Thorax and Lungs Flashcards
loud intensity, low pitch, e.g., normal lung
resonance
very loud intensity, low pitch, e.g., fully inflated lung
hyperresonance
Emphysema, unilateral - pneumothorax, sometimes asthma
hyperresonance
loud intensity, high pitch, e.g., gastric bubble/puffed out cheek
tympany
Cavity or large pneumothorax
tympany
Medium intensity, medium pitch e.g., liver
dullness
Lobar pneumonia, atelectasi
dullness
soft intensity, high pitch, e.g., thigh
flatness
Pleural effusion
flatness
Classification of normal breath sounds
Location
Pitch
Intensity
Timing in respiratory cycle
Vesicular Breath Sound - inspiration
Inspiration normally 2-3 times expiration
Vesicular Breath Sound - where
everywhere on the thoracic wall across the lung
Vesicular Breath Sound - sound characteristics
low pitched, soft rustling sound
Bronchial Breath Sound - breath sounds
Inspiration/expiration equal, with pause between inspiration and expiration
Bronchial Breath Sound - where
over the manubrium of the sternum
Bronchial Breath Sound - sound characteristics
high pitched, tubular, hollow sound
Tracheal Breath Sound - breath sounds
Equal inspiration/expiration with a pause in between
Tracheal Breath Sound - where
over the trachea on the throat
Tracheal Breath Sound - sound characteristics
high pitched, very loud, harsh
Bronchovesicular Breath Sound - breath sound
Equal inspiration & expiration
Bronchovesicular Breath Sound - where
Often in the 1st and 2nd interspaces anteriorly and between scapula
Bronchovesicular Breath Sound - sound characteristics
intermediate pitched, intermediate sound
needle insertion for tension pneumothorax
2nd intercostal space, midclavicular line - anterior chest wall
chest tube insertion
4th intercostal space, anterior axillary line
thoracentesis to remove blood or pus
T7-T8 intercostal space - posterior chest wall
NV structures along _____ margin of each rib
NV structures along inferior margin of each rib
Lung anatomy - apex
2-4 cm above inner 3rd of clavicle
Lung anatomy - lower border
T10 spinous process and descends of inspiration
Lung anatomy - oblique fissure
T3 down and around to 6th rib at midclavicular line
Right main stem bronchus is ______ and more ______ than L main
Right main stem bronchus is shorter and more vertical than L main
Which lung is aspiration pneumonia more common in?
RUL/RML
Where is gas exchange in the lungs?
alveoli
accumulation of pleural fluid
pleural effusion
pleural transudate
heart failure, cirrhosis, nephrotic syndrome
pleural exudate
pneumonia, malignancy PE, TB, pancreatitis
Likely cause if finger pointing to one sport with chest pain
musculoskeletal pain
Likely cause if hand moving from neck to epigastrium with chest pain
heartburn
Likely cause if clenched fist over sternum with chest pain
angina pectoris
Lung tissue has no ___ _____ – pain from _______ due to inflammation of parietal _______
Lung tissue has no pain fibers – pain from inflammation due to inflammation of parietal pleura
telltale sign of cardiac and pulmonary disease
dyspnea - shortness of breath
partial lower airway obstruction
could be due to asthma or foreign body
wheezing
reflex to irritating stimuli
cough
most common cause of cough
viral URI
foul smelling sputum is likely s/s of
anaerobic lung abscess
thick sputum likely s/s of
cystic fibrosis
fever and productive cough likely a s/s of
pneuomonia
cough and wheeze likely s/s of
asthma
cough plus chest pain, dyspnea, orthopnea likely s/s of
acute coronary syndrome
Blood coughed up or blood streaked sputum
hemoptysis
- Quantify volume of blood produced and setting
- Rule out malignancy!
