Lungs and Thorax Lecture

Question 1

What are the ROS for thorax/ lungs?

Answer 1

Chest pain SOB/ dyspnea Wheezing Cough Hemoptysis

Question 2

2 conditions to be concerned with for health maintenance

Answer 2

Smoking

Influenza

Question 3

Where does the trachea bifurcate into main bronchi?

Answer 3

Sternal angle/ T4

Question 4

What is the order to the pulmonary exam?

Answer 4

Inspection Palpation Percussion Auscultation

Question 5

What four things are we looking for on inspection?

Answer 5

Color

Breathing/ wheezing

Neck

Shape of chest

Question 6

What is an acceptable AP to lateral ratio of the chest?

Answer 6

2:1

Question 7

What is a barrel chest associated with?

Answer 7

COPD can be with normal aging

Question 8

What is this a picture of?

Answer 8

Barrel Chest

Question 9

What is a traumatic flail chest?

Answer 9

2 or more ribs broken in 3 or more places

Paradoxical movement

Moves in on inspiration, out on expiration

Question 10

What is this?

Answer 10

Pectus Excavatum (funnel chest)

Question 11

What is this?

Answer 11

Pectus Carinatum (pigeon chest)

Question 12

What are the spots for tactile fremitus?

Answer 12

3 B/L anterior

4 B/L posterior

Question 13

What causes a absent or decrease in tactile fremitus?

Answer 13

Bronchial dilation

COPD

Pneumothorax

Atelectasis

Tumor

Pleural effusion

Question 14

What can cause an increase in tractile fremitus?

Answer 14

Consolidation (lobar pneumonia)

Question 15

What four things can cause abnormal chest excursions?

Answer 15

Splinting

Bronchial obstruction

Pleural effusion

Lobar pneumonia

Question 16

How many sites do you perform percussion?

Answer 16

Posteriorly- 7 sites

Anteriorly 6 sites

Question 17

What type fashion should you move in when doing percussion?

Answer 17

Ladder fashion

Question 18

What is the normal sound with percussion of the lung?

Answer 18

Resonant

Question 19

What is hyper-resonance associated with?

Answer 19

Emphysema, pneumothorax

Question 20

What is tympany associated with?

Answer 20

Large pneumonia

Question 21

What are three specials for lung auscultation?

Answer 21

Bronchophony

Whispered petrolioquy

Egophony

Question 22

What are vesicular breath sounds?

Answer 22

Normal sound heard over healthy tissue

Question 23

What are bronchovesicular lung sounds?

Answer 23

Sounds heard over a large bronchi

Question 24

What does a pleural rub sounds like?

Answer 24

Stepping on snow

Question 25

What is mediastinal crunch (Hamman's Sign)?

Answer 25

Series of precordial crackles syncronous with the heart beat, not with respiration

Question 26

What is atelectasis?

Answer 26

Main bronchus is plugged with fluid or blood

Question 27

What is consolidation?

Answer 27

Alveoli filled with fluid or blood cells, as in pneumonia, pulmonary edema or pulmonary hemorrhage

Question 28

What is a pleural effusion?

Answer 28

Fluid in pleural spaces separates air-filled lung from pluera

Question 29

What is a pneumothorax?

Answer 29

When air leaks into pleural space causing lung to recoil from chest wall, pleural air blocks transmission of sound

Question 30

What age is pnemococcal vaccine given to?

Answer 30

Adults \>65

Question 31

What other populations in pneumococcal vaccine given to?

Answer 31

Routine vaccine for all children and infants adults with chronic illness smokers age 19-64 anyone about to get a cochelar implant adults and children older than 2 who are immunocomprimised

Question 32

What are the 5 A's

Answer 32

Ask Advise Assess Assist Arrange

Question 33

What are the steps of the stages of change model?

Answer 33

Precontemplation Contemplation Preparation Action Maintenance

Question 34

What causes a unilateral decreases in chest expansion?

Answer 34

Chronic fibrosis of the underlying lung or pleura Pleural effusion Lobal pneumonia Pleural pain w/ splinting Unilateral bronchial obstruction

Question 35

What does unilateral hyperresonance suggest?

Answer 35

Large pneumothorax or a large air filled bulla in the lung

Question 36

What's a sound that is soft and low pitched, heard through inspiration, continue without pause through expiration then fade away about 1/3 through expiration

Answer 36

Vesicular

Question 37

What are louder, harsher, sounds higher in pitch. Short silence between inspiratory and expiratory sounds Expiratory sound lasts longer

Answer 37

Bronchial

Question 38

What is a Discontinuous, intermittent, nonmusical, brief sound that is like a dot in time?

Answer 38

Crackle (rales)

Question 39

Where might bronchial breath sounds replace normal vesicular breath sounds?

Answer 39

Over airless areas of the lung

Question 40

What is it called when a spoken "ee" is heard as an "ay"?

Answer 40

Egophony

Question 41

What is it called when spoken words are heard louder on auscultation?

Answer 41

Bronchophony

Question 42

Will tactile fremitus be increased or decreased in the airless state of the lung?

Answer 42

Increased