Flashcards in PD Thorax and Lungs Deck (94):
What are the imaginary lines on the anterior thorax?
What are the imaginary lines on the lateral thorax?
Anterior and posterior axillary
What are the imaginary lines on the posterior thorax?
At what levels anteriorly and posteriorly does the carina sit?
Sternal angle and T4
What fissure do both lungs have?
Oblique major fissure
Where is the oblique fissure located?
T3 to 6th rib anteriorly
Which lung has a second fissure, and what is it called?
Right lung has a horizontal fissure
Where is the horizontal fissure located?
Anteriorly from 4th rib and meets oblique fissure in midaxillary line near 5th rib
Where is the lower border of the lung, anteriorly and posteriorly?
Anteriorly 6th rib midclavicular and 8th rib midaxillary
What are the stimuli for breathing?
Chemoreceptors in medulla sensitive to changes in H concentration
Chemoreceptors in carotid body respond to changes in arterial oxygen and CO2 concentrations
Which organ regulates respiratory muscles?
What is the primary muscle of respiration?
What other muscles are involved in respiration during stress or exercise?
What are the chief pulmonary complaints?
How should the patient be positioned to inspect them?
Sitting and supine, properly draped or exposed
What do we observe about respirations?
Where in respiratory cycle?
Accessory muscle use
Shape of chest - deformity, asymmetry
Movement of chest - unilateral lag
Associated with congenital heart disease
How do we palpate to see if the trachea is midline?
Place finger in sternal notch and slip to each side
Increased AP diameter, kyphosis, ribs more horizontal
Normal during infancy
Anterior chest wall collapse
May make interpretation of lung findings difficult
Abnormal spinal curvatures and vertebral rotation deform the chest
Distortion of underlying lungs, interpretation is difficult
Depression in lower portion of sternum
Compression of heart and great vessels may cause murmurs
Sternum is displaced anteriorly, increasing AP diameter
Costal cartilages next to protruding sternum are depressed
Pleural friction rub
Crackly, crinkly sensation can be felt or heard
Indicates air in soft tissues
Is crepitus a normal finding?
No, always abnormal
Pleural friction rub
Often heard before felt
Palpable, coarse, grating vibration
Usually on inspiration
Inflammation of pleurae
Palpable vibration of chest from speech
Decreased or absent tactile fremitus
Increased tactile fremitus
Non obstructing bronchial secretions
Where do you check chest expansion posteriorly?
Where is fremitus normally more prominent?
Interscapular area than lower lung fields
Right than left
Where do you check chest expansion anteriorly?
Thumbs along costal margin and xiphoid process
Examples of deviated trachea
Severe parenchymal or pleural fibrosis
Compare all areas bilaterally, from superior to inferior and medial to lateral, systematically
How do you position a patent for percussion?
Posterior - flex head with arms folded in front
Anterior lateral - raise arms
What area on the chest do we percuss, over ribs or intercostals?
Normal lungs should sound... on percussion
Hyperresonant lungs examples
Dull lungs examples
Which diaphragm is usually higher?
What conditions limit diaphragmatic excursion?
Piaphragmatic paralysis (phrenic nerve injury)
What is the normal diaphragmatic excursion?
About 5 cm
How should a patient breath for auscultation?
Slow, deep breaths through the mouth
What do we caution the patient of with auscultation?
Go slow, don't hyperventilate
Which side of the stethoscope do we auscultate the lungs with?
Diaphragm - can hear higher pitched sounds better, and is wider than the bell
Listen systematically from side to side for comparison, starting at apex
What are we evaluating during auscultation?
How do inspiration and expiration duration usually compare?
Heard over most lung fields
Low pitched, soft
Fade away 1/3 through expiration
Inspiration and expiration are equal in length
Heard over main bronchus and R posterior lung field
Louder, harsher, higher in pitch
Expiration lasts longer, short silence between
Heard over trachea, consolidation, large effusion
Where is it abnormal to hear bronchovesicular and bronchial lung sounds?
Periphery of lungs
Amphoric breath sounds
Resembles blowing mouth across open bottle
Heard with large pulmonary cavity (blebs with emphysema) or tension PTX with bornchopleural fistula
Decreased breath sounds
Fluid in pleural space
Secretions in airways
Increased breath sounds
Adventitious breath sounds
When are crackles usually heard?
Are crackles continuous or discontinuous?
Discontinuous, lasting only few miliseconds
What can we do to demonstrate what crackles sound like?
Rubbing hair between thumb and forefinger
What causes crackles?
Result from noise of previously closed airways opening in the distal radicals of bronchial tree
Heard with opening and closing of alveoli
High pitched, short in duration, wet
Low pitched, longer in duration, dry
Examples of crackles
Interstitial lung disease
Are rhonchi continuous or discontinuous?
What do rhonchi sound like?
Low pitched rumbling or gurgling sounds
What causes rhonchi?
Passage of air through larger airways that are obstructed by fluid or mucous
What can clear rhonchi?
What is the death rattle?
When rhonchi is heard in agonal states
What are some examples of when patients develop rhocnhi?
Patient can't control secretions
What do wheezes sound like?
High pitched, whistle like
What causes wheezes?
Turbulent air and vibration of the airway walls in which there is partial obstruction to airflow
Are wheezes continuous or discontinuous?
When do you usually hear wheezes, inspiration or expiration?
Examples of wheezes
Where does a pleural friction rub occur?
Outside of the respiratory tree
What causes a pleural friction rub?
Inflamed pleurae rubbing against each other with respiration
Is a pleural friction rub continuous or discontinous?
What does a pleural friction rub sound like?
Dry, crackly, grating, low pitched
New leather rubbing together
Crunching of snow underfoot
How do you differentiate between a pleural and pericardial rub?
Have patient hold breath - pericardial rub persists
What does stridor sound like?
Is stridor heard during inspiration or expiration?
Is stridor continuous or discontinous?
Vocalizations are transmitted through the respiratory tree
Where are whispered words heard in a normal lung?
Faint and syllables are not distinct except over main bronchi
When do you evaluate vocal resonance?
If abnormalities are detected on percussion, palpation, or auscultation
What are the vocal resonance tests?
Loudness of vocalization increased due to pulmonary consolidation or large effusion
EEE turns to AAA with nasally quality
Heard with pleural effusion or consolidation