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Fall IPA > Pulmonology Assessment > Flashcards

Pulmonology Assessment Flashcards

1
Q

RALS of the lung root refers to what?

A

Pulmonary artery is found anterior to the bronchus on the right side and superior to the bronchus on the left side. Right anterior left superior.

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2
Q

What artery carries deoxygenated blood?

A

Pulmonary artery, going away from the heart to the lung.

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3
Q

What is the surface anatomy for the lung apices?

A

2-4 cm above clavicles

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4
Q

Do you want to listen to the lungs along a rib or intercostal space?

A

Intercostal space

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5
Q

What are the surface projections for the trachea, carina, main bronchi, and aorta/svc?

A

Trachea = sternal notch, carina = sternal angle, main bronchi = 3rd ribs, aorta/svc = below manubrium.

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6
Q

4 parts of pulm physical exam

A

Inspection, palpation, percussion, auscultation

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7
Q

Parts of pulm inspection

A

Rate, rhythm +depth, comfort & effort, symmetry, tracheal position, chest anatomy, color, fingernails, smell

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8
Q

What is the normal RR for adults and for infants?

A

Adults: 14-20 breaths/minute. Infants: up to 44 breaths/minute.

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9
Q

What does tidal and regular mean?

A

It flows in and out rhythmically, but expiration can take twice as long as inspiration normally.

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10
Q

What is a functional way to assess comfort/effort of breathing?

A

Are they talking in full sentences or pausing to catch their breath?

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11
Q

How does tracheal position look in a tension pneumothorax?

A

It pushes the trachea toward the other side

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12
Q

What is a flail chest?

A

When multiple ribs are broken in multiple places, 2/2 blunt trauma, creating a flail segment, results in asymmetrical chest raise

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13
Q

Describe barrel chest

A

AP diameter > lateral

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14
Q

Describe Pectus carinatum “pigeon chest”

A

outward chest deformity

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15
Q

Describe Pectus excavataum “funnel chest”

A

inward chest deformity

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16
Q

What is central cyanosis?

A

You don’t have enough blood t/o the body to oxygenate cells, blue discoloration around lips/mucous membranes (eyes, mouth, lips), “hypoxia”

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17
Q

Peripheral cyanosis

A

Typically a local circulation issue, blue discoloration around the extremities, body doesn’t have enough oxygenated blood for everything, can be a precursor to central cyanosis

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18
Q

Describe digital clubbing

A

Hypertopthy of nail bed tissue, unknown cause. But seen in diseases that result in chronic hypoxia, schamroth’s sign (Schamroth’s sign = absence of nail window could mean clubbing)

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19
Q

What are the smells you might notice?

A

Foul smelling - anaerobes. Fruity odor - ketone production. Smoke - active tobacco abuse.

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20
Q

5 steps of respiratory expansion?

A

Ask them to breathe out, place hands on back, bunch up skin with thumbs, observe flattening of skin fold, feel for symmetric chest rise

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21
Q

How to assess for tracheal deviation?

A

ask patient to look up, find suprasternal notch, walk fingers up to laryngeal prominence, confirm midline location

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22
Q

How to assess for tenderness?

A

Ask them throughout if anything hurts: soft tissue, costal cartilage, ribs, intercostal spaces, sternum.

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23
Q

What does tenderness indicate in chest pain?

A

Typically it means it is musculoskeletal, because you can recreate it by pressing on the muscles. This doesn’t rule out an ominous cause of chest pain.

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24
Q

What’s the difference between Pain vs tenderness?

A

Pain is subjective, what the pt tells you. Tenderness is objective, it is elicited by our touch. You can have reported pain without tenderness.

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25
Q

What is tactile fremitus?

A

You are looking for difference in sound transmission based on what is inside the lungs. Vibrations are transmitted through the lung parenchyma and chest wall.

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26
Q

3 steps of assessing tactile fremitus?

A

Palpate the chest with either ball or ulnar surface of hand, ask pt to say ninety nine or blue moon, flee for symmetry, increased or decreased vibration.

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27
Q

Possible dx for increased vibration?

A

consolidation, because vibration is steady when going from solid to solid

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28
Q

Possible dx for decreased vibration?

A

unilateral: pleural effusion, pneumothorax. bilateral: COPD, body habitus, effort. solid to liquid loses vibration, as does solid to air.

29
Q

What is percussion?

A

Force directed into chest to determine nature of underlying structures (air v fluid v solid), can reach 5-7cm.

30
Q

Percussion steps?

A

hyperextend the middle finger of your nondominant hand (pleximeter). press distal interphalangeal joint into surface, use the middle finger of dominant hand to strike the distal phalangeal join. best when pt is sitting.

31
Q

Know the pattern of percussion, see pic in ppt?

A

S ladder pattern, then squares.

32
Q

4 sounds to look for in percussion

A

flatness (muscles/bones), dullness (solid organ), resonant, hyperresonance (like walking into a stadium and reverberates)

33
Q

What is the normal measured distance of diaphragmatic excursion?

A

3.5-5.5 cm

34
Q

What sounds do we hear with auscultation?

