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Physical Diagnosis > PD Thorax and Lungs > Flashcards

PD Thorax and Lungs Flashcards

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1
Q

What are the imaginary lines on the anterior thorax?

A

Midsternal

Midclavicular

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2
Q

What are the imaginary lines on the lateral thorax?

A

Anterior and posterior axillary

Midaxillary

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3
Q

What are the imaginary lines on the posterior thorax?

A

Scapular

Vertebral

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4
Q

At what levels anteriorly and posteriorly does the carina sit?

A

Sternal angle and T4

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5
Q

What fissure do both lungs have?

A

Oblique major fissure

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6
Q

Where is the oblique fissure located?

A

T3 to 6th rib anteriorly

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7
Q

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

A

Right lung has a horizontal fissure

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8
Q

Where is the horizontal fissure located?

A

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

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9
Q

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

A

Anteriorly 6th rib midclavicular and 8th rib midaxillary

Posteriorly T10

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10
Q

What are the stimuli for breathing?

A

Chemoreceptors in medulla sensitive to changes in H concentration
Chemoreceptors in carotid body respond to changes in arterial oxygen and CO2 concentrations

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11
Q

Which organ regulates respiratory muscles?

A

Pons

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12
Q

What is the primary muscle of respiration?

A

Diaphragm

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13
Q

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

A

Parasternal
Scalenes
SCM
Abdominal muscles

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14
Q

What are the chief pulmonary complaints?

A 
Chest symptoms
Dyspnea
Wheezing
Cough
Hemoptysis
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15
Q

How should the patient be positioned to inspect them?

A

Sitting and supine, properly draped or exposed

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16
Q

What do we observe about respirations?

A 
Rate
Rhythm
Depth
Effort
Pattern
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17
Q

Color

A

Cyanosis

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18
Q

Listen

A

Wheezing
Stridor
Where in respiratory cycle?

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19
Q

Inspection

A 
Accessory muscle use
Retraction
Nasal flaring
Pursed lips
Trachea midline
Shape of chest - deformity, asymmetry
Movement of chest - unilateral lag
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20
Q

Supernumerary nipples

A

Associated with congenital heart disease

Polythelia

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21
Q

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

A

Place finger in sternal notch and slip to each side

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22
Q

Barrel chest

Examples

A

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

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23
Q

Kyphosis

A

Anterior chest wall collapse

May make interpretation of lung findings difficult

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24
Q

Kyphoscoliosis

A

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

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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

Physical Diagnosis (10 decks)

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