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H&P exam 2 > Thorax and Lung > Flashcards

Thorax and Lung Flashcards

1
Q

Pleuritic/pleurisy

A

Pain with breathing

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2
Q

Lung fields vs lobes

A

Lung fields= 6 regions (upper/middle/lower right/left)

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3
Q

At what spinal level does the trachea bifurcate?

A

T4, at the sternal angle

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4
Q

Visceral pleura

A

covers outer surface of lungs

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5
Q

Parietal pleura

A

lines inner rib cage and upper surface of the diaphragm

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6
Q

Thorax and lung physical exam

A

inspect palpate percuss auscultate

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7
Q

A-P diameter- barrel chest

A

AP diameter increased

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8
Q

A-P diameter normally

A

Thorax normally 2x wider than it is deep May increase with aging and COPD (i.e. emphysema, chronic bronchitis, etc)

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9
Q

Kyphosis

A

Hunch back

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10
Q

Pectus excavatum

A

Sternum caved in, ribs on either side are higher

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11
Q

Pectus Carinatum

A

Sternum protrudes

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12
Q

stridor

A

a wheeze that is high pitched and largely inspiratory; usually louder in the neck

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13
Q

What does stridor indicate

A

laryngeal/upper airway obstruction (can be associated with epiglotitis, foreign body aspiration

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14
Q

Schamroth’s sign

A

Clubbing Possible sign of COPD

reduces respiratory rate from 20 to 12-15 breaths/min, increases tidle volume, decreases PaCO2, increases PaO2

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15
Q

How do you check chest expansion?

A

Place thumbs at the level of the 10th ribs, fingers parallel to lateral rib cage.

Unilateral decrease/delay in expansion= fibrosis, pleural effusion, possibly lobar pneumonia

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16
Q

What is the purpose of percussion?

A

To determine if underlying tissues are air filled, fluid or solid

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17
Q

When would you use the direct technique vs indirect for percussion?

A

direct- over spine and kidneys (CVA) to check for tenderness

indirect- check for degree of resonance of lung

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18
Q

What should chest percussion sound like?

A

resonance= air

dullness= solid/fluid filled areas

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19
Q

Percussion tones- hyper-resonant

A

intensity= very loud

pitch= low

examples: Emphysema, local pneumothorax

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20
Q

Percussion tones- resonant

A

intensity= loud

pitch= low

example= healthy lungs

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21
Q

Percussion tones- Tympanic

A

intensity= loud

Pitch= high

example= gastric bubble (or puffed out cheek)

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22
Q

Percussion tones- Dull

A

intensity- soft- moderate

pitch- moderate-loud

example: liver, consolidation (pneumonia), pleural effusion

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23
Q

Percussion tones- flat

A

intensity- soft

pitch- high

ex: muscle, consolidation (PNA), pleural effusion

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24
Q

What are the required number of levels for auscultation/percussion of the anterior and posterior chest

A

anterior- 3

posterior- 4 + 1 lateral site on each side

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25
Q

What is the purpose of auscultation?

A

To determine whether there is normal airflow, airway obstruction or abnmormal air or fluid w/in the chest or lungs

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26
Q

Do you use the bell or diaphragm when auscultating the lungs?

A

Diaphragm

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27
Q

Locations or normal breath sounds

A

bronchial is over trachea

Bronchiovesicular is over main bronchi

Vesicular is over lesser bronchi, bronchioles and lobes

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28
Q

Where do you hear bronchial breath sounds

A

over the manubriam

if hear at distant location, suspect fluid filled lung

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29
Q

Where do you hear bronchovesicular breath sounds

A

in 1st and 2nd interspaces anteriorly and b/w scapula posteriorly

if heard at distant location, suspect fluid-filled lung

30
Q

tachypnea

A

fast, shallow breathing

31
Q

hyperventilation

A

deeper, usually faster breathing

32
Q

sighing

A

periodic deeper breaths

33
Q

Biot’s

A

Abnormal breathing pattern

irregular breathing with long periods of apnea

cause- increased intracranial pressure, drug induced respiratory depression, brain damage (usually at medullary level)

34
Q

Cheyne strokes

A

abnormal breathing pattern

irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea

Causes: Drug induced respiratory depression, CHF, Brain damage (usually at the cerebral level)

35
Q

Kussmaul’s breathing pattern

A

Abnormal breathing pattern

fast and deep

cause: metabolic acidosis (seen in uncontrolled DM)

