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ChiroBoards2:Lungs &

ChiroBoards2: Lungs and Thorax

QuestionAnswer
Barrel Chest is seen with what 2 conditions = COPD and Cystic Fibrosis
AP = Lateral diameter of thorax (1:1 ratio) = Barrel Chest
Pectus Excavatum, aka = Funnel Chest
Marked depression of the sternum (sunken in) = Pectus Excavatum (funnel chest)
Pectus Carinatum, aka = Pigeon Chest
Forward protrusion of the sternum (like keel of a ship) = Pectus Carinatum (pigeon chest)
Rapid shallow breathing = Tachypnea
Slow breathing = Bradypnea
group of quick, shallow inspirations followed by irregular periods of apnea (no pattern) = Biot's breathing
characterized by alternating periods of apnea and hyperpnea (has pattern). Also this condition has respiratory acidosis. Cheyne Stokes Respiration
breathing is first rapid and shallow but as metabolic acidosis worsens, breathing becomes deep, slow, labored, and gasping. = Kussmaul's
"Air hunger breathing" = Kussmaul's
Pitted nails seen with psoriasis (look for silver scales)
Seen on nails with Subacute Bacterial Endocarditis Splinter Hemorrhage
Transverse ridges assoc. with acute severe disease = Beau's Lines
Inflammation of the nail fold near the cuticle Paronychia
Nail base has angle of greater than 180 degrees = Clubbing
What kind of nail may indicate hypoxia/COPD? Clubbing
Spoon nail aka. Koilonychia
Koilonychia indicates = iron deficient anemia
Thoracic excursion aka. Respiratory Excursion
Explain procedure for respiratory excursion = Place hands over the posterior ribs and have the patient take a deep breath
What is tactile fremitus entail? = palpable vibration; pt. is instructed to say 99 in a deep voice
Increased tactile fremitus seen with what = Increased fluid, i.e Pneumonia
Decreased tactile fremitus seen with what = (4 conditions) Emphysema, Pneumothorax; Atelectasis; and Pleurisy (PEPA)
Percussion Tones = Resonant Normal over lung tissue
Percussion Tones = Hyperressonant Emphysema; Pneumothorax (Increased air in chest)
Percussion Tones = Dull Pneumonia; Atelectasis (Increased density)
Diaphragmatic Exursion = What is the normal distance between exhalation/inhalation points when compared side to side? 3-5 cm
You suspect a pt. has pneumonia, or pneumothorax, after getting a positive on diaphragmatic excursion... what is your next step to confirm? Take a chest xray.
Breath Sounds = Vesicular = duration? Inspiration is longer than Expiration
Breath Sounds = Vesicular = location? Most of lung; especially the base
Breath Sounds = Bronchovesicular = duration? Inspiration equals expiration
Breath Sounds = Bronchvesicular = location? Anterior 1st-2nd ribs post. between scapula at apex
Breath Sounds = Bronchial = duration? Expiration is longer than inspiration
Breath Sounds = Bronchial = location? Over manubrium
Breath Sounds = Tracheal = duration? Inspiration equals expiration
Breath Sounds = Tracheal = location? Over trachea in neck
Breath Sounds = small clicking, bubbling, or rattling sounds in the lungs. Also can be described as moist, dry, fine, and coarse = Rales
Rales often occurs in what condition = Bronchitis
Breath Sounds = Sounds that resemble snoring. They occur when air is blocked or becomes rough through large airways = Rhonchi
Rhonchi often occurs in what condition = Bronchiectasis
Breath Sounds = High pitched sounds produced by narrowed airways. The can be heard upon exhalation = Wheezes
Wheezes are seen in two generational populations with 2 different conditions = Asthma in young people ; Emphysema in older people
Breath Sounds = A wheeze-like sound heard on inspiration and is usually due to a blockage of airflow. Stridor
If abnormal breath sounds are heard then proceed with what? performing vocal resonance
what is used to perform vocal resonance testing? stethoscope
If clear, distinct sounds are heard as pt. says "99", consolidation is present = what terminology? Bronchophony
If you hear "aaaaa" as pt. says "eeeee", consolidation is present = terminology? Egophony
Asthma = percussion? resonant
Asthma = fremitus? decreased
Asthma = breath sounds? wheezing
Atelectasis = percussion? dull/flat
Atelectasis = fremitus? decreased
Atelectasis = breath sounds? absent
Bronchiectasis = percussion? Resonant
Bronchiectasis =fremitus? Normal
Bronchiectasis = breath sounds? Rhonchi
Bronchitis = percussion? Resonant
Bronchitis = fremitus? Normal
Bronchitis = breath sounds? Rales
Emphysema = percussion? Hyperressonant
Emphysema = fremitus? Decreased
Emphysema = breath sounds? Wheezing
Pleurisy = percussion? Resonant
Pleurisy = fremitus? Decreased
Pleurisy = breath sounds? Crackles (Friction Rub)
Pneumothorax = percussion? Hyperresonant
Pneumothorax = fremitus? Decreased
Pneumothorax = breath sounds? decreased
Pneumonia = percussion? Dull
Pneumonia = fremitus? Increased
Pneumonia = breath sounds? Egophony, bronchophony, whispering pectoriloquy, Crack
If the words "1,2,3" are heard clearly and distincly, consolidation is present. = what test? Whispered Pectoriloquy
Lobar Pneumonia = 4 stages = 1) Consolidation, 2) Red Hepatization, 3) Gray Hepitization, 4) Resolution
