Pulmonary Flashcards
Lungs, fissures, lobes
Each lung is divided roughly in half by oblique fissure
R lung divided by horizontal minor fissure
R lung divided into upper, middle, and lower lobes
L lung divided into upper and lower lobes
Trachea- bifurcated into mainstem bronchi at sternal angle and T4
Pleurae- serous membranes that cover surface of each lung (visceral pleura)
Inner rib cage and upper surface (parietal pleura)
Chest pain
Lung tissue does not have pain fibers. Pain in lung arises from inflammation of adjacent parietal pleura. Surrounding structures can irritate parietal pleura
SOB (dyspnea)
Non-painful, uncomfortable awareness inappropriate for level of exertion
“Have you had any difficulty breathing?” Determine severity based on patient’s daily activities
Wheezing musical respiratory sounds may be audible to patient and others
Cough- reflex response to stimuli that irritate receptors in larynx. Can have cardio origin
Hemoptysis***** TQ!!
Coughing up blood from lungs. Blood-streaked phlegm to frank blood. Like sputum. Can originate from mouth, pharynx, or GI tract
Pulmonary Examination
Inspect, Palpate, Percuss, and Auscultate
Vesicular** TQ!
soft and low pitches; usually heard over most of both lungs. Gentle rushing (normal lung sound)
Bronchial
Louder and higher in pitch. Tubular
- over manubrium
Bronchovesicular
Intermediate intensity and pitch; Rustling but tubular
- over 1st and 2nd interspaces and scapula on posterior
Tracheal
Very loud, very high pitch, very harsh
- over trachea in neck
Egophany, whispered pectoriloquey, and bronchophony are increased with
Consolidation - liquid instead of air
Lobes relation to chest wall
Anterior: RUL, RML, LUL, LLL
Posterior: lLUL, LLL, RUL, RLL (not right middle)
Lateral: RUL, RML, RLL, LUL, LLL (all)
Trachea’s position
Bifurcates into mainstem bronchi at sternal angle and T4, midline
Pectus excavatum
Funnel chest, depression in lower part of sternum. Compression of heart or vessel cause murmurs
Barrel chest
Increase AP diameter. Accompanies aging and COPD
Dyspnea
SOB
Diagnostic meaning of abnormal tactile fremitus
Fremitus decrease/absent when voice is soft, or transmission of vibrations is blocked
Causes- thick chest wall, blocked bronchus, COPD, pleural effusion, fibrosis, air, tumor
Asymmetric decreased fremitus-unilateral pleural effusion, pneumothorax.
Asymmetric increased fremitus- unilateral pneumonia.
Diaphragmatic excursions
Abnormally high indicative of pleural effusion, atelectasis, diaphragmatic paralysis
Percussion sounds
Healthy lungs- resonant
Abnormal lungs-
- Dullness: left lower thorax
- Hyper-resonance: pneumothorax ***** TQ!
- Flatness, tympani: absent breath sounds
Crackles ***** TQ
Crackles- discontinuous, intermittent brief. Occur at late inspirations, early inspiratory, mid-inspiratory, and expiratory crackles.***** TQ!
Fine crackles
Fine crackles- soft, high pitched, brief
Coarse crackles
Louder, lower in pitch brief
Dx meaning- problem with lungs/airway. Pneumonia, early CHF, bronchitis
Pleural rub
Inflamed pleural surfaces grating against each other
Increased friction produce creaking sounds
Mediastinal crunch
Hamman’s sign- crackles with heartbeat, not respiration. Due to mediastinal emphysema
Wheezes**** TQ!
Continuous, high pitched hissing/shrill ***** TQ!
Audible at mouth through chest wall
Dx meaning- narrowed airways, asthma, COPD, bronchitis
Silent chest- airway so narrow, wheezing can’t be produced
Stridor
Wheeze during inspiration
Dx meaning- partial obstruction of larynx or trachea
Rhonchi ***** TQ!!!
Continuous, musical, low snoring ****
Dx meaning - secretions in large airways
Pneumothorax causes absent breath sound at what level
T1-T5/T6
Accessory muscles for breathing
SCM, scalenes, pec minor.
Look for bulging neck muscles, use of muscles one side of the chest, heaving abdomen
Anterior location of lower border of lung
6th rib, midclavicular line and 8th rib - midaxillary line
Posterior location of lower border of lung
T10 spinous process
Trachea bifurcation
Sternal angle anterior and T4 spinous process posteriorly
Location of bronchovesicular breath sounds
1st and 2nd interspaces anteriorly between the scapulae
In a patient with pneumonia, you would expect percussion of the left lower thorax to be
Dull (resonant —-> dull)
In a pt with pneumonia, egophany would produce an ______ to _______ transition
E to A
COPD, you would find increased ___________
AP diameter
Upon auscultation in a pt with COPD, you would expect to hear
Delayed expiratory phase
Pneumothorax would produce
Increased resonance (hyperresonance on affected side)
Bc more air, would also occur with emphysema
In a pt with pneumothorax, auscultation
Absent breath sounds
In a healthy adult, expected distance of descent of diaphragm is
5-6 cm
Normal respiratory rate
14 to 20 breaths per minute
