Lung

Question 1

what is the margin between the sternum and manubrium called?

Answer 1

sternomanubrial angle/angle of louis

Question 2

what is the space called that is formed by the ribs under the sternum?

Answer 2

costal angle

Question 3

false ribs

Answer 3

8 through 10

Question 4

floating ribs

Answer 4

11 through 12

Question 5

what are the intercostal spaces named after?

Answer 5

the ribs above them

Question 6

What do ribs articulate with on the posteiror surface?

Answer 6

facets on the transverse processes and vertebral body

Question 7

where are nerves and vessels for ribs located?

Answer 7

they run along the underside of each rib

Question 8

where is the angle of louis located?

Answer 8

where the 2nd rib attaches to the sternum, associated with T4

Question 9

which rib marks the end of the scapula?

Answer 9

7

Question 10

What landmark marks the bifurcation of the primary bronchus?

Answer 10

the angle of louis

Question 11

what do the 3 imaginary lines on the chest provide marks for?

Answer 11

midlcavicular lines and midsternal lines, sternomanubrial angle, suprasternal notch, costal angle

Question 12

What do the 3 imaginary lines under the arm provide marks for?

Answer 12

from anterior to posterior: anterior axillary line, midaxillary line, posterior axillary line

Question 13

What do the 3 imaginary lines on the back provide marks for?

Answer 13

scapula lines, midspinal line, C7 spinous process

Question 14

what locations are associated with the anterior lines?

Answer 14

infra-mammary, nipple line, costal margin, supra-clavicular, epigastric

Question 15

what locations are associated with the posterior lines?

Answer 15

peri-scapular, infra-scapular, supra-scapular, inter-scapular

Question 16

where is the apex of the lung located in relation to the clavicle?

Answer 16

extends 2-4cm above the clavicle

Question 17

where is the horizontal fissure?

Answer 17

located between the RUL and RML, at the level of the 4th rib

Question 18

what is the location of the lungs on the right lateral view?

Answer 18

from the peak of the axilla to the 7th or 8th rib

Question 19

What are the lobs of the left lung?

Answer 19

LUL, LLL, left lingular lobe

Question 20

What is the lower border of the lungs on posterior view?

Answer 20

T10 spinous process, descends to T12 with inhalation

Question 21

What makes up most auscultation on posterior exam of the lungs?

Answer 21

the lower lobes

Question 22

Describe the right bronchus

Answer 22

shorter and wider than the left main bronchus

Question 23

what does mucoid sputum look like?

Answer 23

transluscent - due to viral infection

Question 24

What does purulent sputum look like?

Answer 24

yellow/green - due to bacterial infection

Question 25

How can you differentiate blood from the GI tract from hempptysis?

Answer 25

blood from the GI tract is darker

Question 26

How much hemoptysis is OK?

Answer 26

1 tsp

Question 27

What causes clubbing?

Answer 27

respiratory or heart disease, MCC CF, bronchiectasis, lung CA, pulmonary fibrosis

Question 28

Can COPD cause clubbing?

Answer 28

no

Question 29

describe the barrel chest

Answer 29

increased A/P diameter, caused by aging or COPD

Question 30

what is pectus excavatum

Answer 30

congenital cause, funnel chest, can compress mediastinal structures

Question 31

Pigeon chest

Answer 31

pectus carinatum, traumatic flail chest

Question 32

Kyphosis

Answer 32

dorsal curvature of thoracic spine, painful, restrictive, older women, T spine is prone to compressione Fx

Question 33

Kyphoscoliosis

Answer 33

spinal convexity to the right with pt bending forward, ribs close together on the left and spread apart on the right

Question 34

most missed place for melanoma

Answer 34

the back

Question 35

where do supernumerary nipples appear?

Answer 35

aong embryonic milk line

Question 36

what accessory muscles can be used to breath?

Answer 36

abdominal, SCM, trapezius, scalenes

Question 37

What are retractions?

Answer 37

when the intercostal muscles are sucked inward on inspiration, possibly due to an airway obstruction, look in interspaces and supraclavicular fossa - very ominous in kids

Question 38

Pink puffer

Answer 38

emphysema - need more nutrition, pursed lip breathing

Question 39

Blue bloater

Answer 39

chronic bronchitis

Question 40

Normal breahting rates

Answer 40

14-20/min

Question 41

bradypnea

Answer 41

\<12/min

Question 42

Tachypnea

Answer 42

\>20/min, normal depth

Question 43

Hyperpnea

Answer 43

hyperventillation, \>20/min, deep

Question 44

Cheyne-stokes

Answer 44

gradually increasing depth with period of apnea

Question 45

what is respiratory excursion?

