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99 Cards in this Set

  • Front
  • Back
name the lobes of the lung
RUL,RML, RLL, LUL, LLL
What corrspeonds to the RML in the L lung?
Lingula
the horizontal fissure, aka minor fissure, is where?
b/t RUL and RML
where are the major fissures, aka oblique fissures?
b/t RML and RLL, b/t LUL and LLL
which lung has greater excursion?
the left, right is restricted d/t liver
what spinal level is the superior border of the major fissures?
T3 (-5?), one side above and one side below
what R level does the trachea branch?
R2
most likely location of an aspirated FB?
trachea>right main bronchus>Right inferior lobe bronchus in the RLL
What landmark is on the chest wall to locate the RML?
nipple, RML is mostly inferior and medial
what landmark is on the chest wall to find the lingula?
nipple,same but smaller
which lung has a higher oblique fissure from the back side?
left lung
what is rib level of inferior of lungs anteriorly?
6th rib
what is vertebral level of inferior of lungs posteriorly?
T10
what R level is horizontal fissure anteriorly?
R4
what vertebral level is oblique fissure posteriorly to anteriorly?
T3-R6 in midclavicular line
anterior location of apex of lungs?
2-4 cm above medial third of clavicle
order of chest exam
inspect, palpate, percuss, auscultate
what is funnel chest called?
unfortunate>>>pectus excavatum
what is pigeon chest called?
Pectus carinatum
what is a V at the top of the sternum called?
bifid sternum
name four anomolies of the thorax that can F@#K you up?
pectus excavatum, pectus carinatum, Thoracic kyphoscloliosis, Barrel chest
which thoarcic anomoly is not congenital?
barrel chest, secondary to COPD, asthma, or OA of costovertebral joints
what do you assess with apalpation?
tenderness, massesm lymph nodes, breast masses, and axilla
how much should chest expansion on inspiration be?
3-5 cm
what is tactile fremitus?
palpable vibrations when speaking
what decreses fremitus?
greater distance as with tumor pleura, effusion, collapsed lung, etc.
what increases fremitus?
less distance as with pneumonia, lung tumors, etc.
how many points to palpate for femitus anterior? posterior?
5 front and back, for each side (L & R)
How deep does percussion penetrate?
5-7 cm
percussion with dullness from?
fluid or solid tissue
percussion with hyperresonance from?
emphysema, severe asthma, pneumothorax
what is in the way with percussion in the rear?
shoulder blades (aka scapula)
how much lower is the lower border of the left lung than the right?
3-5 cm
what is the most important exam for the lungs?
auscultation
How much pressure on stethoscope to ausculate the lungs?
light
How many places to ausculate on anterior and posterior chest?
6 anterior and 7 posterior, on each side
what do you tell the patient to do when ausculatating the lungs?
breathe through your mouth
How do you distinguish a RML from a RLL pneomonia/consolidation on plain xray?
look at the lateral film, RML will be a triangle with an anterioinferior base; silhoutte sign=RML is in same plane as R side of heart and will not be visible if fluid is present
2 fags are on the floor busting booty when a fire breaks out. Which one gets out first and why?
The one on the bottom b/c his shit is already packed.
What can help you distinguish anair filled lung from an airless lung?
look for vessels going out to the edge of the lung space on the film (like Kerley B-lines)
when do most women stop growing?
2 years after period starts
when should you operate for scoliosis?
before growth stops, before menstration for females
if the pt has COPD what should you not do?
Give 100% O2, it may be bad if patient retains CO2
How far down should an inspiration go?
"to the pubs"
what does a bad image not have?
lung "gutters"
Ca2+ deposits usually signals what regarding growth or etiology?
slow growing
fine crackles sound like?
