Thoracic Clinical Exam Findings Flashcards by Garrett Oberst

Thorax includes

Lung, esophagus, heart

Bound by 1st rib and diaphragm

How well did you know this?

Not at all

Perfectly

Normal inspiration

Diaphragm contract doqn into abdominal cqavity
Thorax expands and IT presdure decreases

Abdominal contents compressed and ab wall extends outward

How well did you know this?

Not at all

Perfectly

Paradoxical breathing

Tachypnea
Bradypnea
Apnea
HYperpnea
Cheyne-stokes

Flail chest (rib dage sings in)

Paralyzed or weak diaphragm

Over 20 PBM
Under 10 BPM
Absence of resp
Increase in depth of respiration

Altering hyperpnea and shallow respiration followed by periods of apnea (Heart failure)

How well did you know this?

Not at all

Perfectly

Trachea deviation

Pneumothorax
Pleural effusion
Lung atelectasis

Away
Away
Toward

How well did you know this?

Not at all

Perfectly

Barrel chest
Pectus carinatum
Pectus excavatum

COPD or emphyema
AP diameter increase
AP diametes decreased

These deformities can cause dyspnea

How well did you know this?

Not at all

Perfectly

Retraction

Most apparent in lower interspaces and children

Severe resp distress (some kind of obstruction)

How well did you know this?

Not at all

Perfectly

Nasal flaring
Clubbing
Cyanosis
Splinter hemorrhage

Acute distress in children

Chronic resp failure, malig…shoud not see it in COPD

Hypoxia

Endocarditis

How well did you know this?

Not at all

Perfectly

COPD pt classic vignette

Daily sputum production

Tx for bronchitis often

Smoker

Short of breath

How well did you know this?

Not at all

Perfectly

Chest expansion…what should you see?

Lateral distance bt thumbs should increase symmetrically

How well did you know this?

Not at all

Perfectly

MSK chest pain is

Reproducible by compression or lateral twisting

How well did you know this?

Not at all

Perfectly

Tactile femitus

Palpable vibration while pt speaks (99)

Use palmar or ulnar surface

Normal is consistent throguhout and side to side with no increase or decrease

How well did you know this?

Not at all

Perfectly

INcrease and decreased fremitus

Increased in pneumonia or with increased density

Decreased or absnet when sound traveling through lungs is impeded…effusion, pnuemothorax, atelectasis, bronchial obstruction

How well did you know this?

Not at all

Perfectly

Pulm fibrosis findings classic

Clubbing

Decreased lung expansion, crackles

How well did you know this?

Not at all

Perfectly

Hyperresonance
Dullness
Flatness

loud, low-pitched booming sound with a long duration
Occurs with more air
Pneumothorax, emphyema, large bullae

Medium soft instensity with a thud-like sound
Pleural effusions, pneumonia, atelectasis

Soft, high pitched
Pleural effusion

Dullness and flatness are basically the same

How well did you know this?

Not at all

Perfectly

Diaphragmatic excursion

Dullness between full inspiration and expiration and assess distance

Should be about 5-6 cm

Decreased means diaphragm paralysis or bilateral emphysema

How well did you know this?

Not at all

Perfectly

Vesicular

Quality, timing, location, abnormal location

Soft and low pitched

Inspiration>exp

Periphery

Trachea or sternum

Bronchovesicular

Q, tim, loc, abnorm, loc

Moderate, mod pitch

Eqaul

First and second IC spaces at border over major bronchi

Peripheral lung

Bronchial or tracheal

Q, tim, loc, abnormal loc

Loud and high pitfched

Exp>insp

Over trachea

Lung

Adventitious breath sounds

Continuous and discontinuous

Stridor, wheezes or rhonchi

Crackles and rales

Abnormal voice

Egophony
Bronchophony
Whispered pectoriloquy

E more like A

Spoken words clearer than normal

Whispered louder and clearer

Lung consolidation or lung mass

Dry crackles

Wet crackles

Discon, insp…opening of small airways…implies fibrosis or HF

Dis, inspi…fluid oscillating in small airways…lung edema, HF, or pneumonia

Rhonchi
strido
Wheeze

Cont, insp, and exp…secretions in large airways…bronchiis or increased secretions

Continuous, insp, heard over neck…narrowing of extra-thoracic airway…vocal cord dz, ex edema, occlusion

Continuous, exp»»insp…narrowing of intra-thoracic airways…astham, COPD, edema (unilateral - occlusion or cancer)

JVP

Normal less than 3 cm above sternal angle

Over 4 cm or 9 cm about RA

Increased in HF, tamponade, obstructed veins

PMI

Should be 4th or 5th IC space at midclavicular line on the left

Displaced - enlarged heart or underlying lung dz with lung shift

If a square, start at top left corner nad move right...ausculatation of valves

Aortic valve, pulmonary valve, mitral valve, tricuspid valve

S1 and S2

S1 - mitral and tricuspid valve closure..start of systole S2 - aortic and pulmonary valve closure (systole ends and disatole begins)

S3 and S4

S3 - right after S2...when blood from LA enters already overfilled LV during early diastole S4 - right befroe S1..when blood enters stiff LV during atrial contraction (late diastole)

Diastolic heart murmurs and systolic heart murmurs

Diastolic - valvular heart dz Systolic - may indicate valvular heart dz but also may be normal

PE findings related to airway

Wheezes, rhonchi, hyperexpansion, resonant to hhyperresonant on percussion, sputum production

COPD or bronchitis Asthma PE findings

Both - wheezes, rhonchi, hyperexpansion, resonant to hyperressonant, sputum production SMoking Hx of childhood ilness, allergy or irritant exposure, intermittent episodes

PE findings Pneumonia Pleural effusion/atelectasis Pneumothorax

Crackles, fever, increased fremitus, dullness to percussion, egophony Decreased fremitus, dullness to percussion, tracheal deviation Hyperresonant, tracheal deviation, decreased breath soudns

HF PE findings

Crackles, edema, decreased refill, increased JVP, S3/S4 gallop, displaced PMI Resonant percussion, maybe wheezes, normal fremitus

Cancer PE findings

Unilateral wheeze, atelectasis, or effusion Hx of hemoptysis, prior cancer, recurrent pneumonia, weight loss