Pulmonary And Chest Assessment Flashcards
Where is the angle of Louis
Located approximately 5cm below the sternal notch
Which rib is lateral to the sternal angle/angle of Louis?
2nd rib
Where are the apexes of the lungs?
2-4cm ABOVE the clavicle
What is a normal respiration rate?
14-20 breaths/min
What does stridor sound like?
High pitched, usually inspiration wheeze
What does stridor indicate?
Obstruction in trachea or larynx
Foreign body or airway disease
What is a common cause of stridor in kids?
croup
What can cause tracheal deviation?
Pleural effusion
Pneumothorax
Tumor
What does accessory muscle indicate
Respiratory distress
What is pectins excavatum?
Concave chest
Aka: “funnel chest”
What is pectus carinatum
Convex chest
aka “pigeon chest”
What conditions cause barrel chest?
COPD
Aging
What is bradypnea
Slow breathing (<12 breaths/min)
What is tachypnea?
Rapid breathing (>20 breaths/min)
What can cause bradypnea?
Diabetic coma
Drug induced respiratory depression
What can cause tachypnea?
Restrictive lung disease
Elevated diaphragm
Pain
What is the breathing pattern seen with metabolic acidosis?
Kussmaul breathing-faster deeper respirations
What kind of breathing:
Periods of gradually increasing and decreasing depth of respiration’s with periods of apnea
Cheyenne-Stokes breathing
What are causes of Cheyne-stokes breathing ?
Normal in sleeping children
Normal in elderly
Heart failure
Uremia
Brain damage
Drug-induced
What kind of breathing:
Rapid and deep respiration
Kussmaul breathing
What kind of breathing:
Irregular, unpredictable, shallow or deep, with intermittent apnea
Biot’s breathing
What can cause Biot’s breathing?
Respiratory depression
Brain damage
What is the difference between Cheyne-stokes and biot’s breathing
Cheyne-stokes is cyclical
What can cause increased fremitus?
Pneumonia/consolidation
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
