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PDX : Lungs
Terms in this set (67)
Bifurcation of the trachea is at this level, also site of 2nd rib attachment.
What intercostal space lies just below the tip of the scapula?
True or False - The lower lobes of the lung are mainly posterior, the upper lobes are mainly anterior?
True or False - The diaphragm is located T8 at midscapular line, and goes to T12 upon full inspiration
False - located at T10 midscapular line. Only 2 segments.
What rib is the diaphragm located anteriorly?
True or False : The rib cage is a 2:1 ratio lateral to AP.
What are the normal muscles of respiration during inhalation? What about accessory muscles?
Normal - External intercostals and diaphragm
Accessory (usually not used) - Scaleni, Traps, SCM
True or False : Abnormal expiration recruits the use of the external intercostal and abdominal muscles?
False - Recruits internal intercostal and abdominal
Suprasternal notch pulsations and tracheal tug are indicative of?
True or False - in pneumothroax / pleural effusion the trachea shifts toward the involved side.
False - it shifts away. Trachea shifts towards affected side in atelectasis.
Upon percussion of the chest, you hear a dull sound. What does this indicate?
Fluid / Tumor
Upon percussion of the chest, you hear a hallow sound. What does this indicate?
Upon percussion of the chest, you hear a resonant sound. What does this indicate?
This test listens to patients spoken sounds by saying words like "ninety-nine" checking for increased transmission of sound.
After Vocal Fremitus test, patients say two syllable words where doctor is listening for clarity of words.
After Vocal Fremitus test, patient says the letter "e" where doctor is listening for e to a transition.
After Vocal Fremitus test, patient whispers words where the doctor is listening to hear the words (consolidation)
Tool used to assess ventilation capabilities
Characterized by shallow breathing at a rapid rate, greater than 20RPM
Characterized by deep breathing at a rapid rate, increased volume per breath.
Characterized by slow shallow breathing rate, less than 12RPM.
Name 2 causes of prolonged expiration
Asthma, Chronic Bronchitis, COPD
Name 3 irritating fluids which result in cough
1. Inflammatory fluid
3. Pus from infection
4. Transudate from congestive heart failure (clear sputum)
Disease of air passages promote secretion of _______
Bloody sputum is known as? Indicative of?
Hemoptysis. Indicative of Cancer or Pneumonia
Name two causes of musculoskeletal local tenderness of Thorax
Inflammation of the pleura
Pleurisy / Pleuritis
Name two causes of esophageal pain
2. Hiatal hernia
Characterized by tearing interscapular pain, usually tearing from back to front and does not change with position.
Dissecting Thoracic Aneurysm
Classically radiates down the left armor and described as pressure or weight on chest.
Heart pain / MI
Local pain that is not movement related and experienced at night.
Cancer of Ribs
Patient presents with forward projection of the sternum, also known as pigeon chest.
Patient presents with a hallowing at the lower part of the chest, caused by backward displacement of xiphoid and sternum.
Patient presents with a row of beading at the costochondral junction, often experienced in Vitamin D deficient children.
Patient presents with a barrel chest and is held in the position of inspiration. What is your primary DDX?
Patient presents with intercostal muscles sucked in on inspiration. What is this called and what is it indicative of?
Retraction, indicative of inability to equalize pressure (vacuum)
Patient presents with hands clutched around the throat. What does this suggest?
True or False : If a patient is choking but able to speak, you shouldn't move the obstruction.
Soft and low pitched breathing sounds usually heard over most of both lungs.
Loud and higher in pitch breathing sounds, usually heard near the manubrium.
Intermediate intensity and pitch breathing sounds, usually heard over the first and second interspaces.
Upon auscultation, you hear a whistling, squeaking, puffing sound. What is this called and what is it indicative of?
Wheezing, indicative of Asthma and CO
High pitched noisy respiration like the blowing of wind. What is this called and what is it indicative of?
Stridor, indicative of respiratory obstruction. Medical emergency!
Upon auscultation you hear course rattling or snoring quality. What is this called and what is it indicative of?
Ronchi, indicative of COPD / Acute or severe bronchitis
Patient has a bronchi reaction to pollen, exercise, and stress. What is this known as?
Patient has exudation in the bronchi with a cough that produces green sputum. Upon auscultation you hear longer expiration with rhonchi and crackles. DDX?
Patient presents with an increased AP diameter of thorax, and has symmetrically decreased respiratory movements. Upon auscultation you hear prolonged expiration. DDX?
Patient presents with asymmetrical lung dynamics. Upon palpation, the trachea is not in the midline. Upon auscultation there are no normal sounds over one side of the chest. DDX?
Patient presents with a sickly appearance and rapid breathing. Percussion is dull, and during auscultation you hear crakles over vesicular areas, but wheezes over the tubes. DDX?
Partial Consolidation Pneumonia
Patient presents with sickly appearand and rapid breathing with dyspnea. Upon percussion you hear a dull sound. During auscultation you hear a loss of vesicular sounds, and increased vocal fremitus. DDX?
Complete Consolidation Pneumonia
Patient presents with asymmetry of motion, and decreased tacticle fremitus. Upon percussion you hear a dull sound, and during auscultation you hear a pleural friction rub early, with a lack of normal sounds over inferior and posterior lung. DDX?
Patient presents with a cough. Upon palpation you find a deviated trachea, and dullness during percussion. During auscultation you find a few areas of consolidation. The patient is also coughing up blood. DDX?
Difficulty breathing is also known as?
Exertional Dyspnea is usually caused by? (2)
Emphysema / Chronic Bronchitis
True or False : CO Poisoning Dyspnea happens because O2 binds tighter to hemoglobin than CO
False - CO binds tighter
Condition characterized by an abnormal respiratory pattern of deep breathing, often seen in patients with metabolic acidosis.
Metabolic Dyspnea (Kussmaul respiration)
True or False : Pain often improves when patient places themselves on their side?
Also known as discomfort / dyspnea brought on or aggrevated by lying flat, common at night.
Patient presents with condition of waking up after an hour or two of sleeping suddenly at night with trouble breathing. DDX?
Paroxysmal Nocturnal Dyspnea
In Paroxysmal Nocturnal Dyspnea, where does the fluid come from to the lungs?
True or False : Diabetes Mellitus may cause kussmaul respiration?
Patient presents with alkalosis and extremity/oral tingling. They also being to hyperventilate. DDX?
True or False : repetitious sighing may signify anxiety or depression?
Also known as fish mouth breathing, usually presents when death is imminent.
Patient presents with a gradual increase in depth and rate to a maximum before decreasing which results in apnea. DDX?
A patient who suffers Cheyne-Stokes Respiration is usually in what state?
Patient presents with a completely irregular breathing pattern with different rates and depths of breathing. Results from lesions in respiratory centers of brain stem. DDX?
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