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Advanced Health Assessment > The Chest > Flashcards

The Chest Flashcards

1
Q

What generates the power to breathe?

A

The diaphragm and the external intercostal muscles

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2
Q

At what level does the trachea bifurcates?

A

At the level of the fourth or fifth thoracic vertebrae

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3
Q

How does the right bronchus differ from the left?

A

The right is shorter, wider and straighter than the left bronchus

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4
Q

What lobes are present in the right lung?

A

Upper, Middle, Lower

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5
Q

What lobes are present in the left lung?

A

Upper and Lower only

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6
Q

What is an other name for the sternomanubrial angle?

A

Angle of Louis

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7
Q

Where is the Angle of Louis located?

A

Approximately 5cm below the suprasternal notch lateral to the second rib

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8
Q

What landmark is associated with the inferior wing of the scapula?

A

T7

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9
Q

What landmark is associated with the most prominent cervical spinous process?

A

C7

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10
Q

What ribs articulate with the sternum?

A

Only the first seven ribs

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11
Q

Where do ribs eight, nine and ten articulate?

A

With the cartilage above

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12
Q

What is another name for the eleventh and twelfth ribs?

A

Floating ribs, have free anterior portions

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13
Q

What fissure divides the upper and lower lobes in both the right and left lung?

A

Oblique fissure

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14
Q

What are the borders of the oblique fissure?

A

Begins on the anterior chest at the six rib at the midclavicular line and extends laterally upward to the fifth rib in the midaxillary line ending at the posterior chest at the spinous process T3

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15
Q

What is the fissure that separates the right upper and middle lobes?

A

The horizontal fissure

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16
Q

What are the borders of the horizontal fissure?

A

It extends from the fourth rib at the sternal border to the fifth rib at the midaxillary line

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17
Q

How far up do the lungs extend?

A

Approximately 3-4cm above the medial end of the clavicles

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18
Q

Where are the inferior margins of the lungs?

A

Extend to the sixth rib at the midclavicular line to the eight rib at the midaxillary line and between T9 and T12 posteriorly

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19
Q

What causes the right hemidiaphragm higher than the left?

A

The liver

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20
Q

What is the most common symptom of lung disease?

A

Cough

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21
Q

Describe paroxymal nocturnal dyspnea?

A

Sudden onset of SOB at night, the patient is seized with sudden intense strangulation sensation

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22
Q

What disease is strongly correlated with paroxymal nocturnal dyspnea?

A

CHF

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23
Q

Describe orthopnea?

A

Difficulty breathing while lying flat

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24
Q

How is orthopnea relieved?

A

Use of multiple pillows to prop the patients head

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25
Q

Describe platypnea.

A

Difficulty breathing while sitting up

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26
Q

What relieves platypnea?

A

The recumbent position

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27
Q

Describe Trepopnea.

A

Condition in which patients are more comfortable breathing while lying on one side

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28
Q

What is abnormally high pitched noise hear predominately on expiration?

A

Wheezing

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29
Q

What two situations can cause a decrease in the amount of wheezing hear on auscultation?

A

Either an opening of the airway or a progressive closing off of the air passage

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30
Q

When does central cyanosis occur?

A

Only after the O2 saturation has fallen to less than 80%

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31
Q

How much Hgb must be present in order for central cyanosis to occur?

A

2-3g/100mL blood

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32
Q

What are the two types of COPD?

A

Emphysema

Chronic bronchitis

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33
Q

What is a significant finding to indicate COPD after examining the chest?

A

An increased AP diameter is seen in advanced COPD

34
Q

What is one of the earliest signs of airway obstruction?

A

Use of accessory muscles

35
Q

What are two accessory muscles used on inspiration?

A

Trapezius and the Sternocleidomastoid

36
Q

How do accessory muscles aid in ventilation?

A

They raise the clavicle and the anterior chest to increase the lung volume and produce and increased negative intrathoracic pressure

37
Q

How much clavicular movement is associated with severe obstructive lung disease?

A

More than 5mm

38
Q

What is a normal RR in an adult?

A

10-14 respirations per minute

39
Q

What is an accurate way to calculate respiration in a patient?

A

Count breaths in thirty seconds and multiply by two

40
Q

What information does tactile fremitus provide?

A

Useful information regarding the density of the underlying lung tissues and chest cavity

41
Q

What will increase tactile fremitus?

