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Physical Diagnosis (Shelby) > pulmonary/ chest assessment > Flashcards

pulmonary/ chest assessment Flashcards

1
Q

Bony ridge that joins the manubrium and sternal body

A

Angle of Louis

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2
Q

Major oblique fissure divides each lung in half and goes from ____ spinous process obliquely around chest to ____ rib at midclavicular line

A

T3, 6th

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3
Q

precordial crackles in sync with heartbeat, not respiration

A

mediastinal crunch (hammans sign)

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4
Q

purpose of auscultation for egophony

A

assess underlying lung tissue for collapse/ consolidation

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5
Q

purpose of auscultation

A

determine whether there is normal air-flow, airway obstruction, or abnormal air or fluid w/in chest/lungs

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6
Q

location of broncho-vesicular breath sounds

A

ant- 1st and 2nd interspaces post- interscapular

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7
Q

subQ crepitus caused by

A

subQ emphysema (rice krispies under skin)

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8
Q

increased fremitus (vibration) seen with

A

pneumonia/ consolidation

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9
Q

accessory muscle use

A

signs of resp distress SCM, scalene, supraclavicular contraction COPD, asthma

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10
Q

subQ emphysema

A

air from lung/ chest tracks along tissue planes

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11
Q

alveoli filled with fluid blood/ pus increasing the density and opacity of the lung tissue

A

consolidation/ infiltrate

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12
Q

expiration

A

diaphragm relaxes, chest wall contracts, intrathoracic pressure normalizes

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13
Q

stridor

A

high pitched, wheeze obstruction in trachea or larynx foreign body/ airway disease croup (kids)

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14
Q

inspection- chest size/shape/color

A

lesions, scars, color chest A- P diameter, deformity, body habitus

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15
Q

crackles/ rales heard when

A

small airways pop open during inspiration or when air bubbles flow through secretions or closed airways

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16
Q

pectus excavatum

A

concave anterior chest

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18
Q

mediastinal crunch is a sign of

A

mediastinal emphysema (pneumomediastinum)

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19
Q

egophony positive presence indicates

A

lung consolidation/ collapse eg PNA, atelectasias, tumors

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20
Q

resonant sounds

A

over air (lungs)

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21
Q

wheeze is heard with

A

asthma, COPD, chronic bronchitis, bronchus obstruction

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22
Q

ex of dull

A

pneumonia pleural effusion

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23
Q

intensity and pitch of broncho-vesicular breath sounds

A

moderate, moderate

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25
Q

rhonchi sound

A

low pitched, snoring, “wheeze” large airway secretions (chronic bronchitis)

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26
Q

specialized exams for auscultation

A

bronchophony and egophony

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27
Q

purpose of palpation to evaluate for

A

palpable masses (neoplasm, lipoma) and tender areas (ribs, spine, etc)

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28
Q

5 cm below the Supra sternal notch

A

Angle of Louis

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29
Q

intensity and pitch of tracheal breath sounds

A

very loud, relatively high

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30
Q

bronchophony presence indicates

A

lung consolidation/ collapse eg PNA, atelectasias, tumors

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31
Q

inspiration

A

diaphragm contracts, chest wall expands, intrathoracic neg pressure

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32
Q

bradypnea

A

<12 breaths/min diabetic coma, drug induced resp depression

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33
Q

overdistention of distal airspaces, resulted in limited expiratory flow and lung hyperinflation

A

COPD

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34
Q

rhonchi suggest

A

secretions in larger airways

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35
Q

flail chest

A

rib fractures cause paradoxical movement of chest wall

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35
Q

cheyne stokes in sleeping children and elderly

A

normal

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37
Q

what is this ? resonant breath sounds, versicular normal breath sounds, possible crackes, wheezes, or rhonchi, normal transmitted voice sounds, normal tactile fremitus

A

chronic bronchitis

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38
Q

Lung apices are about _____ clavicle

A

2-4 cm above

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39
Q

duration of broncho-vesicular breath sounds

A

inspiration and expiration equal

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40
Q

pectus carinatum

A

convex anterior chest

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41
Q

continuous, low pitched adventitious sounds

A

rhonchi

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42
Q

barrel chest

A

inc. AP diameter COPD- use chest a lot for breathing

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43
Q

Minor horizontal fissure of the right lung runs close to ____ rib, meeting major fissure at midaxillary line near ____ rib

