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Physical Exam Midterm & Final > Lungs & Thorax > Flashcards

Lungs & Thorax Flashcards

1
Q

How are the intercostalspaces numbered

A

numbered for rib above (ex: 2nd ICS is b/w ribs 2 and 3)

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2
Q

Number the ribs:
True ribs =
False ribs =
Floating ribs =

A

True ribs = 1-7
False ribs = 8-10
Floating ribs = 11 & 12

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3
Q

The costocartial junction is…

A

Between the ribs and cartilage

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4
Q

Intercostal space used for needle insertion for tension pneumothorax

A

2nd intercostal space

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5
Q

Chest tube placement occurs in which intercostal space

A

4th intercostal space

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6
Q

The scapula usually ends around rib ____ or ICS _____

A

Rib #7; ICS #7

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7
Q

Angle of Louis or Sternal angle is….

A

The point where the 2nd rib attaches to the sternum

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8
Q

Angle of Louis also corresponds to…

A

Point where the primary bronchi split & to vertebrae T4

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9
Q

Midsternal line

A

Down the middle of the chest

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10
Q

Right and left midclavicular lines

A

Down the chest, mid-way through the clavicle

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11
Q

Vertebral line AKA midspinal line

A

Line down center of back following the spine

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12
Q

Scapular lines

A

Synonymous to the mid-clavicular line of the chest; posterior side, mid-way through the scapula

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13
Q

Where is the apex of the lung

A

It extends 2-4 cm above the clavicle

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14
Q

Where is the horizontal fissure of the right lung

A

~ level of 4th rib

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15
Q

On the right or left lateral views, where is the lung

A

It ranges from peak of axilla (apex) to ~ the 7th or 8th rib (base)

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16
Q

The left lung actually has a 3rd small lobe called the…

A

Left lingualar lobe

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17
Q

On the posterior, where is the lower border of the lung

A

~ T10 spinous process but decends farther with breath

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18
Q

Where does the trachea bifurcate at

A

At vertebrae T4 (on back) and rib 2 (on front)

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19
Q

How do the right and left main stem bronchi differ?

A

Right main stem bronchus is wider and shorter, and more verticle than left one; it is more likely to have a foreign body lodged in this one

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20
Q

Mucoid sputum is clear and is most likely from what type of cause

A

Viral cause

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21
Q

Purulent sputum is green/yellowish, and may indicate what type of infection

A

A bacterial infection

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22
Q

If someone is coughing up or spitting up blood how do you tell if it is a GI or respiratory source?

A

Blood from the GI tract is darker rather than from pulmonary system (much more red and bright colored)

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23
Q

You see hemoptysis in a patient. Is it normal or abnormal?

A

Small amount (teaspoon or less) of hemoptysis is normal with URIs

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24
Q

Which is worse central or peripheral cyanosis?

A

Central is worse

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25
Q

What are possible causes of clubbing

A

Bronchiectasis, malignancy, congenital heart disease, pulmonary fibrosis, cystic fibrosis

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26
Q

What is a barrel chest? Who is it seen in?

A

It is an increase in Anterior/Posterior diameter

Seen with aging and COPD

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27
Q

What is pectus excavatum? Why is it a problem?

A

It is a funnel chest (caved in) and can compress mediastinal structures; may become a surgical emergency

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28
Q

What is another name for pigeon chest

A

Pectus Carinatum

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29
Q

What is traumatic flail chest? Why is it a problem?

A

It is when part of rib cage is disconnected from the rest of the ribs/sternum; can’t oxygenate lungs when breathing due to disconnection and change in pressure

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30
Q

Dorsal curvature of thoracic spine

A

Kyphosis

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31
Q

Back is completely contorted, curvature to the right with hunching forward; widely separated ribs on one side and very close together on the other; causes intense pain

A

Kyphoscoliosis

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32
Q

Removal of a breast

A

Mastectomy

33
Q

Anatomic variant seen in many mammals occuring along the “milk line” and often mistaken as moles

A

Supernumerary nipples

34
Q

What are the accessory breathing muscles?

A

Abdominal
SCM
Trapezius
Scalens

35
Q

Hyperpnea (hyperventilation) of variable rate seen in DKA (due to metabolic acidosis); very rapid and deep breaths

A

Kussmal’s respirations

36
Q

Breathing associated with pts who have brain lesions; periods of normal breathing with periods of lack of breathing

A

Cheyne-Stokes

37
Q

Normal breathing rate

A

14 to 20/min

38
Q

Bradypnea (breathing rate)

A

< 12/min

39
Q

Tachypnea (breathing rate)

A

> 20/min, normal depth

40
Q

Hyperpnea (hyperventilation)

A

> 20/min, and very deep

41
Q

Cheyne-Stokes (breathing rate)

A

Gradual increasing depth with periods of apnea

42
Q

Difference b/w tachypnea and hyperpnea?

