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Physical Diagnosis > PD Thorax and Lungs > Flashcards

Flashcards in PD Thorax and Lungs Deck (94):
1

What are the imaginary lines on the anterior thorax?

Midsternal
Midclavicular

2

What are the imaginary lines on the lateral thorax?

Anterior and posterior axillary
Midaxillary

3

What are the imaginary lines on the posterior thorax?

Scapular
Vertebral

4

At what levels anteriorly and posteriorly does the carina sit?

Sternal angle and T4

5

What fissure do both lungs have?

Oblique major fissure

6

Where is the oblique fissure located?

T3 to 6th rib anteriorly

7

Which lung has a second fissure, and what is it called?

Right lung has a horizontal fissure

8

Where is the horizontal fissure located?

Anteriorly from 4th rib and meets oblique fissure in midaxillary line near 5th rib

9

Where is the lower border of the lung, anteriorly and posteriorly?

Anteriorly 6th rib midclavicular and 8th rib midaxillary
Posteriorly T10

10

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

11

Which organ regulates respiratory muscles?

Pons

12

What is the primary muscle of respiration?

Diaphragm

13

What other muscles are involved in respiration during stress or exercise?

Parasternal
Scalenes
SCM
Abdominal muscles

14

What are the chief pulmonary complaints?

Chest symptoms
Dyspnea
Wheezing
Cough
Hemoptysis

15

How should the patient be positioned to inspect them?

Sitting and supine, properly draped or exposed

16

What do we observe about respirations?

Rate
Rhythm
Depth
Effort
Pattern

17

Color

Cyanosis

18

Listen

Wheezing
Stridor
Where in respiratory cycle?

19

Inspection

Accessory muscle use
Retraction
Nasal flaring
Pursed lips
Trachea midline
Shape of chest - deformity, asymmetry
Movement of chest - unilateral lag

20

Supernumerary nipples

Associated with congenital heart disease
Polythelia

21

How do we palpate to see if the trachea is midline?

Place finger in sternal notch and slip to each side

22

Barrel chest
Examples

Increased AP diameter, kyphosis, ribs more horizontal
Normal during infancy
Aging, COPD

23

Kyphosis

Anterior chest wall collapse
May make interpretation of lung findings difficult

24

Kyphoscoliosis

Abnormal spinal curvatures and vertebral rotation deform the chest
Distortion of underlying lungs, interpretation is difficult

25

Pectus excavatum

Depression in lower portion of sternum
Compression of heart and great vessels may cause murmurs

26

Pectus Carinatum

Sternum is displaced anteriorly, increasing AP diameter
Costal cartilages next to protruding sternum are depressed

27

Palpation

Tenderness
Pulsations
Bulges
Masses
Depressions
Crepitus
Pleural friction rub

28

Crepitus
Examples

Crackly, crinkly sensation can be felt or heard
Indicates air in soft tissues

Pneumothorax, infection

29

Is crepitus a normal finding?

No, always abnormal

30

Pleural friction rub
Example

Often heard before felt
Palpable, coarse, grating vibration
Usually on inspiration

Inflammation of pleurae

31

Tactile fremitus

Palpable vibration of chest from speech

32

Decreased or absent tactile fremitus

Emphysema
Pleural thickening
Effusion
Bronchial obstruction

33

Increased tactile fremitus

Lung consolidation
Large effusion
Tumor
Non obstructing bronchial secretions

34

Where do you check chest expansion posteriorly?

T10

35

Where is fremitus normally more prominent?

Interscapular area than lower lung fields
Right than left

36

Where do you check chest expansion anteriorly?

Thumbs along costal margin and xiphoid process

37

Examples of deviated trachea

Tension pneumothorax
Tumor
Nodal enlargement
Large effusion
Thyroid enlargement
Severe parenchymal or pleural fibrosis

38

Percussion

Compare all areas bilaterally, from superior to inferior and medial to lateral, systematically

39

How do you position a patent for percussion?

Posterior - flex head with arms folded in front
Anterior lateral - raise arms

40

What area on the chest do we percuss, over ribs or intercostals?

Intercostal spaces

41

Normal lungs should sound... on percussion

Resonant

42

Hyperresonant lungs examples

COPD
Pneumothorax
Asthma

43

Dull lungs examples

Atelectasis
pleural effusion
Consolidated lung
Tumor
Organ

44

Which diaphragm is usually higher?

Right side

45

What conditions limit diaphragmatic excursion?

Emphysema
Ascites
Rib fracture
Piaphragmatic paralysis (phrenic nerve injury)
Large effusion
Tumor

46

What is the normal diaphragmatic excursion?

