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Physical Diagnosis I > Pulmonary & Chest > Flashcards

Pulmonary & Chest Flashcards

1
Q

Where is the 2nd rib located (i.e. how do you find it)?

A

Located lateral to sternal angle

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2
Q

How are the intercostal spaces named in relation to ribs?

A

2nd ICS is BELOW the 2nd rib

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3
Q

What are the three “lines” found anteriorly?

A
  • MSL (midsternal line)
  • MCL (midclavicular line)
  • AAL (ant. axillary line)
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4
Q

Where is the 1st rib located (i.e. how do you find it)?

A

Located at spinous processes of C7/T1

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5
Q

Where is the 7th rib located (i.e. how do you find it)?

A

Located at level of inferior scapular tip

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6
Q

What are the three “lines” found laterally? Where do they “drop from”?

A
  • PAL (posterior axillary line) drops from posterior axillary folds
  • MAL (midaxillary line) drops from lung apex to axilla
  • AAL (ant. axillary line) drops from anterior axillary fold
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7
Q

Where is the lung apices located (i.e. how do you find them)?

A

Located 2-4 cm ABOVE clavicle

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8
Q

During inspiration, what happens to the diaphragm and chest wall? What is the effect on intrathoracic pressure?

A
  • Diaphragm contracts (moves down)
  • Chest wall expands
  • Intrathoracic pressure increases, drawing air in
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9
Q

During expiration, what happens to the diaphragm and chest wall? What is the effect on intrathoracic pressure?

A
  • Diaphragm relaxes (moves up)
  • Chest wall contracts
  • Intrathoracic pressure normalizes and air leaves lungs
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10
Q

What are the three landmarks for the lower lung borders?

A
  • 6th rib at MCL anteriorly
  • 8th rib at MAL anteriorly
  • T10 posteriorly
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11
Q

At what level does the trachea bifurcate (ant. and post.)?

A
  • Anteriorly: sternal angle

- Posteriorly: T4

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12
Q

How should the patient be positioned when listening to the anterior thorax/lungs? What about posterior thorax/lungs?

A
  • Anterior: sitting or supine

- Posterior: sitting

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13
Q

What is a barrel chest? What disease might it be seen with (2)?

A

Increased A-P diameter seen with aging, COPD

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14
Q

What is it called when the sternum protrudes (2 names)

A

Pectus Carinatum = Pigeon Chest (convex anterior chest)

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15
Q

What is it called when the sternum depresses (2 names)

A

Pectus Excavatum = Funnel Chest (concave anterior chest)

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16
Q

What are three abnormalities of the chest?

A
  • Flail chest
  • Kyphosis
  • Scoliosis
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17
Q

What is flail chest?

A

Rib fractures cause paradoxical movement of chest wall

- Opposite of what expected (during inspiration, chest contracts and during expiration, chest expands)

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18
Q

What are three potential causes of tracheal deviation?

A
  • Large pleural effusion
  • Large pneumothorax
  • Mass/tumor
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19
Q

What three muscles are you looking to see move if you are using accessory muscles? What two conditions might cause this?

A

SIGN OF RESP. DISTRESS
- Scalenes, SCM, and supraclavicular will contract

Caused by:

  • COPD
  • Asthma
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20
Q

What two conditions might cause bradypnea?

A
  • Diabetic coma

- Drug-induced resp. depression

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21
Q

What three conditions might cause tachypnea?

A
  • Restrictive lung disease
  • Elevated diaphragm
  • Pain
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22
Q

What is hyperventilation? What condition might cause this?

A

Faster, deeper respiration

Caused by metabolic acidosis

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23
Q

What is sighing?

A

Periodic deeper breaths

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24
Q

What is obstructive breathing What three conditions might cause this?

A

Prolonged expiration

Caused by:

  • Asthma
  • Chronic bronchitis
  • COPD
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25
Q

What is Cheyne-Stokes breathing?

A

Periods of gradually increasing and decreasing depth of respirations with periods of apnea (fast → slow → none and repeat…)

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26
Q

In what two populations is Cheyne-Stokes breathing normal?

A
  • Sleeping children

- Elderly

27
Q

What four conditions might cause Cheyne-Stokes breathing?

A
  • CHF
  • Uremia
  • Brain damage
  • Drug-induced
28
Q

What is Kussmaul breathing, and what type of breathing is it a subtype of? What condition might cause this?

A

Rapid and deep respiration (type of hyperventilation)

Caused by metabolic acidosis

29
Q

What is Biot’s breathing? What two conditions might cause this?

A

Irregular, unpredictable, shallow or deep with intermittent apnea

Caused by:

  • Respiratory depression
  • Brain damage
30
Q

What is crepitus? What two conditions might cause this?

A

Crackling/grating feeling or sound

Caused by:

  • Rib fracture (bone crepitus)
  • Subcutaneous emphysema (subcutaneous crepitus)
31
Q

What does subcutaneous emphysema feel like? What else can it cause on the body?

A

“Rice Krispies” under the skin

Can also cause swelling of eyelids, cheeks, lips, neck, chest

32
Q

What is limited chest excursion and what four conditions might it be caused by?

A

Unilateral decreased lung expansion

Caused by:

  • Chronic lung/pleural fibrosis
  • Pleural effusion
  • Lobar pneumonia
  • Pain/splinting
33
Q

What five conditions might cause decreased fremitus?

