What are the ROS for thorax/ lungs?
Chest pain SOB/ dyspnea Wheezing Cough Hemoptysis
2 conditions to be concerned with for health maintenance
Where does the trachea bifurcate into main bronchi?
Sternal angle/ T4
What is the order to the pulmonary exam?
Inspection Palpation Percussion Auscultation
What four things are we looking for on inspection?
Shape of chest
What is an acceptable AP to lateral ratio of the chest?
What is a barrel chest associated with?
COPD can be with normal aging
What is this a picture of?
What is a traumatic flail chest?
2 or more ribs broken in 3 or more places
Moves in on inspiration, out on expiration
What is this?
Pectus Excavatum (funnel chest)
What is this?
Pectus Carinatum (pigeon chest)
What are the spots for tactile fremitus?
3 B/L anterior
4 B/L posterior
What causes a absent or decrease in tactile fremitus?
What can cause an increase in tractile fremitus?
Consolidation (lobar pneumonia)
What four things can cause abnormal chest excursions?
How many sites do you perform percussion?
Posteriorly- 7 sites
Anteriorly 6 sites
What type fashion should you move in when doing percussion?
What is the normal sound with percussion of the lung?
What is hyper-resonance associated with?
What is tympany associated with?
What are three specials for lung auscultation?
What are vesicular breath sounds?
Normal sound heard over healthy tissue
What are bronchovesicular lung sounds?
Sounds heard over a large bronchi
What does a pleural rub sounds like?
Stepping on snow
What is mediastinal crunch (Hamman's Sign)?
Series of precordial crackles syncronous with the heart beat, not with respiration
What is atelectasis?
Main bronchus is plugged with fluid or blood
What is consolidation?
Alveoli filled with fluid or blood cells, as in pneumonia, pulmonary edema or pulmonary hemorrhage
What is a pleural effusion?
Fluid in pleural spaces separates air-filled lung from pluera
What is a pneumothorax?
When air leaks into pleural space causing lung to recoil from chest wall, pleural air blocks transmission of sound
What age is pnemococcal vaccine given to?
What other populations in pneumococcal vaccine given to?
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
What are the 5 A's
What are the steps of the stages of change model?
What causes a unilateral decreases in chest expansion?
Chronic fibrosis of the underlying lung or pleura
Pleural pain w/ splinting
Unilateral bronchial obstruction
What does unilateral hyperresonance suggest?
Large pneumothorax or a large air filled bulla in the lung
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
What are louder, harsher, sounds higher in pitch.
Short silence between inspiratory and expiratory sounds
Expiratory sound lasts longer
What is a Discontinuous, intermittent, nonmusical, brief sound that is like a dot in time?
Where might bronchial breath sounds replace normal vesicular breath sounds?
Over airless areas of the lung
What is it called when a spoken "ee" is heard as an "ay"?
What is it called when spoken words are heard louder on auscultation?
Will tactile fremitus be increased or decreased in the airless state of the lung?