Week 4 Pulm Flashcards
What is the thoracic cavity made up of?
12 pairs of ribs that connect to the vertebral bodies of the spinal column
How are the first 7 pairs of ribs connected in the anterior thorax?
Attached to the sternum by cartilage
What are the 11th and 12th ribs known as?
Floating ribs
Where is the Sternal Angle located?
At the junction of the manubrium and sternum
What does the Sternal Angle correspond to?
The level of the 2nd rib and bifurcation of the trachea
What is the Midsternal Line?
A vertical line running down the center of the sternum
Where is the Midclavicular Line (MCL) located?
Runs vertically through the midpoint of the clavicle
What does the Anterior Axillary Line (AAL) represent?
Runs vertically along the anterior axillary fold
What anatomical line runs vertically through the middle of the axilla?
Midaxillary Line (MAL)
What is the Vertebral Line?
Runs down the middle of the spine
What anatomical landmark runs vertically through the inferior angle of the scapula?
Scapular Line
What is the anatomical location of the Right Upper Lobe (RUL) in the right lung?
Extends from the apex to about the 4th rib (anteriorly)
Where is the Right Middle Lobe (RML) located?
Between the 4th and 6th ribs, medial to the midclavicular line
What is the location of the Left Upper Lobe (LUL)?
Extends from the apex to the 6th rib
What are the posterior lung fields dominated by?
Both Lower Lobes (RLL & LLL)
At what level does the trachea bifurcate?
At the Sternal Angle (T4-T5 level)
Which bronchus is shorter, wider, and more vertical?
Right Mainstem Bronchus
What is the location of the diaphragm at rest?
Around the 5th rib anteriorly and T10 posteriorly
What does the Visceral Pleura cover?
The lungs
What is anatomical dead space?
Trachea and Bronchi where no gas exchange occurs
Where are the upper lobes best heard during auscultation?
Anteriorly
What is the most common cause of acute cough?
Upper Respiratory Tract Infections (URTIs)
What are common viruses causing the Common Cold?
- Rhinovirus * Coronavirus * Adenovirus
What are the symptoms of Acute Sinusitis?
- Facial pain * Purulent nasal discharge * Headache
What symptoms are associated with Influenza?
- Sudden fever * Myalgia * Fatigue * Cough
What is a key symptom of Pertussis?
Severe paroxysmal coughing fits
What is the cough mechanism for Postnasal Drip Syndrome?
Mucus irritation and stimulation of cough receptors
What symptoms indicate an asthma exacerbation?
- Cough * Wheezing * Dyspnea * Chest tightness
What can cause cough due to environmental exposure?
- Smoke inhalation * Air pollution * Strong odors
What is the cough mechanism for Gastroesophageal Reflux Disease (GERD)?
Acid irritation of the esophagus and microaspiration
What is a common cause of hemoptysis?
Acute Bronchitis
What can indicate severe or life-threatening hemoptysis?
Massive Hemoptysis (>600 mL/24 hr)
What is the distinguishing factor between true hemoptysis and hematemesis?
True hemoptysis is expectoration of blood from the lower respiratory tract
What does the Left Lower Lobe (LLL) cover laterally?
Covers the 6th to 8th rib
What are the symptoms of Chronic Obstructive Pulmonary Disease (COPD)?
- Persistent productive cough * Dyspnea
What is a key symptom of lung cancer?
- Chronic cough * Hemoptysis * Weight loss
What are common symptoms of lung cancer?
Chronic cough, weight loss, hemoptysis, history of smoking
Lung cancer is often associated with a history of smoking and presents with these key symptoms.
What is classified as massive hemoptysis?
Massive Hemoptysis (>600 mL/24 hr) requires immediate intervention
This volume indicates a life-threatening situation that necessitates urgent medical care.
What are the key sputum characteristics and symptoms for pneumonia?
Rust-colored or blood-tinged sputum; fever, productive cough, pleuritic chest pain
These symptoms help differentiate pneumonia from other causes of hemoptysis.
When should serious causes of hemoptysis be suspected?
Persistent hemoptysis >1 week, large-volume hemoptysis (>100 mL per episode), hemoptysis with weight loss, night sweats, associated chest pain, dyspnea, history of smoking or occupational exposure
These factors significantly increase the risk of serious underlying conditions.
What is the first-line diagnostic tool for pneumonia?
Chest X-ray
Chest X-ray is critical for initial assessment of pneumonia and other respiratory conditions.
What are the normal respiratory rates for adults?
12-20 breaths per minute
This range is considered normal for adult respiratory rates.
What does increased tactile fremitus indicate?
Pneumonia, lung consolidation
Increased fremitus suggests denser lung tissue as seen in pneumonia.
What are the characteristics of central cyanosis?
Bluish discoloration of lips, tongue, mucous membranes; caused by low arterial oxygenation (PaO₂ < 85%)
Central cyanosis indicates systemic hypoxia and can be caused by severe pulmonary diseases.
What causes clubbing of nails?
Chronic hypoxia, lung disease, heart disease, GI disorders
Clubbing is often associated with conditions that cause prolonged low oxygen levels.
