Pulmonary PE

Question 1

Location of the Lung Lobes

Answer 1

Question 2

Which nerves innervate the diaphram

Answer 2

• the phrenic nerves (C3, C4, and C5)
  *

Question 3

Muscles of Inspiration vs Expiration

Answer 3

• Muscles of Inspiration:
  
  • Core Muscles:
    
    • external intercostal
    • diaphragm
  • Accessory Muscles:
    
    • sternocleinomastoid
    • Pectoralis minor/major
    • Scalene
• Muscles of Expiration:
  
  • Core Muscles:
    
    • Internal intercostals
    • Diaphragm
  • Accessory Muscles:
    
    • abdominals
    • Quadratus lumborum

Question 4

Causes of Chest Pain

Answer 4

Question 5

Most common causes of Dyspnea

Answer 5

• asthma
• pneumonia
• COPD
• Myocardial ischemia
• Deconnditioning
• see photo

Question 6

Quality of Sputum says what:

Answer 6

• green = often pseudomonas
• foul smelling = anaerobes
• pink/frothy = pulmonary edema

Question 7

Any pulm complain should also involve which physical exams:

Answer 7

• EENT and Cardiac

Question 8

What is the chest expansion exam?

Answer 8

Question 9

Tactile Fremitus (Normal vs. Abnormal)

Answer 9

• say “99” with hands on back and then chest
• normal finding = mild purrlike sensation
• Abnormal:
  
  • increase vibrations will indicate a solid in the lung
    
    • ex. pneumonia, tumor, pulmonary fibrosis
  • decrease in vibrations occurs when there is increased distance that the sound has to travel before it reaches the chest wall
    
    • ex. pleural effusion, pneumothorax, COPD
      *

Question 10

Egophany vs bronchophony

Answer 10

• While listening to the chest:
  
  • egophony:
    
    • say “ee” if sounds like an “aa” suggests the air filled lung has collapsed or been filled in with a fluid or solid
  • bronchophony:
    
    • say “99” if it is heard louder and clearer this suggests that the air filled lung has collapsed or been filled in with a fluid or a solid

Question 11

Pectoriloquy

Answer 11

• tell patient to whisper “1,2,3,4”
  
  • normal should not be able to hear/only hear a faint muffled sound, abnormal = louder and clearer and indicates that the normal air filled lung has either collapsed or filled with fluid or a solid

Question 12

Where to find the lung lobes on an chest

Answer 12

Question 13

Types of Advenitious breath sounds

Answer 13

• crackles (rales)
• wheeze
• rhonchi
• stridor
• pleural rub

Question 14

Coarse Crackles

Answer 14

• aka Coarse Rales
• Characteristics:
  
  • discontinuous, low-pitched
  • bubbling or gurgling
  • start early in inspiration and extend into expiration
• Clinical Findings:
  
  • same as fine crackles but usually more advanced disease
    
    • pulmonary edema
    • pulmonary fibrosis
• Location:
  
  • usually in the base of the lower lung

Question 15

Fine Rales

Answer 15

• aka Fine crackles
• Chracteristics:
  
  • discontinuous
  • fine, high-ptiched crackling
  • end of inspiration
  • not cleared by a cough
• Clinical
  
  • pneumonia
  • heart failure
  • chronic bronchitis
  • asthma
  • COPD
• Location:
  
  • usually in the base of the lower lung

Question 16

Wheeze

Answer 16

• Characteristics
  
  • continuous
  • high-ptiched, muscial sound similar to squeak
  • more common in expiration
  • occurs in the small airways
• Clinical Indications:
  
  • Asthma
  • COPD
  • Heart failure
• Location:
  
  • heard all over the lungs

Question 17

Rhonchi

Answer 17

• Characteristics:
  
  • continuous
  • low-pitched, coarse, loud, low snoring or moaning tone
  • more common in expiration
  • **coughing may clear**
• Clinical finding:
  
  • obstructed trachea
  • bronchitis
  • pneumonia
• Location:
  
  • can be heard all over lung but especially in the trachea and the bronchi

Question 18

Pleural Friction Rub

Answer 18

• character:
  
  • superficial, low-pitched, coarse rubbing or grating sound
  • sounds like two surfaces rubbing together
  • heard throughout inspiration and expiration
  • loudest over the lower anterolateral surface
  • **not cleared by a cough**
• Clincical finding:
  
  • pleurisy
  • pericarditis
  • pericardial effusion
• Location:
  
  • mostly anterioraly in areas of the greatest thoracic expansion