

A

heartburn

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34
Q

What is the most frequent cause of chest pain in children

A

Anxiety, costochondritis is also common

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35
Q

Anxious patients have have episodes of this during both rest and exercise

A

hyperventillation, rapid or shallow breathing, frequent sigh

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36
Q

What does wheezing suggest

A

Partial airway obstructions from secretions, tissue inflammation, or foreign body

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37
Q

This can be a symptom of Left Heart Failure

A

Coughing

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38
Q

This is the most common cause for acute cough

A

Viral upper respiratory infections

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39
Q

Describe mucoid sputum

A

translucent, white or gray

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40
Q

Describe purulent sputum

A

yellowish greenish

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41
Q

Foul smelling sputum is commonly found due to this

A

lung abscess

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42
Q

Tenacious sputum is usually a result of this

A

cystic fibrosis

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43
Q

Large volumes of purulent sputum is found as a result of this

A

bronchiectasis or lung abscess

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44
Q

What are some diagnostically helpful symptoms

A

Fever, chest pain, dyspnea, orthopnea, and wheezing

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45
Q

This is rare in infants, children, and adolescents

A

hemoptysis

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46
Q

This is commonly seen in patients with Cystic fibrosis

A

Hemoptysis

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47
Q

Describe blood which originates in the stomach

A

usually darker than blood from the respiratory tract and can be mixed with food

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48
Q

What are the main things to observe while inspecting your patient during the pulmonary exam

A

Respiratory rate

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49
Q

Cyanosis is a signal for what

A

hypoxia

50
Q

Clubbing can result from what

A

lung abscess, malignancy, congenital heart disease

51
Q

Audible stridor and a high pitches wheeze is a sign of what

A

Airway obstruction in the larynx or trachea

52
Q

Lateral displacement of the trachea occurs when

A

Pneumothorax, pleural effusion, or atelectasis

53
Q

What is a sign of sever difficulty breathing

A

inspiratory contractions of the sternomastoids and scalenes at rest

54
Q

What would cause the anteroposterior (AP) diameter to increase

A

COPD, aging

55
Q

What can cause abnormal retractions during inspiration

A

severe asthma, COPD, and upper airway obstruction

56
Q

What does unilateral impairment or lagging of respiratory movements suggest

A

Disease of the underlying lung pleura

57
Q

What does intercostal tenderness usually imply

A

inflamed pleura

58
Q

What do sinus tracts indicate

A

infection of the underlying pleura and lung as in tuberculosis and actinomycosis

59
Q

What are the causes for unilateral decreased delay in chest expansion

A

Chronic fibrosis of the underlying lung pleura, pleural effusion, labor pneumonia, pleural pain associated with splinting, and unilateral bronchial expansion

60
Q

What are some causes for decreased Fremitus

A

Thick chest wall, obstructed bronchus, COPD, Pleural effusion, fibrosis, pneumothorax, infiltrating tumor

61
Q

What are the causes of asymmetric decreased fremitus

A

unilateral pleural effusion, pneumothorax, and neoplasm

62
Q

What are the causes of asymmetric increased fremitus

A

unilateral pneumonia

63
Q

When does dullness replace resonance

A

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

64
Q

What are some examples of dullness replacing resonance

A

labor pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue, tumor

65
Q

When can Generalized resonance be heard

A

over the hyperinflated lungs of COPD (not a reliable sign)

66
Q

What does unilateral hyperresonance suggest

A

Large pneumothorax or a large air-filled bulla in the lung

67
Q

When percussing the diaphragm an abnormally high level indicates what

A

pleural effusion, or a high diaphragm which can occur due to atelectasis or diaphragmatic paralysis

68
Q

When can breath sounds be decreased

A

when air flow is decreased as in obstructive lung disease, or muscular weakness

69
Q

What can cause poor sound transmission when auscultation the lungs

A

pleural effusion, pneumothorax, COPD

70
Q

Describe Vesicular breath sounds

A

inspiratory sounds last longer than expiratory

71
Q

Describe bronchovesicular lung sounds

A

Inspiratory and expiratory sounds are equal

72
Q

Describe Bronchial breath sounds

A

Expiratory sounds last longer than inspiratory

73
Q

Describe tracheal breath sounds

A

inspiratory and expiratory sounds are equal

74
Q

What would cause bronchovesicular or bronchial breath sounds to be heard in abnormal locations

A

Occurs when air filled lung is replaced with fluid filled or solid tissue

75
Q

What a silent gap between inspiration and expiration breath sounds suggest

A

bronchial breath sounds

76
Q

What is a sign of abnormal lung tissue

A

Fine late inspiratory crackles that persist from breath to breath

77
Q

When does dullness replace resonance when percussing the chest

A

When fluid or solid tissue replaces air containing lung or pleural space

78
Q

Hyperresonance of this disease may totally replace cardiac dullness

A

COPD

79
Q

Where does the dullness of right middle lobe pneumonia typically occur

A

behind the right breast this is why you must displace the breast when you percuss

