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Lung assessment Flashcards

(69 cards)

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1
Q

Left axillary lung

A

U and L lobe seperation, posteriorly 3rd rib anteriorly 6th

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2
Q

R axillary lung

A

RUL runs posteriorly 3rd rib to anteriorly 6th rib but RML is mid axillary ~5th rib

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3
Q

Broncial lung sounds

A

Throat, high pitch, harsh amplitude short inspiration long exp

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4
Q

Bronchialvesicular sounds

A

Moderate pitch mixed quality = insp and exp length

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5
Q

Vesicular

A

Low pitch breezy quality soft amplitude Long insp SHORT exp (peripheral lungs

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6
Q

Fine crackles

A

Short high pitched popping during insp, not cleared with cough
Pneumonia, CHF.
If EARLY in insp COPD
Air opening small deflated passages coated with exudate

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7
Q

Course crackles

A

Low-pitch bubbling moist
Early insp to early exp
Air hitting secretions in large bronchi and trachea
Pneumonia, PE, fibrosis

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8
Q

Pleural rub

A

Low pitched dry grating
Inflamed pleural surfaces rubbing
Pleuritis

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9
Q

Sibilant wheezes

A

High pitched and musical
Expiration mainly
Air through constricted passages (swelling, secretions, tumour)
Asthma or emphysema

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10
Q

Sonorous wheezes

A

Low pitched snoring or moaning mainly during expiration
Air through constricted passages
Bronchitis, single obstructions

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11
Q

Resonance

A

Part air part solid

Normal lung

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12
Q

Hyper resonance

A

Mostly air

Lung with emphysema

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13
Q

Tympany

A

Over air, puffed out cheek or gastic bubble, pneumo

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14
Q

Dullness

A

Solid tissue

Diaphragm pleural effusion, liver

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15
Q

Flatness

A

Dense tissue like muscle bone sternum

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16
Q

Bronchophony test

A

Lung consolidation
Say 99 while auscultating posterior thorax
Soft and muffled normally, louder and more easily understood over consolidation

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17
Q

Egophony

A

Eeee outloud listening to lung fields
Sound like AAAA over consolidation
Good for pneumonia and effusion

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18
Q

Tactile Fremitus

A

Ulnar surface of hands and say 99, fremitus increased over consolidation

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19
Q

Whispered pectoriloquy

A

Pt speaking clearly if over consolidation

Get pt to whisper 1-2-3

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20
Q

S1

A

First heard sound, produced by AV closing at beginning of systole.

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21
Q

Intensity of S1 is dependant on

A

Position of mitral valve at start if systole, structure of valve leaflets, how quicky pressure rises in ventricles

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22
Q

S1 clinical (just the) tip

A

Normal S1 variations heard at apex of heart.

S1 softer at base and louder at apex

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23
Q

Accenuated S1

A

Louder than S2, occurs when mitral valve is wide open and closes quickly from:
Hyperkinetic states from increased blood velocity (fever, anemia, hyperthyroidism)
or Mitral stenosis in which leaflets are mobile but increased ventricular pressure needed to close the valve

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24
Q

Diminshed S1

A

Mitral valve not fully open from
Delayed conduction from atria to ventricles (1st degree block) - mitral starts drifting closed before closing
Mitral insufficiency (extreme calcification limits mobility)
Delayed/diminished ventricular contraction from forceful atrial contraction or into a noncompliant ventricle (severe pulmonary or systemic HTN)

