Pcs Lung Sounds

Front 1

name the lobes of the lung

Back 1

RUL,RML, RLL, LUL, LLL

Front 2

What corrspeonds to the RML in the L lung?

Back 2

Lingula

Front 3

the horizontal fissure, aka minor fissure, is where?

Back 3

b/t RUL and RML

Front 4

where are the major fissures, aka oblique fissures?

Back 4

b/t RML and RLL, b/t LUL and LLL

Front 5

which lung has greater excursion?

Back 5

the left, right is restricted d/t liver

Front 6

what spinal level is the superior border of the major fissures?

Back 6

T3 (-5?), one side above and one side below

Front 7

what R level does the trachea branch?

Back 7

R2

Front 8

most likely location of an aspirated FB?

Back 8

trachea>right main bronchus>Right inferior lobe bronchus in the RLL

Front 9

What landmark is on the chest wall to locate the RML?

Back 9

nipple, RML is mostly inferior and medial

Front 10

what landmark is on the chest wall to find the lingula?

Back 10

nipple,same but smaller

Front 11

which lung has a higher oblique fissure from the back side?

Back 11

left lung

Front 12

what is rib level of inferior of lungs anteriorly?

Back 12

6th rib

Front 13

what is vertebral level of inferior of lungs posteriorly?

Back 13

T10

Front 14

what R level is horizontal fissure anteriorly?

Back 14

R4

Front 15

what vertebral level is oblique fissure posteriorly to anteriorly?

Back 15

T3-R6 in midclavicular line

Front 16

anterior location of apex of lungs?

Back 16

2-4 cm above medial third of clavicle

Front 17

order of chest exam

Back 17

inspect, palpate, percuss, auscultate

Front 18

what is funnel chest called?

Back 18

unfortunate>>>pectus excavatum

Front 19

what is pigeon chest called?

Back 19

Pectus carinatum

Front 20

what is a V at the top of the sternum called?

Back 20

bifid sternum

Front 21

name four anomolies of the thorax that can F@#K you up?

Back 21

pectus excavatum, pectus carinatum, Thoracic kyphoscloliosis, Barrel chest

Front 22

which thoarcic anomoly is not congenital?

Back 22

barrel chest, secondary to COPD, asthma, or OA of costovertebral joints

Front 23

what do you assess with apalpation?

Back 23

tenderness, massesm lymph nodes, breast masses, and axilla

Front 24

how much should chest expansion on inspiration be?

Back 24

3-5 cm

Front 25

what is tactile fremitus?

Back 25

palpable vibrations when speaking

Front 26

what decreses fremitus?

Back 26

greater distance as with tumor pleura, effusion, collapsed lung, etc.

Front 27

what increases fremitus?

Back 27

less distance as with pneumonia, lung tumors, etc.

Front 28

how many points to palpate for femitus anterior? posterior?

Back 28

5 front and back, for each side (L & R)

Front 29

How deep does percussion penetrate?

Back 29

5-7 cm

Front 30

percussion with dullness from?

Back 30

fluid or solid tissue

Front 31

percussion with hyperresonance from?

Back 31

emphysema, severe asthma, pneumothorax

Front 32

what is in the way with percussion in the rear?

Back 32

shoulder blades (aka scapula)

Front 33

how much lower is the lower border of the left lung than the right?

Back 33

3-5 cm

Front 34

what is the most important exam for the lungs?

Back 34

auscultation

Front 35

How much pressure on stethoscope to ausculate the lungs?

Back 35

light

Front 36

How many places to ausculate on anterior and posterior chest?

Back 36

6 anterior and 7 posterior, on each side

Front 37

what do you tell the patient to do when ausculatating the lungs?

Back 37

breathe through your mouth

Front 38

How do you distinguish a RML from a RLL pneomonia/consolidation on plain xray?

Back 38

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

Front 39

2 fags are on the floor busting booty when a fire breaks out. Which one gets out first and why?

Back 39

The one on the bottom b/c his shit is already packed.

Front 40

What can help you distinguish anair filled lung from an airless lung?

Back 40

look for vessels going out to the edge of the lung space on the film (like Kerley B-lines)

Front 41

when do most women stop growing?

Back 41

2 years after period starts

Front 42

when should you operate for scoliosis?

Back 42

before growth stops, before menstration for females

Front 43

if the pt has COPD what should you not do?

Back 43

Give 100% O2, it may be bad if patient retains CO2

Front 44

How far down should an inspiration go?

Back 44

"to the pubs"

Front 45

what does a bad image not have?

Back 45

lung "gutters"

Front 46

Ca2+ deposits usually signals what regarding growth or etiology?

Back 46

slow growing

Front 47

fine crackles sound like?

Back 47

"snap-n-pops"

Front 48

what should you document other than the type of sound you heard?

Back 48

where you heard the sound?

Front 49

with Bronchophony, what happens to the sound with consolidation?

Back 49

spoken words get louder (fluid transmit sounds better)

Front 50

with Egophony, what happens with consolidation?

