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Clinical Skills I > Thorax + lungs > Flashcards

Thorax + lungs Flashcards

1
Q

Locating findings on chest wall

A

Describe the chest findings in TWO DIMENSIONS:
- vertical axis: using ribs + interspaces
- circumference of the chest: midsternal, midclavicular, midaxillary (imagine a series of vertical lines)

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2
Q

What is the 4th rib a special landmark for?

A

For the lower margin of endotracheal tube on chest x ray

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3
Q

Where is chest tube insertion? + triangle of safety?

A

Intercostal space between 4th and 5th ribs Triangle of safety:
- Anatomical region in midaxillary line
-SAFE POSITION FOR CHEST TUBE INSERTION

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4
Q

Where should needles/ tubes be places?

A

Superior to rib margins
-Bc of neurovascular structures

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5
Q

What is the intercostal space between T7 and T8 serve as a landmark for?

A

Thoracentesis

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6
Q

Lung anatomy:

A

Right lung: 3 lobes (upper, middle, lower)
- oblique fissure
- horizontal fissure Left lung: 2 lobes (upper, lower)
- oblique fissure

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7
Q

Trachea and major bronchi anatomy

A

Trachea: bifurcates into mainstem bronchi at:
- Anteriorly: sternal angle
- Posteriorly: T4 spinous process R main bronchus: wider, shorter, and more vertical
- aspiration pneumonia MC in R middle and lower lobe (more vertical)
- ET advanced too far = lodged in R mainstem bronchus

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8
Q

Where is aspiration pneumonia more common?

A

right middle and lower lobe because the right main bronchus is more vertical

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9
Q

If an ET tube is advanced too far where will it enter?

A

Right mainstem bronchus

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10
Q

Pleurae anatomy

A

Visceral: covers outer surface of each lung

Parietal: covers inner rib cage and upper surface of diaphragm
- inflammation/irritation = PAIN Lubricated by pleural fluid; potential space

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11
Q

Transudates are seen in

A

HF, Cirrohosis, Nephrotic Syndrome

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12
Q

Exudates are seen in

A

Pneumonia, TB, Malignancy, PE, pancreatitis

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13
Q

What is a key component of COPD classification systems that guide patient management?

A

Degree of dyspnea combined with spirometry

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14
Q

When does wheezing occur? describe

A

Partial lower airway obstruction from secretions and tissue inflammation in asthma, or from a foreign body
- MUSICAL respiratory sounds
- +/-audible to the pt and to others

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15
Q

Cough: description, what does it signal, acute vs subacute vs chronic

A

Cough = reflex action to stimuli irritating receptors in the airways
- internal stimuli: mucus, pus, and blood
- external: allergens, dust, cold air signals: Left sided HF acute: under 3 wks subacute: 3-8 wks chronic: 8+ wks

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16
Q

What is the most common cause of acute cough?

A

viral upper respiratory infections

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17
Q

Before using the term “hemoptysis,” try to confirm: _____

A

Before using the term “hemoptysis,” try to confirm the source of the bleeding
- hemoptysis: coughing up blood from the lungs
- coudl be GI bleed, nose, mouth

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18
Q

What are causes of subacute cough?

A

Post-infectious cough Bacterial sinusitis Asthma

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19
Q

What are causes of chronic cough?

A

Post-nasal drip Asthma Gastroesophageal reflux Chronic bronchitis Bronchiectasis

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20
Q

A finger pointing to a tender area on the chest wall suggests

A

Musculoskeletal Pain

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21
Q

A hand moving from neck to epigastrium suggests?

A

Heartburn

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22
Q

Most frequent cause of chest pain in children?

A

Anxiety
-Costochonditis is also common

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23
Q

What color is mucoid sputum? vs purulent

A

mucoid: Translucent, white or gray

purulent: Yellow or green
- Bronchiectasis
- Lung Abscess

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24
Q

When is Foul-smelling sputum present?

A

Anaerobic lung abscess

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25
Q

When is thick tenacious sputum present?

A

Cystic fibrosis

26
Q

Who is Hemoptysis rare in?

A

infants, children, and adolescents

27
Q

Blood originating in the stomach is ____ than blood from respiratory tract

A

Darker
-can be mixed w food particles

28
Q

Causes of hemoptysis?

A

CF, Bronchitis, Malignancy

29
Q

Massive hemoptysis is more than _______ml/24 hours.

A

> 500 ml
- may be life threatening

30
Q

When is clubbing of the nails seen?

A

Bronchiectasis, CHD, PF, CF, Lung Abscess, Malignancy

31
Q

What is stridor?

A

Audible high-pitched inspiratory whistling, or stridor, is an ominous sign of upper airway obstruction in the larynx or trachea that requires urgent airway evaluation.

32
Q

Accessory muscle use can signal

A

Increased ventilatory requirements d/t airways/ parynchemal lung ds or respiratory muscle fatigue

33
Q

When would the trachea be lateral displaced?

A

Pneumothorax, PE, Atelectasis

34
Q

The AP ratio may exceed ____ in COPD

A

0.9 = Barrel Chest Appearance

35
Q

Asymmetric expansion occurs in

A

large pleural effusion

36
Q

Retraction occurs in

A

severe asthma, COPD, or upper airway obstruction

37
Q

Unilateral impairment or lagging indicates

A

pleural disease from asbestosis or silicosis; it is also seen in phrenic nerve damage or trauma

38
Q

Tenderness, bruising, and bony “step-offs” are common over a

A

Fractured rib

39
Q

Unilateral decrease or delay in chest expansion occurs in

A

Chronic fibrosis of underlying pleura, PE, or unilateral bronchial obstruction

40
Q

Tactile Fremitus: definition; when is it more prominent vs decreased/absent

A

Assess the intensity of vibrations transmitted through the chest wall when a patient speaks (99)
- 4 areas posteriorly, 3 areas anterior

More prominent:
- interscapular area: closer to trachea
- right lung: R main bronchus is shorter = better vibration
- solid/fluid filled lungs: pneumonia, PE

Decreased/absent:
- Higher Pitched/Soft Voice
- thick chest wall: dampens transmission
- obstructed bronchus
- COPD , PE , fibrosis, tumor

41
Q

Asymmetric decreased fremitus vs asymmetric increased fremitus

A

Decreased:
- unilateral pleural effusion
- pneumothorax
- neoplasm

Increased:
-unilateral pneumonia

42
Q

What does percussion help you establish

A

whether the underlying tissues are air-filled, fluid-filled, or consolidated

43
Q

What is the middle finger of your left hand hyperextended known as

A

Pleximeter finger

44
Q

When percussing, dull can be heard in

A

Lobar pneumonia + Pleural effusion
- Dull = fluid or solid tissue
- dullness makes pneumonia and pleural effusion three to four times more likely, respectively.

45
Q

When percussing, flat can be heard in

A

Large PE

46
Q

When percussing, resonant can be heard in

A

Chronic bronchitis

47
Q

When percussing, hyperressonant can be heard in

A

Pneumothorax, COPD

48
Q

When percussing, tympanic can be heard in

A

Large pneumothorax

49
Q

Generalized hyperresonance is common over the

A

Hyperinflated lungs of COPD or asthma

50
Q

Unilateral hyperressonance suggests

A

Large pneumothorax or air filled bulla

51
Q

Breath sounds may be decreased when

A

air flow is decreased (as in obstructive lung disease or respiratory muscle weakness) or when the transmission of sound is poor (as in pleural effusion, pneumothorax, or COPD).

52
Q

An abnormally high level of diaphragmatic excursion suggests

A

PE or a high diaphrgarm as in atelectasis or phrenic nerve paralysis

53
Q

Clearing of crackles, wheezes, or rhonchi after coughing or position change suggests

A

iNPISSATED SECRETIONS

54
Q

If bronchovesicular or bronchial breath sounds are heard in locations distant from those listed, suspect

A

that air filled lung has been REPLACED by fluid filled or solid lung tissue

55
Q

Bronchovesicular breath sounds are best heard between the _____________of the anterior chest. Bronchial sounds are best heard over the body of the _______

A

first and second intercostal spaces manubrium

56
Q

Crackles can arise from

A

abnormalities of the lung parenchyma
-pneumonia interstitial lung disease, pulmonary fibrosis, atelectasis , heart failure or of the airways bronchitis, bronchiectasis

57
Q

Wheezes suggest

A

Asthma copd bronchitis

58
Q

What are findings predictive of COPD?

A

Signs and symptoms Wheezing HX of smoking Age Decreased breath sounds DX W SPIROMETRY AND PFTs

59
Q

The crackles of heart failure are usually best heard in the

A

posterior inferior lung fields.

60
Q

Localized bronchophony and egophony are seen in

A

lobar consolidation from pneumonia.

61
Q

The hyperinflated lung of COPD often displaces the

A

upper border of the liver downward and lowers the level of diaphragmatic dullness posteriorly.

62
Q

What are the five “A”s of tobacco cessation counseling?

A

Ask about smoking at each visit
Advise patients regularly to stop smoking using a clear, personalized message.
Assess patient readiness to quit.
Assist patients to set stop dates and provide educational materials for self-help.
Arrange for follow-up visits to monitor and support patient progress.

ASK
ADVISE
ASSESS
ASSIST
ARRANGE

Clinical Skills I (11 decks)

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