Pulmonary And Chest Assessment Flashcards by Lauren F

Where is the angle of Louis

Located approximately 5cm below the sternal notch

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Which rib is lateral to the sternal angle/angle of Louis?

2nd rib

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Where are the apexes of the lungs?

2-4cm ABOVE the clavicle

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What is a normal respiration rate?

14-20 breaths/min

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What does stridor sound like?

High pitched, usually inspiration wheeze

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What does stridor indicate?

Obstruction in trachea or larynx

Foreign body or airway disease

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What is a common cause of stridor in kids?

croup

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What can cause tracheal deviation?

Pleural effusion

Pneumothorax

Tumor

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What does accessory muscle indicate

Respiratory distress

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What is pectins excavatum?

Concave chest

Aka: “funnel chest”

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What is pectus carinatum

Convex chest

aka “pigeon chest”

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What conditions cause barrel chest?

COPD

Aging

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What is bradypnea

Slow breathing (<12 breaths/min)

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What is tachypnea?

Rapid breathing (>20 breaths/min)

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What can cause bradypnea?

Diabetic coma

Drug induced respiratory depression

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What can cause tachypnea?

Restrictive lung disease

Elevated diaphragm

Pain

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What is the breathing pattern seen with metabolic acidosis?

Kussmaul breathing-faster deeper respirations

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What kind of breathing:

Periods of gradually increasing and decreasing depth of respiration’s with periods of apnea

Cheyenne-Stokes breathing

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What are causes of Cheyne-stokes breathing ?

Normal in sleeping children

Normal in elderly

Heart failure

Uremia

Brain damage

Drug-induced

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What kind of breathing:

Rapid and deep respiration

Kussmaul breathing

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What kind of breathing:

Irregular, unpredictable, shallow or deep, with intermittent apnea

Biot’s breathing

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What can cause Biot’s breathing?

Respiratory depression

Brain damage

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What is the difference between Cheyne-stokes and biot’s breathing

Cheyne-stokes is cyclical

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What can cause increased fremitus?

Pneumonia/consolidation

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What can cause decreased fremitus (vibration)?

Obstructed bronchus COPD Pleural effusion Lung fibrosis Pneumothorax

What type of percussion tone: Intensity: Very loud Pitch: Low Duration: Long

Hyper-resonant

What type of percussion tone: Intesnity: Loud Pitch: Low Duration: Long

Resonant

What type of percussion tone: Intensity: loud Pitch: high Duration: moderate

Tympanic

What type of percussion tone: Intesnity: medium Pitch: moderate Duration: moderate

Dull

What type of percussion tone: Intensity: soft Pitch: high Duration: short

Flat Sponge bob

What is a normal place to hear a “resonant” percussion tone?

Healthy lungs

What is a normal place to hear a “hyper-resonant” percussion tone?

Never normal

What is a normal place to hear a “tympanic” percussion tone?

Gastric bubble

What is a normal place to hear “dull” percussion tone?

Liver

What is a normal place to hear a “flat” PErcsussion tone?

Muscle

What is an abnormal cause of a “hyper-resonant” percussion tone?

COPD Pneumothorax

What is an abnormal cause of a “resonant” percussion tone?

Chronic bronchitis

What is an abnormal cause of a “tympanic” percussion tone?

Large pneumothorax

What is an abnormal cause of a “dull” percussion tone?

Pneumonia Pleural effusion

What is an abnormal cause of a “flat” percussion tone?

Pleural effusion

What do “tracheal” breath sounds sound like?

Inspiration and expiration are about equal | (very loud and high pitched)

What is a “bronchial” breathing pattern?

Expiration longer than inspiration | Loud and high pitched

What does a “broncho-vesicular” breathing pattern sound like?

Inspiration and expiration about equal

What does a “vesicular” breathing pattern sound like?

Inspiration is longer than expiration | Relatively low pitched

Where would you place your stethoscope to hear the “tracheal” breathing pattern?

Over the trachea in the neck

Where would you place your stethoscope to hear the “bronchial” breathing pattern?

Over the manubrium

Where would you place your stethoscope to hear the “broncho-vesicular” breathing pattern?

Anteriorly: 1st and 2nd intercostal spaces Posterior: interscapular

Where would you place your stehtoscpe to hear the “vesicular” breathing pattern?

Most of the peripheral lung

What is bronchophony?

When a patient says 99 during auscultation, voice sound is louder

What can bronchophny indicate?

Pneumonia Atelectasis Tumors

What does egophony sound like?

When patient says E it sounds like A

What can cause egophony?

