Thorax and Lungs

Question 1

sternal angle/angle of louie

Answer 1

horizontal bridge joining the manubrium to the body of the sternum T4/T5

Question 2

physical landmarks for lungs

Answer 2

Apex: 2-4 cm above clavicle

Lower border: 6th rib MCL, 8th rib midaxillary line,
T10 posterior

Question 3

right bronchus v. left bronchus

Answer 3

right bronchus is wider, shorter and more vertical, more susceptible to aspiration of FB

Question 4

What may cause an increase in AP diameter?

Answer 4

aging, chronic obstructive pulmonary disease (emphysema, chronic bronchitis)

Question 5

Stridor

Answer 5

a wheeze that is high pitched &largely inspiratory, usually louder in the neck. Results from turbulent airflow in upper airway. Indicates laryngeal/upper airway obstruction

Question 6

What are some possible signs of COPD?

Answer 6

Clubbing of the fingers-fingertips spread out and become rounder

pursed lip breathing- reduces respiratory rate, increased tidal volume

Question 7

Why do we percuss the lungs?

Answer 7

to determine if underlying tissues are air-filled, fluid or solid. Also detects areas of tenderness

resonance over air, dullness over solid or fluid filled areas

Question 8

hyper-resonant percussion tone

Answer 8

very loud, low pitch

ex. emphysematous lungs (diffuse) pneumothorax (local)

Question 9

resonant percussion tone

Answer 9

loud, low pitch

ex. healthy lungs

Question 10

tympanic percussion tone

Answer 10

loud, high pitch

ex. gastric bubble, puffed out cheek

Question 11

Dull percussion tone

Answer 11

soft-moderate intensity, moderate-high pitch

ex. liver, consolidation (pna), pleural effusion

Question 12

Flat percussion tone

Answer 12

soft, high pitch

ex. muscle, consolidation (pna), pleural effusion

Question 13

What side of the stethoscope should you use to auscultate the lungs?

Answer 13

diaphragm

listen for one full breath at each area

Question 14

Where can you heard bronchial breath sounds?

Answer 14

over the manubrium

suspect fluid filled lung if heard at a distant location

Question 15

Where can you hear bronchovesicular breath sounds?

Answer 15

in 1st and 2nd interspaces anteriorly and between scapula posteriorly

suspect fluid filled lung if heard at a distant location

Question 16

Crackles (rales)

Answer 16

discontinuous high pitched, caused by “popping open” of small airways & alveoli that have collapsed. Fluid in the lungs can cause this

Question 17

Rhonchi

Answer 17

snoring quality (coarse, low pitch) , caused by airway secretion & narrowing/partial obstruction

may clear with cough

Question 18

Wheeze

Answer 18

high pitched, whistle, caused by airway obstruction

Question 19

Biot’s

Answer 19

irregular breathing with long periods of apnea

causes: increased ICP, drug induced respiratory depression, brain damage

Question 20

Cheyne-stokes

Answer 20

irregular breathing with intermittent periods of increased and decreased rates and depths of breathing alternating with periods of apnea

causes:drug induced respiratory depression, brain damage, CHF

Question 21

Kussmaul’s

Answer 21

fast and deep pattern of breathing

causes: metabolic acidosis

Question 22

Atelectasis

Answer 22

loss of air from lung or collapse of lung tissue with reduced lung volume, can result from blockage of air passages with mucus or from pleural effusion

Question 23

Tension pneumothorax

Answer 23

large amount of air entering the chest when a one-way valve (air in) is formed by an area of damaged tissue

Question 24

Pneumonia/consolidation

Answer 24

pneumonitis (inflammation of the lung) usually due to infection but sometimes has noninfectious cause; has the addition feature of pulmonary infiltrates/consolidation

Question 25

consolidation

Answer 25

lung tissue becomes firm and solid due to accumulated fluids & tissue debris

Question 26

pulmonary infiltrate

Answer 26

filling of the air spaces with fluid, can cause consolidation

Question 27

Pleural effusion

Answer 27

collection of fluid in the pleural space

Question 28

hemothorax

Answer 28

blood in the pleural space

Question 29

empyema

Answer 29

pus in the pleural space, usually results from infection that spread from the lungs

Question 30

Pleurisy/Pleuritis

Answer 30

inflammation of the pleura

Question 31

Acute bronchitis

Answer 31

inflammation of the bronchi (no involving the lungs, bronchi are considered part of the upper airway

Question 32

Asthma

Answer 32

obstructive airway disease bronchial tubes are hyper-responsive, airways become inflamed & produce excess mucous, muscles around the airway tighten making the airways narrower, which obstructs breathing

Question 33

COPD

Answer 33

associated with airway resistance & RV even after full expiration, can result in hyper inflated lungs

Question 34

Pleural friction rub

Answer 34

squeaking or grating sound of the pleural lines rubbing together, associated with pleurisy. Heard on inspiration & expiration

Question 35

Crepitus

Answer 35

palpable grating or crunching, can occur with rib movement due to fracture

Question 36

What does tactile fremitus look for?

Answer 36

consolidation- vibrations transmitted through the bronchopulmonary tree palpate "99" increased fremitus = consolidation decreased fremitus = air/effusions

Question 37

What can coarse crackles be indicative of?

Answer 37

airway disease such as damage to bronchi

Question 38

Stridor

Answer 38

a wheeze that is high pitched & largely inspiratory, usually louder in the neck results from turbulent airflow in the upper airway

Question 39

Mediastinal crunch (Hamman sign)

Answer 39

loud crackles, clicks and gurgling sounds due to pnuemo-mediastinum synchronous with heart beat

Question 40

How can you perform a clinical PFT?

Answer 40

ask pt to walk down hall or climb one flight of stairs, observe rate and effort

Question 41

How can you test forced expiratory time?

Answer 41

ask pt to "blow out the candles" >6 seconds suggests obstructive pulmonary disease

Question 42

Why would you auscultate during forced exhalation?

Answer 42

may allow faint wheezes to be heard better

Question 43

What would pna do to tactile fremitus? percussion?

Answer 43

increased tactile fremitus percussion would be dull

Question 44

What breath sounds would you hear on a pt with pna? voice sounds? Adventitious sounds?

Answer 44

bronchial increased voice sounds crackles

Question 45

What breath sounds would you hear on a pt with COPD ? voice sounds? Adventitious sounds?

Answer 45

diminished breath sounds decreased voice sounds may hear wheeze or rhonchi

Question 46

What breath sounds would you hear on a pt with pleural effussion? voice sounds? Adventitious sounds?

Answer 46

diminished breath sounds decreased voice sounds may hear pleural friction rub

Question 47

Tactile fremitus for pt with COPD? percussion sounds?

Answer 47

decreased tactile fremitus hyper-resonant percussion

Question 48

Tactile fremitus for pt with pleural effusion? percussion sounds?

Answer 48

decreased or absent tactile fremitus dull or flat