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Emma - Physical Diagnosis > PD - Pulm > Flashcards

PD - Pulm Flashcards

1
Q

sternal angle of Louis landmark

A

rib 2

Bifurcation of trachea to bronchi
Carina
T4

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2
Q

inferior wing of scapula landmark

A

rib 7

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3
Q

boundaries of the lungs landmarks

A

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

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4
Q

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 ___:

A

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:

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5
Q

At the end of expiration, the diaphragm is at the level of

A

Rib 5 Anteriorly

T9 Posteriorly

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6
Q

Barrel Chest

A

AP diameter equals or is greater than the lateral diameter; eg. advanced COPD

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7
Q

Flail Chest

A

multiple ribs broken in multiple places, causing that portion of the chest to move paradoxically inward during inspiration

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8
Q

Pectus Carinatum

A

anterior protrusion of sternum; usually does not compromise ventilation

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9
Q

Pectus Excavatum

A

depression of sternum; usually accompanied by mitral valve prolapse

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10
Q

Kyphoscoliosis

A

abnormal AP diameter and lateral curvature of the spine

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11
Q

open pneumothorax

A

Air bubbling from an open wound in the chest; very abnormal

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12
Q

I:E Ratio

A

1:2

Expiration may be prolonged in obstructive states such as Asthma or COPD (I:E Ratio of 1:3 or 1:4)

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13
Q

During normal, quiet breathing, muscle contraction occurs only during ____, and ____ is passive.

A

inspiration –> contraction

expiration –> passive

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14
Q

Normal adult respiratory rate

A

10-14 breaths per minute

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15
Q

Bradypnea

A

abnormal slowed slowed breathing

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16
Q

Tachypnea

A

abnormal increase in breathing

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17
Q

apnea

A

absent breathing

18
Q

Hyperpnea (Kussmaul’s breathing)

A

increased depth; usually associated with metabolic acidosis

19
Q

Biot breathing

A

irregular with long periods of apnea; eg. Increased intracranial pressure, drug-induced, brain damage

20
Q

Cheyne-Stokes breathing

A

irregular with periods of increased and decreased rates and depths and apnea; eg. drug-induced, brain damage

21
Q

evaluation of the degree of symmetry of chest expansion

A

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.

22
Q

Tactile Fremitus

A

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

23
Q

Flat percussion

A

high-pitched sound produced from a thick dense mass such as bone or a muscular thigh

24
Q

Dull percussion

A

low amplitude, short-duration sound produced from a solid organ such as the liver

25
Q

Resonant percussion

A

higher amplitude, low-pitched sound produced from an air-filled tissue such as the lung

26
Q

Tympanic percussion

A

high-pitched, hollow sound produced from a hollow, air-filled structure such as stomach

27
Q

Hyperresonant percussion

A

low-pitched, hollow sound produced from emphysematous lung

28
Q

Normal breath sounds

A

tracheal
bronchial
vesicular
bronchovesicular

29
Q

Adventitious (abnormal) breath sounds

A 
rales (crackles)
wheezes
ronchi 
stridor
pleural ribs
30
Q

abnormal transmission of breath sounds

A

egophany
whispered pectoriloquy
bronchophony

31
Q

Tracheal (normal breath sound)

A

harsh, loud, high-pitched sounds heard over trachea; inspiratory and
expiratory sounds are equal in length

32
Q

Bronchial (normal breath sound)

A

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

33
Q

Vesicular (normal breath sound)

A

soft, low-pitched sounds heard over most lung fields; inspiratory is longer and louder than expiratory

34
Q

Bronchovesicular (normal breath sound)

A

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

35
Q

Rales (crackles)

A

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

36
Q

Wheezes

A

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”)

37
Q

Rhonchi

A

low-pitched; associated with mucus plugging and poor movement of secretions

bronchitis

38
Q

Stridor

A

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

39
Q

Pleural Rubs

A

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

40
Q

Egophany

A

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)

41
Q

Whispered Pectoriloquy

A

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

42
Q

Bronchophony

A

increased transmission of spoken words

when pt says “ninety-nine”, words will be transmitted louder than normally if there is consolidation

Emma - Physical Diagnosis (12 decks)

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