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115 Cards in this Set

  • Front
  • Back
the inferior tip of the scapula usually lies at what rib/interspace
7th
when the neck is flexed forward what vertebra is most prominent
C7
how many lobes does the right lung have? the left?
3, 2
the lower border of the lung crosses the __th rib at the midclavicular line and the __th rib at the midaxillary line
6th, 8th
the trachea bifurcates into its mainstem bronchi at the _____ anteriorly and the ___ spinous process posteriorly
sternal angle, T4
the _____ pleura cover the outer surface of the lung while the ____pleura line the inner rib cage and upper surface of the diaphragm
visceral, parietal
when laying supine, breathing movements are more visible in the ______ and when sitting they are more visible in the ____
abdomen, thorax
the ____ fissure divides the lungs in half and can be estimated by running a string from ___ to ____
oblique, T3 spinous process, 6th rib at the midclavicular line
the right lung has a _____ fissure that runs close to the ____ and meets the oblique fissure in the _____ line near the _____
horizontal, 4th rib, midaxillary, 5th rib
the ____ lungs and thorax should be inspected with the patient sitting
posterior
the ____ lungs and thorax should be inspected with the patient laying supine
anterior
a normal resting adult breathes how many times per minute?
14-20
cyanosis signals ____
hypoxia
clubbing of the nails is seen in ___
lung abscesses or malignancy and congenital heart disease
stridor is ____ and is a sign of ____
a high-pitched wheeze, and ominous sign of airway obstruction in the larynx or trachea
inspiratory contraction of the sternocleidomastoids at rest signals...
severe difficulty breathing
lateral displacement of the trachea during inspiration signals...
pneumothorax, pleural effusion or atelectasis
Anteroposterior (AP) diameter of the chest may increase in....
chronic obstructive pulmonary disease (COPD)
T/F in a normal adult, the lateral diameter of the thorax is smaller than the anteroposterior diameter?
False
funnel chest is also known as...
pectus excavatum
funnel chest leads to compression of the heart and great vessels which may cause...
murmurs
an increased anteroposterior chest diameter is called
barrel chest
barrel chest shape is normal in what phases of life?
during infancy and often accompanies normal aging and COPD
pigeon chest is AKA
pectus carinatum
the sternum is displaced anteriorly, increasing AP diameter and costal cartilages adjacent to the protruding sternum are depressed in...
pigeon chest
multiple rib fractures may result in paradoxical movements of the thorax called...
traumatic flail chest
name the condition where on inspiration the injured area caves inward and on expiration it moves outward
traumatic flail chest
thoracic kyphoscoliosis
abnormal spinal curvatures and vertebral rotation deform the chest in...
this distortion of the underlying lungs may make interpretation of lung findings very difficult
thoracic kyphoscoliosis
abnormal retraction of the interspaces during inspiration is seen in these conditions and in the ____ interspaces
severe asthma, COPD, or upper airway obstruction, lower
unilateral impairment or lagging of respiratory movements suggests...
disease of the underlying lung or pleura
intercostal tenderness upon palpation indicates...
inflamed pleura
T/F bruises are normally found over a fractured rib?
true
what is a sinus tract on the chest?
blind, imflammatory, tubelike structure opening onto the skin
sinus tracts usually indicate ...
infection of the underlying pleura and lung (as in tuberculosis and actinomycosis)
causes of unilateral decrease or delay in chest expansion include...
chronic fibrotic disease of the underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain with associated splinting and unilateral bronchial obstruction
fremitus is decreased or absent when...
voice is soft or transmission of vibrations from the larynx to the surface of the chest is impeded
causes of decreased tactile fremitus include...
obstructed bronchus, COPD, separation of the pleural surfaces by fluid (pleural effusion), fibrosis (pleural thickening), air (pneumothorax), infiltrating tumor, or very thick chest wall
percussion helps establish whether a underlying tissues are .... and penetrates about ____ cm.
air-filled, fluid-filled or solid; 5-7
the finger that is hyperextended and hit during percussion is called the ....
pleximeter finger
the finger that taps the other finger in contact with the body is caled the...
plexor finger
t/f the other fingers of the hand should be touching the pt during percussion
false
to create a louder percussion sound you should increase the pressure you apply on the _____ finger
pleximeter
the normal percussion note for the lungs is...
resonant
normal percussion note for the liver is..
dull
which percussion note is not found normally in the body
hyperresonance
what percussion note would be found in over a gastric air bubble?
tympany
what percussion note is normal for the thigh?
flat
_____ replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers
dullness
dullness would replace the normal lung sound of resonance in what conditions?
lobar pneumonia (alveoli fill with fluid and blood cells, pleural effusion (pleural accumulations of serous fluid), blood (hemothorax), pus (empyema), fibrous tissue or tumor
generalized hyperresonance may be heard over the ______ lungs of _____
overinflated, emphysema or asthma
unilateral hyperresonance suggests...
large pneumothorax or possibly a large air-filled bulla in the lung
what area of the posterior chest do you not percuss?
over the scapulae
an abnormally high diaphragm level suggests...
pleural effusion, or a high diaphragm as in atelectasis or diaphragmatic paralysis
general hyperresonance would be heard over _______ lungs, as in _______
hyperinflated; emphysema or asthma
unilateral hyperresonance sugests....
large pneumothorax or possibly a large air-filled bulla in the lung
abnormally high diaphragm suggests...
pleural effusion, or atelectasis or diaphragmatic paralysis
the normal extent of diaphragmatic excursion is ...
