Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Physical Dx > L6: Pulmonary & Chest Assessment > Flashcards

L6: Pulmonary & Chest Assessment Flashcards

1
Q

Chest Anatomical Terms

  • Supraclavicular
  • Infraclavicular
  • Interscapular
  • Infrascapular
  • Upper, middle and lower lung fields
  • Apex of the lungs
  • Bases of the lungs
A
  • Supraclavicular: above clavicle
  • Infraclavicular: below clavicle
  • Interscapular: between scapulae
  • Infrascapular: below scapulae
  • Upper, middle and lower lung fields
  • Apex of the lungs: most superior portion of the lungs
  • Bases of the lungs:lowest portion of lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Vertical Axis Landmarks (anterior)

Angle of Louis

2nd Rib

A
  • Sternal angle (aka Angle of Louis)
    • Bony ridge that joins the manubrium and sternal body
      • Located approximately 5cm below the suprasternal notch
  • 2nd rib
    • located lateral to sternal angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Counting Ribs (anterior)

Counting ribs: how?

Intercostal spaces: define

A
  • Counting ribs
    • Walk fingers laterally from sternal angle to the 2nd rib
    • Continue walking fingers down, at an angle, to count ribs and intercostal spaces
  • Intercostal spaces
    • Space between two ribs, numbered by rib above:
      • 2nd left intercostal space (2nd LICS) is below the 2nd rib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Vertical axis landmarks (posterior)

12th rib

Inferior tip of scapula

Spinous process of C7

A
  • 12th rib
    • Start here and walk up the interspaces to count ribs/interspace
  • Inferior tip of scapula
    • Correlates with 7th rib/intercostal space
  • Spinous process of C7
    • Count down from C7: T1 = first rib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Circumferential Landmarks

What are the anterior landmarks?

What are the axillary landmarks?

A
  • Anterior circumferential landmarks
    • Midsternal line (MSL) - precise
    • Midclavicular line (MCL) - estimated
    • Anterior axillary line (AAL) - estimated
  • Axillary circumferential landmarks
    • Posterior axillary line (PAL)
      • Drops from posterior axillary fold
    • Midaxillary line (MAL)
      • Drops from apex of axilla
    • Anterior axillary line (AAL)
      • Drops from anterior axillary fold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lung basics

R & L long lobes

Lung apices: location

Lower lung borders

A
  • Right lung
    • 3 lobes: RUL, RML, RLL
  • Left lung
    • 2 lobes: LUL, LLL
  • Lung apices
    • ~2-4cm above clavicle
  • Lower lung borders
    • 6th rib midclavicular line
    • 8th rib midaxillary line
    • T10 posteriorly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lung basics

Major & minor fissures

What are the other names for these fisures?

Location?

A
  • Major (Oblique) fissure
    • Divides each lung in half
    • From T3 spinous process obliquely around chest to 6th rib at midclavicular line
  • Minor (Horizontal) fissure
    • R lung only
    • Runs close to 4th rib, meeting major fissure at midaxillary line near 5th rib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Trachea & Major Bronchi

Trachea: location

Bronchi: where does it bifurcate

A
  • Trachea
    • Normal position: midline
    • Bifurcates into R & L mainstem bronchi at the level of the sternal angle (anteriorly) and T4 (posteriorly)
  • NOTE: breath sounds over trachea and bronchi are different than breath sounds over lung parenchyma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Respiration

What is the normal respiration rate?

Sounds?

What occurs during inspiration and expiration?

A
  • Normal rate: 12-20 breaths/min
  • Quiet, slight thorax movement, more prominent abdominal movement
  • Inspiration – diaphragm contracts, chest wall expands, negative intrathoracic pressure draws air into lungs
  • Expiration – diaphragm relaxes, chest wall contracts, intrathoracic pressure normalizes, air leaves lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Neck Abnormalities

What are the common neck abnormalities?

A
  • Stridor
  • Tracheal deviation
  • Accessory muscle use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stridor

What does it sound like?

What does it indicate?

Cause?

What can it lead to in kids?

