Week 4 Pulm Flashcards
1
Q
What is the thoracic cavity made up of?
A
12 pairs of ribs that connect to the vertebral bodies of the spinal column
2
Q
How are the first 7 pairs of ribs connected in the anterior thorax?
A
Attached to the sternum by cartilage
3
Q
What are the 11th and 12th ribs known as?
A
Floating ribs
4
Q
Where is the Sternal Angle located?
A
At the junction of the manubrium and sternum
5
Q
What does the Sternal Angle correspond to?
A
The level of the 2nd rib and bifurcation of the trachea
6
Q
What is the Midsternal Line?
A
A vertical line running down the center of the sternum
7
Q
Where is the Midclavicular Line (MCL) located?
A
Runs vertically through the midpoint of the clavicle
8
Q
What does the Anterior Axillary Line (AAL) represent?
A
Runs vertically along the anterior axillary fold
9
Q
What anatomical line runs vertically through the middle of the axilla?
A
Midaxillary Line (MAL)
10
Q
What is the Vertebral Line?
A
Runs down the middle of the spine
11
Q
What anatomical landmark runs vertically through the inferior angle of the scapula?
A
Scapular Line
12
Q
What is the anatomical location of the Right Upper Lobe (RUL) in the right lung?
A
Extends from the apex to about the 4th rib (anteriorly)
13
Q
Where is the Right Middle Lobe (RML) located?
A
Between the 4th and 6th ribs, medial to the midclavicular line
14
Q
What is the location of the Left Upper Lobe (LUL)?
A
Extends from the apex to the 6th rib
15
Q
What are the posterior lung fields dominated by?
A
Both Lower Lobes (RLL & LLL)
16
Q
At what level does the trachea bifurcate?
A
At the Sternal Angle (T4-T5 level)
17
Q
Which bronchus is shorter, wider, and more vertical?
A
Right Mainstem Bronchus
18
Q
What is the location of the diaphragm at rest?
A
Around the 5th rib anteriorly and T10 posteriorly
19
Q
What does the Visceral Pleura cover?
A
The lungs
20
Q
What is anatomical dead space?
A
Trachea and Bronchi where no gas exchange occurs
21
Q
Where are the upper lobes best heard during auscultation?
A
Anteriorly
22
Q
What is the most common cause of acute cough?
A
Upper Respiratory Tract Infections (URTIs)
23
Q
What are common viruses causing the Common Cold?
A
- Rhinovirus * Coronavirus * Adenovirus
24
Q
What are the symptoms of Acute Sinusitis?
A
- Facial pain * Purulent nasal discharge * Headache
25
What symptoms are associated with Influenza?
* Sudden fever * Myalgia * Fatigue * Cough
26
What is a key symptom of Pertussis?
Severe paroxysmal coughing fits
27
What is the cough mechanism for Postnasal Drip Syndrome?
Mucus irritation and stimulation of cough receptors
28
What symptoms indicate an asthma exacerbation?
* Cough * Wheezing * Dyspnea * Chest tightness
29
What can cause cough due to environmental exposure?
* Smoke inhalation * Air pollution * Strong odors
30
What is the cough mechanism for Gastroesophageal Reflux Disease (GERD)?
Acid irritation of the esophagus and microaspiration
31
What is a common cause of hemoptysis?
Acute Bronchitis
32
What can indicate severe or life-threatening hemoptysis?
Massive Hemoptysis (>600 mL/24 hr)
33
What is the distinguishing factor between true hemoptysis and hematemesis?
True hemoptysis is expectoration of blood from the lower respiratory tract
34
What does the Left Lower Lobe (LLL) cover laterally?
Covers the 6th to 8th rib
35
What are the symptoms of Chronic Obstructive Pulmonary Disease (COPD)?
* Persistent productive cough * Dyspnea
36
What is a key symptom of lung cancer?
* Chronic cough * Hemoptysis * Weight loss
37
What are common symptoms of lung cancer?
Chronic cough, weight loss, hemoptysis, history of smoking
## Footnote
Lung cancer is often associated with a history of smoking and presents with these key symptoms.
38
What is classified as massive hemoptysis?
Massive Hemoptysis (>600 mL/24 hr) requires immediate intervention
## Footnote
This volume indicates a life-threatening situation that necessitates urgent medical care.
