Thorax and lungs Flashcards
Define Adventitious breath sounds
abnormal auscultated breath sounds like crackles, rhonchi, wheezes and friction rub
Define Atelectasis
incomplete expansion of the lung
Define Barrel chest
increased AP diameter, often with some degree of kyphosis - COPD
Define Biot respirations
irregular respirations varying in depth and intermittent apnea intervals, no repetitive pattern
Define Bronchiectasis
chronic dilation of the bronchi or bronchioles, caused by repeated infections of bronchial obstructions
Define Bronchophony
exaggeration of vocal resonance emanating from a bronchus surround by consolidated lung tissue
- greater clarity and increased loudness of spoken word
Define COPD
nonspecific diagnosis of decreased ability of lungs to ventilate - includes chronic bronchitis and emphysema
Define Egophony
consolidated lung tissue, e’s turn to a’s
Define Vesicular
normal breath sounds:
low pitch, soft, short expirations
Define Tubular
normal breath sounds: heard only over trachea, high pitch; loud and long expirations, longer than inspiration
Define Bronchovesicular
normal breath sounds:
heard over main bronchus area and over upper right posterior lung field; medium pitch; expiration equals inspiration
Define Othopnea
SOB, lying down
Define Pectoriloquy
striking transmission of voice sounds through pulmonary structures so they are clearly audible through stethoscope - lung consolidation
Define Pectus carinatum
Pigeon chest:
forward protrusion of sterum
Define Pectus excavatum
Funnel chest:
depression of sternum
Define Tactile fremitus
tremor or vibration in any body part detected on palpation
Define Whispered pectoriloquy
whisper heard same way as normal speech when lung is consolidated by pneumonia
Most sensitive place in chest to look for fluid?
Sulcuses where diaphragm meets chest wall
Boundaries of horizontal fissure
with inhalation = 4th rib at sternum, 5th rib at midaxillary line
Boundaries of oblique fissure
with inhalation = 6th rib at midaxillary line
Basic ausculatation vs. detailed
6 points vs 12
Normal diaphragm movement height
4 cm
What’s important about right mainstem bronchus?
Runs straighter than the left. Aspirated object will more likely be here.
Bifurcation of right and left occurs at sternal angle (2nd rib)
Thorax and lungs physical exam - order?
- LOOK: assess for stability
- Listen
- Palpate
- Percuss
Things to LOOK for in PE:
Shape, movement, posture (walking), acting*, accessory muscles
Cyanosis, clubbing, edema, bad odor to breath, needle marks
*Accessory muscle use is another form of acting ill
Tripoding
maximize air space, COPD, epiglottitis
Bell use
light touch, just seal skin
heart sounds
*must be on skin
Diaphragm use
dimpling skin is ok
lungs
Where to percuss middle lobe?
in front
Pulmonary embolism on palpation
localized collapse so ribs don’t move over area with embolism
Pneumonia on palpation
feel fremitus with consolidation
COPD PE
thorax symmetric with moderate kyphosis and increased AP diameter, decreased expansion, hyperresonant lungs, distant breath sounds, delayed expiratory phase, scattered exp. wheezes, diaphragm descent 2 cm bilaterally.
fremitus decreased; no bronchophony/egophony or whispered pectoriloquy.
Asthma PE
thorax symmetric with flattened kyphosis and normal AP diameter (use secondary muscles of respiration), lungs are resonant (unless bronchial plug), broncho-vesicular breath sounds and scattered expiratory wheezes bilaterally (stronger with forced expiration)
No bronchophony, egophony, or whispered pectoriloquy.
Diaphragms descend 4cm bilat.
Pneumothorax PE
thorax asymmetry, decreased movement on one side, hyperresonant lung on that side, BS decreased on that side in all lobes, diaphragms descend 4 cm on the opposite side only
