Lung and Thoracic Exam II Flashcards Preview

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Flashcards in Lung and Thoracic Exam II Deck (40)
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1
Q

what questions should you ask during the lung health history?

A
chest pain
dyspnea (SOB)
wheezing
cough
hemoptysis (spitting up blood)
2
Q

what extrathoracic structures may also cause chest pain

A

neck
gallbladder
stomach
pancreas (pancreatitis)

3
Q

what thoracic structure is not innervated with sensory nerves?

A

lung parenchyma

4
Q

dyspnea

A

abnormal or uncomfortable breathing in the context of that person’s “normal”
unpleasant sensation or difficulty in breathing

5
Q

wheezing

A

musical respiratory sounds that may be audible

  • indicates airway obstruction (secretions, tissue inflammation)
  • does not always mean asthma
6
Q

cough

A

common symptom (trivial-ominous)
reflex response to stimulae that irritate receptors in the larynx, trachea, or large bronchi
typically respiratory but may be cardiac or GI

7
Q

what is often the last symptom to go when a person has an URI

A

cough

8
Q

why does the cough persist even after the disease is over with?

A

reactive inflammation of the airway

9
Q

how can GERD cause a cough

A

acid in esophagus can cause bronchospasm in the airway

10
Q

what should you differentiate in a cough?

A

dry or moist
productive or non productive
-may be moist but non productive if they can not expectorate any sputum

11
Q

what should you consider with sputum?

A

volume
color
odor
consistency

12
Q

orthopnea

A

difficulty breathing while lying down

-described by how many pillows it takes to breathe comfortably

13
Q

mucoid sputum

A

translucent, white, grey

14
Q

purulent sputum

A

yellowish, green

15
Q

mycoplasma pneumonia typically has a

A

dry hacking cough

-atypical pneumonia

16
Q

bronchitis (viral), viral/bacterial pneumonia typically has a

A

sputum producing cough

17
Q

anaerobic lung abscess typically has

A

foul smelling sputum

18
Q

cystic fibrosis typically has

A

tenacious, sticky sputum

19
Q

bronchiectasis or lung abscess typically has

A

large volumes of sputum

20
Q

where can blood come from that comes out of the mouth?

A

oral mucosa (lesions)
nose
lungs
GI

21
Q

characteristics of hemoptysis

A
blood streaked
frank blood (glob of blood)-what size? (quarter, half dollar, dime)
22
Q

hemoptysis

A

blood that is expectorated from somewhere below the vocal cords (trachea, bronchi)

23
Q

what are the 4 A’s for smoking cessation?

A

Ask
Advise
Assist
Arrange

24
Q

Steps of the exam

A

initial survey (breathing, color, accessory muscle use, posture)
exam of posterior chest (sitting)
exam of anterior chest (supine)
special techniques

25
Q

what to observe on palpation

A

tenderness? abnormalities?
test chest expansion
tactile fremitus (vibration on palpation)

26
Q

tactile fremitus

A

transmitted through bronchopulomary tree to the chest wall

  • use ball or ulnar surface of hand
  • say “ninety nine” if faint, speak louder or deeper
  • have to have a baseline
27
Q

what does decreased fremitus mean?

A
obstructed bronchus
COPD
pleural effusion
fibrosis
pneumothorax
some tumors
thick chest wall (obese)
28
Q

when is a good time to do tactile fremitus?

A

if someone has aspirated something or has some problem that would be only on one side, you would be able to note a decrease in vibration on one side only

29
Q

what does increased fremitus mean?

A

increased density of tissue (consolidation)

-almost impossible to tell the difference

30
Q

what does percussion do?

A

produces audible sound and palpable vibration
establishes content of underlying fluid
penetrates 5-7 cm

31
Q

elevated hemidiaphragm

A

when one side of the diaphragm is higher than the other

32
Q

what is the normal amount of diaphragmatic excursion

A

5-6 cm

33
Q

bronchophony

A

say “ninety nine”

normal: sounds should be muffled or indistinct
abnormal: louder, clearer sounds (something is helping sound to transmit more readily through the chest wall)
- while auscultating

34
Q

egophony

A

say “ee”

normal: hear a long e sound
abnormal: “ee” sounds like “ay”
- while auscultating

35
Q

whispered pectoriloquy

A

whisper “ninety nine”

normal: sounds heard faintly, if at all
abnormal: loud, clear sounds

36
Q

a percussed lung that gives a flat sound could indicated

A

large pleural effusion

37
Q

a percussed lung that gives a dull sound could indicate

A

a lobar pneumonia

38
Q

a percussed lung that gives a normal resonant sound could indicate

A

simple chronic bronchitis

39
Q

a percussed lung that gives a hyperresonant sound could indicate

A

emphysema, pneumothorax

40
Q

a percussed lung that gives a tympany sound could indicate

A

large pneumothorax

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