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Physical Diagnosis > PD Thorax and Lungs > Flashcards

PD Thorax and Lungs Flashcards

1
Q

What are the imaginary lines on the anterior thorax?

A

Midsternal

Midclavicular

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2
Q

What are the imaginary lines on the lateral thorax?

A

Anterior and posterior axillary

Midaxillary

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3
Q

What are the imaginary lines on the posterior thorax?

A

Scapular

Vertebral

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4
Q

At what levels anteriorly and posteriorly does the carina sit?

A

Sternal angle and T4

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5
Q

What fissure do both lungs have?

A

Oblique major fissure

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6
Q

Where is the oblique fissure located?

A

T3 to 6th rib anteriorly

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7
Q

Which lung has a second fissure, and what is it called?

A

Right lung has a horizontal fissure

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8
Q

Where is the horizontal fissure located?

A

Anteriorly from 4th rib and meets oblique fissure in midaxillary line near 5th rib

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9
Q

Where is the lower border of the lung, anteriorly and posteriorly?

A

Anteriorly 6th rib midclavicular and 8th rib midaxillary

Posteriorly T10

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10
Q

What are the stimuli for breathing?

A

Chemoreceptors in medulla sensitive to changes in H concentration
Chemoreceptors in carotid body respond to changes in arterial oxygen and CO2 concentrations

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11
Q

Which organ regulates respiratory muscles?

A

Pons

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12
Q

What is the primary muscle of respiration?

A

Diaphragm

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13
Q

What other muscles are involved in respiration during stress or exercise?

A

Parasternal
Scalenes
SCM
Abdominal muscles

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14
Q

What are the chief pulmonary complaints?

A 
Chest symptoms
Dyspnea
Wheezing
Cough
Hemoptysis
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15
Q

How should the patient be positioned to inspect them?

A

Sitting and supine, properly draped or exposed

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16
Q

What do we observe about respirations?

A 
Rate
Rhythm
Depth
Effort
Pattern
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17
Q

Color

A

Cyanosis

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18
Q

Listen

A

Wheezing
Stridor
Where in respiratory cycle?

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19
Q

Inspection

A 
Accessory muscle use
Retraction
Nasal flaring
Pursed lips
Trachea midline
Shape of chest - deformity, asymmetry
Movement of chest - unilateral lag
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20
Q

Supernumerary nipples

A

Associated with congenital heart disease

Polythelia

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21
Q

How do we palpate to see if the trachea is midline?

A

Place finger in sternal notch and slip to each side

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22
Q

Barrel chest

Examples

A

Increased AP diameter, kyphosis, ribs more horizontal
Normal during infancy
Aging, COPD

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23
Q

Kyphosis

A

Anterior chest wall collapse

May make interpretation of lung findings difficult

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24
Q

Kyphoscoliosis

A

Abnormal spinal curvatures and vertebral rotation deform the chest
Distortion of underlying lungs, interpretation is difficult

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25
Q

Pectus excavatum

A

Depression in lower portion of sternum

Compression of heart and great vessels may cause murmurs

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26
Q

Pectus Carinatum

A

Sternum is displaced anteriorly, increasing AP diameter

Costal cartilages next to protruding sternum are depressed

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27
Q

Palpation

A 
Tenderness
Pulsations
Bulges
Masses
Depressions
Crepitus
Pleural friction rub
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28
Q

Crepitus

Examples

A

Crackly, crinkly sensation can be felt or heard
Indicates air in soft tissues

Pneumothorax, infection

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29
Q

Is crepitus a normal finding?

A

No, always abnormal

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30
Q

Pleural friction rub

Example

A

Often heard before felt
Palpable, coarse, grating vibration
Usually on inspiration

Inflammation of pleurae

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31
Q

Tactile fremitus

A

Palpable vibration of chest from speech

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32
Q

Decreased or absent tactile fremitus

A

Emphysema
Pleural thickening
Effusion
Bronchial obstruction

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33
Q

Increased tactile fremitus

A

Lung consolidation
Large effusion
Tumor
Non obstructing bronchial secretions

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34
Q

Where do you check chest expansion posteriorly?

A

T10

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35
Q

Where is fremitus normally more prominent?

A

Interscapular area than lower lung fields

Right than left

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36
Q

Where do you check chest expansion anteriorly?

A

Thumbs along costal margin and xiphoid process

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37
Q

Examples of deviated trachea

A 
Tension pneumothorax
Tumor
Nodal enlargement
Large effusion
Thyroid enlargement
Severe parenchymal or pleural fibrosis
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38
Q

Percussion

A

Compare all areas bilaterally, from superior to inferior and medial to lateral, systematically

39
Q

How do you position a patent for percussion?

A

Posterior - flex head with arms folded in front

Anterior lateral - raise arms

40
Q

What area on the chest do we percuss, over ribs or intercostals?

A

Intercostal spaces

41
Q

Normal lungs should sound… on percussion

A

Resonant

42
Q

Hyperresonant lungs examples

A

COPD
Pneumothorax
Asthma

43
Q

Dull lungs examples

A 
Atelectasis
pleural effusion
Consolidated lung
Tumor
Organ
44
Q

Which diaphragm is usually higher?

A

Right side

45
Q

What conditions limit diaphragmatic excursion?

A 
Emphysema
Ascites
Rib fracture
Piaphragmatic paralysis (phrenic nerve injury)
Large effusion
Tumor
46
Q

What is the normal diaphragmatic excursion?

