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Thorax & Lungs
Physical Assessment. Exam 2
| Question | Answer |
|---|---|
| Which intercostal cartilages articulate with the sternum? | intercostal cartilages 1 – 7 |
| Which intercostal cartilages articulate with each other? | Intercostal cartilages 8 – 10 |
| Which intercostal cartilages are free-floating? | Intercostal cartilages 11 & 12 |
| What is significant about the 2nd intercostal space? | this is where you would place a needle for tension pneumothorax decompression |
| What is significant about the 4th intercostal space? | generally where chest tubes are placed |
| Where would the lower margin of ETT be on CXR? | T4 |
| Inferior angle (tip) of the scapula is a good place to estimate ____ | T7 |
| The most protruding spinous process when flexing the neck forward is... | C7 |
| The ____ interspace is a landmark for thoracentesis | T7-8 |
| Lower border of the lung crosses around the 6th rib at the ___ line, & the 8th rib at the ____ line | midclavicular line, midaxillary line |
| Posteriorly the lower border of the lung is around _____ | T10 |
| The right lung has _____ and ______ fissures | oblique, horizontal |
| Trachea bifurcates into the left and right mainstem bronchi at the ____ anteriorly and ____ posteriorly | sternal angle anteriorly, T4 posteriorly |
| ______ covers the outermost portion of the lung. The ____ lies on the chest wall | visceral pleura, parietal pleura |
| The _____ (internal/external) intercostals are used during inspiration. The _____ (internal/external) intercostals are used during exhalation. | external for inhalation, internal for exhalation |
| Muscular contraction vs lung recoil: which one dominates during inspiration? During exhalation? | Muscular contraction of the chest dominates during inspiration. Lung recoil dominates during exhalation |
| What controls intercostals? | Spinal nerves |
| Lung tissue ____ (does/does not) have pain receptors | does not |
| What causes lung-related chest pain? | Pain results from inflammation of the adjacent parietal pleura or muscle strain from persistent coughing (not the lung itself) |
| Two examples of pulmonary-related chest pain are ________ | tracheobronchitis, pleuritic pain |
| Dyspnea is ________ | painless, but uncomfortable awareness of breathing that is not proportional to the level of exertion |
| Wheezing is ________ | musical respiratory sounds caused by partial airway obstruction from secretions, tissue inflammation, or foreign bodies |
| What is the duration of an acute cough? Causes? | Less than 3 weeks. Causes = typically d/t URIs. Could be d/t acute bronchitis, pneumonia, LV heart failure, asthma, or foreign body |
| What is the duration of a subacute cough? Causes? | 3 - 8 weeks. Causes = post-infection cough (resolving URIs). Could be seen in sinusitis, asthma |
| What is the duration of chronic cough? Causes? | Over 8 weeks. Causes = post-nasal drip, chronic asthma, “GERD is a big one”, chronic bronchitis, bronchiectasis |
| Purulent, foul-smelling sputum could be due to ______ | possibly an anaerobic lung abscess |
| Large volume of purulent sputum could be due to ______ (2 causes) | possibly lung abscess or bronchiectasis |
| 3 causes of coughing are ______ | Reflex response to stimuli at receptors in larynx, trachea, & large bronchi in response to mucus, blood, pus, dust, foreign bodies, or hot/cold air. Inflammation of resp mucosa or pressure on the air passages from a tumor. Cardiovascular in origin |
| Hemoptysis is rare in infants, kids & adolescents, but it is seen in kids with _____ | cystic fibrosis |
| Increased anterior-posterior diameter is seen in _____ & ______ | aging and COPDers |
| _____ is an indication of the presence of an obstruction | audible stridor |
| Asymmetrical chest expansions are present in ______ | pleural effusions |
| Retractions are seen in ____, ____, or _____ | severe asthma, COPD, or upper airway obstruction |
| Unilateral impairment or lagging is seen in ____, ____, or _____ | pleural disease w/ asbestosis or silicosis, phrenic nerve damage, or trauma to the area |
| Tactile fremitus is _____ | Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking |
| When measuring posterior chest expansion, at what level are the thumbs placed? | 10th rib |
| Abnormal chest expansion can occur in _____ (5 causes) | chronic fibrosis; pleural effusion; PNA; pleuritic pain & the patient is splinting; rib fracture & the patient is not taking a deep breath |
| What do you have the patient say to assess for tactile fremitus? What is a normal finding? What is an abnormal finding? | Patient says "ninety-nine". Normal = vibrations. Abnormal = no vibrations |
| What are some causes of abnormal tactile fremitus (6 of them)? | Really thick chest wall, Obstructed bronchus, COPD, Pleural changes or fibrosis, Air d/t pneumothorax, or Infiltrating tumor |
| Tactile fremitus is asymmetrically decreased in ______, or the presence of _____ or _____ | unilateral pleural effusion, or the presence of pneumothorax or tumor |
| The only time we may see asymmetrically increased tactile fremitus is in ______ | unilateral PNA d/t increased transmission through consolidated tissue |
| In COPDers & asthmatics tactile fremitus will be _____ | symmetrically decreased |
| Flat percussion: what is the intensity? Pitch? Duration? Example? | soft intensity, high pitch, short duration, muscle or bone (thigh) |
| Dull percussion: what is the intensity? Pitch? Duration? Example? | medium intensity, pitch & duration; solid organs (liver) |
| Resonant percussion: what is the intensity? Pitch? Duration? Example? | loud intensity, low pitch, long duration, present in healthy lung |