A

Both are very fast but hyperpnea is fast with deeper breaths

43
Q

Feeling for vibrations through the chest wall; testing for whether or not there is any solid or semi-solid pathology in the way

A

Tactile fremitus

44
Q

Decreased or Absent Tactile Fremitus could indicate…

A 
Voice too soft (have them say it louder)
COPD
Thick chest wall
Pneumothorax
Added air
45
Q

Increased Tactile Fremitus could indicate…

A

Obstruction of any kind would increase the tactile femitus

Due to fluid or tumor (solid mass)

46
Q

What may cause a flat, dull, or hyper-resonant sound upon percussion

A

Flat – pleural effusion
Dull – tumor or pneumonia
Hyperresonant – pneumothorax or COPD

47
Q

What type of sound should you get upon percussion above the diaphram? What about below?

A

Should be resonant above and dull below

48
Q

Normal excursion should be _______ cm and….

A

5-6cm and equal bilaterally

49
Q

Abnormally high level of excursion may indicate…

A

Pleural effusion or elevated diaphragm

50
Q

Abnormally high level of excursion may be due to…

A

Atelectasis, Phrenic nerve, Paralysis

51
Q

What are vesicular lung sounds? Where are they heard and what do they sound like?

A

Inspiratory sounds last longer than expiratory, the intensity is soft, the pitch is relatively low, & they are heard over most healthy lung fields

52
Q

What are broncho-vesicular lung sounds? Where are they heard and what do they sound like?

A

Inspiratory and expiratory sounds are about equal, are of intermediate intensity, intermediate pitch, heard over the 1st and 2nd interspaces anteriorly and between scapulae posteriorly

53
Q

What are bronchial lung sounds? Where are they heard and what do they sound like?

A

Expiratory sounds are slightly longer than inspiratory sounds; they are loud, high pitched (tubular), and heard over the manubrium (if at all)

54
Q

What are tracheal lung sounds? Where are they heard and what do they sound like?

A

Inspiration and expiration sound about equal; they are very loud, high pitched (tubular), and heard over the trachea in the neck

55
Q

Decreased Intensity of Normal Lung Sounds with…

A

Obesity, Thick chest wall, Shallow breaths, Pathology

56
Q

Brief discontinuous sounds, most often at end of inspiration

A

Crackles (rales)

57
Q

With what conditions can you hear crackles?

A

CHF, pneumonia, bronchitis

58
Q

Can have a snoring or gurgling quality, Indicate secretions in large airways (Main stem bronchi, trachea, etc)

A

Rhonchi

59
Q

With what conditions can you hear Rhonchi?

A

CHF, bronchitis

60
Q

Musical sounds created when air flows rapidly through bronchi that are narrowed significantly; Heard in expiration and sometimes on inspiration

A

Wheezes

61
Q

With what conditions can you hear wheezes?

A

COPD, asthma, bronchitis, even CHF

62
Q

Wheeze heard primarily during inspiration and mainly over larger airways

A

Stridor

63
Q

Stridor can be sign of…

A

Airway obstruction, foreign body, croup, & epiglottitis

64
Q

Related to inflammation of pleural surfaces; Coarse grating sound timed with lung movement; Evidence of local inflammation

A

Pleural rub

65
Q

Occurs over areas of the lung in which the alveoli are filled with fluid or replaced by solid tissue

A

Bronchophony

66
Q

Bronchophony can be heard with what conditions?

A

Pneumonia, atelectasis, or tumors.

67
Q

If the patient says “E” and you hear “A” this is called…

A

Egophony

68
Q

Egophony is a sign of…

A

Consolidation in the area

69
Q

What is the normal result for the following:

  • Predominant lung sounds?
  • Spoken words?
  • Spoken “ee”?
  • Whispered words?
  • Tactile fremitus?
  • Percussion?
  • Respiratory rate?
A
  • Predominant lung sounds? = Vessicular
  • Spoken words? = Distant
  • Spoken “ee”? = Hear e over normal lung
  • Whispered words? = Distant
  • Tactile fremitus? = Distant
  • Percussion? = Resonance
  • Respiratory rate? = 14 to 20
70
Q

Expected sound with consolidation for the following:

  • Predominant lung sounds?
  • Spoken words?
  • Spoken “ee”?
  • Whispered words?
  • Tactile fremitus?
  • Percussion?
  • Respiratory rate?
A
  • Predominant lung sounds? = Bronchial or broncho-vessicular
  • Spoken words? = Increased
  • Spoken “ee”? = E to A change
  • Whispered words? = Increased (i.e. would hear words)
  • Tactile fremitus? = Increased
  • Percussion? = Dull or flat
  • Respiratory rate? = variable
71
Q

Differential for Crackles

A

Pneumonia

72
Q

Differential for Rhonchi

A

CHF

73
Q

Differential for Dullness/asymmetric excursion

A

Tumor

74
Q

Differential for Tender ICS

A

Pleuritis (also might hear friction rub!)

75
Q

Differential for Retractions

A

Respiratory distress (increased work of breathing)

76
Q

Differential for Left supraclavicular adenopathy

A

Pancost tumor (apex of lung)

77
Q

Differential for Pink Puffer

A

Emphysema (wheezing, not vessicular sounds)

78
Q

Differential for Blue Bloater

A

Chronic bronchitis (blue/cyanotic, obese, rhonchi)

Physical Exam Midterm & Final (11 decks)

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