Phsyical assessment of Pulmonary system lecture Flashcards Preview

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Flashcards in Phsyical assessment of Pulmonary system lecture Deck (37):
1

which of the 4 cornerstones are used in the pulmonary exam?

Inspection
palpation
percussion
auscultation

2

Where can we get the closest to the lung tissue?

the intercostal space

3

What is a good starting point for determining clinical anatomy?

suprasternal notch

4

What is located 5cm below the suprasternal notch?

the sternal angle (angle of Louis)

5

What intercostal space is located at the same level and the sternal angle?

2nd

6

What is marker for the beginning of the posterior chest wall?

the C-7 spinous process.

7

Which lobes can you auscultate anteriorly?

RUL, RML, LUL

8

Where can you auscultate the Lower Lobes anteriorly?

LLL and RLL are located at the costophrenic angle

9

What lobes can you osculate posteriorly?

LLL and RLL (uppers as well)

10

systemic signs of pulmonary dz.

cyanosis
clubbing
barrel chest
tripod position

11

signs of respiratory distress

Rate and effort
accessory muscle use
Unusual respiratory noises

12

What do you inspect anteriorly?

trachea midline
obvious deformities
asymmetry
trauma

13

pectus carinatum

pigeon chest (convex)

14

Pectus excavatum

funnel chest (concave)

15

Pectus excavatum

funnel chest (concave)

16

inspection of posterior chest

deformities
asymmetry
abnormal retractions

17

Palpation of chest

Any abnormalities seen on inspection.
Symmetric chest expansion

18

causes of asymmetric chest expansion

pna
bronchial obstruction
pleural effusion
pain (splinting

19

Decreased tactile fremitus indicates

bronchial obstruction
pleural effusion
Pleural fibrosis
COPD
PTX
tumor
unusual thick chest wall

20

Increased tactile fremitus indicates:

pneumonia

21

percussion note for pleural effusion

dull/flat depending on size

22

Percussion note for consolidation (edema/pna)

dull over area of decreased aeration

23

percussion note for atelectasis

dull over atelectasis

24

percussion note for normal lung tissue

resonant

25

percussion note for ptx

hyperresonant or tympanic if large

26

percussion note for COPD

hyperresonant diffusely

27

percussion note for Asthma

hyperresonant

28

what 3 things are you listening for on ausculation?

Lung sounds
Presence of adventitious sounds
when abnormal-sound of whispered word

29

What must you ALWAYS ask pt to do when auscultating?

breathe through mouth.

30

Vesicular sounds

soft and low
throughout inspiration but fade after 1/3 expiration.
throughout lungs

31

Bronchovesicular sounds:

Louder than vesicular sounds
Heart equally insp. and exp. usually separated by interval
Heart best at 1 and 2 ICS anterior, and between scap posterior

32

Bronchial sounds:

very loud high pitched sounds
Exp sounds longer
heart best over manibrium

33

3 types of adventitious sounds

Rhonchi
Wheezes
Crackles (Rales)

34

Rhonci

low pitched - snoring/geese honking-secretions in large airways

35

Wheezes

High pitched, shrill, inspiratory/expiratory, assoc. w/ asthma, COPD, bronchitis
Stridor-long inspiratory wheeze

36

Crackles

fine-high pitched brief duration (suddenly pop open during late inspiration!!
Coarse-Low pitched louder longer duration-alveoli bubbles through secretions early inspiration!!
NOTE WHAT PHASE OF BREATHING YOU HEAR THE CRACKLES!

37

Pleural friction rub

inflamed pleural spaces