Chest And Lungs - Lesson 9, Revised

Front 1

Angina pectoris

Back 1

Temporary myocardial ischemia, usually secondary to coronary atherosclerosis

Front 2

Regarding chest pain:
Are there pain fibers in the lung?
What is causing the pain in certain lung conditions (ie: PNA or pulmonary infarction)?
Where else can pain be originating from?

Back 2

Lung contains no pain fibers
Pain arising from inflammation of adjacent parietal pleura
Muscle strain
Pericardium contains few pain fibers

Front 3

SOB assoc. w/ CHF - description and assoc. sx

Back 3

Orthopnea, DOE, peripheral edema, cough, usually gradual onset but could be sudden in flash edema

Front 4

Wheezing

Back 4

- Musical respiratory sound heard w/ inspiration and expiration
- "Accordion sound"
- Typically signifies airway obstruction from secretions, inflammation, or foreign body

Front 5

Cough: descriptions and causes

Back 5

- Typically a reflex response to stimuli that irritate R in larynx, trachea, or large bronchi
- Can be dry or productive
- Causes: irritants (ie: mucus, pus, blood, dust, foreign bodies, heat/cold, medication, other), inflammation of respiratory mucosa, pressure/tension in airways from tumor, or enlarged peribronchial lymph nodes
* can be CV in origin, ie: w/ L-sided heart failure

Front 6

Hemoptysis: origin, color, always concerning sign for ____

Back 6

- Blood could be postnasal, mouth, pharynx, or GI source
- Bright red to rust colored (blood from stomach usually darker and may have food particles)
- Always concerning for neoplasms
- When vomited, it probably originates from GI tract
- Always quantify amt, freq, and last episode

Front 7

Hemoptysis most often seen in ______

Back 7

Pts w/ CF

Front 8

Kussmal breathing

Back 8

deep, labored breathing pattern

Front 9

Cheyne- Stokes respirations

Back 9

deep breathing alternating w/ periods of apnea

Front 10

Retractions of the chest

Back 10

- Intercostal, during inspiration
- Seen in severe asthma, COPD, or upper airway obstruction
- Most apparent in lower interspaces

Front 11

Abn chest expansion seen in _____

Back 11

Fibrosis, pleural effusion, lobal PNA, bronchial obstruction

Front 12

Fremitus: def, how to test, decreased in ____, increased in_____

Back 12

Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall

Compare L to R using ball or ulnar aspect of hand

Decreased: thick chest wall, obstructed bronchus, COPD, pleural effusion, fibrosis, air, or tumor

Increased: unilateral PNA

Front 13

Sinus tracts: def, usually indicates, seen in ____

Back 13

- Blind, inflammatory, tubelike structures opening onto the skin
- Usually indicates inf of underlying pleura and lung
- Seen in TB, actinomycosis

Front 14

Percussion notes: intensity, pitch, duration, ex
Flatness....

Back 14

Soft intensity
High pitch
Short duration
Ex: thigh

Front 15

Percussion notes: intensity, pitch, duration, ex
Hyperresonance...

Back 15

Very loud intensity
Lower pitch
Longer duration
Ex: hyper-inflated lungs of pts w/ COPD or asthma (not a reliable sign)

Front 16

Percussion notes: intensity, pitch, duration, ex
Dullness...

Back 16

Medium intensity
Medium pitch
Medium duration
Ex - liver

Front 17

Percussion notes: intensity, pitch, duration, ex
Resonance...

Back 17

Loud intensity
Low pitch
Long duration
Ex: HEALTHY LUNG

Front 18

Percussion notes: intensity, pitch, duration, ex
Tympany...

Back 18

Loud intensity
High pitch - has a musical timbre
Ex: gastric air-bubble or puffed out cheek

Front 19

Pathological example of hyperresonance

Back 19

COPD, pneumothorax

Front 20

Pathological example of dullness

Back 20

Consolidated PNA

Front 21

Pathological example of flatness

Back 21

large pleural effusion

Front 22

Pathological example of tympany

Back 22

Lg. pneumothorax

Front 23

Dullness replaces resonance in the lungs when ....

Back 23

Fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers

Front 24

Lobar PNA - def.

Back 24

Alveoli are filled with fluid and blood cells

Front 25

Pleural effusion - def.

Back 25

Pleural accumulations of serous fluid

Front 26

Abn high diaphragmatic excursion suggests ...