- May originate in mouth, nose, pharynx, GI tract
hemoptysis
breathing cessation >10seconds, awakening with chocking sensation or morning headache
apnea
Common in obesity and related disorders
Daytime Sleepiness/Snoring/Disordered Sleep
IPPA
inspect
palpate
percuss
auscultate
Tachypnea >25 breaths/min
Cyanosis/pallor
Audible high pitched whistling (stridor) – OMINOUS SIGN of upper airway obstruction
Accessory muscle use? SCM, scalene
Observe shape of chest – normally wider than deep
signs of respiratory distress
Audible high pitched whistling
stridor
OMINOUS SIGN of upper airway obstruction
stridor
Deformities or asymmetry in expansion on posterior wall
large pleural effusion
Compression of heart and great vessels may cause murumurs
pectus excavatum
Normal in infancy, seen in aging and COPD
barrel chest
Anteriorly displaced sternum
Costal cartilages adjacent are depressed
pectus carinatum
pigeon chest
Due to rib fractures – caves inward on inspiration, outward on expiration
traumatic flail chest
Abnormal spinal curvature and vertebral rotation
Underlying lungs distorted – makes interpretation of findings difficult
thoracic kyphoscoliosis
Loss of symmetry during lung exclusion on posterior chest wall - possible causes
fibrosis, effusion, pneumonia, bronchial obstruction, paralysis of hemidiaphragm, phrenic nerve issue
Palpable vibrations transmitted through the bronchopulmonary tree to chest wall as patient speaks
tactile premitus on posterior chest wall
- Either bony part of palm at base of fingers or ulnar surface of hand
- Ask patient to say “99” or “one-one-one”
how to palpate for tactile fremitus on posterior chest wall
More prominent over interscapular area and over R lung vs the left
tactile fremitus on posterior chest wall
Asymmetric decreased tactile fremitus
Pleural effusion, pneumothorax, neoplasm
Asymmetric increased tactile fremitus
pneumonia
Sets chest wall and underlying structure into motion
Establish whether tissues are air filled, fluid filled, or consolidated (solid)
Only penetrates 5-7cm into chest
percussion
Healthy lungs on percussion exam - posterior chest wall
resonant
fluid/solid on percussion exam - posterior chest wall
dullness
hyperresonance on percussion exam - posterior chest wall
COPD/asthma
distance between dullness on full expiration and dullness on full inspiration
Estimate of diaphragmatic excursion on posterior chest wall
Air flow decreased on breath sound auscultation
- Muscular weakness
- Obstructive lung disease
- Shallow from pain
Transmission is poor on breath sound auscultation
- Pleural effusion
- Pneumothorax
added sounds super-imposed on usual breath sounds
adventitious sounds
types of adventitious sounds
- Crackles- AKA rales
- Wheezes
- Rhonchi
- Results from air bubbles flowing through secretions or lightly closed airways during respiration.
- Result from series of tiny explosions when small airways, deflated during expiration, pop open during inspiration.
rales/crackles
- Discontinuous, heard usually during inspiration
- Indicate abnormalities in lung
- NOT CLEARED BY A COUGH
rales/crackles
2 types of rales/crackles
- Fine - soft, and high-pitched, brief
- Coarse - louder, lower in pitch, longer
high pitch, shrill, hissing quality
wheezing
Continuous, heard either inspiration or expiration
wheezing
Suggest narrowed airways: Asthma Bronchitis COPD Unilaterally possibly foreign body or tumor
wheezing
low pitch, snoring quality, rumbling
rhonchi
Usually through expiration, prolonged and continuous
rhonchi
Air passing over secretion such as mucous plugs:
Asthma
Bronchitis
COPD
rhonchi
- Machine-like quality
- Heard during inspiration and expiration
- Caused by inflamed, rough surfaces rubbing together
friction rub
- AKA Hamman sign
- Found with mediastinal emphysema (air in mediastinum)
- Variety of noises synchronous with heart beat, not with respiration
mediastinal crunch
friction rub over lungs
pleurisy
friction rub over heart/pericardium
pericarditis
- alveoli are filled with fluid/debris in (consolidation)
- bronchial breath sounds replace normal vesicular sounds in areas where there is no longer any air
- Increased voice sounds – loss of airflow
lobar pneumonia
Decreased/absent transmitted voice sounds
Pleural effusion (dull lung) or hyperinflated lung (hyperresonant)
- ask patient to say “ee”
- If abnormal “ee changes to A”
egophony
if “ee” changes to “aay” during egophony then what is likely cause
lobar consolidation from pneumonia
- ask patient to say “ninety nine”
- Voice travels better through something solid
broncophony
If ninety nine is heard during broncophony, there is loss of airspace - what are you worried about
worried about consolidation
ask patient to whisper “99” – usually faint
whispered pectorilogy
If whispered ninety nine is loud during whispered bronchoscopy, there is loss of airspace - what are you worried about
whispered pectorilogy
during percussion of anterior chest - dullness over heart from __ to __ interspaces on the left
during percussion of anterior chest - dullness over heart from 3rd to 5th interspaces on the left
_________ lung may displace upper border of liver downward
Hyperinflated lung may displace upper border of liver downward