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History & Physical > Thorax and Lungs > Flashcards

Thorax and Lungs Flashcards

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1
Q

sternal angle/angle of louie

A

horizontal bridge joining the manubrium to the body of the sternum T4/T5

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2
Q

physical landmarks for lungs

A

Apex: 2-4 cm above clavicle

Lower border: 6th rib MCL, 8th rib midaxillary line,
T10 posterior

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3
Q

right bronchus v. left bronchus

A

right bronchus is wider, shorter and more vertical, more susceptible to aspiration of FB

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4
Q

What may cause an increase in AP diameter?

A

aging, chronic obstructive pulmonary disease (emphysema, chronic bronchitis)

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5
Q

Stridor

A

a wheeze that is high pitched &largely inspiratory, usually louder in the neck. Results from turbulent airflow in upper airway. Indicates laryngeal/upper airway obstruction

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6
Q

What are some possible signs of COPD?

A

Clubbing of the fingers-fingertips spread out and become rounder

pursed lip breathing- reduces respiratory rate, increased tidal volume

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7
Q

Why do we percuss the lungs?

A

to determine if underlying tissues are air-filled, fluid or solid. Also detects areas of tenderness

resonance over air, dullness over solid or fluid filled areas

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8
Q

hyper-resonant percussion tone

A

very loud, low pitch

ex. emphysematous lungs (diffuse) pneumothorax (local)

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9
Q

resonant percussion tone

A

loud, low pitch

ex. healthy lungs

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10
Q

tympanic percussion tone

A

loud, high pitch

ex. gastric bubble, puffed out cheek

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11
Q

Dull percussion tone

A

soft-moderate intensity, moderate-high pitch

ex. liver, consolidation (pna), pleural effusion

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12
Q

Flat percussion tone

A

soft, high pitch

ex. muscle, consolidation (pna), pleural effusion

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13
Q

What side of the stethoscope should you use to auscultate the lungs?

A

diaphragm

listen for one full breath at each area

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14
Q

Where can you heard bronchial breath sounds?

A

over the manubrium

suspect fluid filled lung if heard at a distant location

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15
Q

Where can you hear bronchovesicular breath sounds?

A

in 1st and 2nd interspaces anteriorly and between scapula posteriorly

suspect fluid filled lung if heard at a distant location

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16
Q

Crackles (rales)

A

discontinuous high pitched, caused by “popping open” of small airways & alveoli that have collapsed. Fluid in the lungs can cause this

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17
Q

Rhonchi

A

snoring quality (coarse, low pitch) , caused by airway secretion & narrowing/partial obstruction

may clear with cough

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18
Q

Wheeze

A

high pitched, whistle, caused by airway obstruction

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19
Q

Biot’s

A

irregular breathing with long periods of apnea

causes: increased ICP, drug induced respiratory depression, brain damage

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20
Q

Cheyne-stokes

A

irregular breathing with intermittent periods of increased and decreased rates and depths of breathing alternating with periods of apnea

causes:drug induced respiratory depression, brain damage, CHF

21
Q

Kussmaul’s

A

fast and deep pattern of breathing

causes: metabolic acidosis

22
Q

Atelectasis

A

loss of air from lung or collapse of lung tissue with reduced lung volume, can result from blockage of air passages with mucus or from pleural effusion

23
Q

Tension pneumothorax

A

large amount of air entering the chest when a one-way valve (air in) is formed by an area of damaged tissue

24
Q

Pneumonia/consolidation

A

pneumonitis (inflammation of the lung) usually due to infection but sometimes has noninfectious cause; has the addition feature of pulmonary infiltrates/consolidation

25
Q

consolidation

A

lung tissue becomes firm and solid due to accumulated fluids & tissue debris

26
Q

pulmonary infiltrate

A

filling of the air spaces with fluid, can cause consolidation

27
Q

Pleural effusion

A

collection of fluid in the pleural space

28
Q

hemothorax

A

blood in the pleural space

29
Q

empyema

A

pus in the pleural space, usually results from infection that spread from the lungs

30
Q

Pleurisy/Pleuritis

A

inflammation of the pleura

31
Q

Acute bronchitis

A

inflammation of the bronchi (no involving the lungs, bronchi are considered part of the upper airway

32
Q

Asthma

A

obstructive airway disease

bronchial tubes are hyper-responsive, airways become inflamed & produce excess mucous, muscles around the airway tighten making the airways narrower, which obstructs breathing

33
Q

COPD

A

associated with airway resistance & RV even after full expiration, can result in hyper inflated lungs

34
Q

Pleural friction rub

A

squeaking or grating sound of the pleural lines rubbing together, associated with pleurisy. Heard on inspiration & expiration

35
Q

Crepitus

A

palpable grating or crunching, can occur with rib movement due to fracture

36
Q

What does tactile fremitus look for?

A

consolidation- vibrations transmitted through the bronchopulmonary tree

palpate “99”

increased fremitus = consolidation

decreased fremitus = air/effusions

37
Q

What can coarse crackles be indicative of?

A

airway disease such as damage to bronchi

38
Q

Stridor

A

a wheeze that is high pitched & largely inspiratory, usually louder in the neck

results from turbulent airflow in the upper airway

39
Q

Mediastinal crunch (Hamman sign)

A

loud crackles, clicks and gurgling sounds

due to pnuemo-mediastinum

synchronous with heart beat

40
Q

How can you perform a clinical PFT?

A

ask pt to walk down hall or climb one flight of stairs, observe rate and effort

41
Q

How can you test forced expiratory time?

A

ask pt to “blow out the candles” >6 seconds suggests obstructive pulmonary disease

42
Q

Why would you auscultate during forced exhalation?

A

may allow faint wheezes to be heard better

43
Q

What would pna do to tactile fremitus? percussion?

A

increased tactile fremitus

percussion would be dull

44
Q

What breath sounds would you hear on a pt with pna? voice sounds? Adventitious sounds?

A

bronchial

increased voice sounds

crackles

45
Q

What breath sounds would you hear on a pt with COPD ? voice sounds? Adventitious sounds?

A

diminished breath sounds

decreased voice sounds

may hear wheeze or rhonchi

46
Q

What breath sounds would you hear on a pt with pleural effussion? voice sounds? Adventitious sounds?

A

diminished breath sounds

decreased voice sounds

may hear pleural friction rub

47
Q

Tactile fremitus for pt with COPD? percussion sounds?

A

decreased tactile fremitus

hyper-resonant percussion

48
Q

Tactile fremitus for pt with pleural effusion? percussion sounds?

A

decreased or absent tactile fremitus

dull or flat

History & Physical (8 decks)

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