pulmonary/ chest assessment Flashcards
1
Q
Bony ridge that joins the manubrium and sternal body
A
Angle of Louis
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
3
Q
precordial crackles in sync with heartbeat, not respiration
A
mediastinal crunch (hammans sign)
4
Q
purpose of auscultation for egophony
A
assess underlying lung tissue for collapse/ consolidation
5
Q
purpose of auscultation
A
determine whether there is normal air-flow, airway obstruction, or abnormal air or fluid w/in chest/lungs
6
Q
location of broncho-vesicular breath sounds
A
ant- 1st and 2nd interspaces post- interscapular
7
Q
subQ crepitus caused by
A
subQ emphysema (rice krispies under skin)
8
Q
increased fremitus (vibration) seen with
A
pneumonia/ consolidation
9
Q
accessory muscle use
A
signs of resp distress SCM, scalene, supraclavicular contraction COPD, asthma
10
Q
subQ emphysema
A
air from lung/ chest tracks along tissue planes
11
Q
alveoli filled with fluid blood/ pus increasing the density and opacity of the lung tissue
A
consolidation/ infiltrate
12
Q
expiration
A
diaphragm relaxes, chest wall contracts, intrathoracic pressure normalizes
13
Q
stridor
A
high pitched, wheeze obstruction in trachea or larynx foreign body/ airway disease croup (kids)
14
Q
inspection- chest size/shape/color
A
lesions, scars, color chest A- P diameter, deformity, body habitus
15
Q
crackles/ rales heard when
A
small airways pop open during inspiration or when air bubbles flow through secretions or closed airways
16
Q
pectus excavatum
A
concave anterior chest
18
Q
mediastinal crunch is a sign of
A
mediastinal emphysema (pneumomediastinum)
19
Q
egophony positive presence indicates
A
lung consolidation/ collapse eg PNA, atelectasias, tumors
20
Q
resonant sounds
A
over air (lungs)
21
Q
wheeze is heard with
A
asthma, COPD, chronic bronchitis, bronchus obstruction
22
Q
ex of dull
A
pneumonia pleural effusion
23
Q
intensity and pitch of broncho-vesicular breath sounds
A
moderate, moderate
25
Q
rhonchi sound
A
low pitched, snoring, “wheeze” large airway secretions (chronic bronchitis)
26
Q
specialized exams for auscultation
A
bronchophony and egophony
27
purpose of palpation to evaluate for
palpable masses (neoplasm, lipoma) and tender areas (ribs, spine, etc)
28
5 cm below the Supra sternal notch
Angle of Louis
29
intensity and pitch of tracheal breath sounds
very loud, relatively high
30
bronchophony presence indicates
lung consolidation/ collapse eg PNA, atelectasias, tumors
31
inspiration
diaphragm contracts, chest wall expands, intrathoracic neg pressure
32
bradypnea
\<12 breaths/min diabetic coma, drug induced resp depression
33
overdistention of distal airspaces, resulted in limited expiratory flow and lung hyperinflation
COPD
34
rhonchi suggest
secretions in larger airways
35
flail chest
rib fractures cause paradoxical movement of chest wall
35
cheyne stokes in sleeping children and elderly
normal
37
what is this ? resonant breath sounds, versicular normal breath sounds, possible crackes, wheezes, or rhonchi, normal transmitted voice sounds, normal tactile fremitus
chronic bronchitis
38
Lung apices are about _____ clavicle
2-4 cm above
39
duration of broncho-vesicular breath sounds
inspiration and expiration equal
40
pectus carinatum
convex anterior chest
41
continuous, low pitched adventitious sounds
rhonchi
42
barrel chest
inc. AP diameter COPD- use chest a lot for breathing
43
Minor horizontal fissure of the right lung runs close to ____ rib, meeting major fissure at midaxillary line near ____ rib
4th, 5th
44
biots breathing caused by
respiratory depression/ brain damage
47
prolonged expiration 2/2 increased airway resistance
obstructive breathing
49
Intercostal spaces are numbered by
Rib above
50
adventitious means
added
51
ex of flat
pleural effusion
52
wheeze sound
high pitched, hissing, shrill whistling
53
Interscapular
Between scapulae
54
tachypnea
\>20 breaths/min restrictive lung disease, elevated diaphragm, pain
55
Lower lung midaxillary border
8th rib
56
scoliosis
abnormal lat curvature of spine
57
diseases where you hear crackles
bronchitis pulmonary fibrosis, CHF
58
normal respirations
14-20 breaths/min
60
MSL- mid sternal line is
Precise
61
pleural friction rub is seen with
recent URI, PNA
62
discontinuous adventitious sounds
crackles aka rales
63
subQ emphysema is seen with
lung injury (rib fx), postop thoracic surgery
64
duration of bronchial breath sounds
expiration \> inspiration
66
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
COPD
69
an inspiratory wheeze
stridor larynx/ tracheal obstruction
70
purpose of auscultation for bronchopony
assess underlying lung tissue for collapse/ consolidation
71
adventitious lung sounds
sounds are superimposed on usual breath sounds
72
subQ emphysema can cause swelling of the
eyelids, cheeks, lips, neck, chest
73
what is this? resonant percussion, mostly vesicular breath sounds (except over bronchi and trachea), normal transmitted voice sounds, normal tactile fremitus
