Ch 8 and 9 Red Bolded Info Flashcards
1
Q
insertion for tension pnumo decompression
A
2nd ICS
2
Q
chest tube location
A
4th ICS
3
Q
lower margin of an endotracheal tube on chest xray
A
T4
4
Q
what runs along the inferior margin of each rib
A
neurovascular structures
5
Q
where do we place needles (in according to ribs)
why?
A
SUPERIOR to rib margins bc neurovascular structures run along the inferior margin
6
Q
- landmark for thoracentesis
- needle insertion?
A
T7-T8–landmark
inser needle immediately superior to 8th rib
7
Q
which lobe is MC for aspirational pnm
why?
A
right middle and lower lobe
bc right main bronchus is more vertical
8
Q
accumulations of pleural efffusions can be?
A
transudates
exudates
9
Q
what diseases cause transudative pleural effusions
A
HF
cirrhosis
nephrotic syndrome
10
Q
what diseases cause exudative pleural effusions
A
pnm malignancy PE TB pancreatitis
11
Q
what diseases causes irritation of the parietal pleura–causing pleuritic pain on deep inspiration
A
viral plurisy pnm PE pericarditits collagen vasc disease
12
Q
viral plurisy pnm PE pericarditits collagen vasc disease
all cause what
A
pleuritic chest pain on deep inspiration
13
Q
define a cough that is:
- acute
- subacute
- chronic
A
- <3 weeks
- 3-8wks
- 8+ weeks
14
Q
MCC for acute cough
list other causes (7)
A
viral URI
OTHERS
- ACE inhibitors
- FB
- smoking
- HF left
- asthma
- pnm
- acute bronchitis
15
Q
MC causes for subacute cough
A
post-infectious cough pertussis acid reflux bacterial sinusitis asthma
16
Q
MCC chronic cough
A
post nasal drip asthma GERD chronic bronchitis bronchiectasis
17
Q
describe mucoid sputum
seen with?
A
transluent white or gray
seen with viral URI and cystic fibrosis
18
Q
descirbe puruelnt sputum
seen with>
A
yellow or green
bacterian pnm
19
Q
foul smelling sputum assoc with
A
anaerobic lung abscess
20
Q
thick tenacious sputum is seen with?
A
CF
21
Q
large volume of purulent sputum seen with
A
bronchiectasis and lung abcess
22
Q
diagnostically helpful s/s to r/i pnm
A
productive cough
fever
23
Q
chest pain
dyspnea
orthopnea
all diagnostic s/s for?
A
Acute coronary syndrome
24
Q
causes of cough + hemopytsis
A
bronchitis
malignancy
CF
less common: -bronchiectasis mitral stenosis Goodpasture syndrome Wegener granulomatosis
25
define life threatning hemoptysis
>200 cm
26
blood originating from stomach is waht color
darker + mixed with food particles
27
blood from resp tract is what color
lighter vs the blood from GI
28
hallmark s/s of obstructive sleep apnea
daytime sleepines and snoring
29
PT population you can see obstructive sleep apnea
```
obesity
posterior malocclusion of jaw
tx resistant HTN
HF
AFIB
stroke
DM2
```
30
bradypnea
under 14 with or w/o increase in tidal volume
31
tachypnea
over 20 and shallow
32
sighing respirations
breathing punctured by frequent signs-- suggests hyperventillation syndrome
33
cheyne-stokes breathing
pds of deep breathing alternating with periods of apnea
34
ataxic breathing
irregular--perids of apnea, alternate with regular deep breaths which stop suddently for shot intervals
35
audible high pitched inspiratory whistling
stridor
36
stridor=
upper airway obstruction in larynx or trachea
| emergency
37
wheezing is???
either expiratory or continuous
38
accessory muscle use signifies (2)
diff breathing from COPD
or
muslce fatigue
39
lateral displacement of trachea seen with
pnothorax
plerual eff
atelectasis
40
barrel chest ratio
over 0.9 for COPD
41
asymmetric chest expansion seen with
plerual effusion
42
retractions occur in?
COPD
severe asthma
upper airway obstruction
43
unilateral impairment or lagging suggests?
*impaired resp movement on one or both sides*
pleural effusion from asbestosis or silicosis
-also seen with phrenic nerve damage or trauma
44
intercostal tenderness develops over?
| indicates?
over the inflammed pleurae
| *costochondritis*
45
tenderness +bruising + bony step offs
fx rib
46
crepitus in chest wall
=chest wall edema seen in mediastinitis
47
sinus tracts suggests
underlying pleura and lung infection
TB
actinomycosis
48
unilateral decrease or delay in chest expansion occurs in?