Back 26

suggestive of pleural effusion, or high diaphragm as in atelectasis or diaphragmatic paralysis

Front 27

Bronchophony - def. and ex of cause

Back 27

Louder, clearer voice sounds
Causes: Lobar consolidation

Front 28

Egophony - def. and ex of cause

Back 28

Voice sounds w/ a nasal quality, E-A change present
Ex: present in lobar consolidation from PNA

Front 29

Whispered pectoriloquy - def and ex of cause

Back 29

Louder, clearer whispered sounds
Causes: Lobar consolidation

Front 30

Transmitted Voice Sound Tests - when to use, diff. sounds, and what does increased transmission mean?

Back 30

- Used if bronchovesicular or bronchial breath sounds are heard in abn locations
- bronchophony, egophony, and whispered pectoriloquy
- Increased = suggest that air-filled lung has become airless

Front 31

*Vesicular breath sounds

Back 31

- Normal
- soft, low pitched
- Usually heard over most of both lungs

Front 32

*Bronchial breath sounds

Back 32

- Normal
- Louder and higher in pitch
- Usually heard over manubrium

Front 33

*Bronchovesicular breath sounds

Back 33

- Normal
- Intermediate intensity and pitch
- Usually heard over the 1st and 2nd interspaces

Front 34

*Tracheal breath sounds

Back 34

- Normal
- Very loud and high pitched
- Heard over trachea

Front 35

*If bronchovesicular or bronchial sounds are heard in distant locations, suspect .....

Back 35

air-filled lung has been replaced by fluid or solid tissue mass

Front 36

Breath sounds may be decreased:
when air flow is ____ as in ____
or when _______ as in ______

Back 36

When air flow is decreased as in obstructive lung disease or muscular weakness
Or when transmission of sound is poor as in pleural effusion, pneumothorax, or COPD

Front 37

A silent gap b/w inspiratory and expiratory sounds suggests ______

Back 37

Bronchial breath sounds

Front 38

Crackles (rales): def and causes

Back 38

Discontinuous sound, BRIEF, Intermittent, Relatively HIGH PITCHED sound ("rubbing hair b/w 2 fingers")
Fine: higher pitched, very brief
Coarse: louder, lower pitched, brief
Causes: PNA, fibrosis, early CHF

Front 39

Persistent crackles (rales) after cough suggests ...

Back 39

Lung tissue abnormality

Front 40

Wheeze: def and causes

Back 40

Continuous, MUSICAL sounds, prolonged through respiration, HIGH PITCHED, hissing or shrill quality
Causes: narrowed airways as in obstructive disease (asthma, COPD)
Can be described as: coarse, diffuse, mild, moderate, or severe

Front 41

Rhonchi: def and causes

Back 41

Continuous, LOW PITCHED, snoring quality, prolonged through respiration
Causes: secretions in larger airways
* May clear w/ cough

Front 42

Friction rub: def and causes

Back 42

Continuous sound, loud, grading or squeaking, prolonged
Causes: inflamed pleura w/ loss of lubrication b/w pleura. Pleuritis, PNA, PE

Front 43

Stridor: def, causes, assoc. w/

Back 43

- Continuous adventitious sound
- Entirely or predominantly inspiratory high-pitched wheeze, often louder in neck
- Causes: laryngeal or tracheal obstruction (ominous sign)
- Assoc. w/ epiglotitis, laryngeal spasms, foreign body

Front 44

Atelectasis - def.

Back 44

Collapse or plugging of airway resulting in obstruction of airflow and lung tissue collapse into airless state

Front 45

Bronchiectasis: def

Back 45

Rare, chronic obstructive lung disease characterized by localized and irreversible dilation or widening of part of the bronchial tree

Front 46

5 As of smoking

Back 46

- Ask about smoking @ each visit
- Advise pts to stop smoking
- Assess readiness to quit
- Assist pts by setting stop dates and providing resources
-Arrange f/u visits to monitor and support

Front 47

Lung CA is commonly referred to as ....
Causes, sx

Back 47

Bronchogenic carcinoma, CA or bronchial epithelial structures
Causes: smoking, asbestos, radiation, noxious inhaled agents
Sx: cough, wheezing, SOB, hemoptysis, DOE, pleurisy, weight loss

Front 48

Hemoptysis in the setting of weight loss is ___ until proven otherwise

Back 48

Lung CA