Exam 2 Flashcards
What is a Normal Adult Chest? Draw
Symmetrical
What is a Funnel Chest? Draw
Breastbone sinks into the chest
What is Pectus Excavatum?
Congenital chest wall deformity caused by growth abnormality of the cartilage that connects the ribs to the breastbone (Sternum). Sunken in or funnel chest appearance. More common in boys.
What is Barrel Chest? Draw
Anterior and posterior are the same width as the left and right. Round like a barrel due to lungs being chronically OVER inflated with air (associated with COPD or Emphysema; CO2 is unable to escape).
What is Pigeon Chest (Pectus Carinatum)? Draw.
Non-Life threatening condition. Marked by an abnormally outward protruding breastbone.
Cause: Rapid cartilage growth forcing the front o the chest cavity outward.
What is Traumatic Flail Chest? Draw.
When does it occur?
2 or more contiguous rib fractures with 2 or more breaks per rib. Serious. Associated with morbidity and mortality.
Occurs when a portion of the chest wall is destabilized. Typically from blunt force trauma.
What is Thoracic Kyphoscoliosis? Draw. (Hint: Zombie Walk)
What causes this?
Abnormal curve of the spine on two planes: Coronal (side to side) and Sagittal (back to front)
No known cause but can be the result of: Prolonged bad posture, Osteochondrodysplasia, Degenerative Disease(s), Neuromuscular Disease(s), Connective Tissue Disease(s), & TB
What are the abnormal s/s in patients (pt) with Dyspnea/Respiratory Distress?
Trouble Breathing
Use of accessory muscles (Sternocleidomastoids & Scalenes)
Asthma (Bronchial Hyper-responsiveness & Broncho-constriction)
Pneumonia
Spontaneous Pneumothorax
Acute Pulmonary Embolism (sudden onset with Tachypnea)
Chronic Bronchitis
COPD
Left sided heart failure
Hyper ventilation
What is the primary subjective data process in order to assess a pt with complains of chest discomfort?
OLDCART
What does OLDCART stand for?
Onset Location Duration Characteristics of Symptoms Associated Manifestations Treatment
What is Tactile Fremitus?
Vibration of the chest wall
How do you assess Tactile Fremitus?
Compare both sides of the chest, using the ball or ulnar surface of your hand.
Fremitus is usually decreased or absent over the precordium when examining a woman (displace breasts if needed)
Ask the patient to repeat the words “ninety-nine” or “one-on-one”.
What does an increase transmission of voice sounds suggest?
An air-filled lung has become airless.
Increase in tactile fremitus indicates denser or inflamed lung tissue
Characteristics of Breath Sounds: Vesicular
Duration: Inspiratory sounds last longer than expiratory sounds
Intensity of Expiratory Sound: Soft
Pitch of Expiratory Sound: Relatively Low
Locations where heard normally: Over most of both lungs
Breath Sounds: Bronchovesicular
Duration: Inspiratory and expiratory sounds are about equal
Intensity: Intermediate
Pitch: Intermediate
Locations to hear: Often in the 1st and 2nd intercostal spaces anteriorly and between the scapulae
Breath sounds: Bronchial
Duration: Expiratory lasts longer than inspiratory
Intensity: Loud
Pitch: Relatively High
Locations to hear: Over the manubrium if heard at all
Breath Sounds: Tracheal
Duration: Inspiratory and expiratory sounds are about equal
Intensity: Very Loud
Pitch: Relatively high
Location to hear: Over the trachea in the neck
Abnormal Breath Sounds: Non-Continuous. What does it sound like?
Crackles (or rales)
Intermittent, nonmusical, and brief
Like dots in time
Fine crackles (soft, high pitched, very brief) 5-10 msec
Coarse Crackles (louder, lower in pitch, brief) 20-30 msec
Abnormal breathing sounds: Continuous. What does it sound like?
Wheezes and Rhonchi
Greater or equal to 250 msec. Sinusoidal prolonged
Like dashes in time
Wheezes = musical, relatively high pitched with hissing or shrill more than or equal to 400 hz
Rhonchi = low pitched with snoring quality less than 200 hz
Factors that aggravate asthma and associated symptoms. What is the process?
Bronchial hyper responsiveness involving release of inflammatory mediators, increased airway secretions and bronchoconstriction
What is the Timing?
