Pulmonary Flashcards
the interspace is named for the rib above or below it?
above
scapular inferior angle is located about where?
just under the 7th rib
Costal cartilages of ______ articulate with the sternum
Cartilages of _____ articulate with costal cartilages just above
first 7 ribs
8-10
______ are floating ribs
11 and 12th
___is appreciated laterally (it is short so it does not come all the way around)
____ – is posterior – may use as posterior landmark to count ribs from bottom up
11: lateral
12: posterior
______ needle insertion for tension pneumothorax
________-intercostal space for chest tube insertion
The tube is generally placed where it is needed.
2nd interspace - tension pneumo
4th or 5th interspace - chest rube
_______ landmark for thoracentesis
T7-T8 interspace
why do we insert just on top of the rib for chest tube?
The neurovascular structures run under the ribs so insert things on top of the rib…
what are our 7 circumferential landmarks?
lines: midsternal, midclavicular, anterior axillary , mid-axillary, post-axillary, scapular (mid-scapular) and vertebral
the apex of the lung is _____ above the _____
2-4 cm above the clavicle
lower border of the lung crosses the ______ posterior it lines at about ___________
6th rib at midclavicular and 8th rib at midaxillary line , posteriorly lies at the level of the T10 spinous process but descends with inspiration
oblique (the major) fissure of the _(right or left?)____ lung, starts at ___ and ends ____
right lung, starts at T3 and ends at 6th rib, midaxillary line
- this divides the lung in half
the horizontal (minor) of the __(right or left?)_lung divides ______
right lung, divides upper lobe into two- into right upper and right middle
the trachea bifurcates at …
the sternal angle anteriorly, at the T4 level posteriorly
the conducting zone walls are line with ______ and include ____
smooth muscle, mucus secreting and ciliated cells
Respiratory bronchioles are ______ with some smooth muscle and cilia and have a few alveoli
transitional
______has an effect on the blood flow to the different areas in the lungs
gravity
what pressure keeps the lungs inflated?
negative intrapleural pressure
what are the receptors in the resp. center of the brainstem
chemoreceptors
what are the primary (1) and accessory (5) muscles of breathing?
primary: diaphragm
accessory:
scalene (cervical vert. to first two ribs)
parasternal (sternum to ribs obliquely)
sternocleidomastoid
intercostals
abdominals
what do the external vs internal intercostals do?
external: inhale
internal: exhale
abdominal muscles assist in …
expiration
what are the two pleura layers of the lung?
inner: Visceral pleura covers the outer surface of the lung
outer: Parietal pleura lines the lung cavity (rib cage and diaphragm)
- fluid between the two allow easy movement of lungs
pleural effusions: transudates vs exudates
transudates: pressure problem-imbalance of hydrostatic and osmotic forces (i.e. atelectasis, HF)
exudates: injury or inflammation problem (ie pneumonia, PE)
air trapped in pleural space?
pneumothorax - can be small or entire lung
how can you recognize a Pneumothorax?
clinical, chest Xray
technique for exam, for posterior exam if the pt can’t sit up you can…
roll them from side to side - document that they were unable to sit
technique for exam, anterior - easier to examine if pt is …
lying down
4 purposes of the lung and thorax exam
- lung function
- musculature- internal and external
- skeletal
- skin
initial survey of breathing, examine …
rate, rhythm, depth, effort
inspection of the thorax
shape and condition of thorax: bony deformities, splinting (obviously favoring one lung over the other), asymmetry
depression of lower part of sternum can cause what to the heart …. and is deemed the term ______
compression of heart and great vessels- may cause murmurs. Called Funnel Chest (pectus excavatum)
what are the 3 possible reasons for barrel chest?
children, older people, COPD (from emphysema)
Pectus carinatum, commonly known as ______, is caused by what anatomical abnormality?
pigeon chest- costal cartilages near protruding sternum are depressed - make it look like sternum is sticking out
how does a flail chest present? common cause?
paradoxical movement of chest- injured area caves in with inspiration, out with expiration. From multiple rib fractures - car accident likely.
how does thoracic kyphoscoliosis present?
curved spine anteriorly, one side of ribs spread wider and one sider ribs are closer
what is “respiratory excursion”?
examining chest expansion (putting hands on either side of chest and pinching skin between)
tactile fremitus
vibrations transmitted through the lung tissue when pt talks
tactile fremitus- how many anterior and posterior areas do you examine? what about for percussion?