A
  • High-pitched usually inspiratory wheeze
  • Indicates obstruction in trachea or larynx
  • Foreign body or airway disease
  • Croup in kiddos
  • Displacement of the trachea from midline
  • Causes: Large pleural effusion, large pneumothorax, mass/tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tracheal Deviation

What is tracheal deviation?

Causes?

A
  • Displacement of the trachea from midline
  • Causes:
    • Large pleural effusion
    • Large pneumothorax
    • Mass/tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Accessory Muscle Use

What is this a sign of?

What to look for?

What illnesses is it comonly seen in?

A
  • Sign of respiratory distress
  • Look for sternocleidomastoid, scalene, supraclavicular contraction
  • Seen with COPD, asthma…
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Thorax Abnormalities

Pectus excavatum

A

Pectus Excavatum (Funnel Chest)

Concave anterior chest

Depression of distal sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thorax Abnormalities

Pectus Carinatum

A

Pectus Carinatum (Pigeon Chest)

  • Convex anterior chest
  • Anterior displacement of sternum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Thorax Abnormalities

Barrel chest

A

Barrel Chest: Increased A-P (anteroposterior) diameter

  • Seen in aging, COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Thorax Abnormalities

Flail Chest

A

Flail Chest: rib fractures cause paradoxical movement of chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Thorax Abnormalities

Kyphosis

A

Kyphosis: abnormal forward curvature of spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Thorax Abnormalities

Scoliosis

A

Scoliosis: abnormal lateral curvature of the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Bradypnea vs. Tachypnea

Fast/slow?

Breaths/min?

Commonly seen in what medical conditions?

A
  • Normal:
    • 14-20 breaths/min
  • Bradypnea: slow
    • <12 breaths/min
    • Diabetic coma, drug-induced respiratory depression
  • Tachypnea: rapid, shallow depth
    • >20 breaths/min
    • Restrictive lung disease, elevated diaphragm, pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hyperventilation vs. sighing

What are they commonly seen in?

A
  • Hyperventilation: faster, deeper respiration
    • Metabolic acidosis (Kussmaul breathing)
  • Sighing: periodic deeper breaths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Obstructive Breathing

What is it?

What conditions is it commonly seen in?

A
  • Prolonged expiration and increased airway resistance
  • Asthma, chronic bronchitis, COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Kussmaul Breathing

What is it?

What is it a sign of?

A

Rapid & deep respiration

Sign of metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cheyne-Stokes Breathing

What is it?

Causes?

