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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
Q

Crepitus (bone vs subq)

A

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

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26
Q

Causes of limited chest excursion

A

Unilaterally due to chronic lung/pleural fibrosis, pleural effusion, lobar pneumonia, pain/splinting

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27
Q

Subcutaneous emphysema

A

Trapped air from lung/chest tracks along tissue plans that can cause “swelling” of the eyelids, cheeks, lips, neck and chest

28
Q

Reasons for decreased fremitus

A

Obstructed bronchus, COPD, pleural effusion, lung fibrosis, pneumothorax

29
Q

Reasons for increased fremitus

A

Pneumonia or consolidation

30
Q

Resonant percussion tone

A

Over air (lungs)
Intensity: loud
Pitch: low
Duration: long

31
Q

Dull percussion tone

A

Over solid (liver and sometimes muscle)
Intensity: medium
Pitch: moderate
Duration: moderate

32
Q

Flat percussion tone

A

Over fluid-filled areas (bone or muscle)
Intensity: soft
Pitch: high
Duration: short

33
Q

Tympani percussion tone

A

Over hollow areas (stomach/gastric bubble)
Intensity: loud
Pitch: high
Duration: moderate

34
Q

Hyper-resonant percussion tone

A

Intensity: very loud
Pitch: low
Duration: long

35
Q

Abnormal hyper-resonant percussion sound in lungs

A

COPD, pneumothorax

36
Q

Abnormal resonant percussion sound in lungs

A

Chronic bronchitis

37
Q

Abnormal tympanic percussion sound in lungs

A

Large pneumothorax

38
Q

Abnormal dull percussion sound in lungs

A

Pneumonia or pleural effusion

39
Q

Abnormal flat percussion sound in lungs

A

Pleural effusion

40
Q

Tracheal breath sounds

A

Duration: inspiration and expiration about equal
Intensity: very loud
Pitch: relatively high
Location: over the trachea in the neck

41
Q

Bronchial breath sounds

A

Duration: expiration longer than inspiration
Intensity: loud
Pitch: relatively high
Location: over manubrium

42
Q

Broncho-vesicular breath sounds

A

Duration: inspiration and expiration about equal
Intensity: moderate
Pitch: moderate
Location: 1st and 2nd interspaces anteriorly, interscapular posteriorly

43
Q

Vesicular breath sounds

A

Duration: inspiration longer than expiration
Intensity: soft
Pitch: relatively low
Location: most of peripheral lung

44
Q

Bronchophony (what does it indicate)

A

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
Q

Egophony (what does it indicate)

A

When patient says “EE” and it sounds nasally like “AAY” during auscultation, presence of the E-A change indicates lung consolidation/collapse

46
Q

Adventitious lung sound examples

A

Sounds that are superimposed on the usual breath sounds like crackles, rhonchi or wheezes

47
Q

Crackles

A

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
Q

Rhonchi

A

Continuous, low pitched musical sounds (longer) that suggests secretions in larger airways that often clear with a cough (chronic bronchitis)

49
Q

Wheezes

A

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
Q

Fine vs course crackles

A

Fine: soft, high pitched, very brief (5-10 msec)
Coarse: louder, lower pitch, brief (20-30 msec)

51
Q

Pleural friction rub

A

Crackle-like creaking sounds due to inflamed pleural surfaces rubbing together (recent URI, pneumonia)

52
Q

Mediastinal crunch (Hamman’s sign)

A

Precordial crackles in sync with heartbeat not respiratiion that is from mediastinal emphysema (pneumomediastinum)
*best heard in left lateral position

53
Q

Fremitus

A

Palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization

54
Q

Pleural effusion

A

Fluid collection within the chest but outside lung, causing compression

55
Q

Pneumothorax

A

Air collection within the chest but outside lung, causing compression

56
Q

COPD

A

Overdistention of distal airspaces, resulting in limited expiratory flow and lunch hyperinflation

57
Q

Consolidation/infiltrate

A

Alveoli filled with fluid/blood/pus increasing the density and opacity of the lung tissue

58
Q

What disorders can the physical findings from our pulmonary exam help diagnose?

A

Normal lung, pneumonia, pleural effusion, pneumothorax, COPD, asthma, chronic bronchitis

59
Q

Characteristics of a normal air-filled lung

A

Percussion: resonant
Breath sounds: mostly vesicular except over large bronchi (bronchovesicular) and trachea (bronchial)
Transmitted voice sounds: normal
Tactile fremitus: none

60
Q

Characteristics of consolidation/pneumonia

A

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
Q

Whispered pectoriloquy

A

Whispers sound louder on auscultation of the lung

62
Q

Characteristics of pleural effusion

A

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
Q

Characteristics of pneumothorax

A

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
Q

Characteristics of COPD

A 
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
Q

Characteristics of asthma

A

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
Q

Characteristics of chronic bronchitis

A

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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