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Clin Skills > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

the interspace is named for the rib above or below it?

A

above

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2
Q

scapular inferior angle is located about where?

A

just under the 7th rib

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3
Q

Costal cartilages of ______ articulate with the sternum

Cartilages of _____ articulate with costal cartilages just above

A

first 7 ribs

8-10

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4
Q

______ are floating ribs

A

11 and 12th

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5
Q

___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

A

11: lateral
12: posterior

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6
Q

______ needle insertion for tension pneumothorax
________-intercostal space for chest tube insertion
The tube is generally placed where it is needed.

A

2nd interspace - tension pneumo

4th or 5th interspace - chest rube

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7
Q

_______ landmark for thoracentesis

A

T7-T8 interspace

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8
Q

why do we insert just on top of the rib for chest tube?

A

The neurovascular structures run under the ribs so insert things on top of the rib…

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9
Q

what are our 7 circumferential landmarks?

A

lines: midsternal, midclavicular, anterior axillary , mid-axillary, post-axillary, scapular (mid-scapular) and vertebral

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10
Q

the apex of the lung is _____ above the _____

A

2-4 cm above the clavicle

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11
Q

lower border of the lung crosses the ______ posterior it lines at about ___________

A

6th rib at midclavicular and 8th rib at midaxillary line , posteriorly lies at the level of the T10 spinous process but descends with inspiration

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12
Q

oblique (the major) fissure of the _(right or left?)____ lung, starts at ___ and ends ____

A

right lung, starts at T3 and ends at 6th rib, midaxillary line
- this divides the lung in half

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13
Q

the horizontal (minor) of the __(right or left?)_lung divides ______

A

right lung, divides upper lobe into two- into right upper and right middle

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14
Q

the trachea bifurcates at …

A

the sternal angle anteriorly, at the T4 level posteriorly

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15
Q

the conducting zone walls are line with ______ and include ____

A

smooth muscle, mucus secreting and ciliated cells

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16
Q

Respiratory bronchioles are ______ with some smooth muscle and cilia and have a few alveoli

A

transitional

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17
Q

______has an effect on the blood flow to the different areas in the lungs

A

gravity

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18
Q

what pressure keeps the lungs inflated?

A

negative intrapleural pressure

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19
Q

what are the receptors in the resp. center of the brainstem

A

chemoreceptors

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20
Q

what are the primary (1) and accessory (5) muscles of breathing?

A

primary: diaphragm
accessory:
scalene (cervical vert. to first two ribs)
parasternal (sternum to ribs obliquely)
sternocleidomastoid
intercostals
abdominals

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21
Q

what do the external vs internal intercostals do?

A

external: inhale
internal: exhale

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22
Q

abdominal muscles assist in …

A

expiration

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23
Q

what are the two pleura layers of the lung?

A

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

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24
Q

pleural effusions: transudates vs exudates

A

transudates: pressure problem-imbalance of hydrostatic and osmotic forces (i.e. atelectasis, HF)
exudates: injury or inflammation problem (ie pneumonia, PE)

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25
Q

air trapped in pleural space?

A

pneumothorax - can be small or entire lung

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26
Q

how can you recognize a Pneumothorax?

A

clinical, chest Xray

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27
Q

technique for exam, for posterior exam if the pt can’t sit up you can…

A

roll them from side to side - document that they were unable to sit

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28
Q

technique for exam, anterior - easier to examine if pt is …

A

lying down

29
Q

4 purposes of the lung and thorax exam

A
  1. lung function
  2. musculature- internal and external
  3. skeletal
  4. skin
30
Q

initial survey of breathing, examine …

A

rate, rhythm, depth, effort

31
Q

inspection of the thorax

A

shape and condition of thorax: bony deformities, splinting (obviously favoring one lung over the other), asymmetry

32
Q

depression of lower part of sternum can cause what to the heart …. and is deemed the term ______

A

compression of heart and great vessels- may cause murmurs. Called Funnel Chest (pectus excavatum)

33
Q

what are the 3 possible reasons for barrel chest?

A

children, older people, COPD (from emphysema)

34
Q

Pectus carinatum, commonly known as ______, is caused by what anatomical abnormality?

A

pigeon chest- costal cartilages near protruding sternum are depressed - make it look like sternum is sticking out

35
Q

how does a flail chest present? common cause?

