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Physical Diagnosis Lecture > Thorax and Lungs > Flashcards

Thorax and Lungs Flashcards

1
Q

Lable the anatomy

A
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2
Q

area above the clavicles

A

supraclavicular

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3
Q

area below the clavicles

A

infraclavicular

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4
Q

area between the scapulae

A

Interscapular

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5
Q

area below the scapulae

A

infrascapular

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6
Q

the lowermost portions of the lungs

A

bases on the lungs

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7
Q

What are the three fields of the lungs?

A

upper, middle, and lower

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8
Q

What are the common or concerning symptoms of chest?

A

chest pain (ex. blood clot, embolism), sob (dyspnea), wheezing, cough, blood-streaked sputum (hemoptysis), daytime sleepiness or snoring and disordered sleep (sleep apnea)

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9
Q

Complaints of chest pain/ chest discomfort can raise concerns of?

A

give concern to the heart but often arise from the thorax and lungs which is why you must pursue a dual investigation of thoracic and cardiac causes

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10
Q

Angina pectoris, myocardial infarction, myocarditis cause concern in what area of the chest?

A

myocardium

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11
Q

Pericarditis causes concern to what area of the chest?

A

percardium

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12
Q

Bronchitis causes concern to what area of the chest?

A

trachea and large bronchi

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13
Q

Aortic Dissection causes concern to what area of the chest?

A

aorta

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14
Q

Percarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus causes concern to what area of the chest?

A

parietal pleura

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15
Q

Costochondritis (infammation in ribs), herpes zoster causes concern to what area of the chest?

A

chest wall, including musculoskeletal and neurologic systems

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16
Q

Gastroesphageal reflux disease, esophageal spasm, esophageal tear causes concern to what area of the body?

A

esophagus

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17
Q

Cervical arthritis, biliary colic, gastritis causes concern to what area of the chest?

A

extrathoracic structures such as neck, gallbladder, and stomach

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18
Q

When a patient complains of chest pain what are the steps to follow? and what does it suggest?

A
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19
Q

If pt is complaining of SOB, what are the steps to follow? and questions to ask?

A
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20
Q

The most common cause of an acute cough is?

A

viral upper respiratory infections

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21
Q

What should be considered when a pt has a cough?

A

acute bronchitis, pneumonia, left sided heart failure, asthma, foreign body, smoking, and ace inhibitor therapy

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22
Q

When is chronic cough seen?

A

postnasa drip, asthma, gastroesophageal reflux, chronic bronchitis, and bronchiectasis (kids)

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23
Q

If a patient is present with a cough what are questions that you can ask?

A
  1. prooductive? (dry, sputum)
  2. voulme of sputum and its color, odor(can tell you if its viral), and consistency
  3. purulent?
  4. hemopytsis?
  5. mucoid? (translucent, white or gray?)
  6. foul smelling? (abscess/ viral)
  7. large colume of purulent sputum meas bronciectasis or lung abscess
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24
Q

What topics if mentioned should the provider offer counseling or health promotion for?

A
  1. tobacco cessation ( if they have a smoking history ask if they want to get educated on the matter or how to stop)
  2. marijuna - only for daily/ chronic use
  3. lung cancer - rest scans?
  4. immunizations - covid, influenza, pneumonia vaccines
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25
Q

During the initial survey of a lungs and throax exam wha should be done?

A
  1. observe the rate, rhythm, depth, and effort of breathing (verbalize)
  2. rate should be 18-20 breaths a minute
26
Q

What are the signs of respiratory distress?

A
  • tachypnea (fast breathing)
  • cyanosis in lips, tongue, and oral mucosa signals hypoxia
  • audible sounds of breathing ex. high pitched inspiratory whistling, stridor, wheezing
  • inspect the neck
    *for contraction of accessory muscles during inspiration, supraclavicular retraction *
    contraction of accessory muscles during expiration,
    trachea midline
27
Q

During bradypnea what is the rate? and what does it cause?

A

Rate: < 12/min
- metabolic alkalosis: volume depletion, vomiting
- narcotics
- raised intracranial pressure
- extreme obesity

28
Q

During tachypnea what is the rate? and what does it cause?

A

Rate: > 20-25/ min
* metabolic acidosis: DKA
* hypoxemia
* stimulants
* anxiety
* pain

29
Q

What is the Tri-pod position?

A

In cases of real distress, pts may lean forward resting their hands on their knees. This is a sign of COPD, emphysema ( will also purse their lips)

30
Q

What should be inspected during a lung/ thorax examination?

A
  • observe the shape of the chest
  • ratio of the anteriorposterior diameter to lateral chest diameter is 0.7 up to 0.9 and increases with aging (verbalize diameter)
  • > 0.9 in COPD, producing barrel-chest appearance
31
Q

What is funnel chest/ Pectus Excavatum?

A

-depression in the lower portion of the sternum. compression of the heart and great vessels may cause murmurs
-occurs in males during growth spurge

32
Q

What is a Barrel chest deformity?

A

an increased AP diameter. this shape is normal during infancy, and often accompanies aging and chronic obstructive pulmonary disease

33
Q

What is the Pigeon chest/ pectus Carinatum deformity?

A

-when the sternum is displaced anteriorly, increasing the AP diameter. The costal cartilages adjacent to the protruding sternum are depressed

34
Q

What is the Traumatic Flail Chest deformity?

A

-multiple rib fractures may result in paradoxical movements of th thorax. As descent of the diaphragm decreases intrathoracic pressure, on inspiration, the injured area caves inward; on expiration, it moves outward

35
Q

What should be examined during palpation of the lungs and thorax?

