CM- pulm -9- ABN. Lung Findings
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| How many lobes does the right lung have How many lobes does the left lung have | right-3
left-2
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| What evidence would show that a patient is suffering from respiratory distress | use of accessory muscles
retractions
nasal flaring
pursed lip breathing
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| What sound will you hear in large airway obstruction | stridor
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| What conditions can lead to a deviation of the trachea | pleural effusion, pneumothorax, atelectasis
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| If a person is breathing at a rate of less than 8 per minute how would you describe their breathing | Bradypnea
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| What is tachypnea | breathing rate greater than 25 per minute
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| pattern of breathing marked by Rapid, Deep, regular sighing respirations/ rapid respiration chracteristic of diabetic acidosis or other conditions causing acidosis | Kussmal breathing
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| Breathing pattern where breathing is briefly interrupted or evens stops episodically during sleep | sleep apnea
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| breathing pattern characterized by periods of gradually increasing and decreasing tidal volume interspersed with periods of apnea | cheyne strokes
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| Pattern of breathing where patient is short of breath in supine position and gets relief by siting or standing up | orthopnea
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| 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
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| 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
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| 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
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| What does clubbing indicate | indicates pulmonary or cardiac disease
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| What is schamroth's sign | indicates clubbing is when fingernails angle away from each other when lined up together
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| 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
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| if you patient is emaciated what pulmonary problem may they have | malignancy or TB
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| if your patient is obese what pulmonary problem may they suffer from | sleep apnea
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| 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
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| what is the description of the classic position a patient with difficulty breathing will assume to help them breath | tri-pod position
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| AP diameter = Transverse diameter | Barrel chest
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| What is a barrel chest associated with | associated with emphysema and lung hyperinflation
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| What would your x-ray findings be with a barrel chested patient | increases AP diameter as well as diaphragmatic flattening
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| congenital posterior displacement of lower aspect of sternum, chest has hollowed out appearance, X-ray shows subtle concave appearance of lower sternum | Pectus Excavatum
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| patient has extreme curvature of the spine often in elderly and causes patient to be bent forward | kyphosis
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| spine is curved either left or right often one shoulder will appear higher than the other | Scoliosis
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| what type of tracheal deviation will the following conditions cause atelectasis fibrosis agenesis surgical resection | They pull the trachea toward the lesion
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| 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
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| 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
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| 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
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| if you have dullness on percussion of the lung what may be possible causes | may be pleural effusion, pneumonia
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| What may cuase hyperresonance on lung percussion | lung distention, asthma, emphysema, bullous disease or pneumothorax
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| what are breath sounds a good measure of in lung function | intensity of breath sounds is good index of ventilation of underlying lung
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| What will happen to breath sounds in emphysema | they will be markedly reduced
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| if you have asymmetry in breath sound intensity which side is abnormal | the one with decreased intensity
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| If your breath sounds are harsh or increased what does this indicate | indicates more ventilation and intensity increase
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| 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
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| What happens to breath sounds in consolidation | low pitched tubular type of bronchial breathing is heard in the lungs
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| what type of breath sounds will you hear in cavitary disease | high pitched, hollow sounds called cavernous breathing
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| What are ronchi | long continious adventitious sounds created from obstruction to airways
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| what would diffuse ronchi possibly indicate | suggest generalized airway obstruction like asthma or COPD
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| How are vesicular breath sounds defined | inspiratory > expiratory , soft, low sound
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| HOw is broncho-vesiuclar breath sound defined | inspiratory=expiratory best heard between scapula 1st and 2nd interspaces intermediate
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| how are bronchial breath sounds defined | expiratoyr > inspiratory best heard over manubrium loud and high sound
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| how is tracheal breath sound defined | expiratory = inspiratory very loud, high over trachea and neck
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| Where should you hear vesicular sounds | most of the lungs
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| where should you hear bronchovesicular | 1st and 2nd interspaces, between scapulae,
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| where should you hear bronchial sounds | manubrium
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| where should you hear tracheal sounds | trachea
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| If you have absent of decreased breath sounds what disease should come to mind | ARDS
Asthma
actelectasis
pneumothorax
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| if you have bronchial breath sounds in abnormal areas what disease state should come to mind | consolidation
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| What are the adventitious breath sounds | crackles/rales
wheezes
Rhonchi
Stridor
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| How are crackles/rales defined | sounds like velcro can be coarse or fine
fine= shorter, higher pitched softer
coarse= longer lower pitched louder
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| How are Rhonchi described | sounds like snoring
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| How is stridor described | predominantly inspiratory, louder in neck than over chest wall and indicates large airway obstruction
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| What does Rhonchi suggest | obstruction such as tumor, foreign body or mucous.
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| If the rhonchi is caused by mucous what should happen with coughing | the rhonchi should disappear as the mucous is removed or moved
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| what would expiratory rhonchi indicate | implies obstruction to intrathoracic airways
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| if you hear a scratching, grating sound that is localized and palpable what are you likely hearing | pleural rub
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| whistling type noises produced during expiration when air is forced through airways narrowed by bronchoconstriction secretions mucosal edema | Wheezes
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| when are wheezes most common | most common with diffuse processes that affect all lobes of the lung like asthma or emphysema
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| 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
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| What causes fine crackles heard at the end on inspiration | sound is from when collapsed alveoli pop open can be from depleted surfactant
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| 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
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| if you hear crackles throughout inspiration and expiration how would you classify the crackle | coarse crackle
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| what are rales (aka crackles) | scratchy sounds like rubbing hair together next to your ear from fluid accumulating in alveolar and interstitial spaces
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| what are common cause of rales (aka crackles) | pulmonary edema
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| what is the vibration sensation the lungs transmit to the chest wall called | fremitus
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| if you have absent or decreased tactile fremitus what may that indicate | Bronchial obstruction
COPD
pneumothorax
tumor
pleural effusion
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| If you have increased tactile fremitus what do you likely have | consolidation
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| If you have bronchial breathing or sound become loud, sharp and distinct what is that called | bronchophony
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| what is it called in extreme situations where whispered words are heard clearly on ascultation | pectoriloquy
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| this occurs when normally air filled lung parenchyma becomes engorged with fluid or tissue most commonly in pneumonia | consolidation
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| what happens to tactile fremitus in consolidation | becomes more pronounced
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| 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
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| what will happen to fremitus over an effusion | it will be decreased
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| Exaggerated vocal resonance heard over a bronchus that is surrounded by consolidated lung tissue | Bronchophony
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| Increased quality/ loudness of whispers. Heard with stethoscope over areas of consolidation | whispering pectoroliquy
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| EEE to AAA changes while listening with stethoscope | egophony
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| if you have increased fremitus, dullness to percussion, bronchial breath sounds, crackels and transmitted breath sounds what disease state is likely present | pneumonia
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| Fremitus is absent dullness to percussion absent breath sounds may have bronchial BS or friction rub near top of effusion | pleural effusion
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| absent fremtius dull sounds over affected lung decreased breath sounds over affected lung trachea may be deviated toward affected side | atelectasis
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| Increased A-P diameter Decreased fremitus Diffuse Hyperresonance Decreased breath sounds Wheezes, rhonchi, prolonged expiratory time | COPD emphysema
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| Decreased fremitus Hyperresonance to percussion Decreased/absent breath sounds Possible friction rub or tracheal deviation | Pneumothorax
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| Review all the x-rays | review all the x-rays
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