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Session 2 CM pulm9

CM- pulm -9- ABN. Lung Findings

QuestionAnswer
How many lobes does the right lung have How many lobes does the left lung have right-3 left-2
What evidence would show that a patient is suffering from respiratory distress use of accessory muscles retractions nasal flaring pursed lip breathing
What sound will you hear in large airway obstruction stridor
What conditions can lead to a deviation of the trachea pleural effusion, pneumothorax, atelectasis
If a person is breathing at a rate of less than 8 per minute how would you describe their breathing Bradypnea
What is tachypnea breathing rate greater than 25 per minute
pattern of breathing marked by Rapid, Deep, regular sighing respirations/ rapid respiration chracteristic of diabetic acidosis or other conditions causing acidosis Kussmal breathing
Breathing pattern where breathing is briefly interrupted or evens stops episodically during sleep sleep apnea
breathing pattern characterized by periods of gradually increasing and decreasing tidal volume interspersed with periods of apnea cheyne strokes
Pattern of breathing where patient is short of breath in supine position and gets relief by siting or standing up orthopnea
this conditions results from pulmonary dysfunction mumous membrane and conjunctiva are bluish tongue is bluish chronic hypoxemia secondary erythrocytosis conjunctival and scleral vessels are seen as full, tortuous and bluish central cyanosis
Right sided heart failure is an enlargement of the right ventricle due to high b/p in the lungs caused by chronic lung disease Cor Pulmonale
Widening of AP and lateral diameter of terminal portion of fingers and toes giving appearance of clubbing Angle between nail & skin is greater than 180 Periungual skin is stretched and shiny There is fluctuation of nail bed Palpable posterior edge of clubbing of nails
What does clubbing indicate indicates pulmonary or cardiac disease
What is schamroth's sign indicates clubbing is when fingernails angle away from each other when lined up together
On inspection of the chest what are you looking for in the resting size and shape of the thorax looking for -deformities or asymmetry -impaired respiratory movement -trauma, masses old surgical scars skin lesions
if you patient is emaciated what pulmonary problem may they have malignancy or TB
if your patient is obese what pulmonary problem may they suffer from sleep apnea
what should you look for when inspecting effort of ventilation breathing that appears uncomfortable or voluntary accesory muscle use expiratory muscles are active expiration is not passive degree of negative pleural pressure is high respirator rate is increased
what is the description of the classic position a patient with difficulty breathing will assume to help them breath tri-pod position
AP diameter = Transverse diameter Barrel chest
What is a barrel chest associated with associated with emphysema and lung hyperinflation
What would your x-ray findings be with a barrel chested patient increases AP diameter as well as diaphragmatic flattening
congenital posterior displacement of lower aspect of sternum, chest has hollowed out appearance, X-ray shows subtle concave appearance of lower sternum Pectus Excavatum
patient has extreme curvature of the spine often in elderly and causes patient to be bent forward kyphosis
spine is curved either left or right often one shoulder will appear higher than the other Scoliosis
what type of tracheal deviation will the following conditions cause atelectasis fibrosis agenesis surgical resection They pull the trachea toward the lesion
what type of tracheal deviation will the following conditions cause Space occupying lesions such as Pleural effusion Pneumothorax Large mass lesions Mediastinal masses Thyroid tumors they push the trachea away from the side of the lesion
What are you looking for when checking chest expansion chest should expand symmetrically. asymmetric expansion can indicate lung disease Splinting Bronchial obstruction Pleural effusion Lobar pneumonia
What will you here on percussion over an air filled strucutre vs fluid or tissue filled cavitiy air will be resonant fluid or tissue = dull
if you have dullness on percussion of the lung what may be possible causes may be pleural effusion, pneumonia
What may cuase hyperresonance on lung percussion lung distention, asthma, emphysema, bullous disease or pneumothorax
what are breath sounds a good measure of in lung function intensity of breath sounds is good index of ventilation of underlying lung
What will happen to breath sounds in emphysema they will be markedly reduced
if you have asymmetry in breath sound intensity which side is abnormal the one with decreased intensity
If your breath sounds are harsh or increased what does this indicate indicates more ventilation and intensity increase
where are the places you should hear bronchial breath sounds trachea, right clavicle or right inter scapular space. if you hear it anywhere else it is abnormal
What happens to breath sounds in consolidation low pitched tubular type of bronchial breathing is heard in the lungs
