Lecture 4.1 thorax and lung pt 1 (3%)

Question 1

1) What line is straight down the middle of the back?
2) What line is lateral to that?

Answer 1

1) Vertebral line
2) Scapular line

Question 2

1) What line is at the midline of the chest?
2) What two lines are parallel and on opposite sides of this line?

Answer 2

1) Anterior median (midsternal) line
2) Midclavicular lines

Question 3

1) What line runs through the middle of the armpit?
2) What line runs parallel and anterior to this?
3) What line runs parallel and posterior to this?

Answer 3

1) Midaxillary line
2) Anterior axillary line
3) Posterior axillary line

Question 4

How far do the lungs rise up?

Answer 4

3-4cm above inner 1/3 of the clavicles

Question 5

Lung sounds will be harsher where?

Answer 5

Over trachea and bronchi

Question 6

The space in between the lungs and where the lungs sit is called what?

Answer 6

Pleura

Question 7

1) Breathing is least visible when?
2) Where is there movement during breathing?

Answer 7

1) The pt is supine
2) Some thoracic movement, but mostly in the abdomen.

Question 8

When sitting, what is more easily observed in motion?

Answer 8

The rib cage

Question 9

___________________ are recruited when breathing becomes more labored, either due to exercise or pathology.

Answer 9

Accessory muscles

Question 10

What are the two groups of accessory muscles?

Answer 10

Sternocleidomastoid and scalenes

Question 11

1) What does “pulling hard” mean?
2) What 5 places do you need to look for this?

Answer 11

1) Breathing difficulty, causing retractions (sucking tissue into thoracic cavity)
2) Subcostal, intercostal, substernal, suprasternal, supraclavicular

Question 12

What are the 7 respiratory red flags?

Answer 12

1) Chest pain
2) Shortness of breath
3) Wheezing
4) Cough
5) Blood-streaked sputum
6) Painful inspiration
7) Daytime sleepiness

Question 13

What are the 5 Ps of respiratory related chest pain?

Answer 13

1) Pneumonia (Pneu. . .)
2) Pneumothorax (Pneu. . .)
3) Pulmonary embolus (P  E)
4) Pleural effusion (P  E)
5) Bronchitis (The ugly P. . .)

Question 14

What are the 3 key questions you should ask about respiratory related chest pain? What would the answers indicate?

Answer 14

1) Does it hurt when I press on it?
2) Is it worse when you breathe in?
-PE
3) Is there one-sided swelling/redness/pain in your calves?
-DBT

Question 15

Define SOB / dyspnea / wheezing. Is this subjective or objective?

Answer 15

The feeling of being out of breath; a subjective sensation

Question 16

What are the 6 diagnoses you should consider when a pt complains of SOB/ dyspnea/ wheezing?

Answer 16

1) COPD: smoking
2) Asthma: childhood
3) PNA (pneumonia): Infxn
4) Anxiety: associated symptoms
5) Cancer: progressive symptoms
6) Heart failure: rapid weight gain and lower extremity edema
-anxiety is a diagnosis of exclusion

Question 17

What two key questions should you ask when a pt complains of SOB/ dyspnea/ wheezing?

Answer 17

1) Under what circumstances or particular activities does this occur?
2) How much of the activity can you perform?

Question 18

What are the 3 types of cough? Define the parameters for each

Answer 18

1) Acute: < 3 weeks
2) Subacute: 3-8 WEEKS
3) Chronic: > 8 WEEKS

Question 19

1) What is the most common cause of cough?
2) What are some other causes?

Answer 19

1) Acute respiratory infxn (virus)
2) Smoking, asthma, COPD, pneumonia, acid reflux, FB, postnasal drip, bronchiectasis, medicines (ACE inhibitor)

Question 20

1) What is the key question to ask about a cough?
2) What conditions cause foul smelling sputum?
3) What condition causes thick sputum?
4) What causes profuse sputum?

Answer 20

1) Is it productive?
2) Lung abscess
3) CF
4) Bronchiectasis

Question 21

True or false: sputum is not specific for bacterial infection

Answer 21

True

Question 22

What 4 diagnoses should you consider regarding hemoptysis?

Answer 22

1) Cancer
2) TB
3) PE
4) Out of the box dx: upper GI bleed or epistaxis

Question 23

What is the key question to ask when a pt displays/ reports hemoptysis?

Answer 23

Define the source and amount and note the color; is it truly bright red blood from the lungs?

Question 24

What 3 Dxs should you consider when a pt has painful inspiration?

Answer 24

1) PE
2) Pleurisy
3) MSK

Question 25

What Dx should you consider when a pt has daytime sleepiness?

Answer 25

OSA (obstructive sleep apnea)

Question 26

1) Quitting smoking cuts your risk of heart attack in half after __________.
2) Lung cancer risk is cut in half after __________.
3) Stroke risk cut in half after_____________.

Answer 26

1) 1 year
2) 10 years
3) ~3 years

Question 27

1) When should flu shots begin? What should you do before this?
2) When do pneumococcal vaccines begin?

Answer 27

1) Influenza begins at 6 months
-If they’re under 6 months, vaccinate the family
2) 65 yo