Pulmonary & Chest Flashcards by Kyle Campbell

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

Located lateral to sternal angle

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How are the intercostal spaces named in relation to ribs?

2nd ICS is BELOW the 2nd rib

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What are the three “lines” found anteriorly?

MSL (midsternal line)
MCL (midclavicular line)
AAL (ant. axillary line)

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

Located at spinous processes of C7/T1

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

Located at level of inferior scapular tip

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

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

Located 2-4 cm ABOVE clavicle

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

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

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

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

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What are the three landmarks for the lower lung borders?

6th rib at MCL anteriorly
8th rib at MAL anteriorly
T10 posteriorly

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

Anteriorly: sternal angle

- Posteriorly: T4

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

Anterior: sitting or supine

- Posterior: sitting

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

Increased A-P diameter seen with aging, COPD

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

Pectus Carinatum = Pigeon Chest (convex anterior chest)

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

Pectus Excavatum = Funnel Chest (concave anterior chest)

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What are three abnormalities of the chest?

Flail chest
Kyphosis
Scoliosis

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What is flail chest?

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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What are three potential causes of tracheal deviation?

Large pleural effusion
Large pneumothorax
Mass/tumor

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

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

Caused by:

COPD
Asthma

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What two conditions might cause bradypnea?

Diabetic coma

- Drug-induced resp. depression

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What three conditions might cause tachypnea?

Restrictive lung disease
Elevated diaphragm
Pain

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What is hyperventilation? What condition might cause this?

Faster, deeper respiration

Caused by metabolic acidosis

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What is sighing?

Periodic deeper breaths

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What is obstructive breathing What three conditions might cause this?

Prolonged expiration

Caused by:

Asthma
Chronic bronchitis
COPD

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What is Cheyne-Stokes breathing?

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

In what two populations is Cheyne-Stokes breathing normal?

- Sleeping children | - Elderly

What four conditions might cause Cheyne-Stokes breathing?

- CHF - Uremia - Brain damage - Drug-induced

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

Rapid and deep respiration (type of hyperventilation) Caused by metabolic acidosis

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

Irregular, unpredictable, shallow or deep with intermittent apnea Caused by: - Respiratory depression - Brain damage

What is crepitus? What two conditions might cause this?

Crackling/grating feeling or sound Caused by: - Rib fracture (bone crepitus) - Subcutaneous emphysema (subcutaneous crepitus)

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

"Rice Krispies" under the skin Can also cause swelling of eyelids, cheeks, lips, neck, chest

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

Unilateral decreased lung expansion Caused by: - Chronic lung/pleural fibrosis - Pleural effusion - Lobar pneumonia - Pain/splinting

What five conditions might cause decreased fremitus?

- Obstructed bronchus - COPD - Pleural effusion - Lung fibrosis - Pneumothorax

What condition might cause increased fremitus?

- Pneumonia (consolidation)

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

- Resonant: air - Dull: solid - Flat: fluid-filled, bone, muscle - Tympani: hollow

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

Hyper-resonance - Intensity: very loud - Pitch: low - Duration: long

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

Resonance - Intensity: loud - Pitch: low - Duration: long

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

Tympanic - Intensity: loud - Pitch: high - Duration: moderate

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

Dull - Intensity: medium - Pitch: moderate - Duration: moderate

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

Flat - Intensity: soft - Pitch: high - Duration: short

What two conditions are associated with hyper-resonance?

- COPD | - Pneumothorax

What condition is associated with resonance?

Chronic bronchitis

What condition is associated with tympanic?

Large pneumothorax

What two conditions are associated with dull?

- Pneumonia | - Pleural effusion

What condition is associated with flat?

Pleural effusion

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

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

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

Tracheal - Duration: inspiration = expiration - Intensity: very loud - Pitch: relatively high

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

Bronchial - Duration: expiration longer - Intensity: loud - Pitch: relatively high

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

Broncho-vesicular - Duration: inspiration = expiration - Intensity: moderate - Pitch: moderate

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

Vesicular - Duration: inspiration longer - Intensity: soft - Pitch: relatively low

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

Discontinuous sounds - Fine: soft, high-pitched, very brief - Coarse: louder, low-pitched, brief

What three conditions might cause crackles/rales?

- Bronchitis - Pulmonary fibrosis - CHF

What are rhonchi? What condition might cause this?

Continuous low-pitched sound Caused by chronic bronchitis (large airway secretions)

What are wheezes? What four conditions might cause this?

Continuous high-pitched sound Caused by: - Asthma - COPD - Chronic bronchitis - Bronchial obstruction

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

High-pitched inspiratory wheeze | - Type of wheeze

What three conditions might stridor be caused by?

- FB in airway - Airway disease - Croup in children

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

Crackle-like creaking sound Caused by - Recent URI - Pneumonia

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

Aka "Hamman's Sign" Precordial crackles in sync with heartbeat, not respiration - Best heard in left lateral position

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

- Respiratory expansion (inspection, palpation) - Tactile fremitus (palpation) - Diaphragmatic excursion (percussion) - Bronchophony (auscultation) - Egophony (auscultation)

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

10th rib posteriorly

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

Pneumothorax - Breath sounds: decreased/absent - Percussion: hyperresonant - Transmitted voice sounds: decreased/absent - Tactile fremitus: decreased/absent

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

COPD - Breath sounds: decreased/absent - Percussion: hyperresonant - Transmitted voice sounds: decreased - Tactile fremitus: decreased

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

Pneumonia - Breath sounds: decreased - Percussion: dull - Transmitted voice sounds: increased - Tactile fremitus: increased

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

Pleural effusion - Breath sounds: decreased/absent - Percussion: dull - Transmitted voice sounds: decreased/absent - Tactile fremitus: decreased/absent