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CPA > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What position should the patient be in during a respiratory examination?

A

45 degree angle

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2
Q

What should be exposed during a respiratory examination?

A

anterior chest wall

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3
Q

What should you ask the patient to do when examining lymph nodes?

A

as the patient to sit across the couch with their legs dangling off the sides

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4
Q

Where does the trachea divide into the left and right main bronchi?

A

the level of the sternal angle - T4/T5

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5
Q

Where is the trachea?

A
  • middle of the neck

- suprasternal notch of the manubrium

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6
Q

What should you tell the patient before assessing for tracheal deviation?

A

warn them that it may be uncomfortable

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7
Q

What does tracheal displacement towards the side of the lung lesion suggest?

A
  • upper lobe collapse
  • upper lobe fibrosis
  • pneumectomy
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8
Q

What does tracheal displacement away from the side of the lung lesion suggest?

A
  • extensive pleural effusion
  • tension pneumothorax
  • chest expansion
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9
Q

Where do you place your hands when assessing chest expansion (anterior)?

A
  • below the 5th and 6th rib

- thumbs should align in the mid-sternal line

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10
Q

How much chest expansion would you expect to see in a normal healthy adult?

A

5 cm

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11
Q

Where do you place your hands when assessing chest expansion (posterior)?

A
  • posterior midline

- level T10

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12
Q

What does the movement of the anterior chest wall indicate?

A

the expansion of the upper and middle lobes

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13
Q

What does the movement of the posterior chest wall indicate?

A

the expansion of the lobes of the lung

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14
Q

What can cause unilateral decreased expansion?

A
  • pneumothorax
  • pleural effusion
  • collapsed lung
  • consolidation
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15
Q

Where should you percuss/auscultate during a respiratory exam?

A
  • apex
  • 2nd intercostal space
  • 5th intercostal space
  • axilla
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16
Q

What is different when auscultating the apex of the lungs?

A

use the bell not diaphragm of the stethoscope

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17
Q

What does hyper-resonant percussion suggest?

A
  • pneumothorax
  • hollow bowels
  • COPD
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18
Q

What does hypo-resonant percussion suggest?

A
  • pleural effusion (stoney dull)
  • lung tumour (flat/dull)
  • consolidation (flat/dull)
  • collapse (flat/dull)
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19
Q

What are the 2 types of sounds heard during auscultation of the lungs?

A
  • vesicular sounds

- bronchial sounds

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20
Q

What are bronchial sounds?

A

high pitched notes heard over the trachea, suprasternal notch, manubrium, sternal angle and the sternoclavicular joints.

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21
Q

Where are bronchial sounds heard?

A
  • anteriorly over the manubrium
  • posteriorly between C7 and T3
  • over areas of pathology
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22
Q

Why are bronchial sounds heard?

A

airways are not surrounded by alveolar tissue - therefore turbulence is heard without any filtering

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23
Q

What are the characteristics of bronchial sounds?

A
  • hollow and high pitch
  • expiratory phase > inspiratory phase
  • distinct pause between the expiratory and inspiratory phase
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24
Q

In which pathologies are bronchial sounds heard?

A
  • consolidation
  • localised pulmonary fibrosis
  • pleural effusion
  • collapsed lung
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25
Q

What are vesicular sounds?

A

low notes present all over the rest of the chest where normal lung tissue is present?

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26
Q

What are the characteristics of vesicular sounds?

A
  • inspiratory sound in lobar and segmental airways
  • expiratory sound in the central airways
  • inspiratory phase > expiratory phase (time and intensity)
  • no pause between the 2 phases
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27
Q

What causes vesicular sounds?

A

lung tissue filters the sounds of air turbulence, low pitched sound

28
Q

What does reduced intensity of vesicular sounds suggest?

A
  • shallow breathing
  • airway obstruction
  • hyperinflation
  • pneumothorax
  • pleural effusion
  • pleural thickening
  • obesity
29
Q

What happens to the expiratory phase (vesicular sound) in asthma and chronic bronchitis?

A

prolonged expiration phase

30
Q

Where can you auscultate for the middle lobe of the right lung in females?

A

right axilla

31
Q

Where can you auscultate for the lower lobe of the lungs in females?

