Lung Flashcards
Dyspnea
Difficult or labored breathing
SOB
Shortness of breath
Hemopytis
Coughing up blood
COPD
Chronic obstructive pulmonary disease
Emphysema
-Alveoli are damaged & rupture leading to fewer and larger sac instead of many tiny ones
-Causes SOB & difficulty getting older air out
Symptoms of lung disease
-Cough, sputnum, SOB, vocal cord dysfunction, chest pain
Cough
-Mechanical or chemical irritation of the trachea or bronchi
Sputum
-Diseases of the air passages
Exam findings of Dyspnea & SOB
-Use of accessory muscle use, pursed lips, tripod position
Types of Dyspnea
-Activity: Dyspnea at rest, exertional dyspnea
-Position: Orthopnea, Paroxsymal nocturnal dyspnea
Other causes of dyspnea
Anemia, CO2 poisoning, metabolic dyspnea
Vocal cord dysfunction
-Respiratory disorder can cause vocal cord inflammation
-Causes: Smoking, Cold, post nasal drip, acid reflux
Wheezing
-High pitched sound, whistling
Pain of the chest
-Pain from lung conditions do not originate from lung
-Can be the result of msk issues, pleura, esophageal issues…
Causes of pain in thorax region
-Pain from msk issues: Local pain, costochondritis, intercostal sprain/strain, rib fx, cancer of the ribs, vertebrogenic,
-Pain from the pleura: Local catch when moving the pleura, cause is early pleural effusion in pleurisy, common cause of locaal pain in thorax
-Pain from esophalgeal
-Pain from dissecting thoracic aneurysm
-Pain from the heart
Inspection of lungs
Fingernails and lips, trachea, chest (thorax) structure, respiration pattern
Cyanosis may suggest
interstitial lung disease
Clubbing of nails
-Bulbous enlargement of the ends of one or more fingers
-Associated with cardiopulmonary disease
Yellow nails
May be result from lung issues, lympodema etc.
Trachea
-Static: Positioning
-Abdnormal: Deviates to one side
(IL-atelectasis, CL-mediastinal mass..)
Abnormal chest structures
-Thorax: congenital or developed
-Bumps
Chest/thorax shape deformities
Congenital: Pectus carianatum, pectus excavatum,
-Developed: Barrel chest
Pectus carinatum
Pigeon chest
Pectus excavatum
Inward bend
Bumps on ribs
Metastasis, fracture callus, benign growths, rachitic rosary
Rachitic rosary
Row of beading at the costochondral junction
Normal respiration
Eupnea
Eupnea
12-20 rpm, unlaboured
Apnea
Absence of breathing
Kussmaul breathing
-“air hunger”
-Rapid rate, deep depth…
Chyene-Stokes
-Alternating rate, rhythm, depth, alternating deep breathing
Hippocratic respiration
<10 breaths/minute
Referred to as fish mouth breathing
Death is imminent
Anxiety attack
-May be hyperpnea
-Extremity or oral tingling may be experienced
-Patients or observers may not notice
…
Thoracic Retraction
-Intercostal muscles are sucked in on inspiration
Tracheal palpation and tracheal tug
-If the trachea is not in midline, doing the tracheal tug can confirm observations
-Normal: Trachea is midline, no movement or tugging
-Abnormal: Trachea not midline, IL deviation…
Lateral chest expansion
-Posterior: Place hands along 10th intercostal space; thumbs touching mid spine and fingers along rib angle
-Anterior: Place thumbs together at midline of chest at subcostal margins, keep off chest so the patient can breathe freely
Lateral chest expansion findings
-Normal: Symmetrical/>2.5 inches excursion
-Abnormal: Asymmetrical/<2.5 inches excursion, restrictive lung disease…
Tactile fremitis
Vibrations on the chest wall, comparing side to side
-Posterior: Place ulnar edge of hand or MP joints along mid scapular line lung area bilaterally
-Anterior: Place ulnar edge of hand or MP joints along mid-clavicular line
Patient is saying: “99,99,99”/Feel for vibrations
Percussion of posterior lungs
-Percuss in the intercostal spaces in ladder formation; make sure to percussion lateral aspects
-Listen for normal dull and tympanic sounds
Percussion Tones
Resonant, Flat, Dull, Tympanic, Hyper resonant
Resonant
Hollow; Loud intensity, low pitch, long duration
Flat
Extremely Dull; Soft intensity, high pitch, short duration
Dull
Thud Like; Medium intensity, medium/high pitch, medium duration
Hyper resonant
Booming; Very loud, very low, longer
Tympanic
Drum like; Loud intensity, high pitch, medium duration
Auscultation of posterior lung
Listen for normal bronchial, bronchovesicular & vesicular sounds
-Determine if adventitius sounds are present/absent
-Perform in ladder format
Auscultation of anterior lung
-Use bell for apex (exception), everything else diaphragm
-Listen for one full breath cycle at each spot
Normal breathing sounds
-Bronchial: High pitched tubular or hollow (trachea & bifurcation of disection of louis?)
