Lung Exam Flashcards
Landmarks of the Sternum & distances
sternum and ribs
Sternal Angle (Angle of Louis)
- 5 cm inferior to the sternal notch
- at this point –> the level of the 2nd rib
Ribs
- most people have 12 ribs
- T1 = 2nd rib = parallel to the top of the scapula
- false ribs: all attached to same cartilage
- floating ribs: 11 & 12
Lung Anatomy & Landmarks
apex, base, trachea & bronchi
- apex: top of lung (above clavicle)
- base: bottom
- Right Lung: 3 lobes
- Left Lung: 2 lobes
- both lungs have oblique fissure
- right lung has horizontal fissure
- major fizzure of upper and lower lungs: T3
Principle Muscles of Breathing
Accessory Muscles?
Principle: intercoastals (external and internal) & Diaphragm
Accessory Muscle use: SCM, scalenes (all 3), abdominals
The Pleurae
Visceral pleurae: on the lung
parietal: the lining of the rib cage
pleural space: the potential space between the visceral and parietal pleurae
pain in lungs. v costochondritis
- lungs have no painfibers: pain in the “lungs” asocaited with pneumonia, infarct is related to the inflammation or irritation of the pleaura
costochrondritis: muscle strain pain – usually due to coughing
health history
- cough (amount of time acute v subacute v chronic)
- wheeze
- blood
- associated symtpoms
- PMHx. & PFHx.
cough
- irritant, dry, productive, color
- duration: acute = < 3 weeks, subacute 3-8weeks, chronic > 8 weeks
Wheezing
- partial obstruction of airway, inflammation, increased secretions, astham, FB
Blood
- amount, where
- bright red: higher up (UR)
- coffee ground emisis, darker = GI related
Associated Symptoms
- fever, chills, sweats, fatigue, weakness, dizzy, weight changes
PMHx.
- immunizations, illnesses, screening, accidnets
- smoking cessaion: advise to quit
- flu shot
- pnuemococcal vaccine > 65 years old or immunosup
PFHx.
- cancer, TB, asthma, bronchitits, emphysemsa
changes found on Inspection of the chest
- what changes with age
- waht is barrel chest
- AP diamete
- kyphosis
- pectus excavatum
- pectus carinatum
- flail chest
- thoracic kyphoscolosis
age changes
- chest wal becomes stiffer
- respiratory muscles weakened
- elastic recoil less
- skeletal changes
Barrel Chest
- air trapping; harder t breath –> body compensates by making the barrel
AP diameter
- increased in COPD
Kyphosis- skeletal cahnges: hunchback (superior)
Pectucus Excavatum: (CAVA– think cave)
- funnel chest: more common in kids
- in marfans
Pectus Carinatum: pidgeon chest (points out)
- EDS, Marfans, downs
Flail Chest
- mutiple rib fractures cause movement of the thoarx
- inspireation: decreased pressure: sucked in
- expiration: injured area blows outwards
- because the ribs arent holding them in teh right spot
Thoarcic Kyphoscolosis
- severe scolosis and kyphosis
breathing rhythms
- cheyne-stokes
- ataxix
- sighing
- obstructive
- normal!
- tachypnea
- hyerpnea/ventilation
- brady
Cheyne-Stokes: periods of hyperapnea and apnea (can be normal in babies – abnormal in adults) fast—-stop—-fast—stop (heart failure/stroke)
Ataxic (Biot’s breathing): unpredictable and irregular no rhythm or reasons for the breathing pattern (neruo conditions)
Sighing: normal– then a deep– but patterned
Obstructive: prolonged expiration becausae the airway is narrow— takes more time to get out
normal: 14-20 RR, 44 in infants
Tachypnea: > 22 –> FAST and SHALLOW
Hyperpnea/ventilation: Kussmal’s breathing: DEEP and fast
brady: slow
Palpation
- tracheal deviation
- crepitus/step-offs
- respiration expansion
tracheal deviation
- assess with grasp of tracheal and breath in & out
- deviation TOWARDS a atelectasis, AWAY from a PTX (tension)
crepitus/step-off
- crepitus: air in the subq. spaces sounds like cracking
- step-off: brusing and tenderL fractured rib
- sinus tracts: wounds
respiratory expansion
- to asess symmetry of chest wall movements @10th rib level
Tactile Fremitus
- reasons for increased or decreased
- where
feeling vibrations transmitted through the bronchopulmonary tree to the chest wall
- pt. repeats 99
- 4 locations on the posterior
- 3 on the anterior
failure of the vocal cords or blockage of the airway will result in absent vibrations
Increased: think consolidations or inflammation of the tissue,since sound travels better through hard objects
Decreased: think liquids : thickened pleura, pleural effusion or PTX
Percussion
- resonance
- dull
- hyper-resonace
- tympany
- flateness
resonace: normal lungs with air
tympany: gastric air bubble
dullness: over an organ
flatness: muscle
hyper-resonace: NOT normal: too much air (emphysema)
Auscultation
- Breath sounds
- vesciular
- bronchovesiclar
- bronchial
- tracheal
Vesicular: normal & heard over most of the lung
bronchovesicular: heard over large airways (think bronchial and vesciular)
bronchial: heard over manbrium
tracheal: over trachea
Auscultation
Adventicious Breathe Sounds
- crackles/rales
- rhonchi
- wheeze
- stridor
- pleural rub
- mediastinal crunch
Crackles/Rales: sounds of fluid within the smaller airways
(think- alveoli popping open)
fine crackles: thin fluid
coarse crackles: thicker (mucus) fluid (go away with a cough)
Rhonchi: sound of fluid in the larger airways (dissappears with a cough) snore sound
Wheeze: a musical sound that occurs with rapid fairflow in or out more narrow -> smaller airway -> bigger emergency
Stridor: continuous and high pitched muscial sound due to obstructed airflow in the larynx or trachea (upper airways) need for emergency intervention
Pleaural rub: grating sound of the visceral and parietal pleura due to inflammation in the cavity
mediastinal crunch: crackles which are assocaited with heartbeat NOT breathing–> due to air in the mediastinum painful
Auscultation of Transmitted Voice Sounds
Bronchophony
Egophony
Whispered Pectorlioquoy
bronchophony: “99” & hear a muffled 99 sound
Egophony: “eee” & hear a muffeld “EEE” sounds aa is abnormal
whispered: “99 whispered”& hear nothing or very faint “99” loud is abnormal
what will an AIRLESS lung sound like for
- tactle fremitus
- whipser test
- bronchophony
- egophony
- increased tactile fremitus
- hear “ay” for “ee”
- heard worders louder
- heard whisper louder