A

6th rib

32
Q

Where can you auscultate for the superior lobe of the lungs?

A

2nd intercostal space and infraclavicular

33
Q

Where can you auscultate for the middle lobe of the lungs?

A

6th intercostal space

34
Q

Where can you auscultate for the inferior lobe of the lungs?

A

axillae

35
Q

Where is the lung hilum?

A

mid point of the scapular and posterior median line opposite the spines of T4-T6

36
Q

Where should you auscultate on the anterior chest wall?

A
  • supraclavicular (bell)
  • infraclavicular
  • 2nd intercostal space
  • 6th intercostal space
  • axillae
37
Q

Where should you auscultate on the posterior chest wall?

A
  • level of trapezius
  • level of scapulae spine
  • level of 10th rib
38
Q

What is tactile vocal fremitus?

A

the vibration of the chest wall during vocal sound (from the larynx, down the bronchial tree and into the chest wall)

39
Q

How do you assess tactile vocal fremitus?

A
  • ask the patient to say 99
  • palpate the chest wall
  • vibrations should be equal
40
Q

What does a decrease in tactile vocal fremitus suggest?

A

decrease in density (increased distance between chest wall and the lungs)

  • pneumothorax
  • COPD
  • pleural effusion
41
Q

What does a increase in tactile vocal fremitus suggest?

A

increase in density

  • consolidation in pneumonia
  • tumour tissue in cancer
42
Q

Where do you asses for tactile vocal fremitus?

A

both the anterior and posterior chest wall

43
Q

What lymphnodes should be palpated?

A
  • submental
  • submandibular
  • preauricular/parotid
  • postauricular
  • occipital
  • superior deep cervical nodes
  • inferior deep cervical nodes
  • supraclavicular nodes
44
Q

Where are the submental nodes?

A

inferior to the chin

45
Q

Where are the submandibular nodes?

A

inferior to the angle of the mandible

46
Q

Where are the preauricular/parotid nodes?

A

anterior to the ear

47
Q

Where are the postauricular nodes?

A

posterior to the ear

48
Q

Where are the occipital nodes?

A

base of the occipital

49
Q

Where are the superior deep cervical nodes?

A

superior aspect of the sternocleidomastoid

50
Q

Where are the inferior deep cervical nodes?

A

inferior aspect of the sternocleidomastoid

51
Q

Where are the supraclavicular nodes?

A

superior to the clavicle

52
Q

What does cervical lymphadenopathy suggest?

A
  • lung cancer metastasis
  • tuberculosis
  • sarcoidosis
  • respiratory tract infection
53
Q

What would be seen during an examination when there is community acquired pneumonia?

A
  • sharp pain on deep inspiration
  • dullness to percussion (in effected region of the lung)
  • crackles and reduced air entry (in effected region)
54
Q

How is consolidation seen on an x-ray?

A

consolidation is more dense than air, and therefore whiter - increased opacification

55
Q

What can cause consolidation?

A
  • pus
  • pulmonary oedema
  • haemorrhage
  • cancer
56
Q

What can be seen on air bronchograms?

A

consolidated airways with trapped air - darker and superimposed over the increased opacification

57
Q

What is the silhouette sign?

A

loss of the normal border of a structure on a chest x-ray

58
Q

What is the borders of the triangle of safety for chest drains?

A

superior: apex below the axilla
medial: anterior axillary fold of pectoralis major
lateral: posterior axillary fold of latissimus dorsi
inferior: 4th/5th intercostal space

59
Q

Where can you place the needle for a chest drain?

A

2nd, 3rd, 4th and 5th intercostal space on the midaxillary line

60
Q

Where is the anterior oblique fissure?

A

junction of 6th rib and midclavicular line

61
Q

What are the top point of the pleura?

A

1 inch above the medial 3rd of the clavicle

62
Q

What are the bottom point of the pleura?

A

8th rib, midclavicular line

63
Q

What is the landmark of the lung hilum?

A

mid point of scapular and posterior median line opposite spines of T4-T6

64
Q

Where is the scapular line?

A

medial border of scapula

65
Q

Where is the posterior oblique fissure?

A

T3 level

CPA (6 decks)

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