What are the symptoms of a panic attack?
Chest tightness, palpitations, hyperventilation, fear of dying
These symptoms are indicative of a psychological cause of chest pain.
What is the mechanism behind myocardial infarction (MI)?
Ischemia due to coronary artery occlusion
MI occurs when blood flow to part of the heart is blocked, leading to tissue damage.
What are the normal breath sounds over the trachea?
Bronchial breath sounds; high-pitched, loud, with expiration longer than inspiration
Abnormal bronchial sounds heard in lung fields suggest consolidation.
What are the signs of respiratory distress that indicate accessory muscle use?
Recruitment of muscles beyond the diaphragm, such as sternocleidomastoid and scalene muscles
Accessory muscle use suggests increased work of breathing in conditions like COPD or asthma.
What is the significance of pink frothy sputum?
Indicates pulmonary edema due to severe congestive heart failure
The presence of pink frothy sputum is a classic sign of pulmonary edema.
What are the symptoms of croup in children?
Barking cough, inspiratory stridor
Croup is typically caused by viral infections and presents with distinctive respiratory symptoms.
What is the mechanism of pleuritis?
Inflammation of the pleura, often due to viral infection
Pleuritis can cause sharp, localized pain that worsens with breathing.
What does the presence of dullness on percussion indicate?
Pneumonia, pleural effusion, tumor
Dullness suggests fluid or solid tissue in the lung fields.
What does a high-pitched inspiratory sound indicate?
Stridor, suggesting upper airway obstruction
Stridor is a critical sign that requires immediate evaluation and intervention.
What are the common causes of retractions during breathing?
Airway resistance, severe lung disease
Retractions reflect increased effort to breathe due to compromised airflow.
What is the significance of a sudden onset tearing pain radiating to the back?
Aortic dissection
This symptom is a classic presentation that requires urgent medical evaluation.
What is tubular sound and when is it considered abnormal?
Normal over trachea but abnormal if heard in lung fields (suggests consolidation, as in pneumonia).
Where are bronchovesicular breath sounds located?
Mainstem bronchi (1st and 2nd intercostal spaces anteriorly, between scapulae posteriorly).
What is the pitch and intensity of bronchovesicular breath sounds?
Moderate pitch and moderate intensity.
What is the quality of bronchovesicular breath sounds?
Softer and breezier than bronchial sounds.
How does the duration of inspiration compare to expiration in bronchovesicular breath sounds?
Equal duration.
What are vesicular breath sounds and where are they located?
Normal breath sounds over most of the lung fields.
What is the pitch and intensity of vesicular breath sounds?
Low pitch and soft intensity.
How do the inspiratory and expiratory phases compare in vesicular breath sounds?
Inspiratory phase is longer than expiratory.
What is the quality of vesicular breath sounds?
Rustling, breezy.
What is a characteristic of crackles (rales)?
Types: Fine crackles (soft, high-pitched) and coarse crackles (louder, lower-pitched).
Where are crackles typically heard?
Often heard in the lower lung fields.
What causes crackles?
Fluid accumulation in alveoli (e.g., pneumonia, pulmonary edema, fibrosis).
What clinical condition is associated with fine crackles?
Interstitial lung diseases (e.g., pulmonary fibrosis).
What clinical conditions are associated with coarse crackles?
Pneumonia, heart failure, bronchiectasis.
What describes wheezes?
High-pitched, musical, continuous sounds.
What is the cause of wheezes?
Airflow narrowing or obstruction (e.g., asthma, COPD).
What are rhonchi characterized by?
Low-pitched, snoring, gurgling sound.
What causes rhonchi?
Airflow through mucus or secretions in large airways.
What is stridor and its clinical significance?
High-pitched, harsh, crowing sound indicating upper airway obstruction (e.g., croup, foreign body).
What is a pleural friction rub?
Low-pitched, grating, leathery sound caused by inflamed pleural surfaces rubbing together.
What conditions are associated with diminished or absent breath sounds?
Pneumothorax, pleural effusion, severe emphysema, atelectasis.
What does increased clarity of spoken words through the chest wall indicate?
Positive bronchophony suggests alveolar consolidation, lobar pneumonia, or mass effect.
What is egophony and what does it indicate?
When ‘ee’ is heard as ‘ay’ over an abnormal lung area, indicating lobar pneumonia or lung consolidation.
What is whispered pectoriloquy?
Increased clarity of whispered sounds over abnormal lung areas indicating lung consolidation.
What are common pulmonary causes of dyspnea?
- Asthma
- COPD
- Pneumonia
- Pulmonary embolism
- Pneumothorax
What are key inspection findings in chest disorders?
- Respiratory Rate & Effort
- Chest Shape & Deformities
- Skin & Nail Findings
What does increased tactile fremitus indicate?
Consolidation (e.g., pneumonia).
What does dullness on percussion suggest?
Consolidation (pneumonia) or pleural effusion.
What are common causes of anxiety-related dyspnea?
Anxiety and panic attacks.
What is the clinical significance of stridor?
It indicates a life-threatening upper airway obstruction.
What are the key features of crackles?
Discontinuous, popping sounds associated with conditions like CHF and pneumonia.
