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Intro to Physical Exam - 2016 > Lecture 3 - Thorax & Cardiac Exam > Flashcards

Lecture 3 - Thorax & Cardiac Exam Flashcards

1
Q

What are the key parts from the checklist for the thorax exam?

A
  1. Check for chest expansion
  2. Percuss lung fields bilaterally and symmetrically
  3. Auscultate lung fields bilaterally and symmetrically
  4. Ask patient to breath through open mouth
  5. Feel for axillary nodes bilaterally
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2
Q

How can you estimate where the sternal angle is, and what rib is lateral to the sternal angle?

A

Place finger in suprasternal notch and move the finger down about 5 cm to a bony ridge; this is the sternal angle
2nd rib is lateral to it

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3
Q

Where does the trachea bifurcate on the anterior and posterior side?

A

Anterior: bifurcates at the sternal angle
Posterior: at the level of T4 spinous process

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4
Q

At what rib does the inferior tip of the scapula lie?

A

Level of the 7th rib

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5
Q

Generally, what is examined during the inspection aspect of the thorax?

A

1) Rate, rhythm, depth, and effort of breathing
2) Color
3) Asymmetry of breathing
4) Difficulty of breathing (is there retraction of SCM during inspiration?)

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6
Q

What is indicated if stridor is heard during the inspection?

A

Stridor is audible high pitched wheeze, indicating an upper airway obstruction in larynx or airway and is an emergency

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7
Q

What is indicated if the anteroposterior diameter of the chest is expanded during inspection?

A

COPD or emphysema (barrel chest)

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8
Q

What is indicated if there is asymmetry of breathing?

A

Can indicate phrenic nerve damage

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9
Q

How is chest expansion tested?

A

Put thumbs at the 10th rib, ask patient to breath, and the thumbs should move apart during inspiration

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10
Q

What is fremitus, and how is it tested?

A

Fremitus is a palpable vibration transmitted through the chest wall as patient is speaking

  • use bony part of palm at various locations on posterior of back and ask patient to say ninety-nine
  • should be symmetry
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11
Q

What is indicated if there is a decrease in fremitus?

A

Atelectasis (collapsed lung)
Pulmonary effusion (fluid in pleural space)
COPD (too much air in alveolar)

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12
Q

What is indicated if there is an increase in fremitus?

A

pneumonia/consolidation (fluid in the alveolar)

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13
Q

What should the sound appear as when the thorax is percussed?

A

Healthy lungs are resonant

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14
Q

What is indicated if percussion is dull or decreased?

A

There is solid or fluid replacing the air filled lung

indicates: lobar pneumonia, pleural effusion, atelectasis

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15
Q

What is indicated if percussion is increased or hyperresonant?

A

Indicates asthma, emphysema, or pneuomothorax

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16
Q

What is the normal difference of diaphragmatic excursion?

A

5-6cm

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17
Q

What is a vesicular sound heard when auscultating, where is it heard?

A 
Vesicular sound is soft and low pitched
Heard throughout inspiration
Continue without pause through expiration
fade away 1/3 of way through expiration
Can be heard over most of both lungs
18
Q

What is a bronchovesicular sound heard when auscultating, and where is it heard?

A

Intermediate sound and pitch, and inspiratory and expiratory sounds are almost equal; heard in the 1st and 2nd intercostal spaces

19
Q

What is a bronchial sound heard when auscultating, and where is it heard?

A

Is a louder, harsher, higher in pitch sound with a short silence between inspiratory and expiratory; heard over the manubrium

20
Q

What is a tracheal sound heard when auscultating and where is it heard?

A

loud harsh, high pitched sounds heard over the trachea in neck; inspiratory and expiratory sounds are almost equal

21
Q

What are rales/crackles heard when auscultating? What do they indicate?

A

Discontinuous, intermittent, nonmusical sounds, brief

Indicate congestive heart failure, pneumonia, and fibrosis

22
Q

What are wheezes and rhonchi heard when auscultating?

A

continuous, musical, prolonged sounds mainly during expiration; indicates asthma or emphysema

23
Q

What are the 3 transmitted voice sounds, and what do abnormalities of these indicate?

A

Egophony: patient says “ee”, if you hear A, egophony is present and may indicate pneumonia
Bronchophony: ask patient to say ninety-nine, increased transmission of voice sounds (normally muffled, if you hear it, bronchophony is present)
Whispered pectoriloquy: the whisper is normally heard faintly, if at all. If heard, whispered pectoriloquy is present

24
Q

Each lung is divided roughly in half by:

A

oblique/major fissure

25
Q

Each lung is divided roughly in half by the oblique/major fissure. The ______ lung is further divided by the horizontal/minor fissure.

26
Q

What is represented by the upper lobes of the lung?

A

Top part of posterior chest

27
Q

“Barrel-chest” signifies what?

28
Q

Asymmetry of breathing suggests what?

A

Underlying lung, pleural, or phrenic nerve disease

29
Q

Decreased fremitus is seen in what 3 conditions?

A
  1. Atelectasis
  2. Pulmonary effusion
  3. COPD
30
Q

Increased fremitus is seen in what condition?

A

Pneumonia/consolidation

31
Q

Decreased resonance during percussion is seen in 3 conditions. Which is NOT one of these?

A. Pleural effusion
B. Pneumothorax
C. Pneumonia
D. Atelectasis

A

B. Pneumothorax is indicated with increased resonance during percussion.

32
Q

Increased resonance during percussion is seen in 3 conditions. Which is NOT one of these?

A. Asthma
B. Pneumothorax
C. Emphysema
D. Atelectasis

A

D. Atelectasis is indicated by decreased resonance during percussion.

33
Q

What two breath sounds are heard in abnormal locations if the lung may be fluid-filled?

A. Bronchovesicular/bronchial
B. Bronchial/tracheal
C. Vesicular/tracheal
D. Bronchial/vesicular

A

A. If bronchovesicular or bronchial breath sounds are heard in locations distant from those listed, suspect that air filled lung has been replaced by fluid or solid lung tissue.

34
Q

Which of the following is seen during expiration?

A. Rales
B. Wheezes
C. Rhonchi
D. Crackles

A

B. All others are seen in inspiration.

35
Q

Adventitious sounds include rales, rhonchi, and wheezes. Which one signifies congestive heart failure?

36
Q

Adventitious sounds include rales, rhonchi, and wheezes. Which one signifies emphysema?

37
Q

The Jugular Venous Pressure reflects pressure in the:

A. Right atrium
B. Left atrium
C. Left ventricle
D. Right ventricle

38
Q

Which pulsations are rarely palpable?

A. Internal jugular pulsations
B. Carotid pulsations
C. Neither
D. Both

A

A. Internal jugular pulsations are rarely palpable, carotid pulsations are palpable.

39
Q

The ______ occupies most of the anterior cardiac surface.

A. Right atrium
B. Left atrium
C. Left ventricle
D. Right ventricle

40
Q

The ________ produces the apical impulse, or point of maximal impulse (PMI).

A. Right atrium
B. Left atrium
C. Left ventricle
D. Right ventricle

Intro to Physical Exam - 2016 (7 decks)

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