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H & P > Thorax & Lungs > Flashcards

Thorax & Lungs Flashcards

1
Q

Signs of distress

A
  • Retractions & paradoxical breathing

- Audible sounds (wheezes, stridor)

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2
Q

Stridor

A
  • High pitched wheeze
  • Largely inspiratory
  • Louder in the neck
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3
Q

Stridor results from what?

A

Turbulent airflow in upper airway

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4
Q

What does stridor indicate?

A

Laryngeal/upper airway obstruction

- Can be associated w/ epiglottis, foreign body aspiration

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5
Q

Signs of COPD

A
  • Clubbing

- Pursed lip breathing

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6
Q

Clubbing

A
  • Fingertips become rounder
  • Linked to heart/lung conditions
  • “Schamroth’s Sign”
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7
Q

Pursed lip breathing

A
  • Reduces RR (12-15)
  • Increases tidal volume
  • ↓PaCO2
  • ↑PaO2
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8
Q

Checking chest expansion

A
  1. Place thumbs at level of 10th ribs, fingers parallel to lateral rib cage
  2. Ask pt to inhale deeply
  3. Make note of how far your thumbs diverge as the thorax expands, looking for symmetry
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9
Q

What does a unilateral decrease or delay in expansion suggest?

A
  • Fibrosis
  • Pleural effusion
  • Lobar pneumonia
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10
Q

Indirect percussion

A

Finger of one hand strikes finger of other hand, but does not strike the pt directly

  • Only 1 finger should be placed on pt
  • Should be used to check for degree of resonance
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11
Q

Direct percussion

A

Fingers or fist strike pt’s body directly

- Should be used to check for areas of tenderness

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12
Q

Atelectasis

A

Loss of air from lung or collapse of lung tissue w/ reduced lung volume

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13
Q

What is atelectasis a result of?

A

Blockage of air passages w/ mucous or from pleural effusion

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14
Q

Tension pneumothorax

A
  • Large amount of air entering chest

- When 1-way valve is formed by area of damaged tissue

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15
Q

Pneumonia

A
  • Refers to inflammation of the lung
  • Pulmonary infiltrates/ consolidation
  • Usually due to infection (lower respiratory)
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16
Q

Consolidation

A

Lung tissue becomes firm & solid

  • Due to accumulated fluids & tissue debris
  • An infiltrate can cause consolidation
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17
Q

If CC = cough, what questions should you ask?

A
  1. Sputum?
    - Amount, color, consistency?
  2. Blood?
  3. SOB?
    - At rest or w/ exertion?
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18
Q

*Note

A

Costal cartilage & ribs feel identical

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19
Q

1st bony prominence

A

Usually C7/T1

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20
Q

Thorax & lungs: circumferential landmarks

A
  • Midsternal line
  • Midclavicular line(MCL)
  • Anterior axillary line
  • Midaxillary line
  • Posterior axillary line
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21
Q

Lung apex

A

2-4 cm above clavicle

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22
Q

Lower border of the lung

A
  • 6th rib midclavicular line (MCL)
  • 8th rib midaxillary line
  • T10 posterior
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23
Q

Major (oblique) fissure

A
  • Divides lung in 1/2

- From T3 spinous process to 6th rib at MCL

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24
Q

Minor (horizontal) fissure

A
  • R lung only

- Runs close to 4th rib

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25
Q

Lung fields

A
  • Subdivided into 6 regions
  • Region 1-6 denote upper right, middle right, lower right, upper left, middle left, & lower left
  • Auscultate to determine affected lobe (not definitive dx though!)
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26
Q

Signs in R upper lung field originate from where?

A
  • Almost certainly from a process in R upper lobe
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27
Q

Signs in R middle lung field originate from where?

A
  • Could come from any of the lobes
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28
Q

Trachea bifurcation

A
  • Anteriorly: Level of sternal angle

- Posteriorly: T4

29
Q

Pleurae

A
  • Visceral: covers outer surface of lungs
  • Parietal: lines inner rib cage & upper surface of diaphragm
  • Pleural fluid: lubrication
  • Pleural space: Btwn parietal & visceral pleura
30
Q

Primary muscles of respiration

A

Diaphragm & intercostal muscles

31
Q

Accessory muscles of respiration

A
  • Sternocleidomastoid & trapezius
  • “Recruited”
  • May be visible when extra work to breathe is required
32
Q

AP diameter

A

May increase w/ age & w/ COPD

33
Q

Purpose of palpation

A

To check for tender areas & palpable masses

34
Q

Purpose of percussion

A
  • To determine if underlying tissues are air-filled, fluid, or solid
  • Detect areas of tenderness
35
Q

Hyper-resonant percussion tone

A
  • Very loud intensity
  • Low pitch
  • Ex. Emphysematous lungs, pneumothorax
36
Q

Resonant percussion tone

A
  • Loud intensity
  • Low pitch
  • Ex. Healthy lungs
37
Q

Tympanic percussion tone

A
  • Loud intensity
  • High pitch
  • Ex. Gastric bubble
38
Q

Dull percussion tone

A
  • Soft to moderate intensity
  • Moderate to high pitch
  • Liver
    Ex. Consolidation, pleural effusion
39
Q

Flat percussion tone

A
  • Soft intensity
  • High pitch
  • Muscle
    Ex. Consolidation, pleural effusion
40
Q

Purpose of ausculation

A
  • To determine whether there is normal air-flow, airway obstruction, or abnormal air or fluid within the chest/lungs
41
Q

Normal breath sounds

A
  • Trachea: heard over trachea
  • Bronchial: heard over manubrium
  • Bronchovesicular: heard in 1st & 2nd interspace anteriorly & btwn scapula posteriorly
42
Q

What should you suspect if bronchial &/or bronchovesicular sounds are heard at distant location?