A

breath sounds, adventitious (added) sounds, transmitted voice sounds

35
Q

Make cards for the breath sounds chart

A
36
Q

Describe crackles AKA rales

A

fine rales: soft, brief, high pitched. coarse rales are louder, longer, lower pitched. chest hair can sound like rales if the stethoscope moves during auscultation

37
Q

Name the 2 continuous added breath sounds

A

wheeze, ronchi

38
Q

What things are pleaural friction rub seen in

A

pneumonia, PE, pleurisy

39
Q

What is happening with subcutaneous emphysema or crepitus?

A

subQ trapped air: pneumomediastinum

40
Q

Acute tracheobronchitis pathophys and sxs?

A

airway inflammation, cilia aren’t getting the mucous out, increased mucous, bronchospasm, >90% viral, sxs are cough, sputum production, burning retrosternal discomfort (pleuritis)

41
Q

Acute bronchitis findings? (percussion, breath sounds, added sounds, fremitus)

A

resonant, vesicular breath sounds, crackles wheeze rhonchi, normal fremitus. It is an airway disease not lung tissue dz

42
Q

Pneumonia

A

alveolar infection, infiltration of WBCs, bacterial debris. caused by bacteria, viral, fungal. Sxs of fever, chills, dyspnea, chest pain, cough and sputum. Rust colored: streptococcus pneumoniae (mcc). currant jelly: klebsiella

43
Q

Pneumonia findings? (percussion, breath sounds, added sounds, fremitus)

A

dullness, bronchial, crackles, increased fremitus

44
Q

What is a consolidation?

A

Any semi-solid that fills the alveoli

45
Q

What is a Pleural effusion?

A

fluid collection in the pleural cavity, can result from heart failure, infection, malignancy, trauma

46
Q

Pleural effusion findings? (percussion, breath sounds, added sounds, fremitus)

A

Dull/flat, decreased breath sounds, friction rub, decreased fremitus + tracheal deviation

47
Q

What is a Pneumothorax?

A

negative pressure causes air to rush in, can be spontaneous from trauma, lung dz, sxs of acute onset dyspnea, pleuritic chest pain

48
Q

Pneumothorax findings? (percussion, breath sounds, added sounds, fremitus)

A

hyperresonant, decreased breath sounds, friction rub, decreased fremitus + tracheal deviation

49
Q

All asthma wheezes, but…

A

not everything that wheezes is asthma

50
Q

What is Asthma?

A

reversible airway inflammation, bronchospasm, typically some trigger precipitating attack, dyspnea, wheezing, chest tightness/anxiety

51
Q

Asthma findings? (percussion, breath sounds, added sounds, fremitus)

A

resonant, wheezing breath sounds, decreased fremitus

52
Q

COPD

A

chronic and irreversible airway/alveolar inflammation, destruction of airway/alveolar architecture, sxs of dyspnea and productive cough.

53
Q

What are the key players in alveoli?

A

smooth muscle, elastin, surfactants, and vessels

54
Q

4 Qualities of Dullness

A

sounds like a thud, medium intensity, medium pitch, medium duration

55
Q

Dullness is seen in…?

A

Pneumonia, tumors

56
Q

4 Qualities of Flatness

A

extremely dull sounding, soft intensity, high pitch, short duration.

57
Q

Flatness is heard in…?

A

Pleural effusion (because the effusion is preventing the vibration from reaching the lung)

58
Q

4 Qualities of Resonant

A

hollow sounding, loud intensity, low pitch, long duration. Seen in normal lungs!

59
Q

4 Qualities of hyperressonance

A

louder than resonant sounds, very loud intensity, very low pitch, longer duration

60
Q

Hyperresonance is seen in…

A

COPD, pneumothorax, asthma exacerbation

61
Q

Intensity, pitch, and duration of pneumonia?

A

medium intensity, medium pitch, medium duration, sounds like the liver

62
Q

Intensity, pitch, duration of pleural effusion?

A

soft intensity, high pitch, short duration, sound like thigh or scapula

63
Q

Intensity, pitch, duration of normal lungs or bronchitis

A

loud intensity, low pitch, long duration

64
Q

Intensity, pitch, duration of COPD, pneumothorax, asthma exacerbation

A

very loud, very low, very long

65
Q

Vesicular (normal) breath sound characteristics? (duration, intensity, pitch, location heard)

A

inspiratory > expiratory, soft sound, relatively low pitch, heard over both lungs

66
Q

Broncho-vesicular (normal) breath sound characteristics? (duration, intensity, pitch, location heard)

A

Inspiratory = expiratory time, intermediate intensity, intermediate pitch, heard in the 1st and 2nd interspaces anteriorly and between the scapula

67
Q

Bronchial (normal) sound characteristics? (duration, intensity, pitch, location heard)

A

Expiratory > inspiratory time, loud sound, relatively high pitch, heard over the manubrium

68
Q

Tracheal (normal) breath sound characteristics? (duration, intensity, pitch, location heard)

A

Inspiratory = expiratory time, very loud sound, relatively high pitch, heard over the trachea in the neck

69
Q

COPD: Emphysema findings? (percussion, breath sounds, added sounds, fremitus)

A

+ thin with barrel chest, tripod, decreased i:e; decreased fremitus, hyperresonant, decreased to absent breath sounds, course crackles, wheeze, ronchi

Fall IPA (6 decks)

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