36
Q
A

Pectus carinatum

37
Q
A

Pectus excavatum

38
Q
A

Kyphosis

39
Q

Pleural friction rub

A

squeaking or grating sound of the pleural linings rubbing together

=pleurisy

Heard on inspiration AND expiration

40
Q

Crepitus

A

Palpable grating or crunching

ex: rib movement due to fx

41
Q

What is tactile fremitus looking for

A

consolidation

“99”

increased fremitus (vibration)= consolidation/PNA b/c consolidation increases transmission

decreased fremitus= air/effusions decrease transmission—> ex pleural effusion, pneumo, COPD, fibrosis

42
Q

Will tactile fremitus increase or decrease with a pneumothorax?

A

decrease

43
Q

Will tactile fremitus increase or decrease with a pleural effusion

A

decrease

44
Q

Will tactile fremitus increase or decrease with consolidation

A

increase

45
Q

Will percussion be dull or resonant with pneumothorax?

A

resonant

46
Q

Will percussion be dull or resonant with Pleural effusion

A

dull

47
Q

Will percussion be dull or resonant with consolidation

A

dull

48
Q

Bronchovesicular breath sounds

A

combination bronchial and vesicular, normal in some areas

49
Q

Rhonchi

A

coarse low-pitched (snoring); may clear with cough

continuous sound

heard when patient is ill

Caused by airway secretions and narrowing/partial obstruction (ex: bronchitis, COPD)

50
Q

Wheeze

A

whistlig, high pitched bronchus- continuous

ILL

caused by airway obstruction (ex asthma)

51
Q

Bronchial breath sounds

A

coarse, loud

heard with consolidation

ILL

52
Q

Pleural friction Rub

A

scratchy, high pitched

squeaking or grating sound of the pleural linings running together

=pleurisy

heard on inspiration and expiration

ILL

53
Q

Crackles

A

fine crackling, high pitched- discontinuous sounds

ILL

Caused by “popping open” of small airways and alveoli that have collapsed. Fluid in the lung can cause this

Fine crackles- ex. interstitial process, can be normal

medium crackles

coarse crackles: airway dz such as damage to bronchi

0819

54
Q

Crackles (rales), wheezes and rhonchi picture

A
55
Q

Stridor

A

wheeze that is high pitched and largely inspiratory; usually louder in the neck

Results from turbulent airflow in upper airway

indicates: laryngeal/upper airway obstruction (ex: epiglotitis, aspiration)

56
Q

Mediastinal crunch (Hamman sign)

A

Loud crackles, clicks and gurgling sounds

due to pneumo mediastinum (mediastinal emphysema

synchronous with heart beat

not as common

57
Q

What is broncophony, egophony, whispered pectoriloquy

A

looking for consolidation- solid transmits sound better than air

58
Q

Bronchophony

A

“99” heard louder and clearer than normal even at dist. away from larynx

occurs with consolidation- indicates presence of fluid or solid tissue in alveoli

59
Q

Egophony

A

When voice sounds are louder, have a nasal quality and E sounds like A

occurs with consolidation

60
Q

Does consolidation increase or decrease transmission of sound/vibration?

A

consolidation INCREASES transmission

air and effusions DECREASE transmission

61
Q

Consolidation

A

condition in which lung tissue becomes firm and solid rather than elastic and air filled- usually due to accumulated fluids and tissue debris

62
Q

Lung/pulmonary infiltrates

A

filling of the air spaces with fluid

infiltrates can cause consolidation

63
Q

Empyema

A

pus in pleural space

usually results from infection that spreads from the lungs

64
Q

pleurisy/pleuritis

A

inflammation of the pleura

65
Q

Asthma

A

bronchial tubes are hyper responsive

airways become inflamed and produce excess mucus

muscles around the airways tighten, making the airways narrower–> this obstructs breathing

reversible

66
Q

COPD

A

ex: emphysema

associated with airway resistance and residual volume of air even after full expiration

can result in hyperinflated lungs (and barrel chest)

considered irreversible

67
Q

How many seconds of forced expiratory time suggests COPD?

A

>6 seconds

68
Q

How to perform a PFT

A

ask pt to walk down hall and observe rate and effort

69
Q
A
70
Q

What adventitious sounds are heard with pneumonia/consolidation?

A

crackles

H&P exam 2 (6 decks)

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