What is indicated by dullness on percussion?
Consolidation (pneumonia), effusion, or mass
Dullness suggests fluid or solid matter in the lung fields.
What does hyperresonance suggest?
Pneumothorax or emphysema
Hyperresonance indicates excessive air in the thoracic cavity.
What does increased fremitus indicate?
Consolidation (pneumonia)
Increased fremitus occurs when lung tissue becomes denser.
What does decreased fremitus suggest?
Pleural effusion or pneumothorax
Decreased fremitus is due to fluid or air in the pleural space.
What does wheezing suggest?
Asthma, COPD, or airway obstruction
Wheezing is caused by narrowed airways.
What does crackles (rales) indicate?
Pneumonia, pulmonary edema, or fibrosis
Crackles are produced by fluid in the alveoli.
Where can you hear bronchial sounds?
Trachea and large airways
Bronchial sounds are high-pitched and loud.
Where are bronchovesicular sounds normally heard?
Over the mainstem bronchi
Bronchovesicular sounds have equal inspiratory and expiratory phases.
What is the normal location for vesicular breath sounds?
Over most of the lung fields
Vesicular sounds are soft and low-pitched.
What does absent tracheal breath sounds indicate?
Airway obstruction
Absent sounds suggest a blockage in the trachea.
What is the significance of tympanic sound on percussion?
Large pneumothorax or air trapping
Tympanic sounds indicate a significant accumulation of air.
What is the technique for percussing the chest?
Use the non-dominant hand to strike the dominant hand on the chest
This technique helps assess lung sounds systematically.
What is the expected percussion sound over normal lung tissue?
Resonant
Resonance indicates healthy lung tissue.
What are the main components of assessing dyspnea?
- Onset
- Location
- Duration
- Character
- Aggravating Factors
- Relieving Factors
- Timing
- Severity
These components help determine the cause of shortness of breath.
What does sudden onset of dyspnea with pleuritic pain indicate?
Pulmonary embolism (PE)
Sudden onset may suggest acute respiratory conditions.
What are the USPSTF recommendations for lung cancer screening?
Annual LDCT for adults aged 50-80 with a 20 pack-year smoking history
Screening should stop after 15 years of cessation or significant health limitations.
What is the significance of paroxysmal nocturnal dyspnea?
Hallmark of heart failure
PND occurs when fluid accumulates while lying down.
What is a key finding in pneumonia during auscultation?
Bronchial breath sounds and crackles
These sounds indicate consolidation in the lungs.
What is the clinical significance of dull percussion notes?
Suggests pneumonia, pleural effusion, or lung mass
Dull notes indicate fluid or solid density in lung fields.
What are the locations for auscultating the right lung lobes?
- RUL: Above the 4th rib midclavicular line
- RML: Between the 4th and 6th ribs midclavicular line
- RLL: Below the 6th rib
These locations are crucial for accurate lung assessment.
What is the role of diaphragmatic excursion in assessment?
To assess diaphragm movement and lung function
Normal range for excursion is 3-5 cm.
What is the impact of early detection via LDCT on lung cancer mortality?
Significantly reduces lung cancer mortality
LDCT stands for low-dose computed tomography.
Is chest X-ray recommended for lung cancer screening?
No, it is not recommended
Chest X-ray has not been shown to be effective in lung cancer screening.
What is the most effective strategy to reduce lung cancer risk?
Smoking cessation
Quitting smoking greatly lowers the risk of developing lung cancer.
Is routine screening recommended for children and adolescents?
No, it is not recommended
The focus should be on prevention and education.
What is emphasized in education regarding vaping and e-cigarettes?
Risks of vaping and e-cigarettes may increase future lung cancer risk
Awareness of these risks is crucial for young populations.
List some additional risk factors that may justify lung cancer screening.
- Occupational exposures: Asbestos, radon, diesel fumes
- Family history of lung cancer
- History of chronic lung disease (COPD, pulmonary fibrosis)
- Secondhand smoke exposure
- History of radiation therapy to the chest
These factors can increase the likelihood of lung cancer development.
What are the limitations and risks of lung cancer screening?
- False positives can lead to unnecessary procedures
- Radiation exposure from LDCT
- Overdiagnosis may result in treating slow-growing tumors that wouldn’t impact lifespan
These risks must be considered when deciding on screening.
What is the screening frequency recommended by the USPSTF for eligible individuals?
Annual LDCT
This applies to individuals aged 50-80 with a significant smoking history.
What is the age range for lung cancer screening according to the ACS?
50+
Individuals must have a smoking history to qualify for screening.
What should be considered for discontinuation of screening according to USPSTF?
Stopped smoking 15+ years, poor health
Health status is a key factor in determining the need for continued screening.
What is the NCCN’s stance on screening frequency for lung cancer?
Annual LDCT
They include consideration of other risk factors in their recommendations.
Fill in the blank: Smoking cessation is the most effective strategy to reduce _______.
lung cancer risk
This emphasizes the importance of quitting smoking.
True or False: Routine screening for lung cancer is recommended for all age groups.
False
Routine screening is not recommended for children and adolescents.