A
  • Obstructed bronchus
  • COPD
  • Pleural effusion
  • Lung fibrosis
  • Pneumothorax
34
Q

What condition might cause increased fremitus?

A
  • Pneumonia (consolidation)
35
Q

What are the four types of percussion tones? When is each heard?

A
  • Resonant: air
  • Dull: solid
  • Flat: fluid-filled, bone, muscle
  • Tympani: hollow
36
Q

What is the intensity, pitch and duration associated with hyper-resonance?

A

Hyper-resonance

  • Intensity: very loud
  • Pitch: low
  • Duration: long
37
Q

What is the intensity, pitch and duration associated with resonance?

A

Resonance

  • Intensity: loud
  • Pitch: low
  • Duration: long
38
Q

What is the intensity, pitch and duration associated with tympanic?

A

Tympanic

  • Intensity: loud
  • Pitch: high
  • Duration: moderate
39
Q

What is the intensity, pitch and duration associated with dull?

A

Dull

  • Intensity: medium
  • Pitch: moderate
  • Duration: moderate
40
Q

What is the intensity, pitch and duration associated with flat?

A

Flat

  • Intensity: soft
  • Pitch: high
  • Duration: short
41
Q

What two conditions are associated with hyper-resonance?

A
  • COPD

- Pneumothorax

42
Q

What condition is associated with resonance?

A

Chronic bronchitis

43
Q

What condition is associated with tympanic?

A

Large pneumothorax

44
Q

What two conditions are associated with dull?

A
  • Pneumonia

- Pleural effusion

45
Q

What condition is associated with flat?

A

Pleural effusion

46
Q

What are the four types of breath sounds (think location)? Where is each heard?

A
  • Tracheal: over trachea in neck
  • Bronchial: over manubrium
  • Broncho-vesicular: 1st and 2nd ICS or interscapular
  • Vesicular: peripheral of lung
47
Q

What is the duration, intensity and pitch heard with tracheal?

A

Tracheal

  • Duration: inspiration = expiration
  • Intensity: very loud
  • Pitch: relatively high
48
Q

What is the duration, intensity and pitch heard with bronchial?

A

Bronchial

  • Duration: expiration longer
  • Intensity: loud
  • Pitch: relatively high
49
Q

What is the duration, intensity and pitch heard with broncho-vesicular?

A

Broncho-vesicular

  • Duration: inspiration = expiration
  • Intensity: moderate
  • Pitch: moderate
50
Q

What is the duration, intensity and pitch heard with vesicular?

A

Vesicular

  • Duration: inspiration longer
  • Intensity: soft
  • Pitch: relatively low
51
Q

What are crackles/rales? What are the two subtypes? Describe each type.

A

Discontinuous sounds

  • Fine: soft, high-pitched, very brief
  • Coarse: louder, low-pitched, brief
52
Q

What three conditions might cause crackles/rales?

A
  • Bronchitis
  • Pulmonary fibrosis
  • CHF
53
Q

What are rhonchi? What condition might cause this?

A

Continuous low-pitched sound

Caused by chronic bronchitis (large airway secretions)

54
Q

What are wheezes? What four conditions might cause this?

A

Continuous high-pitched sound

Caused by:

  • Asthma
  • COPD
  • Chronic bronchitis
  • Bronchial obstruction
55
Q

What is stridor? What type of breath sound is this a subtype of?

A

High-pitched inspiratory wheeze

- Type of wheeze

56
Q

What three conditions might stridor be caused by?

A
  • FB in airway
  • Airway disease
  • Croup in children
57
Q

What is pleural friction rub?What two conditions might cause this?

A

Crackle-like creaking sound

Caused by

  • Recent URI
  • Pneumonia
58
Q

What is mediastinal crunch? What is another name for this? In what position is this best heard?

A

Aka “Hamman’s Sign”
Precordial crackles in sync with heartbeat, not respiration
- Best heard in left lateral position

59
Q

What are the five specialized exams? What part of the physical exam is each associated with (think IPPA)?

A
  • Respiratory expansion (inspection, palpation)
  • Tactile fremitus (palpation)
  • Diaphragmatic excursion (percussion)
  • Bronchophony (auscultation)
  • Egophony (auscultation)
60
Q

When performing the respiratory expansion test, at what level do you place your thumbs?

A

10th rib posteriorly

61
Q

What breath sounds, percussion, transmitted voice sounds and tactile fremitus are present with pneumothorax?

A

Pneumothorax

  • Breath sounds: decreased/absent
  • Percussion: hyperresonant
  • Transmitted voice sounds: decreased/absent
  • Tactile fremitus: decreased/absent
62
Q

What breath sounds, percussion, transmitted voice sounds and tactile fremitus are present with COPD?

A

COPD

  • Breath sounds: decreased/absent
  • Percussion: hyperresonant
  • Transmitted voice sounds: decreased
  • Tactile fremitus: decreased
63
Q

What breath sounds, percussion, transmitted voice sounds and tactile fremitus are present with pneumonia?

A

Pneumonia

  • Breath sounds: decreased
  • Percussion: dull
  • Transmitted voice sounds: increased
  • Tactile fremitus: increased
64
Q

What breath sounds, percussion, transmitted voice sounds and tactile fremitus are present with pleural effusion?

A

Pleural effusion

  • Breath sounds: decreased/absent
  • Percussion: dull
  • Transmitted voice sounds: decreased/absent
  • Tactile fremitus: decreased/absent

Physical Diagnosis I (4 decks)

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