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H&P exam 2 > Thorax and Lung > Flashcards

Thorax and Lung Flashcards

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1
Q

Pleuritic/pleurisy

A

Pain with breathing

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2
Q

Lung fields vs lobes

A

Lung fields= 6 regions (upper/middle/lower right/left)

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3
Q

At what spinal level does the trachea bifurcate?

A

T4, at the sternal angle

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4
Q

Visceral pleura

A

covers outer surface of lungs

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5
Q

Parietal pleura

A

lines inner rib cage and upper surface of the diaphragm

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6
Q

Thorax and lung physical exam

A

inspect palpate percuss auscultate

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7
Q

A-P diameter- barrel chest

A

AP diameter increased

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8
Q

A-P diameter normally

A

Thorax normally 2x wider than it is deep May increase with aging and COPD (i.e. emphysema, chronic bronchitis, etc)

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9
Q

Kyphosis

A

Hunch back

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10
Q

Pectus excavatum

A

Sternum caved in, ribs on either side are higher

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11
Q

Pectus Carinatum

A

Sternum protrudes

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12
Q

stridor

A

a wheeze that is high pitched and largely inspiratory; usually louder in the neck

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13
Q

What does stridor indicate

A

laryngeal/upper airway obstruction (can be associated with epiglotitis, foreign body aspiration

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14
Q

Schamroth’s sign

A

Clubbing Possible sign of COPD

reduces respiratory rate from 20 to 12-15 breaths/min, increases tidle volume, decreases PaCO2, increases PaO2

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15
Q

How do you check chest expansion?

A

Place thumbs at the level of the 10th ribs, fingers parallel to lateral rib cage.

Unilateral decrease/delay in expansion= fibrosis, pleural effusion, possibly lobar pneumonia

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16
Q

What is the purpose of percussion?

A

To determine if underlying tissues are air filled, fluid or solid

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17
Q

When would you use the direct technique vs indirect for percussion?

A

direct- over spine and kidneys (CVA) to check for tenderness

indirect- check for degree of resonance of lung

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18
Q

What should chest percussion sound like?

A

resonance= air

dullness= solid/fluid filled areas

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19
Q

Percussion tones- hyper-resonant

A

intensity= very loud

pitch= low

examples: Emphysema, local pneumothorax

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20
Q

Percussion tones- resonant

A

intensity= loud

pitch= low

example= healthy lungs

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21
Q

Percussion tones- Tympanic

A

intensity= loud

Pitch= high

example= gastric bubble (or puffed out cheek)

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22
Q

Percussion tones- Dull

A

intensity- soft- moderate

pitch- moderate-loud

example: liver, consolidation (pneumonia), pleural effusion

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23
Q

Percussion tones- flat

A

intensity- soft

pitch- high

ex: muscle, consolidation (PNA), pleural effusion

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24
Q

What are the required number of levels for auscultation/percussion of the anterior and posterior chest