A
  • ID tender areas
  • carefully palpate any areas the patient reports pain or has visible lesions or bruises
36
Q

What is commone feeling during the palpation of a fractured rib?

A

tenderness, bruising, and bony “step-offs”

37
Q

Where is crepitus palpable?

A

overt fractures and arthritic joints

38
Q

How do you test Chest Expansion?

A
  • Place your thumbs at about the level of the 10th ribs, with your fingers loosely grasping and parallel to the lateral rib cage.
  • As you position your hands, slide them medially just enough to raise a loose fold of skin between your thumbs over the spine.
  • Ask the patient to inhale deeply. Watch the distance between your thumbs as they move apart during inspiration, and feel for the range and symmetry of the rib cage as it expands and contracts.
  • This movement is sometimes called lung excursion.
39
Q

refers to the palpable vibrations that are transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking normal

A

Fremitus

40
Q

Where is Fremitus more prominent?

A

in the interscapular area than the lower lung fields

41
Q

When is Fremitus decreased or absent?

A
  • voice is higher pitched or soft
  • impeded by a thick chest wall, an obstructed bronchus, COPD, pleural effusion, fibrosis, air (pneumothorax) or tumor
42
Q

If there is an increased tactile fremitus that means?

A
  • there is a coarser or rougher feel
  • consolidation: lobar pneumonia, tumor
  • heavy bronchial secretions
  • segmental atelectasis
43
Q

If there is an decreased tactile fremitus that means?

A
  • feels muffled or diminished
  • emphysema, pneumonia
  • pleural effusionn, fibrosis or thickening
  • massive pulmonary edema
  • hemothorax (only in one lung)
44
Q

What are the steps to examining for tactile fremitus

A
  • use either ball or ulnar surface of your hand (optimizes the vibrartory sensitivity)
  • ask the patient to repeat the words “ninety- nine” or “one-one-one”
  • ID areas of increased, decreased, or absent fremitus
  • if faint, ask pt to speak more loudly or in a deeper voice
45
Q

Percussions help establish whether the underlying tissues are?

A

-air-filled
-fluid filled
-consolidated

45
Q

What are the steps to performing a percussion?

A
  1. hyperextend the middle finger of your left hand
  2. press its distal interphalangeal joint firmly on the surface - avoid surface contact by any other part of the hand because it dampens vibrations
  3. with a quick, sharp motion, strike the pleximeter finger with the right middle finger
  4. strike using the tip of finger not the finger pad
46
Q

What is the ladder pattern and what is it used for?

A

Percussion and auscultation

47
Q

Fill for the percussion sounds

A
48
Q

What do these percussion sounds mean:
* Resonant:
* Hyperresonant:
* Hyperresonant:
* Dullness:

A

Resonant = Normal
Hyperresonant = hyperinflated. COPD, ASTHMA
Hyperresonant on one side = pneumothorax
Dullness = Fluid or solid (ex. liver)

49
Q

What are these for?

A

Auscultation

50
Q

How deep does percussion go?

A

Penetrates 5-7 cm into chest; will not aid in detection of deep-seated lesions

51
Q

How do you perform a percussion?

A
  • Hyperextend the middle finder of your left hand.
  • Press its distal interphalangeal joint firmly on the surface to be percussed
  • Avoid surface contact by any other part of the hand because it dampens out vibrations
  • With a quick, sharp motion, strike the pleximeter finger with the right middle finger.
  • Strike using the tip of the finger, not the finger pad.
52
Q

What are some tips for percussion?

A
  • Have the patient keep both arms crossed in front of the chest
  • Percuss one side of the chest and then the other in the ladder-like pattern.
  • Omit areas over the scapulae
53
Q

How do you auscultate?

A
  • Listen directly on skin with the diaphragm of stethoscope
  • Instruct patient to breathe deeply through an open mouth
  • Use the ladder pattern
  • Listen to at least one full breath in each location
  • If patient becomes light-headed, allow patient to take a few normal breaths
54
Q

Fill in for breath sounds

A
55
Q

What are the adventitious Breath Sounds?

A
  • May be continuous
  • Cont. long sounds are divided into **wheezes and rhonchi **
  • Discontinuous lung sounds are called crackles
  • Stridor: inspiratory and expiratory, harsh wheeze like accompanied by retractions

If a patient is sick, have them cough deep to hopefully clean up so there is no more rhonchi

56
Q

For friction rub: what do you hear?

A
  • Pitch: Low to medium
  • Quality: Raspy, dry, scratchy (e.g. leather rubbing on leather)
  • Timing: I, E, or both, usually loudest at end inspiration and early expiration; sound disappears with breath holding
57
Q

What causes the Friction rub?

A

Hypertrophy and CHF enlargement in athelets and elders

58
Q

When are special tests used?

A

These are follow-up tests utilized when abnormal breath sounds are present and are performed via auscultation.

59
Q

What is egophony?
What is bronchophony?
What is the whispered pectoriloquy?
⭐️

A
  • Egophony – ask the patient to say “eeeee” then it should sound like a muffled long E. If it sounds like an “A”, egophony is present and may indicate lung pathology
  • Bronchophony – ask the patient to say “ninety-nine”, should sound muffled, if the sound is loud, may indicate lung pathology
    Whispered pectoriloquy – ask the patient to whisper “ninety-nine”, should sound like a whisper, if loud and clear, may indicate lung pathology
60
Q

Fill in the lungs sounds

A

Physical Diagnosis Lecture (3 decks)

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