A
  • Periods of gradually increasing and decreasing depth of respirations with periods of apnea (no breathing)
  • Can be normal in sleeping children, elderly
  • Causes include
    • Heart failure
    • Uremia
    • Brain damage
    • Drug-induced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
**Biot’s Breathing** What is it? Cause?
Irregular, unpredictable, shallow or deep, with intermittent apnea Respiratory depression, brain damage
26
**Apnea** What is it?
The absence of spontaneous respiration
27
**Crepitus** What condition is it usually seen in?
Palpation Abnormality * **Crepitus:** crackling/grating feeling or sound * Rib movement from fracture (bone crepitus) * **_Subcutaneous emphysema_** (subQ crepitus) – feels like “Rice Krispies” under the skin
28
**Limited chest excursion**
Palpation Abnormalities **Limited chest excursion:** Unilaterally from chronic lung/pleural fibrosis, pleural effusion, lobar pneumonia, pain/splinting
29
**Subcutaneous Emphysema** What is it? **What can it cuse?** **What is it seen in?**
Air from lung/chest tracks along tissue planes Can cause: “swelling” of eyelids, cheeks, lips, neck, chest Seen w/lung injury (rib fx), postop thoracic surgery, etc.
30
**Fremitus** Define
**Fremitus:** Palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization
31
**Abnormal Tactile Fremitus** _What are the cause(s) of:_ Decreased fremitus Increased fremitus
* **Decreased fremitus** (vibration) * Obstructed bronchus * COPD * Pleural effusion * Lung fibrosis * Pneumothorax * **Increased fremitus** (vibration) * Pneumonia/consolidation
32
**Percussion** Purpose Technique
* _Purpose:_ * Determine if underlying tissues are air-filled, fluid-filled, or solid (up to 7cm deep into chest) * Detect areas of tenderness (spine, ribs, etc) Technique: * _Technique:_ * Finger of one hand strikes the finger of the other hand, not striking the patient directly * For louder notes, apply more pressure to finger on chest wall
33
What are the locatoins for chest perucssion & ascultation Anteriorly Posteriorly
Note: Required for Exam - 3 levels anteriorly, 4 levels posteriorly, plus 1 lateral site on each side
34
**Chest Percussion Tones** Resonant Dull Flat Tympanic
**Resonant** over air (lungs) **Dull** over solid (liver) **Flat** over fluid-filled areas/bone/muscle **Tympani** over hollow areas (stomach)
35
**Normal Percussion Tones**
36
**Abnormal percussion tones** _What conditions might be associated with the following tones?_ Hyper-resonant Resonant Tympanic Dull Flat
* _Hyper-resonant_ * COPD * Pneumothorax (PTX) * _Resonant_ * Chronic bronchitis * _Tympanic_ * Large pneumothorax * _Dull_ * Pneumonia * Pleural effusion * _Flat_ * Pleural effusion
37
**Characteristics of Breath Sounds**
38
**Adventitious Sounds** What are adventitious sounds? Crackles Rhonchi Wheezes
* **Adventitious Sounds:** Sounds are superimposed on usual breath sounds * “Adventitious” = added * **Crackles:** discontinuous sounds * **Rhonchi:** continuous, low-pitched * **Wheezes:** continuous, high-pitched
39
**Crackles** Continuous or discontinuous? Sound? Conditions where these sounds may be present Fine vs. coarse crackles: sound/pitch/duration?
* Adventitious Sounds: 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 * Bronchitis, pulmonary fibrosis, CHF * **Fine crackles:** soft, high pitched, very brief (5-10msec) * **Coarse crackles:** louder, lower pitch, brief (20-30msec)
40
**Rhonchi & Wheezes** Continuous or discontinuous? What are they? Duration? Pitch? Seen in what conditions?
* Adventitious Sounds: Continuous * Longer (≥250 msec), musical * **Rhonchi** – suggest secretions in larger airways, often clear with cough * Low pitched, snoring “wheeze” * Large airway secretions (chronic bronchitis) * **Wheeze** – rapid airflow through narrowed (almost closed) bronchi * High-pitched, hissing, shrill, whistling * Asthma, COPD, chronic bronchitis, bronchus obstruction, * Stridor – inspiratory wheeze (larynx/tracheal obstruction)
41
**Pleural friction rub** What is it? Cause?
Adventitious Sound * **Pleural Friction Rub** – crackle-like creaking sounds * Inflamed pleural surfaces rubbing together * Recent URI, pneumonia, etc.
42
**Mediastinal crunch** What is it also called? What is it? Cause? Where/how is it best heard?
* **Mediastinal Crunch aka “Hamman’s Sign”**– precordial crackles in sync with heartbeat, not respiration * Mediastinal emphysema (pneumomediastinum) * Best heard in left lateral position
43
*Specialized Exam* **Respiratory Expansion** How to test?
_How to test_ 1. Place your thumbs at the level of the 10th ribs, your fingers parallel to lateral rib cage 2. Slide your hands medially to loosen skin folds 3. Ask the patient to inhale deeply 4. Make note of how your thumbs diverge as the thorax expands – distance and symmetry