39
What are the key sputum characteristics and symptoms for pneumonia?
Rust-colored or blood-tinged sputum; fever, productive cough, pleuritic chest pain
## Footnote
These symptoms help differentiate pneumonia from other causes of hemoptysis.
40
When should serious causes of hemoptysis be suspected?
Persistent hemoptysis >1 week, large-volume hemoptysis (>100 mL per episode), hemoptysis with weight loss, night sweats, associated chest pain, dyspnea, history of smoking or occupational exposure
## Footnote
These factors significantly increase the risk of serious underlying conditions.
41
What is the first-line diagnostic tool for pneumonia?
Chest X-ray
## Footnote
Chest X-ray is critical for initial assessment of pneumonia and other respiratory conditions.
42
What are the normal respiratory rates for adults?
12-20 breaths per minute
## Footnote
This range is considered normal for adult respiratory rates.
43
What does increased tactile fremitus indicate?
Pneumonia, lung consolidation
## Footnote
Increased fremitus suggests denser lung tissue as seen in pneumonia.
44
What are the characteristics of central cyanosis?
Bluish discoloration of lips, tongue, mucous membranes; caused by low arterial oxygenation (PaO₂ < 85%)
## Footnote
Central cyanosis indicates systemic hypoxia and can be caused by severe pulmonary diseases.
45
What causes clubbing of nails?
Chronic hypoxia, lung disease, heart disease, GI disorders
## Footnote
Clubbing is often associated with conditions that cause prolonged low oxygen levels.
46
What are the symptoms of a panic attack?
Chest tightness, palpitations, hyperventilation, fear of dying
## Footnote
These symptoms are indicative of a psychological cause of chest pain.
47
What is the mechanism behind myocardial infarction (MI)?
Ischemia due to coronary artery occlusion
## Footnote
MI occurs when blood flow to part of the heart is blocked, leading to tissue damage.
48
What are the normal breath sounds over the trachea?
Bronchial breath sounds; high-pitched, loud, with expiration longer than inspiration
## Footnote
Abnormal bronchial sounds heard in lung fields suggest consolidation.
49
What are the signs of respiratory distress that indicate accessory muscle use?
Recruitment of muscles beyond the diaphragm, such as sternocleidomastoid and scalene muscles
## Footnote
Accessory muscle use suggests increased work of breathing in conditions like COPD or asthma.
50
What is the significance of pink frothy sputum?
Indicates pulmonary edema due to severe congestive heart failure
## Footnote
The presence of pink frothy sputum is a classic sign of pulmonary edema.
51
What are the symptoms of croup in children?
Barking cough, inspiratory stridor
## Footnote
Croup is typically caused by viral infections and presents with distinctive respiratory symptoms.
52
What is the mechanism of pleuritis?
Inflammation of the pleura, often due to viral infection
## Footnote
Pleuritis can cause sharp, localized pain that worsens with breathing.
53
What does the presence of dullness on percussion indicate?
Pneumonia, pleural effusion, tumor
## Footnote
Dullness suggests fluid or solid tissue in the lung fields.
54
What does a high-pitched inspiratory sound indicate?
Stridor, suggesting upper airway obstruction
## Footnote
Stridor is a critical sign that requires immediate evaluation and intervention.
55
What are the common causes of retractions during breathing?
Airway resistance, severe lung disease
## Footnote
Retractions reflect increased effort to breathe due to compromised airflow.
56
What is the significance of a sudden onset tearing pain radiating to the back?
Aortic dissection
## Footnote
This symptom is a classic presentation that requires urgent medical evaluation.
57
What is tubular sound and when is it considered abnormal?
Normal over trachea but abnormal if heard in lung fields (suggests consolidation, as in pneumonia).
58
Where are bronchovesicular breath sounds located?
Mainstem bronchi (1st and 2nd intercostal spaces anteriorly, between scapulae posteriorly).
59
What is the pitch and intensity of bronchovesicular breath sounds?
Moderate pitch and moderate intensity.
60
What is the quality of bronchovesicular breath sounds?
Softer and breezier than bronchial sounds.
61
How does the duration of inspiration compare to expiration in bronchovesicular breath sounds?
Equal duration.
62
What are vesicular breath sounds and where are they located?
Normal breath sounds over most of the lung fields.