what type of breath sounds will you hear in cavitary disease high pitched, hollow sounds called cavernous breathing
What are ronchi long continious adventitious sounds created from obstruction to airways
what would diffuse ronchi possibly indicate suggest generalized airway obstruction like asthma or COPD
How are vesicular breath sounds defined inspiratory > expiratory , soft, low sound
HOw is broncho-vesiuclar breath sound defined inspiratory=expiratory best heard between scapula 1st and 2nd interspaces intermediate
how are bronchial breath sounds defined expiratoyr > inspiratory best heard over manubrium loud and high sound
how is tracheal breath sound defined expiratory = inspiratory very loud, high over trachea and neck
Where should you hear vesicular sounds most of the lungs
where should you hear bronchovesicular 1st and 2nd interspaces, between scapulae,
where should you hear bronchial sounds manubrium
where should you hear tracheal sounds trachea
If you have absent of decreased breath sounds what disease should come to mind ARDS Asthma actelectasis pneumothorax
if you have bronchial breath sounds in abnormal areas what disease state should come to mind consolidation
What are the adventitious breath sounds crackles/rales wheezes Rhonchi Stridor
How are crackles/rales defined sounds like velcro can be coarse or fine fine= shorter, higher pitched softer coarse= longer lower pitched louder
How are Rhonchi described sounds like snoring
How is stridor described predominantly inspiratory, louder in neck than over chest wall and indicates large airway obstruction
What does Rhonchi suggest obstruction such as tumor, foreign body or mucous.
If the rhonchi is caused by mucous what should happen with coughing the rhonchi should disappear as the mucous is removed or moved
what would expiratory rhonchi indicate implies obstruction to intrathoracic airways
if you hear a scratching, grating sound that is localized and palpable what are you likely hearing pleural rub
whistling type noises produced during expiration when air is forced through airways narrowed by bronchoconstriction secretions mucosal edema Wheezes
when are wheezes most common most common with diffuse processes that affect all lobes of the lung like asthma or emphysema
If the wheeze is only heard on inspiration and is associated with mechanical obstruction of upper airway at tracheal level what is it called stridor
What causes fine crackles heard at the end on inspiration sound is from when collapsed alveoli pop open can be from depleted surfactant
If you hear crackels at end of inspiration and beggining of inspiration what is likely causing it and how would you classify the crackle probably form fluid or secretion in respiratory bronchioles: medium crackles
if you hear crackles throughout inspiration and expiration how would you classify the crackle coarse crackle
what are rales (aka crackles) scratchy sounds like rubbing hair together next to your ear from fluid accumulating in alveolar and interstitial spaces
what are common cause of rales (aka crackles) pulmonary edema
what is the vibration sensation the lungs transmit to the chest wall called fremitus
if you have absent or decreased tactile fremitus what may that indicate Bronchial obstruction COPD pneumothorax tumor pleural effusion
If you have increased tactile fremitus what do you likely have consolidation
If you have bronchial breathing or sound become loud, sharp and distinct what is that called bronchophony
what is it called in extreme situations where whispered words are heard clearly on ascultation pectoriloquy
this occurs when normally air filled lung parenchyma becomes engorged with fluid or tissue most commonly in pneumonia consolidation
what happens to tactile fremitus in consolidation becomes more pronounced
if you have fluid collecting in potential space that exists between the lung and chest wall that displaces the lung upwards what is this called pleural effusion
what will happen to fremitus over an effusion it will be decreased
Exaggerated vocal resonance  heard over a bronchus that is surrounded by consolidated lung tissue Bronchophony
Increased quality/ loudness of whispers. Heard with stethoscope over areas of consolidation whispering pectoroliquy
EEE to AAA changes while listening with stethoscope egophony
if you have increased fremitus, dullness to percussion, bronchial breath sounds, crackels and transmitted breath sounds what disease state is likely present pneumonia
Fremitus is absent dullness to percussion absent breath sounds may have bronchial BS or friction rub near top of effusion pleural effusion
absent fremtius dull sounds over affected lung decreased breath sounds over affected lung trachea may be deviated toward affected side atelectasis
Increased A-P diameter Decreased fremitus Diffuse Hyperresonance Decreased breath sounds Wheezes, rhonchi, prolonged expiratory time COPD emphysema
Decreased fremitus Hyperresonance to percussion Decreased/absent breath sounds Possible friction rub or tracheal deviation Pneumothorax
Review all the x-rays review all the x-rays
Created by: Max Smith Max Smith on 2010-01-07



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