Pulmonary PE Lecture Flashcards

1
Q

Chest cavity

A

All that falls between clavicles and diaphragm

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2
Q

Anterior chest

A

Formed by the ribs

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3
Q

Intercostal spaces are named by:

A

The rib superior to it

2nd ICS space is between 2nd and 3rd rib

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4
Q

Diaphragm at rest is located between which ribs?

A

5th and 6th

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5
Q

Sternal angle is at the level of the:

A

2nd rib

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6
Q

Posterior chest borders

A

C7 SP is superior border

T8 (9th rib or 2nd rib below scapula) is inferior portion

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7
Q

Where is the RLL represented anteriorly?

A

Costophrenic angle

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8
Q

Inspection for systemic signs of pulmonary disease:

A

Cyanosis of lips/fingers
Clubbing of fingers
Barrel chest
Tripod position

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9
Q

Signs of respiratory distress:

A

Rate and effort of breathing
Use of accessory muscles
Unusual respiratory noises

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10
Q

Displacement of the trachea could mean:

A

PTX

Atelectasis

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11
Q

Pectus carinatum

A

Pigeon chest (convex)

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12
Q

Pectus excavatum

A

Funnel chest (concave)

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13
Q

Causes of asymmetric expansion:

A

Pneumonia
Bronchial obstruction
Pleural effusion
Pleural pain

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14
Q

Tactile fremitus

A

Palpable vibrations transmitted from bronchial and lung tissue to chest wall
*Avoid bony areas

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15
Q

Most sensitive part of hand to detect tactile fremitus:

A

Ulnar surface

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16
Q

Decreased tactile fremitus occurs with:

A
Bronchial obstruction
Pleural effusion
COPD
PTX
Tumor
COPD
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17
Q

Increased tactile fremitus occurs because:

A
  • An increase in solid tissue will conduct the vibrations better
  • Consolidation (caused by PNA) will increase TF
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18
Q

Pleximeter

A

Finger placed onto the ICS for percussion

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19
Q

Plexor

A

Finger making the motion of percussion onto the pleximeter

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20
Q

Percussion is performed at which joint?

A

Distal Interphalangeal Joint (DIPJ)

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21
Q

T/F: Percuss anteriorly AND posteriorly

A

FALSE, only percuss anteriorly if abnormal findings

22
Q

Percussion notes:

A
Flat
Dull
Resonant
Hyperresonant
Tympanic
23
Q

Flat percussion

A

High pitched, short

Thigh

24
Q

Dull percussion

A

Medium pitch & duration

Liver

25
Q

Resonant percussion

A

Low pitch, long duration

Normal lungs

26
Q

Hyperresonant percussion

A

Lower pitch, longer duration

COPD

27
Q

Tympanic percussion

A
Lowest pitch (almost musical), longest duration
(PTX, empty stomach)
28
Q

Pleural effusion percussion

A

Dull or flat depending on size

29
Q

Consolidation percussion

A

Dull over area of decreased aeration (PNA, pulmonary edema)

30
Q

Atelectasis percussion

A

Dull - lobar collapse often due to mucus plug (airflow obstructed)

31
Q

Normal tissue percussion

A

Resonant

32
Q

Pneumothorax percussion

A

Hyperresonant or tympanic if large (air escapes lungs, fills chest cavity, closer to surface)

33
Q

COPD percussion

A

Hyperresonant - air trapped in alveoli become hyperinflated

34
Q

Asthma percussion

A

Resonant to hyperresonant depending on severity

35
Q

The diaphragm of the stethoscope picks up ____ pitched sounds, while the bell picks up ____ pitched sounds

A

High

Low

36
Q

Use ____ pressure when using diaphragm of stethoscope and ____ pressure when using bell

A

Higher

Lighter

37
Q

T/F: Auscultation can be done both lying down and sitting up

A

FALSE, every effort should be made to auscultate with patient sitting up

38
Q

How does chest hair interfere with auscultation and how can you improve this?

A
  • Chest hair can sound like crackles

- Press harder or try moistening the hair

39
Q

What should you do if you hear an abnormal breath sound?

A

Ask pt to cough to clear any secretions. If the sound is still there, it’s not from secretions

40
Q

Normal breath sounds:

A

Vesicular
Bronchovesicular
Bronchial

41
Q

Vesicular breath sounds

A
  • Soft, low pitched
  • All of inspiration, fade out after about 1/3 of expiration
  • Heard thru all lung fields
42
Q

Bronchovesicular breath sounds

A
  • Louder than vesicular

- Heard equally in inspiration and expiration

43
Q

Where are bronchovesicular sounds heard best?

A

Anteriorly: 1st/2nd ICS
Posteriorly: between scapulae

44
Q

Bronchial breath sounds

A

Very loud, high pitched

Expiratory lasts longer

45
Q

Where are bronchial sounds heard best?

A

Over the manubrium

46
Q

Adventitious sounds:

A

Rhonchi
Wheezes
Crackles (rales)

47
Q

Rhonchi

A
  • Low pitched
  • Sounds like snoring or geese honking
  • Represents secretions in large airways
48
Q

Wheezes

A
  • High pitched (shrill)
  • Can be inspiratory or expiratory
  • Represents a narrow airway
  • A/w asthma, COPD, bronchitis
49
Q

Stridor

A
  • Loud inspiratory wheeze
  • Heard best over trachea
  • Indicates partial tracheal obstruction
50
Q

Crackles

A
  • Fine: high pitched, brief, arise from alveoli

- Coarse: low pitched, louder, longer, arise from alveoli

51
Q

Pleural friction rub

A
  • Rarely heard
  • Brief and confined to small area
  • Disappears w/pleural effusion (fluid is interspersed between inflamed surfaces)
52
Q

When should vocal fremitus be performed?

A

If abnormal breath sounds are heard