Pd L4: Thorax And Lungs

Front 1

To locate findings around the circumference of the chest, what series of vertical lines can be used (6)?

Back 1

1. Midsternal line
2. Midclavicular line
3. Anterior and Posterior Axillary Lines
4. Midaxillary lines
5. Vertebral line
6. Scapular line

Front 2

Which lobe on which lung can be best accessed laterally?

Back 2

The right middle lobe

Front 3

Segments of the right lung:
1. right upper lobe segments
2. right middle lobe segments
3. right lower lobe segment

Back 3

1. Right upper lobe segments: "AAP"
Apical
Anterior
Posterior(seen only posteriorly)
2. Right middle lobe segments: "LM"
Lateral
Medial (seen only anteriorly)
3. Right lower lobe segment: "ASPL"
Anterior basal
Superior (seen only posteriorly)
Posterior(seen only posteriorly)
Lateral (seen only posteriorly)

Front 4

Segments of the left lung:
1. left upper lobe
2. left middle lobe **
3. left lower lobe

Back 4

1. Left upper lobe "AAPSI"
Apical
Anterior
Posterior(only seen posteriorly)
Superior lingula (only seen anteriorly)
Inferior lingula (only seen anteriorly)
2. Trick--there is NO middle lobe on the left lung!
3. Left lower lobe "ASLP"
Anterior basal
Superior (only seen posteriorly)
Lateral (only seen posteriorly)
Posterior (only seen posteriorly)

Front 5

Which type of serous membrane covers the outer surface of each lung?

Back 5

Visceral pleura

Front 6

What type of serous membrane lines the inner thorax and superior surface of the diaphragm?

Back 6

Parietal pleura

Front 7

What do you call the region between the opposing surfaces of the visceral and parietal pleura?

Back 7

Pleural space

Front 8

What 6 things is a thoracic/lung exam comprised of?

Back 8

1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Anterior and posterior exams
6. Lateral exams

"IPPAAPL"

Front 9

Initial survey includes what 6 things?

Back 9

1. Observe rate, rhythm, depth, and effort of breathing
2. Inspect patient for signs of respiratory difficulty
3. Assess patient's color for cyanosis
4. Listen to patient's breathing
5. Inspect the neck
6. Observe the shape of the chest

"OIALIO"

Front 10

What should you identify during palpation (4 things)?

Back 10

tender areas, skin, respiratory expansion and fremitus (vibration)

Front 11

Where should one place the hands while palpating anterior or posterior respiratory expansion?

Back 11

Below the rib cage to monitor rib elevation.

Front 12

What are the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks?
What is the word typically used to palpate multiple areas of the chest for it?

Back 12

Fremitus

"ninety-nine"

Front 13

How many regions should be palpated for fremitus posteriorly (unilaterally)?

Back 13

4 on each side of the body
(3 along the medial border of the scapula and one lateral to the inferior angle of the scapula)

Front 14

How many regions should be palpated for fremitus anteriorly (unilaterally)?

Where else can you access the right middle lobe?

Back 14

3 on each side of the chest
(1 lateral to the maubrium and following the midclavicular line
2 around the nipple in line with the xyphoid process)

Instead of using the location medial to the nipple, the RML can be accessed laterally.

Front 15

A soft voice is comparable to what problem regarding fremitus?

Back 15

The interference of transmission of vibrations from the larynx to the surface of the chest.

Front 16

What are some causes for decreased fremitus (7 listed)?

Back 16

Obstructed bronchus, COPD, separation of the pleural surfaces by fluid (pleural effusion), fibrosis (thickening), air (pneumothorax), infiltrating tumor of thick chest wall

Front 17

What technique sets the chest wall and underlying tissues into motion, producing audible sound and palpable vibrations?

What can this help to determine?

Back 17

Percussion

Whether underlying tissues are air-filled, fluid-filled or solid

Front 18

How many percussion/auscultation points are there posteriorly?
Anteriorly?

Back 18

8 posteriorly
6 anteriorly

Front 19

What is it called when the pleura accumulates serous fluid?
Blood?
Pus?

Back 19

pleural effusion
hemothorax
empyema

Front 20

What is indicative of fluid/solid tissues (percussion)?

What can cause this (6 listed)?

Back 20

Dullness upon percussion

lobar pneumonia (alveoli filled with fluid and blood cells), pleural effusion, hemothorax, empyma, fibrous tissue, tumor (flat sound)

Front 21

Generalized hyperresonance may be heard over hyperinflated lungs in what two conditions?

Is this a reliable sign?

Back 21

Emphysema or asthma

Though not a reliable sign

Front 22

What does a unilateral hyperresonance suggest?

Back 22

Large pneumothorax or possible large air-filled bulla in the lung

Front 23

What is the most important examining technique for assessing air flow through the tracheobronchial tree?

