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Flashcards in H&P Exam 2 Deck (44)
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1
Q

Note special landmarks:● 2nd intercostal space for● 4th intercostal space for ● T4 for the lower margin of an

A

needle insertion for tension pneumothorax.

chest tube insertion.

endotracheal tube on a chest x-ray.

2
Q

Note the T7–T8 intercostal space as alandmark for

A

thoracentesis with needle

insertion immediately superior to

the 8th rib.

3
Q

Anteriorly, the apex of each lung rises approximately

A

2 to 4 cm

above the inner third of the clavicle

4
Q

The lower border of the lung

crosses the _____ rib at the midclavicular line and the _____ rib at the midaxillary line.

A

6th

8th

5
Q

Aspiration pneumonia is more commonin the

A

right middle and lower lobe

because the right main bronchus is

more vertical.

6
Q

The trachea bifurcates into its mainstem bronchi at the levels of the _____ anteriorly and the _______ posteriorly

A

sternal angle

T4 spinous process

7
Q

Accumulations of pleural fluid, or pleural

effusions, may be ______ , seen

in heart failure, cirrhosis, and nephrotic

syndrome, or ________ , seen in numerous

conditions including pneumonia,

malignancy, pulmonary embolism,

tuberculosis, and pancreatitis.

A

transudates

exudates

8
Q

Irritation of the parietal pleura produces __________, as in viral pleurisy, pneumonia, pulmonary embolism, pericarditis, and collagen vascular diseases.

A

pleuritic pain with deep inspiration

9
Q

The muscles in the rib cage also expand the thorax, especially

the _______ , which run from the cervical vertebrae to the first two ribs, and

the ____________ , which cross obliquely

from the sternum to the ribs.

A

scalenes

parasternal intercostal muscles, AKA parasternals

10
Q

Lung tissue has no pain fibers. Pain in conditions such as pneumonia or pulmonary infarction usually arises from inflammation of the adjacent ________?

A

parietal pleura

11
Q

Cough can signal?

A

left-sided heart failure

12
Q

______ sputum is translucent, white, or gray and seen in viral infections and cystic fibrosis

_______ sputum is yellow or green and often accompanies bacterial pneumonia.

A

Mucoid

Purulent

13
Q

Clearing of crackles, wheezes, or rhonchi

after coughing or position change

suggests ___________ , seen

in bronchitis or atelectasis.

A

inspissated (thickened) secretions

14
Q
A
15
Q

Foul-smelling sputum is present in _________.

Thick tenacious sputum is present in _________.

A

anaerobic lung abscess

cystic fibrosis

16
Q

Large volumes of _________ are present in bronchiectasis and lung abscess.

A

purulent sputum

17
Q

Diagnostically helpful symptoms:

________ and ________ in pneumonia;

________ in asthma;

________, _________ and _______

in acute coronary syndromes.

A

fever and productive cough

wheezing

chest pain, dyspnea, and orthopnea

18
Q

These symptoms, especially__________ and __________, are hallmarks of obstructive sleep apnea

A

daytime sleepiness and snoring

19
Q
  1. ______in the lips, tongue, and oral mucosa signals hypoxia.
  2. ______ are common in heart failure.
  3. ______occurs in bronchiectasis, congenital heart disease, pulmonary fibrosis, cystic fibrosis, lung abscess, and malignancy.
A

Cyanosis

Pallor and sweating (diaphoresis)

Clubbing of the nails

20
Q

The ratio of the anteroposterior (AP) diameter to the lateral chest diameter is usually ______ up to 0.9 and increases with aging

This ratio may exceed 0.9 in _______,

producing a barrel-chest appearance,

although evidence of this correlation

is conflicting.

A

0.7 to 0.75

COPD

21
Q

Asymmetric expansion occurs in large ________.

A

pleural effusions

22
Q

Retraction occurs in ________.

A

severe asthma, COPD, or upper airway obstruction

23
Q

Intercostal tenderness can develop over ________

A

inflamed pleurae

24
Q

Unilateral impairment or lagging suggests pleural disease from _________; it is also seen in phrenic nerve damage or trauma.

A

asbestosis or silicosis

25
Q

Test chest expansion. Place your

thumbs at about the level of the

_____ ribs, with your fingers loosely

grasping and parallel to the lateral

rib cage

A

10th

26
Q

_______is decreased or absent when

the voice is higher pitched or soft or

when the transmission of vibrations

from the larynx to the surface of the

chest is impeded by a thick chest wall,

an obstructed bronchus, COPD, or

pleural effusion, fibrosis, air (pneumothorax),

or an infiltrating tumor.

A

Fremitus

27
Q

Asymmetric decreased fremitus raises the likelihood of ________, which decreases transmission of low-frequency sounds; asymmetric increased fremitus occurs in unilateral pneumonia which increases transmission through consolidated tissue.

A

unilateral pleural effusion, pneumothorax, or neoplasm

28
Q

An abnormally high diaphragm level found during percussion suggests a ______ or ______ from atelectasis or phrenic nerve paralysis.

A

pleural effusion or an elevated hemidiaphragm

29
Q

Is there a silent gap between the inspiratory and expiratory sounds?

A gap suggests?

A

bronchial breath sounds.

30
Q

Normal breath sound heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration?

A

Vesicular, or soft and low pitched

31
Q

Normal breath sound, with inspiratory and expiratory sounds about equal in length, at times separated by a silent interval. Detecting differences in pitch and intensity is often easier during expiration.

A

Bronchovesicular

32
Q

Normal breath sounds that are louder, harsher and higher in pitch, with a short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.

A

Bronchial

33
Q

Normal breath sounds that are loud, harsh sounds heard over the trachea in the neck.

A

Tracheal

34
Q

Fine late inspiratory crackles that persist from breath to breath suggest?

A

abnormal lung tissue.

35
Q

The crackles of heart failure are usually best heard in the?

A

posterior inferior lung fields.

36
Q

Stridor and laryngeal sounds are loudest over the neck, whereas true wheezes and rhonchi are ________ over the neck.

A

faint or absent

37
Q

Pleural rubs may be heard in?

A

pleurisy, pneumonia, and pulmonary embolism.

38
Q

Increased transmission of voice sounds

suggests that embedded airways are?

A

blocked by inflammation or secretions

39
Q

Localized bronchophony and egophony are seen in_______ .

In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood?

A

lobar consolidation of pneumonia

pneumonia

40
Q

The hyperresonance of COPD during percussion may obscure ______

A

dullness over the heart.

41
Q

Breathing is irregular—periods of apnea

alternate with regular deep breaths

which stop suddenly for short intervals.

Causes include meningitis, respiratory

depression, and brain injury, typically at

the medullary level.

A

Ataxic Breathing (Biot Breathing)

42
Q

Periods of deep breathing alternate with

periods of apnea (no breathing). This

pattern is normal in children and older

adults during sleep. Causes include heart

failure, uremia, drug-induced respiratory

depression, and brain injury (typically

bihemispheric).

A

Cheyne–Stokes Breathing

43
Q

In obstructive lung disease,

expiration is prolonged due to

narrowed airways increase the

resistance to air flow. Causes include

asthma, chronic bronchitis, and

COPD.

A

Obstructive Breathing

44
Q

Kussmaul breathing is compensatory overbreathing due to?

A

systemic acidosis.