Exam Findings for Lobar Pneumonia = (7) Productive Cough at 10 days, Dull percussion, Rales, Increased tactile fremitus, Rusty brown sputum; silhouette sign; air bronchogram
Productive cough at 10 days = seen in? Lobar Pneumonia
Rales, aka = Crackles
Rusty brown sputum = seen in? Lobar Pneumonia
Silhoutte sign = seen in? Lobar Pneumonia
Air bronchogram is positive in? Lobar Pneumonia
Red jelly sputum; what condition? (seen in immunocompromised hosts) Friedlander's Pneumonia
What bacteria causes Friedlander's Pneumonia? Klebsiella pneumona
what is the most common opportunistic infection? Pneumocystic Carinii
Pneumocystic Carinii is caused by = yeast/fungus
Pneumocystic Carinii is most commonly seen in this type of patient = AIDs patient
Cytomegalovirus is most commonly seen in this type of patient = AIDs patient
Tuberculosis is caused by what bacteria? mycobacterium (tuberculosis)
What condition presents with productive cough, yellow/green sputum, and has ghon lesions on xray? TB
ghon lesions on xray with what condition? TB
Ghon lesions start where in the lungs? At the Apices
Special tests for Tuberculosis: (3) Tine test/Mantoux test ; Purified protein derivative test; Sputum Culture
Most definitive test for Tuberculosis is = Sputum Culture
Usually produces an exudative pleural effusion and stabbing chest pain that worsens b respiration and cough = Pleurisy
Pleurisy Exam findings? Dull percussion, non-productive cough, decreased respiratory excursion, decreased tactile fremitus, friction rub present, decreased breath sounds, :(+) Schepelmann's test
(+) Schepelmann's test seen with ? Pleurisy
Unilateral darkening of the chest due to collapse of the lung; tracheal shifts AWAY from lesion = what condition? Pneumothorax
Bronchial obstruction due to a mucous plug causes lung collapse in what condition? = Atelectasis
On xray, a collapsed lung is seen with increased density and the mediastinal shift to the same side, = what condition? Atelectasis
Irreversible focal bronchial dilation that presents with a chronic, productive cough = Bronchiectasis
What test is necessary to diagnose and confirm Bronchiectasis? CT scan
Defined by a long term cough with mucous and shortness of breath, and wheezing. (Smoking is the main cause) = Chronic Bronchitis/ COPD
What respiratory condition will show increased eosinophils on labs? Asthma
Bronchospasm constricting airways = Asthma
Type I hypersensitivity reaction that is usually triggered by airborne allergens = Asthma
Presents with tachycardia, tachypnea, decreased tactile fremitus, wheezing, eosinophils and IgE rise = condition? Asthma
Curshmann's spirals and Charcot Laden Crystals = seen in .... Asthma
Destruction of elastic pulmonary connective tissue results in permanent dilation of alveoli air sacs = condition? Emphysema
Caused by a deficiency of alpha 1 anti-trypsin Emphysema
Emphysema is due to a deficiency of what? alpha 1 anti-trypsin
Presents with decreased tactile fremtius, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze = condition? Emphysema
In Emphysema, fluid will accumulate where first? costophrenic recesses
Xray findings for Emphysema = (4) Bilateral darkening lung fields; narrowed compressed heart; horizontal ribs; flattening of diaphragmatic domes
Pancoast tumor is an example of this type of carcinoma and is directly related to smoking = Bronchogenic Carcinoma Bronchogenic Carcinoma
Primary malignant lung tumor that starts in the area of the bronchus Bronchogenic Carcinoma
Long term hx of smoking; non-productive cough for more than 30 days; afebrile; dyspnea; weight loss; and clubbing of the finger nails = what condition? Bronchogenic Carcinoma
Costochodritis, aka = Tietze Syndrome
This condition exhibits palpable tenderness at the costosternal articulation = Costochondritis (Tietze Syndrome)
CN most commonly associated with Herpes Zoster = CN V
Herpes Zoster, aka = Shingles
Disease with abnormal collection of inflammatory cells (granulomas) that form as nodules = Sarcoidosis
granulomas that most often appear in the lungs or lymph nodes = what condition? Sarcoidosis
Sarcoidosis is seen in which cultural descent, in US = African
Sarcoidosis on xrays show = bilateral hilar lymphadenopathy
Unilateral hilar lymphadenopathy is seen with what condition? Hodgkin's
Cancer of the lymphatic system that can spread to the spleen? Hodgkin's
Hodgkin's can bee seen most commonly in what demographical group? YOUNG, caucasian males
Presents with fever, night sweats, weight loss, intense pruritis (release of IgE) and enlarged spleen = Hodgkin's
Best diagnosis for Hodgkin's = Reed Sternberg cells, on biopsy
Chronic, progressive, and frequently fatal genetic disease of the body's sweat and mucus glands Cystic Fibrosis
Loss of excessive amounts of salt; thick accumulations of mucus in intestines and lungs; COPD; Barrel Chest; pancreatic insufficiency; and meconium ileus is seen in what condition? Cystic Fibrosis
Created by: bglasman on 2012-03-05



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