Pneumonia Atelectasis Tumors

What does the presence of bronchophony or egophony indicate?

Lung consolidation/collapse

What are adventitious breath sounds?

SOunds that are ~superimposed~ on usual breath sounds

Name the sound: Intermittent Non-musical Brief Velcro-like sounds

Crackles

What causes the sound of crackles

Small airways popping open during inspiration or when air bubbles flow through secretions or closed airways

What are possible causes of crackles?

Bronchitis pulmonary fibrosis CHF

What sound: Longer Musical Low pitched, snoring “wheeze”

Rhonchi

What sound: High-pitched Hissing Shrill Whistling

Wheeze

What can cause rhonchi?

Secretions in large airways

What can cause wheezes?

Asthma COPD chronic bronchitis Bronchus obstruction

What is the term for an inspiratory wheeze?

Stridor

What sound: | Crackle-like creaking sounds

Pleural friction rub

What causes pleural friction rub?

Inflamed pleural surfaces rubbing together

What is mediastinal crunch aka “Hamman’s sign”

Precordial crackles in sync with heartbeat, not respiration Often caused by mediastinal emphysema

What position should the patient be in for you to listen to mediastinal crunch/Hamman’s sign?

Left lateral position

WHat is a pleural effusion?

Fluid collection within the chest but outside the lung, casing lung compression

What is a pneumothorax?

Air collection within the chest but outside the lung, causing lung compression

What is COPD?

Overdistention of distal airspaces, resulting in limited exploratory flow and lung hyperinflation (Can’t get air out)

What is consolidation/infiltrate?

Alveoli filled with fluid/blood/pus increasing the density and opacity of the lung tissue SHIT IN LUNGS

What does a normal, air filled lung sound like on: Percussion Breath sounds Transmitted Voice Sounds Tactile Fremitus

Resonant Mostly vesicular over large bronchi (bronchovesicular) and trachea (bronchial) Normal Normal

What does consolidation/pneumonia sounds like on: Percussion Breath sounds Transmitted voice sounds Tactile fremitus

Percussion: dull over affected area Breath sounds: bronchial over involved area, crackles Transmitted Voice Sounds: increased. Bronchophnoy- present (spoken words clearer, louder) Egophony: present (e to a present) Whispered pectoriloquy: present (whispers sound loud) Tactile fremitus: increased

What will pleural effusion sound like on: Percussion Breath sounds Transmitted voice sounds Tactile fremitus

Percussion: dull to flat over fluid Breath sounds: decreased to absent over fluid, possible pleural rub Transmitted voice sounds: decreased to absent Tactile fremitus: decreased to absent

What will pneumothorax sound like on: Percussion Breath sounds Transmitted voice sounds Tactile fremitus

Percussion: hyperresonant or tympanic over pleural air pocket Breath sounds: decreased to absent over pleural air pocket, possible pleural rub Transmitted voice sounds: decreased to absent over air pocket Tactile fremitus: decreased/absent over pleural air pocket

What does COPD sound like on Percussion Breath sounds Transmitted voice sounds Tactile fremitus Inspection

Percussion: diffusely hhyperresonant Breath sounds: decreased to absent Transmitted voice sounds: decreased Tactile fremitus: decreased Inspection: increased AP diameter, possible accessory muscle use

What will asthma smound likes on: Percussion Breath sounds Transmitted voice sounds Tactile fremitus Inspection

Percussion: resonant to diffusely hyperresonant Breath sounds: obscured by high pitched wheezes, possible crackles Transmitted voice sounds: decreased Tactile fremitus: decreased Inspection: possible accessory muscle use

What will chronic bronchitis sounds like on Percussion Breath sounds Transmitted voice sounds Tactile fremitus

percussion: resonant (normal) Breath sounds: vesicular (normal), possible crackles, wheezes or rhonchi Transmitted voice sounds: normal Tactile fremitus: normal

What is a “sighing” breathing pattern?

Periodic deeper breaths

What is “obstructed breathing”?

Prolonged expiration due to increased airway resistance Ex: asthma, COPD

What is crepitus?

Crackling sound/feeling

What does subcutaneous emphysema feel like?

Rice crispies under the skin

What can cause subcutaneous emphysema?

Lung injury, thoracic surgery

What is the difference between flat and dull percussion tones?

Flat: over fluid/bone/muscle Dull: over solid (liver)

What kind of adventitious lung sound will commonly clear with a cough?

Rhonchi

Which is heard during inspiration and which is heard during expiration: Wheeze vs stridor

Wheeze: expiration Stridor: inspiration