Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
111 Cards in this Set
- Front
- Back
|
2nd rib articulates with sternum
|
sternal angle
|
|
|
2nd intercostal space important for
|
needle insertion for tension pneumothorax
|
|
|
Chest tubes inserted?
|
4th intercostal space mid ax
|
|
|
tip of scapula at what rib level, whats done?
|
7th rib, thoracentesis
|
|
|
HOw do you find the C7-T1 junction
|
flex head
|
|
|
apex of lung located?
|
2-4 cm above innter third of clavicle
|
|
|
right lung: lobes? divded by?
|
3,
major (oblique) runs anterior to posterior from T3 to 6th rib mid clavicular Upper middle by horizontal, anterior near 4th rib, meets oblique at 5th fissure |
|
|
left lung: lobes? divided by?
|
2, left oblique
he oblique fissure extends from the spinous process of T2 (posteriorly) to 6th costal cartilage (anteriorly). |
|
|
Most common cause of chest pain in children
|
anxiety, costochondritis
|
|
|
clenched fist over chest indicates?
|
angina in adults
|
|
|
musculoskeltal pain indicated by?
|
finger pointing to tender area on chest wall
|
|
|
Dyspnea
|
non-painful SOB, acitivty level is the most important part
|
|
|
wheezing differentiated from stridor
|
wheezing: musical hihg pitched
stridor: crowing sound, shorter |
|
|
acute v subacute v chronic cough?
|
acute: < 3
subcrhonic: 3-8 weeks chronic - > 8 weeks |
|
|
mucoid v. purulent sputum?
|
mucoid: translucent white gray
purulent: green yellow |
|
|
what is bronchiectasis? what type of sputum?
|
destruction and widening of large airways with lots of purulent sputum
|
|
|
what is hemoptysis?
|
coughing up blood from the lungs. Blood from stomach is darker than respiratory blood
|
|
|
what are the two types of flu vaccines? when do you use them? how many strains?
|
shot: dead virus
nasal: live (ppl only from 5-50) 3 strains in each ppl wiht COPD, immunosuppresed, nursing homes, medical personel, caregivers/fam of children under 5 |
|
|
two types of pneumococcal vaccines? who gets them
|
polysaccharide and conjugated, both inactive
> 65, chronic diseases such as sickle, cardiovascular, pulmonary, DM, cirrhosis, leaks of CSF anyone gettng a cochlear implant alaska natives immunocomprimised HIV, or steroids radiation chemotherapy |
|
|
4 methods for examining the chest?
|
inspecton, palpation, percussion, auscultation
|
|
|
define normal chest shape
|
widers than deep, lateral dia > anteroposterior diameter
|
|
|
barrel chest affects? what is it?
|
infancy, aging COPD
increased AP diameter |
|
|
difference between pectus carinatum and barrel chest
|
both have sternum anteriorly
but adjact costal cartiledges in pectus are depressed |
|
|
flail chest is?:
|
on inspiration injured segment moves inward, expiration moves outward.. 2 or more broken ribs in succession in 2 or more places
|
|
|
what is pectus excavatum
|
depression in lower portion of sternum.. compresses heart and great vessels > Murmurs
|
|
|
Surgical intervention for pectus excavatum
|
1. place a sternal bar (ravttich approach) then remove after 12 mos
2. Nuss procedure: lower 4-5 cartiledges are removed, then a wire goes through and attached to external brace 3 months |
|
|
is pectus excavatum related to kyphoscoliosis of thoracic spine?
|
no. kypho is abnormal spinal curve and verterbral rotation , distorts lungs
|
|
|
What disease causes retraction of intercostals?
|
asthma COPD
|
|
|
Where are your hands when you palpate:
anterior chest posterior chest what does a delay in expansion tell us? |
pos: thumbs at 10th rib level slide hands medially and raise loose fold of skin on each side b/t thumb and spine
ant: use ball or ulnar surface delay: chronic fibrosis, pleural effusion, pneumonia, unilateral bronchial obstructon |
|
|
areas of tenders in chest wall indicate: (2)
|
inflammed pleura
bruises over fracatured rib |
|
|
Chest wall pain
process: location quality timing exacerbating remitting |
process: unlcear
location below left breast, costa; cartiledge qual: stabbing, sticking, dull, ache timing: fleeting to days exc: movement of chest arms rem: local tenderness |
|
|
Pleuritic pain
rocess: location quality timing exacerbating remitting |
pneumonia, pulmonary infarct, neoplasm
chest wall over issue quality: sharp. knifey timing, persistent exac: inspiration, coughing remitting: underlying illness |
|
|
tracheobronchitis
process: location quality exacerbating remitting |
process:inflam of trachea
location upper sternal quality burning exacerbating cough remitting lying on involved side |
|
|
reflex osphagitis
process: location quality exacerbating remitting |
process: inflamm of esophageal mucosa
location restrosternal quality burning exacerbating large meal, bending over lying down remitting antacids |
|
|
what is tactile fremitus?
