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Pathology > Lung assessment > Flashcards

Lung assessment Flashcards

1
Q

Left axillary lung

A

U and L lobe seperation, posteriorly 3rd rib anteriorly 6th

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2
Q

R axillary lung

A

RUL runs posteriorly 3rd rib to anteriorly 6th rib but RML is mid axillary ~5th rib

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3
Q

Broncial lung sounds

A

Throat, high pitch, harsh amplitude short inspiration long exp

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4
Q

Bronchialvesicular sounds

A

Moderate pitch mixed quality = insp and exp length

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5
Q

Vesicular

A

Low pitch breezy quality soft amplitude Long insp SHORT exp (peripheral lungs

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6
Q

Fine crackles

A

Short high pitched popping during insp, not cleared with cough
Pneumonia, CHF.
If EARLY in insp COPD
Air opening small deflated passages coated with exudate

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7
Q

Course crackles

A

Low-pitch bubbling moist
Early insp to early exp
Air hitting secretions in large bronchi and trachea
Pneumonia, PE, fibrosis

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8
Q

Pleural rub

A

Low pitched dry grating
Inflamed pleural surfaces rubbing
Pleuritis

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9
Q

Sibilant wheezes

A

High pitched and musical
Expiration mainly
Air through constricted passages (swelling, secretions, tumour)
Asthma or emphysema

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10
Q

Sonorous wheezes

A

Low pitched snoring or moaning mainly during expiration
Air through constricted passages
Bronchitis, single obstructions

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11
Q

Resonance

A

Part air part solid

Normal lung

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12
Q

Hyper resonance

A

Mostly air

Lung with emphysema

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13
Q

Tympany

A

Over air, puffed out cheek or gastic bubble, pneumo

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14
Q

Dullness

A

Solid tissue

Diaphragm pleural effusion, liver

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15
Q

Flatness

A

Dense tissue like muscle bone sternum

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16
Q

Bronchophony test

A

Lung consolidation
Say 99 while auscultating posterior thorax
Soft and muffled normally, louder and more easily understood over consolidation

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17
Q

Egophony

A

Eeee outloud listening to lung fields
Sound like AAAA over consolidation
Good for pneumonia and effusion

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18
Q

Tactile Fremitus

A

Ulnar surface of hands and say 99, fremitus increased over consolidation

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19
Q

Whispered pectoriloquy

A

Pt speaking clearly if over consolidation

Get pt to whisper 1-2-3

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20
Q

S1

A

First heard sound, produced by AV closing at beginning of systole.

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21
Q

Intensity of S1 is dependant on

A

Position of mitral valve at start if systole, structure of valve leaflets, how quicky pressure rises in ventricles

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22
Q

S1 clinical (just the) tip

A

Normal S1 variations heard at apex of heart.

S1 softer at base and louder at apex

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23
Q

Accenuated S1

A

Louder than S2, occurs when mitral valve is wide open and closes quickly from:
Hyperkinetic states from increased blood velocity (fever, anemia, hyperthyroidism)
or Mitral stenosis in which leaflets are mobile but increased ventricular pressure needed to close the valve

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24
Q

Diminshed S1

A

Mitral valve not fully open from
Delayed conduction from atria to ventricles (1st degree block) - mitral starts drifting closed before closing
Mitral insufficiency (extreme calcification limits mobility)
Delayed/diminished ventricular contraction from forceful atrial contraction or into a noncompliant ventricle (severe pulmonary or systemic HTN)

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25
Q

Split S1

A

L and R ventricles contract at different times
BBB
Ventricular ectopy in which impulse starts in one ventricle, contracting it first and spreading into second

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26
Q

Varying S1

A

Mitral valve is in different position when contraction occurs
A and V bating independendtly (a-fib, AV dissociation, blocks)

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27
Q

S2 sounds

A

Closure of aortic and pulmonary valves. Closure of pulmonic is delayed by inspiration, resulting in split S2

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28
Q

Accenuated S2

A

Aortic or pulmonic valves have higher closing pressure
From increased pressure in aorta (excercise, excitment, systemic HTN)
Increased pulmonary vasculature (mitral stenosis or CHF)
Calcification of semi-lunar valve (valve still mobile, pulmonic or aortic stenosis)

29
Q

Diminished S2

A

Aortic or pulmonic valves have decreased mobility
Decreased systemic BP (weakens valves) as in shock
Aortic or pulmonic stenosis in which valves are thickened and calcified with decreased mobility

30
Q

Normal S2 split

A

Heard over second or third intercostal
Usually best heard during inspiration (can’t during expiration)
If it doesn’t disappear during expiration that’s pathologic

31
Q

Wide S2 split

A

Increase in usual splitting that persists throughout entire resp cycle and widens on exp. Occurs when there is delayed electrical activation of RV (RBBB)