44
*Specialized Exam* **Tactile Fremitus** How to test? Normal/abnormal
_How to test:_ Place ulnar side of hand against chest wall and ask patient to say “99”, feeling for vibrations _Normal:_ Palpable vibrations _Abnormal:_ increased or decreased vibrations
45
*Specialized Exam* **Diaphragmatic Excursion** What is it? How to test? Normal?
* _What is it:_ the movement of the thoracic diaphragm during breathing * Measures the contraction of the diaphragm. * How to test: * Normal: 3 - 5.5 cm
46
*Specialized Exam* **Bronchophony** What is it? Purpose? How to test? Normal/abnormal?
* _What is it:_ * abnormal transmission of sounds from the lungs or bronchi * Transmitted voice sound * Presence indicates lung consolidation/collapse * e.g. pneumonia, atelectasis, tumors * _Purpose:_ Assess underlying lung tissue for collapse/consolidation * _How to test:_ Ask patient to say “99” while auscultating lung fields * _Normal lung:_ spoken words are muffled & indistinct * _Abnormal lung:_ louder voice sounds, called bronchophony
47
Specialized Exam **Egophony** What is it? Purpose? How to test? Normal/abnormal?
* _What is it:_ * increased resonance of voice sounds heard when auscultating the lungs * Presence indicates lung consolidation/collapse * e.g. pneumonia, atelectasis, tumors * _Purpose:_ Assess underlying lung tissue for collapse/consolidation * _How to test:_ Ask patient to say “EE” while auscultating lung fields * When patient says “EE”, it sounds like nasally “AAY” during auscultation * “E-A change” present * _Normal lung:_ muffled long “EE” sound * _Abnormal:_ if “EE” sound changes to “AAY”, Egophony is present
48
*Specialized Exam* **Whispered Pectoriloquy** Purpose? How to test? Normal/abnormal?
* _Purpose:_ * Assess underlying lung tissue for collapse/consolidation * _How to test:_ * Ask patient to whisper “1-2-3” while auscultating lung fields * _Normal lung:_ * whispered words inaudible/barely audible * _Abnormal:_ * Louder, clearer whispered sounds are called Whispered Pectoriloquy
49
**Pleural Effusion** What is it?
**Pleural Effusion:** fluid collection within the chest but outside the lung, causing lung compression
50
**Pneumothorax** What is it?
**Pneumothorax:** air collection within the chest but outside the lung, causing lung compression
51
**COPD** What does it stand for? What is it?
**COPD (Chronic Obstructive Pulmonary Disease):** over-distention of distal airspaces, resulting in limited expiratory flow and lung hyperinflation
52
**Consolidation/infiltrate** What is it?
**Consolidation/infiltrate:** alveoli filled with fluid/blood/pus increasing the density and opacity of the lung tissue
53
**Normal, Air-Filled Lung** Percussion Breath sounds Transmitted voice sounds Tactile fremitus
_Percussion:_ Resonant _Breath sounds:_ Mostly vesicular except over large bronchi (bronchovesicular) and trachea (bronchial) _Transmitted voice sounds:_ Normal _Tactile fremitus:_ Normal
54
**Pneumonia (consolidation)** Percussion Breath sounds Transmitted voice sounds Tactile fremitus
* _Percussion:_ Dull over affected area * _Breath sounds:_ Bronchial over involved area, crackles * _Transmitted voice sounds:_ Increased * _Bronchophony:_ Present (spoken words are louder, clearer) * _Egophony:_ Present (“EE” to “AAY” change present) * _Whispered Pectoriloquy:_ Present (whispers sound loud) * _Tactile fremitus:_ Increased
55
**Infintrate vs. Effusion**
56
**Pleural Effusion** Percussion Breath sounds Transmitted voice sounds Tactile fremitus
* _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
57
**Pneumothorax** Percussion Breath sounds Transmitted voice sounds Tactile fremitus
* _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
58
**COPD** Percussion Breath sounds Transmitted voice sounds Tactile fremitus Inspection
* COPD = Chronic Obstructive Pulmonary Disease * _Percussion:_ Resonant to diffusely hyperresonant * •_Breath sounds:_ Obscured by high pitched wheezes, possible crackles * _Transmitted Voice Sounds:_ Decreased * _Tactile fremitus:_ Decreased * _Inspection:_ Possible accessory muscle use
59
**Asthma** Percussion Breath sounds Transmitted voice sounds Tactile fremitus Inspection
* _Percussion:_ Resonant to diffusely hyperresonant * _Breath sounds:_ Obscured by high pitched wheezes, possible crackles * _Transmitted voice sounds:_ Decreased * _Tactile fremitus:_ Decreased * _Inspection:_ Possible accessory muscle use
60
**Chronic Bronchitis** Percussion Breath sounds Transmitted voice sounds Tactile fremitus
_Percussion:_ Resonant (normal) _Breath sounds:_ Vesicular (normal), possible crackles, wheezes, or rhonchi _Transmitted voice sounds:_ Normal _Tactile fremitus:_ Normal
61
What is the breath pattern?

Physical Dx (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions