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Clinical Medicine > Exam #3: Chest, Thorax, & Lungs > Flashcards

Exam #3: Chest, Thorax, & Lungs Flashcards

1
Q

How do you describe chest findings?

A
  • Along the vertical axis

- Around the circumference of the chest

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2
Q

Midclavicular Line

A
  • Drops vertically from the midpoint of the clavicle
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3
Q

Anterior & Posterior Axillary Lines

A
  • Anterior drops from the anterior axillary fold

- Posterior drops from the posterior axillary fold

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4
Q

Midaxillary Line

A

Drops from the apex of the axilla

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5
Q

Vertebral Line

A

Overlies the spinous processes of the vertebrae

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6
Q

Scapular Line

A

Drops from the inferior angle of the scapula

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7
Q

Apex of the Lung

A

2-4cm above the inner 1/3 of the clavicle

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8
Q

Inferior Border of Lung

A 
Anterior= 6th rib, midclavicular line 
Lateral= 8th rib, mixaxillary line 
Posterior= T10

Drops further on inspiration (roughly 4cm)

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9
Q

Oblique Fissure (Lung)

A
  • Divides the lungs into anterior and posterior halves
  • T3 spinous process–>6th rib at the midclavicular line
  • Both lungs
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10
Q

Horizontal Fissure (Lung)

A
  • Divides the right lung into superior & inferior halves or thirds
  • 4th rib at the sternum–>5th rib at the midaxillary line
  • RIGHT lung only
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11
Q

Right Lung # Lobes

A

Three: upper, middle, & lower

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12
Q

Left Lung # Lobes

A

Two: upper & lower

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13
Q

Where does the trachea divide into mainstem bronchi?

A 
Anterior= Sternal Angle 
Posterior= T4
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14
Q

Visceral Pleura

A

Covers the outer surface of the lung

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15
Q

Parietal Plerua

A

Lines the inner rib cage & upper surface of the diaphragm

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16
Q

Into which mainstem bronchi is foreign body aspiration more common & why?

A

Right b/c it is straighter, wider, & shorter than the left

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17
Q

Principal Muscles of Inspiration

A
  • Diaphragm

- Intercostals (External & Interchondral part of Internal)

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18
Q

Accessory Muscles of Inspiration

A
  • SCM

- Scalenes

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19
Q

Muscles of Active Expiration

A
  • Internal Intercostals (except interchondral part)

- Abdominal Muscles

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20
Q

Common or Concerning Symptoms

A
  • Chest pain
  • Dyspnea
  • Wheezing
  • Cough
  • Hemoptysis
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21
Q

What is key in obtaining a history or assessment of a patient complaining of chest pain or dyspnea?

A

General impression or the apparent stability of the patient

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22
Q

Cardiac Causes of Chest Pain

A

1) Myocardium: angina pectoris, MI, myocarditis
2) Pericardium: pericarditis
3) Aorta: Dissecting aortic aneurysm

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23
Q

Pulmonary Causes of Chest Pain

A

1) Trachea & Large Bronchi: Bronchitis

2) Parietal Pleura: Percarditis, pneumonia, pneumothorax, pleural effusion, PE

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24
Q

“Other Causes of Chest Pain”

A

1) Chest Wall: Costochondritis, Herpes Zoster
2) Esophagus: Reflux esophagitis, esophageal spasm, esophageal tear
3) Extrathoracic: Cervical Arthritis, Biliary Colic, Gastritis

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25
Q

Important Characteristics of Breathing

A
  • Rate (14-20 is normal)
  • Rhythm
  • Depth
  • Effort
26
Q

Dyspnea Differential

A
  • Lung= COPD, Pneumonia, Asthma, Acute Bronchitis, PE, Pneumothorax
  • Other= Chest Wall, Compression Fracture, Phrenic Nerve, Central or Peripheral Neurologic, Psychologic (Anxiety), Systemic, MI, Epigastric
27
Q

What is the chief goal when obtaining a history from a dyspneic patient?

A
  • Stability

- Determining the severity based on the patient’s daily activities

28
Q

Wheezing/ Coughing/ Hemoptysis Differential

A
  • Lung= Cancer, COPD, Pneumonia, Asthma, Acute Bronchitis
  • Nose & Mouth= Allergic Rhinitis, Aspiration, Irritant
  • Stomach= GERD, Bulimia, Cyclic Vomiting Syndrome
  • Other= Phrenic Nerve, Central or Peripheral Neurologic, Psychologic (Habit Cough, Chronic Throat Clearing), Systemic (Bleeding Problem)
29
Q

What is increased tactile fremitus a sign of?

