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86 Cards in this Set
- Front
- Back
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Pectus Excavatum
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depression in the lower sternum
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Pectus Carinatum
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anteriorly displaced sternum
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Traumatic Flail chest - def
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* multiple rib fractures resulting in paradoxical movements of the thorax.
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Flail chest: On inspiration injured area...
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caves inward and expiration outward
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Thoracic Kyphoscoliosis
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abnormal spine curve and vertebral rotation causing chest deformities.
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2nd intercostal space is location for
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tension pneumothorax needle insertion
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4th intercostal space is location for
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chest tube insertion
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Last rib to articulate with the sternum?
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7th
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Inferior tip of Scapula lies at the level of?
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* 7th rib/interspace.
* T7-T8 interspace is location for thoracentesis |
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Spinous process of T3 approximates
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the location of oblique fissure
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The horizontal fissure lies near the
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4th rib to midaxillary line near 5th rib
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The treachea bifurcates at what level?
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sternal angle anteriorly and T4 posteriorly
* aka the corina |
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The bases of the lung lobes may be approximated at what level?
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* 6th rib midclavicular
* 8th rib midaxillary * T10 spinous process posteriorly |
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Possible causes of chest pain?
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cardiovascular, pulmonary, GI, musculoskeletal, skin, anxiety, and others
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Location questions to ask about chest Px?
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substernal, shoulder, jaw, neck
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Quality questions to ask about chest Px?
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pressure, ache, heavy, “crushing”, “ripping or tearing”, sharp
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Quantity questions to ask about chest Px?
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mild to severe (typically more significant)
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1-20 min and intermittent chest px is more typical of?
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angina
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Constant chest px is more typical of?
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pericarditis and dissection
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Aggravating chest px to exertion is more typical of?
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exertion (angina/MI),
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Aggravating chest px to breathing and position is more typical of?
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pericarditis
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Chest px alleviated to leaning forward is more typical in?
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pericarditis
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Associated symptoms of chest pain due to MI?
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cool, pale and diaphoretic
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Levine sign
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a clenched fist over the anterior chest typical in coronary syndrome, high specificity
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Common causes of chest px due to lung disorder/dysfunction?
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1) Tracheobronchitis
2) Pleuritic px 3) bronchospasm |
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Tracheobronchitis - S/S
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* upper chest
* burning, mild-moderate * aggravated by cough/deep breathing * alleviated by lying on involved side |
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Pluritis - S/S
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* any chest wall area
* sharp/stabbing, mod-severe, constant * aggravated by cough/breathing/chest wall motion |
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Bronchospams - S/S
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* substernal
* sharp to ache, mild-severe, episodic * aggravated by cough/breathing deep * associated with wheezing/dyspnea |
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Common causes of chest px due to GI disorder/dysfunction?
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1) GERD
2) Esophageal spasm 3) Peptic ulcer 4) Gallbladder |
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GERD - S/S
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* substernal and to back
* burning/squeezing, mild-severe * worse after meals and lying down * alleviated with antacids (some) |
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Esophageal spasm - S/S
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* substernal to jaw or back
* squeezing, mild-severe * aggravated with swallowing * improved occasionally with belching and antacids |
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Peptic ulcer - S/S
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* substernal to back/abdomen
* ache to burn, mild-severe * initially may improve with food then worsen later |
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MSK Chest wall pain - S/S
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* any location
* stabbing to ache, mild-severe * lasts hours to days constant to variable * aggravated by chest motion, tender over area |
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Anxiety related chest pain - S/S
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* Any chest location
* ache-dull-sharp-pressure, mild-severe * variable timing usually hours-days * may follow emotion stress event (but not always) |
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Congestive heart failure -S/S
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* orthopnea
* DOE * peripheral edema * cough * usually gradual onset but could be sudden in flash edema |
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COPD/Chronic bronchitis - S/S
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* cough
* congestion * DOE * wheezing * Decreased Tactile Fremitus |
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Asthma - S/S
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* wheezing
* cough * prolonged expiration |
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Interstitial lung disease - S/S
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* progressive SOB
* DOE * weakness |
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Pneumonia - S/S
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* ill
* fever * cough * congestion |
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Pneumothorax - S/S
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* MOI
* sudden onset * pleuritic pain * often hypoxic * increasing dyspnea over time * positional discomfort * JVD, Trachea deviation, tachycardia * hyper resonance upon percussion * Absent breath sounds over lung field * Decreased Tactile Fremitus |
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Pulmonary embolism - S/S
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* sudden onset
* substernal ache to pleuritic * risk factors (smokers, heart disease, DVT, clotting disorders) |
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Anxiety attack - S/S
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* tachypnea
* tingling/numbness in hands * look of panic |
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respiratory sound heard with inspiration and expiration “accordion sound” -
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Wheezing
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Wheezing typically signifies what?
