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Clinical Skills I > thorax juju > Flashcards

thorax juju Flashcards

1
Q

Lobe anatomy

A

R: oblique and horizontal fissure
- upper, middle, lower
- R main bronchus more VERTICAL so abscesses tend to be in the R middle or lower lobes
- inserting a ET tube too far will go into here

L: oblique fissure
- upper, lower

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2
Q

Trachea anatomy bifurcation

A

Bifurcation
- anteriorly: sternal angle
- posteriorly: T4

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3
Q

chest pain

A

PARIETAL PLEURA:
- lines the pleural cavity and inner rib cage and upper surface of diaphragm
- innervated by: intercostal and phrenic nerve
- pain: pleuritic pain with deep inspiration
- visceral pleura and lungs = NO pain fibers

DDx:
Viral pleurisy, pneumonia, PE, pericarditis and collagen vascular diseases

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4
Q

pectus carinatum and pectus excavatum

A

carinatum - pigeon chest: the sternum is displaced anteriorly -> INCREASED AP
- costal cartilages adjacent to protruding sternum = depressed

excavatum - funnel chest; sunken chest
- sternum depresses into the chest
= compression of heart/great vessels + MURMURs

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5
Q

cough

A

reflex response to stimuli that irritates the receptors in:
- larynx
- trachea
- large bronchi
- can be cardiovascular in origin: SX OF LEFT SIDED HF

Ask about: sputum
- mucoid: white, translucent
- purulent: green, yellow -> bronchiectasis
- foul smelling: abscess

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6
Q

hemoptysis

A

make sure bleeding is from lungs
- stomach: darker blood that can be mixed with food

rare in infants children

common in:
- CF
- malignancy
- bronchitis
- less common: MS, bronchiectasis

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7
Q

asymmetric chest expansion + Unilateral decrease or delay in chest expansion

A

asymmetric: pleural effusion

Unilateral decrease or delay in chest expansion:
- Chronic fibrosis of the underlying lung of pleura
- Pleural effusion
- Lobar pneumonia
-Pleural pain with associated splinting
-Unilateral bronchial obstruction

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8
Q

retraction of interspaces

A

Severe asthma
COPD
Upper airway obstruction

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9
Q

unilateral impairment or lagging

A

▪ Asbestosis or silicosis
▪ Phrenic nerve damage/trauma

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10
Q

tactile fremitus: when is it decreased

A

3 anterior, 4 posterior

transmission of vibrations from the larynx to the chest wall is impeded or there is an increase in AIR (More air = worse conduction of
- Thick chest wall: obesity
- Obstructed bronchus: asthma
- Pneumothorax: more air
- Pleural effusion*: fluid blocks the transmission of the vibration; asymmetric

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11
Q

increased tactile fremitus

A

Air is replaced with more dense fluid/solids that increase transmission

Consolidation
Pneumonia
Pulmonary edema: fluid within the alveoli and interstitium
Atelectasis: more dense over the collapsed lung

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12
Q

Basics of percussion:

A

Use lightest percussion that produces a clear note!!
Percussion blow: penetrates 5-7 cm into the chest
Helps establish whether the underlying tissues are: air filled vs fluid filled vs consolidated
Hyperextend the pleximeter hand and press distal interphalangeal joint on skin (avoid any other contact with the hand or other fingers: dampens the vibration)
Strike: same force and pressure each time using fingerTIP

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13
Q

intensity/loudness, pitch, duration

A

Flat: LEAST RESONANT - think large fluids or bone; tapping a solid wall; least resonant (sad meow): soft intensity high pitch short duration

Dull: Dull: less resonant - think less air than normal with more fluid/tissue; tapping a thick book (normal = wall); THREE Ms ( dull = meh): Medium loud Medium pitch Medium duration

Resonant: 3 Ls

hyperresonant: even louder, even longer, even lower

tympanic: louder, higher pitch, longer duration (think hitting drum)

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14
Q

dull

A

organs, areas with less air but not solid organs or large fluid accumulations- liver, heart, spleen, lobar pneumonia, pleural effusion (usually cannot percuss anteriorly)

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15
Q

hyperresonant

A

COPD
asthma

pneumothorax
air filled bulla

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16
Q

Flat

A

LEAST resonant - BONE, muscle; large pleural effusion

17
Q

tympanic

A

higher pitch and more musical quality because tympanic sites indicate a larger, enclosed pocket of air:
- LARGE PNEUMOTHORAX,
- bowel obstruction,
- gastric air bubble

18
Q
  • Diaphragmatic excursion: procedrure
A

Step 1: estimate location of diaphragm with quiet respiration (tends to overestimate actual movement of diaphragm)
Step 2: EXHALE completely and hold breath
Step 3: inhale completely and hold breath
Normal diaphragmatic excursion: 3-5.5 cm