Back 50

ee sounds like ay

Front 51

with Whispered Pectoriliquoy, what happens with consolidation?

Back 51

whispered sounds are louder, clearer with consolidation

Front 52

_____crackles are louder, lower in pitch, and lnger lasting than ______crackles

Back 52

coarse, fine

Front 53

discontinuous sounds are called?

Back 53

crackles

Front 54

continuous sounds are called?

Back 54

wheezes and rhonchi

Front 55

_______are high pitched and sound shrill or like hissing and _______are low pitched and sound like snoring

Back 55

wheezes, rhonchi

Front 56

if the airway radius decreases by 1/2 what happens to airway resistance?

Back 56

it increase 16x, R ~1/r^4

Front 57

if the airway length increases, what happens to the airway resistance?

Back 57

it increases 2x, R~L

Front 58

asthma increases________ & _______

Back 58

bronchoconstriction and airway edema

Front 59

what is the characteristic sound with asthma?

Back 59

wheezes

Front 60

wheezing + JVD=?

Back 60

CHF

Front 61

CHF, COPD, and Chronic bronchitis have what characteristic sound?

Back 61

wheezing

Front 62

Bronchiolitis, producing airway edema, decreased radius of the airway , and wheezing, is 2ndary to what?

Back 62

RSV

Front 63

Who's the leader of the club made for you and me?

Back 63

M_I_C, K_E_Y, M_O_U_S_E

Front 64

upper airway obstruction has the characteristic sound of?

Back 64

stridor

Front 65

what etiologies can cause stridor (specific)?

Back 65

croup, epiglottitis, FB, chemical burns, burns to face/neck, trauma

Front 66

physical reasons for epiglottitis?

Back 66

epiglottic, laryngeal, upper tracheal, or pharyngeal edema or obstruction

Front 67

what does stridor sound like?

Back 67

wheeze of upper airway

Front 68

classic sign of epiglottitis?

Back 68

steeple sign

Front 69

Katz says a coin caught in the esophagus looks_____ and a coin in the epiglottis looks ______

Back 69

round (like the coin), a straight line (like the edge of the coin caught in the larynx)

Front 70

What do epiglottitis pts look like?

Back 70

upright, in distress or anxious, and drooling

Front 71

rhonchi may decrease temporarily with _____upon coughing, but will persist with_____

Back 71

bronchitis, pneumonia

Front 72

rhonchi occur in _____ airways as a result of secretions

Back 72

large

Front 73

rales produce crackling sounds in _____ airways

Back 73

small

Front 74

rhonchi are heard with?

Back 74

CHF, pulmonary fibrosis, bronchiectasis, asthma, chronic bronchitis

Front 75

this sound is associated with pain with respirations

Back 75

pleural friction rub

Front 76

Pleural friction rubs are heard with?

Back 76

pleuritis, inflammmatory diseases, pneumonia

Front 77

foul breath is associated with?

Back 77

respiratory infection

Front 78

air in the chest cavity outside the lung is ?

Back 78

pneumothorax

Front 79

how does pneumothorax arise?

Back 79

usually spontaneously from a bleb, secondary to pulmonary disease or trauma

Front 80

what type of pneumonthorax is an emergency?

Back 80

>50%, AS TENSION INCREASES

Front 81

what breath sounds are present with pneumothorax?

Back 81

decreased or absent

Front 82

percussion with pneumothorax?

Back 82

hyperresonance

Front 83

fremitus with pneumothorax?

Back 83

voice transmission decreased, no advwntitious sounds

Front 84

palpable or visible sign is there with pneumothorax?

Back 84

tracheal shift away

Front 85

in pneumothorax, what imaging fin ding can tip you off?

Back 85

no blood vessels seen in lung

Front 86

Hamman's sign is what?

Back 86

precordial crackles synchronous with heart beat, aka mediastinal crunch, best heard in left lateral recumbant

Front 87

esophageal rupture aka?

Back 87

Boerhaave's syndrome

Front 88

Boerhaave's syndrome is characterized by ____'s triad=?

Back 88

Mackler's triad= vomiting, lower thoracic pain, subcutaneous emphysema

Front 89

subcutaneous emphysema is ?

Back 89

gas in the tissue

Front 90

what physically makes crackles?

Back 90

airways popping open during inspiration

Front 91

late inspiratory crackles=

Back 91

CHF, fibrosis

Front 92

early inspiratory crackles=

Back 92

asthma

Front 93

wheezes physical cause=

Back 93

narrowed airway

Front 94

physical cause of rhonchi=

Back 94

secretions in large airways

Front 95

physical cause of stridor=

Back 95

upper airway restriction (act immedicately)

Front 96

pleural rub physical cause=

Back 96

inflammed pleural space

Front 97

mediastinal crunch physical cause=

Back 97

air in the mediastinum, synchronous with the heart beat (pneumomediastinum is ominous)

Front 98

lungs are innervated by?

Back 98

cervical, thoracic, and vagus nerves (direct treatment accordingly)

Front 99

the thorax is rich in lymphatics so...

Back 99

remember lymphatic techniques