Pulmonary Flashcards
What region does the RUL sit
Anterior
Where is the apex of the lung
4cm above the 1st rib, T1 posteriorly
Where is the base of the lung
Posteriorly T12 on inspiration
T9 on expiration
Respiration
Exchange of gases between lungs and air
Ventilation
Movement of air into and out of the lungs, eventually moves gases(inhalation/exhalation)
Hyperventilation
Increased rate and depth of breathing, greater than 20 a minute
Hyperpnea
Deep labored breathing
Kussmaul
Rapid, deep, labored breathing
Hypopnea
Abnormally shallow respirations
What does a caved in sternum suggest
restrictive disease
What is an indented sternum called
Pectus excavatum
Pectus carinatum
When the sternum is bulged out. aka pigeon chest, obstructive disease
What does clubbing indicate
Pulmonary or cardiac difficulties. EX: emphysema, lung cancer, or congenital heart disease
Pleural friction rub
Feels like a coarse grating vibration during inspiration, caused by inflammation of pleural surfaces.
When does vocal/tactile fremitis increase
When there is consolidation of lung tissue, like pneumonia or cystic fibrosis
When does vocal/tactile fremitis decrease
When lung tissue is replaced by fluid or air. Like pneumothorax or pleural effusion
What conditions cause the trachea to deviate towards the affected lung
- Atelectasis
- pneumonectomy
- pleural fibrosis
- agenesis of the lung
What conditions cause the trachea to deviate away from the affected lung
- thyroid enlargement
2. pleural effusion
When percussing and you hear a hyperresonant sound, what might that indicate
emphysema, pneumo, asthma….means there is excess air in the lungs
When percussing and you hear a dull sound, what might that indicate
Pneumonia, atelectasis, pleural effusion….more dense material
Vesicular breath sounds
Low, intensity and pitch, heard on sides and lower lobes in healthy lungs
Bronchovesicular sounds
Heard over main bronchi and upper lungs. Medium pitch, inspiration and expiration equal
Bronchial/tubular sounds
Highest pitch, usually only heard over the manubrium. Abnormal if heard over the normal lung fields
Crackles
Discontinuous, abnormal popping respirations heard normally during inspiration. Excess secretions in small airways
Rhonci
Loud, low coarse sounds like a snore. Usually continuous caused by rattling of secretions in large airways
Wheezes
Musical noise that sounds like a squeak, continuous. Swelling or obstruction, heard most often in upper lungs
what is another name for the angle of Louis
The manubriosternal junction
What level is the horizontal fissure at
5th rib axillary
4th rib anteriorly
What do you inspect for during the respiratory exam
- Shape and symmetry of the chest
- Symmetry of chest wall during inspiration
- ap/lateral diameter
- RR and depth of breathing
- Cyanosis or clubbing
Initial palpation looks for?
- Crepitus
2. Pain on chest (holding chest while pt breathes)
How do you test for tactile fremitus
Place ulnar surface of the hand on the chest and have pt say 99. Go all the way down, AP, lateral, posterior
What does increased tactile fremitus indicate
Means there is more fluid or a mass in the lung. (Sound vibration travels better through dense material)
What are you listening for with percussion
A change from resonance to hyper or dull sounds.
If you hear hyper resonance over the lungs what does that mean
Increased amount of air in the lungs
If you hear dullness in the lungs, what does that mean
Indicative of a mass, fluid, or consolidation
What is diaphragmatic excursion
The measurement of the diaphragm between inspiration and expiration. done using percussion
Egophony
special test, pt says e, will sound like a (goat) heard with emphysema
Pectoriloquy
pt says 1,2,3 whispered words will be clear. Indicates pneumonia, cystic fibrosis
Broncophony
Bronchial sounds, determined by vocal femitus. If louder and clearer it is indicative of consolidation
What should the ratio of AP to Lateral be
.70-.75, if not, then it is most likely a barrel chest
Barrel chest
AP diameter is larger than lateral diameter
Flail chest
Chest wall becomes separated from the rib cage, causes paradoxical breathing (rib fxs)
Scoliosis
Lateral curvature of the spine
Kyphosis
Rounded curvature of the spine
Gibbus
Sharp angular (90 degrees) deformity associated with a collapsed vertebra from osteoporosis
Lordosis
Excessive inward curvature of the spine
Pulsus paradoxus
Exaggerated decrease in the amplitude and rate of systolic pressure during inspiration and an increase during expiration
Stridor
High pitched, piercing sound heard during inspiration due to obstruction in trachea or larynx.
Paroxysmal nocturnal dyspnea
attacks of severe SOB and coughing that wakes the pt up
orthopnea
SOB or sensation of breathlessness while lying down
Tracheal breath sounds
High pitched, harsh, heard over neck and trachea…darth vader
How would you determine if it is a pleural or pericardial friction rub
Have pt hold their breath. If the sound continues it is a pericardial rub
What do you look for during INSPECTION
- Shape/symmetry
- AP/lateral diameter
- Trachea midline
What are you listening for with percussion
Normal resonant sounds
What are you looking for with palpation
- Areas of pain
- crepitus
- Respiratory expansion (diaphragmatic excursion)
- Tactile fremitus - symmetry important