A

anterior- 3

posterior- 4 + 1 lateral site on each side

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25
What is the purpose of auscultation?
To determine whether there is normal airflow, airway obstruction or abnmormal air or fluid w/in the chest or lungs
26
Do you use the bell or diaphragm when auscultating the lungs?
Diaphragm
27
Locations or normal breath sounds
bronchial is over trachea Bronchiovesicular is over main bronchi Vesicular is over lesser bronchi, bronchioles and lobes
28
Where do you hear bronchial breath sounds
over the manubriam if hear at distant location, suspect fluid filled lung
29
Where do you hear bronchovesicular breath sounds
in 1st and 2nd interspaces anteriorly and b/w scapula posteriorly if heard at distant location, suspect fluid-filled lung
30
tachypnea
fast, shallow breathing
31
hyperventilation
deeper, usually faster breathing
32
sighing
periodic deeper breaths
33
Biot's
Abnormal breathing pattern irregular breathing with long periods of apnea cause- increased intracranial pressure, drug induced respiratory depression, brain damage (usually at medullary level)
34
Cheyne strokes
abnormal breathing pattern irregular breathing with intermittent periods of increased and decreased rates and depths of breaths alternating with periods of apnea Causes: Drug induced respiratory depression, CHF, Brain damage (usually at the cerebral level)
35
Kussmaul's breathing pattern
Abnormal breathing pattern fast and deep cause: metabolic acidosis (seen in uncontrolled DM)
36
Pectus carinatum
37
Pectus excavatum
38
Kyphosis
39
Pleural friction rub
squeaking or grating sound of the pleural linings rubbing together =pleurisy Heard on inspiration AND expiration
40
Crepitus
Palpable grating or crunching ex: rib movement due to fx
41
What is tactile fremitus looking for
consolidation "99" increased fremitus (vibration)= consolidation/PNA b/c consolidation increases transmission decreased fremitus= air/effusions decrease transmission---\> ex pleural effusion, pneumo, COPD, fibrosis
42
Will tactile fremitus increase or decrease with a pneumothorax?
decrease
43
Will tactile fremitus increase or decrease with a pleural effusion
decrease
44
Will tactile fremitus increase or decrease with consolidation
increase
45
Will percussion be dull or resonant with pneumothorax?
resonant
46
Will percussion be dull or resonant with Pleural effusion
dull
47
Will percussion be dull or resonant with consolidation
dull
48
Bronchovesicular breath sounds
combination bronchial and vesicular, normal in some areas
49
Rhonchi
coarse low-pitched (snoring); may clear with cough continuous sound heard when patient is ill Caused by airway secretions and narrowing/partial obstruction (ex: bronchitis, COPD)
50
Wheeze
whistlig, high pitched bronchus- continuous ILL caused by airway obstruction (ex asthma)
51
Bronchial breath sounds
coarse, loud heard with consolidation ILL
52
Pleural friction Rub
scratchy, high pitched squeaking or grating sound of the pleural linings running together =pleurisy heard on inspiration and expiration ILL
53
Crackles
fine crackling, high pitched- discontinuous sounds ILL Caused by "popping open" of small airways and alveoli that have collapsed. Fluid in the lung can cause this Fine crackles- ex. interstitial process, can be normal medium crackles coarse crackles: airway dz such as damage to bronchi 0819
54
Crackles (rales), wheezes and rhonchi picture
55
Stridor
wheeze that is high pitched and largely inspiratory; usually louder in the neck Results from turbulent airflow in upper airway indicates: laryngeal/upper airway obstruction (ex: epiglotitis, aspiration)
56
Mediastinal crunch (Hamman sign)
Loud crackles, clicks and gurgling sounds due to pneumo mediastinum (mediastinal emphysema synchronous with heart beat not as common
57
What is broncophony, egophony, whispered pectoriloquy
looking for consolidation- solid transmits sound better than air
58
Bronchophony
"99" heard louder and clearer than normal even at dist. away from larynx occurs with consolidation- indicates presence of fluid or solid tissue in alveoli
59
Egophony
When voice sounds are louder, have a nasal quality and E sounds like A occurs with consolidation
60
Does consolidation increase or decrease transmission of sound/vibration?
consolidation INCREASES transmission air and effusions DECREASE transmission
61
Consolidation
condition in which lung tissue becomes firm and solid rather than elastic and air filled- usually due to accumulated fluids and tissue debris
62
Lung/pulmonary infiltrates
filling of the air spaces with fluid infiltrates can cause consolidation
63
Empyema
pus in pleural space usually results from infection that spreads from the lungs
64
pleurisy/pleuritis
inflammation of the pleura
65
Asthma
bronchial tubes are hyper responsive airways become inflamed and produce excess mucus muscles around the airways tighten, making the airways narrower--\> this obstructs breathing reversible
66
COPD
ex: emphysema associated with airway resistance and residual volume of air even after full expiration can result in hyperinflated lungs (and barrel chest) considered irreversible
67
How many seconds of forced expiratory time suggests COPD?
\>6 seconds
68
How to perform a PFT
ask pt to walk down hall and observe rate and effort
69
70
What adventitious sounds are heard with pneumonia/consolidation?
crackles

H&P exam 2 (6 decks)

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