80
Q

A lung affected by COPD often has this result on the liver

A

displaces the upper border of the liver downward as a result lowering the level of diaphragmatic dullness posteriorly

81
Q

Patients older than 60 years with a forced expiratory time of 6-8 sec are twice as likely to have what disease

A

COPD

82
Q

An increase in the local pain (distant from your hands) suggests this

A

rib fracture rather than just soft tissue injury

83
Q

Describe a normal thorax

A

wider than deep, lateral diameter is larger than its anteroposterior

84
Q

Describe a Funnel chest (pectus excavatum)

A

Depression in the lower portion of the sternum

85
Q

Describe Barrel Chest

A

Increased anteroposterior diameter

86
Q

Pigeon Chest (Pectus carinatum)

A

Sternum is displaced anteriorly, increasing the anteroposterior diameter

87
Q

Describe traumatic flail chest

A

multiple rib fractures result in paradoxical movements of the thorax

88
Q

Describe thoracic kyphoscoliosis

A

abnormal spinal curvatures and vertebral rotations deform the chest can make lung findings very difficult

89
Q

Describe the breath sounds in normal air filled lungs

A

Predominantly vesicular

90
Q

Describe transmitted voice sounds in normal air filled lungs

A

muffled indistinct, spoken ee heard as ee whispered words are faint, indistinct if heard at all

91
Q

Describe tactile fremitus in normal lungs

A

normal

92
Q

describe tactile fremitus in airless lungs as in lobar pneumonia

A

increased

93
Q

Describe transmitted voice sounds in airless lungs as in lobar pneumonia

A

spoken words are louder, clearer. spoken ee heard as ayy.

94
Q

Describe breath sounds in a airless lung as in lobar pneumonia

A

bronchial or bronchialvesicular over the involved area

95
Q

Describe late inspiratory crackles

A

begin in the first half of inspiration and are continue into late inspiration

96
Q

What are the causes of late inspiratory crackles

A

interstitial lung disease (fibrosis), early CHF

97
Q

Describe early inspiratory crackles

A

appear and end soon after the start of inspiration

98
Q

What are the causes of early inspiratory crackles

A

chronic bronchitis and asthma

99
Q

When are mid inspiratory and expiratory crackles heard

A

bronchiectasis but not specific for diagnosis. Can be associated with wheezing and rhonchi

100
Q

When do wheezes occur

A

when air flows rapidly through bronchi that are narrowed nearly to the point of closure. Often are audible through the mouth and chest.

101
Q

What are the causes of wheezing

A

Asthma, COPD, chronic Bronchitis, CHF

102
Q

What do rhonchi suggest

A

secretions in the larger airways and can be cleared with coughing in diseases such as chronic bronchitis

103
Q

In sever obstructive pulmonary disease what does silent chest mean

A

Pt is unable to force enough air through the narrowed bronchi to produce wheezing this warrants immediate attention

104
Q

What does persistent localized wheezing suggest

A

partial obstruction of the bronchus by a tumor or foreign body

105
Q

What is a wheeze that is predominantly inspiratory called

A

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

106
Q

Creaking sounds that occur when pleural surfaces are inflammed and roughened

A

pleural rub

107
Q

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

A

Mediastinal crunch

108
Q

What are some evidence of distress

A

tripoding, pursed lip breathing, central cyanosis, accessory muscle use, retractions

109
Q

Percussion helps to determine what

A

air filled lungs vs fluid filled or solid mass

110
Q

When percussing during the pulmonary exam Resonance means what

A

healthy aerated lungs loud intensity

111
Q

When percussing during the pulmonary exam hyperresonance means what

A

air trapping, very loud intensity

112
Q

When percussing during the pulmonary exam hyporesonance sounds like what

A

dull/flat lower intensity

113
Q

When would you perform diaphragmatic excursion

A

respiratory expansion is asymmetrical, abnormal percussion notes, adventitious breath sounds

114
Q

Describe a normal diaphragmatic excursion

A

Resonance above the level of the diaphragm

115
Q

This adventitious sound is intermittent, brief, nonmusical and is more fine than course

A

Crackle (rales)

116
Q

This adventitious sound is continuous, musical, and high pitched

A

Wheezes

117
Q

This adventitious breath sound is continuous, snoring quality, and low pitched

A

Rhonchi

118
Q

This test is performed if crackles are appreciated

A

Post tussive check

119
Q

This test involves the patient saying EE during auscultation and if abnormal will sound like AYY

A

egophony

120
Q

This test involves the pt whispering 123 during auscultation if abnormal the sounds will be loud and clear as a result of consolidation

A

whispered pectoriloquy

Physical Diagnosis (9 decks)

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