A

Fluid-filled lung

43
Q

Adventitious sounds

A
  • Crackles
  • Rhonchi
  • Wheeze
44
Q

Crackles (rales)

A
  • Discontinuous
  • Caused by “popping open”of small airways & alveoli that have collapsed.
  • Fluid in lung (E.g. pneumonia, congestive heart failure).
45
Q

Rhonchi

A
  • Low-pitched, continous
  • Snoring quality
  • Caused by airway secretions & narrowing / partial obstruction (E.g. bronchitis, COPD)
46
Q

Wheeze

A
  • Continuous
  • High-pitched, whistle
  • Caused by airway obstruction (E.g. asthma)
47
Q

Pleural effusion

A

Collection of fluid in the pleural space

48
Q

Emphysema

A
  • Pus in pleural space

- Results from infection that spreads from lungs (e.g. pneumonia, abscess)

49
Q

Acute bronchitis

A
  • Inflammation of bronchi (not involving the lungs)

- Bronchi are considered part of the upper airway

50
Q

Asthma

A
  • Bronchial tubes are hyper-responsive
  • Airways become inflamed & produce excess mucus
  • Muscles around airways tighten –> narrower airways –> obstruct breathing
  • Reversible
51
Q

COPD (e.g. emphysema)

A
  • Assoc. w/ airway resistance & residual volume of air after full expiration
  • Can result in hyperinflated lungs –> barrel chest
  • Considered irreversible
52
Q

Pleural friction rub

A
  • Squeaking, grating sound of pleural linings rubbing together
  • Assoc. w/ pleurisy
  • Heard on inspiration & expiration
53
Q

Crepitus

A
  • Palpable grating, crunching
  • Occurs w/ rib movement due to fracture
    (bone crepitus)
54
Q

Tactile fremitus

A
  • Looking for consolidation
  • Vibrations transmitted through bronchopulmonary tree
  • Use ulnar surface of the hand to appreciate palpable vibrations
  • Ask the pt to say “ninety-nine”
55
Q

Increased tactile fremitus

A
  • Consolidation increases transmission (E.g. pneumonia)

- “Solid” transmits sound better than air

56
Q

Decreased tactile fremitus

A
  • Air & effusions decrease transmission (Eg. Pleural effusion, pneumothorax, COPD, fibrosis)
57
Q

Types of crackles

A 
- Fine crackles: interstitial process, can 
 be normal
- Medium crackles 
- Coarse crackles: airway disease s/a
  damage to bronchi
58
Q

Mediastinal hunch (Hamman sign)

A
  • Loud crackles, clicks, & gurgling
  • Due to pneumo-mediastinum (mediastinal emphysema)
  • Synchronous w/ heart beat
59
Q

What tests check for consolidation?

A
  • Bronchophony
  • Egophony
  • Whispered pectoriloquy
60
Q

Bronchophony

A
  • “99” heard louder & clearer than normal
  • Indicates presence of fluid or solid tissue in alveoli
  • Ex. pneumonia, atelectasis, tumors
61
Q

Egophony

A
  • When voice sounds are louder, have a nasal quality, & “E” sounds like “A”
  • aka. “E to A sounds”
  • Indicates presence of fluid or solid tissue in alveoli
    Ex. pneumonia, atelectasis, tumors
62
Q

Whispered pectoriloquy

A
  • Whisper heard more loudly through consolidated lung tissue
  • Most noticeable when comparing a normal area of lung to an abnormal area
  • Indicates presence of fluid or solid tissue in alveoli
    Ex. pneumonia, atelectasis, tumors
63
Q

Pneumonia characteristics

A
  • Increased tactile fremitus
  • Dull percussion
  • Bronchial breath sounds
  • Present voice sounds
  • Crackles
64
Q

Pleural effusion characteristics

A
  • Decreased tactile fremitus
  • Dull percussion
  • Decreased breath sounds
  • Absent voice sounds
65
Q

Obstructive lung disease characteristics

A
  • Decreased tactile fremitus
  • Hyperresonant percussion
  • Decreased breath sounds
  • Absent voice sounds
  • Wheezes, rhonchi
66
Q

Acute bronchitis characterisitcs

A
  • Normal tactile fremitus
  • Resonant percussion
  • Vesicular breath sounds
  • Absent voice sounds
  • Wheezes, rhonchi
67
Q

Clinical pulmonary fxn tests (PFTs)

A
  • Ask pt to walk down hall or climb 1 flight of stairs 

- Observe rate & effort

68
Q

Forced expiratory time

A
  • Ask pt to “blow out the candles”

- >6 seconds = obstructive pulmonary disease

69
Q

Auscultate during forced exhalation

A

May allow faint wheezes to be heard better

H & P (8 decks)

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