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Medicine 1 > Block 4 > Flashcards

Block 4 Flashcards

1
Q

The first palpable rib

A

2nd rib, at the level of the sternal angle

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2
Q

Costal cartilages of 1-7 ribs articulate with?

A

the sternum

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3
Q

Cartilages of 8th, 9th , and 10th ribs articulate with ?

A

the costal cartilages just above them

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4
Q

Ribs ______ are “floating”, - no anterior attachments

A

Ribs 11 and 12

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5
Q

Tip of 11 – felt _____

A

laterally

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6
Q

Tip of 12 – felt _____

A

more posteriorly

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7
Q

Inferior tip of scapula – at the level of ?

A

7th rib or interspace

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8
Q

most prominent vertebrae

A

C7 is the most prominent vertebrae, it is followed by T1

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9
Q

– drop vertically from the anterior and posterior axillary folds

A

Anterior and Posterior axillary lines

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10
Q

– drops from the apex of the axilla

A

Midaxillary line

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11
Q
  • along spinous process
A

Vertebral line

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12
Q

– from inferior angle of scapula

A

Scapular line

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13
Q

Apex rises _______cm above the clavicle

A

2 -4cm

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14
Q

The lower border of the lung crosses the ?

A

6th rib – 8th rib

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15
Q

The lung descends or ascends during inspiration?

A

Descends

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16
Q

The lower border of the lung crosses the 6th rib at the _____ and 8th rib at the _____

A

The lower border crosses the 6th rib at the MCL and 8th rib at the MAL

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17
Q

Posteriorly, the lower border of the lungs is about the level of ?

A

T10

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18
Q
  • above the clavicles
A

Supraclavicular

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19
Q

– below the clavicles

A

Infraclavicular

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20
Q

– between the scapulae

A

Interscapular

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21
Q

– below the scapulae

A

Infrascapular

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22
Q

– lowermost portions

A

Bases of the lungs

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23
Q

The trachea bifurcates into its mainstem bronchi at the levels of the _____ anteriorly…

A

Sternal Angle

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24
Q

The trachea bifurcates into its mainstem bronchi at the levels of the _____ posteriorly…

A

T4 Spinous Process

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25
Q

Pursed lip

A

COPD

Creates pressure and keeps airways open

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26
Q

Seen in Difficulty of Breathing, widened nostrils for air seen in infants

A

Nasal flaring

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27
Q

Supraclavicular fossae – is it an acute or chronic finding?

A

chronic finding

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28
Q

Accessory muscles of breathing:

A

sternocleidomastoid
scalene
serratus anterior

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29
Q

Anteroposterior diameter is increased due to air trapping

Seen in COPD patients

AP>Transverse diameter

A

Barrel Chest

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30
Q

structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally

This produces a caved-in or sunken appearance of the chest.

A

Pectus Excavatum

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31
Q

“pigeon chest”

Protrusion of the sternum and ribs

A

Pectus Carinatum

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32
Q

Configuration in whch one chest wall moves paradoxically inward during inspiration

Seen in 2-point fracture of the same rib

Distal and proximal ends of the rib

trauma

A

Flail Chest

Why? Inspiration – negative pressure – sucks flail segment out
Expiration – positive pressure – flail segment pushed out

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33
Q

Is it okay to ask the patient to breathe normally?

A

Never ask the patient to breathe “normally”

Patient becomes anxious or conscious, thus voluntarily change their breathing patterns and rates

A better way is to direct your eyes to the patient’s chest after taking the radial pulse

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34
Q

Seen in exercise, anxiety, and metabolic acidosis

A

Rapid Deep Breathing (Hyperpnea, Hyperventilation)

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35
Q

is deep breathing due to metabolic acidosis. It may be fast, normal, or slow

A

Kussmaul breathing

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36
Q

What to consider in Rapid Deep Breathing (Hyperpnea, Hyperventilation)?

A

Consider infarction, hypoxia, or hypoglycemia

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37
Q

Mechanism of Rapid Deep Breathing (Hyperpnea, Hyperventilation) in renal failure?