A

paradoxical movement of chest- injured area caves in with inspiration, out with expiration. From multiple rib fractures - car accident likely.

36
Q

how does thoracic kyphoscoliosis present?

A

curved spine anteriorly, one side of ribs spread wider and one sider ribs are closer

37
Q

what is “respiratory excursion”?

A

examining chest expansion (putting hands on either side of chest and pinching skin between)

38
Q

tactile fremitus

A

vibrations transmitted through the lung tissue when pt talks

39
Q

tactile fremitus- how many anterior and posterior areas do you examine? what about for percussion?

A

3 anterior, 4 posterior

percussion: 6 anterior, 7 posterior

40
Q

percussion is examining whether the tissue underneath is ______, ______ or ________

A

air-filled, fluid-filled, or solid

41
Q

diaphragmatic excursion - normal is _______. reduced will indicate … absent will indicate…

A

normal: 3-5 cm
reduced: emphysema
absent: phrenic nerve palsy

42
Q

auscultation: what to note about breath sounds (3)

A

character, intensity (flow from mouth), presence of adventitious sounds

43
Q

breath through nose or open mouth for auscultation?

A

open mouth

44
Q

never auscultate ______

A

through clothing!

45
Q

auscultating the back… what is your process?

A

ask pt to cross arms in front of him, start on top and zig-zag your way down (right to left)

46
Q

tracheal sounds

A

loud, harsh, high-pitched
heard over trachea and neck
inspiratory = expiratory

47
Q

bronchial sounds

A

loud and high-pitches
heard over manubrium (if at all)
expiratory longer than inspiratory
short silence between sounds

48
Q

bronchiovesicular sounds

A

intermediate -> low pitched

  • heard between 1st and 2nd interspaces anteriorly, scapula posteriorly
  • inspiratory = expiratory
49
Q

Vesicular sounds

A

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
50
Q

crackles/ rales

A

fine: like hair rubbing (from alveoli and terminal bronchioles)
coarse: like crinkling cellophane (from bronchioles).

51
Q

you hear coarse crackles, what will you ask pt to do? why?

A

ask them to cough. If pt cant clear with a cough or sound is louder with cough- maybe fluid in the lung

52
Q

“fine” or “course” summarizes the _______, ________, and _______ of crackles

A

loudness, pitch, duration

53
Q

wheezes

A

high-pitched, musical

54
Q

whats important to remember when considering wheezing

A

sometimes person is so restricted that you can no longer hear the wheeze. BAD- no air moving through.

55
Q

stridor

A

a wheeze that entirely or majorly inspiratory, heard louder in the neck than in chest. Indicates partial obstruction of airway in neck, larynx, trachea.

56
Q

friction rub

A

sounds scratchy: inflamed surfaces move jerkily - theyre momentarily delayed by friction

57
Q

mediastinal crunch

A

“boot in dry snow” sound (hammans sign).

-precordial (over the heart) crackles with each heart beat and not respirations

58
Q

what causes a mediastinal crunch?

A

pneumomediastinum- air dissects along bronchus and mediastinum

59
Q

transmitted voice sounds: what are we looking for?

A

if you hear a change if means possible consolidation or other compression of lung tissue

60
Q

3 transmitted voice sound tests

A

bronchophony: “ninety nine” - more distinct sound
egophony: “ee” to “ay”
whisper pectoriloquy: “ninety-nin” whispered- gets louder and clearer.

61
Q

how many lobes in right and left lung?

A

3- right

2 - left

62
Q

paroxysmal nocturnal dyspnea- how does it present and what causes it?

A

acute dyspnea appear suddenly at night - waking the pt. caused by pulm. congestion/edema from Left HF

63
Q

seven attributes

A

location, quality, quantity/severity, timing, setting, worsening/alleviating factors, associated manifestations

64
Q

chest pain.. can have multiple causes, so check…

A

system below and system below

65
Q

duration of cough: acute, subacute, chronic

A

acute: < 3 wks
subacute: 3-8wks
chronic: >8 wks

66
Q

what 3 things would have resonant sounds

A 
normal lungs
chronic bronchitis (but with coarse crackles, wheezes, rhonci)
Left HF (but w/ inspiratory crackles)
67
Q

dull sounds could be what 3 causes?

A

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)

68
Q

what three things could cause hyperresonant sounds?

A

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)

Clin Skills (25 decks)

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