```
chronic fibrosis of underlying lung or pleura
plerual eff
lobar pnm
pleural pain assoc with splinting
unilateral bronchial obstruction
paralysis of hemidriaphrahm
```
49
unilateral decrease or delay in chest expansion occurs in?
```
chronic fibrosis of underlying lung or pleura
plerual eff
lobar pnm
pleural pain assoc with splinting
unilateral bronchial obstruction
paralysis of hemidriaphrahm
```
50
define decreased or absent fremitus
when the voice is higher pitched or soft or when transmission of vibrations from larynx to the surface of the chest is impeded by a thick chest wall, an obstructed bronchus ...
51
what dz cause decrease fremitus
```
COPD
obstructed bronchus
thick chest wall
plerural eff
fibrosis
air (pnothx)
infiltrating tumor
```
52
asymmetric decrease fremitus raises likelihood of?
unliteral plerual eff, pnuthox, neoplasm
| **all decrease tranmissions of low freq sounds*
53
asymmetric increased fremitus caused BY?
unilateral pnm via increasing transmissions thru consolidations
54
asymmetric increased fremitus caused BY?
unilateral pnm via increasing transmissions thru consolidations
55
dullness replaces resonance when?
fluid or solid tissue replaces air-containing lung
56
dz states that cause dullness to percussion
```
lobar pnm
plerual eff
hemothorax
empyema
firbous tissue
tumor
```
57
dullness is very very suggestive of?
pneumonic and pleral effusions
| 3-4X more likely
58
generalize hyperresonance is common over (antomic location)
| -what dz?
the HYPERinflated lungs
COPD
asthma
59
unilateral hyperresonance suggests?
large pneumothorax or air filled bulla
60
what do u do with your stethescope if there is chest hair
press dow harder or moisten the hair
61
what do u do with your stethescope if there is chest hair
press dow harder or moisten the hair
62
what dz cause transmisson of sound to be poor
pleural eff
pnumothorax
copd
63
a gap b.w inspiration and expiration suggests?
bronchial breath sounds
64
muscle contraction sounds?
what can eliminate this sound
how to reproduce these sounds on yourself?
muffled, low-pitched rumbling or roaring noises
change PT position--elms sound
to recreate: do a valsalva (bearing down)
65
bronchial:
| what is longer expirtion or inspiration
expiratory sounds last longer
66
vesciular: what is longer? exp or insp
inspiration longer
67
bronchial sounds is heard over?
manudrium--- hearing larger airways
68
crackles arise from abnormalities of?
parenchyma (CHF, pnm, etc) or of the airways (bronchitis)
69
crackles arise from abnormalities of?
parenchyma (CHF, pnm, etc) or of the airways (bronchitis)
70
crackles of CHF heard best where
posterior fields
71
define inspissated
thickened secretions
72
clearing of crackles, wheezes or rhonchi after coughing suggests?
inspissated (thick) secretions,
bronchitis
atelectasis
73
stridor and layrngeal sounds best heard over?
neck
74
wheezing and rhonchi are LEAST heard where
neck
75
pleural rubs heard in?
PE
| pleurisy pnm
76
increased voice transmission suggest?
airways are blocked by inflammation or secretions
77
"ee" sounds like?
| indicates?
A
+egophony
lobar pnm from consolidation
78
"ee" sounds like?
| indicates?
A
+egophony
lobar pnm from consolidation
79
only small/large euffions are detected anteriorly
LARGE
| since they usually fall posterior with gravity
80
dulness of right middle love pnm typically occurs where
behind right breast
81
hyperinflated lung of COPD does waht to the liver
displaces the upper border of the liver downward and lowers the level of diaphragmatic dullness posteriorly
82
Pts >60 YO with a forced expiratory time of >9 seconds are?
4x likely to have COPD
83
increase in local pain ---distant from hands---suggests?
rib fx rater than soft tissue injury
84
define crackles
discontinuous nonmusical
early inspiration (COPD)
late inspiration (pulm fibrosis)
biphasic (pnm)
85
are fine or coarse crackles more frequent ber breath?