A

Usually in renal failure -> decrease in plasma bicarbonate -> acidosis -> compensatory increase in ventilation mitigates the fall in systemic pH -> blow off co2

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38
Q

An oscillation of ventilation between apnea and hyperpnea with a crescendo-decrescendo pattern

Periods of deep breathing alternate with periods of apnea (no breathing)

Associated with changing serum partial pressures of oxygen and carbon dioxide

Brain tumor, stroke

Pons

A

Cheyne-Stokes Breathing

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39
Q

Seen in brain tumors, stroke -> affected respiratory centers

A

Cheyne-Stokes Breathing

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40
Q

Begins with hyperventilation -> blow of CO2 -> triggers apnea ->Rise in CO2 -> hyperventilation recurs -> cycle repeats

A

Cheyne-Stokes Breathing

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41
Q

Characterized by unpredictable irregularity

Breaths may be shallow or deep, and stop for short periods

Causes: respiratory depression and brain damage typically at the medullary level

Most commonly seen in meningitis

A

Biot’s Breathing (Ataxic Breathing)

42
Q

used to assess patients with CNS depression

A

Cheyn Stokes and Biots

43
Q

– Medulla

A

Biots

44
Q

– Pons

A

Cheyn Stokes

45
Q
  • Rapid Gasping + apnea
A

Biot’s

46
Q
  • Increase and Decrease + Apnea
A

Cheyn Stoke’s

47
Q

“chest pain” may musculoskeletal –

A

costochondritis

48
Q

How to do Chest Lag Test for Lung Excursion?

A

Place your thumbs at about the level of the 10th ribs, with fingers loosely grasping and parallel to the lateral rib cage
Slide your hands slightly medially just enough to raise a loose fold of skin
Ask the patient to inhale deeply
Watch the distance between your thumbs as they move apart
Check for symmetry
Localized pulmonary disease may cause one side of the chest to move less than the opposite

49
Q

palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks

A

Fremitus

50
Q

Use the _____ surface of the hand in palpating fremitus

A

ulnar

51
Q

Locations of palpating fremitus

A

Image

52
Q

Transmission of fremitus is increased in what conditions?

A

in conditions that increase the density of the lung

Consolidation

Mass

53
Q

Fremitus is decreased as it travels through liquid or air:

Examples of conditions—–

A

Pneumothorax

Pleural effusion

54
Q

sound travels faster in what medium?

A

sound travels faster through solid

55
Q

Percussion Penetrates only up to ____cm

A

5cm to 7cm

56
Q

How to perform percussion?

A

Hyperextend the middle finger of your left hand (pleximieter finger)
Press its distal interphalangeal joint firmly on the surface to be percussed
Other fingers should not be touching the chest
With a quick, sharp but relaxed wrist motion, strike the pleximeter finger with the right middle finger (plexor finger)
Strike using the tip of the plexor, not the finger pad

57
Q

Pattern of Percussion

A

Image

58
Q

thigh on percussion

A

Flat –

59
Q

liver on percussion

A

Dull –

60
Q

Normal lung on percussion

A

Resonant –

61
Q

COPD on percussion

A

Hyperresonant –

62
Q
  • stomach on percussion
A

Tympanitic

63
Q

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

A

Dullness

64
Q

Condition with dull percussion

A

Lobar pneumonia
Pleural effusion
Hemothorax
Empyema

65
Q

– heard over hyperinflated lungs

A

Generalized Hyperresonance

66
Q

Conditions with generalized hyperresonance

A

COPD or Asthma

67
Q

Unilateral hyperresonance in?

A

Large pneumothorax

68
Q

barrel chest

A

COPD –

69
Q

How to check for Descent of Diaphragm (Diaphragmatic Excursion)?

A

Hold the pleximeter finger above and parallel to the expected level of dullness
Percuss downward until dullness clearly replaces resonance

70
Q

An abnormally high level of diaphragm suggests?