Overestimates actual movements of diaphragm
- you are identifying the boundary between the resonant lung tissue and the duller structures below the diaphragm. You are not percussing the diaphragm itself.
- normal: 3-5.5 cm

19
Q

high diaphragmatic excursion

A

▪ Pleural effusion

▪ High diaphragm: Atelectasis; Phrenic nerve paralysis

20
Q

Auscultation key points

A
  • Pt should breath deeply through an open mouth
  • Listen to at least one full breath in each location using the DIAPHRAGM
  • Place diaphragm directly onto SKIN
  • Clothes, chest hair, paper gowns: generate confusing crackling sounds that interfere… chest hair = press down harder or moisten the hair (?)

anterior: 6; posterior - 7

21
Q

Bronchovesicular or bronchial breath sounds heard in abnormal locations

A

Air-filled lung replaced by fluid filled or solid lung tissue

22
Q

breath sounds what does it reflect and when is it decreased

A

reflects the air flow rate at the mouth, and may vary from one area to another
- louder: lower posterior lung fields
- need pt to breath deeply

shallow breathing and thick chest wall decrease breath sounds

Decreased:
- air flow decreased -> OBSTRUCTIVE lung ds; respiratory muscle weakness
- transmission of sound is decreased: pleural effusion, pneumothorax, COPD

23
Q

vesicular breath sounds

A

low pitch
soft intensity
over all lung fields

24
Q

bronchovesicular

A

inspiration = expiration

medium
medim

25
Q

bronchial

A

over manubrium

exhalation > inhalation
- loud
- high pitch

GAP between inspiration and exhalation

26
Q

tracheal

A

over trachea
- loud
- harsh

inspiration = expiration

27
Q

bronchovesicular

A

inspiration = expiration
- medium loudness
- medium pitch

1st, 2nd interspaces
between the scapulae

28
Q

coarse vs fine crackles

A

fine: soft, high pitched, very brief (fine women)
- suggest abnormal lung tissue

coarse: louder, lower pitched, brief (tomboy = coarse)

crackles:
- airways: bronchitis, bronchiectasis
- lung parenchyma: pneumonia, ILD, PF, HF (posterior inferior lung fields), atelectasis

29
Q

Pleural friction rub

A

heard in expiration

pleurisy, pneumonia, and pulmonary embolism.

30
Q

Wheezing

A

NARROWED airways

Exhalation: High pitched whistling sound from the turbulent airway
musical~~

Asthma
COPD
Bronchitis
airway obstructions

31
Q

Rhonchi

A

associated with constricted/partially obstructed LARGE airway with mucus or secretions that are rattling

Low pitched snoring

Changes with coughing: inspissated secretions*

32
Q

area of dullness to left of sternum from 3-5 rib interspaces

A

heart

33
Q

percuss liver

A

percuss down the right midclavicular line

The hyperinflated lung of COPD often displaces the upper border of the liver downward and lowers the level of diaphragmatic dullness posteriorly.

34
Q

latent tb screen

A

only screen populations with increased RISK

Screening Test: tuberculin skin test (TST) and interferon-gamma release assay (IGRA) blood Test
TST: 48-72 hr turnover ; measured in mm of induration
IGRA: 8-30 hr turnover; single venous blood sample

35
Q

Sleep Apnea Screening:

A

Sleep Apnea Screening: NOT RECOMMENDED
- OSA: repeated episodes of upper airway collapse -> hypoxemia + disrupted sleep
estimated prevalence of OSA in adults ages 30 to 70 is about 15% for men and 5% for women, though OSA is often undiagnosed

Risks:
- Male
- Older
- Craniofacial and upper airway abnormalities
- Postmenopause
- Obese

Definitive dx: polysomnography

36
Q

lung cancer screening

A

3 years of ANNUAL LOW DOSE CT

  • screen Adults 50-80 with a 20 year pack hx who currently smoke or quit within 15 years
  • Pack-Years= (Number of Packs per Day) × (Number of Years Smoked)
  • 20 cigarettes = 1 pack
  • Ex: you smoke 0.5 packs for 5 years - 0.5 x 5 = 2.5 pack years

Lung Cancer: Leading COD of cancer in men + women: often not caught till late stage

37
Q

GERIATRICS ADL

A

BDTTCF

bathing
dressing
toileting
transferring
continence
feeding

38
Q

GERIATRICS: ETHNICS

A
  • Explanation
  • Treatment
  • Healers
  • Negotiate
  • Intervention
  • Collaborate
  • Spirituality
39
Q

Frailty

A

suggests frailty:
- Undernutrition
- slowed motor performance
- loss of muscle mass
- weakness

Frailty:
- decreased muscle mass
- decreased energy and exercise intolerance, and decreased physiologic reserve, with increasing vulnerability to physiologic stressors.

Clinical Skills I (11 decks)

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