-Bronchovesicular: Medium intensity and pitch (closer to upper 1/2 chest near sternum)
-Vesicular: Soft and airy, low pitched (most of the lungs)
Adventitious lung sounds
Fine crackling, coarse crackling, wheezes, rhonchi, stidor, pleural friction rub, mediastinal crunch
Fine Crackles
High pitched cracking ike a fire place (Inspiration/Expiration)
Coarse Crackling
Low pitched popping sound like a bubbling or moist quality
Wheezes
High pitched whistling sound/squeaking, more pronounced on the expiration d/t narrow pathways
-Asthma, chronic bronchitis, COPD, CHF
Rhonchi
Lower pitched, sounds like a moaning, gurgling or snoring
-COPD, Pneumonia, Chronic bursitis, cystic fibrosis
Stridor
-Loud, high pitched wheezing/whistling or crowing like sound
-Croup, Epiglossitis
Pleural friction rub
Cracking or grating sound, low pitched, sounds like walking on fresh snow
-Pleurisy, pneumonia
Mediastinal Crunch “Hanman’s sign”
-Precordial crackles synchronous with heart beat
-Mediastinal emphysema
Vocal Fermitus Tests
-Bronchophony: Patient says 99 several times
-Egophony: Patient repeats saying the letter “e”
-Whispered pectoriloguy: Patient whispers repeatedly blue moon
-Abnormal: If the word is muffled, it suggests consolidation
Respiratory Syncytial Virus (RSV)
Most common lung and airway infection of infants and small children
Can also be seen in adults
-Caused by airborne pathogen
-Inspection: dyspnea, thoracic retraction
-Auscultation: Wheeze crackles
-Special: Cotton swag of the nose, CBC
Influenza
RNA virus that infects the respiratory tract
-Symptoms: Fever, fatigue, cough, headache, sore throat, nausea
-Inspection: Dynpnea
-Auscultation: Wheezing
-Special tests: Nasal swab, CBC
Croup
Difficulty breathing with stridor (crowing sounds)
-Typically worse at night
-Lasts 5-6 days
-Inspection: Cyanosis, retractions, tachpnea
-Auscultation: Decreased breath sounds, wheezing
-Special tests: Nasal swab, CBC, neck and chest x-ray
Reactive airway disease (RAD)
-Bronchi overreact to irritant & spasms
-Irritants: like pollen, exercise, stress
-Describes a set of sx to indicate pe…
Asthma
-A reactive airway disease
-Inspection: Accessory muscle use, tachypnea, prolonged expiration
-Palpation: Decreased respiratory movements, decreased tactile fremitus
-Percussion: Normal
-Auscultation: Wheezing, possible crackles
Bronchitis
Upper respiratory tract infection
-Sx include: Cough w/ mucus, GREEN sputum is classic
-Inspection: Normal to rapid breathing, coughing, prolonged expiration
-Palpation: Possible wheezing vibration or tactile fremitius
-Percussion: Normal
-Auscultation: crackles, wheezing, rhonchi
COPD
-Group of progressive lung diseases
-Inhaled toxins causes inflammatory response
-Patient cannot breathe out air fully
Exam Findings for COPD
-Inspection: Barrel chest, accessory muscle use
-Palpation: Decreased respiratory movements
-Percussion: Hyperresonance
-Auscultation: none, or the crackles, wheezes & rhonchi
associated with chronic bronchitis
Blue bloaters
Person looks blue and overweight
-Sx: SOB, chronic cough
-Coexsisting cardiovascular conditions
-Now recognized as chronic bronchitis
Pink puffers
Person looks pink, is thin and breathing fast
-Sx: pursed lips, barrel chested, SOB
-Now recognized as severe emphysema
Pneumothorax
-Presence of air or gas in pleural cavity
-May occur spontaneously
-May occur with penetrating trauma
-May accompany other lung pathology
Pneumothorax exam findings
-Inspection: Trachea shifts to opposite side, dyspnea
-Palpation: Tracheal deviation, decreased tactile fremitus
-Percussion: Hyperresonant on the involved side
-Auscultation: Absence of normal sounds over the collapsed area
Pneumonia
-Inflammation of the lung parenchyma
-Most cases are due to infection by bacteria or viruses
-Distribution may be lobar, segmental or lobular
-Can be partial/complete
Partial consolidation
-Inspection: Tachypnea, cough
-Palpation: normal or minor asymmetry of motion
-Percussion: Hyperesonant to dull over the consolidated area
-Auscultation: Crackles over the vesicular areas, rhonchi over the tubes
Complete consolidation: Lung Findings
-Inspection: Tachypnea, cough
-Palpation: Symmetry of motion, increased tactile fremitus over the consolidated area
-Percussion: Dullness in the area involved
-Auscultation: Loss of vesicular sounds, increased vocal fremitus
Pleural effusion
-Excess fluid in the pleural cavity due to another condition
-Causes: congestive heart failure, pneumonia
-Common sx: Chest pain and dypnea
Pleural effusion exam findings
-Inspection: Accessory muscle use, dyspnea, prolonged expiration, trachea deviation
-Palpation: Trachea deviation, opposite side of effusion, asymmetry of chest motion, decreased tactile fremitus
-Percussion: Dullness
-Auscultation: Pleural rub, loss of vesicular sounds, increased vocal fremitus
Lung cancer
-Asymptomatic to a variety of symptoms
-A chronic cough is common
-May cough up blood (hemoptysis)
Lung Cancer exam findings
-Inspection: Deviated trachea, retraction signs
-Palpation: Deviated trachea
-Percussion: Dullness in areas
-Auscultation: Altered sounds-may include crackles, wheezes