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25
Split S1
L and R ventricles contract at different times BBB Ventricular ectopy in which impulse starts in one ventricle, contracting it first and spreading into second
26
Varying S1
Mitral valve is in different position when contraction occurs A and V bating independendtly (a-fib, AV dissociation, blocks)
27
S2 sounds
Closure of aortic and pulmonary valves. Closure of pulmonic is delayed by inspiration, resulting in split S2
28
Accenuated S2
Aortic or pulmonic valves have higher closing pressure From increased pressure in aorta (excercise, excitment, systemic HTN) Increased pulmonary vasculature (mitral stenosis or CHF) Calcification of semi-lunar valve (valve still mobile, pulmonic or aortic stenosis)
29
Diminished S2
Aortic or pulmonic valves have decreased mobility Decreased systemic BP (weakens valves) as in shock Aortic or pulmonic stenosis in which valves are thickened and calcified with decreased mobility
30
Normal S2 split
Heard over second or third intercostal Usually best heard during inspiration (can't during expiration) If it doesn't disappear during expiration that's pathologic
31
Wide S2 split
Increase in usual splitting that persists throughout entire resp cycle and widens on exp. Occurs when there is delayed electrical activation of RV (RBBB)
32
Fixed split S2
Wide splitting does not vary with resp From delayed closure of one valve Atrial septal defect, RV failure
33
Observing JVP
R side, pt lays 30-45 supine. Torso elevated. Pt turns head to left, use light to see, use light to inspect Internal jugular veins first
34
Reasons for JVP increased
``` Cardiac tamponade Tricuspid stenosis Tricuspid regurg RV failure Pulmonary htn PE ```
35
Internal jugular collects
Brain, superficial face and neck
36
External jugular collects
External cranium, deep parts of the face, occipital
37
Jugular vein should not be
distended bulging or protruding at greater than 45
38
Evaluating JVP
Position bed 30,45,60,90. Turn head and mark what degree pt was at with elevation.
39
Auscultation & palp of carotid | ask pt to hold breath for 30 seconds use bell end
Bruit- blowing or swishing caused by turbulent blood flow from narrowed arteries Check pulses are equal with normal rate Palpation should reveal elastic arteries - otherwise arterioslcerosis
40
Inspection of heart sounds
Pt 30-45 degrees Pulsations other than apical are abnormal If apical (normal) is visible it will be at mitral area Pulsations may mean enlarged ventricle or weakened vessel
41
Palpation of apical pulse
Two fingers palpate mitral area (lie on L to increase) should feel like gentle tapping Difficult pulse to find from emphysema, fatty fat fat fat, tig ol bitties Check for pulses in other areas Palpate radials and apical to see if there are differences (a fib PVCs heart block)
42
Auscultate heart sounds
Study guide says diaphragm for S1 S2, and S3 S4 then bell for S3 S4 Ask pt to breath normally S1 heard everywhere but best at 5th spot S2 heard everywhere, loudest at erbs Note location and timing of extra sounds.
43
Benign S3
Children, young adults, rare after 40
44
Benign S4
End of diastole in well conditioned athletes and those over 40
45
Ejection or clicks
Mitral valve prolapse
46
Pathologic S3
Ventricular gallop, possibly ischemic heart disease
47
Pathologic S4
Atrial gallop, L side of precordium heard with CAD, cardiomyopathy, aortic stenosis
48
Murmur
Listen for swishing sounds in the 5 areas. Variations include Patholigc, midsystolic, pansystolic, diastolic
49
Heart sounds other positions
L lateral. Use bell. S1 S2 normally present. S3 or S4 mitral stenosis that was not detected may be revealed Sit up, lean forward, exhale use diaphragm. Aortic regurg heard when pt sits upright mebbe
50
Normal breath sounds
Bronchial over throat, BV near sternum, vesicular peripherally
51
Tachypnea
24 minute+. Fever anxiety exercise, hypoxia, alkalosis, pneumonia, pleurisy
52
Bradypnea
Less than 10, neuro damage, drugs, diabetic coma
53
Hyperventilation
Increased rate and dpeth
54
Kussmaul
Rapid, deep, laboured
55
Hypovent
Decreased depth, irregular pattern
56
Cheyne-Stokes
Reg pattern with deep rapid and periods of apnea
57
Biots resps
Irregular, varying depth and rate with periods of apnea
58
Ataxic
Significant disorganization with irregular and varying depths of resps
59
Air trapping
Difficulty getting breath out
60
Percussion locations posterior
123, 456 posterior traps | 8-18 ~2nd intercostal back and forth, getting wider 16-17 wider again 17-18 then 19-20 and 21-22 are more lateral
61
Anterior percussion
1st intercostal L to R each intercostal, 5th spot is more lateral
62
Resonant
Low pitched hollow normal lungs
63
Dull or thud
heart liver or fluid in lung tissues like pneumonia pleural effusion or tumors
64
Hyperresonant
Loud, lowwer pitched. Children or skinny adults | COPD, asthma attack, or pneumothorax
65
Tympanic
High, drum like, normally over stomach but maybe a pneumo
66
Inspect lungs for
Nasal flaring, pursed lip, skin colour, nails, even chest rise, scapulae not protruding, downward rib slope
67
Lower ribs posteriorly
8th-9th rib
68
Same insp and exp
BV
69
High pitched musical constricted airway passages
Sibilant wheeze

Pathology (24 decks)

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