A

About 5 cm

47
Q

How should a patient breath for auscultation?

A

Slow, deep breaths through the mouth

48
Q

What do we caution the patient of with auscultation?

A

Go slow, don’t hyperventilate

49
Q

Which side of the stethoscope do we auscultate the lungs with?

A

Diaphragm - can hear higher pitched sounds better, and is wider than the bell

50
Q

Auscultation

A

Listen systematically from side to side for comparison, starting at apex

51
Q

What are we evaluating during auscultation?

A

Intensity
Pitch
Quality
Duration

52
Q

How do inspiration and expiration duration usually compare?

A

Equal

53
Q

Vesicular

A

Heard over most lung fields
Low pitched, soft
Fade away 1/3 through expiration

54
Q

Bronchovesicular

A

Medium pitch
Inspiration and expiration are equal in length
Heard over main bronchus and R posterior lung field

55
Q

Bronchial (tubular)

A

Louder, harsher, higher in pitch
Expiration lasts longer, short silence between
Heard over trachea, consolidation, large effusion

56
Q

Where is it abnormal to hear bronchovesicular and bronchial lung sounds?

A

Periphery of lungs

57
Q

Amphoric breath sounds

A

Resembles blowing mouth across open bottle

Heard with large pulmonary cavity (blebs with emphysema) or tension PTX with bornchopleural fistula

58
Q

Decreased breath sounds

A

Fluid in pleural space
Secretions in airways
Severe emphysema

59
Q

Increased breath sounds

A

Consolidated lung
Large effusion
Empyema
Large tumor

60
Q

Adventitious breath sounds

A 
Crackles, rales
Rhonchi
Wheeze
Pleural/friction rub
Stridor
61
Q

When are crackles usually heard?

A

Inspiration

62
Q

Are crackles continuous or discontinuous?

A

Discontinuous, lasting only few miliseconds

63
Q

What can we do to demonstrate what crackles sound like?

A

Rubbing hair between thumb and forefinger

64
Q

What causes crackles?

A

Result from noise of previously closed airways opening in the distal radicals of bronchial tree
Heard with opening and closing of alveoli

65
Q

Fine crackles

Example

A

High pitched, short in duration, wet

CHF

66
Q

Coarse crackles

Example

A

Low pitched, longer in duration, dry

Pneumonia

67
Q

Examples of crackles

A 
Interstitial lung disease
Pulmonary fibrosis
Pneumonia
Atelectasis
Bronchiectasis
ARDS
Pulmonary edema
68
Q

Are rhonchi continuous or discontinuous?

A

COntinuous

69
Q

What do rhonchi sound like?

A

Low pitched rumbling or gurgling sounds

70
Q

What causes rhonchi?

A

Passage of air through larger airways that are obstructed by fluid or mucous

71
Q

What can clear rhonchi?

A

Cough

72
Q

What is the death rattle?

A

When rhonchi is heard in agonal states

73
Q

What are some examples of when patients develop rhocnhi?

A 
Patient can't control secretions
Tracheobronchitis
Pneumonia
Bronchial obstruction
Foreign body
74
Q

What do wheezes sound like?

A

High pitched, whistle like

75
Q

What causes wheezes?

A

Turbulent air and vibration of the airway walls in which there is partial obstruction to airflow

76
Q

Are wheezes continuous or discontinuous?

A

Continuous

77
Q

When do you usually hear wheezes, inspiration or expiration?

A

Expiration

78
Q

Examples of wheezes

A 
Bronchospasm
Asthma
Neoplasm
Edema (CHF)
Foreign body
79
Q

Where does a pleural friction rub occur?

A

Outside of the respiratory tree

80
Q

What causes a pleural friction rub?

A

Inflamed pleurae rubbing against each other with respiration

81
Q

Is a pleural friction rub continuous or discontinous?

A

Discontinuous

82
Q

What does a pleural friction rub sound like?

A

Dry, crackly, grating, low pitched
New leather rubbing together
Crunching of snow underfoot

83
Q

How do you differentiate between a pleural and pericardial rub?

A

Have patient hold breath - pericardial rub persists

84
Q

What does stridor sound like?

A

High pitched

85
Q

Is stridor heard during inspiration or expiration?

A

Inspiration

86
Q

Is stridor continuous or discontinous?

A

Continuous

87
Q

Stridor examples

A 
Malignancy
Laryngeal obstruction
Eplglottitis
Foreign body
Tracheal stenosis
Laryngomalacia
Croup
88
Q

Vocal resonance

A

Vocalizations are transmitted through the respiratory tree

89
Q

Where are whispered words heard in a normal lung?

A

Faint and syllables are not distinct except over main bronchi

90
Q

When do you evaluate vocal resonance?

A

If abnormalities are detected on percussion, palpation, or auscultation

91
Q

What are the vocal resonance tests?

A

Bronchophony
Egophony
Whispered pectoriloquy

92
Q

Bronchophony example

A

Loudness of vocalization increased due to pulmonary consolidation or large effusion

93
Q

Egophony example

A

EEE turns to AAA with nasally quality

Heard with pleural effusion or consolidation

94
Q

Whispered pectoriloquy example

A

Whispered words are clearly audible

Consolidation, pulmonary infarction, atelectasis

Physical Diagnosis (10 decks)

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