A

Conditions that increase the density of the lungs and make them more solid –> consolidations

42
Q

What factors might decrease tactile fremitus?

A

Clinical conditions that decrease transmission of these sounds:
Excess fat
Air or fluid in chest cavity
Over expansion of the lung (emphysema)

43
Q

How many sites should tactile fremitus be evaluated in?

A

Six locations

44
Q

What information can percussion provide?

A

Air-tissue ratio

45
Q

What sounds should be heard when percussing over a solid organ?

A

Dull, low amplitude short note

46
Q

What sounds should be heard when percussing over a structure containing air within a tissue?

A

Resonant, higher amplitude, low pitch note

47
Q

What sounds should be heard when percussing over a hollow air-containing structure?

A

Tympanic, high pitched , hollow note

48
Q

What sounds should be heard when percussing over a large muscle mass?

A

Flat, high pitch note

49
Q

What is a normal finding when percussing over the chest?

A

Dullness over the hart and resonance over the lung fields

50
Q

What does the term hyperresonacne indicate?

A

Percussion note obtained from a lung with decreased density such as in emphysema

51
Q

What is the normal amount the diaphragm moves between inspiration and expiration?

A

4-5cm

52
Q

How does diaphragmatic movement change in patients with emphysema?

A

It is decreased

53
Q

What part of the stethoscope is used to hear high pitched sounds?

A

The diaphragm

54
Q

What part of the stethoscope is used to hear low pitched sounds?

A

The bell

55
Q

What can occur if the bell is pressed too tightly against the patient?

A

It turns into a diaphragm

56
Q

Harsh, loud, high pitch sounds heard over the extra thoracic portion of the trachea?

A

Tracheal breath sounds

57
Q

Why aren’t tracheal breath sounds really evaluated?

A

They do not represent any clinical lung problems

58
Q

Loud and high pitched sounds that sounds like air rushing through a tube?

A

Bronchial breath sounds

59
Q

Where are bronchial breath sounds typically heard?

A

Listening over the manubrium

60
Q

What part of the respiratory cycle are bronchial breath sounds heard best?

A

Expiratory component is louder and longer than the inspiratory component

61
Q

What type of breath sounds are a mixture of bronchial and vesicular sounds?

A

Bronchovesicular

62
Q

What part of the respiratory cycle are bronchovesicular breath sounds heard best?

A

The inspiratory and expiratory components are equal in length

63
Q

Where are bronchovesicular breath sounds best heard?

A

The first and second intercostal spaces anteriorly and between the scapula posteriorly

64
Q

What sounds are soft, low pitch heard over most of the lung fields?

A

Vesicular

65
Q

What part of the respiratory cycle are vesicular breath sounds heard best?

A

The inspiratory component is much longer than the expiratory component

66
Q

When are distant breath sounds heard?

A

In hyperinflated lungs such as emphysema

67
Q

What is thought to be the cause of crackles?

A

Opening of collapsed distal airways and alveoli

68
Q

What do crackles sound like and when are they best head?

A

Heard on inspiration, short, discontinuous, non-musical sounds

69
Q

What are the most common causes of crackles?

A

Pulmonary edema
CHF
Pulmonary fibrosis

70
Q

What do wheezes sound like?

A

Continous, musical, high pitched sounds

71
Q

What is the cause of wheezes?

A

Produced by airflow though narrowed bronchi

72
Q

What does ronchi sound like?

A

Low pitch, more sonorous lung sounds

73
Q

When is ronchi typically heard?

A

Transient mucous plugging and poor movement of airway secretions

74
Q

What does a pleural rub sound like?

A

Grating sound produced by motion of the pleura

75
Q

When is a pleural rub best heard?

A

End inspiration, beginning of expiration

76
Q

When is egophony said to be present?

A

When a patient is saying eeee and it sounds like aaaa

77
Q

What does positive egophony indicate?

A

Consolidation of lung tissue

78
Q

What is whispered pectoriloquy?

A

Asking the patient to whisper while listening to their chest

79
Q

What does positive whispered pectoriloquy indicate?

A

Consolidation is present

80
Q

What does bronchophony examine?

A

Patient talking while listening to them with stethoscope, if words become louder consolidation is likely present

Advanced Health Assessment (7 decks)

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