H&P Thorax/Lungs

Question 1

Trachea Bifurcation

Answer 1

• Sternal Angle

- T4 posteriorly

Question 2

Visceral Pleura

Answer 2

Covers outer surface of lungs

Question 3

Parietal Pleura

Answer 3

Lines inner rib cage and upper surface of diaphragm

Question 4

Pleura Space

Answer 4

Space between visceral and parietal pleura

Question 5

Primary Muscles of Respiration

Answer 5

Diaphragm and intercostal muscles

Question 6

Accessory Muscles of Respiration

Answer 6

Sternocleidomastoid and Trapezius

Question 7

Stridor

Answer 7

• High pitched wheeze
• Largely Inspiratory
• Results from turbulent airflow in upper airway
• Indicates laryngeal/upper airway obstruction
• ->epiglottitis, foreign body aspiration

Question 8

Clubbing of fingers

Answer 8

-Linked to heart or lung condition (COPD)

Question 9

Pursed lip breathing

Answer 9

• Possible sign of COPD
• Reduces respiratory rate from 20–>12/15
• Increases Tidal Volume
• Decrease PaCO2, Increases Pa02

Question 10

Crackles (rales)

Answer 10

• Caused by “popping open” of small airways and alveoli that have collapsed
• ->fluid in the lung (e.g pneumonia, CHF)
• High pitched, discontinuous sounds

Question 11

Rhonchi

Answer 11

• Snoring, coarse quality
• Caused by airway secretions and narrowing/partial obstruction (e.g. bronchitis, COPD)
• Low-pitched, continuous

Question 12

Wheeze

Answer 12

• High pitched, continuous
• Whistle
• Caused by airways obstruction (e.g. asthma)
• Bronchus

Question 13

Apnea

Answer 13

• Absence of breathing

- Cause: Cardiac arrest

Question 14

Biot’s

Answer 14

• irregular breathing with long periods of apnea

- Causes: increased ICP, drug induced respiratory depression, brain damage

Question 15

Cheyne-Stokes

Answer 15

• Irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea
• Causes: Drug induced respiratory depression, CHF, brain damage

Question 16

Kussmaul’s

Answer 16

• Fast and deep breathing

- Causes: metabolic acidosis

Question 17

Pectus carinatum

Answer 17

Protrusion of sternum and ribs

Question 18

Pectus excavatum

Answer 18

Caved-in or sunken chest

Question 19

Atelectasis

Answer 19

• Loss of air from lung or collapse of lung tissue with reduced lung volume
• Can result from blockage of air passage with mucus or from pleural effusion

Question 20

Tension Pneumothorax

Answer 20

Large amount of air entering the chest when a one-way valve (air in) is formed by an area of damaged tissue

Question 21

Pneumonia

Answer 21

• Refers to pneumonitis (inflammation of the lung)
• Lower respiratory infection
• Usually due to infection, but sometimes has noninfectious cause
• Has additional feature of pulmonary infiltrates/consolidation

Question 22

Consolidation

Answer 22

• Condition in which lung tissue becomes firm and solid rather elastic and air-filled
• Due to accumulated fluids and tissue debris

Question 23

Lung/pulmonary infiltrates

Answer 23

• Filling of the air spaces with fluid

- Infiltrates can cause consolidation

Question 24

Pleural effusion

Answer 24

Collection of fluid in the pleural space (space between visceral and parietal pleura)

Question 25

Hemothorax

Answer 25

-Blood in the pleural space

Question 26

Empyema

Answer 26

• Pus in the pleural space

- Usually results from infection that spreads from the lungs (e.g. pneumonia, abscess)

Question 27

Pleurisy/Pleuritis

Answer 27

Inflammation of the pleura

Question 28

Bronchitis

Answer 28

• Inflammation of the bronchi (does not involve the lungs)
• URI
• Acute or chronic

Question 29

Asthma (obstructive lung dz)

Answer 29

• Bronchial tubes (airways) are hyper-responsive
• Airways become inflamed and produce excess mucus
• Muscles around the airways tighten making the airways narrow=obstruct breathing
• Reversible w/ steroids
• Wheezing

Question 30

COPD (emphysema)

Answer 30

• Airway resistance and residual volume of air even after expiration
• Can result in hyper inflated lungs and barrel chest
• Irreversible

Question 31

Pleural Friction Rub

Answer 31

• Squeaking/grating sound of the pleural linings rubbing together
• Associated with pleurisy

Question 32

Crepitus

Answer 32

• Palpable grating/crunching

- Can occur with rib movement due to fracture (bone crepitus)

Question 33

Tactile Fremitus

Answer 33

• Vibrations transmitted through bronchopulmonary tree
• Use ulnar surface of the hand, ask pt to say “ninety-nine”
• Increased Fremitus: consolidation increases transmission (e.g. pneumonia)
• ->solid transmits sound better than air
• Decreased fremitus: Air and effusions decrease transmission (e.g. pleural effusion, pneumothorax, COPD, fibrosis)

Question 34

Normal breath sounds

Answer 34

Tracheal-heard over trachea in the neck
Bronchial-heard over manubrium
Bronchiovesicular- heard in 1st and 2nd interspaces anteriorly and between scapula posteriorly

Question 35

Stridor

Answer 35

• High pitched wheeze
• Largely inspiratory
• Results from turbulent airflow in upper airway
• Indicates laryngeal/upper airway obstruction
• ->epiglottitis, FB aspiration

Question 36

Mediastinal crunch (Hamman sign)

Answer 36

• Loud crackles, clicks and gurgling sounds
• Due to pneumo-mediastinum (mediastinal emphysema)
• Synchronous with heart beat

Question 37

Bronchophony

Answer 37

• “99” heard louder and clearer than normal even at a distance from larynx
• Indicates presence of fluid or solid tissue in alveoli
• E.g. consolidation (pneumonia), atelectasis, tumors

Question 38

Egophony

Answer 38

• “E to A sounds”
• When voice sounds are louder, have a nasal quality
• Indicates consolidation (pneumonia), atelectasis, tumors

Question 39

Whispered pectoriloquy

Answer 39

-whisper heard more loudly through consolidated lung tissue

=consolidation (pneumonia), atelectasis, tumors