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airway obstructive from secretions, inflammation, or foreign body
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audible high pitched wheezed. Ominous sign of airway obstruction in the larynx or trachea
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Stridor
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Adventitious lung sound heard in epiglottitis, laryngeal spasm, foreign body
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Stridor
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coughing up blood from the lungs
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Hemoptysis: Always quantify amount and frequency and last episode
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Your first concern hemoptysis until proven other wise?
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Neoplasm
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Causes of hemoptysis?
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infection, lung cancer, CHF, PE, irritant
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dyspnea that occurs when the patient is lying down and improves with sitting up
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Orthopnea - common in CHF
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sudden dyspnea and orthopnea that awakens the patient form sleep
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Paroxysmal nocturnal dyspnea
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deep labored breathing pattern
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Kussmal - common DKA
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deep breathing alternating with periods of apnea
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Cheyne stokes - common in head injuries
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How do you test chest expansion anteriorly?
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thumbs along costal margin
* Watch the distance between the thumbs during inspiration and feel for symmetry |
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How do you test chest expansion posterioly?
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thumbs at T10
* Watch the distance between the thumbs during inspiration and feel for symmetry |
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An abnormal findings when examining chest expansion may indicate?
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* unilat/bilat fibrosis
* pleural effusion * lobar pneumonia * bronchial obstruction * pneumothorax |
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palpable vibrations transmitted through the bronchopulmonary tree to the chest wall.
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Tactile Fremitus
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Decreased Tactile Fremitus: transmission of vibrations from the larynx to chest is impeded, may be caused by?
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1) chest wall size
2) obstructed bronchus 3) COPD 4) Pleural effusion 5) fibrosis 6) pneumothorax 7) tumor |
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Increased Tactile Fremitus may be caused by?
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unilateral pneumonia
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Pleural Effusion - S/S
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* SOB
* flat percussion * adventitious breath sounds |
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Dull percussion lung sounds may by a sign of?
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* hemothorax
* consolidated pneumonia * atelectasis |
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Hyperresinance percussion lung sounds may by a sign of?
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* Pneumothorax
* COPD |
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Normal breath sound:
* soft and low pitched * usually heard over most of both lungs |
Vesicular
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Normal breath sound:
* louder and higher in pitch * usually heard over the manubrium |
Bronchial
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Normal breath sound:
* intermediate intensity and pitch * usually heard over the 1st and 2nd interspaces |
Bronchovesicular
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Normal breath sound:
* very loud, high pitched * heard over the trachea in the neck |
Treacheal
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What adventitious breath sounds is brief, intermittent, relatively high pitched sound, “like rubbing hair between two fingers”
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Crackles or rales
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Crackles/rales may occur in?
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pneumonia, fibrosis, early CHF, other
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What adventitious breath sounds makes musical sounds, prolonged through respiration, high pitched, with hissing or shrill quality.
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Wheezing
* Causes: narrowed airways as in obstructive disease (asthma, COPD) |
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What adventitious breath sounds makes relatively low pitched, snoring quality, prolonged through respiration
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Rhonchi
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Secretions in the the upper lungs may cause what breath sound?
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Rhonchi
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What adventitious breath sounds makes loud, grading or squeaking sound, prolonged.
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Friction rub
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Friction rub may be diagnostic of what pathology in the lungs?
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Pleuritis, pneumonia, PE
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What adventitious breath sounds makes an entirely or predominantly inspiratory wheeze, often louder in the neck
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Stridor
* laryngeal tracheal obstruction |
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1) diminished or absent fremitus, tracheal shift toward involved side
2) dullness over area upon percussion - These physical findings may be caused by |
Atelectasis
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What findings would be expected with atelectasis upon auscultation
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diminished or absent breath sounds, egophony and whispered pectoriloquy
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Bronchiectasis - def?
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A rare chronic obstructive lung disease characterized by localized and irreversible dilation or widening of part of the bronchial tree
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What findings would you except with bronchiectasis?
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* Auscultation: crackles usually coarse, rhonchi
* Inspection: tachypnea, respiratory distress, clubbing, cyanosis, wasting |
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Would you expect increased or decreased fremitus in a COPD pt?
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decreased
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Would you expect hypo or hyper resonance in a COPD pt?
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hyperresonant
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What lung sounds are associated with COPD pt's?
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crackles, wheezes, and rhonchi associated with bronchitis
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What position would aggravate an CHF pt?
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exertion, lying flat
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What lung pathologies may cause clubbing?
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1) Bronchiectasis
2) COPD 3) TB 4) Diffuse Interstitial Lung Disease |
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Findings expected in a pt with pneumonia
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1) Inspection: febrile, distress, labored respiration
2) Palpation: increased fremitus, bronchophony, egophony, and whispered pectoriloquy 3) Percussion: dull over consolidated area 4) Auscultation: bronchial sounds over consolidated area, late inspiratory crackles |
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Hemoptysis is worrisome with what conditions?
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weight loss and cough is lung cancer until proven otherwise
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Lung cancer general symptoms?
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cough, wheezing, shortness of breath, hemoptysis, DOE, pleurisy, weight loss
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