fine
86
define wheezing
continous musical
| *cannot dissapear with coughing
87
define rhonchi
similar to wheezing but just deeper in pitch
| *can dissapear with coughing
88
```
explain findings for LHF:
percussion
trachea
breath sounds
adventitious sounds
tacticle frem and voice transmission tests
```
```
resonant percussion
midline trachea
vesicular normal breath sounds
adventitious would : late inspiratory crackles in dependent portions of lungs--- sometimes wheezing
normal tacticle fremitus
```
89
```
explain findings for lobar pnm:
percussion
trachea
breath sounds
adventitious sounds
tacticle frem and voice transmission tests
```
dullness to percussion over affected area
midline trachea
bronchial breath sounds over the invovled area
adventious: late insp crackles over inv area
increased tacticle frem and voice transm
+egophony
+brochophony
+whispered pectr
90
```
explain findings for Pleural effusion:
percussion
trachea
breath sounds
adventitious sounds
tacticle frem and voice transmission tests
```
dull to flat over aff area
shifted tachea TOWARDS unaffected side
decreased to absent breath sounds--sometimes bronchial breath sounds over the top of effusion
no adventious sounds----maybe frictoin rub
decreased to absent tacticle fremitus
91
what does it mean if PMI is on the right side
situs inversus and dextrocardia
92
PMI > what number suggests LVH
2.5
93
PMI >2.5
LVH
94
at wht age do s3 and s4 become pathologic in nature
| indicate waht
40
| correlated with HF and acute myocardial ischemia
95
CP in the absence of CAD on angiogram include?
microvascular cardiac nociception and abnormal cardiac nociception
96
anterior CP that is tearing and ripping and radiating to the back
Acute aortic dissection
97
Sudden dyspnea occurs in?
PE
spontaneous pnothx
anxiety
98
orthopnea and PND occur with?
Left ven HF
mitral stenosis
obstructie lung dz
99
PND can be mimcked by?
nocturnal asthma attacks
100
anasarca
severe generalized edema sacrum-->abdomen `
101
a high arm level will make a falsey ___ BP
low bp
102
at lower levels-- the BP will be falsey _____
high
103
JVP measures?
elevations in fluid volume of heart
104
how to lay a hypovolemic or septic pT in order to see jugular veins
supine
105
elevated JVP highly correlated with? (6)
acute and chronic HF
* tricuspid stenosis
* chronic pulm HTN
* SVC obstruction
* cardiac tamponade
* constrictive pericarditis
106
in PT who has obstrucitve lung dz, the JVP will appear?
elevated on expiration
and
veins collapse on inspiration
***DOES NOT indicate HF***
107
elevated JVP is over ____% diagnostic for?
>95% diagnostic for increased left vent end diastolic pressure and low left ventrictular EF
108
abnormally prominent A waves ocurr in? (5)
```
tricuspid stenosis
1st 2nd 3rd HB
SVT
pulm HTN
pulmonc stenosis
```
109
absent a waves indicates?
afib
110
inreased V waves seen with? 3
tricuspid regurg
atrial septal defects
constricitve pericarditis
111
tortuous and kinked carotid artery produces?
inulateral pulsatile bulge
112
causes of decreased jugular pulsastions
drecreas SV from shock or MI
| local athersclerotic narrowing or occulsion
113
putting pressure on cartoids may cause?
reflex bradycardia or drop in BP
114
bounding carotid pulse seen in?
aortic regurg
115
carotid upstroke is delyed in?
aortic stenosis
116
carotid upstroke is ____ in aortic stenosis
delayed
117
pulsus alternans
rhyhtm of pulse remains but the force of arterial pulse alternartes b/w strong and weak
118
paradoxical pulse
varies with respirations
| *greater than normal drop in BP
119
pressure when korotkoff sounds are first heard?
highest systolic pressure respiratory cycle
120
Korotkoff sounds
are generated when a blood pressure cuff changes the flow of blood through the artery.
121
MCC for paradoxical pulse
asthma
Obstructive dz
pericardial tamponade
acute PE
122
thrills
aortic stenosis
123
bruits caused by?
```
athlresclerosis
or
tortuous carotid artery
external carotid arterial dz
aortic stenosis
hyperthyroidsm
```
124
carotid artery stenosis causes?
strokes
| doubles the risk of CHD
125
opening snap
mitral stenosis
126
soft decrescendo
diastolic
high pitch murmur
aortic regurg
127
in sinus situs inversus what is on the right side and left sides?
```
RIGHT:
heart
tri-lobed lung
stomach
spleen
```
LEFT:
liver
GB
128
hyperkinetic high amplitude impulse occurs in?
hyperthyroidism
129
left displacement toward the axillary line from ventricular dilation is seen in?
HF
cardiomyipathy
ischemic HD
130
in the Left lat decubitus position, a ____ PMI with a diameter >3cm signals LVH enlargement
diffuse
131
normal PMI
3-4 cm
132
PMI >4 cm means
left ventricualr overload 5x more likely
133
palpable s2 points to?
increased pulmonary artery pressure from pulmonary HTN
134
what does laying PT in left lateral decubitcus do?
accentuates a left sided S3 and 4 and mitral murmurs---esp mitral stenosis
135
MC extra sound to hear on ausc?
systolic click of mitral valve prolapse
136
mitral regurg usually radiates where
axilla
