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cpa > resp > Flashcards

resp Flashcards

1
Q

What position should you place someone in a resp exam?

A

45 degrees

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2
Q

What position should you place someone when examining posterior chest wall or lymph nodes?

A

Posterior chest wall - lean forwards
Lymph nodes - across the couch with legs dangling off

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3
Q

At what level does the trachea divide?

A

T4/T5

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4
Q

Where is the trachea palpated from and to?

A

Extends from larynx into thorax
palpated from larynx to suprasternal notch

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5
Q

What causes the trachea to displace towards the site of a lesion?

A
  • Upper lobe collapse
  • Upper lobe fibrosis
  • Pneumonectomy
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6
Q

What causes the trachea to displace away from the site of a lesion?

A
  • extensive pleural effusion
  • tension pneumothorax
  • chest expansion
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7
Q

How much do the tip of your thumbs move apart in normal chest expansion?

A

At least 5cm

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8
Q

At what level do you do chest expansion both anterior and posterior?

A

Anterior - below 5/6th rib
Posterior - 10th thoracic vertebrae

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9
Q

What does chest expansion in the front give you an idea about?

A

Expansion of upper and middle lobes (check for symmetry)

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10
Q

What does posterior chest expansion give you an idea about?

A

Expansion of lower lobes
(check for symmetry)

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11
Q

What are causes of unilateral decreased chest expansion?

A
  • Pneumothorax
  • Pleural effusion
  • Collapsed lung
  • consolidation
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12
Q

What are causes of bilateral decreased chest expansion?

A

Asthma or COPD (difficult to detect)

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13
Q

When percussing posterior chest wall what must you make sure the patient does?

A

Rotates scapulae anteriorly (crosses arms in front of themselves)

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14
Q

What are the causes of hyper-resonant sounds on chest percussion?

A
  • Pneumothorax
  • Hollow bowels
  • COPD
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15
Q

What are the causes of hypo-resonant sounds on chest percussion?

A
  • Pleural effusion (stony dull)
  • Lung tumour (flat/dull)
  • Consolidation (flat/dull)
  • Collapse (flat/dull)
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16
Q

What are the two types of sounds on airway auscultation?

A

Vesicular
Bronchial

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17
Q

What type of sounds are bronchial sounds and where can they be heard?
Where can they be listened to clinically?

A

High pitch notes

Over:
trachea
suprasternal notch
manubrium
sternal angle
sternoclavicular joints
(airways not covered by alveolar tissue)

Listened to
- anteriorly over manubrium
- posteriorly between C7 and T3 vertebrae

18
Q

What are the characteristics of bronchial breathing sounds?

A
  • Hollow and high pitched
  • Expiratory phase > inspiratory phase (time and intensity)
  • Distinct pause between inspiration and expiration
  • Heard over areas of pathology - consolidation, localised pulmonary fibrosis, pleural effusion and collapsed lung
    (indicates pathology if found outside of its normal anatomical areas)
19
Q

What are the characteristics of vesicular breathing sounds?

A
  • Low pitch notes present over area of healthy lung tissue
  • inspiratory sound = lobar/segmental airways
  • expiratory sound = central airways
  • Inspiratory phase > expiratory phase (time and intensity)
  • No pause in-between
20
Q

What causes reduction in the intensity of vesicular sounds?

A
  • shallow breathing
  • airway obstruction
  • pneumothorax
  • hyperinflation
  • pleural effusion
  • obesity
  • pleural thickening
21
Q

What causes prolongation of the expiratory phase in breathing?

A

Obstructive lung disease - asthma and chronic bronchitis

22
Q

How is the middle lobe and lower lobe of the lung accessed to listen to in females?

A

Middle lobe - below right axilla
Lower lobe - below base of breast at 6th rib level

23
Q

What are the sites of auscultation on the anterior chest?

A
  • Apex (supraclavicular - above 1st rib)
  • Infra clavicular
  • 2nd intercostal space
  • 6th intercostal space
  • Axilla (ask patient to raise arms and percuss in mid-axillary line)
24
Q

Where and what do you auscultate for at the hilum of the lung?

A

Mid point of scapular and posterior median line opposite the spines of T4-T6
Whether the sound is bronchial or vesicular

25
Q

What are the sites of auscultation on the posterior chest?

A

Level of trapezius
Level of spine of scapulae
Level of 10th/11th rib

26
Q

What causes a decrease in tactile vocal femitus?

A

Decrease in density
- air in pneumothorax
- COPD

Increase in distance between chest wall and lungs
- pleural effusion (due to fluid)

27
Q

What causes an increase in tactile vocal femitus?

A

Increased density
- consolidation in pneumonia
- tumour tissue in cancer

28
Q

What are the different lymph nodes to palpate ?

A

Submental
Submandibular
Preauricular
Post auricular
occipital
Superior deep cervical
Inferior deep cervical
Supraclavicular nodes

29
Q

What are causes of cervical lymphadenopathy?

A
  • lung cancer metastasising to lymph nodes
  • tuberculosis
  • sarcoidosis
  • respiratory tract infection
30
Q

What are the abnormal findings in a community acquired pneumonia respiratory examination?

A

Chest expansion - normal but gets sharp pain on deep inspiration

Percussion - dullness to percussion in right inferior axilla

Auscultation - vesicular breath sounds on left, crackles and reduced air entry in right inferior axilla (vesicular breathing sounds elsewhere on right)

Affects right lung more than left

31
Q

What can cause consolidation in the lungs? How does this appear on X-rays?

A

Things denser than air
- pus
- pulmonary oedema
- haemorrhage
- cancer

Appears as increased opacification

32
Q

What is the Air bronchogram sign?

A

In consolidated tissues, some airways are still filled with air
This appears darker and superimposed over increased opacification

33
Q

What is the silhouette sign?

A

Loss of a normal border of a structure on chest X-ray

34
Q

What is the triangle of safety for chest drains?

A

Base of axilla (top)
5th intercostal space (base)
Lateral edge of pectoralis major (anterior)
Lateral edge of latissimus dorsi (posterior)

35
Q

What is the outline for the pleura?

A

ANTERIORLY
- 1 inch above medial 3rd clavicle
- Sternoclavicular joint
- Manubriosternal joint - 2nd CC
- 4th rib or Rib 4-6 (cardiac notch (left only))
- 6th rib - Xiphesternal joint
- 8th rib on mid clavicular line

POSTERIORLY
- 10th rib at mid-axillary line
- 12th rib at scapular line
- L1 vertebrae , below 12th rib
- T1

36
Q

What is the outline for the lungs

A

ANTERIORLY
- 1 inch above medical 3rd clavicle
- Sternoclavicular joint
- Manubriosternal joint - 2nd CC
- Rib 4-6 = cardiac notch (left only)
- Xiphesternal joint
- 6th rib at mid-clavicular line

POSTERIORLY
- 8th rib at mid axillary line
- 10th rib at scapular line
- T10
- T1

37
Q

Where is the cardiac notch?

A

Rib 4-6 (left only)

38
Q

What are the surface markings for the bottom of the costal margin?

A
  • Tip of 9th rib where lateral border of rectus abdominis meets costal margin
  • 10th rib (lowest part of costal margin)
39
Q

What is the surface marking for the horizontal fissure of the lung?

A

4th rib

40
Q

What is the surface marking for the oblique fissure of the lung?

A

junction of 6th rib and mid clavicular line anteriorly
T3 level posteriorly

cpa (6 decks)

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