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Physical Diagnosis > Thorax and Lungs > Flashcards

Thorax and Lungs Flashcards

1
Q

loud intensity, low pitch, e.g., normal lung

A

resonance

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2
Q

very loud intensity, low pitch, e.g., fully inflated lung

A

hyperresonance

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3
Q

Emphysema, unilateral - pneumothorax, sometimes asthma

A

hyperresonance

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4
Q

loud intensity, high pitch, e.g., gastric bubble/puffed out cheek

A

tympany

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5
Q

Cavity or large pneumothorax

A

tympany

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6
Q

Medium intensity, medium pitch e.g., liver

A

dullness

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7
Q

Lobar pneumonia, atelectasi

A

dullness

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8
Q

soft intensity, high pitch, e.g., thigh

A

flatness

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9
Q

Pleural effusion

A

flatness

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10
Q

Classification of normal breath sounds

A

Location
Pitch
Intensity
Timing in respiratory cycle

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11
Q

Vesicular Breath Sound - inspiration

A

Inspiration normally 2-3 times expiration

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12
Q

Vesicular Breath Sound - where

A

everywhere on the thoracic wall across the lung

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13
Q

Vesicular Breath Sound - sound characteristics

A

low pitched, soft rustling sound

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14
Q

Bronchial Breath Sound - breath sounds

A

Inspiration/expiration equal, with pause between inspiration and expiration

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15
Q

Bronchial Breath Sound - where

A

over the manubrium of the sternum

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16
Q

Bronchial Breath Sound - sound characteristics

A

high pitched, tubular, hollow sound

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17
Q

Tracheal Breath Sound - breath sounds

A

Equal inspiration/expiration with a pause in between

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18
Q

Tracheal Breath Sound - where

A

over the trachea on the throat

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19
Q

Tracheal Breath Sound - sound characteristics

A

high pitched, very loud, harsh

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20
Q

Bronchovesicular Breath Sound - breath sound

A

Equal inspiration & expiration

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21
Q

Bronchovesicular Breath Sound - where

A

Often in the 1st and 2nd interspaces anteriorly and between scapula

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22
Q

Bronchovesicular Breath Sound - sound characteristics

A

intermediate pitched, intermediate sound

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23
Q

needle insertion for tension pneumothorax

A

2nd intercostal space, midclavicular line - anterior chest wall

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24
Q

chest tube insertion

A

4th intercostal space, anterior axillary line

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25
Q

thoracentesis to remove blood or pus

A

T7-T8 intercostal space - posterior chest wall

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26
Q

NV structures along _____ margin of each rib

A

NV structures along inferior margin of each rib

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27
Q

Lung anatomy - apex

A

2-4 cm above inner 3rd of clavicle

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28
Q

Lung anatomy - lower border

A

T10 spinous process and descends of inspiration

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29
Q

Lung anatomy - oblique fissure

A

T3 down and around to 6th rib at midclavicular line

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30
Q

Right main stem bronchus is ______ and more ______ than L main

A

Right main stem bronchus is shorter and more vertical than L main

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31
Q

Which lung is aspiration pneumonia more common in?

A

RUL/RML

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32
Q

Where is gas exchange in the lungs?

A

alveoli

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33
Q

accumulation of pleural fluid

A

pleural effusion

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34
Q

pleural transudate

A

heart failure, cirrhosis, nephrotic syndrome

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35
Q

pleural exudate

A

pneumonia, malignancy PE, TB, pancreatitis

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36
Q

Likely cause if finger pointing to one sport with chest pain

A

musculoskeletal pain

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37
Q

Likely cause if hand moving from neck to epigastrium with chest pain

A

heartburn

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38
Q

Likely cause if clenched fist over sternum with chest pain

A

angina pectoris

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39
Q

Lung tissue has no ___ _____ – pain from _______ due to inflammation of parietal _______

A

Lung tissue has no pain fibers – pain from inflammation due to inflammation of parietal pleura

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40
Q

telltale sign of cardiac and pulmonary disease

A

dyspnea - shortness of breath

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41
Q

partial lower airway obstruction

could be due to asthma or foreign body

A

wheezing

42
Q

reflex to irritating stimuli

A

cough

43
Q

most common cause of cough

A

viral URI

44
Q

foul smelling sputum is likely s/s of

A

anaerobic lung abscess

45
Q

thick sputum likely s/s of

A

cystic fibrosis

46
Q

fever and productive cough likely a s/s of

A

pneuomonia

47
Q

cough and wheeze likely s/s of

A

asthma

48
Q

cough plus chest pain, dyspnea, orthopnea likely s/s of

A

acute coronary syndrome

49
Q

Blood coughed up or blood streaked sputum

A

hemoptysis

50
Q
  • Quantify volume of blood produced and setting
  • Rule out malignancy!
  • May originate in mouth, nose, pharynx, GI tract
A

hemoptysis

51
Q

breathing cessation >10seconds, awakening with chocking sensation or morning headache

A

apnea

52
Q

Common in obesity and related disorders

A

Daytime Sleepiness/Snoring/Disordered Sleep

53
Q

IPPA

A

inspect
palpate
percuss
auscultate

54
Q

Tachypnea >25 breaths/min

Cyanosis/pallor

Audible high pitched whistling (stridor) – OMINOUS SIGN of upper airway obstruction