A

pleural effusion, or a high diaphragm as in phrenic nerve paralysis

71
Q

Pattern of auscultation

A

Image

72
Q

The most important examination technique for assessing air flow through the tracheobronchial tree

A

Auscultation

73
Q

Breath sounds:

A

Vesicular
Bronchovesicular
Bronchial

74
Q

Adventitious breath sounds:

A

Crackles
Wheezes
rhonchi

75
Q

Soft, low pitched sounds heard over most of the lung field
Produced by air moving through the small bronchioles and alveoli
Inspiratory component is much longer than the expiratory component

A

Vesicular

76
Q

Mixture of bronchial and vesicular sounds
Inspiratory and expiratory components are equal in length
Normally heard in the first and second interspaces anteriorly, and between the scapulae posteriorly (mainstem bronchi)

A

Bronchovesicular

77
Q

Loud, high pitched, and sound like air rushing through a tube
Expiratory component is louder and longer than the inspiratory component
Normally heard over the manubrium (over the trachea)

A

Bronchial

78
Q

Harsh, loud, high-pitched sounds heard over the extrathoracic trachea
Inspiratory and expiratory components are approximately equal

A

Tracheal

79
Q

Short, discontinuous, nonmusical sounds heard mostly during inspiration
Caused by opening or expansion of collapsed distal airways and alveoli due to secretions
“Rubbing hair next to ear”

A

Crackles/Rales or crepitation

80
Q

Inspiratory phase
High pitch
hair

A

Fine:

81
Q

Both phases
Low pitch
bubble

A

Coarse:

82
Q

Continous, high-pitched sounds heard mostly during expiration
Produced by turbulent airflow through narrowed bronchi
Swelling, secretions, tumor, foreign body
Bronchospasm of asthma

A

Wheeze

83
Q

Can wheezing be both inspiratory and expiratory?

A

Can be both inspiratory and expiratory - worse

84
Q

Lower pitched, more sonorous lung sounds
“snoring” quality
More common with transient mucus plugging and poor movement of airways

A

Rhonchi

85
Q

Low pitch and continuous (insp/exp) compared to wheezing

Occurs when air passes through large airways filled with secretions -> turbulent fow

Cleared with coughing (secretions)

A

Rhonchi

86
Q

Grating sound produced by motion of pleura, which is impeded by frictional resistance
When pleural surfaces are roughened or thickened
Pleuritis/pleurisy
Best heard: end of inspiration and beginning of expiration
Creaking leather

A

Pleural Rub

87
Q

Mechanism:

Crackles

A

Alveolar secretions

88
Q

Mechanism:

Wheeze

A

Airflow through obstructed airway

“whistle”

89
Q

Mechanism:

Rhonchi

A

Airway plugging;

Turbulent flow through large airway secretions

90
Q

Mechanism:

Pleural Rub

A

Inflammation of the pleura, loss of lubrication

91
Q

Causes:

Crackles

A

Bronchitis, pneumonia, pulmonar9y edema, atelectasis

92
Q

Causes:

Wheeze

A

Asthma

Bronchitis

93
Q

Causes:

Rhonchi

A

Bronchitis

94
Q

Causes:

Pleural Rub

A

Pleuritis, Pneumonia

95
Q

Is an increased resonance of voice sounds
Enhanced transmission of high-frequency sound across fluid
Caused by consolidation, pleural effusion and fibrosis
E to A transition

A

Egophony

96
Q

Intensification of the whispered word heard
Instruct the patient to whisper “one two three”, while examiner listen to the area suspected of consolidation
Normally, whispering produces high-pitched sounds that are filtered out by the lungs, so nothing is heard
If consolidation is present, whispered words are louder and clearer

A

Whispered Pectoriloquy

97
Q

Increased transmission of spoken words heard in the presence of consolidation of the lungs
Says “ninety-nine”, while the examiner listens
If bronchophony is present, words are transmitted more loudly than normally

A

Bronchophony or “Tactile Fremitus”

98
Q

Same as whispered pectoriloquy, but spoken instead of whispered

A

Bronchophony or “Tactile Fremitus”

99
Q

Inreased vocal fremitus =

A

increased tactile fremitus also

100
Q
  1. The clerk notes that a client has periods of deep breathing alternating with periods of apnea. He documents the presence of which of the following?

Cheyne-Stokes respirations
Dyspnea
Kussmaull’s
Biot’s (Ataxic breathing)

A

Cheyne-Stokes respirations

Medicine 1 (7 decks)

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