Thorax and Lungs

Question 1

Asthma

Answer 1

• causes SOB, noctural cough
• often assoc with history of allergies
• can be made worse by exercise or irritants like smoke in a bar
• on auscultation there can be normal to decreased air movement
• wheezing heard on expiration (sometimes inspiration)
• with severe asthma may not hear wheezing because of lack of air movement

Question 2

Pneumonia

Answer 2

• usually associated with dyspnea, cough and fever
• on auscultation there can be coarse or fine crackles heard over the affected lobe
• percussion over the affected area is dull and there is often an increase in fremitus
• egophony and pectoriloquy are heard because of increased transmission of high-pitched components of sounds

Question 3

Spontaneous pneumothoraz

Answer 3

• occurs suddenly
• severe dyspnea and chest pain on affected side
• more common in young males
• on auscultation of affected side there will be no breath sounds
• on percussion there is hyperresonance or tympany
• absense of fremitus to palpation

Question 4

COPD

Answer 4

• insidious in onset
• generally affects older populations with a smoking history
• diameter of chest if often enlarged like a barrel
• percussing chest elicits hyperresonance
• auscultation there are distant breath sounds
• coarse sounds of rhonchi are also often heard
• IMPT to quantify patient’s exercise capacity- may affect employment and allows to follow for progession of disease

Question 5

Pericarditis

Answer 5

• pain sharp, knifelike
• located over left side of chest
• change of position, breathing and coughing often make the pain worse
• leaning forward improves the pain
• oftern seen in rheumatologic disease such as systemic lupus and in patients with chronic kidney disease
• may experience after MI

Question 6

angina

Answer 6

• dull chest pain in retrosternal area or anterior chest
• often radiates to shoulders, arms, neck and jaw
• associated with SOB, N and sweating
• pain generally relieved by rest or medication after several minutes

Question 7

Dissecting aortic aneurysm

Answer 7

-associated with a ripping or tearing sensation that radiates to the neck, back or abdomen
-because blood supply to the brain and extremities is disrupted, syncope and paraplegia or hemiplegia can occur
-bp will usually be different between the 2 arms
-carotid pulses often show asymmetry
(because aneurysm decreases flow distally and causes inequality of flow between sides

Question 8

Pleural pain

Answer 8

• sharp, knifelike
• occurs over affected area of pleura
• breathing deeply usually makes the pain worse
• lying quietly on affected side make the pain better
• pleurisy often occurs from inflammation due to an infection, neoplasm or autoimmune disesse

Question 9

left-sided heart failure

Answer 9

• fluid starts “backing up” into lungs because heart is unable to handle the volume
• xs fluid collects in dependent areas, causing crackle in bases of lower lobes
• sitting up allows patients to breathe easier
• 2 main causes: chronic high bp, and CAD, which lead to MI and decreased contractility of the heart

Question 10

funnel chest

Answer 10

• causes by a depression in the lower portion of the sternum
• severe enough can be compression of heart and great vessels,leading to murmurs on asuculation
• usually only a cosmetic problem, corrective surgery can be performed if necessary

Question 11

2nd intercostal space

Answer 11

location of needle insertion for tension pneumothorax

Question 12

T4

Answer 12

approximate bifurcation of trachea

-marks inferior limit for endotracheal tube on chest x-ray

Question 13

Sternal angles

Answer 13

• marks the 2nd rib,which helps establish the 2nd interspace for needle insertion or
• locations for cardiac auscultation (aortic and pulmonary areas)

Question 14

4th intercostal space

Answer 14

normally used to chest tube insertion

Question 15

When percussing, large pneuomthorax produces what sound

Answer 15

• hyperresonant

- great deal of air in the chest with a large pneumothorax, producing a hyperresonant note

Question 16

Bronchial

Answer 16

• lung sound louder and higher in pitch
• short silence between inspiration and expiration
• expiration longer than inspiration
• -reason - sound from trachea is carried very well to chest wall by fluid

Question 17

late inspiratory crackles might be indicative of

Answer 17

• heart failure

- timing of crackles within inspiration provides important clues

Question 18

early inspiratory crackles

Answer 18

COPD and asthma

Question 19

adventitious sounds that clear with a cougn are usually consistent with

Answer 19

bronchitis or atelectasis

Question 20

myocardium pain

Answer 20

angina pectoris, MI, myocarditis

Question 21

pericardium pain

Answer 21

pericarditis

Question 22

aorta

Answer 22

dissecting aortic aneurysm

Question 23

trachea and large bronchi

Answer 23

bronchitis

Question 24

parietal pleura

Answer 24

pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus

Question 25

chest wall, including the musculosketal system and skin

Answer 25

costochondritis, herpes zoster

Question 26

esophagus

Answer 26

reflux esophagitis, esophageal spasm, esophageal tear

Question 27

extrathoracic structures such as the neck, gallbladder and stomach

Answer 27

cervical arthritis, biliary colic, gastritis

Question 28

Bronchitis

Answer 28

Crackles, wheezed or rhonchi clear with a cough

-adventitious sounds that clear with cough are usually consistent with bronchitis or atelectasis.

Question 29

Heart Failure

Answer 29

• last inspiratory crackles that were not present a week aga
• timing of crackles with inspiration provides important clues
• last inspiratory crackles that appeared suddenly would be most consistent with heart failure
• copd and asthma usually produce early inspiratory crackles

Question 30

Bronchial

Answer 30

-lung sound that possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration.

Question 31

Large pneumothorax produces

Answer 31

hyperressonant note

-good deal of free air in the chest with a large pneumothorox

Question 32

sound heard over a gastric bubble

Answer 32

tympany

• gastric bubble produces one of the longest percussion notes
• patient with copd may have nyperresonance over his chest, while a normal person would have resonance
• dullness is heard over a normal liver, and flatness is heard is one percusses a large muscel

Question 33

what happens with respiratory distress

Answer 33

• skin between the ribs moves inward with inspiration
• other features include; speaking in short sentences, use of accessory muscles, leaning forward to gain mechanical advantage for the diaphragm and pursed lip breathing.