normal air filled lung
74
Infraclavicular
Below clavicle
75
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
pleural effusion
76
AAL anterior axillary line is
Estimated
77
absence of spontaneous respiration
apnea
79
Normal breath sounds are ___ with ____ thorax movement and ____ abdominal movement
Quiet, slight, more prominent
80
kyphosis
abnormal FW curvature of spine
80
periods of gradually inc and dec respirations w/ periods of apnea
cheyne stokes
80
resonant sounds
over air (lungs) loud, low, long
81
intensity and pitch of vesicular breath sounds
soft and relatively low
82
decreased fremitus (vibration) seen with
obstructed bronchus, COPD, pleural effusion, lung fibrosis, pneumothorax
83
dull sounds
over solid (liver) medium intensity, moderate ptich, moderate duration
85
fluid collection within the chest but outside the lung causing compression
pleural effusion
86
location of vesicular breath sounds
most of peripheral lung
87
hyperventilation
faster, deeper respiration metabolic acidosis
88
specialized exam percussion
diaphragmatic excursion
89
periodic deeper breaths
sighing
89
of auscultation required for exam
3 anterior, 4 posterior, 1 lateral
90
crackling/ grating feeling/ sound
crepitus
93
location of tracheal breath sounds
over trachea
94
Lateral to sternal angle
2nd rib
95
Lower lung midclavicular border
6th rib
96
cheyne stokes in adults/ awake people
heart failure, uremia, brain damage, drug induced
96
during auscultation, listen to
pitch, intensity, duration, and location of sounds listen to a sufficient number of areas to allow for accurate assessment of any underlying pathophys
99
duration of tracheal breath sounds
inspiration and expiration equal
100
air collection within the chest but outside the lung causing compression
pneumothorax
102
specialized exam for inspection and palpation
respiratory expansion
103
MCL midclavicular line is
Estimated
104
kussmaul breathing is a sign of
metabolic acidosis
104
ex of hyper-resonant
COPD pneumothorax
105
Breath sounds over trachea and bronchi are ____ breath sounds over lung parenchyma
Different
105
crackles that are loud, lower pitched, brief (20-30msec)
coarse
106
intermittent, nonmusical, brief, velcro like sounds
crackles/ rales
107
positive egophony
E-A change present
109
rhonchi and wheezes are ____ and \_\_\_\_
longer (\>250 msec) and musical
109
rhonchi are ___ with a cough
clear
110
tympani sounds
over hollow areas (stomach)
110
ex of tympanic
large pneumothorax
110
crackles that are soft, high pitched, very brief (5-10msec)
fine
111
intensity and pitch of bronchial breath sounds
loud, relatively high
113
location of bronchial breath sounds
over manubrium
113
crackle-like creaking sounds caused by inflamed pleural surfaces ribbing together
pleural friction rub
114
Lower lung posterior border
T10
115
tracheal deviation
large pleural effusion, large pneumothorax mass/ tumor
115
tympanic sounds
over hollow areas (stomach) soft, high pitched, short
115
continuous, high pitched adventitious sounds
wheezes
116
hyper-resonant
very loud, low, long
117
wheeze is caused by
rapid airflow through narrowed (almost closed) bronchi
118
inspection- respiration
- rate - rhythm, depth, effort of breathing - audible sounds (wheezes, stridor) - signs of resp distress (accessory muscle use, trachea position, stridor) - asymmetry
120
rapid and deep respiration
kussmaul breathing
120
unilateral chronic lung/ pleural, fibrosis, pleural effusion, lobar pneumonia, pain/ splinting
limited chest excursion
121
diaphragmatic excursion measure
3-5.5 cm
122
Inferior tip of scapula correlates with _____ rib/intercostal space
7th
123
egophony
when a pt says EE, it sounds like AAY during auscultation
123
pleural effusion
dull to flat over fluid percussion
124
positive bronchophony
voice is louder and more clear over that area if positive
126
bone crepitus caused by
rib movement from fracture
126
duration of vesicular breath sounds
inspiration \> expiration
126
bronchophony
when a pt says 99 during auscultation
127
techniques
IPPA inspection, palpation, percussion, auscultation
128
irregular, unpredictable, shallow or deep breaths with intermittent apnea
biots breathing
129
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
pneumonia
130
specialized exam for palpation
tactile fremitus
131
purpose of percussion
determine if underlying tissues are solid (up to 7 cm)/ air filled/ fluid filled and detect areas of tenderness (spine, ribs, etc)
131
ex of resonant
chronic bronchitis
131
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
pneumothorax
131
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
asthma
131
Angle of Louis
Sternal angle
132
fremitus
palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization looking for increase or decrease in vibrations (abnormal)
133
mediastinal crunch best heard in
left lateral position