63
What is the pitch and intensity of vesicular breath sounds?
Low pitch and soft intensity.
64
How do the inspiratory and expiratory phases compare in vesicular breath sounds?
Inspiratory phase is longer than expiratory.
65
What is the quality of vesicular breath sounds?
Rustling, breezy.
66
What is a characteristic of crackles (rales)?
Types: Fine crackles (soft, high-pitched) and coarse crackles (louder, lower-pitched).
67
Where are crackles typically heard?
Often heard in the lower lung fields.
68
What causes crackles?
Fluid accumulation in alveoli (e.g., pneumonia, pulmonary edema, fibrosis).
69
What clinical condition is associated with fine crackles?
Interstitial lung diseases (e.g., pulmonary fibrosis).
70
What clinical conditions are associated with coarse crackles?
Pneumonia, heart failure, bronchiectasis.
71
What describes wheezes?
High-pitched, musical, continuous sounds.
72
What is the cause of wheezes?
Airflow narrowing or obstruction (e.g., asthma, COPD).
73
What are rhonchi characterized by?
Low-pitched, snoring, gurgling sound.
74
What causes rhonchi?
Airflow through mucus or secretions in large airways.
75
What is stridor and its clinical significance?
High-pitched, harsh, crowing sound indicating upper airway obstruction (e.g., croup, foreign body).
76
What is a pleural friction rub?
Low-pitched, grating, leathery sound caused by inflamed pleural surfaces rubbing together.
77
What conditions are associated with diminished or absent breath sounds?
Pneumothorax, pleural effusion, severe emphysema, atelectasis.
78
What does increased clarity of spoken words through the chest wall indicate?
Positive bronchophony suggests alveolar consolidation, lobar pneumonia, or mass effect.
79
What is egophony and what does it indicate?
When 'ee' is heard as 'ay' over an abnormal lung area, indicating lobar pneumonia or lung consolidation.
80
What is whispered pectoriloquy?
Increased clarity of whispered sounds over abnormal lung areas indicating lung consolidation.
81
What are common pulmonary causes of dyspnea?
* Asthma
* COPD
* Pneumonia
* Pulmonary embolism
* Pneumothorax
82
What are key inspection findings in chest disorders?
* Respiratory Rate & Effort
* Chest Shape & Deformities
* Skin & Nail Findings
83
What does increased tactile fremitus indicate?
Consolidation (e.g., pneumonia).
84
What does dullness on percussion suggest?
Consolidation (pneumonia) or pleural effusion.
85
What are common causes of anxiety-related dyspnea?
Anxiety and panic attacks.
86
What is the clinical significance of stridor?
It indicates a life-threatening upper airway obstruction.
87
What are the key features of crackles?
Discontinuous, popping sounds associated with conditions like CHF and pneumonia.
88
What is indicated by dullness on percussion?
Consolidation (pneumonia), effusion, or mass
## Footnote
Dullness suggests fluid or solid matter in the lung fields.
89
What does hyperresonance suggest?
Pneumothorax or emphysema
## Footnote
Hyperresonance indicates excessive air in the thoracic cavity.
90
What does increased fremitus indicate?
Consolidation (pneumonia)
## Footnote
Increased fremitus occurs when lung tissue becomes denser.
91
What does decreased fremitus suggest?
Pleural effusion or pneumothorax
## Footnote
Decreased fremitus is due to fluid or air in the pleural space.
92
What does wheezing suggest?
Asthma, COPD, or airway obstruction
## Footnote
Wheezing is caused by narrowed airways.
93
What does crackles (rales) indicate?
Pneumonia, pulmonary edema, or fibrosis
## Footnote
Crackles are produced by fluid in the alveoli.
94
Where can you hear bronchial sounds?
Trachea and large airways
## Footnote
Bronchial sounds are high-pitched and loud.
95
Where are bronchovesicular sounds normally heard?
Over the mainstem bronchi
## Footnote
Bronchovesicular sounds have equal inspiratory and expiratory phases.
96
What is the normal location for vesicular breath sounds?
Over most of the lung fields
## Footnote
Vesicular sounds are soft and low-pitched.
97
What does absent tracheal breath sounds indicate?
Airway obstruction
## Footnote
Absent sounds suggest a blockage in the trachea.
98
What is the significance of tympanic sound on percussion?