Accessory muscle use? SCM, scalene

Observe shape of chest – normally wider than deep

A

signs of respiratory distress

55
Q

Audible high pitched whistling

A

stridor

56
Q

OMINOUS SIGN of upper airway obstruction

A

stridor

57
Q

Deformities or asymmetry in expansion on posterior wall

A

large pleural effusion

58
Q

Compression of heart and great vessels may cause murumurs

A

pectus excavatum

59
Q

Normal in infancy, seen in aging and COPD

A

barrel chest

60
Q

Anteriorly displaced sternum

Costal cartilages adjacent are depressed

A

pectus carinatum

pigeon chest

61
Q

Due to rib fractures – caves inward on inspiration, outward on expiration

A

traumatic flail chest

62
Q

Abnormal spinal curvature and vertebral rotation

Underlying lungs distorted – makes interpretation of findings difficult

A

thoracic kyphoscoliosis

63
Q

Loss of symmetry during lung exclusion on posterior chest wall - possible causes

A

fibrosis, effusion, pneumonia, bronchial obstruction, paralysis of hemidiaphragm, phrenic nerve issue

64
Q

Palpable vibrations transmitted through the bronchopulmonary tree to chest wall as patient speaks

A

tactile premitus on posterior chest wall

65
Q
  • Either bony part of palm at base of fingers or ulnar surface of hand
  • Ask patient to say “99” or “one-one-one”
A

how to palpate for tactile fremitus on posterior chest wall

66
Q

More prominent over interscapular area and over R lung vs the left

A

tactile fremitus on posterior chest wall

67
Q

Asymmetric decreased tactile fremitus

A

Pleural effusion, pneumothorax, neoplasm

68
Q

Asymmetric increased tactile fremitus

A

pneumonia

69
Q

Sets chest wall and underlying structure into motion

Establish whether tissues are air filled, fluid filled, or consolidated (solid)

Only penetrates 5-7cm into chest

A

percussion

70
Q

Healthy lungs on percussion exam - posterior chest wall

A

resonant

71
Q

fluid/solid on percussion exam - posterior chest wall

A

dullness

72
Q

hyperresonance on percussion exam - posterior chest wall

A

COPD/asthma

73
Q

distance between dullness on full expiration and dullness on full inspiration

A

Estimate of diaphragmatic excursion on posterior chest wall

74
Q

Air flow decreased on breath sound auscultation

A
  • Muscular weakness
  • Obstructive lung disease
  • Shallow from pain
75
Q

Transmission is poor on breath sound auscultation

A
  • Pleural effusion

- Pneumothorax

76
Q

added sounds super-imposed on usual breath sounds

A

adventitious sounds

77
Q

types of adventitious sounds

A
  1. Crackles- AKA rales
  2. Wheezes
  3. Rhonchi
78
Q
  • Results from air bubbles flowing through secretions or lightly closed airways during respiration.
  • Result from series of tiny explosions when small airways, deflated during expiration, pop open during inspiration.
A

rales/crackles

79
Q
  • Discontinuous, heard usually during inspiration
  • Indicate abnormalities in lung
  • NOT CLEARED BY A COUGH
A

rales/crackles

80
Q

2 types of rales/crackles

A
  • Fine - soft, and high-pitched, brief

- Coarse - louder, lower in pitch, longer

81
Q

high pitch, shrill, hissing quality

A

wheezing

82
Q

Continuous, heard either inspiration or expiration

A

wheezing

83
Q 
Suggest narrowed airways:
Asthma
Bronchitis
COPD
Unilaterally 
possibly foreign body or tumor
A

wheezing

84
Q

low pitch, snoring quality, rumbling

A

rhonchi

85
Q

Usually through expiration, prolonged and continuous

A

rhonchi

86
Q

Air passing over secretion such as mucous plugs:
Asthma
Bronchitis
COPD

A

rhonchi

87
Q
  • Machine-like quality
  • Heard during inspiration and expiration
  • Caused by inflamed, rough surfaces rubbing together
A

friction rub

88
Q
  • AKA Hamman sign
  • Found with mediastinal emphysema (air in mediastinum)
  • Variety of noises synchronous with heart beat, not with respiration
A

mediastinal crunch

89
Q

friction rub over lungs

A

pleurisy

90
Q

friction rub over heart/pericardium

A

pericarditis

91
Q
  • alveoli are filled with fluid/debris in (consolidation)
  • bronchial breath sounds replace normal vesicular sounds in areas where there is no longer any air
  • Increased voice sounds – loss of airflow
A

lobar pneumonia

92
Q

Decreased/absent transmitted voice sounds

A

Pleural effusion (dull lung) or hyperinflated lung (hyperresonant)

93
Q
  • ask patient to say “ee”

- If abnormal “ee changes to A”

A

egophony

94
Q

if “ee” changes to “aay” during egophony then what is likely cause

A

lobar consolidation from pneumonia

95
Q
  • ask patient to say “ninety nine”

- Voice travels better through something solid

A

broncophony

96
Q

If ninety nine is heard during broncophony, there is loss of airspace - what are you worried about

A

worried about consolidation

97
Q

ask patient to whisper “99” – usually faint

A

whispered pectorilogy

98
Q

If whispered ninety nine is loud during whispered bronchoscopy, there is loss of airspace - what are you worried about

A

whispered pectorilogy

99
Q

during percussion of anterior chest - dullness over heart from __ to __ interspaces on the left

A

during percussion of anterior chest - dullness over heart from 3rd to 5th interspaces on the left

100
Q

_________ lung may displace upper border of liver downward

A

Hyperinflated lung may displace upper border of liver downward

Physical Diagnosis (2 decks)

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