A

4th, 5th

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44
Q

biots breathing caused by

A

respiratory depression/ brain damage

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47
Q

prolonged expiration 2/2 increased airway resistance

A

obstructive breathing

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49
Q

Intercostal spaces are numbered by

A

Rib above

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50
Q

adventitious means

A

added

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51
Q

ex of flat

A

pleural effusion

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52
Q

wheeze sound

A

high pitched, hissing, shrill whistling

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53
Q

Interscapular

A

Between scapulae

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54
Q

tachypnea

A

>20 breaths/min restrictive lung disease, elevated diaphragm, pain

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55
Q

Lower lung midaxillary border

A

8th rib

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56
Q

scoliosis

A

abnormal lat curvature of spine

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57
Q

diseases where you hear crackles

A

bronchitis pulmonary fibrosis, CHF

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58
Q

normal respirations

A

14-20 breaths/min

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60
Q

MSL- mid sternal line is

61
Q

pleural friction rub is seen with

A

recent URI, PNA

62
Q

discontinuous adventitious sounds

A

crackles aka rales

63
Q

subQ emphysema is seen with

A

lung injury (rib fx), postop thoracic surgery

64
Q

duration of bronchial breath sounds

A

expiration > inspiration

66
Q

what is this? diffusely hyperresonant percussion, decreased to absent breath sounds, decrease transmitted voice sounds and tactile fremitus, increased AP diameter, possible accessory muscle use

69
Q

an inspiratory wheeze

A

stridor larynx/ tracheal obstruction

70
Q

purpose of auscultation for bronchopony

A

assess underlying lung tissue for collapse/ consolidation

71
Q

adventitious lung sounds

A

sounds are superimposed on usual breath sounds

72
Q

subQ emphysema can cause swelling of the

A

eyelids, cheeks, lips, neck, chest

73
Q

what is this? resonant percussion, mostly vesicular breath sounds (except over bronchi and trachea), normal transmitted voice sounds, normal tactile fremitus

A

normal air filled lung

74
Q

Infraclavicular

A

Below clavicle

75
Q

what is this? decreased or absent breath sounds over FLUID with possible pleural rub, decreased or absent transmitted voice sounds, decreased to absent tactile fremitus

A

pleural effusion

76
Q

AAL anterior axillary line is

77
Q

absence of spontaneous respiration

79
Q

Normal breath sounds are ___ with ____ thorax movement and ____ abdominal movement

A

Quiet, slight, more prominent

80
Q

kyphosis

A

abnormal FW curvature of spine

80
Q

periods of gradually inc and dec respirations w/ periods of apnea

A

cheyne stokes

80
Q

resonant sounds

A

over air (lungs) loud, low, long

81
Q

intensity and pitch of vesicular breath sounds

A

soft and relatively low

82
Q

decreased fremitus (vibration) seen with

A

obstructed bronchus, COPD, pleural effusion, lung fibrosis, pneumothorax

83
Q

dull sounds

A

over solid (liver) medium intensity, moderate ptich, moderate duration

85
Q

fluid collection within the chest but outside the lung causing compression

A

pleural effusion

86
Q

location of vesicular breath sounds

A

most of peripheral lung

87
Q

hyperventilation

A

faster, deeper respiration metabolic acidosis

88
Q

specialized exam percussion

A

diaphragmatic excursion

89
Q

periodic deeper breaths

89
Q

of auscultation required for exam

A

3 anterior, 4 posterior, 1 lateral

90
Q

crackling/ grating feeling/ sound

93
Q

location of tracheal breath sounds

A

over trachea

94
Q

Lateral to sternal angle

95
Q

Lower lung midclavicular border

96
Q

cheyne stokes in adults/ awake people

A

heart failure, uremia, brain damage, drug induced

96
Q

during auscultation, listen to

A

pitch, intensity, duration, and location of sounds listen to a sufficient number of areas to allow for accurate assessment of any underlying pathophys