where is it normally absent in front/back? hear it best where? assymetric decrease? assymetric increase? |
palpable vibrations through bronchopulmonary tree to chest wall while speaking say 99,99,99
absent: COPD, bronchus obstruction, pleural effusion, pneumothorax prominant on the R>L, in inner scapular area, ends past diaphargm a. decrease: unilateral pleural effu, pneumothorax a. increase: pneumonia |
|
|
Percussion ladder...?
|
one side of chest then other in ladder pattern, omit over scapula
|
|
|
3 components of auscultaiton
|
sounds of breathing, sounds of adventitious, sounds of speaking
|
|
|
3 normal patterns of breathing?
which one isnt heard? |
vesicular: soft, through inspiration wihtout pause through expiration, fades 1/3 after exp
bronchovesicualr: insp = exp sounds, sometimes seperated by interval bronchial: loud. high pitch. insp < exp sounds, short silence b/t insp and exp |
|
|
adventtious sound:
crackles wheezing rhonchi bronchophony egophony pectoriloquy |
pneumoia, fibrosis, early CHF
wheezing: COPD, asthma, bronchitis only on exp: asthma only insp?: rhonhi: low pitched weezing, secretions in airways bronchophony: loud clear voice sounds egophony: e to a change, sounds nasal (pneumonia) pector: louder clearer whispered words |
|
|
pleural friction rubs
mediastinal crunch |
harsh, stepping on fresh snow
inflammed pleural surfaces hammans sign: precordial crackles with heartbeat not resp: emphysema |
|
|
laryngitis
cough + sputum? symptoms? |
dry cough
hoarseness |
|
|
tracheobronchitis
cough + sputum? symptoms? |
dry cough
acute viral illness |
|
|
mycoplasma and Viral pneumon
cough + sputum? symptoms? |
dry hacking cough
febrile illness, malaise headache |
|
|
bacterial pneumonias
cough + sputum? symptoms? |
purulent sputum, blood
chills, fever, dyspnea, chest pain |
|
|
klebsellia
cough + sputum? symptoms? |
red sticky sputum
older alcoholics |
|
|
with age and loss of compliacne what happens to expiratory phase
|
speed of breath out diminishes
|
|
|
purse lip breathing? disease?
|
in through nose, out of mouth like whistleing
COPD |
|
|
central cyanosis.. arc welder?
|
pulmonary fibrosis
blue lips |
|
|
four abnoraml breathing patterns
|
apnea: suspension of external breathing (opiates, strangling)
Biots: cluster resp groups of shallow quick breaths, damage to medulla oblongata Cheyne Stokes: apnea followeed by tachnypea crescendo decrescendo. HF, strokes, sleep of people at high alts Kussmauls: DKA labored |
|
|
deep cervical chain has superior? and inferior node?
|
tonsilar sup, supraclavicular inferior
|
|
|
mouth face and throat drain to what nodes?
|
tonsillar, submandibular, submental
|
|
|
which nodal site is expected to have malignancy from thoracic or abdominal metastasis
|
supraclavicular (esp left)
|
|
|
if you find a palpable lump what must u be able to do to make it a node ont muscle
|
roll in 4 directions (up down side to side
|
|
|
Axillary nodes drain?
|
most of arm
|
|
|
epitrochlear nodes drain? where?
|
medial surface of arm, drain ulnar surface of forearm and hand, little ring and medial middle finger
|
|
|
horizontal inguinal nodes drain?
|
superficial abdomen anal canal, genitalia except testes,
|
|
|
vertical superficial inguinal can be palpated..
|
medial to femoral a. and great saphenous v.
|
|
|
infection in heel.. can u palpate lymph nodes?
|
no. outer foot and heel drain to small saphenous vein and join deep system at popliteal space
|
|
|
lymphadenopathy
|
enlargement with or without tenderness
|
|
|
atelectasis.. what? trachea to or away
|
collpase of lung
deviates trachea towards collapsed lung |
|
|
pneumothorax shifts trachea..
|
away from affected lung
|
|
|
substernal thyroid?
|
thyroid below sternum
|
|
|
JVP? What does it reflect? Measured? starting angle up or down?normal measurement? elevation means?
|
JVP = Central Venous Pressure, RAP
Right internal jugular v. hypervolemic.. >30 deg hypo 0 deg sternal angle remains 5 cm above RAP elevation (3-4 cm above sternal angle or 8-9 above RA > Increased LV EDV low ejection fraction |
|
|
What is lemierres syndorme?
|
affects Int. Jugular v. fatal
streptococcus infection, causes atherosclerosis in the RIJV SOB, pain, pneumonia |
|
|
what causes a thyroid bruit
|
excess thryoid hormone
|
|
|
in the carotid pulse, waht does amplitude correlate with?
|
pulse pressure
|
|
|
3 tests to distuingish between thyroid and carotid bruit
|
Duplex Ultrasound: dopplar and ultrasound finds carotid stenosesof >50%
MRI: contrast helps Digital Subtraciton Angiography: less cost effective |
|
|
hepatojugular reflux? how is it performed? indicates?