About 5 cm

47

How should a patient breath for auscultation?

Slow, deep breaths through the mouth

48

What do we caution the patient of with auscultation?

Go slow, don't hyperventilate

49

Which side of the stethoscope do we auscultate the lungs with?

Diaphragm - can hear higher pitched sounds better, and is wider than the bell

50

Auscultation

Listen systematically from side to side for comparison, starting at apex

51

What are we evaluating during auscultation?

Intensity
Pitch
Quality
Duration

52

How do inspiration and expiration duration usually compare?

Equal

53

Vesicular

Heard over most lung fields
Low pitched, soft
Fade away 1/3 through expiration

54

Bronchovesicular

Medium pitch
Inspiration and expiration are equal in length
Heard over main bronchus and R posterior lung field

55

Bronchial (tubular)

Louder, harsher, higher in pitch
Expiration lasts longer, short silence between
Heard over trachea, consolidation, large effusion

56

Where is it abnormal to hear bronchovesicular and bronchial lung sounds?

Periphery of lungs

57

Amphoric breath sounds

Resembles blowing mouth across open bottle
Heard with large pulmonary cavity (blebs with emphysema) or tension PTX with bornchopleural fistula

58

Decreased breath sounds

Fluid in pleural space
Secretions in airways
Severe emphysema

59

Increased breath sounds

Consolidated lung
Large effusion
Empyema
Large tumor

60

Adventitious breath sounds

Crackles, rales
Rhonchi
Wheeze
Pleural/friction rub
Stridor

61

When are crackles usually heard?

Inspiration

62

Are crackles continuous or discontinuous?

Discontinuous, lasting only few miliseconds

63

What can we do to demonstrate what crackles sound like?

Rubbing hair between thumb and forefinger

64

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

65

Fine crackles
Example

High pitched, short in duration, wet
CHF

66

Coarse crackles
Example

Low pitched, longer in duration, dry
Pneumonia

67

Examples of crackles

Interstitial lung disease
Pulmonary fibrosis
Pneumonia
Atelectasis
Bronchiectasis
ARDS
Pulmonary edema

68

Are rhonchi continuous or discontinuous?

COntinuous

69

What do rhonchi sound like?

Low pitched rumbling or gurgling sounds

70

What causes rhonchi?

Passage of air through larger airways that are obstructed by fluid or mucous

71

What can clear rhonchi?

Cough

72

What is the death rattle?

When rhonchi is heard in agonal states

73

What are some examples of when patients develop rhocnhi?

Patient can't control secretions
Tracheobronchitis
Pneumonia
Bronchial obstruction
Foreign body

74

What do wheezes sound like?

High pitched, whistle like

75

What causes wheezes?

Turbulent air and vibration of the airway walls in which there is partial obstruction to airflow

76

Are wheezes continuous or discontinuous?

Continuous

77

When do you usually hear wheezes, inspiration or expiration?

Expiration

78

Examples of wheezes

Bronchospasm
Asthma
Neoplasm
Edema (CHF)
Foreign body

79

Where does a pleural friction rub occur?

Outside of the respiratory tree

80

What causes a pleural friction rub?

Inflamed pleurae rubbing against each other with respiration

81

Is a pleural friction rub continuous or discontinous?

Discontinuous

82

What does a pleural friction rub sound like?

Dry, crackly, grating, low pitched
New leather rubbing together
Crunching of snow underfoot

83

How do you differentiate between a pleural and pericardial rub?

Have patient hold breath - pericardial rub persists

84

What does stridor sound like?

High pitched

85

Is stridor heard during inspiration or expiration?

Inspiration

86

Is stridor continuous or discontinous?

Continuous

87

Stridor examples

Malignancy
Laryngeal obstruction
Eplglottitis
Foreign body
Tracheal stenosis
Laryngomalacia
Croup

88

Vocal resonance

Vocalizations are transmitted through the respiratory tree

89

Where are whispered words heard in a normal lung?

Faint and syllables are not distinct except over main bronchi

90

When do you evaluate vocal resonance?

If abnormalities are detected on percussion, palpation, or auscultation

91

What are the vocal resonance tests?

Bronchophony
Egophony
Whispered pectoriloquy

92

Bronchophony example

Loudness of vocalization increased due to pulmonary consolidation or large effusion

93

Egophony example

EEE turns to AAA with nasally quality
Heard with pleural effusion or consolidation

94

Whispered pectoriloquy example

Whispered words are clearly audible
Consolidation, pulmonary infarction, atelectasis