Large pneumothorax or air trapping
## Footnote
Tympanic sounds indicate a significant accumulation of air.
99
What is the technique for percussing the chest?
Use the non-dominant hand to strike the dominant hand on the chest
## Footnote
This technique helps assess lung sounds systematically.
100
What is the expected percussion sound over normal lung tissue?
Resonant
## Footnote
Resonance indicates healthy lung tissue.
101
What are the main components of assessing dyspnea?
* Onset
* Location
* Duration
* Character
* Aggravating Factors
* Relieving Factors
* Timing
* Severity
## Footnote
These components help determine the cause of shortness of breath.
102
What does sudden onset of dyspnea with pleuritic pain indicate?
Pulmonary embolism (PE)
## Footnote
Sudden onset may suggest acute respiratory conditions.
103
What are the USPSTF recommendations for lung cancer screening?
Annual LDCT for adults aged 50-80 with a 20 pack-year smoking history
## Footnote
Screening should stop after 15 years of cessation or significant health limitations.
104
What is the significance of paroxysmal nocturnal dyspnea?
Hallmark of heart failure
## Footnote
PND occurs when fluid accumulates while lying down.
105
What is a key finding in pneumonia during auscultation?
Bronchial breath sounds and crackles
## Footnote
These sounds indicate consolidation in the lungs.
106
What is the clinical significance of dull percussion notes?
Suggests pneumonia, pleural effusion, or lung mass
## Footnote
Dull notes indicate fluid or solid density in lung fields.
107
What are the locations for auscultating the right lung lobes?
* RUL: Above the 4th rib midclavicular line
* RML: Between the 4th and 6th ribs midclavicular line
* RLL: Below the 6th rib
## Footnote
These locations are crucial for accurate lung assessment.
108
What is the role of diaphragmatic excursion in assessment?
To assess diaphragm movement and lung function
## Footnote
Normal range for excursion is 3-5 cm.
109
What is the impact of early detection via LDCT on lung cancer mortality?
Significantly reduces lung cancer mortality
## Footnote
LDCT stands for low-dose computed tomography.
110
Is chest X-ray recommended for lung cancer screening?
No, it is not recommended
## Footnote
Chest X-ray has not been shown to be effective in lung cancer screening.
111
What is the most effective strategy to reduce lung cancer risk?
Smoking cessation
## Footnote
Quitting smoking greatly lowers the risk of developing lung cancer.
112
Is routine screening recommended for children and adolescents?
No, it is not recommended
## Footnote
The focus should be on prevention and education.
113
What is emphasized in education regarding vaping and e-cigarettes?
Risks of vaping and e-cigarettes may increase future lung cancer risk
## Footnote
Awareness of these risks is crucial for young populations.
114
List some additional risk factors that may justify lung cancer screening.
* Occupational exposures: Asbestos, radon, diesel fumes
* Family history of lung cancer
* History of chronic lung disease (COPD, pulmonary fibrosis)
* Secondhand smoke exposure
* History of radiation therapy to the chest
## Footnote
These factors can increase the likelihood of lung cancer development.
115
What are the limitations and risks of lung cancer screening?
* False positives can lead to unnecessary procedures
* Radiation exposure from LDCT
* Overdiagnosis may result in treating slow-growing tumors that wouldn’t impact lifespan
## Footnote
These risks must be considered when deciding on screening.
116
What is the screening frequency recommended by the USPSTF for eligible individuals?
Annual LDCT
## Footnote
This applies to individuals aged 50-80 with a significant smoking history.
117
What is the age range for lung cancer screening according to the ACS?
50+
## Footnote
Individuals must have a smoking history to qualify for screening.
118
What should be considered for discontinuation of screening according to USPSTF?
Stopped smoking 15+ years, poor health
## Footnote
Health status is a key factor in determining the need for continued screening.
119
What is the NCCN's stance on screening frequency for lung cancer?
Annual LDCT
## Footnote
They include consideration of other risk factors in their recommendations.
120
Fill in the blank: Smoking cessation is the most effective strategy to reduce _______.
lung cancer risk
## Footnote
This emphasizes the importance of quitting smoking.
121
True or False: Routine screening for lung cancer is recommended for all age groups.
False
## Footnote
Routine screening is not recommended for children and adolescents.