Answer 45

chest wall expansion

Question 46

what can cause asymmetric respiratory excursion?

Answer 46

pain, splinting, paralysis, pneumothorax, hemothorax, pleural effusion

Question 47

what could cause decreased or absent tactile fremitus?

Answer 47

voice is too soft, COPD, thick chest wall, pneumothorax, obstruction (air, fluid, tumor)

Question 48

where is percussion heard best on lung exam?

Answer 48

over interspaces, over the DIPJ of one finger

Question 49

What is normal lung sounds?

Answer 49

resonance

Question 50

What does hyperresonance of the lung mean?

Answer 50

hyperinflation (tympany)

Question 51

What does dullness of the lung mean on palpation?

Answer 51

bone, fluid, solid organ

Question 52

normal sound of percussion over the diaphragm?

Answer 52

dull

Question 53

what is normal diaphragm excursion?

Answer 53

5-6cm

Question 54

what does a high excursion number of the diaphragm mean?

Answer 54

pleural effusion, elevated diaphragm, atelectasis, phrenic nerve paralysis

Question 55

what part of the stethoscope is used on lung auscultation?

Answer 55

diaphragm

Question 56

how should pts breath on lung exam?

Answer 56

with their mouths open

Question 57

how many areas are auscultated on A/P/L exam of the lungs?

Answer 57

A/P: 4 paired, L: 2 paired

Question 58

what are normal lung sounds?

Answer 58

vesicular, inspiratory sounds are longer than expiratory sounds, soft intensity, low pitch

Question 59

Bronch-vesicular lung sounds

Answer 59

inspiratory/expiratory rate is about the same, intermediate intesnsity, intermediate pitch, heard over 1st and 2nd interspaces anteriorly and between scapulae posteriorly

Question 60

bronchial lung sounds

Answer 60

expiratorys ounds slightly longer than inspiratory, loud, high pitch (tubular), heard over manubrium if at all

Question 61

tracheal lung sounds

Answer 61

inspiration and expiration are about equal, very loud, high pitch (tubular), heard over trachea in neck

Question 62

what should be suspected if you hear bronchial or bronchovesicular sounds are ehard in locations distant from expected sites?

Answer 62

air filled lung has been replaced by fluid-filled or solid lung tissue

Question 63

What can cause decreased intensity of normal lung sounds

Answer 63

obesity, thick chest wall, shallow breaths, pathology

Question 64

crackles

Answer 64

rales. Brief, discontinuous sounds, most often at end of inspiration

Question 65

what do fine-late crackles indicate?

Answer 65

lung disease

Question 66

What do clear crackles with a cough indicate?

Answer 66

inspiratory secretions

Question 67

Rhonchi

Answer 67

snoring or gurgling quality, indicate secretions in large airways

Question 68

wheezes

Answer 68

musical sounds created when air flows rapidly through bronchi that are narrowed significantly, hear in expiration and sometimes on inspiration

Question 69

Stridor

Answer 69

wheeze heard primarily during inspiration and mainly over larger airways, can be a sign of airway obstructino

Question 70

examples of airway obstruction

Answer 70

foreign body, croup, epiglottitis

Question 71

Pleural rub

Answer 71

related to inflammation of pleural surfaces, coarse, grating sound timed with lung movement, evidence of inflammation, pleurasy

Question 72

when are transmitted voice sounds louder?

Answer 72

consolidation (pneumonia)

Question 73

When are transmitted voice sounds softer?

Answer 73

when fluid or air pushes lung away from the chest wall

Question 74

when can bronchophony be present?

Answer 74

over lung areas where the alveoli are filled with fluid or replaced by solid tissue (pneumonia, atelectasis or tumors)

Question 75

differential for for crackles

Answer 75

pneumonia

Question 76

differential for rhonchi

Answer 76

CHF

Question 77

Ddx for dullness/asymmetric excursion

Answer 77

tumor

Question 78

Ddx tender ICS

Answer 78

pleuritis + rub

Question 79

Ddx retractions

Answer 79

respiratory distress

Question 80

Ddx for left supraclavicular adenopathy

Answer 80

pancoast tumor