A

Fluids, secretion, or a solid mass in the lung

30
Q

What is decreased tactile fremitus a sign of?

A

Excess air in the lungs

31
Q

Resonant percussion tone

A
  • Loud
  • Low pitched
  • Long
  • Hollow
32
Q

Flat percussion tone

A
  • Soft
  • High pitched
  • Short
  • Very dull
33
Q

Dull percussion tone

A
  • Medium
  • Medium to high pitched
  • Medium duration
  • Dull-thud in quality
34
Q

Tympanic percussion tone

A
  • Loud
  • High pitched
  • Medium duration
  • Drum-like
35
Q

Hyperresonant percussion tone

A
  • Very loud
  • Very low pitched
  • Long
  • Booming
36
Q

Diaphragmatic Excursion Technique

A

1) Find lower border of lung w/ percussion first, bilaterally
2) Percuss the lower border after exhalation

Normal is 3-5cm (also, note that the diaphragm is higher on the right due to the liver)

37
Q

Vesicular Breath Sounds

A
  • Inspiration longer than expiration
  • Inspiration louder than expiration
  • No gap between inspiration & expiration
  • Heard best in the bases of the lungs
  • Normal
38
Q

Bronchial Breath Sounds

A
  • Louder than vesicular breath sounds
  • Inspiration & expiration same loudness
  • Inspiration & expiration same duration
  • Gap between inspiration & expiration
  • SHOULD NOT be heard in the normal lung parenchyma
39
Q

What causes bronchial sounds in the normal lung parenchyma?

A
  • Consolidated lung of pneumonia
  • Atelectasis
  • Pulmonary mass
40
Q

Crackles

A

Caused by disruption of air passage through small airways & do not clear with coughing

  • Heard during inspiration
  • Discontinuous
  • Short Duration
  • Formerly rales
41
Q

Rhonchi

A

A deeper rumbling that is continuous and prolonged.

  • Usually heard during expiration
  • Suggest airway obstruction by thick secretions, muscle spasm, or external pressure
42
Q

Wheezes

A

A high pitched musical sound

  • Often heard continuously during inspiration & expiration
  • Higher pitch= worse obstruction
43
Q

Bronchophony

A
  • Tested by having the patient say 99

- LOUDER= abnormal & indicates the presence of a consolidation

44
Q

Egophony

A
  • Tested by having the patient say E

- “ee” transitioning to “ay”= ABNORMAL & indicates consolidation

45
Q

Pectoriloquy

A
  • Tested by having the patient whisper 1,2,3

- LOUD & CLEAR= abnormal & indicates consolidation

46
Q

Cheyne Stokes

A
  • Alternating periods of apnea & hyperpnea
  • Can be normal during sleep & at high altitude
  • 30% due to CHF
  • Also neurologic disorders & TBI
47
Q

Kussmal’s

A
  • Very deep
  • Rapid
  • Gasping
  • Seen in metabolic acidosis
48
Q

Grunting

A
  • Short & explosive sounds
  • Common in children, indicates respiratory fatigue in adults
  • Attempt to slow expiration & allow maximal gas exchange
49
Q

Adventitious Breath Sounds

A

Abnormal auscultated breath sounds e.g. crackles, rhonchi, wheezes & friction rub

50
Q

Apnea

A

Halt to breathing

51
Q

Asthma

A

Small airway obstruction caused by inflammation and hyperactive airways

52
Q

Atelectasis

A

Incomplete expansion of the lung

53
Q

Barrel Chest

A

Increased anteroposterior diameter of the chest, often with some degree of kyphosis; commonly seen in COPD

54
Q

Biot Respirations

A

Irregular respirations varying in depth and interrupted by intervals of apnea that lacks repetitive pattern

55
Q

Bronchiectasis

A

Chronic dilation of the bronchi or bronchioles caused by repeated infections of bronchial obstructions

56
Q

Bronchitis

A

Inflammation of the large airways

57
Q

Bronchiolitis

A

Inflammation of the bronchioles

58
Q

COPD

A

Disease process which causes decreased ability of the lungs to perform their function of ventilation

59
Q

Tubular Breath Sounds

A
  • Heard only over the trachea
  • High pitch
  • Loud & long expirations
60
Q

Bronchovesicular Breath Sounds

A
  • Heard over main bronchus area & right posterior lung field
  • Medium pitch
  • Expiration equals inspiration
61
Q

Pectus Carinatum

A

Forward protrusion of the chest commonly referred to as a Pigeon Chest

62
Q

Pectus Excavatum

A

Depression of the sternum commonly called a Funnel Chest

Clinical Medicine (27 decks)

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