Thorax and Lung Exam Flashcards
Tactile Fremitus
palpable vibrations transmitted through the chest wall when patient speaks
Increased tactile fremitus could be __________
INCREASE in lung density
Consolidation (PNA, PE)
Pulmonary fibrosis
Decreased tactile fremitus could be ____________
Lung tissue is REPLACED by fluid or air Pleural effusion Emphysema/COPD Pneumothorax Foreign body
What is the difference between Consolidation and pleural effusion?
Consolidation: Lung is engorged with fluid
Effusion: Lung tissue is replaced by fluid or air
Vesicular BS
Normal breath sounds. Soft, relatively low pitched. Heard at ends of bronchiole branches in alveoli. Abnormal if heard over trachea or bronchii
Bronchovesicular BS
May not exist, inbetween 1st and 2nd interspaces anteriorly and between scapulae
Bronchial/Tubular BS
Abnormal if heard anywhere but over bronchial area. REaltively high pitched.
Tracheal BS
Relatively high pitched, harsh; heard over trachea and neck. “Darth Vader”
Stridor
a wheeze that is entirely or predominantly inspiratory. Partial obstruction of trachea or larynx
Things to note for adventitious BS
Timing: insp. and/or exp.
Location: LUL/RML, scattered…
Number: intermittent, continuous
Change: coughing or position?
Egophony is common in __________
Emphysema
Pleural effusion
Fluid displacing the lung space compressing the lung. Pushes everything to opposite side.
Right lung has ____lobes, left lung has ____ lobes
3, 2
oblique fissures divide the ____ and ____ lobes
upper and lower
the horizontal fissure is only in the ____ lung and creates the ____ lobe
right, middle
Where is the lung apex?
about 4cm superior to the first rib
Where is are the lower borders?
Between T9 and T12 depending on inspiration or expiration
Fine crackles are heard when?
End of inspiration, and coughing won’t clear
When are course crackles heard?
Entire inspiration, loud and bubbly
Ronchi are?
low pitched snoring, honking sounds
Vocal fremitus tests
egophony, whispered pectoriliquy, bronchophony, in each of these if words are louder, clearer, mean consolidation or pneumonia, but if none, assumes some sort of effusion
Diaphragmatic excursion normal measurement
3-5 cm, diaphragm usually higher on the right as it sits on the liver
barrel chest
due to intercostal musculature growing - seen in emphysema
flail chest
when a section of the chest is disconnected from the bony structure and creates paradoxical chest movement
scoliosis
spine deviated laterally
Kyphosis
spine deviated posteriorly (hunch)
gibbus
Sharp angular deformity associated with a collapsed vertebrae
Lordosis
inward curvature of inner spine, seen in pregnancies
Hemoptysis
coughing up blood
pulsus paradoxus
decrease of 10 mm Hg or more during inspiration, or increased pulse during expiration
