PD - Pulm Flashcards
sternal angle of Louis landmark
rib 2
Bifurcation of trachea to bronchi
Carina
T4
inferior wing of scapula landmark
rib 7
boundaries of the lungs landmarks
Superiorly – 3-4 cm above medial end of clavicle
Inferiorly- to rib 6 at the midclavicular line, rib 8 at the midaxillary line and posteriorly to the level of T9 and T12
In both the right and left lungs, the oblique fissure separates the ___________ from the rest of the lung.
The line runs from ____________ to ___________ then posteriorly to the level of ___:
In both the right and left lungs, the oblique fissure separates the lower lobe from the rest of the lung.
The line runs from rib 6 at the midclavicular line to rib 5 at the midaxillary line then posteriorly to the level of T3:
At the end of expiration, the diaphragm is at the level of
Rib 5 Anteriorly
T9 Posteriorly
Barrel Chest
AP diameter equals or is greater than the lateral diameter; eg. advanced COPD
Flail Chest
multiple ribs broken in multiple places, causing that portion of the chest to move paradoxically inward during inspiration
Pectus Carinatum
anterior protrusion of sternum; usually does not compromise ventilation
Pectus Excavatum
depression of sternum; usually accompanied by mitral valve prolapse
Kyphoscoliosis
abnormal AP diameter and lateral curvature of the spine
open pneumothorax
Air bubbling from an open wound in the chest; very abnormal
I:E Ratio
1:2
Expiration may be prolonged in obstructive states such as Asthma or COPD (I:E Ratio of 1:3 or 1:4)
Normal adult respiratory rate
10-14 breaths per minute
Bradypnea
abnormal slowed slowed breathing
Tachypnea
abnormal increase in breathing
apnea
absent breathing
Hyperpnea (Kussmaul’s breathing)
increased depth; usually associated with metabolic acidosis
Biot breathing
irregular with long periods of apnea; eg. Increased intracranial pressure, drug-induced, brain damage
Cheyne-Stokes breathing
irregular with periods of increased and decreased rates and depths and apnea; eg. drug-induced, brain damage
evaluation of the degree of symmetry of chest expansion
Place your hands flat on the patient’s back with thumbs parallel to the midline at around the tenth ribs, pulling the skin slightly towards midline.
Ask the patient to inhale deeply and note the symmetry of your chest as your hands expand.
Your hands should move symmetrically with expansion of the chest wall. Localized pulmonary disease may result in lack of symmetry.
Tactile Fremitus
vibration felt on the chest wall by the examiner when a pt is speaking
increased density of the lung will increase transmission of sound wave, result in increased tactile fremitus
decreased density (fat, air, or fluid) in the chest cavity –> decreased transmission of sound waves, reduced tactile fremitus
To test: place ulnar side of right hand against one side of the patient’s back, away from the scapulae. Ask the patient to say “ninety-nine”, move hand from side to side and top to bottom to detect difs
Flat percussion
high-pitched sound produced from a thick dense mass such as bone or a muscular thigh
Dull percussion
low amplitude, short-duration sound produced from a solid organ such as the liver
Resonant percussion
higher amplitude, low-pitched sound produced from an air-filled tissue such as the lung
Tympanic percussion
high-pitched, hollow sound produced from a hollow, air-filled structure such as stomach
Hyperresonant percussion
low-pitched, hollow sound produced from emphysematous lung
Normal breath sounds
tracheal
bronchial
vesicular
bronchovesicular
adventitious (abnormal) breath sounds
rales (crackles) wheezes ronchi stidor pleural rubs
abnormal transmission of breath sounds
egophany
whispered pectoriloquy
bronchophony
Tracheal (normal breath sound)
harsh, loud, high-pitched sounds heard over trachea; inspiratory and
expiratory sounds are equal in length
Bronchial (normal breath sound)
loud, high-pitched sounds like air rushing through a tube heard over the manubrium; expiratory is longer and louder than inspiratory; a pause exists between the two components
Vesicular (normal breath sound)
soft, low-pitched sounds heard over most lung fields; inspiratory is longer and louder than expiratory
Bronchovesicular (normal breath sound)
mixture between bronchial and vesicular sounds heard in the area of the carina and mainstem bronchi; inspiratory and expiratory equal in length; best heard in the first and second interspaces anteriorly and scapulae posteriorly
Rales (crackles)
short, discontinuous, nonmusical sounds heard on inspiration (via opening of collapsed distal airways and alveoli)
also called rales or crepitation
sound is similar to Velcro opening or hair rubbed next to the ear
causes: pulmonary edema, CHF, pulmonary fibrosis, pneumonia, atelectasis
Wheezes
continuous, musical, high-pitched sounds heard during expiration caused by narrowing of bronchi due to swelling, secretion, foreign body, tumor
assoc w/ asthma/COPD and occasionally pulmonary edema and CH (sometimes referred to by the misnomer “cardiac asthma”)
Rhonchi
low-pitched; associated with mucus plugging and poor movement of secretions
bronchitis
Stridor
high-pitched, inspiratory, upper airway sound caused by turbulent flow in the upper airway due to upper airway obstruction such as mass or swelling
causes: tumors, croup, foreign bodies
Pleural Rubs
grating sound made by pleura that is roughened or thickened by inflammation, neoplasm, or fibrin deposits
best heard on inspiration and beginning of expiration; sounds like creaking leather
assoc w/ pneumonia and pulmonary infarction
Egophany
E –> A
spoken word heard through the lungs is increased in intensity and takes on a nasal quality
when pt says “eee”, heard as “aaa” in an area of consolidation (eg. fluid-filled)
Whispered Pectoriloquy
intensification of a whispered word heard in consolidation of the lung
when pt whispers “one-two-three”, normally little or nothing will be heard by the examiner
the words will be heard clearly in consolidation of the lung
Bronchophony
increased transmission of spoken words
when pt says “ninety-nine”, words will be transmitted louder than normally if there is consolidation
symptoms of pulmonary disease
Cough. Sputum. Hemoptysis (cough up blood). Dyspnea (SOB). Wheezing. Cyanosis. Chest pain.