|
distension of the jugular v. by manual pressure over the liver
suggests insufficiency of R heart, usually an increased central blood volume indicates the ability of the right hear to handle volume |
|
|
cystic hygroma? forms? causes?
|
congenital multioculated lymp lesion that results in blockage
posterior triangle maternal infections (parvo and fifths disease), substance abuse |
|
|
genetic cystic hygroma?
|
turner syndrome, females with only 1 X
trisomies 13 18 21 Noonan |
|
|
S1?
|
Av valves
|
|
|
Loudest S1?
|
mitral
|
|
|
where do you listen for mitral?
|
cardiac apex
|
|
|
Split in S1, where do yu listen what causes
|
lower left sterna border
|
|
|
Does S1 vary with respiration?
|
No
|
|
|
WHen do you expect physiologic splitting of S2?
|
inspiration: right heart filling time increases, whuich increases RV stroke volume, delays closure of the pulmonic valve
|
|
|
S2 splitting.. 1st and 2nd sounds?
|
aortic then pulmonic
|
|
|
if splitting is heard, most likely listening post? Why/
|
2nd and 3rd left intercostal space
each in own area |
|
|
Systolic BP corresponds to?
regulated by? |
ventricular pressure
stroke volume and compliance |
|
|
Pousieilles law..?
|
total R of vessels in parallel is greater than 1 great vessel in series
> branched arteries in lower extremeties have higher BP in supine |
|
|
When is S3 a normal sound?
|
children young adults
|
|
|
S4 is..
|
abnormal in adults, atrial contraction
|
|
|
Athletes and S3 and S4
|
can be normal, usually abnormla
|
|
|
What factors influence a. bloop pressure
|
LV SV, distensibility of aorta, peripheral resistance (arteriolar level) blood volume
|
|
|
Cardiac Output =
|
SV x HR
|
|
|
what decreases RV preload
|
exhalation, decreased LV output, pooling of blood in caps or veins
|
|
|
what does afterload have ot do with circulating volume?
|
refers to degree of vascular resistance to ventricular contraciton, tone of aorta and peripherals, and blood of aorta
|
|
|
6cm to the left of th sternum resonance changes to dullness, if >10.5 cm indicates?
|
LV enlargement from EDV increase or ventricular mass itself
|
|
|
PMI.. area of? where?
undetectable how? |
2 intercostal spaces, MCL of the 5th interspace
obesity, muscular chest, AP diameter increaser |
|
|
how do you estimate the 5th interspace using sternum?
|
move horizontally from midsternal line
|
|
|
What does a PMI that taps against your finger indicate?
|
high amplitude,
excercise, hyperthyroid, anemia, pressure overlaod of LV (aortic stenosis) volume overload of LV (mitral regurg) |
|
|
What does a PMI that is barely palpable indicate paired with large percussion dullness over heart?
|
dilated cardiomyopathy
|
|
|
If the RV enlarges, heart rotates.. PMI that is greater than ? indicates this.
|
CCW, 3cm
|
|
|
When listening to the heart, you have fingers on carotid.. why?
|
feel for pulsations
|
|
|
where do you place fingers so not to caress the carotid sinus?
|
just inside medial border of SCM at the circoid cartilage level
|
|
|
Stethoscope:
Diaphragm detects? Bell detects? press too hard does? and youll miss? |
D: S1 and S2, aortic and mitral regurg, pericardial friction rub
B: S3 S4, mitral stenosis, bell at the apex, move medially alonger sternal border Hard: diagharmn function, S3/S4 |
|
|
What position is S3 and S4 heard?
|
left lateral decubitus, brings LV close to wall. Bell on apical impulse
|
|
|
What you hear if patient breath quietly then deeply as you listen over left 2nd and 3rd
|
splitting of S2.
|
|
|
Murumurs
Shape? 4 |
crescendo
decrescendo combined, plateau |
|
|
Murumurs:
Location of Max intensity: aortic? pulmonic? tricuspid? mitral? |
a: 2nd right interspace p: 2nd left interspace, t: lower left sternal border m: apex (PMI)
|
|
|
Murmurs:
radiation? |
heard in neck > aortic stenosis
|
|
|
Murmurs:
midsystolic |
A and P valves
|
|
|
Murmurs:
Pansystolic |
M and T regurg
|
|
|
Murmurs:
late systolic |
mitral prolapse (click)
|
|
|
Murmurs:
early diastolic |
M and T regurg
|
|
|
Murmurs:
Mid diastolic and pre-systolic |
turbulent flow across M T valves
|
|
|
Murmurs:
Presystolic crescendo |
M stenosis in normal sinus rhythm
|
|
|
Murmurs:
early diastolic decrescendo? |
aortic regurg
|
|
|
Murmurs:
Midsystolic crescendo decrescendo |
aortic stenosis and innocent flow murmurs
|
|
|
Murmurs:
Pansystolic with plateau? |
mitral stenosis
|
|
|
What are the 4 considerations when the HR is >100?
|
Sinus Tach, supraventricular tach, a flut, ventiruclar tach
|