"snap-n-pops"
what should you document other than the type of sound you heard?
where you heard the sound?
with Bronchophony, what happens to the sound with consolidation?
spoken words get louder (fluid transmit sounds better)
with Egophony, what happens with consolidation?
ee sounds like ay
with Whispered Pectoriliquoy, what happens with consolidation?
whispered sounds are louder, clearer with consolidation
_____crackles are louder, lower in pitch, and lnger lasting than ______crackles
coarse, fine
discontinuous sounds are called?
crackles
continuous sounds are called?
wheezes and rhonchi
_______are high pitched and sound shrill or like hissing and _______are low pitched and sound like snoring
wheezes, rhonchi
if the airway radius decreases by 1/2 what happens to airway resistance?
it increase 16x, R ~1/r^4
if the airway length increases, what happens to the airway resistance?
it increases 2x, R~L
asthma increases________ & _______
bronchoconstriction and airway edema
what is the characteristic sound with asthma?
wheezes
wheezing + JVD=?
CHF
CHF, COPD, and Chronic bronchitis have what characteristic sound?
wheezing
Bronchiolitis, producing airway edema, decreased radius of the airway , and wheezing, is 2ndary to what?
RSV
Who's the leader of the club made for you and me?
M_I_C, K_E_Y, M_O_U_S_E
upper airway obstruction has the characteristic sound of?
stridor
what etiologies can cause stridor (specific)?
croup, epiglottitis, FB, chemical burns, burns to face/neck, trauma
physical reasons for epiglottitis?
epiglottic, laryngeal, upper tracheal, or pharyngeal edema or obstruction
what does stridor sound like?
wheeze of upper airway
classic sign of epiglottitis?
steeple sign
Katz says a coin caught in the esophagus looks_____ and a coin in the epiglottis looks ______
round (like the coin), a straight line (like the edge of the coin caught in the larynx)
What do epiglottitis pts look like?
upright, in distress or anxious, and drooling
rhonchi may decrease temporarily with _____upon coughing, but will persist with_____
bronchitis, pneumonia
rhonchi occur in _____ airways as a result of secretions
large
rales produce crackling sounds in _____ airways
small
rhonchi are heard with?
CHF, pulmonary fibrosis, bronchiectasis, asthma, chronic bronchitis
this sound is associated with pain with respirations
pleural friction rub
Pleural friction rubs are heard with?
pleuritis, inflammmatory diseases, pneumonia
foul breath is associated with?
respiratory infection
air in the chest cavity outside the lung is ?
pneumothorax
how does pneumothorax arise?
usually spontaneously from a bleb, secondary to pulmonary disease or trauma
what type of pneumonthorax is an emergency?
>50%, AS TENSION INCREASES
what breath sounds are present with pneumothorax?
decreased or absent
percussion with pneumothorax?
hyperresonance
fremitus with pneumothorax?
voice transmission decreased, no advwntitious sounds
palpable or visible sign is there with pneumothorax?
tracheal shift away
in pneumothorax, what imaging fin ding can tip you off?
no blood vessels seen in lung
Hamman's sign is what?
precordial crackles synchronous with heart beat, aka mediastinal crunch, best heard in left lateral recumbant
esophageal rupture aka?
Boerhaave's syndrome
Boerhaave's syndrome is characterized by ____'s triad=?
Mackler's triad= vomiting, lower thoracic pain, subcutaneous emphysema
subcutaneous emphysema is ?
gas in the tissue
what physically makes crackles?
airways popping open during inspiration
late inspiratory crackles=
CHF, fibrosis
early inspiratory crackles=
asthma
wheezes physical cause=
narrowed airway
physical cause of rhonchi=
secretions in large airways
physical cause of stridor=
upper airway restriction (act immedicately)
pleural rub physical cause=
inflammed pleural space
mediastinal crunch physical cause=
air in the mediastinum, synchronous with the heart beat (pneumomediastinum is ominous)
lungs are innervated by?
cervical, thoracic, and vagus nerves (direct treatment accordingly)
the thorax is rich in lymphatics so...
remember lymphatic techniques