Chapter 8 The Lungs

Question 1

Chest pain- myocardium

Answer 1

Angina pectoris, myocardial infarction

Question 2

Chest pain- pericardium

Answer 2

Pericarditis

Question 3

Chest pain- aorta

Answer 3

Dissecting aorta aneurysm

Question 4

Chest pain- the trachea and large bronchi

Answer 4

Bronchitis

Question 5

Chest pain- the parietal pleura

Answer 5

pericarditis, pneumonia

Question 6

Chest pain- the chest wall, including the musculoskeletal system and skin

Answer 6

Costochonditis, herpes zoster

Question 7

Chest pain- the esophagus

Answer 7

Reflux esophagitis, esophageal spasm

Question 8

Chest pain- extrathoracic structures such as the neck, gallbladder, and stomach

Answer 8

Cervical arthritis, biliary colic, gastritis

Question 9

Angina pectoris

Answer 9

a clenched fist over the sternum

Question 10

Musculoskeletal pain

Answer 10

finger pointing to tender area on the chest wall

Question 11

Cyanosis

Answer 11

Hypoxia

Question 12

Audible stridor

Answer 12

high-pitched wheeze, a sign of airway obstruction in the larynx or trachea

Question 13

AP diameter

Answer 13

May increase in COPD

Question 14

Decreased or absent fremitus

Answer 14

COPD, bronchial obstruction, pleural effusion, fibrosis (pleural thickening), pneumothorax, tumor

Question 15

Dullness to percussion

Answer 15

indicate lobar pneumonia, pleural effusion, hemothorax (blood), or empyema (pus), fibrous tissue, or tumor

Question 16

Hyperresonance

Answer 16

COPD, large pneumothorax

Question 17

Diaphragmatic excursion

Answer 17

diaphragmatic paralysis, pleural effusion, atelectasis, or normal variant

Question 18

Vesicular auscultation

Answer 18

soft/low pitched; inspiratory>expiratory sounds

Question 19

Bronchovesicular auscultation

Answer 19

moderate; inspiratory/expiratory sounds equal in length

Question 20

Bronchial auscultation

Answer 20

louder or higher in pitch, with short silence (gap) between inspiratory and expiratory sounds; expiratory>inspiratory sounds

Question 21

Late inspiratory crackles

Answer 21

fibrosis or CHF

Question 22

Early inspiratory crackles

Answer 22

seen in asthma, chronic bronchitis (appear after the start of insiration)

Question 23

Expiratory crackles

Answer 23

Could reflect bronchiectasis

Question 24

Wheezes (high-pitched)

Answer 24

suggest narrow airways (partial obstruction), as in asthma, COPD, and bronchitis

Question 25

Rhonchi (low-pitched)

Answer 25

suggest secretions in large airways

Question 26

COPD- s/s & diagnosis

Answer 26

Findings include wheezing, hx of smoking, age, and decreased breath sounds. Diagnosis requires pulmonary function test such as spirometry. Persons with severe COPD may prefer to sit leaning forward with lips pursed during exhalation and arms supported on their knees

Question 27

Bronchophany

Answer 27

when a normal lung becomes airless, transmitted voice sounds will change

Question 28

Egophany

Answer 28

changes sound of a whispered "ee" to an "ay" as in lobar consolidation from pneumonia

Question 29

Whispered pectoriloquy

Answer 29

when whispered numbers are clearer and louder than expected

Question 30

Dullness

Answer 30

replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space.

Question 31

Pleural effusion

Answer 31

Because pleural fluid usually sinks to the lowest part of the pleural space (posteriorly in a supine pt), only a very large effusion can be detected anteriorly.

Question 32

COPD

Answer 32

affected lung often displaces the upper border of the liver downward. It also lowers the level of diaphragmatic dullness posteriorly.

Question 33

Chronic Bronchitis- Physical findings

Answer 33

``` Percussion note: Resonant Trachea: Midline Breath Sounds: Vesicular (normal) Adventitious Sounds: Wheezes or Rhonchi; scattered coarse crackles in early inspiration and expiration Tactile Fremitus/Voice Sounds: Normal ```

Question 38

CHF (left sided)- physical findings

Answer 38

``` Percussion note: Resonant Trachea: Midline Breath Sounds: Vesicular (normal) Adventitious Sounds: Late inspiratory crackles; possibly wheezes Tactile Fremitus/Voice Sounds: Normal ```

Question 43

Diffuse lymphadeopathy

Answer 43

HIV, AIDS

Question 44

Consolidation- physical findings

Answer 44

Percussion note: Dull over the airless area Trachea: Midline Breath Sounds: Bronchial over the involved area Adventitious Sounds: Late inspiratory crackles over the involved area Tactile Fremitus/Voice Sounds: Increased over the involved area with bronchophony, egophony, and whispered pectroliloquy

Question 48

Atelectasis- physical findings

Answer 48

Percussion note: Dull over the airless area Trachea: May be shifted toward involved sided Breath Sounds: Usually absent when bronchial plug persists. Exceptions include RUL atelectasis, where adjacent tracheal sounds may be transmitted Adventitious Sounds: None Tactile Fremitus/Voice Sounds: Usually absent when the bronchial plug persists.

Question 53

Pleural Effusion- physical findings

Answer 53

Percussion note: Dull to flat over the fluid Trachea: Shifted toward opposite side in a large effusion Breath Sounds: Decreased to absent but bronchial breath sounds may be heard near top of large effusion Adventitious Sounds: None except a possible pleural rub Tactile Fremitus/Voice Sounds: Decreased to absent, but may be increased toward the top of a large effusion

Question 58

Pneumothorax- Physical findings

Answer 58

Percussion note: Hyperresonant or tympanic over the pleural air Trachea: Shifted toward opposite side if much air Breath Sounds: Decreased to absent over the pleural air Adventitious Sounds: None, except a possible pleural rub Tactile Fremitus/Voice Sounds: Decreased to absent over the pleural air

Question 63

COPD- Physical findings

Answer 63

``` Percussion note: Diffusely hyperresonant Trachea: Midline Breath Sounds: Decreased or absent Adventitious Sounds: None, or the crackles, wheezes, and rhonchi of associated chronic bronchitis Tactile Fremitus/Voice Sounds: Decreased ```

Question 68

Asthma- Physical findings

Answer 68

Percussion note: Resonant to diffusely hyperresonant Trachea: Midline Breath Sounds: Often obscured by wheezes Adventitious Sounds: Wheezes, possibly crackles Tactile Fremitus/Voice Sounds: Decreased

Question 73

CVA tenderness

Answer 73

Infection; kidney stones

Question 74

Lymphadenopathy

Answer 74

Found in breast cancer

Question 75

Causes of unilateral decrease or delay in chest expansion

Answer 75

chronic fibrosis, pleural effusion, lobar pneumonia, or bronchial obstruction