32
Q

Fixed split S2

A

Wide splitting does not vary with resp
From delayed closure of one valve
Atrial septal defect, RV failure

33
Q

Observing JVP

A

R side, pt lays 30-45 supine. Torso elevated.
Pt turns head to left, use light to see, use light to inspect
Internal jugular veins first

34
Q

Reasons for JVP increased

A 
Cardiac tamponade
Tricuspid stenosis
Tricuspid regurg
RV failure 
Pulmonary htn
PE
35
Q

Internal jugular collects

A

Brain, superficial face and neck

36
Q

External jugular collects

A

External cranium, deep parts of the face, occipital

37
Q

Jugular vein should not be

A

distended bulging or protruding at greater than 45

38
Q

Evaluating JVP

A

Position bed 30,45,60,90. Turn head and mark what degree pt was at with elevation.

39
Q

Auscultation & palp of carotid

ask pt to hold breath for 30 seconds use bell end

A

Bruit- blowing or swishing caused by turbulent blood flow from narrowed arteries
Check pulses are equal with normal rate
Palpation should reveal elastic arteries - otherwise arterioslcerosis

40
Q

Inspection of heart sounds

A

Pt 30-45 degrees
Pulsations other than apical are abnormal
If apical (normal) is visible it will be at mitral area
Pulsations may mean enlarged ventricle or weakened vessel

41
Q

Palpation of apical pulse

A

Two fingers palpate mitral area (lie on L to increase)
should feel like gentle tapping
Difficult pulse to find from emphysema, fatty fat fat fat, tig ol bitties
Check for pulses in other areas
Palpate radials and apical to see if there are differences (a fib PVCs heart block)

42
Q

Auscultate heart sounds

A

Study guide says diaphragm for S1 S2, and S3 S4 then bell for S3 S4
Ask pt to breath normally
S1 heard everywhere but best at 5th spot
S2 heard everywhere, loudest at erbs
Note location and timing of extra sounds.

43
Q

Benign S3

A

Children, young adults, rare after 40

44
Q

Benign S4

A

End of diastole in well conditioned athletes and those over 40

45
Q

Ejection or clicks

A

Mitral valve prolapse

46
Q

Pathologic S3

A

Ventricular gallop, possibly ischemic heart disease

47
Q

Pathologic S4

A

Atrial gallop, L side of precordium heard with CAD, cardiomyopathy, aortic stenosis

48
Q

Murmur

A

Listen for swishing sounds in the 5 areas. Variations include
Patholigc, midsystolic, pansystolic, diastolic

49
Q

Heart sounds other positions

A

L lateral. Use bell. S1 S2 normally present. S3 or S4 mitral stenosis that was not detected may be revealed
Sit up, lean forward, exhale use diaphragm. Aortic regurg heard when pt sits upright mebbe

50
Q

Normal breath sounds

A

Bronchial over throat, BV near sternum, vesicular peripherally

51
Q

Tachypnea

A

24 minute+. Fever anxiety exercise, hypoxia, alkalosis, pneumonia, pleurisy

52
Q

Bradypnea

A

Less than 10, neuro damage, drugs, diabetic coma

53
Q

Hyperventilation

A

Increased rate and dpeth

54
Q

Kussmaul

A

Rapid, deep, laboured

55
Q

Hypovent

A

Decreased depth, irregular pattern

56
Q

Cheyne-Stokes

A

Reg pattern with deep rapid and periods of apnea

57
Q

Biots resps

A

Irregular, varying depth and rate with periods of apnea

58
Q

Ataxic

A

Significant disorganization with irregular and varying depths of resps

59
Q

Air trapping

A

Difficulty getting breath out

60
Q

Percussion locations posterior

A

123, 456 posterior traps

8-18 ~2nd intercostal back and forth, getting wider 16-17 wider again 17-18 then 19-20 and 21-22 are more lateral

61
Q

Anterior percussion

A

1st intercostal L to R each intercostal, 5th spot is more lateral

62
Q

Resonant

A

Low pitched hollow normal lungs

63
Q

Dull or thud

A

heart liver or fluid in lung tissues like pneumonia pleural effusion or tumors

64
Q

Hyperresonant

A

Loud, lowwer pitched. Children or skinny adults

COPD, asthma attack, or pneumothorax

65
Q

Tympanic

A

High, drum like, normally over stomach but maybe a pneumo

66
Q

Inspect lungs for

A

Nasal flaring, pursed lip, skin colour, nails, even chest rise, scapulae not protruding, downward rib slope

67
Q

Lower ribs posteriorly

A

8th-9th rib

68
Q

Same insp and exp

A

BV

69
Q

High pitched musical constricted airway passages

A

Sibilant wheeze

Pathology (24 decks)

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