5-6 cm
what should you do eliminate sounds made by hair during auscultation?
press harder or wet the hair
t/f a cold or tense pt can create muscle contraction sounds that can be heard during auscultation?
true
what breath sounds are soft and low pitched, heard over most of both lungs?
vesicular
____ breath sounds have inspiratory sounds that last longer than expiratory and are continuous from insp. to exp.
vesicular
broncho-vesicular breath sounds are heard where and sound like what?
heard in the 1st and 2nd interspaces anteriorly and between the scapulae; inspiratory/expiratory sounds are equal with a silent interval between; intermediate intensity and pitch
these breath sounds are heard over the manubrium
bronchial
_____ breath sounds are loud, high pitched and expiratory sounds last longer than inspiratory
bronchial
these breath sounds are very loud, high, heard over the trachea and insp. and exp. are about equal
tracheal
***know the chart on p. 259
just do it
breath sounds may be _____ when air flow is decreased, as in obstructive lung disease or muscular weakness
decreased
a gap between inspiratory and expiratory breath sounds suggests.....
bronchial breath sounds
if bronchovesicular or bronchial breath sounds are heard in locations distant from normal suspect...
that air-filled lung has been replaced by fluid-filled/solid lung tissue
in lobar pneumonia the alveoli fill with fluid and blood cells in a process called...
(lobar) consolidation
in a normal air-filled lung the predominant breath sound is...
vesicular
in a normal air-filled lung spoken words sound...and "ee" is heard as .... and tactile fremitus is....
muffled, "ee", normal
in an airless lung (i.e. lobar pneumonia) the predominant breath sound is...
bronchial or bronchovesicular over involved area
in an airless lung (i.e. lobar pneumonia)spoken and whipered words are.... and "ee" is heard as .... while tactile fremitus is...
louder/clearer, "ay", increased
bronchophony is...
when spoken words sound louder during auscultation due to an airless lung
egophony is...
"ee" to "ay" changes in auscultation
whispered pectoriloquy is...
when whispered words sound louder and clearer during auscultation
crackles may be due to ...
abnormalities of the lungs (esp. pneumonia, fibrosis, early congestive heart failure) or of the airways (bronchitis, bronchiectasis)
wheezes suggest...
narrowed airways (as in asthma, COPD, or bronchitis)
rhonchi suggest...
secretions in large airways
crackles are also called
rales
crackles sound like...
discontinuous, intermittent, non-musical, brief
fine crackles sound____ and last for ______ while coarse crackles sound ____ and last for ____
soft, high-pitched; very brief; louder and lower-pitched; brief
wheezes sound like
continuous, more than a quarter second, relatively high-pitched with hissing/shrill quality
rhonchi sound like
relatively low-pitched with snoring quality
2 explanations for crackles are
1. result from tiny explosions when small airways pop open during inspiration
2. from air bubbles flowing through secretions/lightly closed airways
late inspiratory crackles
may start in firt half of insp. but must continue into late insp., are usually fine, persist from breath to breath, appear first at bases of lungs
causes of late insp. crackles
interstitial lung disease (like fibrosis) and early congestive heart failure
early insp. crackles appear ____ and sound like..
soon after the start of insp. and do not continue into late insp.; often, not always coarse, and few in number
early insp. crackles are caused by ______and associated with_____
chronic bronchitis and asthma; expiratory crackles
midinspiratory and expiratory crackles are heard in ... and may be associated with...
bronchiectasis; wheezes and rhonchi
wheezes occur when...
air flows rapidly through bronchi that are narrowed nearly to the point of closure
t/f wheezes are often audible at the mouth as well as through the chest wall
true
causes of wheezes generalized throughout the chest include...
asthma, chronic bronchitis, COPD and congestive heart failure (cardiac asthma)
in asthma, wheezes may be heard only during ____ or in both phases of resp. cycle
expiration
a persistent localized wheeze suggests...
partial obstruction of a bronchus, as by a tumor or foreign body and may be insp., exp or both
some times in severe obstructive pulmonary disease wheezing may stop due to...
not enough air getting through to create sound, not an improvement
a wheeze that is predominantly or entirely inspiratory is called...
stridor
t/f stridor does not require immediate attention
false
stridor is normally louder in the ____ than in the chest wall
neck
stridor indicates..
a partial obstruction of the larynx or trachea
pleural rubs are a creaking chest sound produced when...
inflamed and roughened pleural surfaces grate against each other during resp.
t/f pleural rubs are normally present in both phases of the resp. cycle
true
a mediastinal crunch is...
series of precordial crackles synchronous with the heart beat NOT with respiration
mediastinal crunch is also known as.... and is best heard in the ____ position
hamman's sign; left lateral
mediastinal crunch is due to ...
mediastinal emphysema (pneumomediastinum)
fine late inspiratory crackles that persist from breath to breath suggest...
abnormal lung tissue
clearing of crackles, wheezes or rhonchi after cough or position change suggests...
inspissated (thickened by evaporation) secretions as in bronchitis or atelectasis
tender pectoral muscles or costal cartilages tend to corroborate that chest pain has...
musculoskeletal origin
t/f the hyperresonance of COPD may totally replace cardiac dullness
true
dullness of right middle lobe pneumonia typically occurs behind the _____ and you may miss the abnormal percussion note if you don't displace the _____
right breast
a lung with COPD will displace the liver and diaphragm _____
inferiorly
a forced expiration test time of 6 seconds or more indicates...
obstructive pulmonary disease
how to id a fractured rib?
place one hand on sternum and other on thoracic spine and squeeze, if pain is local (distant from your hand) then they got it