Back 23

Auscultation

Front 24

For auscultaion, one would generally listen to __ to __ areas posteriorly, and __ to __ areas anteriorly and laterally

Back 24

4, 6
1, 2

Front 25

What is the name of a normal lung sound?
Mixed normal and abnormal sounds?
Abnormal "breathy" sounds?

Back 25

Vesicular
Bronchovesicular
Bronchial

Front 26

Which kind of lung sound is soft and low pitched?

Back 26

Vesicular

Front 27

Which lung sound is associated with inspiratory and expiratory sounds that are about equal length at times and are separated by a silent interval?

Back 27

Bronchovesicular

Front 28

Which lung sound represents air blowing through a small airway, which act as baffles and have been compared to a breeze rustling the leaves of a tree. (aka normal sounds)

Back 28

Vesicular

Front 29

Which lung sound is classically heard in a region of resolving pneumonia, where some regions allow for bronchial breathing and other areas showing the normal pattern of vesicular breathing?

Back 29

Bronchovesicular

Front 30

Which lung sound is louder and higher in pitch, with a short silence between inspiratory and expiratory sounds?

Back 30

Bronchial

Front 31

Which lung sound is associated with an expiratory sounds lasting longer than inspiratory sounds?

Back 31

Bronchial

Front 32

Which lung sound is heard through inspiration, continues without pause through expiration, and then fades away about 1/3rd of the way through expiration?

Back 32

Vesicular

Front 33

Which lung sound is associated with a detectable difference in pitch and intensity during expiration?

Back 33

Bronchovesicular

Front 34

Which lung sounds is more "breathy"?

Back 34

Bronchial

Front 35

Which lung sound represents air blowing through the larger bronchi, and can be heard (for example) over the trachea and often normally along the left side of the upper sternum near the angle of Louis?

Back 35

Bronchial

Front 36

Which lung sound is associated with abnormal breathing over an area of pneumonic consolidation where the alveoli are filled with fluid, do not conduct air therefore only hear the sound of air traveling through the open bronchi?

Back 36

Bronchial

Front 37

Where would you normally hear vesicular sounds?

Back 37

Over most of both lungs

Front 38

Where would you normally hear bronchovesicular sounds?

Back 38

Often in the 1st and 2nd intercostal spaces anteriorly and between the scapulae posteriorly

Front 39

Where would you normally hear bronchial sounds

Back 39

Over the manubrium, if heard at all

Front 40

What lung sound is associated with inspiratory and expiratory sounds that are about equal and expiratory sounds that are very loud and relatively high pitched?

Back 40

Tracheal

Front 41

Where would you normally hear tracheal sounds?

Back 41

Over the trachea in the neck

Front 42

Which added lung sound is heard as crackling as air bubbles through fluid in the bronchioles OR as contracted and fibrotic alveoli snap open late in inspiration?
Is this considered a discontinuous or a continuous sound?

Back 42

Crackles (Rales)

Discontinuous

Front 43

There are two types of rales:
Which one is associated with fluid in the alveoli and small airways?
What condition is this heard in?
Which one is associated with loud, leathery, rasping sounds that reflect scarred alveoli snapping up at the end of inspiration, and therefore are heard in late inspiration?
What conditions is this heard in?

Back 43

Fine or "wet" rales heard in patients with pulmonary edema (fluid in lung)

Coarse or "dry" rales heard in patients with fibrotic lung diseases and congestive heart failure.

Front 44

Which added lung sound is heard as whistling as air rushes through narrowed pathways?
Is this considered discontinuous or continuous?

Back 44

Wheezes

Continuous

Front 45

Which added lung sound reflects air rushing through narrowed, wider caliber bronchi, suggesting secretions in large airways? (snore like)

Discontinuous or continuous?

Back 45

low pitched wheezes or rhonchi

continuous

Front 46

True or False:
Normal transmitted sounds heard through the chest should be muffled and indistinct

Back 46

True

Front 47

What does INCREASED transmission of voice sounds suggest?

What is the name for louder, clearer sounds?

Back 47

Air-filled lung has become airless.
Louder, clearer sounds = bronchophony

Front 48

What voice sound is associated with egophony?

What is egophony indicative of?

Back 48

The normally muffled long "E" sound will sound like "A"

Egophony indicates lung consolidation, which acts as a great conductor.

Front 49

How do you test for whispered pectoriloquy?
What would be a normal result of this test?

Back 49

When you ask the patient to whisper "one-two-three"
Normal: whispered voice is faint and indistinct, if heard at all.
Abnormal: louder, as if it was being whispered into the stethoscope = whispered pectoriloquy

Front 50

What is pectus excavatum?

Back 50

Sinking in of the chest as a result of the congenital deformity of the anterior wall.