Chest Flashcards
What area corresponds to the second rib?
manubriosternal junction - angle of louis
Who has chest that are AP=transverse in size?
infants
What is SOB with sitting up?
platypnea
What causes barrel chest in geriatrics?
loss of muscle strength, losee of lung resiliency
What are symptoms that mean chest pain is not from the heart?
There is a constant achiness that lasts all day.
It does not radiate.
It is made worse by pressing on the chest wall.
It is a fleeting, needle-like jab that lasts only a few seconds.
It is situated in the shoulders or between the shoulder blades in the back.
Think of the heart but, importantly, in such circumstances, also think of other possibilities in the chest
What family hx do you want for chest/lung complaint?
Tuberculosis Cystic fibrosis Emphysema Allergy, asthma, atopic dermatitis Malignancy Bronchiectasis Bronchitis Clotting disorders (risk of pulmonary embolism)
How do you calculate pack year?
Number of years of smoking X Number of packs smoked per day
What is in india, indonesia, south africa, nigeria?
TB
What is in midwest?
histo
What is in southwest?
coccidioidmycosis
What is in southwest asia, africa, caribbean?
schistosomiasis
What is a life threatening emergency that occurs when sternum or rib fractures, becoming detached from the rest of the chest and causing loss of stability of the thoracic cage. Can cause respiratory failure?
flail chest
What is the normal resp rate?
10-14/min up to 20
What is SOB when lying down?
orthopnea
Regular and comfortable at a rate of 12-20
normal
slower than 12 breaths per min
bradypnea
faster than 20 breaths per min
tachypnea
faster than 20/min, deep breathing
hyperventilation
freuqently interspersed deeper breaths
sighing
increasing difficulty getting breath out?
air trapping
varying peroids of increasing depth interspersed with apnea
cheyne-stokes
rapid, deep, labored
kussmaul
irregularly interspersed peroids of apnea in disorganized sequence of breaths
biot
significant disorganized with irregular varying depths of respiration
ataxic
What causes an increase in resp?
acidosis, CNS lesion (pons), anxiety, aspirin poisoning, oxygen need (hypoxemia), pain
What causes decrease in resp?
alkalosis, CNS (cerebrum), MG, narcotic overdoses, obesity
What would the breathing be like for a cerebral brain damage pt?
cheyne stokes resp
What are peripheral clues to CV/pulm issues?
Cyanosis of lips and nails especially Breath - malodorous Lips – pursed Nares - flared Nails – clubbing
What does ammonia breath mean?
uremia
What is the normal costal angle?
90
Where is tactile fremitus best felt?
bifurcation of bronchi
What contracts on inspiration?
SCM
What retracts on inspiration
clavicule, intercostals
When is costal angle widened?
pregnancy
Where does the examiner percuss for diaphragmatic excusion?
scapular line
What are low intensity sounds heard over healthy lung fields?
vesicular
What breath sounds are heard over trachea, are high intensity and pitch?
bronchial
What is rales now called?
crackles
In what position is the hammans sign best heard?
LLD
What can cause deviation of trachea away from affected side?
thyroid enlargment, pleural effusion
What way does the trachea deviate in pneumothorax?
either
: a crackly or crinkly sensation, a gentle, bubbly feeling, rubbing hair next to the ear, or sound when Velcro is pulled apart.
Crackles
caused by inflammation of the pleural surfaces. Think of it as the feel of leather rubbing on leather.
pleural friction rub
mucous moving through airways (simple congestion), or with plugging
rhonchi
air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas-producing organism
crepitus
What are the most useful findings for pleural effusion?
tactile fremitus and dullness to percussion
How can you evaluate tactile fremitus?
palmar surface, hand or finger tips, ulnar side of hands
What is egophony?
say eeh and ayy
When is bronchophony clearer?
airless or consildated lungs - lobar pneumonia/ pleural effusion
What causes increased tactile fremitus?
lobar pneumonia of pleural effusion
Where do you put your hands in thoracic expansion?
xiphoid process front
10th rib in back
What is normal percussion?
resonance
What is hyperresonance related to?
emphysema, pneumothorax, asthma
What is dullness of perscussion related to?
pneumonia, atelectasis, pleural effusion, pneumothoax, asthma
What are some percussion errors?
Failing to exert firm pressure with the finger placed on the skin surface
Failing to separate the hammer finger from other fingers
Snapping downward from the elbow or shoulder rather than from the wrist
Tapping by moving just the hammer finger rather than the whole hand
Striking with the finger pad rather than the fingertip of the hammer finger
Failing to trim the fingernail of the hammer finger
What is the diaphragm for?
high pitched
What is the bell for?
low pitched
If you strongly suspect pathologic condition, what do you do with chest auscultation?
start at lung bases
What causes crackles?
bronchitis, resp infection, pulm edema, atelectasis, fibrosis, CHF
What causes wheezes?
asthma, pulm edema, bronchitis, CHF
What causes rhonchus?
bronchitis
What causes pleural rub?
pneumonia, pulmonary infarct
What causes stridor?
after extubation, pertussis, croup, epiglottis, aspiration
high pitched, discrete, discontinuous crackling or popping sounds heard during end of inspiration; not cleared by cough. Can sound like Velcro being pulled apart.
Fine crackles
Lower, more moist sound heard during mid-stage of inspiration; not cleared by cough
Medium crackles
loud, bubbly noise heard during inspiration; not cleared by cough.
coarse crakcles
Loud, low, coarse sounds, like a snore, most often heard continuously during inspiration or expiration; coughing may clear the sound (usually means mucous accumulation in trachea or large bronchi).
rhonchi
Musical noise sounding like a squeak; most often heard continuously during inspiration or expiration; usually louder during expiration
Wheeze
Dry rubbing, creaking or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface. Can sound like walking on fresh snow.
pleural friction rub
a loud, high pitched sound heard during inspiration, but may occur throughout the entire respiratory cycle.
stridor
What is something to note about back percussion?
dont do it over scapula, have pt lean forward
What side is the diaphragm usually higher?
right
What is normal diaphragmatic excusion?
3-5 cm
When is diaphragm motion absent?
phrenic nerve palsy
Where do you listen for middle lobe of right and lingula of left?
axillae
