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

Exam #3: Chest, Thorax, & Lungs Flashcards

(62 cards)

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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
Important Characteristics of Breathing
- Rate (14-20 is normal) - Rhythm - Depth - Effort
26
Dyspnea Differential
- 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
What is the chief goal when obtaining a history from a dyspneic patient?
- Stability | - Determining the severity based on the patient's daily activities
28
Wheezing/ Coughing/ Hemoptysis Differential
- 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
What is increased tactile fremitus a sign of?
Fluids, secretion, or a solid mass in the lung
30
What is decreased tactile fremitus a sign of?
Excess air in the lungs
31
Resonant percussion tone
- Loud - Low pitched - Long - Hollow
32
Flat percussion tone
- Soft - High pitched - Short - Very dull
33
Dull percussion tone
- Medium - Medium to high pitched - Medium duration - Dull-thud in quality
34
Tympanic percussion tone
- Loud - High pitched - Medium duration - Drum-like
35
Hyperresonant percussion tone
- Very loud - Very low pitched - Long - Booming
36
Diaphragmatic Excursion Technique
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
Vesicular Breath Sounds
- Inspiration longer than expiration - Inspiration louder than expiration - No gap between inspiration & expiration - Heard best in the bases of the lungs - Normal
38
Bronchial Breath Sounds
- 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
What causes bronchial sounds in the normal lung parenchyma?
- Consolidated lung of pneumonia - Atelectasis - Pulmonary mass
40
Crackles
Caused by disruption of air passage through small airways & do not clear with coughing - Heard during inspiration - Discontinuous - Short Duration - Formerly rales
41
Rhonchi
A deeper rumbling that is continuous and prolonged. - Usually heard during expiration - Suggest airway obstruction by thick secretions, muscle spasm, or external pressure
42
Wheezes
A high pitched musical sound - Often heard continuously during inspiration & expiration - Higher pitch= worse obstruction
43
Bronchophony
- Tested by having the patient say 99 | - LOUDER= abnormal & indicates the presence of a consolidation
44
Egophony
- Tested by having the patient say E | - "ee" transitioning to "ay"= ABNORMAL & indicates consolidation
45
Pectoriloquy
- Tested by having the patient whisper 1,2,3 | - LOUD & CLEAR= abnormal & indicates consolidation
46
Cheyne Stokes
- Alternating periods of apnea & hyperpnea - Can be normal during sleep & at high altitude - 30% due to CHF - Also neurologic disorders & TBI
47
Kussmal's
- Very deep - Rapid - Gasping - Seen in metabolic acidosis
48
Grunting
- Short & explosive sounds - Common in children, indicates respiratory fatigue in adults - Attempt to slow expiration & allow maximal gas exchange
49
Adventitious Breath Sounds
Abnormal auscultated breath sounds e.g. crackles, rhonchi, wheezes & friction rub
50
Apnea
Halt to breathing
51
Asthma
Small airway obstruction caused by inflammation and hyperactive airways
52
Atelectasis
Incomplete expansion of the lung
53
Barrel Chest
Increased anteroposterior diameter of the chest, often with some degree of kyphosis; commonly seen in COPD
54
Biot Respirations
Irregular respirations varying in depth and interrupted by intervals of apnea that lacks repetitive pattern
55
Bronchiectasis
Chronic dilation of the bronchi or bronchioles caused by repeated infections of bronchial obstructions
56
Bronchitis
Inflammation of the large airways
57
Bronchiolitis
Inflammation of the bronchioles
58
COPD
Disease process which causes decreased ability of the lungs to perform their function of ventilation
59
Tubular Breath Sounds
- Heard only over the trachea - High pitch - Loud & long expirations
60
Bronchovesicular Breath Sounds
- Heard over main bronchus area & right posterior lung field - Medium pitch - Expiration equals inspiration
61
Pectus Carinatum
Forward protrusion of the chest commonly referred to as a Pigeon Chest
62
Pectus Excavatum
Depression of the sternum commonly called a Funnel Chest

Clinical Medicine (27 decks)

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