99
Q

duration of tracheal breath sounds

A

inspiration and expiration equal

100
Q

air collection within the chest but outside the lung causing compression

A

pneumothorax

102
Q

specialized exam for inspection and palpation

A

respiratory expansion

103
Q

MCL midclavicular line is

104
Q

kussmaul breathing is a sign of

A

metabolic acidosis

104
Q

ex of hyper-resonant

A

COPD pneumothorax

105
Q

Breath sounds over trachea and bronchi are ____ breath sounds over lung parenchyma

105
Q

crackles that are loud, lower pitched, brief (20-30msec)

106
Q

intermittent, nonmusical, brief, velcro like sounds

A

crackles/ rales

107
Q

positive egophony

A

E-A change present

109
Q

rhonchi and wheezes are ____ and ____

A

longer (>250 msec) and musical

109
Q

rhonchi are ___ with a cough

110
Q

tympani sounds

A

over hollow areas (stomach)

110
Q

ex of tympanic

A

large pneumothorax

110
Q

crackles that are soft, high pitched, very brief (5-10msec)

111
Q

intensity and pitch of bronchial breath sounds

A

loud, relatively high

113
Q

location of bronchial breath sounds

A

over manubrium

113
Q

crackle-like creaking sounds caused by inflamed pleural surfaces ribbing together

A

pleural friction rub

114
Q

Lower lung posterior border

115
Q

tracheal deviation

A

large pleural effusion, large pneumothorax mass/ tumor

115
Q

tympanic sounds

A

over hollow areas (stomach) soft, high pitched, short

115
Q

continuous, high pitched adventitious sounds

116
Q

hyper-resonant

A

very loud, low, long

117
Q

wheeze is caused by

A

rapid airflow through narrowed (almost closed) bronchi

118
Q

inspection- respiration

A
  • rate - rhythm, depth, effort of breathing - audible sounds (wheezes, stridor) - signs of resp distress (accessory muscle use, trachea position, stridor) - asymmetry
120
Q

rapid and deep respiration

A

kussmaul breathing

120
Q

unilateral chronic lung/ pleural, fibrosis, pleural effusion, lobar pneumonia, pain/ splinting

A

limited chest excursion

121
Q

diaphragmatic excursion measure

122
Q

Inferior tip of scapula correlates with _____ rib/intercostal space

123
Q

egophony

A

when a pt says EE, it sounds like AAY during auscultation

123
Q

pleural effusion

A

dull to flat over fluid percussion

124
Q

positive bronchophony

A

voice is louder and more clear over that area if positive

126
Q

bone crepitus caused by

A

rib movement from fracture

126
Q

duration of vesicular breath sounds

A

inspiration > expiration

126
Q

bronchophony

A

when a pt says 99 during auscultation

127
Q

techniques

A

IPPA inspection, palpation, percussion, auscultation

128
Q

irregular, unpredictable, shallow or deep breaths with intermittent apnea

A

biots breathing

129
Q

what is this? percussion dull over affected area, breath sounds bronchial over involved area, crackles, increased transmitted voice sounds (bronchophony, egophony, and whispered pectoriloquy are all present) , increased tactile fremitus

130
Q

specialized exam for palpation

A

tactile fremitus

131
Q

purpose of percussion

A

determine if underlying tissues are solid (up to 7 cm)/ air filled/ fluid filled and detect areas of tenderness (spine, ribs, etc)

131
Q

ex of resonant

A

chronic bronchitis

131
Q

what is this? hyperresonant/ tympanic percussion over pleural air pocket, decreased to absent breath sounds and tactile fremitus over PLEURAL air pocket with possible pleural rub, decreased to absent transmitted voice sounds over AIR pocket

A

pneumothorax

131
Q

what is this? resonant to diffusely hyperresonant percussion, breath sounds obscured by high pitched wheezing with possible crackles, decreased transmitted voice sounds, decreased tactile fremitus, possible accessory muscle usage

131
Q

Angle of Louis

A

Sternal angle

132
Q

fremitus

A

palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization looking for increase or decrease in vibrations (abnormal)

133
Q

mediastinal crunch best heard in

A

left lateral position

Physical Diagnosis (Shelby) (1 decks)

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