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PCM > Lower Respiratory Exam > Flashcards

Lower Respiratory Exam Flashcards

1
Q

Midsternal Line & Midclavicular Line

A

Midsternal - drops from suprasternal notch

Midclavicular - drops vertically from midpoint to clavicle

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2
Q

Landmarks

A 
Sternal angle (angle of Louis) where 2nd rib meets with the the manubrium and the body of sternum
Suprasternal notch
Xiphoid process
Scapula
Thoracic vertebrae
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3
Q

Needle Decompression

A

2nd ICS just superior to the 3rd rib margin at midclavicular line

Emergent decompression tension pneumothorax, followed by chest tube placement

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4
Q

Chest Tube Insertion

A

4th ICS at mid or anterior axillary line

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5
Q

T4

A

Lower margin of endotrachial tube on a chest X-Ray

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6
Q

7th ICS

A

Landmark for thoracentesis

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7
Q

Evaluation of Respiration

A

Healthy resting adult breathes quietly and regularly 14-20 bpm
Assess for quality of movement: asymmetry, intercostal retractions
Assess patients for cyanosis (hypoxia)
Listen to breathing (audible wheezing)
Look for pursed lips while breathing (obstructive lung disease)
Patient’s posture and position (obstructive lung disease = sit leaning forward with shoulders elevated)
Inspections of neck
- contraction of accessory muscles (sternomastoid, scalenes, supraclavicular retraction)
- tracheal position - should be midline (lateral displacement can occur in tension pneumothorax)

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8
Q

Clubbing of Fingernails

A

Bulbous swelling of soft tissue at nail base
Loss of normal angle between nail and proximal nail fold (>180 degrees)
Spongy or floating feeling
Vasodilation, changes in connective tissue, inner action or platelet-derived growth factor from fragments of platelet clumps

Seen in:

  • congenital heart disease
  • interstitial lung disease
  • lung cancer
  • cystic fibrosis
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9
Q

Thoracic Expansion

A

Place thumbs at about level of 10th rib
Fingers loosely grasping and parallel to lateral rib cage
Patient inhales deeply
Watch distance between thumbs as they move apart during inspiration
Feel for range and symmetry of rib cage as it expands and contracts

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10
Q

Tactile Fremitus

A

Palpable vibrations transmitted through bronchopulmonary tree to chest wall
Patient speaks “ninety-nine” or “one-one-one”

More prominent in inter scapular area than lower lung fields
More prominent on right than left
Disappears below diaphragm

Decreased/Absent = COPD, pleural effusions, fibrosis, pneumothorax, infiltrating tumor
Increased = pneumonia (increased transmission through consolidated tissue)
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11
Q

Percussion Notes

A

Flat

  • soft intensity
  • high pitch
  • short duration
  • ex: thigh

Dull

  • medium intensity
  • medium pitch
  • medium duration
  • ex: liver

Resonant

  • loud intensity
  • low pitch
  • long duration
  • ex: healthy lung

Hyperresonant

  • very loud intensity
  • lower pitch
  • longer duration
  • ex: usually none (COPD)

Tympanitic

  • loud intensity
  • high pitch
  • longer duration
  • ex: gastric air bubble or puffed-out cheeck
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12
Q

Dullness

A

Replaces resonance when fluid or solid tissue replaces air-containing lung or occupies space beneath per cussing fingers

Lobar pneumonia (alveoli filled with fluid and blood cells)
Pleural accumulations
- effusion (serous fluid)
- hemothorax (blood) - treatment with chest tube
- empyema (pus)
- fibrous tissue or tumor

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13
Q

Hyperresonance

A

Generalized: Hyperinflated lungs

  • COPD
  • Asthma

Unilateral

  • large pneumothorax
  • large air-filled bulla in lung
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14
Q

Diaphragmatic Excursion

A

Determine distance between level of dullness on full inspiration and level of dullness on full expiration by progressive percussion down from resonance (lung parenchyma) to dullness (structures below diaphragm)

Normal = 3-5.5 cm

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15
Q

Vesicular Breath Sounds

A

Soft and low pitched
Heard through inspiration and about 1/3 of expiration
Heard over most of lungs (parenchyma)

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16
Q

Bronchovesicular Breath Sounds

A

Intermediate in intensity and pitch
Heard equally in inspiration and expiration
Head best in 1st and 2nd ICS anteriorly and between scapulae
At bifurcation

17
Q

Bronchial Breath Sounds

A

Load and high pitch
Expiration sounds heard longer than inspiratory
Head best over manubrium (larger proximal airways)

18
Q

Tracheal Breath Sounds

A

Very loud and high pitched
Heard equally in inspiration and expiration
Heard best over trachea in neck

19
Q

Crackles (Rales)

A

Discontinuous
Intermittent
Nonmusical
Brief

Fine crackles = soft, high-pitched, very brief (5-10 msec)
Coarse crackles = louder, lower in pitch, brief (20-30 msec)

20
Q

Wheezes and Rhonchi

A

Continuous
Musical quality
Prolonged

Wheezes = relatively high pitched, musical, hissing or shrill quality
- narrowed airway (asthma, COPD, bronchitis)

Rhonchi = relatively low-pitched, snoring quality
- secretions in large airways

21
Q

Stridor

A

Wheeze that is entirely or predominantly inspiratory in nature
Often louder in neck vs. chest wall
Indicates partial obstruction of larynx or trachea (immediate attention)

22
Q

Pleural Friction Rub

A

Inflamed and roughened pleural surfaces grate against each other
Sounds like creaking, usually during expiration but can occur during both phases
Usually confined to a relatively small area of the chest wall

23
Q

Bronchophony

A

Spoken words become louder and clearer

Normal = muffled and indistinct

24
Q

Egophony

A

“ee” sounds like “A” - nasal bleating quality, localized

Normal = muffled long E sound

25
Q

Whispered Pectoriloquy

A

Whispers heard louder and clearly during auscultation

Normal = fain and indistinct or not heart at all

26
Q

Acute Cough

A

3 weeks

Upper respiratory, viral

27
Q

Subacute Cough

A

3-8 weeks

Post infection

28
Q

Chronic Cough

A

> 8 weeks
Low grade infection
Post nasal drainage
Cough more in morning

29
Q

Traumatic Flail Chest

A

Broken several ribs
Paradoxical motion: inhale - goes out, exhale - goes in
Potential collapsed lung

30
Q

Pectus Excavatum

Funnel Chest

A

Most common bony structure abnormality of chest wall
Prone to progressive dypsnea
Exercise intolerance

31
Q

Pectus Carinatum

Pigeon Chest

A

Dyspnea

Exercise intolerance

32
Q

Anterior/Posterior/Midaxillary Line

A

Drops vertically from anterior and posterior axillary folds

Midaxillary line drops from the apex of the axilla

PCM (26 decks)

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