| Hyperresonant percussion: what is the intensity? Pitch? Duration? Example? | very loud intensity, lower pitch, longer duration, seen in COPDers d/t presence of more air compared to normal lungs |
| Tympanic percussion: what is the intensity? Pitch? Duration? Example? | loud intensity, high/musical pitch, longer duration, noted over stomach or puffed cheek |
| When will dullness be heard in the lungs? | If air is replaced by mucus (ex. PNA) |
| Soft & low pitched. Heard throughout inspiration, continue without pause through expiration, and fade about 1/3 of the way through expiration. Heard over the majority of both lungs. Which breath sound am I? | vesicular |
| Inspiratory and expiratory sounds equal in length, and may be separated by a silent interval. Often heard in 1st/2nd interspaces anteriorly, between scapulae. Which breath sound am I? | Bronchovesicular |
| Louder, harsher and higher in pitch. Short silence between inspiratory and expiratory sounds, and expiratory sounds last longer Over the manubrium. Which breath sound am I? | Bronchial |
| Very loud, high pitched. Inspiratory and expiratory sounds are about equal. Heard over the trachea in the neck. Which breath sound am I? | tracheal |
| What type of lung sound is heard in heart failure pts? | Late inspiratory crackles |
| Early inspiratory crackles appear & end soon after inspiration. Seen in patients w/ _____ | asthma or in chronic bronchitis patients |
| Mid-inspiratory & expiratory crackles are heard with ______ | bronchiectasis |
| Clearing of crackles, wheezing or rhonchi after coughing or changing position suggests _______ | atelectasis or bronchitis |
| When should you assess for transmitted voice sounds? | If you hear abnormally located bronchial or bronchovesicular breath sounds |
| The abnormal response when the patient says "ninety-nine" is _____, and it is called _____ | we can clearly hear the patient say “ninety-nine”, it is called bronchophony |
| The abnormal response when the patient says "ee" is _____, and it is called _____, and it is seen in patients with ______ | the “ee” sounds like “A” = E to A change, which is called egophony (seen in PNA pts) |
| The abnormal response when the patient whispers "ninety-nine" is _____, and it is called _____ | loud, clear whispered sounds are heard, which is called whispered pectoriloquy |
| Where are thumbs & hands placed to measure anterior chest excursion? | Thumbs on costal margin. Hands on lateral rib cage |
| Funnel chest AKA _____ is depression of _____. May cause ______, resulting ______ | Pectus excavatum, the lower portion of the sternum. May cause compression of the heart & vessels in some people, resulting in murmur |
| Barrel chest is _________, and is normal in _____ | increased anterior/posterior diameter, normal in infants |
| In adults barrel chest often accompanies _____ and ______ | aging & COPD |
| Anteriorly displaced sternum with depressed costal cartilages is called ______ | Pectus Carinatum aka “Pigeon Chest” |
| What is Kyphoscoliosis? What does it do to lung findings? | Kyphoscoliosis is abnormal spinal curvatures and vertebral rotation that deforms the chest. Distortion of underlying lungs makes interpretation of lung findings very difficult |
| The patient presents w/: Resonant percussion, Midline trachea, Predominantly vesicular breath sounds (in vesicular areas), No adventitious sounds, Normal tactile fremitus and transmitted voice sounds. What is their lung disorder? | Normal lung findings |
| The patient presents w/: Bronchi chronically inflamed, Productive cough, Airway obstruction, Vesicular breath sounds, Possibly scattered crackles in early inspiration & expiration, Wheezes present, Normal tactile fremitus. What does the pt have? | Chronic bronchitis |
| The pt presents w/: Increased pressure in pulmonary veins = congestion & interstitial edema, Late inspiratory crackles in dependent portions of lungs, possibly wheezes, Normal tactile fremitus. What lung issue does the pt have? | Left-sided Heart Failure (Early) |
| The pt presents w/: Alveoli filled w/ fluid, Dull percussion, Bronchial sounds, Late inspiratory crackles, Increased tactile fremitus over involved area, with bronchophony, egophony, & whispered pectoriloquy. What lung issue does the pt have? | Consolidation (PNA, pulmonary edema) |
| The pt has: Plug in mainstem bronchus obstructing air flow & affected lung tissue collapses into airless state, Dull percussion, Trachea shifted toward involved side, Tactile fremitus usually absent when the bronchial plug persists. Diagnosis is: | Atelectasis (Lobar obstruction) |
| The pt has: Fluid in pleural space, Dull to flat percussion over fluid areas, Trachea shifted toward opposite side, Decreased to absent breath sounds, may hear pleural friction rub, Decreased to absent tactile fremitus. Diagnosis is: | Pleural Effusion |
| The pt has: Air leaking into the pleural space, Hyperresonant or tympanitic over the pleural air, Trachea shift toward opposite side, Decreased to absent breath sounds, possible friction rub, Decreased to absent tactile fremitus. Diagnosis is: | Pneumothorax |
| The pt has: Slowly progressive enlargement of distal air spaces & lung hyperinflation, Diffusely hyperresonant percussion, Decreased to absent breath sounds, crackles, wheezes, & rhonchi, Decreased tactile fremitus. Diagnosis is: | COPD |
| The pt has: Widespread narrowing of the tracheobronchial tree w/ diminished air flow, Resonant to diffusely hyperresonant percussion, wheezes, Possibly crackles, Decreased tactile fremitus and transmitted voice sounds. Diagnosis is: | asthma |
Created by:
Thommy413
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