ChiroBoards2: Lungs and Thorax
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| Barrel Chest is seen with what 2 conditions = | COPD and Cystic Fibrosis
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| AP = Lateral diameter of thorax (1:1 ratio) = | Barrel Chest
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| Pectus Excavatum, aka = | Funnel Chest
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| Marked depression of the sternum (sunken in) = | Pectus Excavatum (funnel chest)
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| Pectus Carinatum, aka = | Pigeon Chest
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| Forward protrusion of the sternum (like keel of a ship) = | Pectus Carinatum (pigeon chest)
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| Rapid shallow breathing = | Tachypnea
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| Slow breathing = | Bradypnea
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| group of quick, shallow inspirations followed by irregular periods of apnea (no pattern) = | Biot's breathing
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| characterized by alternating periods of apnea and hyperpnea (has pattern). Also this condition has respiratory acidosis. | Cheyne Stokes Respiration
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| breathing is first rapid and shallow but as metabolic acidosis worsens, breathing becomes deep, slow, labored, and gasping. = | Kussmaul's
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| "Air hunger breathing" = | Kussmaul's
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| Pitted nails seen with | psoriasis (look for silver scales)
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| Seen on nails with Subacute Bacterial Endocarditis | Splinter Hemorrhage
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| Transverse ridges assoc. with acute severe disease = | Beau's Lines
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| Inflammation of the nail fold near the cuticle | Paronychia
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| Nail base has angle of greater than 180 degrees = | Clubbing
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| What kind of nail may indicate hypoxia/COPD? | Clubbing
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| Spoon nail aka. | Koilonychia
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| Koilonychia indicates = | iron deficient anemia
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| Thoracic excursion aka. | Respiratory Excursion
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| Explain procedure for respiratory excursion = | Place hands over the posterior ribs and have the patient take a deep breath
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| What is tactile fremitus entail? = | palpable vibration; pt. is instructed to say 99 in a deep voice
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| Increased tactile fremitus seen with what = | Increased fluid, i.e Pneumonia
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| Decreased tactile fremitus seen with what = (4 conditions) | Emphysema, Pneumothorax; Atelectasis; and Pleurisy
(PEPA)
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| Percussion Tones = Resonant | Normal over lung tissue
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| Percussion Tones = Hyperressonant | Emphysema; Pneumothorax (Increased air in chest)
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| Percussion Tones = Dull | Pneumonia; Atelectasis (Increased density)
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| Diaphragmatic Exursion = What is the normal distance between exhalation/inhalation points when compared side to side? | 3-5 cm
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| 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.
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| Breath Sounds = Vesicular = duration? | Inspiration is longer than Expiration
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| Breath Sounds = Vesicular = location? | Most of lung; especially the base
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| Breath Sounds = Bronchovesicular = duration? | Inspiration equals expiration
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| Breath Sounds = Bronchvesicular = location? | Anterior 1st-2nd ribs post. between scapula at apex
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| Breath Sounds = Bronchial = duration? | Expiration is longer than inspiration
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| Breath Sounds = Bronchial = location? | Over manubrium
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| Breath Sounds = Tracheal = duration? | Inspiration equals expiration
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| Breath Sounds = Tracheal = location? | Over trachea in neck
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| Breath Sounds = small clicking, bubbling, or rattling sounds in the lungs. Also can be described as moist, dry, fine, and coarse = | Rales
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| Rales often occurs in what condition = | Bronchitis
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| Breath Sounds = Sounds that resemble snoring. They occur when air is blocked or becomes rough through large airways = | Rhonchi
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| Rhonchi often occurs in what condition = | Bronchiectasis
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| Breath Sounds = High pitched sounds produced by narrowed airways. The can be heard upon exhalation = | Wheezes
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| Wheezes are seen in two generational populations with 2 different conditions = | Asthma in young people ; Emphysema in older people
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| Breath Sounds = A wheeze-like sound heard on inspiration and is usually due to a blockage of airflow. | Stridor
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| If abnormal breath sounds are heard then proceed with what? | performing vocal resonance
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| what is used to perform vocal resonance testing? | stethoscope
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| If clear, distinct sounds are heard as pt. says "99", consolidation is present = what terminology? | Bronchophony
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| If you hear "aaaaa" as pt. says "eeeee", consolidation is present = terminology? | Egophony
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| Asthma = percussion? | resonant
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| Asthma = fremitus? | decreased
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| Asthma = breath sounds? | wheezing
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| Atelectasis = percussion? | dull/flat
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| Atelectasis = fremitus? | decreased
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| Atelectasis = breath sounds? | absent
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| Bronchiectasis = percussion? | Resonant
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| Bronchiectasis =fremitus? | Normal
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| Bronchiectasis = breath sounds? | Rhonchi
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| Bronchitis = percussion? | Resonant
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| Bronchitis = fremitus? | Normal
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| Bronchitis = breath sounds? | Rales
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| Emphysema = percussion? | Hyperressonant
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| Emphysema = fremitus? | Decreased
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| Emphysema = breath sounds? | Wheezing
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| Pleurisy = percussion? | Resonant
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| Pleurisy = fremitus? | Decreased
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| Pleurisy = breath sounds? | Crackles (Friction Rub)
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| Pneumothorax = percussion? | Hyperresonant
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| Pneumothorax = fremitus? | Decreased
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| Pneumothorax = breath sounds? | decreased
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| Pneumonia = percussion? | Dull
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| Pneumonia = fremitus? | Increased
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| Pneumonia = breath sounds? | Egophony, bronchophony, whispering pectoriloquy, Crack
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| If the words "1,2,3" are heard clearly and distincly, consolidation is present. = what test? | Whispered Pectoriloquy
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| Lobar Pneumonia = 4 stages = | 1) Consolidation, 2) Red Hepatization, 3) Gray Hepitization, 4) Resolution
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| Exam Findings for Lobar Pneumonia = (7) | Productive Cough at 10 days, Dull percussion, Rales, Increased tactile fremitus, Rusty brown sputum; silhouette sign; air bronchogram
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| Productive cough at 10 days = seen in? | Lobar Pneumonia
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| Rales, aka = | Crackles
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| Rusty brown sputum = seen in? | Lobar Pneumonia
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| Silhoutte sign = seen in? | Lobar Pneumonia
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| Air bronchogram is positive in? | Lobar Pneumonia
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| Red jelly sputum; what condition? (seen in immunocompromised hosts) | Friedlander's Pneumonia
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| What bacteria causes Friedlander's Pneumonia? | Klebsiella pneumona
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| what is the most common opportunistic infection? | Pneumocystic Carinii
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| Pneumocystic Carinii is caused by = | yeast/fungus
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| Pneumocystic Carinii is most commonly seen in this type of patient = | AIDs patient
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| Cytomegalovirus is most commonly seen in this type of patient = | AIDs patient
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| Tuberculosis is caused by what bacteria? | mycobacterium (tuberculosis)
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| What condition presents with productive cough, yellow/green sputum, and has ghon lesions on xray? | TB
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| ghon lesions on xray with what condition? | TB
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| Ghon lesions start where in the lungs? | At the Apices
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| Special tests for Tuberculosis: (3) | Tine test/Mantoux test ; Purified protein derivative test; Sputum Culture
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| Most definitive test for Tuberculosis is = | Sputum Culture
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| Usually produces an exudative pleural effusion and stabbing chest pain that worsens b respiration and cough = | Pleurisy
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| Pleurisy Exam findings? | Dull percussion, non-productive cough, decreased respiratory excursion, decreased tactile fremitus, friction rub present, decreased breath sounds, :(+) Schepelmann's test
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| (+) Schepelmann's test seen with ? | Pleurisy
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| Unilateral darkening of the chest due to collapse of the lung; tracheal shifts AWAY from lesion = what condition? | Pneumothorax
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| Bronchial obstruction due to a mucous plug causes lung collapse in what condition? = | Atelectasis
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| On xray, a collapsed lung is seen with increased density and the mediastinal shift to the same side, = what condition? | Atelectasis
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| Irreversible focal bronchial dilation that presents with a chronic, productive cough = | Bronchiectasis
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| What test is necessary to diagnose and confirm Bronchiectasis? | CT scan
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| Defined by a long term cough with mucous and shortness of breath, and wheezing. (Smoking is the main cause) = | Chronic Bronchitis/ COPD
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| What respiratory condition will show increased eosinophils on labs? | Asthma
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| Bronchospasm constricting airways = | Asthma
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| Type I hypersensitivity reaction that is usually triggered by airborne allergens = | Asthma
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| Presents with tachycardia, tachypnea, decreased tactile fremitus, wheezing, eosinophils and IgE rise = condition? | Asthma
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| Curshmann's spirals and Charcot Laden Crystals = seen in .... | Asthma
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| Destruction of elastic pulmonary connective tissue results in permanent dilation of alveoli air sacs = condition? | Emphysema
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| Caused by a deficiency of alpha 1 anti-trypsin | Emphysema
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| Emphysema is due to a deficiency of what? | alpha 1 anti-trypsin
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| Presents with decreased tactile fremtius, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze = condition? | Emphysema
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| In Emphysema, fluid will accumulate where first? | costophrenic recesses
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| Xray findings for Emphysema = (4) | Bilateral darkening lung fields; narrowed compressed heart; horizontal ribs; flattening of diaphragmatic domes
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| Pancoast tumor is an example of this type of carcinoma and is directly related to smoking = Bronchogenic Carcinoma | Bronchogenic Carcinoma
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| Primary malignant lung tumor that starts in the area of the bronchus | Bronchogenic Carcinoma
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| 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
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| Costochodritis, aka = | Tietze Syndrome
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| This condition exhibits palpable tenderness at the costosternal articulation = | Costochondritis (Tietze Syndrome)
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| CN most commonly associated with Herpes Zoster = | CN V
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| Herpes Zoster, aka = | Shingles
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| Disease with abnormal collection of inflammatory cells (granulomas) that form as nodules = | Sarcoidosis
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| granulomas that most often appear in the lungs or lymph nodes = what condition? | Sarcoidosis
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| Sarcoidosis is seen in which cultural descent, in US = | African
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| Sarcoidosis on xrays show = | bilateral hilar lymphadenopathy
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| Unilateral hilar lymphadenopathy is seen with what condition? | Hodgkin's
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| Cancer of the lymphatic system that can spread to the spleen? | Hodgkin's
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| Hodgkin's can bee seen most commonly in what demographical group? | YOUNG, caucasian males
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| Presents with fever, night sweats, weight loss, intense pruritis (release of IgE) and enlarged spleen = | Hodgkin's
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| Best diagnosis for Hodgkin's = | Reed Sternberg cells, on biopsy
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| Chronic, progressive, and frequently fatal genetic disease of the body's sweat and mucus glands | Cystic Fibrosis
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| 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
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