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X Physical Diagnosis > L4 Pulmonary and Chest Assessment > Flashcards

L4 Pulmonary and Chest Assessment Flashcards

1
Q

Lower lung borders

A

6th rib midclavicular line, 8th rib midaxillary line, T10 posteriorly

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2
Q

What is the level of the bronchi?

A

Sternal angle anteriorly and T4 posteriorly

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3
Q

Normal respirations

A

14-20 breaths/min

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4
Q

Techniques of examination for lungs

A

Inspection, palpation, percussion and auscultation

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5
Q

Stridor

A

High-pitched usually inspiratory wheeze due to larynx or tracheal obstruction

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6
Q

What does stridor indicate?

A

Obstruction in trachea or larynx (foreign body or airway disease)

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7
Q

What is stridor called in children?

A

Croup (from tracheolaryngeal bronchitis)

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8
Q

Causes of tracheal deviation

A

Large pleural effusion, large pneumothorax, mass/tumor

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9
Q

When is accessory muscle use seen?

A

Respiratory distress in COPD or asthma

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10
Q

5 different chest shapes

A

Barrel chest, scoliosis, pectus carinatum, pectus excavatum, kyphosis

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11
Q

Pectus excavatum

A

Also called funnel chest, concave anterior chest (depression of distal sternum)

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12
Q

Pectus carinatum

A

Also called pigeon chest, convex anterior chest (anterior displacement of sternum)

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13
Q

Barrel chest

A

Increased A-P diameter that is seen in aging or COPD

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14
Q

Flail chest

A

Rib fractures that cause paradoxical movement of chest wall, usually blunt trauma that fractures 3+ ribs

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15
Q

Kyphosis

A

Abnormal forward curvature of the spine

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16
Q

Scoliosis

A

Abnormal lateral curvature of the spine

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17
Q

Reasons for bradypnea

A

Diabetic coma, drug-induced respiratory depression

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18
Q

Reasons for tachypnea

A

Restrictive lung disease, elevated diaphragm, pain

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19
Q

Sighing

A

Periodic deeper breaths

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20
Q

Obstructive breathing

A

Prolonged expiration, increased airway resistance

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21
Q

Cheyne-Stokes breathing

A

Periods of gradually increasing and decreasing depth of respiration with periods of apnea (irregular but cyclic)

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22
Q

Possible causes of Cheyne-Stokes breathing

A

Heart failure, uremia, brain damage, drug-induced

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23
Q

Kussmaul breathing

A

Rapid and deep respirations that can be a sign of metabolic acidosis

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24
Q

Biot’s breathing

A

Irregular, unpredictable, shallow or deep, with intermittent apnea (not cyclical), can be due to respiratory depression or brain damage

