Chest and thorax Flashcards
What is the normal range for diaphragmatic excursion
3-5 cm
True or false: the diaphragm is usually higher on the left side
True
What sounds are the highest in pitch and intensity
bronchial sounds
What sounds are low-oitched, low intensity sounds of healthy lungs?
vesicular sounds
True or false: crackles usually clear with coughing?
False
When in the breathing cycle are crackles heard?
With inspiration
What are rhonchi?
wheezes usually heard with expiration
When in the breathing cycle are wheezes usually heard?
continuously
True or false: a higher pitched wheeze usually indicates a less severe obstruction
False–higher = worse
What a friction rubs indicative of?
Inflammation
How is bronchophony tested?
having patient say “99”. this will look for consolidation
When is egophony tested?
looking for consolidation
What are the three tests that you can perform for consolidation?
egophony
bronchophony
Whispered pectoriloquy
What are cheyne-stokes patterns?
alternating period of apnea and hypernea, periodic breathing
What are Kussmaul’s respiration?
very deep, gasping and rapid breathing seen in metabolic acidosis
What are grunting respirations?
Short and explosive sounds, more common in children but also in adults as a sign of respiratory muscle fatigue
What are adventitous breath sounds?
abnormal breath sounds auscultated such as crackles, rhonchi, wheezes, and friction rub
Define: atelectasis?
incomplete expansion of the lungs
true or false: patients with a barrel chest also have some degree of kyphosis
true
Define: biot respirations
irregularly respiration varying in depth an interrupted by intervals of apnea that lacks a repetitive pattern
Define: bronchiectasis
chronic dilation of the bronchi or bronchoiles caused by repeated infections or bronchial obstructions
Define: Bronchitis
inflammation of the large airways.
Define: Bronchophony
tissue (greater clarity and increased loudness of the spoken word)
Define: Bronchiolitis
inflammation of the bronchioles
What are the three normal breath sounds?
- Vesicular
- Tubular
- Bronchovesicular
What are vesicular breath sounds?
heard over most of the lung fields; low pitch, soft and short expirations
What are tubular breath sounds?
heard only over trachea, high pitch; loud and long expirations, sometimes a bit longer than
inspiration
What are Bronchovesicular breath sounds?
heard over main bronchus area and over upper right posterior lung field;
medium pitch; expiration equals inspiration
Define: Pectoriloquy
a striking transmission of voice sounds through the pulmonary structures, so that they are
clearly audible through the stethoscope; commonly occurs from lung consolidation.
Define: Pectus carinatum
forward protrusion of the chest
What are the principle muscles used in inspiration?
External intercostals
Diaphragm
What part of the chest do you use in quiet respiration?
Passive recoil of the diaphragm
What are the muscles used in active, expiration?
Internal intercostals
Abdominal muscles
Obliques
What are the muscles used in activeinspiration?
SCM
Scalenes
About what phsycial landmark do the bronchi split?
Sternal angle
The lung exists down to which vertebra?
T10
How far does the diaphragm move?
4-5 cm
What are the four steps of the physical exam?
- Look
- Listen
- Palpate
- Percuss
To get flail chest, what must happen?
Break two portions of three ribs
What palpation sounds are characterisitcs of COPD?
Hyperresonant.
What are the breath sounds of a COPD patient?
Distant with delayed expiratory phase and scattered expiratory wheezes
Will fremitus be increased or decrease in patient with COPD?
Decreased
Will the diaphragm move more or less in a patient with COPD?
Less
Will there be kyphosis in asthma?
No–flattening of it
Will the lungs be resonant in asthma
Yes
Will there be bronchophony, egophony, or whispered pectoriloquy in Asthma?
No
Will there be diaphragmatic changes in asthma?
No
When (in the breath cycle) do wheezes usually occur with asthma?
Expiration
What should be the top thing on your differential if you see a patient with asymmetric chest movement?
Pneumothorax
Will the lung be more or less resonant in pneumothorax?
More
Will breath sounds be decreased or increased in penumothorax?
Decreased throughout
Will there be diaphragamatic excursion changes in pneumothorax?
Yes, decreased on the affected side
Which breath sounds are continuous?
Wheezes and rhonchi
Which breath sounds are discontinuous?
Crackles
What do wheezes indicate?
Narrowed airway
What do rhonchi indicate?
Secretions in large airways
What do crackles indicate?
either abnormalities of the lung, or inspissated secretions (if able to clear)
What is the pitch different between wheezes and rhonchi?
Rhonchi are low
Wheezes are high
Where is the oblique fissue of the right lung found with inspiration (relative to the ribcage)
Right 5th rib along the sternum, traveling to the 6th rib at the midclavicular line
Where is the transverse fissure found in either lung with inspiration (relative to the ribcage)?
4th rib at the midclavicular line
