Thorax + lungs Flashcards by Juju Go

Locating findings on chest wall

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)

How well did you know this?

Not at all

Perfectly

What is the 4th rib a special landmark for?

For the lower margin of endotracheal tube on chest x ray

How well did you know this?

Not at all

Perfectly

Where is chest tube insertion? + triangle of safety?

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

How well did you know this?

Not at all

Perfectly

Where should needles/ tubes be places?

Superior to rib margins
-Bc of neurovascular structures

How well did you know this?

Not at all

Perfectly

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

Thoracentesis

How well did you know this?

Not at all

Perfectly

Lung anatomy:

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

How well did you know this?

Not at all

Perfectly

Trachea and major bronchi anatomy

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

How well did you know this?

Not at all

Perfectly

Where is aspiration pneumonia more common?

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

How well did you know this?

Not at all

Perfectly

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

Right mainstem bronchus

How well did you know this?

Not at all

Perfectly

Pleurae anatomy

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

How well did you know this?

Not at all

Perfectly

Transudates are seen in

HF, Cirrohosis, Nephrotic Syndrome

How well did you know this?

Not at all

Perfectly

Exudates are seen in

Pneumonia, TB, Malignancy, PE, pancreatitis

How well did you know this?

Not at all

Perfectly

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

Degree of dyspnea combined with spirometry

How well did you know this?

Not at all

Perfectly

When does wheezing occur? describe

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What is the most common cause of acute cough?

viral upper respiratory infections

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What are causes of subacute cough?

Post-infectious cough Bacterial sinusitis Asthma

How well did you know this?

Not at all

Perfectly

What are causes of chronic cough?

Post-nasal drip Asthma Gastroesophageal reflux Chronic bronchitis Bronchiectasis

How well did you know this?

Not at all

Perfectly

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

Musculoskeletal Pain

How well did you know this?

Not at all

Perfectly

A hand moving from neck to epigastrium suggests?

Heartburn

How well did you know this?

Not at all

Perfectly

Most frequent cause of chest pain in children?

Anxiety
-Costochonditis is also common

How well did you know this?

Not at all

Perfectly

What color is mucoid sputum? vs purulent

mucoid: Translucent, white or gray

purulent: Yellow or green
- Bronchiectasis
- Lung Abscess

How well did you know this?

Not at all

Perfectly

When is Foul-smelling sputum present?

Anaerobic lung abscess

How well did you know this?

Not at all

Perfectly

When is thick tenacious sputum present?

Cystic fibrosis

Who is Hemoptysis rare in?

infants, children, and adolescents

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

Darker -can be mixed w food particles

Causes of hemoptysis?

CF, Bronchitis, Malignancy

Massive hemoptysis is more than _______ml/24 hours.

>500 ml - may be life threatening

When is clubbing of the nails seen?

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

What is stridor?

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.

Accessory muscle use can signal

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

When would the trachea be lateral displaced?

Pneumothorax, PE, Atelectasis

The AP ratio may exceed ____ in COPD

0.9 = Barrel Chest Appearance

Asymmetric expansion occurs in

large pleural effusion

Retraction occurs in

severe asthma, COPD, or upper airway obstruction

Unilateral impairment or lagging indicates

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

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

Fractured rib

Unilateral decrease or delay in chest expansion occurs in

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

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

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

Asymmetric decreased fremitus vs asymmetric increased fremitus

Decreased: - unilateral pleural effusion - pneumothorax - neoplasm Increased: -unilateral pneumonia

What does percussion help you establish

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

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

Pleximeter finger

When percussing, dull can be heard in

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

When percussing, flat can be heard in

Large PE

When percussing, resonant can be heard in

Chronic bronchitis

When percussing, hyperressonant can be heard in

Pneumothorax, COPD

When percussing, tympanic can be heard in

Large pneumothorax

Generalized hyperresonance is common over the

Hyperinflated lungs of COPD or asthma

Unilateral hyperressonance suggests

Large pneumothorax or air filled bulla

Breath sounds may be decreased when

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).

An abnormally high level of diaphragmatic excursion suggests

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

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

iNPISSATED SECRETIONS

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

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

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

first and second intercostal spaces manubrium

Crackles can arise from

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

Wheezes suggest

Asthma copd bronchitis

What are findings predictive of COPD?

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

The crackles of heart failure are usually best heard in the

posterior inferior lung fields.

Localized bronchophony and egophony are seen in

lobar consolidation from pneumonia.

The hyperinflated lung of COPD often displaces the

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

What are the five "A"s of tobacco cessation counseling?

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