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25
Crepitus (bone vs subq)
Crackling/grating feeling or sound Bone is seen in rib movement from a fracture Subq feels like "rice krispies" under the skin from subcutaneous emphysema
26
Causes of limited chest excursion
Unilaterally due to chronic lung/pleural fibrosis, pleural effusion, lobar pneumonia, pain/splinting
27
Subcutaneous emphysema
Trapped air from lung/chest tracks along tissue plans that can cause "swelling" of the eyelids, cheeks, lips, neck and chest
28
Reasons for decreased fremitus
Obstructed bronchus, COPD, pleural effusion, lung fibrosis, pneumothorax
29
Reasons for increased fremitus
Pneumonia or consolidation
30
Resonant percussion tone
Over air (lungs) Intensity: loud Pitch: low Duration: long
31
Dull percussion tone
Over solid (liver and sometimes muscle) Intensity: medium Pitch: moderate Duration: moderate
32
Flat percussion tone
Over fluid-filled areas (bone or muscle) Intensity: soft Pitch: high Duration: short
33
Tympani percussion tone
Over hollow areas (stomach/gastric bubble) Intensity: loud Pitch: high Duration: moderate
34
Hyper-resonant percussion tone
Intensity: very loud Pitch: low Duration: long
35
Abnormal hyper-resonant percussion sound in lungs
COPD, pneumothorax
36
Abnormal resonant percussion sound in lungs
Chronic bronchitis
37
Abnormal tympanic percussion sound in lungs
Large pneumothorax
38
Abnormal dull percussion sound in lungs
Pneumonia or pleural effusion
39
Abnormal flat percussion sound in lungs
Pleural effusion
40
Tracheal breath sounds
Duration: inspiration and expiration about equal Intensity: very loud Pitch: relatively high Location: over the trachea in the neck
41
Bronchial breath sounds
Duration: expiration longer than inspiration Intensity: loud Pitch: relatively high Location: over manubrium
42
Broncho-vesicular breath sounds
Duration: inspiration and expiration about equal Intensity: moderate Pitch: moderate Location: 1st and 2nd interspaces anteriorly, interscapular posteriorly
43
Vesicular breath sounds
Duration: inspiration longer than expiration Intensity: soft Pitch: relatively low Location: most of peripheral lung
44
Bronchophony (what does it indicate)
When patient says "99" during auscultation and the voice sound is louder Presence indicated lung consolidation or collapse like in pneumonia, atelectasis or tumors
45
Egophony (what does it indicate)
When patient says "EE" and it sounds nasally like "AAY" during auscultation, presence of the E-A change indicates lung consolidation/collapse
46
Adventitious lung sound examples
Sounds that are superimposed on the usual breath sounds like crackles, rhonchi or wheezes
47
Crackles
Discontinuous/intermittent, nonmusical, brief, velcro-like sounds, heard when small airways pop open during inspiration or when air bubbles flow through secretions or closed airways Ex: bronchitis, pulmonary fibrosis, CHF
48
Rhonchi
Continuous, low pitched musical sounds (longer) that suggests secretions in larger airways that often clear with a cough (chronic bronchitis)
49
Wheezes
Continuous, high pitched, shrill, whistling like sounds seen usually on expiration that suggest rapid airflow through narrowed bronchi (asthma, COPD, chronic bronchitis, bronchus obstruction)
50
Fine vs course crackles
Fine: soft, high pitched, very brief (5-10 msec) Coarse: louder, lower pitch, brief (20-30 msec)
51
Pleural friction rub
Crackle-like creaking sounds due to inflamed pleural surfaces rubbing together (recent URI, pneumonia)
52
Mediastinal crunch (Hamman's sign)
Precordial crackles in sync with heartbeat not respiratiion that is from mediastinal emphysema (pneumomediastinum) *best heard in left lateral position
53
Fremitus
Palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization
54
Pleural effusion
Fluid collection within the chest but outside lung, causing compression
55
Pneumothorax
Air collection within the chest but outside lung, causing compression
56
COPD
Overdistention of distal airspaces, resulting in limited expiratory flow and lunch hyperinflation
57
Consolidation/infiltrate
Alveoli filled with fluid/blood/pus increasing the density and opacity of the lung tissue
58
What disorders can the physical findings from our pulmonary exam help diagnose?
Normal lung, pneumonia, pleural effusion, pneumothorax, COPD, asthma, chronic bronchitis
59
Characteristics of a normal air-filled lung
Percussion: resonant Breath sounds: mostly vesicular except over large bronchi (bronchovesicular) and trachea (bronchial) Transmitted voice sounds: normal Tactile fremitus: none
60
Characteristics of consolidation/pneumonia
Percussion: dull over affected area Breath sounds: bronchial over involved area, crackles Transmitted voice sounds: increased (bronchophony present, egophony present, whispered pectoriloquy present) Tactile fremitus: increased
61
Whispered pectoriloquy
Whispers sound louder on auscultation of the lung
62
Characteristics of pleural effusion
Percussion: dull to flat over fluid Breath sounds: decreased or absent over fluid (possible pleural rub) Transmitted voice sounds: decreased to absent Tactile fremitus: decreased to absent
63
Characteristics of pneumothorax
Percussion: hyperresonant or tympanic over pleural air pocket Breath sounds: decreased to absent over pleural air pocket (possible pleural rub) Transmitted voice sounds: decreased to absent over air pocket Tactile fremitus: decreased/absent over pleural air pocket
64
Characteristics of COPD
``` Percussion: diffusely hyperresonant Breath sounds: decreased to absent Transmitted voice sounds: decreased Tactile fremitus: decreased Inspection: increased AP diameter of chest and possibly accessory muscle use ```
65
Characteristics of asthma
Percussion: resonant to diffusely hyperresonant Breath sounds: obscured by high pitched wheezes, possible crackles (have patient cough to see if clear) Transmitted voice sounds: decreased Tactile fremitus: decreased Inspection: possibly accessory muscle use
66
Characteristics of chronic bronchitis
Percussion: resonant (normal) Breath sounds: vesicular (normal), possibly crackles, wheezes or rhonchi Transmitted voice sounds: normal Tactile fremitus: normal

X Physical Diagnosis (3 decks)

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