3 anterior, 4 posterior
percussion: 6 anterior, 7 posterior
percussion is examining whether the tissue underneath is ______, ______ or ________
air-filled, fluid-filled, or solid
diaphragmatic excursion - normal is _______. reduced will indicate … absent will indicate…
normal: 3-5 cm
reduced: emphysema
absent: phrenic nerve palsy
auscultation: what to note about breath sounds (3)
character, intensity (flow from mouth), presence of adventitious sounds
breath through nose or open mouth for auscultation?
open mouth
never auscultate ______
through clothing!
auscultating the back… what is your process?
ask pt to cross arms in front of him, start on top and zig-zag your way down (right to left)
tracheal sounds
loud, harsh, high-pitched
heard over trachea and neck
inspiratory = expiratory
bronchial sounds
loud and high-pitches
heard over manubrium (if at all)
expiratory longer than inspiratory
short silence between sounds
bronchiovesicular sounds
intermediate -> low pitched
- heard between 1st and 2nd interspaces anteriorly, scapula posteriorly
- inspiratory = expiratory
Vesicular sounds
soft, low-pitched
- heard over most of the lung fields bilaterally
- inspiratory longer than expiratory (which fades 1/3 of the way)
- sounds heard posteriorly
crackles/ rales
fine: like hair rubbing (from alveoli and terminal bronchioles)
coarse: like crinkling cellophane (from bronchioles).
you hear coarse crackles, what will you ask pt to do? why?
ask them to cough. If pt cant clear with a cough or sound is louder with cough- maybe fluid in the lung
“fine” or “course” summarizes the _______, ________, and _______ of crackles
loudness, pitch, duration
wheezes
high-pitched, musical
whats important to remember when considering wheezing
sometimes person is so restricted that you can no longer hear the wheeze. BAD- no air moving through.
stridor
a wheeze that entirely or majorly inspiratory, heard louder in the neck than in chest. Indicates partial obstruction of airway in neck, larynx, trachea.
friction rub
sounds scratchy: inflamed surfaces move jerkily - theyre momentarily delayed by friction
mediastinal crunch
“boot in dry snow” sound (hammans sign).
-precordial (over the heart) crackles with each heart beat and not respirations
what causes a mediastinal crunch?
pneumomediastinum- air dissects along bronchus and mediastinum
transmitted voice sounds: what are we looking for?
if you hear a change if means possible consolidation or other compression of lung tissue
3 transmitted voice sound tests
bronchophony: “ninety nine” - more distinct sound
egophony: “ee” to “ay”
whisper pectoriloquy: “ninety-nin” whispered- gets louder and clearer.
how many lobes in right and left lung?
3- right
2 - left
paroxysmal nocturnal dyspnea- how does it present and what causes it?
acute dyspnea appear suddenly at night - waking the pt. caused by pulm. congestion/edema from Left HF
seven attributes
location, quality, quantity/severity, timing, setting, worsening/alleviating factors, associated manifestations
chest pain.. can have multiple causes, so check…
system below and system below
duration of cough: acute, subacute, chronic
acute: < 3 wks
subacute: 3-8wks
chronic: >8 wks
what 3 things would have resonant sounds
normal lungs chronic bronchitis (but with coarse crackles, wheezes, rhonci) Left HF (but w/ inspiratory crackles)
dull sounds could be what 3 causes?
consolidations (w/ bronchial sounds in involved area, late insp crackles, inc. transmitted voice sounds)
atelectasis (w/ tracheal shift toward effected side, absent sounds, absent tactile F and transmitted sounds)
pleural effusion: (w/ trachea to non-effected side, dec. breath sounds, maybe friction rub, possible increase tactile F and transmitted voice sounds over large effusion)
what three things could cause hyperresonant sounds?
pneumothorax: hyperressonant/tympanic (w/ trachea shifted to unaffected side, decreased breath sounds, maybe tactile F and transmitted sounds)
COPD (maybe w/ crackles,wheezes, rhonci)
asthma (w/ wheezes and crackles)