Acute episodes, separated by symptom-free periods, nocturnal episodes are common
What are the aggregating factors?
Allergies, Pollen, Chemicals, Mold, Pollution, Sinus Infections, Acid Reflux, Bad Weather, Physical exercise
What are the symptoms of Asthma?
Wheezes on exhalation, Dyspnea (SOB), Tachypnea, Chest pain, Frequent coughing/wheezing, Fatigue, Low peak flow meter reading.
Percussion Notes: Flatness
Intensity: Soft Pitch: High Duration: Short Location: Thigh Pathologic ex: Large pleural effusion
Percussion sounds: Dullness
Intensity: Medium Pitch: Medium Duration: Medium Location: Liver Pathologic Ex.: Lobar Pneumonia
Percussion Sounds: Resonance
Intensity: Loud Relative Pitch: Low Relative Duration: Long Location: Healthy lung Pathologic Ex.: Simple chronic bronchitis
Percussion: Hyperresonance
Intensity: Very loud Pitch: Lower Duration: Longer Location: N/a Pathologic Ex.: COPD, Pneumothorax
Percussion: Tympany
Intensity: Loud Pitch: High Duration: Longer Location: Gastric air bubble or puffed out cheek Patho Ex.: Large pneumothorax
What is the order of the Lung Lobes?
RUL = Right Upper Lobe RML = Right Middle Lobe RLL = Right Lower Lobe
LUL = Left Upper Lobe LLL = Left Lower Lobe
What are the sources of chest pain? : Pulmonary
Bronchitis = trachea and large bronchi Pneumonia = parietal pleura
Source Chest Pain: Cardiac
Pericarditis = Pericardium (around heart)
Angina Pectoris = Myocardium
Myocardial Infarction = Myocardium
Dissecting Aortic Aneurysm = Aorta
Sources of Chest Pain: Epigastric
Reflux Esophagitis = Esophagus
Esophageal Spasm = Esophagus
Gastritis = Stomach
Biliary Colic = Gallbladder
What is the proper use of a Rescue Inhaler?
Blow all your air out
Start creating a vacuum with your diaphragm
Just as breathing in = pop rescue inhaler
Hold it in as long as possible then exhale
Rinne Test: How to determine Conductive Loss?
Turning fork at external auditory meatus then on mastoid bone
Air Conduction = vertical when turning fork
Bone Conduction = Horizontal turning fork
BC greater than AC
Rinne Test: How to determine Sensorineural Loss?
Turning fork at external auditory meatus then on mastoid bone
Air conduction: vertical turning fork
Bone Conduction: horizontal turning fork
AC greater than BC (Normal finding)
Weber Test: What comes with conductive loss?
Sound lateralizes toward the affected ear
What comes with unilateral sensorineural loss?
Sound lateralizes to the normal or better-hearing side
Weber Test: What is the difference between Conductive and Sensorineural Loss?
Conductive
Turning fork @ Vertex
Sound lateralizes to impaired ear = room noise not well heard, detection of vibration improves
Sensorineural
Turning fork at Vertex
Sound lateralizes to good ear = inner ear or cochlear nerve damage impaired transmission to affected ear
What are the visual characteristics of a normal eardrum?
Tympanic membrane is pinkish gray
Malleus lies behind the upper part of the ear drum
Above the short process lies the pars flaccida
Remainder of the drum is the pars tensa
From the umbo, the bright cone of light fans anteriorly and downward
Posterior to the malleus, part of the incus is visible behind the drum
The small blood vessels along the handle of the malleus are normal
What does an Abnormal Eardrum look like?
Opaque, erythema, bulging, discharge from ruptured eardrum (no perforation)
What are the S/S of inner ear problems?
Earache = pain in the ear Discharge = associated with trauma or ear-ache Tinnitus = perceived sound that has no external stimulus and commonly heard as musical ringing, buzzing or a rushing or roaring noise Vertigo = perception that the room in spinning or rotating (middle or inner ear problem)
How do you palpate paranasal sinuses?
Palpate with your thumbs
Frontal = Above orbit
Maxillary sinus = below orbit
Which cranial nerve is associated with the inability to move the tongue
Hypoglossal nerve (CN XII)
Ctrl. Muscles of the tongue
Cranial nerves 11 & 12
